Learning Experience: Hospital Pharmacy Practice

Preceptor: Nadine Gilmore, R.Ph.

The resident will be responsible for interpreting prescriber medication orders for accuracy and acting as a drug information resource to medical staff, nursing staff, and ancillary department personnel. The resident will gain an understanding of USP <797> requirements involving hazardous and non-hazardous drug compounding, TPN order management, and pharmacokinetic dosing. The resident will also gain an understanding of automated drug distribution systems to include computer prescriber order entry, electronic medical records, automated dispensing cabinets, and bedside barcode medication administration. After successfully completing this rotation, the resident will be capable of fulfilling the service requirement component of the residency experience.

Learning Experience: Clinical Practice

Preceptor: Stephanie Puckett, Pharm.D. , BCPS

During this rotation the resident will review the general principles of pharmacokinetics, nutritional support and pain management. The resident will spend 4 weeks managing a variety of protocols including aminoglycoside dosing, vancomycin dosing, nutritional support, IV to PO conversions, renal dosing and pain management. The resident will participate on the nutritional support team and learn how to estimate nutritional needs, monitor patient response and adjust regimens for patients with a variety of medical conditions (renal failure, hepatic failure, etc). The resident will have the opportunity to provide pain management and monitor difficult cases. The resident will further apply the skills learned during this experience to the management of drug therapy in more complex situations experienced later in the program

Learning Experience: Internal Medicine

Preceptor: Amanda Keith, Pharm.D., BCPS, Julie Flint, Pharm.D., BCPS

Internal medicine is a required 4-week learning experience designed to increase the resident’s knowledge of pharmacotherapy and promote critical and independent thinking skills. This rotation teaches evidence-based patient-centered care as provided on general medical units. Residents will identify potential drug therapy problems, design and modify drug regimens, and monitor therapy. Daily activities include pharmacokinetic monitoring, nutritional management, and communicating with healthcare providers and patients. The resident will provide drug information and education for providers, patients, and students. Common diseases to be discussed include: infectious diseases, thromboembolic disease, renal failure (acute & chronic), diabetes mellitus and associated complications, cardiovascular conditions, and asthma & COPD (acute care management).

Learning Experience: Critical Care

Preceptor: Jeff Duncan, Pharm.D. , BCPS, BCNSP

The Critical Care Rotation consists of prospective chart reviews, clinical consults and the nutritional management of patients in the Medical and Surgical Trauma Intensive Care units. These units consist of 23 intensive care beds where patients are managed daily by a 6 physician Pulmonology/Critical Care Medicine practice. The critical care service relies on pharmacists for monitoring and intervening in the pharmacotherapy of severely ill patients. The resident is exposed to a variety of disease states and medication management experiences during the rotation

Learning Experience: Long-Term Acute Care

Preceptor: Dan Payne, III, Pharm.D., BCPS

This is a 4 week rotation in the PGY1 pharmacy residency program. This rotation trains residents to provide care to patients admitted to a 36 bed long-term acute care (LTAC) hospital. The residents become fully integrated with the LTAC interdisciplinary team, round on a daily basis with an LTAC physician and focus on managing drug therapy in patients with multiple medical problems.

The core content is covered via patient experiences; discussions of reading materials; and/or case presentation, and includes a review of:

• Management of Common Infectious Diseases
• Antimicrobial Stewardship
• Development of medication regimens based on estimated and calculated pharmacokinetic parameters
• Management and Prevention of Thromboembolic Disease
• Management of Chronic/Acute Renal Failure
• Management of Seizure Disorders
• Nutrition Support

Learning Experience: Neonatal Intensive Care

Preceptor: Julie Flint, Pharm.D. , BCPS

The Neonatal Intensive Care Unit at Virginia Baptist Hospital is a Level IIIA nursery with 21 beds. This rotation teaches the essentials of caring for neonatal patients, including disease states, and drug dosing with an emphasis on the safe and effective use of medications. Residents will attend daily rounds and be an active member of the neonatal healthcare team. Areas of focus include:

• Growth and development
• Nutrition support
• Hyperbilirubinemia of prematurity
• Pharmacokinetic and pharmacodynamic differences in neonates
• Treatment of neonatal sepsis/meningitis
• Treatment of neonatal seizures
• Therapeutic drug monitoring
• Neonatal abstinence syndrome
• Treatment of apnea and bradycardia of prematurity

Pharmacy Leadership (3 Week Rotation and Longitudinal Experience)

Preceptors:
Nadine Gilmore, R.Ph.
Randall Puckett, Pharm.D., BCPS

The three week rotation provides leadership training and gives the resident an opportunity to perform some of the tasks that are routinely performed by the pharmacy administrators. The resident will work directly with the director and operations managers at the various campuses. The resident will be exposed to the real time challenges in operations, human resources management, project management, financial management, quality assurance, medication safety, regulatory preparedness and policy development.

