Pharmacy Residency Rotations

General Orientation:

• The Pharmacy Manager’s practice area includes the pharmacy and all other areas in the health system where medication-related issues are managed. The role of the Pharmacy Manager is to manage pharmacy operations, enforce policies and procedures, and to manage pharmacy staff.

  The Benefis Orientation Rotation is a required 6-week rotation focusing on orientation to the Benefis PGY-1 Residency Program as well as to Benefis Health System. This will include new employee general orientation. The residents will be responsible for learning sterile technique that is compliant with USP 797/800 standards via preparation of IV compounded medications. Residents will gain experience with the pharmacy distribution and delivery systems by rotating through various shifts and working with pharmacists and technicians. The resident is expected to acquire the general skills necessary to care for patients in their required rotations as well as starting to gain proficiency to be able to begin their staffing commitment. This incorporates, but is not limited to, order entry and verification and utilization of hospital policies, pharmacy driven guidelines/protocols. Residents will also gain proficiency in working with the hospital’s medication dispensing cabinets. By the end of this rotation, the resident should have exposure to the basic skills required to work as a staff pharmacist at Benefis Hospital, understand the duties and roles of pharmacy technicians at Benefis and be able to perform said duties when required.

Cardiology:

• The practice area is the Progressive Care Vascular Unit and outside the unit to any cardiovascular-related pharmacy service provided within Benefis Hospitals. The role of the pharmacist in this practice area is to provide comprehensive pharmaceutical care to patients.

  The six-week rotation in cardiovascular pharmacy services will provide the resident with experience in the pharmacy services furnished to all cardiovascular patients. The resident will have many opportunities to participate in solving clinical problems in this specific patient population. The experience will occur within the Progressive Care Vascular Unit (PCVU) as well as outside of the unit in regard to any cardiovascular related pharmacy service provided within Benefis Hospitals.

Critical Care:

• Currently, the ICU pharmacist performs their duties in the ICU. The pharmacist interacts with all members of the healthcare team supplying medication information when requested. Pharmacists review individual patient MARs for drug therapy problems to be presented at daily care rounds. Pharmacists perform real time order entry, respond to medical emergencies as needed, perform pharmacokinetic consults, counsel patients, manage drug distribution and other various tasks.

  This is a six-week rotation intended to develop the skills and expertise necessary to deliver quality pharmacy services to the ICU patient and staff. Specific critical care issues for each patient will be explored to ensure optimal evidence based pharmaceutical care is being utilized. The resident will review each patient, identify drug therapy problems, devise solutions, implement solutions and monitor outcomes after consultation with the care team. The resident will have an opportunity to become familiar with critical care patients directly through interdisciplinary rounding, patient counseling, home medication reconciliation, and other opportunities as they are available. The resident will also be given the opportunity to participate in unit development issues by attending advisory meetings when possible.

Internal Medicine:

• Internal Medicine (IM) is a required, six-week learning experience at Benefis Hospital. There are approximately 80 IM beds, located on the 5th (General Medicine), 6th (Oncology), and 7th (Surgical) floors. The IM rotation will expose the pharmacy resident to a wide variety of patients and their illnesses. Most of these patients have preexisting conditions and are already on an array of medications. This provides the resident a great opportunity to participate in medication therapy management of patients, including (but not limited to) pharmacokinetics, renal dosing, and antibiotic stewardship.

  The resident will review patients' medications and evaluate them for the appropriateness and efficacy of therapy, correct dosage for patients' diagnoses, renal function, age, weight, etc. Medications will be evaluated for drug interactions and duplicate therapy. Findings will be discussed with the preceptor and then acted upon and documented. There will be many required activities, but there is room for flexibility if the resident has a particular area of interest.

Education:

• The Clinical Coordinator's practice area includes the pharmacy and all other areas in the health system where medication-related clinical issues are managed. The role of the Clinical Coordinator is to provide strategic leadership and oversight of all clinical pharmacy activities.

  This four-week experience will provide a concentrated time frame for the resident to focus on their major project and other requirements of the residency program. It will provide them an opportunity to continue to utilize good time management and oral presentation skills. The experience will allow the resident to develop their Drug Utilization Review (DUE) requirement for the residency year. They will develop a journal club presentation and a final report presentation for their major project to be provided to the pharmacy staff and deliver formal continuing education sessions. They will also assist in teaching of pharmacy students.

Emergency Medicine:

• Emergency Medicine is an elective 6 weeks rotation at Benefis Hospital. There is a multidisciplinary team including 2-3 physicians, nurse practitioners and/or physician assistants, nurses, social work, and a clinical pharmacy specialist that manage patients throughout three units in the emergency department. The resident will be part of the multidisciplinary team that cares for the acutely ill patients in the emergency department.

