PGY1 Pharmacy Practice (Inpatient Setting) Greenville - Rotation Descriptions

The academia learning experience is a month-long rotation, offered at the Greenville campus of the University of South Carolina College of Pharmacy. The learning experience is designed to provide residents with opportunities in the areas of teaching, scholarship and service. The resident will be able to develop and/or refine knowledge, skills, behaviors and attitudes in various aspects of academia. The learning experience emphasizes: (1) components of a clinical faculty position (i.e., teaching, scholarship, service); and (2) role as a practitioner, teacher, researcher, educator, and scholar throughout the learning experience. The preceptor will be present and available during the majority of time spent on the learning experience. The resident is expected to be present for the academia-related activities Monday through Friday each week.

The Medical Teaching Service (MTS) or Family Medicine Teaching Service (FMTS) experiences creates a foundation for pharmacy residents on an inpatient general medicine service. The resident will be assigned to a MTS or FMTS team consisting of an attending physician, medical residents, interns, and students. The resident will attend patient care rounds and teaching rounds on a daily basis and present developed therapeutic plans for each of his/her patients to the preceptor on a daily basis, provide patient counseling on medications and disease-states, obtain medication histories, write pharmacokinetic and therapeutic consult notes as necessary, participate in journal club, and give two formal presentations to the preceptor. In addition, the resident will have the opportunity to conduct informal and/or formal educational services to physicians, nurses, and pharmacists.  Topics commonly encountered and/or discussed throughout the rotation include pneumonia, urinary tract infections, bacteremia/sepsis, chronic obstructive pulmonary disease, heart failure, venous thromboembolism, angina/myocardial infarction, stroke, seizure disorders, acute and chronic renal failure, peptic ulcer disease, gastroesophageal reflux disease, pancreatitis, hepatitis/cirrhosis, diabetes, anemia, fluid-electrolyte disorders, acid-base disorders, human immunodeficiency virus, dementia, and liver disease.

The Hospitalists Service experience is an elective rotation for pharmacy residents on an inpatient general medicine service. The resident will be assigned to a portion of the Hospitalists Service (based on interest). The Hospitalists Service is comprised of 7 day-shift physicians rounding on patients throughout the hospital, 3 pharmacists, and students.  As a member of the patient care team, each resident will work closely with the preceptor to provide pharmaceutical care.  The resident will attend Grand Rounds each Friday morning, present developed therapeutic plans for each of his/her patients to the preceptor on a daily basis, independently round on patients daily, provide patient counseling on medications and disease-states, obtain medication histories, write therapeutic consult notes as necessary, participate in journal club, and give formal presentations to the preceptor. In addition, the resident will have the opportunity to conduct informal and/or formal educational services to physicians, nurses, and pharmacists.  Topics commonly encountered and/or discussed throughout the rotation include internal medicine-based topics. 

The Hematologic Malignancies/Adult Oncology rotation is an elective option for PGY-1 residents.  This rotation involves the provision of direct pharmaceutical care to patients with a variety of hematologic malignancies including, but not limited to, leukemia, lymphoma, and multiple myeloma.  Based on patient census and the interest of the resident, bone marrow transplant and/or solid tumor pharmacotherapy may be included.  The resident will obtain knowledge and experience as it relates to the general principles of oncology pharmacy practice, including oncologic supportive care issues.

Medical Oncology is an elective rotation for PGY-1 residents. Focusing on provision of pharmaceutical care to patients undergoing new diagnosis and work up of malignancy followed by transition of care to outpatient setting, chemotherapy related admission for supportive care, and those with non-hematologic blood dyscrasias and factor deficiencies. The goal of this rotation is to develop the resident's knowledge and skills necessary for management of solid organ malignancies as well as optimization of supportive care management. This will be facilitated through participation in multidisciplinary rounds, chemotherapy regimen consideration, patient & family education, and provision of drug information to the healthcare team. The multidisciplinary team consists of attending physician, advance nurse practitioners, PGY1 or PGY2 medical resident, medical students, clinical pharmacist, nurse navigator and the primary nurse.