In addition there will be numerous longitudinal experiences as the resident participates in the work of the Pharmacy and Therapeutics Committee, the Institutional Review Board, the Medication Safety Committee and the Centra Leadership Committee. 

Learning Experience: Infectious Disease

Preceptors:
Stephanie Puckett, Pharm.D., BCPS
Julie Flint, Pharm.D., BCPS

Infectious Disease is a 4-week required learning experience. The resident will develop a broad understanding of the pharmacotherapy of a wide variety of infectious diseases. The resident will be responsible for monitoring patients and participating in Antimicrobial Stewardship rounds with the preceptor and an ID physician. Activities include formulating individual monitoring plans, making recommendations on patient management, and monitoring patients’ drug therapy. Topics of discussion will include management of common infectious diseases: Community Acquired Pneumonia, Hospital Acquired Pneumonia, Skin and Soft tissue infections, Urinary Tract Infections, Bacteremia, Endocarditis, Meningitis, and Osteomyelitis.

Learning Experience: Clinical Informatics

Preceptors:
Kurt Bell, R.Ph., MSHA

The purpose of this rotation will be to teach the pharmacy resident how informatics can benefit all areas of pharmacy including clinical, administration, patient safety, and staffing work flow. The resident will create and query data for clinical rounding reports, design rules and warning messages for staff order entry reminders, and analyze inventory costs and volumes for management. The learning experience will also offer the resident an opportunity to understand how systems and technology are used to meet HITSP standards and core measure guidelines, develop order sets using evidence-based medicine, and promote medication safety throughout the hospital system.

Learning Experience: Family Medicine/Pediatrics

Preceptor: Jeffrey Shearin, Pharm.D., BCPS

During this 5-week required learning experience, the pharmacy resident will round with the Family Medicine team which consists of pharmacists, medical students, interns, residents and attending physicians. The pharmacy resident will experience both inpatient and outpatient clinical pharmacy training, will train family medicine residents and will practice incorporating scientific evidence into the routine use of medication. Daily activities will include monitoring adult and pediatric patients on the inpatient service, rounding with the team, researching drug information questions, and providing formal and informal presentations.

There is sufficient flexibility within the program to allow the resident to repeat a required rotation or develop a unique 4 week experience after meeting certain requirements and receiving the approval of the program director.

Centra Pharmacy Residency will offer a teaching certificate in conjunction with Shenandoah School of Pharmacy. Residents are required to complete all pre-class assignments and view all pedagogy seminars live, in order to participate in the discussion. To meet the requirements, Centra Pharmacy Residents will: develop and deliver 2 formal didactic lectures (1 hour each), develop and deliver 2 small group facilitations (45 min each) in the form of a journal club, precept an APPE student in a rotation that has been completed by the resident, write a teaching philosophy statement, and design an electronic teaching portfolio. The specifics of the program are detailed below.

The Shenandoah University Pharmacy Residency Teaching and Learning Curriculum Program (RTLCP) is a collaborative program between the School of Pharmacy and School of Education and Human Development that combines both the knowledge and practice of teaching in a comprehensive year-long program.  Now starting its ninth year, the program has been very successful in further developing participants’ teaching skills that have been applied in varied practice settings, including academia and practice.  Through the use of synchronous and asynchronous technology and equivalent practice experiences done at the residency sites, residents and preceptors from distant residency sites also took the program in 2014-15 for a total of 12 different programs covering 5 states.  With recent technology and programmatic enhancements, participants in the 2015-16 RTLCP will get a relevant, comprehensive and user-friendly educational experience that can be applied in many settings for the future.

Preceptor: Stephanie Puckett, Pharm.D., BCPS

Cardiology/Neurology Critical Care elective is a four-week learning experience in the Cardiothoracic and Neurological Intensive Care units. The units consist of a total of 20 ICU beds where patients are managed by an intensivists, cardiologist, cardiothoracic surgeons, neurosurgeons, and neurologists, as well as mid-level practitioners. Attending daily rounds is required and active participation is expected. The resident may have the opportunity to shadow or work with Neuro PAs and nurse practitioners and attend Code Strokes. The resident will be offered the opportunity to spend time in the interventional cardiology lab, the cardiovascular operating room and time with a cardiac ambulatory care pharmacist to manage high risk antiarrhythmic agents and anticoagulation. 

