During resident training, valuable experience is obtained in the many integrated aspects of a pharmacy service including quality improvement programs, medication use evaluation programs, and regulatory compliance. These experiences enable the resident to develop the skills needed to communicate effectively; to organize, prioritize, and manage pharmacy services; and to plan for and implement new programs. Rotation experiences are usually 5 weeks long. Each resident will complete 8 required rotations and 3 elective rotations.
During pharmacy rotations, the resident assumes the responsibility for all aspects of patient drug therapy including: conducting patient interviews and patient medication counseling; advising physicians, nurses, and patients on appropriate drug use; attending rounds and conferences; pharmacokinetic consulting; and providing lectures on drug therapy to medical, nursing, and pharmacy staff.
- Orientation - The resident will be required to complete the general Sentara Martha Jefferson Hospital orientation and will begin pharmacy orientation on the following day. The resident will learn the roles and responsibilities of each technician shift and will understand the importance of automated medication dispensing machines and cabinets. The resident will have an introduction to intravenous sterile compounding and will complete the written and practical competencies in this area. The resident will learn the computer system including order verification, order entry, medication administration record review, clinical documentation, and other important aspects of the electronic patient profile. Overall, the resident will learn both staffing and clinical duties of the pharmacist to better prepare them for their weekend staffing component and subsequent clinical rotations.
- Internal Medicine - Internal Medicine is a five week rotation for PGY-1 pharmacy residents. This learning experience allows for the provision of pharmaceutical care for patients followed by the hospitalist service. The hospitalist service consists of physicians, nurse practitioners, and physician assistants who care for the general internal medicine patients throughout the hospital. Residents will be responsible for identifying and resolving problems on patients followed by a specific hospitalist team. Good communication, interpersonal skills, and assertiveness are of extreme importance in this setting. The resident must devise efficient strategies for accomplishing the required activities in a limited time frame. Common disease states in which the resident will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care include: skin and soft tissue infections, tick borne illnesses, Clostridium difficile infections, meningitis, reversal of anticoagulants, community and hospital acquired pneumonia, diabetic foot infections, and urinary tract infections.
- Critical Care -This rotation allows for the provision of pharmaceutical care for those patients on a 20 bed mixed critical and intermediate care unit for medical and surgical patients staffed by an intensivist. Daily, interdisciplinary rounds are managed by our pulmonologists/intensivists. Nurses, respiratory therapists, pharmacists, case managers, and dieticians participate in daily rounds. The resident is responsible for identifying, monitoring, and resolving medication therapy issues for patients and will work toward assuming care of all patients on the unit throughout the five week learning experience. The resident must devise efficient strategies for accomplishing the required activities in a limited time frame. If time permits within the rotation block, the resident will have an opportunity to view a surgery and round for ½ day with a respiratory therapist and a clinical dietician.
- Nutrition/Sterile Intravenous Compounding - The sterile IV compounding learning experience will provide exposure to sterile compounding, nutrition support, and chemotherapy protocol review and admixture. The resident will meet with the Pharmacy Regulatory and Quality Analyst to discuss IV room procedures and USP 797 requirements. Additionally, the resident must devise efficient strategies for accomplishing the required activities in a limited time frame.
- Drug Information - In the required drug information learning experience, residents will receive first-hand experience with formulary management. Residents will research and prepare a monograph for the Pharmacy and Therapeutics Committee. As part of this process residents will focus on evaluating and appropriately using evidence-based information and basic pharmacoeconomic principles. The resident will present the monograph and their recommendation at a Pharmacy and Therapeutics Committee meeting. Residents will also field and formally answer drug information queries from hospital staff members; pearls and pitfalls will be discussed. A total of 10 formal drug information questions will be answered during the course of the residency year (5 or more during the drug information rotation and the remainder during the rest of the residency year). The resident will develop an evidence-based medication use guideline; part of this process will be a medication usage evaluation (MUE). The guideline and MUE will also go to the Pharmacy and Therapeutics Committee for consideration. The resident will also participate in 2 Journal Club presentations during the course of the rotation with the preceptor. The resident will attend all meetings and conferences as assigned.
