726 Exchange Street
Buffalo, NY 14210
PGY2 Internal Medicine Pharmacy Practice with Focus in Academia - Rotation Summary
The Ambulatory Care experience is a required rotation which is four weeks in length that occurs in January or February. The resident will spend the majority of their time in the Primary Medicine Clinic (located in D1) working with attending physicians and medical residents. The resident will provide drug information, medication history taking, patient education, and drug therapy monitoring to clinic patients. The resident is involved in medication selection utilizing knowledge of current literature to compare treatment options with respect to efficacy, pharmacokinetics, adverse effects, and pharmacoeconomics. Dosage adjustment and therapy duration recommendations are based on clinical/laboratory data, patient responses, and the patient's concurrent diseases. Patient outcomes are also routinely assessed. Good communication and interpersonal skills are of paramount importance in this setting.
The resident will also spend two mornings each week in the Coumadin Clinic assisting the anticoagulation pharmacists in the management of the clinic patients.
Anticoagulation Management Service
The Anticoagulation Management Service (AMS) operates as a pharmacist driven consult service focused primarily on dosing warfarin (approximately 25-35 patients daily). The service's responsibilities are divided between two pharmacists and several pharmacy student/interns. Through a P & T approved protocol, the pharmacist monitors all patients on anticoagulants in the hospital.
The AMS pharmacist is responsible for writing initial consults, daily progress notes, daily orders for warfarin and necessary labs, and providing recommendations on "bridging therapy" and DVT prophylaxis. The pharmacist also provides a notice and recommendation for follow-up to the next provider after discharge and serves as a liaison to the medical and nursing staff on other anticoagulant issues, especially, but not limited to, the treatment of heparin-induced thrombocytopenia (HIT).
Finally, through the assistance of pharmacy students/interns, the pharmacists provide face-to-face and written education to all patients on warfarin admitted to the hospital.
The coronary care unit (CCU) at Buffalo General is focused on the management of critically ill cardiac patients. The service consists of an attending cardiologist, a cardiology fellow, two medical residents, several medical interns, and a pharmacist. The pharmacist/resident is responsible for providing evidence-based recommendations on the management of a variety of pharmacotherapeutic issues, including, but not limited to cardiology, general medicine and infectious diseases. They are also responsible for managing drug therapies through verbal/written recommendations along with hospital approved protocols and reporting adverse drug reaction (ADR) and medication errors. The pharmacist may be called upon to discuss different drug therapies with the medical team in small group sessions. Opportunity is given for observation of invasive and non-invasive cardiac procedures. Finally, weekly therapeutics discussions and a formal evidenced based medicine topic presentation are requirements for successful completion of this rotation. Participation in code blues is also required. A formal presentation on a topic pertinent to the patient population is required at the conclusion of the rotation.
Buffalo General – MICU
The Buffalo General medical intensive care unit (MICU) teaching team covers on average 16 - 20 patients. The team members rotate monthly and include an attending physician, a pulmonary/critical care fellow, three residents, four interns, a medical student and a pharmacist. The clinical pharmacist provides educational sessions and materials, as well as drug information to all health-care professionals on the team. The clinical pharmacist has an integral role in medication selection utilizing knowledge of current literature to compare treatment options with respect to efficacy, pharmacokinetics, adverse effects, and pharmacoeconomics. Dosage adjustment and therapy duration recommendations are based on clinical/laboratory data, patient responses, and the patient’s concurrent diseases. The pharmacist is also expected to participate in the medication reconciliation process, especially for clarification of medications prior to admission. Patient outcomes are also routinely assessed. The clinical pharmacist is also responsible for ADR and medication error reporting involving team patients. The PGY2 resident is expected to function independently with daily preceptor oversight and feedback. Participation in code blues is also required. A formal presentation on a topic pertinent to the patient population is required at the conclusion of the rotation.
