Memphis PGY1 Pharmacy Residency

Facilitators: Allison Brunson, PharmD, BCPS; Kelsey Krushinski, PharmD, BCPS, BCGP, CPE; and Allie Crawford, PharmD

The resident completing this required rotation experience is involved in providing comprehensive pharmaceutical care to a variety of patients within the hospital by participating in multidisciplinary rounds with a medicine teaching service team. Throughout the rotation, the resident will develop skills in the disease state management of both acute and chronic conditions. Commonly managed patient conditions include hypertension, heart failure, pneumonia, COPD and asthma, infectious diseases, diabetes mellitus, and stroke. Additionally, residents collaborate and interact with other health care providers including physicians, nurses, and case managers, to assist in the total pharmaceutical care of general medicine patients. A wide range of activities during the rotation are performed including medication review, antibiotic surveillance, pharmacokinetic dosing, anticoagulation management, medication education to patients and their families, drug information assistance to physicians and nurses, medication reconciliation, and educational in-services for health care providers. Topic and patient problem list discussions are conducted frequently.

Facilitators: Ginger Burton, PharmD, BCCP and Allie Crawford, PharmD

During this required rotation, residents have the opportunity to develop clinical skills and concepts of application in cardiovascular patients. The rotation provides practical experience in managing all aspects of the cardiac patient’s pharmacotherapy with a focus on acute care cardiology. Residents can choose between managing patients on the AMI/ACS and CHF units with a focus on chronic disease state management or on the Cardiovascular ICU managing post cardiothoracic surgery patients. Daily activities include monitoring for core measure compliance relating to cardiology and anticoagulation management, developing daily treatment plans for consult services, participating in multidisciplinary rounds and utilizing evidenced based medicine to optimize patient management. Residents provide patient education on anticoagulants, insulins, and other medications as requested. This rotation also heavily focuses on optimal blood glucose management post operatively. Additional educational opportunities during the month include topic discussions, precepting students and nursing/staff development education, as needed.

Facilitator: Maria Zhorne, PharmD, BCCCP and Meghan Vail, PharmD, BCPS

A resident on this core, required rotation will become familiar with the pharmaceutical aspects of critically ill patients by overseeing & managing the care of patients in the 38-bed medical/surgical ICU units. Residents participate in MD led inter-professional rounds five days a week in the ICU. Minimally, a resident is responsible for monitoring continually changing drug therapy and completing pharmacy consults including those for nutrition support, pharmacokinetics, anticoagulation and drug information. The resident is required to read and participate in key ICU topic discussions with the preceptor throughout the month as well as complete a critical care journal club with ICU preceptors and staff.

Critical Care - Cardiology(CVICU)

Facilitator: Sarah Beth Moore, PharmD, BCCP

Cardiovascular Intensive Care Unit (CVICU) is a required (Crit Care - selective) month-long learning experience designed to expose the resident to various acute and chronic cardiac disease states. Baptist Memorial Hospital-Memphis is home to the Baptist Heart Institute which houses a 30-bed CVICU. The PGY1 CVICU rotation focuses on developing patient care skills related to assessment and drug therapy management of adult patients with acute and chronic cardiovascular disease states. The resident will perform as the CVICU pharmacist under the supervision of the rotation preceptor. This experience will allow the resident to further optimize their clinical skills, knowledge base, and communication with various health care providers.

Critical Care - Neurology (NICU)

Facilitator: Kristie Newsom Mitchell, PharmD, BCPS, BCCCP

Residents will have the opportunity to develop skills in the pharmaceutical care of neurology patients in an ICU/critical care setting during this learning experience. Clinical patient care is provided for patients with acute ischemic stroke, hemorrhagic stroke, spinal cord injury, seizure disorders, neurosurgical interventions, and general neurological disorders. Residents also provide pharmaceutical care in the management of all general critical care issues and antimicrobial management. The resident will participate in daily multidisciplinary rounds and one-on-one table rounds with the neuro-intensivist. Other daily responsibilities include completing pharmacy consults for pharmacokinetics, anticoagulation, nutrition support, and stroke core measures, optimizing drug therapies, and researching drug information questions on neuro ICU and general neuro floor patients. The resident will participate in various topic discussions with the preceptor and has the opportunity to lead selected topic discussions as the rotation progresses.

Facilitator: Dawn Waddell, PharmD, BCPS

Residents gain insight into pharmacy administration in the setting of a 700+ bed, flagship hospital in a 22-hospital health system during this learning experience. Time management, organizational skills and open communication with preceptors are key in maximizing this learning opportunity. The resident is responsible for drug information requests, participation in patient safety activities, communication with pharmacy administrative staff and developing and presenting materials for P&T Committee and/or Service Line(s). Rotation project(s) relating to medication usage, appropriateness and or quality measure compliance are the emphasis of this learning experience. Residents will learn to enhance and refine skills in researching drug information and gain experience in presentation skills for multiple audience types. Residents are the lead preceptor for APPE institutional pharmacy students also. This rotation is self-directed and the resident is required to drive the assigned project(s), as well as, any APPE student managed projects. The Medication Use Evaluation (MUE) and drug safety component of residency will overlap with this learning experience.

Facilitator: Dawn Waddell, PharmD, BCPS

Residents will further develop their knowledge and understanding of the pharmacotherapy of patients with infectious diseases during this condensed, required rotation. The focus of this rotation is appropriate overall infective disease state management of patients as well as clinical application of pharmacokinetics /pharmacodynamics with regards to antimicrobials. Residents will be expected to actively participate in infectious disease related daily topic discussions and prepare a mini topic discussion for presentation to the group. Evaluation of patients for appropriateness on high risk antibiotic therapy will also be emphasized during this learning experience.