The purpose of the ambulatory care learning experience is for PGY1 residents to develop skills in optimizing patient care in the ambulatory care setting. Though the resident is paired with one primary ambulatory care preceptor, the resident may work in a variety of ambulatory care clinics since many of the preceptors staff multiple sites. Our current sites include:

Diabetes Self-Management Education and Support (DSMES): 

DSMES is a multidisciplinary service where pharmacists see complex diabetes patients independently or with providers. The team provides care to all patients with diabetes across their lifetime so residents may be exposed patients with Type 1, Type 2, or gestational diabetes. In addition to pharmacotherapy for diabetes, residents will gain experience in lifestyle medicine, insulin pumps, continuous glucose monitors, and remote patient monitoring.  

The primary care learing experience gives the resident an opportunity to work collaboratively with physicians and nurses to provide high quality direct patient care. The resident will see patients independently and in conjugation with a physician in a primary care practice site. The resident may be responsible for Medicare annual wellness visits, anticoagulation visits, and chronic disease state management such as diabetes, COPD, heart failure, etc. During these visits, the resident will interact with patients and families to provide counseling on medications and disease processes while obtaining accurate and complete medication histories. Since medication access can be a barrier to patients obtaining guideline recommended therapies, residents will become familiar with various medication assistance programs and learn to connect patients with the right resources. Lastly, the resident may also have opportunities to assist with education and didactics for medical residents and medical students. Prisma Health Upstate has multiple primary care sites and preceptors and the site selected for each resident depends on schedule availability among other factors.

The purpose of the ambulatory care learning experience is for PGY1 residents to develop skills in optimizing patient care in the ambulatory care setting. Though the resident is paired with one primary ambulatory care preceptor, the resident may work in a variety of ambulatory care clinics since many of the preceptors staff multiple sites. Our current sites include:

Anticoagulation Clinics:

• The Anticoagulation Clinics are our largest ambulatory care service. These sites are pharmacist-run and fast-paced where the resident could expect to see patients independently early on and be exposed to a variety of anticoagulation clinical scenarios.  Anticoagulants managed include warfarin, bridging anticoagulants (enoxaparin and fondaparinux), and the direct oral anticoagulants (apixaban, dabigatran, and rivaroxaban).   

The Prisma Health - Upstate Antimicrobial Stewardship Program (ASP) is a coordinated system level program that promotes appropriate use of antimicrobial therapy, reduces microbial resistance, decreases the spread of infections caused by multidrug-resistant organisms, and improves patient outcomes.  The program is led by an ID trained pharmacist and an ID physician. 

Residents on this rotation will complete active stewardship review and make patient specific recommendations to the primary teams, provide education to various services regarding antimicrobial stewardship topics, and complete antimicrobial stewardship related quality improvement projects for the system.  Topics focused on during this rotation include: antimicrobial stewardship principles; diagnostic testing performed in the microbiology laboratory; urinary tract infections/asymptomatic bacteriuria; bloodstream infections, antimicrobial resistance; respiratory infections.

The Cardiology Teaching Service (CTS) experience is an elective rotation. CTS directly admits patients and accepts consults from various services at the Prisma Health – Upstate GMMC Hospital campus to manage a broad scope of cardiovascular conditions. This rotation is designed to provide a basic overview of the acute and chronic management of commonly encountered adult cardiovascular diseases. CTS provides medical; as well as, interventional management as treatment approaches. The resident will be assigned to a team consisting of an attending physician, medical resident(s), intern(s) and student(s). Disease states encompass: STEMI, NSTEMI/US, CHF exacerbations, arrhythmias, anticoagulation, hypertensive crises, interventional cardiology, and others.

The Cardiovascular Service is a non-teaching service consisting of a pulmonary/critical care board certified attending physician, physician assistants, a clinical pharmacy specialist, and a respiratory therapist. The team provides critical care consultative service to cardiothoracic surgery patients. The average daily census for the service ranges from 10-20 patients depending on consultations, with most patients requiring mechanical ventilation. Disease states managed include post-operative care of coronary artery bypass grafts and valve repair/replacement, sepsis resulting from a multitude of causes, pain management as well as many other disease states.

