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Abbott Northwestern Hospital

Pharmacy Residency Program rotations

Rotation descriptions

Advanced Heart Failure

The Advanced Heart Failure rotation covers an acute patient population including cardiogenic shock, ECMO, LVADs, and heart transplants. In a typical day the resident prepares for and attends multidisciplinary patient care rounds, completes post-rounding clinical follow-up needs, and discusses patient cases with the preceptor. Clinical pearls from the rounding experience are discussed daily and formal clinical topic discussions are scheduled weekly throughout the rotation. By the end of the rotation the resident identifies a topic of interest to be a basis for a rotation project or presentation. The highlights of this rotation are the strong multidisciplinary team rounding experience, working with an interesting patient population where pharmacy makes an impact on the care of the patient and the scope of knowledge that can be gained in critical care and cardiology.

Cardiology

The purpose of the cardiology rotation is to assist the resident in becoming proficient in cardiovascular pharmacotherapy. At the conclusion of the rotation the resident should be able to demonstrate the ability to identify patient specific problems in cardiovascular patients and utilize clinical therapeutic knowledge to resolve medication therapy problems. The aim is that resident will be competent to successfully cover the cardiology units as the decentral pharmacist by the end of the rotation.

Cardiovascular Intensive Care Elective

The resident on this rotation will provide pharmaceutical care for critically ill patients located on Station H4100 (16 beds: cardiovascular surgery and transplant ICU patients) and H4200 (16 beds: cardiovascular ICU patients). The resident will participate in two sets of multidisciplinary rounds for the duration of their rotation: Cardiac surgery rounds (daily 0800-0900), Cardiology rounds (daily 0900-1000).

Critical Care

The Critical Care rotation is a 4 week required rotation. The residents on this rotation will provide pharmaceutical care for critically ill patients located on Station PB 2000 (30 bed ICU: medicine, surgical and neurological ICU).

Daily/Weekly Rotation Activities:

  • Review existing patients
  • See new patients/MD consults
  • TPN monitoring and prescribing
  • Pharmacokinetics
  • Attend multidisciplinary rounds
  • Attend all codes
  • Topic discussion with students (Prophylaxis in Critical Illness)
  • Patient discussions with preceptor(s)
  • Topic discussions with preceptor(s)
  • Verify medication orders (week 3 Wed-Fri from 12-3pm, week 4 and week 6)
  • Complete preceptor assigned projects/tasks.
  • Precept students

Critical Care Elective

The Critical Care elective rotation is a 2 week rotation. An additional week may be requested as schedules allow. The resident on this rotation will provide pharmaceutical care for critically ill patients located on Station PB2000 (30 beds: medicine, surgical and neurological ICU patients). Two sets of multidisciplinary rounds will be selected and the resident will participate for the duration of their rotation. Neuro rounds (daily 0900-1000), General medicine rounds (daily 1000-1030), Cardiac surgery rounds (daily 0800-0900), Cardiology rounds (daily 0900-1000).

Daily/Weekly Rotation Activities:

  • Review existing patients
  • See new patients/MD consults
  • Attend selected multidisciplinary rounds
  • TPN monitoring and prescribing
  • Pharmacokinetics
  • Order verification for assigned patients (Three clusters for PB2000, H4200)
  • Attend all codes
  • Patient discussions with preceptor(s)

Emergency Department

The emergency medicine patient care rotation at Abbott Northwestern Hospital is an elective rotation for PGY1 and PGY2 pharmacy practice residents interested in the specialty with an emphasis on collaborative practice with other disciplines. This rotation will be a minimum of 2 weeks with 4 weeks being ideal. The resident is involved in providing care for patients in the Emergency Department (ED) and in the Clinical Decision and Rapid Treatment (CDART) unit. During this rotation the pharmacy resident is responsible for identifying and resolving medication therapy issues for patients as it pertains to emergency medicine. The resident will utilize current treatment guidelines to develop, monitor, and adjust patient-specific pharmacotherapy regimens and monitoring plans. The resident will have direct patient contact for both medication reconciliation and patient education purposes, as well as be involved in patient education for patients initiating new therapies. The resident will also respond to all STAB/critical patients and follow up on all cultures drawn in the ED.

