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.

Cardiac Care Pharmacy Service is a required, six week learning experience at Mercy Hospital of Buffalo. The first 2 weeks of this rotation will be spent with other ancillary services and cardiology specialists shadowing various roles including electrophysiology, angiography, echocardiogram, cardiac nursing, sleep lab, rounding with cardiology teams and open heart procedures as available. During this time the resident will be acclimating to the daily clinical pharmacy services provided

During the cardiac pharmacy service rotation the resident will be working toward handling the responsibilities for the 7 West patient care area for weeks 3-4. The clinical pharmacist in this area provides comprehensive medication management for all patients, with a focus on cardiac care.  Clinical pharmacy service includes antibiotic stewardship, renal and hepatic dosing, aminoglycoside and vancomycin pharmacokinetic consultation, core measures support, and ADR documentation.  

There are 3 critical care units at MHOB: the medical ICU (MICU), neuro critical care unit (NCC), and the cardiovascular ICU (CVICU).  The MICU is an 18 bed unit that cares for a mix of medical/surgical critically ill patients.  The NCC is a 10 bed unit that cares for critically ill neurologic patients and the CVICU is a 12 bed unit that cares for critically ill cardiac patients.  Patients on these units are cared for by board certified critical care specialists and neurointensivists.  The clinical pharmacists in these areas provide comprehensive medication management for all critically ill patients.  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.

The Emergency Department rotation is a required, six week 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 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.  Clinical pharmacy services are provided in the Mercy Hospital ED from 1300 -2100 Monday through Friday.  Pharmacist responsibilities in the ED include responding to cardiac arrests and stroke emergencies, answering drug information questions from ED and Mercy Hospital caregivers, patients, and families, antibiotic stewardship, collaborating with the centralized pharmacists to assure timely medication availability, and medication reconciliation.  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 to 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 – 5N/5C Clinical Pharmacy Services is a required, five week learning experience at Mercy Hospital. There are 36 general medicine beds on the 5 McCauley North and Center floors (5N/5C).  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 the patients on 5N/5C including nurses, respiratory therapists, case managers, clinical dieticians, 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 5N/5C unit also actively participates in pain rounds and discharge rounds daily; collaborates with centralized pharmacists to assure timely medication availability; educates patients and their family members; and, supports organizational policies and procedures.

Internal Medicine 2 (IM2) is a required, six week learning experience at Mercy Hospital.  There are >300 general medicine beds in the hospital, housed on 8 different units.  The University at Buffalo residency program staffs two medicine teaching teams.  Each teaching team provides care to a maximum of 20 general medicine patients.  These patients are located throughout various units in the hospital.  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 decentralized pharmacists to appropriate medication management; and 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 all 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.  The pharmacy resident will also attend and participate in discussions during the morning reports and noon conferences held daily. Good communication and interpersonal skills are vital to success in this experience.

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.  

The rotation will consist of providing clinical pharmacy services to the Level III Neonatal Intensive Care Unit (NICU) at Sisters of Charity Hospital, under the guidance of the rotation preceptor, for patients born premature and/or having other acute illness requiring intensive monitoring. The resident will have daily interactions with the neonatal intensivists, nurse practitioners, physician’s assistants, nursing staff, pharmacy personnel, and other healthcare professionals as required to optimize the therapeutic management of these patients. In addition to the pharmacotherapeutic consultative services, the resident will also be expected to provide drug information services, patient education (as needed), discharge counseling, and educational presentations to the pharmacy, providers, and nursing staff. The resident will meet frequently with the preceptor to discuss patient care issues and pharmacotherapeutic topics specific to neonatology.

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