The Surgery / Trauma Critical Care Teaching Service (SCCTS) is a multi-disciplinary teaching service consisting of a general surgery / critical care board certified attending physician, surgery critical care fellow, upper-level surgical resident, surgical intern, and a clinical pharmacy specialist. The SCCTS team provides critical care services to neurosurgical, general surgical, trauma, thoracic, and vascular patients in the intensive care units at a Level I Trauma Center. The average daily census for the SCCTS ranges from 15-30 patients depending on consultations. Disease states managed include traumatic brain injuries, acute spinal cord injuries, sepsis resulting from a multitude of causes, adult respiratory distress syndrome, acute alcohol withdrawal, blunt trauma, aortic aneurysms, as well as many other disease states.

Each resident is required to complete a drug monograph usually conducted in support of formulary management at Prisma Health.  Residents completing monographs will follow the policies and procedures determined by pharmacy leadership. Monographs will be presented at Pharmacy & Therapeutics Committee meetings and/or relevant subcommittees or workgroups. Satisfactory performance as determined by the residency program director and RAC for the successful completion of the program.

The learning experience will be a calendar month long rotation focusing on acute management of critically ill patients within the emergency department (ED) at Prisma Health – Upstate Greenville Memorial Hospital. The patient population to which the resident will be exposed during this learning experience covers all age ranges from pediatrics to geriatrics. The learning experience will be targeted at exposing the resident to the role of a clinical specialist within the emergency department. The resident will be pushed towards expertise in managing acutely critically ill patients with a focus on trauma, stroke, acute coronary syndrome, sepsis, and toxicologic emergencies. The rotation will have a focus on policy implementation for disaster preparedness, along with logistical analysis of implementation of standard policies within the emergency department.

The Infectious Diseases Consult Service is utilized by all of the various services in Prisma Health – Upstate GMMC Hospital to participate in the care of patients with difficult to manage infectious diseases.  The service is a multi-disciplinary team consisting of an infectious disease attending physician, internal medicine residents, medical students, and a pharmacist. Disease states commonly encountered include pneumonia (community and hospital acquired), urinary tract infections, bacteremia/sepsis, hepatitis/cirrhosis, human immunodeficiency virus, osteomyelitis, endocarditis, sexually transmitted diseases, opportunistic infections, meningitis, and various fungal infections. 

The clinical on-call/pharmacokinetics longitudinal experience provides on-call consult service and code response at Prisma Health – Upstate GMMC Hospital. The on-call consult service is designed to provide consistent clinical resources to GMH healthcare providers in a timely manner. The resident will design, monitor, and evaluate evidence-based patient-specific therapies involving clinical pharmacokinetics, drug information questions, investigational drug services, therapeutic outcomes program, formulary management, clinical services cross-coverage and additional pharmacotherapy consults.

Each resident is required to participate in a Medication Use Evaluation (MUE); usually conducted in support of patient care at the Medical Center.  Residents participating in MUEs will follow the policies and procedures determined by pharmacy leadership. Satisfactory performance as determined by the residency program director and RAC for the successful completion of the program.

During the medication safety rotation, the resident will gain an understanding of the organizations’ medication-use systems by applying medication safety principles and best practices.  This rotation will help equip residents to understand the complexity of medication safety and the need to identify and manage system failures to improve patient safety.

Residents will have the opportunity to learn about different types of medication errors, factors that contribute to medication errors, the severity of those errors, and the steps that go into their prevention.  Residents will also gain experience in collecting data on medication errors, analyzing the findings, communicating with other healthcare professionals and administrators through a reporting mechanism, and tracking and trending an area of failure and success.  Residents will share the information obtained through various means such as a hospital-wide performance improvement initiative.  Residents may also have the opportunity to attend pharmacy and therapeutics committee meetings, interdepartmental performance improvement meetings, and monthly hospital-wide medication error rate reporting discussions. The resident will have the opportunity to explore a variety of areas within the medication-use system: computerized prescriber order entry (CPOE) systems, electronic health records (EHR), clinical decision support tools, automated dispensing machines, ‘smart’ infusion pumps, and bar code medication administration and medication error surveillance.