Preceptors: Nadine Gilmore, R.Ph and Stephanie Puckett, Pharm.D., BCPS

The orientation period to Centra's PGY1 Residency program is a required four-week learning experience that occurs during the month of July.  During this time, the resident will complete Centra's general hospital orientation on day one, be introduced to Centra Pharmacy distribution and order verification system, and complete initial IV compounding requirements. The goal of the orientation period is for the resident to gain a broad understanding of Centra Pharmacy operations, the daily activities of pharmacists (centralized and decentralized), pharmacy technicians, and the management team. The resident will be trained on basic order verification and medication dispensing to meet weekend service requirements.

Preceptor: Daniel Payne, III Pharm.D., BCPS

Psychiatry is an elective, four-week rotation in the PGY1 pharmacy residency program, developed to provide the opportunity for residents to round with psychiatrists, nurse practitioners, social workers, and psychiatric nurses, specifically for the Adult Psychiatric Unit at Virginia Baptist Hospital. The resident will manage adult hospitalized patients with a variety of mental health conditions, as well as other comorbid conditions. The resident will attend daily rounds with the psychiatric team, present informal drug information topics to the team, provide discharge counseling to patients, and participate in transition of care via follow up phone calls with social work.

Preceptor: Julie Flint, Pharm.D., BCPS

Centra Bridges Treatment Center is a well-established 14-acre residential psychiatric treatment facility in Lynchburg, VA.   Bridges provides comprehensive care for boys and girls ages 6-17 years of life with a variety of emotional and behavioral disorders, as well as their comorbid medical conditions.  The therapeutic environment at Bridges includes participation from the family and the community in each child’s treatment.  Bridges is dedicated to the belief that all children deserve a success-oriented treatment program. The pharmacy resident is responsible for completing 30-day medication reviews for patients at Bridges as part this elective longitudinal learning experience.

Preceptor: Jeff Duncan, Pharm.D., BCPS, BCCCP

While not official members of the Code Blue Team at Centra Health, clinical pharmacists and residents respond to code blue calls during working hours of 7am-1630. The resident will attend American Heart Association ACLS training in August and will participate in Code Blue pages at Lynchburg General and Virginia Baptist Hospitals throughout the residency year. Residents will respond immediately to Code Blue calls when announced overhead. Activities may include, but are not limited to assisting with CPR, preparing medicated drips and syringes, proper labeling of prepared medications, dose/drip calculations, answering iv compatibility questions, obtaining medications from the main pharmacy, and additional support as needed. The resident will round with the Medical Emergency Team (MET) nurse for one day during the critical care rotation and will attend at least one Centra Resuscitation Committee meeting during the residency year.

Preceptor: Amanda Keith, Pharm.D., BCPS

Interpreting and providing drug information is an integral part of pharmacy practice.  Throughout the residency year there will be opportunities to respond to drug information requests from practitioners and staff members.  These requests provide the opportunity for each resident to apply clinical and outcomes research concepts to professional practice.  Practitioner requests for information also help to develop collaboration between residents and providers, as well as to further develop communication skills. In addition, each pharmacy resident will present at minimum, three formal journal clubs during the residency year (traditionally five each).  This longitudinal experience is designed to help residents evaluate and appraise medical literature through the evaluation of statistical methods, the clinical and statistical significance of study results, in addition to the impact on current and future practice.  Residents will attend all journal clubs presented by fellow residents and others as required by rotation preceptors.

Preceptor: Stephanie Puckett, Pharm.D., BCPS

The Pharmacy & Therapeutics Committee at Centra Health consists of physicians, pharmacists, medical and nursing executives.  The committee meets five times per year.  Items discussed at P&T are new formulary items, adverse drug event monitoring, therapeutic substitution, order set development, and therapeutic class reviews.  During this longitudinal experience, the resident will attend all P&T meetings. The resident will review the literature, prepare and present drug monographs and reviews when needed.  The resident will participate in a medication use evaluation during the residency year.

Residents will also take part in retrospective ADE reviews. Various other meetings including Medication Safety Committee meeting. Error reporting and adverse event related monitoring projects may be assigned as necessary throughout this longitudinal rotation, including root cause analysis participation.

Preceptor: Stephanie Puckett, Pharm.D., BCPS

A project administered by the resident and mentored by a primary preceptor is required of all residents. The project is to be of benefit to the individual, the department, and to the institution. There is to be a significant amount of literature review, project design, data collection, statistical evaluation, writing, and reporting done by the resident. A poster describing interim results or final results will be presented at ASHP Midyear Clinical Meeting. The final product will be presented at the Eastern States Residency Conference and to Centra staff. A written manuscript suitable for publication in a selected journal is required.