This unique, elective rotation focuses on both heart failure and common comorbidity chronic disease management. This experience will afford residents the opportunity to work with a multidisciplinary team to manage patients with significant heart failure, diabetes, hypertension, and see a more unique patient population in those with cardiac amyloidosis.

In this ambulatory clinic setting, the resident will see patients as part of a multidisciplinary team with the goal of optimizing medication therapies. This team may include physicians, nurse practitioners, nurses, MAs and pharmacists. Patients seen may include those with advanced HFrEF, patients with HFpEF, pulmonary hypertension patients, and those with TTR cardiac amyloidosis. In addition to the multidisciplinary clinic, residents will be participating in the PharmD medication management clinic as well. Working to optimize heart failure, diabetes, and hypertension management through both phone and in-person visits. Through this clinic the resident will have autonomy to adjust/prescribe therapies and order any labs required for monitoring therapy. The resident will also work to resolve barriers to care, including noncompliance and financial restraints. Residents may, based on need, have opportunities to assist with prior authorizations, adjustment of therapy based on cost/insurance, and assisting patients with PAP enrollment.

Facilitators: Cassidy Ruckel, PharmD, BCEMP and Sarah Harlan, PharmD

This elective rotation gives residents insight into the provision of pharmacy services in an emergency medicine (EM) setting. Residents will develop an understanding of the skills necessary to provide pharmacy support in a high-volume, fast-paced environment. During the course of this rotation experience the resident is expected to actively participate in the care of all EM patients including order processing and medication delivery, participation in medical emergencies at bedside, providing medication information to other health care professionals, and follow-up care of patients discharged from the ED. In addition to direct patient care, the resident is expected to participate in the education of pharmacy students as well as EM physicians and nursing staff. The resident will also participate in the further advancement and development of pharmacy services within the ED.

Facilitator: Amy Evans, PharmD

During this elective learning experience, residents will manage drug therapy necessary for the treatment of complex hematology patients including those undergoing stem cell transplantation. Specifically, residents will become familiar with chemotherapy regimens used in the treatment of acute leukemia, lymphoma, multiple myeloma and conditioning regimens utilized for stem cell transplants. Appropriate supportive care medications, monitoring parameters, and therapeutic endpoints for efficacious drug use as it relates to the oncology patient will be a focus of this experience. Residents will have the opportunity to participate in daily MD led, bedside rounds in addition to interacting with the multi-disciplinary patient care team in the myelosuppression unit. Topics discussions relating to a variety of oncologic disease states, chemotherapy agents and supportive care issues in this patient population are conducted throughout the rotation.

Facilitator: Kristie Mitchell, PharmD, BCPS, BCCCP

The neurology rotation is an elective experience designed to expose the resident to various disease states in the neuro-critically ill patient population. The resident will participate in multidisciplinary rounds in the 12-bed neuro ICU and additionally provide clinical coverage for the 47-bed neuro step-down floor and 4-bed epilepsy monitoring unit (EMU).

Facilitator: Elizabeth Mills, PharmD, BCPS

The resident completing this elective rotation is responsible for managing drug related therapy for patients with cancer and hematological disorders. Specifically, residents become familiar with various chemotherapy regimens used in the treatment of cancer through review of chemotherapy orders for completeness, accuracy, appropriate doses, and appropriate supportive care medications. Residents will also determine monitoring parameters and therapeutic endpoints for efficacious drug use as it relates to the oncology patient with emphasis on nutrition support, pharmacokinetic monitoring and anticoagulation support. Resident actively participate in daily patient rounds on the oncology unit. Topics discussions relating to a variety of disease states (lung, breast, colon cancers) and supportive care issues in the oncology patient population are conducted throughout the rotation.

Facilitator: Elizabeth Mills, PharmD, BCPS

This elective learning experience will expose the resident to management of post-op patients, with a focus on pain management. The resident will attend daily bedside patient care rounds with a multi-disciplinary team including an NP & anesthesiologist. Residents will provide medication recommendations including supportive care and opioid sparing pain control options to the team. The resident will also have the opportunity to participate in various data collection projects for presentation to the hospital based pain committee as needed. Residents actively participate in various topic discussions with the preceptor throughout the rotation block.

Facilitator: Mallory Taylor Baird, PharmD, BCCP

This elective rotation focuses on end stage heart failure patients requiring heart transplant and/or ventricular assist device (VAD) therapy. The cardiac transplant floor includes a 12-bed intensive care unit (ICU) and a 12-bed stepdown unit, and also includes patients receiving extracorporeal membrane oxygenation (ECMO) and a variety of temporary mechanical circulatory support (MCS) devices. Residents are involved with patient care in the acute setting as well as the transplant/MCS outpatient clinic. Residents participate in multidisciplinary rounds, assess patients and develop medications treatment plans, monitor immunosuppression and other medication therapies, manage pharmacy consults, provide medication information to other healthcare professionals, assist in evaluating patients for transplant and VAD selection committee meetings, and participate in topic discussions. Patient interaction and medication counseling are also important aspects of this rotation. Additional required activities and assignments as indicated by the needs of the transplant team may be included.

A resident completing this elective learning experience will provide pharmacist presence in the pediatric emergency department at Baptist Women’s Hospital located adjacent to Baptist Memphis. This rotation seeks to develop skills in the management of medication dosing and monitoring for pediatric patients seen in the ED. Patient education and policy development will be important components of this experience. Prior ED and CC exposure & proficiency is a requirement for this elective.