Pharmacy residency program | veterans affairs

LEARNING EXPERIENCE DESCRIPTIONS ACADEMIC DETAILING Academic detailing (AD) is an innovative method of educational outreach for healthcare professionals. It supports improved clinical

decision-making by fostering one-on-one interaction between healthcare professionals and trained academic detailers to communicate the latest evidence-based clinical data. The resident will

actively participate on the AD service, in collaboration with the AD pharmacist. A target prescribing practice will be identified based on departmental and/or national/regional goals. The

resident will help develop initiatives and formulate an academic detailing plan to address gaps in knowledge that may facilitate prescribing change. The resident will perform a baseline

prescribing assessment, develop educational efforts to address findings, implement education efforts, and measure prescribing patterns following implementation. AMBULATORY CARE – PACT The

Patient Aligned Care Team (PACT) is a team of healthcare professionals that provides comprehensive and personalized primary care in partnership with the patient. The PACT pharmacist is

consulted to provide management for chronic conditions. The resident will perform medical chart review, patient interview and assessment, order and review lab tests, and provide physician

consultation. The resident will evaluate patients, monitor response to treatment, and make changes in therapy as needed in collaboration with the PACT pharmacist. The resident will gain

proficiency in common chronic disease states and consensus guidelines that include, but are not limited to diabetes, hypertension, hyperlipidemia, smoking cessation, thyroid disorders,

COPD/asthma, and osteoporosis. ANTICOAGULATION During this learning experience, the resident will gain a better understanding of disease states and pharmacotherapy as it relates to adult

anticoagulation both in an inpatient and outpatient setting. The resident will develop skills in assessment and monitoring of disease states, gain experience in pharmacist managed clinics,

and collaborate with providers regarding drug therapy. The resident will also provide patient education regarding pharmacotherapy and make interventions to improve medication adherence. For

patients taking warfarin, the resident will order and assess labs, interview the patient, and adjust the regimen as needed in collaboration with the anticoagulation and internal medicine

clinical pharmacist practitioners. For patients taking direct oral anticoagulants (DOAC), the resident will review DOAC consults, provide patient education, will order and assess labs as

needed, and conduct follow-up as appropriate. EMERGENCY MEDICINE Emergency medicine provides a unique training experience that focuses on topics pertinent to working in the emergency

department (ED) including procedural sedation, intubation, toxicology, trauma, hemorrhagic and ischemic stroke, cardiac emergency, ALS, and others. In the ED at the VA, you will see a

multitude of disease dates ranging from acute critical care to management of COPD and asthma and identification of adverse drug reactions. The pharmacist integrates as a team member with

emergency medical technicians, nurses, physicians, and other healthcare professionals to promote the safe and effective use of medications in patients with urgent healthcare needs. In

addition to performing direct patient care activities, the pharmacist serves as the drug information resource for the ED and may provide educational in-services to the ED clinical staff

and/or pharmacy staff as needed.  The pharmacist is involved in mixing or procuring stat or high risk medications for nurses, identifying drug therapy problems and communicating with nurses

or physicians to make changes, starting pharmacokinetic consults for antibiotics, answering drug information questions, reviewing home medication lists and clarifying errors with the

patient, attending codes, reviewing culture and sensitivity reports for the ED and appropriate follow-up with discharged patients, and counseling patients as needed. GERIATRIC AMBULATORY

CARE – GERI-PACT The Geriatric Patient Aligned Care Team (Geri-PACT) provides outpatient primary care to older adults. The Geri-PACT clinical pharmacist practitioner (CPP) provides direct

patient care through comprehensive medication management utilizing scope of practice in addition to performing comprehensive medication reviews with incoming new Geri-PACT patients prior to

their initial visits with the Geri-PACT primary care providers. The resident will function as the pharmacy member of the Geri-PACT team while on rotation and collaborate with the Geri-PACT

CPP to ensure safe and effective medication use for assigned patients in Geri-PACT clinic. The resident is expected to become knowledgeable in evidence-based regimens for common chronic

disease states, understand common geriatric syndromes, manage pharmacotherapy for medically complex patients, understand their roles and responsibilities on an interdisciplinary team,

develop independent judgment and accountability, and increase their comfort level in managing geriatric pharmacotherapy. HOME BASED PRIMARY CARE (HBPC) This rotation will emphasize the

application of therapeutics in the geriatric patient and require the resident to develop skills in proper drug therapy selection, assessment and monitoring, and patient/staff education. The

resident will collaborate with the HBPC pharmacist as part of the interdisciplinary team (includes PT/OT, social worker, dietician, nursing, provider, psychologist, etc.) which provides

comprehensive primary care to patients in a home-based setting. The resident will respond to clinical questions and perform initial and quarterly medication reviews for assigned patients

enrolled in HBPC. The resident may have the opportunity to perform home visits for HBPC patients and/or lead virtual disease state management visits with patients.  HOSPICE/PALLIATIVE CARE

