Core Rotations

This longitudinal rotation is a broad ambulatory care which provides medication therapy management (MTM) services, management of chronic disease and care transitions within an inter-professional healthcare environment. Catholic Health Systems seeks to meet quality measures while reducing the total cost of care for our patient population and this pharmacy service addresses all aspects of the Triple/Quadruple Aim. Additionally, these services will align with Catholic Health Systems values; reverence, compassion, justice and excellence. The pharmacist-led ambulatory care service within the Catholic Health System serves as an outpatient practice which focuses on medication safety and efficacy/outcomes, as well as cost management as they relate to transitions of care and disease management.

Residents will develop necessary knowledge and skills to provide quality, direct patient care, through pharmacist-led relationships and within a collaborative practice agreement within an adult medicine clinic. Residents will assess needs for patient education, lifestyle modification reinforcement, appropriate device use and technique, insulin titration or instruction and adherence with drug therapy plans. They will gain experience as a resource to clinicians by providing drug information, monitoring drug therapy, assessing adherence, considering cost comparisons, and making recommendations for to achieve optimal patient outcomes.

The behavioral health rotation is a 4 week rotation designed to introduce the resident to intensive case management regarding patients with psychiatric illness and substance abuse disorder. The resident will review charts of patients admitted to Clearview (substance abuse residential rehabilitation treatment program), with concurrent psychiatric illnesses. The resident will conduct initial evaluations, development of psychotropic interventions, and subsequent monitoring plans. Additionally, residents will work through the Catholic Health Systems PHQ9 queue, for all patients identified with a moderate depression score (PHQ9 >9). The resident will convey recommendations with the treatment team (psychiatrists, nurses, counselors, etc.), and serve as a vital role with medication reconciliation, drug information service, and medication management consultation. Topic discussions with the preceptor will be held throughout the rotation. All patient care activities should be documented and signed in the medical record within 24 hours of the activity.

Critical Care Unit Pharmacy Services is a required, four week learning experience at Kenmore Mercy Hospital (KMH). The Intensive Care Unit (ICU) is a 14 bed unit that cares for a mix of medical, surgical, and neurocritical care patients. Attending physicians, advance practice providers (APPs), consultants, and occasional medical residents are responsible for caring for our critical care patients. The critical care pharmacist works closely with nurses, providers, dieticians, and respiratory therapists to provide comprehensive medication management services to our patients. Clinical pharmacy services within the ICU include antibiotic stewardship, renal and hepatic dosing adjustments, pharmacokinetic consultations, sedation management, and assisting in appropriate medication selection for patients.

Medication ADR and error reporting involving our critical care patients will also be expected by the resident. The pharmacy resident will spend at minimum four weeks in the ICU, and will be responsible for identifying and resolving medication therapy issues for patients using evidence based medicine principles. The resident will work towards assuming the clinical pharmacist's role in caring for patients in the unit by participating in interdisciplinary rounds. Good communication, interpersonal skills, and appropriate literature evaluation are vital to succeed in this experience.

The Emergency Medicine Pharmacy Residency Rotation is a required, four week learning experience within the Mount St. Mary's Hospital (MSMH) Emergency Department (ED) in Lewiston, New York. This hospital is a designated stroke center. The ED contains 16 beds and provides initial triage, assessment, and treatment for a variety of acute and chronic conditions by a multidisciplinary team. Clinical pharmacy services are provided in the MSM ED from 1400-2200 Monday through Friday. The clinical pharmacist in this area makes recommendations regarding appropriate medication therapy, including antimicrobial therapy at time of care as well as through culture follow-up. Additional responsibilities include responding to ACLS codes, rapid responses, and code strokes throughout the hospital. For a portion of the shift the ED pharmacist serves as the only pharmacist on site for the hospital and at times must assist with staff pharmacist duties as well including processing orders, labeling/delivering medications, and answering nurse/provider drug information questions on the floor. The ED pharmacist also serves on both the ED Committee and Stroke Committee.

This rotation is designed to provide a specialized experience in both the ambulatory care and inpatient settings by concentrating on the medication management of hepatitis C. Throughout the rotation, the resident will learn how to identify patients that are positive for hepatitis C based on chart review and associated risk factors, understand different patient specific treatment strategies, and collaboratively work with providers to develop treatment plans. Furthermore, the resident will act as a drug information resource for providers in the hepatitis C clinic. The resident may be asked to provide education for care team members.

The Antimicrobial Stewardship elective rotation is a 1 month learning experience in the Mount Saint Mary's PGY-1 Pharmacy Residency Program. This elective is for residents who have a strong interest in antimicrobial stewardship and have completed the 1 month core Infectious Diseases rotation. The goal is to provide inpatient and outpatient pharmacy services to patients acutely and/or chronically being treated for infectious processes. Members of the Antimicrobial Stewardship Program include an antimicrobial stewardship pharmacist, physicians, physician assistants, and nurse practitioners.

