PGY2 Pharmacy Residency (Critical Care) Greenville - Rotation Descriptions

The Cardiology Teaching Service (CTS) experience is an elective rotation. CTS directly admits patients and accepts consults from various services at the Greenville Memorial 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.

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 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 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.

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 Neurocritical Care service at Prisma Health – Upstate GMMC Hospital 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, status epilepticus, meningitis, intracranial hypertension, toxic encephalopathy, cerebral venous sinus thrombosis, and neuromuscular emergencies. Students will be responsible for designing and monitoring drug regimens for these critically ill patients. Other services provided by the student may include researching drug information for the team as requested, pharmacokinetic evaluation / dosing, and patient education as needed.

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 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.

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.

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 elective 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 the Critical Care PGY2 program staff in the unit-based model - order entry position and Emergency Department rotating every 3 weeks.

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.

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. (If not already recieved during PGY1 year).