AND ACUTE CARE FOR THE ELDERLY This rotation is designed to give the resident an understanding of disease states and the associated treatment encountered in the acute care geriatric and

hospice/palliative care patient. The resident will participate in daily multidisciplinary rounds on patients admitted to the inpatient hospice unit as well as patients on other inpatient

units that have an Acute Care for the Elderly (ACE) consult or a palliative care consult. ACE team rounds are attended by the ACE team attending physician, physician assistants, and

Coordinated Transitional Care (C-TraC) care managers. Hospice/palliative team rounds are attended by the hospice/palliative attending physician, physician assistants, social worker,

psychologist, and chaplain. This rotation will stress the application of therapeutics in the care of patients 65 years of age or older and patients with life-limiting illness and require the

resident to develop skills in proper drug therapy selection, patient monitoring, and patient/staff education. INFECTIOUS DISEASE This experience involves the provision of patient care for

hospitalized patients receiving antimicrobial therapy. The resident will round daily with the infectious disease (ID) team (i.e., attending physician, ID fellow, medical students) on ID

consult patients. The resident will make recommendations on selection and dosing of antimicrobial agents, evaluate for potential drug interactions or contraindications, and monitor

labs/vitals to evaluate for efficacy and toxicity of antimicrobial therapies. In addition, the resident will participate in antimicrobial stewardship for the facility by performing

pre-authorization and prospective audit with feedback to ensure that antimicrobials are used appropriately in the institution. INPATIENT MENTAL HEALTH This rotation will develop the

resident's knowledge and skills in the treatment of psychiatric diagnoses and comorbid medical disorders. The resident will make recommendations during daily interdisciplinary treatment

team meeting (includes attending psychiatrists, psychiatric residents, nurses, social workers, psychologists, and others). The team provides care for patients suffering from an acute

psychiatric episode. The resident will also conduct patient education classes on various mental health diagnoses and associated treatments for patients admitted to the psychiatric unit. The

resident will complete discharge medication reconciliation for team patients. In addition, the resident will be involved in patient care in the outpatient setting through completion of

mental health pharmacist e-consults and participation in the VA national Psychotropic Drug Safety Initiative, among other activities.   INTERNAL MEDICINE The internal medicine (IM) rotation

will provide the resident experience in managing pharmacotherapy of acutely ill patients. On this rotation, the resident will be responsible for rounding daily with the assigned internal

medicine team (i.e., attending physician, medical residents/interns/students). The resident will work toward assuming care of all patients on the team throughout the learning experience.

Assuming full ownership on the team entails following pharmacotherapy and making appropriate recommendations as well as managing pharmacokinetic and anticoagulation dosing for patients

assigned to the team in collaboration with the IM pharmacist. The resident will also be responsible for completing discharge medication reconciliation for team patients. MEDICAL INTENSIVE

CARE UNIT The medical intensive care unit (MICU) rotation will provide the resident experience in managing pharmacotherapy of critically ill patients. The resident will be exposed to a

variety of both acute and chronic general medicine disease states requiring a higher, intensive level of care. The resident will participate in the comprehensive care of MICU patients from

admission to discharge which includes attending daily interdisciplinary rounds with the MICU team (i.e., attending physician, critical care fellow, medical residents/interns/students). The

resident will recommend appropriate evidence based therapeutic interventions during rounds as well as manage pharmacokinetic and anticoagulation dosing for critical care patients in

collaboration with the MICU pharmacist.  ONCOLOGY In this learning experience, the resident will develop clinical skills in providing pharmaceutical care to hematology and oncology patients.

The resident will take responsibility and function as the oncology pharmacotherapy consultant for nursing staff, attending physicians, nurse practitioners, medical fellows, and pharmacy

staff. The resident will participate in patient education and assessment, management of medication adverse effects, management of oral anticancer treatment, patient care consultation, staff

education, and medication therapy review. The resident will gain knowledge of oncology disease states, treatment guidelines and resources, chemotherapy regimen assessment, supportive care of

the oncology patient, policy development, laboratory value interpretation, medication order review, and hazardous medication preparation and dispensing. OUTPATIENT MENTAL HEALTH This

rotation will develop the resident's knowledge and skills in the treatment of psychiatric diagnoses in the outpatient setting. The resident, working under the scope of practice of the

preceptor, will see Veterans independently and address their psychiatric medication management needs. The resident will also participate and make recommendations for assigned patients to the

behavioral health interdisciplinary program (BHIP) treatment team huddles (including psychiatrists, nurse practitioners, psychiatric residents, nurses, social workers, psychologists). The

resident will be responsible for drug information questions that arise during team meetings and through e-consult service.  In addition, the resident will be responsible for mental health

