Core Rotations

This rotation is designed to provide broad ambulatory care experience by focusing the primary emphasis of clinical interaction on medication therapy management (MTM) services. At Catholic Health, we strive to meet quality measures while reducing the total cost of care for our patient population. Opportunities for pharmacist within the ambulatory care setting have been defined through provisions of the Affordable Care Act (ACA) to support the achievement of quality goals. According to the ACA, local primary care providers should be able to provide access to pharmacist-delivered MTM services which may include medication reconciliation in patient-centered medical homes (PCMHs) or during transitions of care. The Ambulatory Care Clinic is a clinic that serves as an outpatient site for medication therapy management services at Mercy Comprehensive Care Center. The pharmacist role focuses on medication safety and efficacy, as well as cost management as they relate to transitions of care and disease management.

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 a 18-bed unit. Clinical pharmacy service 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 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.

4N/5N/5C Clinical Pharmacy Services is a required, five week learning experience at Mercy Hospital. There are 50+ general medicine beds on these units collectively. Patients on these floors are cared for by several 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 the patients on 4N/5N/5C including nurses, respiratory therapists, case managers, clinical dietitians, and physical therapists.

Mercy Hospital clinical pharmacy services are provided as location-based services where clinical pharmacists are assigned a particular unit to provide safe and effective medication use for all patients on that unit. Services provided by each pharmacist include antibiotic stewardship, IV to PO conversions, renal dosing, aminoglycoside and vancomycin pharmacokinetic consultation, core measures support, ADR documentation, anticoagulation counseling, and medication reconciliation. The clinical pharmacist on the 4N/5N/5C unit also actively participates in pain rounds and discharge rounds, collaborates with centralized pharmacists to assure timely medication availability, educates patients and their family members, and supports organizational policies and procedures.

Internal Medicine (IM) is a required, 1-month learning experience at Mercy Hospital. There are 450 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 (5c,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.

This longitudinal rotation will cover the dispensing and distributive operations of Mercy Hospital of Buffalo.  Within this rotation an initial 5 week period will be incorporated to give residents a chance to orient to the physical layout of the department and hospital, read and understand Catholic Health, Mercy Hospital, and pharmacy department specific policies and procedures, as well as software programs pertinent to pharmacy operations. Staffing requirements include an average of 1 shift per week and coverage of major holidays (max of 3 holiday shifts per resident) as needed by the department.

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 research committee and residency advisory committee.  The resident will work with their assigned preceptor(s) to create a study design proposal which will be presented to the CH IRB, 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.

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 pharmacy services that are critical to safe, effective, and cost-conscious medication use in a hospital and ambulatory care pharmacy departments, 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.

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.  Additionally, the resident may be called upon to develop educational programs for medical/pharmacy staff.  

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.

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 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:

• Internal Medicine 3 with focus on Precepting
• Nephrology
• Cardiac Care Teaching Service
• Advance Teaching Certificate Program
• Methadone Clinic
• Neuro Critical Care
• Ambulatory Care
• Academia
• Emergency Medicine 

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 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
• Pathways Methadone Clinic
• Renal Diseases
• Vascular