Hospice and Palliative Care

Allina hospice serves a census of approximately 450 patients requesting end-of-life comfort care, both in the home-setting and an institutional care setting (SNF's, Asst. Living, Group Homes. The Resident will co-visit patients with the pharmacist or nurse case manager, make therapy recommendations, answer family and pts medication questions, and attend Interdisciplinary Care conferences at the Westgate office for hospice. To tailor medication regimens for patients, the resident will take into account the patient's goals, their current plan of care, pertinent cultural factors, level of caregiver competence in managing medications, and adherence factors.

Infectious Diseases

The Infectious Diseases Antibiotic Stewardship learning experience is a required rotation of the PGY1 Pharmacy Practice Residency at Abbott Northwestern Hospital. The resident is involved in providing pharmaceutical care to patients with infectious diseases as part of a pharmacist-run antibiotic stewardship team.

During the rotation the resident is responsible for reviewing patients with active anti-infective orders and making recommendations and/or interventions as needed. The resident will utilize current treatment guidelines to develop patient-specific infectious diseases pharmacotherapy regimens and monitoring plans. The resident will document all recommendations/interventions made using the IVent Pharmacy Documentation System in Excellian®.

Recommendations will include but are not limited to the following:

  • Change to more effective antibiotic based on lab data
  • Discontinue unnecessary antibiotics
  • Parenteral to oral interchange
  • Change empiric antibiotic therapy
  • Dosage adjustment
  • Change in post-op antibiotic duration
  • Recommend infectious diseases consult

Infectious Disease Elective

This infectious diseases rotation is an elective rotation of the pharmacy practice residency at Abbott Northwestern Hospital. This rotation should be completed after the required infectious diseases antibiotic stewardship rotation. During this rotation, the resident is involved in providing pharmaceutical care to patients with infectious diseases as part of one or more of the infectious diseases consult services. While on the infectious diseases consult service, the pharmacy practice resident will participate in daily rounding with the ID physicians. During this rotation the pharmacy resident is responsible for preventing, identifying, and resolving medication therapy issues for patients as it pertains to infectious diseases. The resident will utilize current treatment guidelines and evidence based medicine to develop patient-specific pharmacotherapy regimens and monitoring plans. The resident will provide recommendations on dosing, drug interactions, drug level monitoring, and drug selection to other members of the health care team. The resident will perform pharmacokinetic calculations to design drug regimens and modify regimens based on drug levels obtained. The resident will document all recommendations using the Excellian IVent functionality.

Common infectious diseases in which the resident will be expected to gain proficiency in through literature review, topic discussions, and/or direct patient care experience include, but are not limited to the following: antibiotic resistance, candidiasis, Clostridium difficile, endocarditis, intra-abdominal infections, meningitis, neutropenic fever, osteomyelitis, pharmacokinetic monitoring, pneumonia (CAP, HAP, HCAP, and VAP), sepsis, skin and soft tissue infections, urinary tract infections. Upon completion of this rotation, the resident will be able to describe pharmacodynamic concepts of anti-infective activity (time vs. concentration dependent activity) and utilize concepts in dosing recommendations. The resident will demonstrate knowledge of the following anti-infectives: beta-lactam antibiotics, drugs for treatment of resistant gram positive infections (e.g., vancomycin, daptomycin, tigecycline, linezolid), drugs for treatment of resistant gram negative infections (e.g., carbapenems, tigecycline, etc), antiviral agents, and antifungal agents.