Internal Medicine – 6th floor Clinical Pharmacy Services is a required, five week learning experience at Mt. St. Mary’s Hospital. There are 25 general medicine beds on the 6th floor. 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 the 6th floor including nurses, respiratory therapists, case managers, clinical dietitians, and physical therapists. Mt. St. Mary’s Hospital clinical pharmacy services are provided as location-based service 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 the 6th floor also actively participates in interdisciplinary round; collaborates with centralized pharmacists to assure timely medication availability; educates patients and their family members; and, supports organizational policies and procedures. This rotation will serve as an extension of the resident’s orientation to pharmacy staffing and their weekend service commitment. The pharmacy resident is responsible for identifying and resolving medication therapy issues for 6th floor patients and will work toward assuming the clinical pharmacist role in the care of all patients on the unit throughout the learning experience. The resident will provide clinical pharmacy services and participate in interdisciplinary rounds. The resident will also establish collaborative relationships with other healthcare professionals by shadowing at least two members of another discipline. Good communication and interpersonal skills are vital to success in this experience.

Internal Medicine 2 (IM2) is a required, one-month learning experience at Mt. St. Mary's Hospital covering clinical pharmacy services on the 5th floor, a general medicine unit with 25 beds. Patients on this floor are cared for by several different hospitalist groups, independent hospitalists, specialists, consultants and their advanced practice providers. Non-physician members of the healthcare team also closely interact with each other to optimize care for the patients on the 5th floor including nurses, respiratory therapists, case managers, clinical dieticians, and physical therapists.

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 area of leadership and ethics. It is recommended that the residents utilize the Catholic Health University to attend classes related to leadership, teamwork, and ethics so long as they do not interfere with scheduled rotations. Leadership series will be a longitudinal experience consisting of 1 hour meetings related to a myriad of topics. Please refer to the Leadership/Management Dashboard for the minimum areas to be covered.

This 1 week orientation rotation will include orientation to the organization, hospital site, pharmacy department, and residency programs. We will discuss the residency manual and ensure all expectations are understood during this initial week.

This 5 week rotation will cover the dispensing and distributive operations of Mount St Mary’s Hospital (MSM). This rotation will be incorporated to give residents a chance to orient to the physical layout of the department and hospital, read and understand Catholic Health, MSM, and pharmacy department specific policies and procedures, as well as software programs pertinent to pharmacy operations. Distributive services has been one of the foundations of pharmacy practice, therefore a competent advanced generalist practitioner should be proficient in their knowledge of the skill-set associated with these functions, including but not limited to: state and federal laws, CHS and MSM policies and procedures, sterile preparation, and a multitude of other skills listed in the operations checklist. During the learning experience, the resident will focus on the goals and objectives outlined below by performing the activities that are associated with each objective. The resident will gradually assume responsibility for all the patients within the assigned unit. The PGY1 resident must devise efficient strategies for accomplishing the required activities in a limited time frame.

This longitudinal rotation will cover the dispensing and distributive operations of Mount St Mary's Hospital (MSM). Staffing requirements are average of 1 shift per week, which generally will be every other weekend, and coverage of major holidays, as needed by the department. Distributive services has been one of the foundations of pharmacy practice, therefore a competent advanced generalist practitioner should be proficient in their knowledge of the skill-set associated with these functions, including but not limited to: state and federal laws, CHS and MSM policies and procedures, sterile preparation, and a multitude of other skills listed in the operations checklist. During the learning experience, the resident will focus on the goals and objectives outlines below by performing the activities that are associated with each objective. The PGY1 resident must devise efficient strategies for accomplishing the required activities in a limited time frame.

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 residency advisory committee and the CH Pharmacy Research Committee. The resident will work with their assigned preceptor(s) to create a study design proposal, 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 1 month 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.

Responsibilities will include working on projects at the discretion of RPD and site manager, attending/presenting at P&T, med safety, antimicrobial stewardship or other committee, presenting a pharmacy Grand Rounds for pharmacists throughout Catholic Health, preparing an MUE, leading the monthly leadership meeting, taking minutes for weekly resident meetings, etc.

This rotation will occur for approximately 4 weeks during the month of December. During this rotation the resident will appropriate manage their time and practice effectively in order to successfully complete the required activities outlined in this rotational description.

The first week of the rotation will be dedicated to attending the Midyear Clinical Meeting where the resident will be required to complete the following activities: attendance at their poster presentation, completion of 10 CE credits during the conference, participate in a CHS pharmacy team building activity and/or dinner, and attendance at residency showcase for recruitment.

In addition, this will be the time to complete all mid-year evaluations on PharmAcademic and follow through with any outstanding work from the first half of the resident year. The resident may also be asked to participate in other departmental/preceptor needs, as approved by the rotation preceptor.

Resident will be required to create once weekly meetings with rotation preceptor to touch base on required activities progress and develop plan for completion by the end of the rotation.

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, teaching certificate program, and grand rounds. The resident may be called upon to develop educational programs for medical/pharmacy staff.

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:

• Behavioral Health
• Infectious Diseases
• Neonatal ICU
• Cardiology
• Palliative Care and Opioid Stewardship
• Transitions of Care