Core Rotations

This longitudinal rotation is a broad ambulatory care experience which provides medication therapy management (MTM) services, management of chronic disease, and care transitions within an inter-professional healthcare environment. Catholic Health Systems seeks to meet quality measures while reducing the total cost of care for our patient population and this pharmacy service addresses all aspects of the Triple/Quadruple Aim. Additionally, these services will align with Catholic Health Systems values; reverence, compassion, justice and excellence. The pharmacist-led ambulatory care service within the Catholic Health System serves as an outpatient practice which focuses on medication safety and efficacy/outcomes, as well as cost management as they relate to transitions of care and disease management.

Residents will develop necessary knowledge and skills to provide quality, direct patient care, through pharmacist-led relationships and within a collaborative practice agreement within an adult medicine clinic. Residents will assess needs for patient education, lifestyle modification reinforcement, appropriate device use and technique, insulin titration or instruction and adherence with drug therapy plans. They will gain experience as a resource to clinicians by providing drug information, monitoring drug therapy, assessing adherence, considering cost comparisons, and making recommendations for to achieve optimal patient outcomes. Common disease states include (but not limited to); hypertension, hyperlipidemia, diabetes, asthma, heart failure, COPD, coagulopathy, obesity, and nicotine addiction.

Furthermore, the resident will act as a drug information resource for providers throughout the Catholic Health system. The resident may be asked to provide education for care to team members or patients. Residents will also interact with students (of many disciplines) to collaborate on (including but not limited to) medication reconciliation, literature review processes or disease state topic discussions.

This service requires interdisciplinary teamwork with primary care staff which include; nurses, care coordinators, medical assistants, social work, nutritionist and other physician office support staff to achieve the primary program goals. Residents must gain the ability to identify the different roles of team-members in order to refer and collaborate effectively. Pharmacy service goals include; reducing medication errors and hospital re-admissions; identifying and resolving drug therapy problems (DTPs); enhancing the patient's understanding of appropriate drug use; increasing adherence to medication therapy; and improving detection of adverse events.

The pharmacy resident (PGY-1) will be responsible for providing medication therapy management services – comprehensive medication therapy review and disease state management, identifying and resolving DTPs, communicating discrepancies along with recommended interventions to the healthcare team, and enhancing drug information communication. The resident will document discrepancies and outcomes related to medication reconciliation and DTPs. These activities will be documented in a tracking template which will track resident progress. The resident will be required to engage in research and data collection related to existing services for quality improvement and tracking of interventions.

Cardiology is a required, 1 month learning experience at Mercy Hospital of Buffalo (MHOB). Residents will be expected to be prepared for daily rounds with nursing and physicians on 7w. Pre-rounds will be necessary including gathering pertinent information from the electronic record, patient chart, and discussions with other healthcare providers. Discussion with preceptor regarding data collection during pre-rounds will occur initially. Preceptor will observe resident on rounds a minimum of 1 time per week.

As part of this rotation, residents will provide and document patient education in multiple different topics, including anticoagulation and heart failure. Based on appropriately collected pertinent information, resident will discuss recommendations with cardiology team after getting approval from preceptor. Resident to follow each cardiac patient on the service to ensure appropriate EBM. Clinical pharmacy service will also include antibiotic stewardship, renal and hepatic dosing, aminoglycoside and vancomycin pharmacokinetic consultation, core measures support, and ADR documentation. Resident will document assessments and plans for these patients.

o The Medical Intensive Care rotation is a required 1 month learning experience at Mercy Hospital. In this rotation, the resident will learn the skills necessary to become a competent clinical pharmacist that can work independently and provide direct patient care to patients in the medical intensive unit (MICU). The MICU at Mercy Hospital is an 18-bed unit. Clinical pharmacy services including antibiotic stewardship, renal and hepatic dosing, aminoglycoside and vancomycin pharmacokinetic consultation, core measures support, and ADR documentation. The critical care pharmacists also participate in rounding on these units.

This rotation will serve as an introduction of the resident to providing care for the critically ill patient. The pharmacy resident is responsible for identifying and resolving medication therapy issues for critically ill patients and will work toward assuming the clinical pharmacist role in the care of the majority patients on the unit. The resident will provide clinical pharmacy services and participate in interdisciplinary rounds. Good communication and interpersonal skills are vital to success in this experience.