Internal Medicine

The Internal Medicine experience is a core component of the pharmacy practice residency at Abbott Northwestern Hospital. The resident is involved in providing pharmaceutical care to Internal Medicine patients with acute and chronic medical illnesses as part of an Internal Medicine teaching service. The pharmacy practice resident’s time will be divided into two primary components: Internal Medicine teaching service team & Primary preceptor(s). The rotation will be at minimum a 4-week block. Pharmacy practice residents will be assigned to a specific Internal Medicine team. The Internal Medicine team consists of a first year and a second year Internal Medicine physician resident, an attending faculty physician, 1-2 medical students and the pharmacy practice resident. The patient census on this service is typically 5-10 patients. The pharmacy practice resident will follow the patients assigned to the team. The primary preceptor will check in with the resident daily to assess ongoing patient care issues that need to be addressed. Formal patient case reviews with the primary preceptor will occur at minimum twice a week. Secondary preceptors will meet formally with the resident, at minimum, two times over the four week rotation to go over patients and discussion topics. The primary preceptor will discuss with physicians the expectations for the pharmacy residents at the beginning the rotation. The primary preceptor will solicit feedback from providers on a daily basis for ongoing assessment at their discretion. Providers will also provide feedback for evaluation at the mid-point and conclusion of the rotation. Due to the semi-autonomous nature of the rotation, the primary preceptor will meet with the residency director and preceptor committee prior to the start of the rotation to assess the resident’s readiness to begin the experience.

Medication Management Systems

Ambulatory Care at Medication Management Systems is a 4 week learning experience focused on providing patient centered pharmaceutical care. Medication Management Systems, Inc. (MMS) is a health care company that provides comprehensive medication management services and MTM software. All services are delivered through our Care Center.

MMS was formally established in 2006, but our journey began more than 30 years ago as we explored the logic behind a meaningful relationship between pharmacists and patients. Our founders created the thought process now known as the Pharmacotherapy Workup, and subsequently the seven categories of Drug Therapy Problems (DTPs) that have become the standard classification system for DTPs around the world. Our mission, values, ethical standards, and goals are centered on five guiding principles: (1) transforming care, (2) enhancing health, (3) patient centrality, (4) comprehensive solutions, and (5) thought leadership. Our goal is to transform the health care experience for every patient. Through a patient-centered approach and access to complete and intelligent software solutions, are able to resolve medication problems and enhance patient health, resulting in better outcomes, improved quality of life and lower costs for both our clients and members.

Nephrology/Transplant

The Nephrology/Transplant elective PGY1 rotation focuses on renal patients throughout the hospital including acute/chronic kidney disease, end stage renal disease (ESRD), continuous renal replacement therapy (CRRT), and renal transplant. The resident will utilize their knowledge, guidelines, and literature to evaluate and develop patient-specific pharmacotherapy regimens. In a typical day the resident prepares for topic discussion, discusses patient cases with the preceptor, and completes patient care follow-up. The resident will be responsible for several topic discussions including one short presentation or rotation project. The resident will work alongside the preceptor during direct patient rounding experience if applicable. The highlights of this rotation are the diverse patient population requiring acute and chronic care, daily interaction with the primary preceptor, and experience working with a multi-disciplinary team.

Neurology/Orthopedics

The neurology/orthopedics rotation provides the opportunity for the resident to improve their knowledge base and pharmacotherapeutic skills while enhancing care for acutely ill patients. The resident will become familiar with pharmacotherapy for the most commonly encountered neurologic and orthopedic conditions; be responsible for providing evidence-based medication therapy recommendations; demonstrate competency in areas of pharmacokinetic and therapeutic consult services; and participate in the education of team members. This rotation provides exposure to various surgical and medical neurological, orthopedic and spinal conditions as well as other co-existent medical conditions patients may present. The pharmacy resident is expected to collaborate within a patient care team (pharmacists, physician assistants, nurse practitioners, physicians and nurses) to optimize pharmacotherapy and clinical outcomes. This will be accomplished through drug utilization review, therapy monitoring, drug therapy recommendations, and coordinating pharmaceutical services. The resident will round with Minnesota Center for Epilepsy (MINCEP) practitioners and/or the Pain Service as available. Residents will discuss patients with preceptor or available team pharmacist daily. The resident will lead or participate in topic discussions at least twice weekly as well as case discussions at least once weekly. When students are also on rotation, the resident will assist in supervision and education of the student.