The major goal of this rotation is to provide a clinical pharmacy practice environment for the resident to apply the clinical, communication and teaching skills necessary to interact in a multidisciplinary emergency medicine environment. The rotation will consist of providing clinical pharmacy services to an emergency medicine service under the preceptorship of a clinical pharmacy specialist. The practice environment will require daily interactions with the medical attendings, house staff, and mid-level practitioners, nursing staff, pharmacy staff and other healthcare professionals as necessary to optimize pharmacotherapy for patients. In addition to monitoring and consulting on pharmacologic issues, the resident will also provide educational presentations to nursing, pharmacy and physician staff members. The preceptor will be available on a daily basis to discuss patient care issues, facilitate interactions with other healthcare team members, provide guidance in preparation and presentation of educational programs, and evaluate resident performance.
The General Medical Teaching services include two internal medicine and one family medicine teams, which are comprised of an attending physician, residents, interns, medical students and a clinical pharmacist. These teams cover approximately 15-20 patients each. The clinical pharmacist provides educational sessions and materials, as well as drug information to other health-care professionals on the team. Drug therapy monitoring is provided to all team patients. The clinical pharmacist has an integral role in medication selection utilizing knowledge of current literature to compare treatment options with respect to efficacy, pharmacokinetics, adverse effects, and pharmacoeconomics. Dosage adjustment and therapy duration recommendations are based on clinical/laboratory data, patient responses, and the patient's concurrent diseases. Patient outcomes are also routinely assessed. All patients are educated regarding their drug therapy and counseled regarding discharge medications to optimize therapeutic outcomes. The clinical pharmacist is also responsible for ADR and medication error reporting involving team patients.
DeGraff Skilled Nursing Facility
The resident's geriatric clinical training involves improving drug therapy in elderly patients in both ambulatory, acute and long term care settings. The rotation focuses on pharmacokinetic/dynamic differences associated with aging, and appropriate interventions are targeted to reduce inappropriate medication use in elderly.
The resident participates in consultant pharmacist activities at DeGraff Skilled Nursing Facility, a 70-bed long term care facility located adjacent to the DeGraff Memorial Hospital (DMH). These activities include performing mandatory comprehensive drug regimen reviews, psychotherapeutic drug monitoring, drug level monitoring, and drug regimen streamlining (i.e. elimination of unnecessary medications). Recommendations for improving drug therapy are formally written and given to the staff for physician approval. The ambulatory experience involves patient counseling and education, adherence assessment, and optimization of the patient's medication regimen with regard to safety and efficacy. The resident is also required to give weekly presentations to pharmacy staff on topics related to geriatric pharmacotherapy.
This is a four week module involving rounds with the private infectious disease attending and antimicrobial stewardship. The resident will work with the attending, assisting in patient monitoring, drug selection, and drug information. Additionally, antimicrobial stewardship principles and processes are introduced to the resident. The stewardship service covers all beds outside the critical care units, and typically follows 30-50 patients as a daily average. Patient antibiotic regimens are routinely reviewed in light of the culture data and clinical data from the chart. All patients currently receiving vancomycin and or aminoglycosides will be followed by this service on a daily basis and provide dosing recommendations/therapeutic drug monitoring as appropriate. Pharmacist interventions are given to the prescriber either verbally or by written note placed in the chart.
The Buffalo General pharmacy employs a registered dietitian (RD) to manage parenteral nutrition therapy and enteral nutrition regimens on a consultative basis. During the nutrition rotation the pharmacy resident will work with the RD to assess nutritional status, calculate nutritional requirements, design a parenteral nutrition regimen and monitoring plan and write the daily parenteral nutrition orders. The resident will also be required to write initial and follow-up notes. Exposure will also be given to the initiation and management of enteral nutrition, with a particular focus on drug nutrient interactions. Daily patient and topic discussion will be help with the preceptor and RD.
The pharmacy resident will participate in daily rounds with the pain management team attending and nurse practitioner. The team typically provides service to 15-20 patients (this includes patients admitted to the Hospice unit). The resident will be involved in patient monitoring and drug selection decisions based on patients response to current therapy. In addition, the resident is often called upon to assist the team in providing drug information. The pharmacy resident is also responsible for ADR and medication error reporting involving team patients. The resident is required to complete a pain medication-related research project during the rotation.