The Emergency Department rotation is a required 1 month learning experience at Mercy Hospital. In this rotation, the resident will learn the skills necessary to become a competent clinical pharmacist that can work independently and provide direct patient care to patients in the emergency department (ED). The ED at Mercy Hospital is a 32-bed unit, with 2 resuscitation rooms, and is one of the largest EDs in the area. During this rotation, the pharmacy resident will work collaboratively with several disciplines including the ED physicians, ED mid-level providers, hospitalists, medical residents and ED nurses to optimize pharmaceutical care for the ED patients. The resident will be required use evidence-based medicine to provide pharmaceutical care to a range of ED patients, from the ambulatory to the critically ill. A typical day in the ED does not exist and the resident will be required to "work on the fly".

The Infectious Diseases rotation is a 1 month learning experience in the Mercy Hospital PGY-1 Pharmacy Residency Program. The goal is to provide inpatient pharmacy services to patients acutely being treated for infectious processes. Members of the infectious diseases team include physicians, physician assistants, and nurse practitioners. The pharmacy resident is responsible for ensuring safe and effective antimicrobial use for all patients admitted to the team, including active participation in daily rounds, education of patients and their family members, and education provided to the ID team as needed. The pharmacy resident is responsible for identifying and resolving medication therapy issues for patients and will work toward assuming care of all patients on the team throughout the learning experience.  The pharmacy resident will also identify antibiotic streamlining opportunities in patients outside the ID team service.  They will make recommendations and collect data as part of the hospital’s Antimicrobial Stewardship Program.  Good communication with team members and strong interpersonal skills are vital to success in this experience.

Internal Medicine Clinical Pharmacy Services rotation is a required, 4 week learning experience at Mercy Hospital of Buffalo. There are an average of 40 general medicine beds between the floors covered by the clinical pharmacist on this service. Patients on this floor are cared for by several different hospitalist groups, independent hospitalists, specialists, consultants and their mid-level providers. Non-physician members of the healthcare team also closely interact with each other to optimize care for patients including nurses, respiratory therapists, case managers, social workers, clinical dieticians, and physical therapists.

During this rotation, the pharmacy resident is responsible for identifying and resolving medication therapy issues for patients, while progressing toward assuming the clinical pharmacist role on the unit throughout the learning experience. The resident will provide clinical pharmacy services and participate in interdisciplinary rounds, establishing collaborative relationships with other healthcare professionals. Good communication and interpersonal skills are vital to success in this experience.

Internal Medicine 2 (IM) is a required, 1-month learning experience at Mercy Hospital. There are 349 beds in the hospital, housed on 8 different units. The University at Buffalo residency program staffs two medicine teaching teams (POD 2 and POD3). The POD 2 (5e,7w) teaching team provides care to a maximum of 20 general medicine patients. Members of the teaching team include an attending physician, a PGY3 senior medical resident, 2 PGY1 medical interns, and medical students.

The pharmacy resident is responsible for ensuring safe and effective medication use for all patients admitted to the team, including active participation on rounds daily. The pharmacy resident is also responsible for collaboration with clinical floor pharmacists to assure education of patients and their family members, and education of physicians. The pharmacy resident will work toward assuming care of all patients on the team throughout the learning experience. Routine responsibilities include: reconciling medications for patients admitted to the team, addressing medication therapy concerns, assisting in discharge medication reconciliation and providing drug information and education to healthcare professionals as well and patients and caregivers. Good communication and interpersonal skills are vital to success in this experience.

This longitudinal experience is designed to give residents a chance to develop their professionalism and to learn about and participate in important pharmacy-related functions of the health system that are not necessarily associated with direct patient care. The resident will demonstrate knowledge and application skills in the area of leadership and ethics. It is recommended that the residents utilize the Catholic Health University to attend classes related to leadership, teamwork, and ethics so long as they do not interfere with scheduled rotations.

Leadership series will be a longitudinal experience consisting of 1 hour meetings related to a myriad of topics.

This rotation will occur for approximately 4 weeks during the month of December. During this rotation the resident will appropriately manage their time and practice effectively in order to successfully complete the required activities outlined in this rotation description.

The first week of the rotation will be dedicated to attending the Midyear Clinical Meeting where the resident will be required to complete the following activities: attendance at their poster presentation, completion of 10 CE credits during the conference, participate in a CHS pharmacy team building activity and/or dinner, and attendance at residency showcase for recruitment.

In addition, this will be the time to complete all mid-year evaluations on PharmAcademic and follow through with any outstanding work from the first half of the resident year. The resident may also be asked to participate in other departmental/preceptor needs, as approved by the rotation preceptor. Resident will be required to create once weekly meetings with rotation preceptor to touch base on required activities progress and develop plan for completion by the end of the rotation.

This 1 week orientation rotation will include orientation to the organization, hospital site, pharmacy department, and residency programs. We will discuss the residency manual and ensure all expectations are understood during this initial week.

