Pharmacy Residency

Rotation Descriptions for PGY1

Required Rotations

Operations

The Operations Rotation of the HUP PGY1 Pharmacy Residency is designed to provide the resident familiarity with the distributive functions of a hospital pharmacy, medication and departmental policies and procedures, and the skills required to serve as a clinical pharmacist during rotations and staffing requirements during residency and beyond. This rotation is a required, longitudinal learning experience of the HUP Pharmacy Practice Residency.

During the month of July, residents participate in an orientation to the Central Inpatient Pharmacy (CIP), and residents will be introduced to the hospital's clinical information systems, departmental procedures, and the robotic unit dose systems. The residents will also be introduced to the IV Admixture and Production Suites, which will provide an overview of aseptic technique, chemotherapeutic handling, dosage calculations, USP797 Guidelines and specialty product preparation.

After general operations orientation, the resident will join the clinical staff on the nursing units to experience the role of the Unit Based Clinical Pharmacist (UBCP). Additionally, the resident will complete Code Call training, to prepare them to participate in the management of medical emergencies.

After the initial one month orientation phase, the resident will continue to serve as a clinical pharmacist on weekends. The weekend requirement equates to every 3-4 weeks throughout the course of the year.

Each resident presents the result of this project at the Eastern States Residency Conference each spring.Residents also have the opportunity to submit research for presentation at specialty meetings. Residents are also encouraged to publish the results of their research project in various medical journals.

Pharmacy Administration

The Pharmacy Administration experience will introduce each resident to the activities required to operate and maintain service from a comprehensive pharmacy department comprised of over 300 employees, an overall pharmacy budget of over $250 million, and a broad scope of clinical, academic, research and distributive services. Residents will experience, in real work situations, the challenges of balancing human and fiscal resources to meet institutional and department needs. The requirement of the Joint Commission (TJC) and national standards of practice will be reviewed and used in program evaluation and justification. The resident will be assigned specific projects requested by hospital administration as well as the medical or nursing staff. This experience will be important whether the resident decides to pursue a clinical practice or administrative position and will provide a solid foundation on which to build their long-term personal and professional career. Residents will work closely with and under the direction of the Director of Pharmacy, who has an advanced degree in business and completed a residency in hospital pharmacy practice.

Drug Information

A formally organized Drug Information (DI) Service was established in 1972. The service is now part or the Center for Medication Use Policy. The DI service provides medical information to health care providers within the health system as well as to the public and receives on average 80 inquiries per month. In addition to providing Drug Information, the Center for Medication Use Policy manages Medication Safety, Drug Shortages, Adverse Drug Event reporting, the Health System formulary, and the smart infusion pump libraries. The Pharmacy Specialists in the Center serve on various multidiscipline committees within the institution such as the Pharmacy & Therapeutics Committee, Medication Safety Committee, Drug Use and Effects Committee, Diabetes Subcommittee, and the Nutrition Subcommittee. The DI pharmacists proactively review medications for formulary addition as well as annually review the current agents within the formulary for safety and efficacy. Residents will also be involved with reviewing newly FDA approved medications and preparing a drug monograph for presentation to the Pharmacy and Therapeutics Committee. The DI Specialists work closely with other specialty areas and departments to develop guidelines and to implement policies, procedures & protocols. Information regarding appropriate use of medications approved for hospital or health system use is also generated and disseminated from this service.

Critical Care: MICU/CCU/SICU

The Critical Care rotation is designed to provide the PGY1 resident with practice experience in providing pharmaceutical care for critically ill patients. The focus of the rotation will be on core ICU topics such as: Stress ulcer prophylaxis; VTE prophylaxis; glycemic control; pain, agitation, and delirium; hemodynamics; mechanical ventilation; rapid sequence intubation; ACLS and clinical emergencies; PK/PD alterations in critically ill patients; AKI and continuous renal replacement therapies; and Sepsis.

There are a total of 122 adult ICU beds at the Hospital of the University of Pennsylvania including: 32 medical, 12 cardiac, 22 neurological, 24 surgical, and 32 cardiac surgery ICU beds. The resident has an opportunity to rotate in any of these ICU settings listed above. A team of pharmacists, including clinical pharmacy specialists in Critical Care Medicine, provide care for the patients in each of these units. HUP is a tertiary care referral site supported by PENNSTAR I and 2 life flight helicopters, which respond as a primary resource for critical care transport. The patient acuity of the ICUs is extremely high, and there are many opportunities for the pharmacy team to interact with the medical, nursing, respiratory, clinical nutrition, physical therapy, and occupational therapy team members. The pharmaceutical care provided to patients includes drug distribution, prospective evaluation of drug therapy, provision of drug information, prevention of medical errors, pharmacokinetic monitoring, education, development of critical pathways and drug utilization guidelines, patient-specific case management, and quality assurance initiatives. Management of critical illness, awareness of the unique considerations of the critically ill patient/family, and the ability to work with a closely aligned interdisciplinary professional staff are unique aspects of this practice site. The clinical pharmacy specialists have advanced degrees, residency training, and have been practicing critical care for several years.