  The clinical pharmacy specialist on the team is responsible for ensuring safe and effective medication use for all patients within the Emergency Department. Routine patient care include attendance and participation in the management of medical emergencies (including but not limited to, stroke, MI, cardiac arrest, trauma), review patient profiles, interview patients to perform complete reconciliation of their home medications and participation in emergency medicine committees. In addition, the clinical pharmacist initiate therapeutic plans by establishing a working relationship with healthcare providers to identify, prevent, or resolve medication-related issues and make recommendations when appropriate.

Oncology:

• The practice area is the Sletten Cancer Institute and inpatient oncology unit, as well as other areas where oncology patients may be cared for. The pharmacist in this practice area is expected to interact with all members of the oncology care team. This rotation in oncology will provide the resident with experience in providing clinical pharmacy services to patients with an underlying oncology diagnosis both in an ambulatory care environment, as well as in the inpatient environment.. The resident will have many opportunities to participate in solving specific clinical problems in a complex patient population which may include managing traditional chemotherapy side effects, assessing for immunotherapy adverse reactions (IARs), assisting ancillary team members in mitigating the financial toxicities of cancer care, as well as providing answers to medication questions posed by patients, caregivers and healthcare professionals.

Pediatrics / NICU:

• The six-week rotation in pediatrics and neonatology will provide the resident with experience in providing clinical pharmacy services to all children from birth through 18 years of age admitted to the PED or NICU units. The resident will have many opportunities to participate in solving specific clinical problems in this unique patient population. This experience will occur within the neonatal intensive care unit (NICU) and on the pediatrics floor, in which the women's and children's unit-based pharmacist is an integral part of the multidisciplinary team. The women's and children's unit-based pharmacist is responsible for ensuring safe and effective medication use for all patients admitted to the team. Routine responsibilities include: rounding daily with the neonatalogy care team, writing TPN orders for NICU patients, as well as addressing formal consults for non-formulary drug requests, therapeutic drug monitoring for all patient's admitted to the NICU, Pediatric and Labor and Delivery units. The pharmacist will also provide drug information and education to healthcare professionals as well and patients and caregivers as needed.

Pharmacy Administration:

• The Pharmacy Administration rotation will provide the resident with an introductory experience in the leadership and administration of a comprehensive pharmaceutical service within a complex health system. This is supplemented by projects, discussions, and participation on various teams and committees as available and appropriate over a period of 6 weeks.

Anti-Coagulation:

• The anticoagulation clinic (ACC) rotation will develop the pharmacist residence ability to monitor and dose anticoagulants in an outpatient setting. The role of the pharmacist is to effectively interview patients, identify factors that may impact the patient’s anticoagulation therapy, develop and communicate a plan to the patient, and alert providers when clinically relevant.

Ambulatory Care:

• The Ambulatory Care Learning Experience is an elective 6-week rotation offered through Benefis Ambulatory Pharmacy (BAP). BAP provides services to assisted living, home health, home infusion, hospice, long-term care, and transitional care. BAP also provides a comprehensive MTM program to select beneficiaries of the Benefis Health Plan.

Hospice / Home Infusion / Palliative Care (In-progress):

Antimicrobial Stewardship / Infectious Disease:

• The practice area is any unit in the hospital where patients with infectious diseases are being cared for. The role of the pharmacist in this practice area is to provide comprehensive pharmaceutical care related to infectious disease treatment and to oversee antimicrobial stewardship activities within the hospital. Antimicrobial Stewardship and Infectious Disease is a longitudinal rotation for pharmacy residents that focuses on the evidence-based provision of antimicrobial agents to acute care patients. Patients span all levels of acuity within the inpatient hospital setting.

Practice Management:

• The Clinical Coordinator's practice area includes the pharmacy and all other areas in the health system where medication-related clinical issues are managed. The role of the Clinical Coordinator is to provide strategic leadership and oversight of all clinical pharmacy activities.

  This rotation in Pharmacy Practice Management will provide the resident with experience in pharmacy management as well as leadership in the pharmacy profession. The resident will have many opportunities to participate in projects directly contributing to improvements in the pharmacy department and the hospital as a whole. This experience over the entire 12 months of the residency program will provide the resident with the necessary skills to contribute to the leadership of pharmacy.

Major Project:

• The Clinical Coordinator's practice area includes the pharmacy and all other areas in the health system where medication-related clinical issues are managed. The role of the Clinical Coordinator is to provide strategic leadership and oversight of all clinical pharmacy activities.

  The major project for this residency will require the resident to contribute to the development of a new pharmacy service or help enhance an existing service.