Pharmacy PGY1 Rotations

Required Rotations

Orientation (one month required)

This rotation involves orientation to and development of proficiency in general pharmacy departmental and operational procedures. The purpose of this rotation is to provide the resident with an opportunity to understand policies and procedures as well as the operational functions of the Pharmacy Department. This rotation will also provide the resident with concentrated outpatient pharmacy and inpatient pharmacy training. The resident will become familiar with computer/education requirements, central pharmacy and IV room pharmacist functions, and pharmacy technician functions. Residents will also be required to obtain BLS certification during this rotation. Initially, the resident will be involved in hospital orientation (for 1 week), followed by the remainder of the month in Pharmacy Orientation.

Ambulatory Care (two months required)

On this rotation, pharmacy residents will participate in the Medication Management Clinic in primary care, where they monitor and manage drug therapy for chronic diseases to ensure optimal outcome as measured by VHA Clinical Performance Measures for veterans referred by PC provider per appropriate VHA Clinical Practice Guidelines. Residents will make drug and dosage adjustments as needed with clinical guidance of preceptor. They complete drug adherence assessment and assist the PC provider with medication management challenges (e.g. non-adherence, adverse drug event identification and reporting, polypharmacy, etc.) as needed. 

Internal Medicine (two months required)

On this rotation, pharmacy residents will participate in medical team rounds and follow assigned patients. Pharmacy residents will provide and document therapeutic drug monitoring services for patients on the internal medicine team. The pharmacy resident is responsible for providing and documenting medication counseling to patients on their team who will be discharged. The resident will document progress notes in the computerized patient record system (CPRS) all pertinent clinical activities and recommendations.

Critical Care (one month required)

On this rotation, pharmacy residents will spend two weeks rounding with the cardiac critical care team (CCU) and two weeks rounding with the medical intensive care team (MICU). The pharmacy resident will provide and document all therapeutic drug monitoring services for assigned patients with supervision by preceptor. The pharmacy resident is responsible for providing and documenting medication counseling to all assigned patients who are being discharged from hospital. The resident will document progress notes in the computerized patient record system (CPRS) all pertinent clinical activities and recommendations.

Practice Management (one month required)

On this rotation, pharmacy residents will be exposed to pharmacy management including, but not limited to, budgeting, procurement, personnel related issues (Union contracts, hiring, scheduling, performance reviews), strategic planning and business plans, compliance with accreditation bodies (DEA, TJC, OIG, ASHP), formulary management, customer service, performance improvement, and patient safety. Throughout the experience, the resident will participate in hospital committee meetings and will assist with agenda’s and minutes for pharmacy ran committees.

Elective Wheel (one month required)

This rotation affords the pharmacy resident an opportunity to spend one-week intervals in various elective rotation sites. Residents will participate as part of the healthcare team during each experience. This experience is intended to give the residents a snapshot of the elective experience to better enable their choice for monthly elective rotations. 

Longitudinal Rotations

Drug Information

This rotation is designed to enhance knowledge and skills of the pharmacist's role as a pharmacotherapy advisor. The pharmacy resident will function as a drug information specialist with supervision by the preceptor(s) to provide unbiased drug information to healthcare professionals. The intent of this experience is to prepare the resident to serve as an effective provider of drug information. Resident’s will also complete pharmacotherapy e-consults, which will allow residents to take lead on new clinical pharmacy questions. Residents will be a part of receiving the consult, locating the information, and accurately and effectively delivering an answer to the patient care team. This experience will drive interactions with patient care team as well as allowing for residents to more clinically and personally experience drug information research. In addition, the resident with be responsible for a 3 different MUETs (medication usage evaluation tracker) throughout the year and a single MUE.

Amiodarone Monitoring

On this rotation, pharmacy residents will be responsible for following patients in which amiodarone management via chart review is appropriate. At the request of cardiology service, a medication utilization evaluation was performed on amiodarone which revealed opportunities exist for improvement of documentation and monitoring of amiodarone therapy. A service agreement and protocol was developed by pharmacy and cardiology services to ensure continuous amiodarone monitoring. Residents are expected to review and be familiar with amiodarone monitoring guidelines as well as BVAMC’s amiodarone monitoring service agreement and protocol. Residents will be expected to discuss all plans of therapy with a preceptor or designee prior to instructing the patient or completing their documentation within CPRS. By the end of the rotation, the resident should be able to demonstrate an adequate knowledge of amiodarone monitoring and potential side effects.

Anticoagulation

On this rotation, pharmacy residents will participate in the Coumadin Clinic, where they will monitor and manage anticoagulation therapy, including but not limited to warfarin, enoxaparin, and DOACs. Residents will make dosage adjustments as needed with clinical guidance of preceptor. They will utilize face-to-face and telephone interviews with patients to assess compliance, side effects, dietary changes, medication changes, and other factors that may affect the patient’s anticoagulation. Residents will also be an integral part of veteran education and will provide counseling to both patients and caregivers.  Residents will also answer consults from providers regarding recommendations for anticoagulation and throughout the rotation will learn to manage a pharmacist-run clinic. The ambulatory care rotation will help residents develop skills in patient interviewing, communication with patients and providers, organization, and time management. They will significantly advance their knowledge in anticoagulation and will contribute to professional development.

Medication Safety

This rotation is designed to enhance knowledge and skills of the pharmacist's role as a medication safety expert. The pharmacy resident will be responsible for entering a specified number of adverse drug events in to the national VA database (VAADERS), attending medication error committee meetings and preparing minutes for those meetings, and presenting both med error reports and ADE reports to the P&T committee.

Pharmacogenomics

This rotation focuses on pharmacogenomics (Pgx) and will orient the resident to the practice of precision medicine. The resident will be introduced to clinical pharmacology as it relates to the fundamentals of precision medicine and its applications to clinical practice. Residents will be involved in implementation of the PHArmacogenomics teSting for vetERans (PHASER) program.  The resident will be expected to gain proficiency in the application of Pgx through literature review, topic discussions, and management of facility e-consults that offer providers assistance with interpreting and implementing Pgx results.

Presentation Series

This experience will help with the development and delivery of various professional presentations including but not limited to: journal club presentations, patient case presentations, in-service presentations, research presentations, etc. On this rotation, pharmacy residents will participate in scheduled lecture/discussion and an assigned series of presentations throughout the course of the residency year.

Research Project

The purpose of the project is to provide the resident with the opportunity to develop the skills and processes necessary to perform research. As part of this rotation, the following are required:

• Poster submission at ASHP Midyear
• Presentation at Southeastern Residency Conference
• Manuscript submission to a professional journal

Staffing

The pharmacy resident will staff in central pharmacy one weekend per month and provide clinical coverage one Saturday per month.

Teaching Certificate Program

Residents may choose to participate in a longitudinal Teaching Certificate Program through the Samford University McWhorter School of Pharmacy to enhance their teaching, precepting, lecturing, and mentoring skills.

Elective Rotations:

• Emergency Medicine
• Endocrine
• Geriatrics
• Home Based Primary Care
• Infectious Diseases
• Mental Health
• Neurology
• Oncology
• Pain Management
• Palliative Care
• Pharmacy Informatics
• Women's Health
• Repeats of Acute Care and Ambulatory Rotations