Infectious Diseases

There are four different inpatient infectious diseases (ID) consult services at HUP: a general consult service, a solid organ transplant consult service, an HIV consult service, and an oncology consult service. First year residents are required to complete a five-week rotation on the general ID consult service. This general ID consult service team consists of an ID attending, an ID fellow, medical residents, a pharmacy resident, and students. The other three services consist mainly of an ID attending with or without an ID fellow. The pharmacy resident participates in daily rounds to monitor patient’s therapy for efficacy and toxicities, provides pharmacokinetic support, and researches any questions that arise. In addition, the pharmacy resident attends ID Management Conference, ID Clinical and Research Conference, and the ID Fellows’ Journal Club. The rotation is precepted by three clinical pharmacy specialists with an advanced degree and residency training in infectious diseases.

Unit based Clinical Pharmacist (UBCP)

The Unit Based Clinical Pharmacist (UBCP) rotation of the HUP PGY1 Pharmacy Residency provides each resident with the opportunity to practice as a patient care pharmacist in our health system. The rotation aims to teach the resident the about the hospital’s approach to patient centered care. This month long, required learning experience takes place on the general medicine floors at HUP.

The UBCP Rotation of the HUP Pharmacy Practice Residency is designed to provide the resident with practice experience in providing pharmaceutical care for patients on a patient care unit. The resident will gain experience and skills in conducting admission and discharge medication reconciliation as well as patient medication education and discharge counseling. The resident will participate in multidisciplinary rounds, patient care assignments, educational conferences, assigned readings and topic discussions. In addition, the resident will develop competency in responding to drug information inquiries, pharmacokinetic monitoring, documentation of interventions, reporting of adverse drug events, communication with the medical or surgical teams, assist in providing optimal medication therapy management, and medical emergencies.

Research

The pharmacy staff and residents participate in various research projects and contribute relevant and high quality material to the pharmacy and medical literature. Many of the projects relate to health services research that directly or indirectly benefit patients of the Medical Center.

Residents are required to develop and complete a research project during their residency. IN 2015, HUP implemented a novel research project design for the residency program. Each PGY1 pharmacy resident will be paired with a PGY2 resident. Each PGY2 resident is responsible for working with his or residency program director to generate a research idea. After finalization of PGY2 projects, research ideas will be presented to all PGY1 residents. The PGY1 residents then have the opportunity to choose which research project the resident would like to pursue during the course of the year. PGY2 and PGY1 residents will be paired and continue to develop the project with the primary research preceptor. These three individuals will comprise the "core research team”. Other team members will be added to the core group as appropriate. These will typically include a secondary preceptor and a physician collaborator. This unique design affords an objective means of dividing project responsibility and accountability between the collaborating residents and most importantly, provides the residents with a research experience that most closely mirrors research project in clinical practice.

Residents participate in an "Epidemiology Discussion Series" throughout the course of the year, which is designed to introduce residents to the basic principles of research methodology and study evaluation. The discussion series includes lecture topics on study designs, measures of association, bias/confounding, database management, and statistical analysis. Additionally, the discussion series includes multiple "Research Think Tanks" throughout the year, which gives the resident the opportunity to present his or her research topics to preceptors and allows the resident to continually improve his or her research project based on feedback generated in the discussions.

Ambulatory Care

The Anticoagulation Management Center

  • Opened in the fall of 1998, the Anticoagulation Management Center (AMC) is a pharmacist run clinic currently managing approximately 1,500 patients and over 2,800 INRs per month. Patients are referred to the clinic for the duration of their anticoagulation therapy.
  • The center is staffed by clinical pharmacists with extensive experience in managing anticoagulation.
  • Pharmacists are responsible for seeing each patient referred, providing education to patients, evaluating laboratory studies, adjusting doses, and managing adverse events.

The MacGregor Infectious Diseases Clinic

  • Provides both primary care and specialized care to over 600 HIV-infected patients.
  • A multidisciplinary team comprised of physicians, nurses, dieticians, psychiatrists, social workers, and clinical pharmacists is available to provide collaborative care to the program participants.
  • The pharmacist's responsibilities include clinical monitoring for medication safety and efficacy, patient education, medication adherence monitoring (as part of the IDP Medication Adherence Program); providing drug information to staff and patients; teaching staff and students; compliance with institutional, JCAHO, and Health Department requirements; collaboration with, and referrals to, the ACTG Clinical Research group and CFAR; coordination of care including Medication Reconciliation as well as the other aspects of medication management that are typical of an outpatient practice.
  • Wellness and prevention of disease progression are major goals of the ambulatory care program. The pharmacist screens patients and charts for the need for health maintenance regimens including pneumococcal vaccination, hepatitis B vaccination, annual PPD, and prophylactic medications.
  • Patient and provider education is another important aspect of the clinical pharmacist's role in the IDP clinic. The clinical pharmacy specialists have Doctor of Pharmacy advanced degree and specialized training in Infectious Diseases.

