Rotation descriptions
Administration
The Pharmacy Administration rotation will allow the resident to observe and participate in the most important pharmacy and hospital leadership, managerial,
administrative and medication use safety activities performed at Corewell Health Dearborn Hospital and the health system. The learning experiences will allow the resident to have a firsthand experience in committees, budgetary
plans, strategic plans, quality assurance, creating and updating polices, along with optimizing clinical and operation services opportunities. Interdisciplinary committees are a significant part in pharmacy administration and medication use safety.
Resident attendance and participation in many of these committees is required. The rotation will involve working with the Director of Pharmacy, pharmacy managers, pharmacy leads and/ or pharmacy specialists, depending on project assignments during
the rotation.
Adult Parenteral Nutrition
The parenteral nutrition service focuses on parenteral nutrition for adult patients. The primary treatment team on this service includes the TPN pharmacist and a registered dietician. The resident is expected to collaborate with the dietitian and other
providers to create the most optimal customized parenteral nutrition order.
Antimicrobial Stewardship Program
The antimicrobial stewardship (AMS) rotation will provide the resident with the opportunity to learn about the management of an antimicrobial stewardship program (ASP). The resident will work under the direction of a clinical pharmacy specialist and infectious
diseases physician to identify and resolve anti-infective pharmacotherapy problems in high-risk patients. The resident will demonstrate proficiency in communication and interpersonal skills with other health care providers in the hospital setting.
The resident will also exercise leadership skills, demonstrate project management skills, provide medication and practice-related education/training, and utilize medical informatics during the rotation.
Critical Care - Cardiology
Four main components:
- Cardiac intensive care rounds with a multidisciplinary team composed of intensive care physicians, nurse practitioner, nurses, respiratory therapist, palliative care, and clinical dietitian. Patients would be worked up in a “head to toe”
approach covering pharmacotherapy evaluation for multiple disease states
- Academic cardiology consult team composed of the attending cardiologist, cardiology fellow, and medical residents. The focus will be on cardiovascular-related pharmacotherapy
- Heart failure consults where patients at very high risk for HF re-admission are referred to the pharmacist for pharmacotherapy evaluation, medication optimization recommendations, and patient education
- Post-acute-myocardial infarction consults where patients with acute MI are referred to the pharmacist for pharmacotherapy evaluation, medication optimization recommendations, and patient education
Critical Care - Neuro/Trauma
The intensive care unit rotation will provide the resident with the opportunity to care for critically ill patients through a collective multidisciplinary approach. Residents will be responsible for working up patients in a head-to-toe fashion, assessing
current therapy comprehensively, identifying any gaps or errors in care, and developing an individual care plan for each patient. During this rotation, residents will develop a hands-on approach to multidisciplinary interactions through discussion
of care strategies as well as presenting evidence-based care with a goal of providing the most effective and safe therapy. Residents will have the opportunity to further develop their knowledge of disease states through frequent resident-led topic
and patient discussions. The intensive care unit serves as an environment which allows residents to establish an understanding of diverse disease states, the treatment of multiple complications at once, and multidisciplinary communication.
Critical Care - Surgical Services
The operating room rotation will provide the opportunity to work in a collaborative manner with various health care providers in caring for the surgical patient population. Residents on this rotation will become proficient in safe and effective therapeutic
management of pre- and post-operative needs while assuring compliance measures are met (ie. preoperative antibiotic prophylaxis). During this rotation, residents will be involved in the operational and clinical aspects of preparing, dispensing, and
verification of surgical care orders. Residents will also develop a hands-on approach to narcotic diversion prevention as well contributing to the advancement of education through participation in quality improvement projects, formulary management,
and mediation safety initiatives.
Emergency Medicine
The Emergency Medicine pharmacists participate as part of an interdisciplinary team to optimize patient care in the acute emergency department (ED) setting 20 hours a day, 7 days a week. Responsibilities include: drug Information resource providing recommendations
for disease state treatments, drug interactions, compatibility, and toxicology, priority/trauma participation, order verification, antimicrobial stewardship, pharmacokinetic consults, medication reconciliations for psychiatric patients, patient education
and pharmacy/nursing/physician education.
Informatics
The goal of pharmacy informatics is to appropriately utilize and manage pharmacy information systems in order to get the right information to the right people at the right time (AHIMA 2014). The resident will gain experience in understanding pharmacy
technology which includes inventory management systems and their integrations to electronic medication record (EMR) systems. The rotation will also include experiences collaborating with the 22 hospitals of Corewell Health to optimize and standardize
components within the electronic medical record (Epic), oversee inventory management, participate in purchasing and operational tasks, ensure 340b compliance, mitigate the effects of drug shortages, create ad hoc data reports to support the administrative
team and work with clinical specialists to operationalize best practices.
Hematology/Oncology Clinic
The oncology clinic rotation will provide the resident the experience to work as a part of a multidisciplinary team to provide optimal care to oncology patients. The resident will gain experience in the prevention and management of adverse effects associated
with antineoplastic therapy, development of institutional guidelines for the management of antineoplastic therapy, education of patients and healthcare providers, hazardous sterile compounding, development and maintaining antineoplastic therapy electronic
protocols.
HIV Clinic
The HIV clinic longitudinal rotation will provide the resident the experience to work with an interdisciplinary team to monitor, educate and participate in selection of safe and effective HIV regimens for patients. The goal is to ensure no drug-drug interactions
are present and to suppress the patients’ HIV viral load. The resident will be responsibilities for the following: participate in selection, implementation, and chronic monitoring of HIV medications, monitor patient labs and medications to ensure
compliance and access, educate and counsel patients, caregivers and other healthcare providers on medications, and provide recommendations to infectious disease providers for proper medication selection and dosing.