This 5 week rotation will cover the dispensing and distributive operations of Mercy Hospital of Buffalo (MHB). This rotation will be incorporated to give residents a chance to orient to the physical layout of the department and hospital, read and understand Catholic Health, MHB, and pharmacy department specific policies and procedures, as well as software programs pertinent to pharmacy operations. Distributive services has been one of the foundations of pharmacy practice, therefore a competent advanced generalist practitioner should be proficient in their knowledge of the skill-set associated with these functions, including but not limited to: state and federal laws, CHS and MHB policies and procedures, sterile preparation, and a multitude of other skills listed in the operations checklist. During the learning experience the resident will focus on the goals and objectives outlined below by performing the activities that are associated with each objective. The resident will gradually assume responsibility for all the patients within the assigned unit. The PGY1 resident must devise efficient strategies for accomplishing the required activities in a limited time frame.

This longitudinal rotation will cover the dispensing and distributive operations of Mercy Hospital of Buffalo (MHB). Staffing requirements are average of 1 shift per week and coverage of 3 major holidays shifts, as needed by the department. Distributive services has been one of the foundations of pharmacy practice, therefore a competent advanced generalist practitioner should be proficient in their knowledge of the skill-set associated with these functions, including but not limited to: state and federal laws, CHS and MHB policies and procedures, sterile preparation, and a multitude of other skills listed in the operations checklist. During the learning experience the resident will focus on the goals and objective outlined below by performing the activities that are associated with each objective. The PGY1 resident must devise efficient strategies for accomplishing the required activities in a limited time frame.

The resident will be required to complete a longitudinal pharmacy research project. This research project may be of a clinical, economic, research, administrative, or quality/process improvement design. A list of possible projects will be provided to the resident at the beginning of the residency year. Additionally, the resident may elect to conduct an unlisted project, only with the approval of the residency advisory committee and the CH Pharmacy Research Committee. The resident will work with their assigned preceptor(s) to create a study design proposal, conduct a literature search, conduct the actual study, interpret the study data, and present the results. The resident will work on their research project longitudinally during the residency year with extra time devoted to research in December.

The resident will also be required to complete a medication use evaluation and prepare 1 of the following, a drug class review, monograph, treatment guideline, or protocol. They will identify, in collaboration with their preceptor, a medication that may have suboptimal use, raise concern, or whose worth is more than the benefit. They will extract data from the EMR, analyze the data, and use this analysis to make a conclusion on how to proceed with the use of the medication. Such conclusions may be to limit its use or remove from the formulary.

This 1 month experience is designed to give residents a chance to develop their professionalism and to learn about and participate in important pharmacy-related functions of the health system that are not necessarily associated with direct patient care. The resident will demonstrate knowledge and application skills in the pharmacy services that are critical to safe, effective, and cost-conscious medication use in a hospital, including (1) practice management; (2) medication-use policy development; (3) optimizing medication therapy; (4) drug product procurement and inventory management; (5) monitoring medication use; and (6) evaluating the effectiveness of the medication-use system.

This experience will provide an insight into the practice management of both an inpatient and an ambulatory care pharmacy department. Throughout the year the resident may need to be "pulled out" of their current rotation to attend various departmental/committee meetings based on need determined by the directors. The rotation length will be 12 months, however there will be one focused month where the resident will act as chief resident. Responsibilities will include working on projects at the discretion of RPD and site manager, attending/presenting at P&T, med safety, antimicrobial stewardship or other committee, presenting a pharmacy Grand Rounds for pharmacists throughout Catholic Health, preparing an MUE, leading the monthly leadership meeting, taking minutes for weekly resident meetings, etc.

Preparing the resident for a future career involving academia or precepting student pharmacists on experiential rotations is a vital skill to be an advanced practitioner. Being involved in different types of teaching and learning experiences also allows the resident to grow as a professional. Educational opportunities exist in multiple settings throughout the residency year, including small group teaching (in-services, drug info, topic discussions), mentoring APPE pharmacy students, and grand rounds. The resident may be called upon to develop educational programs for medical/pharmacy staff.

Elective rotations are an area that allows for customization of our program to fit the interests of the residents. While we have several elective rotations that have been developed based on strengths of our institution, one of the requirements for this program during the December month is for the resident to create their own elective. Creation of an elective provides ownership for the resident in their experiences as well as develops a skill set and understanding of the regulations set forth by our accrediting organization, ASHP. Some examples of created electives include:

• Administration
• Cardiovascular ICU
• Cardiology Teaming Team
• Medical ICU
• Neuro-Critical Care
• Neonatal ICU