Dermatology Clinic

Pharmacist in the clinic is responsible for managing patients who are on specialty medications for conditions that include psoriasis, atopic dermatitis, and cutaneous T cell lymphoma.

Pharmacist works closely with doctors, nursing staff, and other clinic staff to optimize patient care by performing activities, such as initial drug counseling for new starts, medication reconciliation, lab monitoring, and assisting patients who are having difficulty accessing their high cost medications.

The dermatology specialty pharmacy team, which includes a prior authorization technician and a refill technician, work together to streamline the processing of specialty medications, and play a critical role in addressing any issues in a timely manner that could potentially disrupt treatment plans.

Penn Gastroenterology Clinic

Provides care for patient’s suffering from gastrointestinal disorders. The clinic offers specialized programs and services with a pharmacy focus on Inflammatory Bowel Diseases and Neuroendocrine Tumors. Penn GI provides evaluation and the latest treatments for Crohn’s disease and ulcerative colitis, as well as refractory inflammatory bowel disease and unexplained diarrhea. Penn GI offers one of the only dedicated neuroendocrine tumor (NET) programs in the country to treat gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and pheochromomcytomas/paragangliomas (PHEOs/PARAs).

The pharmacist in the GI clinic serves as a liaison between providers, nurses, patients and the Penn Specialty Program to ensure access to prescribed medications. The pharmacist also provides clinical monitoring for efficacy and safety of therapy, education to patients and family members through medication teaching, and medication adherence monitoring.

Oncology

The oncology rotation for the Pharmacy Practice Residency (PGY-1) at the Hospital of the University of Pennsylvania is designed to provide the resident with practice experience in providing pharmaceutical care for patients diagnosed with cancer. The focus of this rotation is placed on managing patients with hematologic malignancies, such as leukemias and lymphomas, and patients undergoing a hematopoietic stem cell transplant. In addition, the resident will learn how to monitor and manage the toxicities associated with the malignancy and its treatment.

The resident's rotation experience can be tailored depending upon the resident's prior experience and their interests. The resident will obtain experience in medication management through participation in multidisciplinary rounds, patient care assignments, educational conferences, assigned readings and topic discussions. In addition, the resident will respond to drug information inquiries, perform pharmacokinetic monitoring, report adverse drug events, perform patient medication reconciliation, provide discharge counseling and participate in the management of medical emergencies. The resident will develop proficiency in proactively solving problems and communicating effectively with all members of the healthcare team and patients as appropriate to assist in providing optimal medication therapy management in a diverse patient population diagnosed with cancer.

Solid Organ Transplant

The Penn Transplant Center is the largest multi-organ transplant center in the region as well as one of the top ten busiest programs in the nation. Our multi-organ center performs over 400 transplants a year consisting of heart, lung, liver, pancreas, and kidney transplantation. We also conduct active research in islet cell transplantation and hand transplantation. For PGY1 residents, elective rotation options may include heart transplant, lung transplant, liver transplant, kidney/pancreas transplant, or transplant research. The rotations are coordinated by five clinical specialists with an advanced degree and residency training. These rotations will focus on development of specialized clinical skills and research abilities in adult solid organ transplantation. The resident will provide comprehensive care to transplant recipients as part of a multidisciplinary team to and will gain experience in both the inpatient and outpatient transplant settings. The resident, participating in both nurse and physician daily rounds, will be expected to provide therapeutic suggestions for: drug therapy selection, monitoring of immunosuppressive agents and transplant related drug information queries. The resident will play an integral role in assisting the transplant team with transplant research protocols, medication reconciliation, and patient education in both the inpatient setting and outpatient transplant clinics. Clinical research skills will be gained through extensive involvement in investigator-initiated and industry sponsored clinical research. The resident will also attend transplant grand rounds, transplant nephrology teaching conferences, transplant patient care selection meetings, and transplant research conferences.

Clinical Nutrition

This 2-4 week experience is coordinated with the nationally-recognized, interdisciplinary Clinical Nutrition Support Services (CNSS) at the Hospital of the University of Pennsylvania. The CNSS Department provides clinical nutrition care through several multi-specialty teams that each provide comprehensive clinical services in disease-specific patient populations. The teams provide care across all inpatient medical and surgical groups as well as with several outpatient clinics. Although occasionally identified by the CNSS, nutrition is rarely the primary problem for patients receiving nutrition support; rather an underlying disease process, condition or drug regimen compromises nutrition status or results in outright nutrient deficiencies

The resident will have the opportunity to work directly with advanced practice dietitians, nurses and pharmacist each with nutrition support expertise. The experience will provide the chance to build on didactic knowledge acquired in the PharmD program and further develop the knowledge and skills for providing care to the patient requiring nutritional pharmacotherapy. It affords the ability to integrate pharmacy sciences, principles of pharmacotherapy and clinical nutrition as it pertains to daily clinical practice.