- Administration/Practice Management - This rotation includes exposure to pharmacy management activities including strategic planning, financial management, human resource management, regulatory compliance and interdepartmental collaboration. Additionally, we will review leadership philosophies and approaches to safe medication system design.
- Information Systems - The PGY1 pharmacy informatics rotation is a longitudinal core experience that exposes residents to the evolution of organizations' medication-use systems by applying pharmacy informatics principles, standards, and best practices. Residents will gain basic understanding of the language and concepts of information technology (IT) thereby equipping the resident recognize, understand, and articulate the basic the professional duties and responsibilities of a pharmacy informatics specialist. The resident will become familiar with medication use information systems in the pharmacy and the health system. Throughout the rotation, the resident will develop an understanding of the planning and implementation of new systems or upgrades to existing systems, along with the unique connection of pharmacy informatics with clinical pharmacy, medication-use processes, medication safety, finance, and regulatory compliance.
- Medication Safety - The goal of this rotation is to expose the resident to the way medication safety science is present in all practice environments. Through this specialty rotation, residents gain experience in various methodologies used to measure medication-use safety, participate in the application of technologies that improve the medication-use process, learn and apply methods to promote a culture of safety, analyze complex systems to identify and correct system flaws, develop effective communication techniques and understand the many human-factors that influence the safety of patient care. Upon completion of this rotation, the individual will have a valuable safety perspective on the key influencing factors of medication use processes in a health-system setting.
- Emergency Medicine - Sentara Martha Jefferson Hospital has a 23 bed on-site emergency department (ED), 13 bed Free Standing Emergency Department (FSED), and an additional 12 bed Pediatric/Clinical decision unit (PCDU). Approximately 60% of hospital admissions are through the ED. The emergency medicine rotation is a 5 week long elective rotation which will incorporate aspects of ambulatory, critical, and transitional care. The ED Pharmacists' responsibilities for ensuring safe and effective medication use for all patients in their clinical area include, but are not limited to: provide drug information for nursing staff and physicians, monitor all clinical consults for PCDU and the ED, clarify physician orders, verify appropriate dosing for each patient, assist in Code Blues, provide a double check on high risk medications as needed, clarify patient’s narcotic history utilizing the Prescription Monitoring Program, follow up on microbiology cultures on discharged patients, and acquire medication histories for admitted patients as needed.
- Oncology – Sentara Martha Jefferson Hospital has a comprehensive cancer center, with primarily outpatient services. The infusion center within the cancer center primarily supports patients referred from the four medical oncologists. The infusion center also treats patients referred from community providers for non-malignant conditions, for example infections requiring intravenous antibiotics. The overall objective of the Hematology-Oncology elective rotation is to build/reinforce the resident's knowledge and skills for this specialty practice area. When available, the resident and preceptor will use evidence-based practice guidelines for patient care issues, topic presentations and topic discussions. Common disease states encountered on this rotation include breast cancer, colon cancer, lung cancer, prostate cancer, multiple myeloma, lymphoma, and leukemia, along with many other types of hematologic and oncologic disease states.
- Cardiology - This learning experience allows for the provision of pharmaceutical care for patients followed by the Heart/Rhythm Center Service. This service consists of physicians, nurses and physician assistants who care for patients throughout the hospital. Each morning the resident will meet the Heart/Rhythm Center team. The pharmacy resident will be responsible for identifying and resolving problems on patients followed by the Heart/Rhythm Center Service. The resident will be responsible for reviewing medication profiles, initiating/managing pharmacy dosing consults, medication reconciliation, providing drug information, and providing patient discharge counseling for the Heart/Rhythm Center Service. The resident will also be responsible for initiating/managing pharmacy dosing consults for all patients on the telemetry unit and providing discharge counseling for heart failure patients. Common topics encountered include heart failure, atrial fibrillation, and antiarrhythmic agents.
- Others elective rotations coordinated with other Sentara Health System Hospitals such as Sentara RMH Medical Center or with the University of Virginia Health System may be available based on need and availability.