The Critical Care Teaching Services (CCTS) are multi-disciplinary teaching services that may consist of critical care board certified attending physicians, pulmonary critical care fellows, advanced practice practitioners, internal medicine interns and residents, medical students, and clinical pharmacy specialists. The average daily patient census for the CCTS teams are on average 15-20 patients, with most patients receiving mechanical ventilation.  Disease states range from COPD exacerbations, community and hospital acquired pneumonias, drug overdoses, acute neurological events, sepsis resulting from various infections, pulmonary embolus, and adult respiratory distress syndrome, as well as cardiac arrest and many other disease states.

The Neonatal Intensive Care Unit (NICU) rotation takes place in a 52-bed, level III NICU on the Prisma Health – Upstate GMMC Hospital.  The resident will be a part of 1 of 3 multidisciplinary teams comprised of an attending physician, a neonatal nurse practitioner, 1-2 pediatric medical residents, nursing, respiratory therapists, and a pharmacist. Topics commonly encountered and/or discussed throughout the rotation include apnea of prematurity, bronchopulmonary dysplasia (BPD), patent ductus arteriosus, congenital heart defects, diaphragmatic hernia, hyperbilirubinemia, intraventricular hemorrhage (IVH), mechanical ventilation of the premature infant, morbidity and mortality of premature infants, neonatal abstinence syndrome, necrotizing enterocolitis, neonatal sepsis, nutrition of the premature infant, respiratory distress syndrome (RDS), sedation/analgesia in premature infants, among others.

The Neurocritical Care service is a multi-disciplinary teaching service consisting of neurointensivists, nurse practitioners, a clinical pharmacy specialist, and medical students/interns/residents. This clinical rotation will provide exposure to various neurological disease states including acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, status epilepticus, meningitis, intracranial hypertension, metabolic encephalopathy, cerebral venous sinus thrombosis, and neuromuscular emergencies. The average daily census for NCC ranges from 20-25 patients depending on consultations. 

The General Pediatrics rotation is an elective option for PGY-1 residents. The primary medical service team for this area is the Pediatric Hospitalist Service (PHS), consisting of medical students, medical residents (pediatrics, family medicine, and internal medicine-pediatrics), respiratory therapists and nurses. The patients seen may range in age from newborns to young adults. While on this rotation, the resident will expand existing pharmacy services by rounding daily with the PHS team.  This rotation will offer the resident experience in designing and recommending therapeutic regimens, application of pharmacokinetic principles, healthcare team interactions, patient and family education, and provision of drug information to other health care providers. The resident's learning will be enhanced by twice weekly topic discussions with the preceptor, led by the resident covering a variety of commonly encountered pediatric disease states. 

The Pediatric Hematology / Oncology group at Prisma Health – Upstate Children's Hospital treats children from birth to age 21. All types of childhood cancer and blood disorders, including coagulopathies, sickle cell disease, and other anemia’s and white blood cell diseases are diagnosed and treated by a multidisciplinary team. The resident will function as an integral part of this medical team with the goal of developing an understanding for the clinical pharmacist’s role in the care of the hematology/oncology patient. Responsibilities include: Attend and actively participate in daily rounds as well as daily review of patients’ medication orders, progress notes, and pertinent laboratory/microbiology data. In addition, the resident will be expected to provide drug information to physicians, nurses, pharmacists and other health care professionals as well as perform daily therapeutic drug monitoring, and document pharmacokinetic recommendations in the patient’s chart. Potential topics for discussion include: hematologic malignancies, solid tumors, fever and neutropenia, oncologic emergencies, tumor lysis syndrome, sickle cell disease, ITP, and aplastic anemia.

The Children’s Hospital at Prisma Health – Upstate GMMC Hospital includes a new 12 bed Level I pediatric intensive care unit (PICU). The unit’s medical staff is composed of 3 pediatric intensivists and pediatric medical residents.  The patient population is diverse.  Services not covered at Prisma Health – Upstate GMMC Hospital PICU include cardiovascular surgery, burns, and transplantation.  Other specialty areas with children requiring intensive care are covered by this service.  The resident is expected to monitor, assess and contribute to the drug therapy plans.  In addition, the resident will develop a base knowledge of the differences in pediatric and adult critical care therapies.