(MH) prior authorization drug requests as assigned. The resident is expected to shadow and/or participate in committee meetings, including but not limited to the VA national Psychotropic

Drug Safety Initiative, BHIP facility meetings, and the CPPO MH Subject Matter Expert (SME) Workgroup. PAIN MANAGEMENT AND OPIOID STEWARDSHIP This combined rotation will introduce the

resident to the general principles of outpatient pain care and the implementation of health system-wide efforts to improve opioid safety. Preceptors are the Pain Medication Management

Clinical Pharmacist Practitioner and the Facility Pain Management, Opioid Safety, and PDMP (PMOP) Coordinator. The resident shall gain practical experience and a better understanding of how

to manage pain in Veterans with various chronic pain conditions, including, but not limited to, lumbar radiculopathy, neuropathy, and arthritis.  The resident will assist the Pain Management

Team in patient education and comprehensive assessments of medication(s) used for pain management. Additional resident responsibilities and learning experiences will include participation

in facility or VISN meetings related to pain management and opioid safety, recommendation of non-pharmacologic methods for reducing pain, providing naloxone education, reconciliation of

medications, review of clinical dashboards to promote safe and effective medication use, and development of educational materials and/or delivery of in-services to Pain Management Clinic or

other departments, among other responsibilities. The trainee will also become familiar with the concept of the biopsychosocial model and VA Stepped Care Model of pain care and VHA’s efforts

to provide risk mitigation for Veterans on opioid therapy. PHARMACY INFORMATICS This elective learning experience is tailored to the interests of the resident.  Pharmacy Informatics topics

include of data analysis, clinical decision support, pharmacy software maintenance and development, formulary management, and procurement.  Learning opportunities include orientation to

electronic health record (EHR) data entry and maintenance, workflow assessment from provider ordering to administration of medications, and data/information management in each step of the

medication process.  The resident will be expected to work independently, attend various meetings, and complete assigned projects.  Innovative solutions to formulary management and clinical

tool development as well as application of the formulary will also be explored during this experience.  PRACTICE MANAGEMENT This rotation will expose the resident to general administrative

and clinical skills necessary to lead a complex tertiary care center with extensive inpatient, outpatient, and clinical pharmacy services. The rotation will provide the resident with insight

into key issues confronting pharmacy practice, specifically from pharmacy leadership's perspective. The resident will attend meetings and work on assigned projects in order to develop

knowledge and skills related to communication, decision making, productivity management, problem identification, problem solving, strategic planning, and policy development. The resident

will also gain a general understanding of human resource management, financial management, labor relations and pharmacy regulations and law. RESEARCH The research elective rotation will

provide the resident with expanded knowledge and skills on all aspects of research, including but not limited to the development of a research protocol, manuscript submission, data

collection and analysis, review of manuscripts, in-depth analysis of journal club articles, and many others. This rotation will be tailored to the interests and needs of the resident. The

resident will have opportunities to perform extensive data/statistical analysis and opportunities for manuscription submission as applicable. The resident will also have topic discussions

with preceptor and may lead topic discussions during this rotation to APPE students. The resident may develop a presentation related to statistical analysis /research. SUBSTANCE USE

DISORDERS This learning experience will provide the resident with experience managing all aspects of pharmacotherapy for substance use disorders and associated mental health conditions. The

resident will provide care for patients engaged in all levels of recovery – inpatient, residential, and ambulatory – on an interprofessional team including psychiatrists, psychologists,

family medicine physicians, social workers, nurses, and peer counselors. The resident will evaluate patients, initiate therapy, monitor response to treatment, and make changes in therapy as

needed, in collaboration with the SUD pharmacist. The resident will gain proficiency in treatments and guidelines for opioid and alcohol use disorders, harm reduction principles, and

motivational interviewing/patient-led treatment plans. VISN PHARMACY INFORMATICS/PHARMACOECONOMICS This elective rotation is tailored to the interests of the resident. Pharmacoeconomic

learning opportunities include formulary management, medication use evaluations, clinical guidance updates/creation, therapeutic interchange management, contracting, cost analyses, and

budget forecasting. Informatics learning opportunities include training in SQL and other data tools, data analysis, and clinical decision support. Additional learning opportunities include

medication safety, quality improvement, compliance, and management. The resident will participate in various VISN committees and may work with staff at the VISN or other facilities to

complete projects. While this virtual rotation contains no direct patient care, clinical skills will be utilized throughout the rotation.