Pharmacy Residency Rotations

General Orientation:

• The role of the pharmacist is to ensure safe and effective medication use for patients at Benefis Hospital. The pharmacist will work in collaboration with pharmacy technicians to provide accurate medication preparation and dispensing. The pharmacist will provide drug information and administration related answers to healthcare professionals.

  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:

• Cardiology is a required, six week learning experience at Benefis Hospitals. The practice area is primarily the Progressive Cardiovascular Unit (PCVU) but may include cardiovascular patients throughout the hospital including the Intensive Care Unit, Cath Lab, or cardiac rehab.

  The role of the pharmacist in this practice area is to provide comprehensive pharmaceutical care to patients with a focus on the vascular system. he resident will have many opportunities to participate in solving clinical problems in this specific patient population. Additionally, the resident will focus on monitoring and dosing of warfarin both inpatient and at the anticoagulation clinic and the associated education and documentation.

Critical Care:

• 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 patients looking to 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 clinical pharmacy specialist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team. Routine responsibilities include: reconciling medications for all patients admitted to the team, addressing formal consults for non-formulary drug requests, therapeutic drug monitoring, and anticoagulation. The pharmacist will also provide drug information and education to healthcare professionals as well and patients and caregivers.

  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:

• 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 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 assist in teaching of pharmacy students by improving their preceptor skills supplemented through the teaching certificate.

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.

  The resident must develop their ability to prioritize acute issues while still completing other less urgent tasks in a timely manner. Upon completion of this learning experience, the resident will be able to provide comprehensive clinical pharmacy services to emergency medicine patients.

Oncology:

• The practice area is primarily the Sletten Cancer Institute with opportunities on the inpatient oncology unit as well. 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), learning about mitigating the financial toxicities of cancer care, as well as providing answers to medication questions posed by patients, caregivers and healthcare professionals. Participation in this clinical rotation will require taking part in the following activities:

  Scheduled activities:

  Additional activities will include real time entry of chemotherapy orders, assisting nursing with questions and management of infusion related reactions, participate in patient chemotherapy teaching sessions, supervise and manage the preparation of both hazardous and nonhazardous sterile preparations, as well as other managerial activities. There is potential to learn about biosimilar initiatives, dose rounding, and investigational drug accountability.

  • Breast or Urology Tumor Board (some Wednesdays 0700 at SCI)
  • General Tumor Board (Fridays 0700 at SCI)
  • MedOnc Provider meeting (Every other Month 0800 TBA)
  • Oncology Committee meetings (Every other Month 0700—TBA)
  • MedOnc Operations meeting (Every other Month 0800 TBA)

Pediatrics / NICU:

• This 6-week elective rotation in neonatology and pediatrics will present the resident with experience in providing clinical pharmacy services to all children from birth through 18 years of age admitted to the NICU or Pediatric 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 neonatology team; managing all orders for the NICU, pediatric, and obstetric units; writing TPN orders for NICU patients; as well as addressing formal consults for therapeutic drug monitoring for all patients admitted to the NICU, pediatric, and obstetric units, and non-formulary drug requests. The pharmacist will also provide drug information and education to healthcare professionals, as well as patients and caregivers, as needed.

Pharmacy Administration:

• The Pharmacy Administration six-week elective rotation will provide the resident with an introductory experience in the leadership and administration of a comprehensive pharmaceutical service within a complex health system. The focus of the rotation is to expand upon the concepts covered during the resident’s longitudinal administrative experience. This rotation will allow residents to develop skills in leadership, problem solving, verbal communication, personnel management, regulatory compliance, improving medication safety practices, and project management. This is supplemented by projects, discussions, and participation on various teams and committees as available and appropriate over a period of six-weeks.

Ambulatory Care:

• The Ambulatory Care Learning Experience is an elective six-week rotation offered through three Benefis pharmacies/clinics: Benefis Ambulatory Pharmacy (BAP), Anticoagulation Clinic (ACC), and Benefis Hospital Home Infusion (BHHI) Pharmacy. Comprehensive pharmacy services are provided to a diverse and growing population of patients residing in assisted living, home health, hospice, long-term care, transitional care, and outpatient settings. BAP also provides a comprehensive medication therapy management (MTM) program to select beneficiaries of the Benefis Health Plan.

Antimicrobial Stewardship / Infectious Disease:

• Antimicrobial Stewardship and Infectious Diseases is a six-week elective rotation at Benefis Hospitals. The role of the pharmacist in this practice area is to provide safe and effective utilization of antimicrobial agents in the treatment of infectious diseases. Patients span all levels of acuity within the inpatient hospital setting. Routine responsibilities include attendance at antimicrobial stewardship meetings when appropriate to the resident’s current practice rotation, participation in infectious diseases topic discussions, and participation in the annual update of the empiric therapy guidelines.

Antimicrobial Stewardship / Infectious Disease:

• Antimicrobial Stewardship and Infectious Diseases is a required longitudinal rotation at Benefis Hospitals. The role of the pharmacist in this practice area is to provide safe and effective utilization of antimicrobial agents in the treatment of infectious diseases. Patients span all levels of acuity within the inpatient hospital setting. Routine responsibilities include attendance at antimicrobial stewardship meetings when appropriate to the resident’s current practice rotation, participation in infectious diseases topic discussions, and participation in the annual update of the empiric therapy guidelines.

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. This rotation in Pharmacy Practice Leadership 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:

• Participating in research is essential in developing a well-rounded practitioner. The Pharmacy Practice Residency program requires the resident to participate in a research project with the goal to educate the resident on the many phases involved with scientific research. The resident will learn about developing a project proposal, collecting data, IRB submission (if needed) and presenting their findings, and provide recommendations based on those findings to improve clinical services or the medication use process. The resident may decide to do original research, identify a process development, enhancement, or evaluation of a current practice, or establish a new service. Preceptors and residents will collaborate to identify a research question, create a project proposal and establish a timeline to ensure success.