Residents will learn to independently care for patients in the setting of a pharmacist-managed ambulatory care clinic. Residents will hone their skills at managing patients with chronic disease states – including, but not limited to hypertension, dyslipidemia, diabetes, COPD, and thyroid disorders.

The Anticoagulation Clinic is primarily telephone based, however the resident will also have experience with individual (face to face) visits, which tend to have greater complexity.  The Anticoagulation clinic manages warfarin, DOACs, and low molecular weight heparins (LMWH) and provides advice to providers in many clinical scenarios including peri-procedural bridging.

The rotation involves providing comprehensive pharmaceutical care in an interdisciplinary inpatient care team. The Community Living Center (CLC) is a unique setting which cares for patients from a variety of care categories including long term care, palliative care, rehabilitation care, and sub-acute care. Activities will focus on learning to write comprehensive drug regimen reviews, monthly review notes as a consultant pharmacist would perform, as well as participation in weekly interdisciplinary team rounds, and discharge responsibilities. Didactic discussions and readings on geriatrics topics including pharmacology, chemical restraints, MDS, falls, etc. will take place regularly, and the resident will be expected to complete at least one in-service presentation. In addition, the resident will participate in wound care clinic weekly.

Residents work in collaboration with an infectious disease specialist physician and infectious disease pharmacists.   Residents round daily with both the medical and infectious disease teams. Specialty outpatient clinics include a hepatitis C clinic and travel clinic. Our antibiotic stewardship program provides hands on experience in the management of antibiotic therapy to minimize the development of antibiotic resistance and ensure appropriate antibiotic spectrum coverage.

During the ICU rotation, residents work with the ICU pharmacists, ICU medical residents, attendings and ICU nurses, in taking care of ICU medical and telemetry patients. Round daily with a Medical ICU team. Evaluate patient information, including laboratory values, disease states and medications, to ensure standard of care, VA guidelines and formulary, and standard processes, i.e. consults and documentation of use of high alert medications, are being followed. Document your interventions in the Computerized Patient Record System (CPRS). Present your patients (disease, drugs, labs, etc.) daily to your preceptor. Provide drug information to members of the healthcare team and patients when necessary. Perform the duties necessary to staff the ICU by the end of the rotation including order entry, discharge medication processing, and counseling patients on discharge.

Work with the medicine pharmacist, medical residents, attending and nurses, in taking care of medical and surgical patients. Round daily with Medical team. Evaluate patient information, including laboratory values, disease states, and medications, to ensure standard of care, VA guidelines and formulary, and standard processes, i.e. consults and documentation of use of high alert medications, are being followed. Document your interventions in the Computerized Patient Record System (CPRS). Be prepared to present your patients (disease, drugs, labs, etc.) at all times to your preceptor. Provide drug information to members of the healthcare team and patients when necessary. Perform the duties necessary to staff by the end of the rotation, including order entry, discharge medication processing, and counseling patients on discharge and if they have any medication questions while in the hospital.

Swing Shift 2 week portion: Work with swing pharmacist, medical residents and attendings for the entire hospital and triage. Evaluate patient information, including laboratory values, disease states and medications, to ensure standard of care, VA guidelines and formulary, and standard processes, i.e. consults and documentation of use of high alert medications, are being followed.

The mental health rotation provides comprehensive pharmaceutical care to mental health patients in both acute inpatient and ambulatory care settings. Experience in the following areas will be provided during the rotation: outpatient and inpatient psychotropic medication management, clozapine clinic and metabolic syndrome clinic. The rotation consists of weekly topic discussions, medication education groups, involvement in addictive disorders treatment and intensive case management programs, and tobacco cessation clinic. The rotation may incorporate other related topics according to individual interests.

This rotation involves providing pharmaceutical care to oncology patients in the outpatient and inpatient settings. Also, this rotation involves participation in the investigational drug program, R&D Committee and other research situations.  This rotation may incorporate other related topics according to individual interests.

The resident will develop skills in the practical application of pharmacoeconomic principles to the VA healthcare environment and in research design and methodologies to assess pharmaceutical-related economic, clinical, and humanistic health outcomes. In addition, the resident will spend time with Pharmacy Management attending meetings related to strategic planning, Chiefs Calls, budgetary planning, financial management, accreditation/regulatory, safety.

The following are established electives; any of the core areas may be selected as an advanced elective rotation, while additional electives may be able to be created based on resident interest:

• Academic Detailing
• Emergency Department 
• “Graveyard” (Inpatient) 

• Home Based Primary Care 

• Hospice/Palliative Care 
• Inpatient Pharmacy Operations 
• Mental Health 
• Oncology/Research 
• Pain Management
• Palliative Care 
• Specialty Clinic 
• VISN 21 Health Care Outcomes and Analytics