Oncology/Hematology

The hematology/oncology clinical rotation at Abbott Northwestern Hospital is an elective rotation for oncology pharmacy practice residents interested in the specialty with an emphasis on supportive care. This rotation will be a minimum of 3 weeks with 4 weeks being ideal. The resident is involved in providing hematology/oncology pharmaceutical care for inpatients on the oncology station (E3000) as well as outpatients in the Infusion Center (W3400). During this rotation the pharmacy resident is responsible for identifying and resolving medication therapy issues for patients as it pertains to oncology or hematology. The resident will utilize current treatment guidelines to develop, monitor, and adjust patient-specific pharmacotherapy regimens and monitoring plans. The resident will be involved in patient education for patients initiating chemotherapy, antibiotics, iron therapy, or other treatments as they come up on W3400. The resident will follow all patients admitted for chemotherapy on E3000, as well as other patients identified by either the resident or preceptor. Common oncologic disease states and treatment issues in which the resident will be expected to familiarity with through literature review, topic discussion, and/or direct patient care experience include, but are not limited to the following: Leukemia ● Lymphoma ● Multiple myeloma ● Lung cancer ● Brain cancer ● Breast cancer ● Ovarian cancer ● Colon Cancer ● Pancreatic cancer ● Renal, bladder, and testicular cancer ● Stem cell transplant ● Tumor lysis syndrome ● Neutropenic fever ● Antiemetic therapy

Pharmacy Informatics

The PGY1 pharmacy informatics rotation is an elective learning 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 to function in the interdisciplinary environment of informatics project teams to advance the professional duties and responsibilities of a pharmacy informatics specialist.

Practice Management

The purpose of the Management and Leadership Rotation is to enhance the resident’s understanding of the role of pharmacy management and leadership in meeting the goals of the organization. Through assigned readings, focused discussions, projects, and observational and participative experiences, the resident will gain knowledge and skills relating to the management of financial operations, purchasing, medication safety, medication distribution, regulatory compliance, and collaboration with other disciplines. The resident will be challenged to evaluate and express insight relative to their ongoing experiences, as well as the manifestations of leadership.

Regional Hospital Practice

This is a one-week rotation allowing the resident to observe and briefly experience health system pharmacy practice in a small hospital.

Renal - Medical/Surgical

The renal-medical/surgical rotation covers a diverse patient population giving the resident with experience with: chronic kidney disease; acute kidney failure; dialysis; kidney transplant; bariatric, thoracic, and abdominal surgery; complications of diabetes; complicated infections, and a variety of medical and surgical related issues. The resident will be responsible for physician requested drug dosing and monitoring, TPN management, kinetics monitoring for antibiotics, drug information questions from nurses and providers, medication safety monitoring, medication profile review, and educating bariatric surgery patients. Other rotation activities will include frequent clinical topic discussions, two patient case presentations, and a formal topic presentation. The highlights of this rotation include a diverse patient population and the opportunity to develop clinical autonomy.

System Formulary

This rotation is directed through the Allina Center for Drug Policy (CDP). The primary functions of the CDP are to coordinate the activities of the Allina System Formulary Committee and to coordinate system-wide responses to medication safety alerts. CDP staff also participate in educational and policy initiatives regarding medications and medication use. The learning experience will consist of focused discussions about literature interpretation and assessment, creation of at least one written in-depth product or drug class review and presentation of that work to the ANW Pharmacy and Therapeutics Committee and System Formulary Committee. Outcomes expected: 1. Make PGY1 resident a better writer in technical form. 2. Make PGY1 resident a better consumer of the biomedical literature and improve their literature synthesis and evaluation skills. 3. Improve PGY1 resident skills in medication use policy development. 4. Improve PGY1 resident skills in verbal presentation. 5. Develop skills via participation in the organization’s formulary process.

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