Inpatient Hematology/Oncology
Develop patient care skills and knowledge in oncology, including but not limited to patient work ups, pharmacy consults patient education, drug information questions, topic discussions, and assigned projects or presentations. Responsibilities may involve
inpatient and Cancer Treatment Center (CTC).
Internal Medicine
The internal medicine rotation is a required learning experience. Residents provide clinical pharmacy services to one of three teaching teams with patients of a wide range of acuity and complexity. The pharmacy resident is expected to conduct thorough
medication histories, facilitate transitions of care, provide drug information services, and actively participate in daily teaching rounds and team assignments. Residents will gain hands-on experience interviewing, evaluating, and educating patients
and families, creating drug therapy and monitoring plans, and communicating with numerous care providers. This rotation utilizes a layered learning model to facilitate the practical training of PGY1 residents, APPE students, as well as the occasional
IPPE student.
Ambulatory Care Internal Medicine Clinic
The Internal Medicine Clinic ambulatory care rotation will provide an opportunity for residents to use an interdisciplinary and collaborative approach to the delivery of patient care via face-to-face clinic visits and non-face-to-face efforts. The goal
of the embedded pharmacist-led Pharmacotherapy Clinic is to promote positive health outcomes related to the use of medications. Residents on this rotation will be involved in patient care services including chronic disease state management, transitions
of care management, and comprehensive medication management. Residents will establish relationships with clinic patients while learning how to enhance medication effectiveness, safety, adherence, education, and accessibility. On this rotation, residents
will learn alongside medical residents, physicians, and other members of the interprofessional health care team.
Integrated Practice Experience - Cardiology Stepdown
The cardiac care step-down unit, located on the 4th floor, is a 36-bed unit that focuses on a number of cardiological illnesses. We manage patients with acute coronary syndrome (ACS), congestive heart failure (CHF), arrhythmias, valvular diseases, interrogation
of pacemaker or automatic implantable cardioverter-defibrillator (AICD), uncontrolled hypertension and other heart diseases. The primary treatment team on this unit includes cardiology and electrophysiology. The resident is expected to take full responsibility
of all medication related aspects on the unit as well as collaborate with other providers to provide comprehensive direct patient care and education to the patients.
Integrated Practice Experience - Critical Care Stepdown
The resident on the critical care stepdown unit rotation will gain experience in facilitating every aspect of the medication process. The resident is expected to take full responsibility of all medication-related aspects on the unit, including assisting
nurses in locating medications, clarifying medications with providers, answering drug information questions, and providing patient educations (when feasible). Additional responsibilities include operational activities (order verification, IV to PO
conversion), and clinical activities ( pharmacokinetic consults, anticoagulation review, renal dosing, antimicrobial stewardship, medication profile reviews).
Internal Medicine Geriatrics
The geriatrics rotation is designed to provide the resident with additional internal medicine experience with a focus on geriatric patients. The resident will work under the direction of a clinical pharmacist and a geriatric interdisciplinary team to
provide optimal pharmacotherapy regimens. The resident will also act as a resource for drug information questions for nurses and other team members. Additional responsibilities may include pharmacokinetic consults, patient education, and topic discussions
based on common disease states in geriatric patients.
Medication Safety
This rotation aims to identify, develop, and implement safe medication practices as it relates to the inpatient/acute care setting. Activities involve review of reported medication errors and adverse drug events, participating in root cause analysis,
oversight of the medication history program, and projects related to medication safety and compliance.
Pediatrics
General pediatrics is an elective 5 week learning experience. The resident will be assigned to a general pediatrics unit team (2 weeks), a NICU team (2 weeks) and a pediatric clinic (1 week) at various times through the rotation. Walking family-centered
care rounds occur daily Monday through Friday with the attending physicians and nurse practitioners. The resident is responsible for monitoring patients pertaining to their service on designated weeks. The resident will identify and resolve medication
therapy issues for patients and will work toward assuming care of assigned patients on the service throughout the learning experience. The resident will become proficient in pediatric and neonatal patient monitoring, while utilizing diagnostic and
laboratory tests in patient therapy evaluations and the clinical use of serum drug concentrations. Emphasis will be placed on the resident demonstrating an understanding of common pediatric and neonatal disease states in hospitalized patients and
the treatment of those diseases, as well as appropriate follow-up care in the outpatient clinic setting. Good communication skills and interpersonal relationships will be essential in this practice setting. The resident will participate in several
academic activities during the rotation. These activities include, but are not limited to, journal club; disease state topic discussions; patient presentations; and assisting with precepting and evaluating Doctor of Pharmacy students. The resident
will also participate in protocol development, standardization and validation in this patient population, as well as attend and participate in relevant meetings.
Specialty Pharmacy
The Specialty Pharmacy Rotation is an elective, patient-centered care rotation. It is a five-week learning experience that will provide residents with a comprehensive outlook on the specialty medication approval, dispensing and counseling process. The
residents will be reviewing national guidelines pertaining to specific disease states such as: Hepatitis B and C Viruses, HIV/AIDS, Multiple Sclerosis, Asthma, Inflammatory diseases (e.g. Crohn’s/Ulcerative Colitis/Rheumatoid Arthritis), Oncology
(Oral and self-injectable chemotherapeutic regimens) as well as Hyperlipidemia/familial hypercholesterolemia. The residents will be expected to assess a prescription for clinical appropriateness, understand the Prior Authorization process, coordinate
optimal care between healthcare providers and patients as well as provide telephonic counseling to all patients receiving prescriptions through the specialty pharmacy. The telephonic counseling will be focused on the proper use of a medication, interpreting,
and discussing laboratory findings as well as assessing patients’ response to therapy. Furthermore, the residents will be involved in any activities related to the patient’s course of care and the medication approval process.