Practice Management is a rotation designed to provide a basic overview of administrative aspects of managing a large Pharmacy department in a complex medical system.  The experiential component of this rotation focuses on actual projects, teams and PI activities currently underway rather than theoretical activities.  The rotation is intended to provide the resident with “hands on” experience in identifying and resolving administrative and clinical problems, forming and functioning within a team-work environment and developing new pharmacy initiatives to name only a few.  In addition, the resident becomes knowledgeable about key administrative responsibilities including planning, budgeting, medication safety and management structures within a large complex pharmacy department.

The preceptorship experience gives pharmacy residents an opportunity to participate as the direct preceptor / mentor for a pharmacy student’s clinical rotation while at Prisma Health - Upstate. It is designed to develop the resident’s clinical preceptorship and mentorship skills through direct precepting of pharmacy students, designing an individualized student curriculum, conducting pharmacotherapy discussions, and providing feedback/evaluations to students.

The psychiatric clinical rotation gives the pharmacy resident an opportunity to provide pharmaceutical care to acutely ill psychiatric patients.  The rotation site is located in an acute inpatient hospital that provides clinical care for adults (22 beds), geriatrics (12 beds), and children/adolescents (6 beds).  The clinical service also includes a 22-bed children's behavioral residential program, partial outpatient program, and an alcohol and drug treatment program.  The resident will design, monitor, and evaluate evidence-based patient-specific pharmacotherapy regimens as well as provide drug information to patients and healthcare providers.

Residents are required to be primarily responsible for at least one major project. The goal of this assignment is to gain experience in various aspects of research methodology. The objectives of the major project include defining a research idea, protocol development, submission to the Institutional Review Board, data collection, data analysis, and presentation/publication of results. The residents are required to present their projects at the Southeastern Residency Conference (SERC) which occurs yearly at the end of April.

The goal of the solid organ transplant learning experience is to provide insight to the resident on the role of a transplant pharmacist on a multidisciplinary team and to build better understanding of the immune system and the management of immunosuppressants. The pharmacist on the transplant team is in a unique position to make a significant impact and is recognized as an essential member of the multidisciplinary team by the Centers for Medicare & Medicaid (CMS) and the United Network of Organ Sharing (UNOS). The resident will work to provide comprehensive pharmaceutical care to transplant recipients and donors in the pre-, peri-, and post-operative phases of care. The resident will assist in managing transitions of care through medication coordination, discharge planning, and medication reconciliation and education. The resident will learn to evaluate transplant recipient medication regimens routinely, provide patient and family education on transplant medications including concepts of adherence, providing support to the Prisma Health kidney transplant department staff, researching, and answering drug information questions and communicating medication concerns to the transplant team. Majority of the rotation will be in the transplant outpatient clinic. Residents will also have the opportunity to attend weekly transplant selection committees, transplant QAPI meetings, and opportunities to shadow in the operating room during a transplant case.

Residents will be required to participate in the department’s operational pharmacy practice experience to ensure that each resident can function independently as a pharmacist. Each resident will be given basic training during the orientation month of the residency. Residents will be scheduled to work in area(s) for which they have trained for, and the experience will occur approximately every 3 weeks. Residents will be evaluated periodically to ensure accurate/efficient participation in the operational model and adherence to departmental/institutional policies and procedures. Residents in acute care service lines may staff in the unit-based model, central pharmacy, order entry, sterile processing areas, or other areas tailored to the residency program and resident’s practice area interests.

The knowledge and experiences gained in this Teaching Certificate Program will be applicable in strengthening the resident’s teaching skills and overall effectiveness regardless of the practice setting.  The program will consist of various experiences during the residency year.  These experiences will include attendance at and participation in a lecture seminar series on pedagogy topics; reading assignments; formal teaching experiences including didactic presentations, small-group facilitation, experiential teaching; evaluations and feedback of teaching; and development of a teaching portfolio. A certificate of completion will be awarded to the resident by University of South Carolina School of Pharmacy after all requirements are satisfactorily met.