Emergency Medicine

The Department of Emergency Medicine provides clinical care in a number of exciting and diverse venues offering a remarkable breadth and depth of care for our patients. Its clinical services include disaster preparedness, emergency medical services, emergency ultrasound, hyperbaric medicine, observation medicine, resuscitation and critical care, toxicology, quality improvement and safety, trauma, and travel medicine. There is a high level of acuity in the HUP ED with a high admission rate to the hospital. The department has developed prioritized care for patients with cardiologic, neurologic, oncologic and traumatic emergencies. The resident will work parallel with a preceptor and with an expectation to take over the responsibility of the primary pharmacist towards the end of the rotation.

Pain and Palliative Care

Palliative Care has been proven to provide increased quality of life and support for patients and families dealing with advanced illness. Pain has been acknowledged by The Joint Commission as the “fifth vital sign.” Pain management is an integral part of patient recovery and quality of life considerations both inpatient and beyond. There are also well-known risks in using opioids and other pain medications on a regular basis. This risk-benefit is an important piece to successful pain management. At HUP, there are two pain service entities - Anesthesia Pain Service (APS) and the Palliative Care Service (PCS).

This rotation is intended to focus on pain and symptom management in patients with advanced disease as part of the consultative PCS, but also to teach general pain management principles for acute, chronic and malignant pain. During this rotation, the resident is expected to participate in PCS Team rounds, see new consults with the preceptor and independently, and provide education to the Team as needed/requested. Additionally, the resident will assist in new pharmacy pain consults. By the end of this rotation, it is expected that the resident will be able to explain the pathophysiology of pain; provide accurate and thorough assessment of patient's complaint of pain; describe the role of individual therapeutic drug classes in pain and symptom management; recommend appropriate therapies to treat patient's pain or symptoms; establish a working relationship with members of the interdisciplinary team; educate patients/caregivers on pain/palliative therapies and interventions.

Investigational Drug Service

The Investigational Drug Service provides research pharmacy services throughout the University of Pennsylvania Health System and to all schools of the University of Pennsylvania, for human, veterinary and laboratory drug and device trials. The IDS operates out of two locations, with a third location opening in 2019. Services include the preparation, procurement, management and dispensing of medications and devices for clinical trials; consultation on protocol design, grant proposals and Investigational New Drug submissions; manufacturing of blinded or customized dosage forms; customized packaging and distribution; and coordination of multisite trials. The IDS includes a team of clinical research pharmacists and BS- and MS-trained research technicians, as well as a drug testing laboratory, small-scale manufacturing facility and a quality assurance division and finance division. Additionally, the IDS is a teaching site for IPPE and APPE students from several pharmacy schools, as well as pharm-sci and pharm-tox students. Lastly, IDS is affiliated with the Institute for Translational Medicine and Therapeutics as well as Penn’s Office of Clinical Research.

Medication Safety

Medication safety is a longitudinal experience for PGY1 residents at the Hospital of the University of Pennsylvania. This longitudinal rotation is offered to help residents understand the safety culture within the department and the whole organization as well as understand what references and resources are available as you continue your pharmacist career. Medication safety is an important component of the overall 'blueprint for quality and safety' within the institution as well the multi-disciplinary patient safety initiatives within the organization. The preceptor for this learning experience is the medication safety clinical pharmacy specialist - Laura Haynes, PharmD., BCPS

The clinical pharmacy specialist is responsible for review and follow-up on medication safety concerns within the organization via Penn Medicine Safety Net(PMSN), Pharmacy Department Near Miss data collection and analysis, High Alert Response Team meetings, Pharmacy Safety and Medication Safety Committee meetings and participation on organizational, pharmacy department and nursing unit-based medication policy and continuous quality improvement committees and other venues in which medication safety is discussed.

During this longitudinal rotation, the pharmacy resident will be exposed to a variety of safety meetings with an interdisciplinary team and identify the importance of medication safety to the whole patient safety focus of this organization. Throughout the longitudinal rotation, the pharmacy resident will report events (actual events reaching patients or near misses identified) into PMSN, including attendance at root cause analyses. Other learning’s include a regulatory readiness discussion and understand of landmark articles within the specialty of medication and patient safety. At the end of this longitudinal rotation, the pharmacy resident will understand the role of the medication safety pharmacist within the organization.

Good communication and interpersonal skills are vital to success in this experience. The resident must devise efficient strategies for accomplishing the required activities in a limited time frame.