This 1 month experience will involve orientation to the site, reviewing the requirements of residency, basic training on the computer system, and work on the residency project. Orientation will be customized based on the needs of the resident and is intended for the new resident to gain proficiency in multiple areas prior to the start of rotations. If the PGY2 resident did not do their PGY1 residency at SNVAHCS,  they would have the opportunity to go through part of orientation with the PGY1 residents.

The resident is expected to be proficient in Vista (both inpatient and outpatient order processing) and CPRS by the conclusion of orientation. During the month of orientation, the resident is expected to have chosen their residency project, perform baseline research, discussed with the research pharmacist, and determined deadlines for the year (for IRB submission, poster presentation at CPNP, etc). The resident will be expected to read and be very familiar with all of the ASHP Outcomes, Goals, and Objectives for a Psychiatric Pharmacy PGY2, as well as the upcoming rotations.  Additionally, there are other clinical/rotation preparatory activities specified in the checklist, including computer trainings on patient assessment and readings on motivational interviewing.

The outpatient psychiatry (op) rotations are a total of 10 weeks (OP 1 is 6 weeks and OP 2 is 4 weeks) required learning experiences. The outpatient psychiatry rotations will consist of several different aspects. Patients are referred by psychiatrists and other providers to the outpatient clinic as well as the telephone clinic . The face to face clinics encompass disease state management for mental health conditions as well as primary care issues, such as diabetes, hyperlipidemia, and hypertension. Often the patient may receive management of both conditions by the pharmacist.  Psychiatric and other disease states are managed through scope of practice.  The rotation will include utilization of the VISN 21 Dashboard for identification and management of  conditions such as lab/metabolic monitoring and identification of potentially unsafe medication practices. There will be opportunities during the rotation to identify and improve existing processes.

The pharmacy resident is responsible for identifying and resolving medication therapy issues and documenting interventions appropriately.  The goal will be for the resident to function independently by the conclusion of the OP 1 rotation, and to consolidate what they have learned and gain additional experience for the OP 2 rotation. Initially, the preceptor will be present during patient visits and interviews, with the resident being given greater autonomy and independence as the rotation progresses. The resident is expected to be involved in utilizing the dashboard to identify patients that may benefit from clinical intervention.  Additionally, the resident will be responsible for following those on long acting antipsychotics as well as clozapine for medication adherence. The resident is expected to complete non-formulary consults within 24 hours of the request.   Patient care documentation is expected to be completed the same day and the preceptor will be identified as a cosigner.

The inpatient psychiatry (IP) rotations are a total of 10 weeks (IP 1 is 6 weeks and IP 2 is 4 weeks) required learning experiences. The 14 bed locked inpatient psychiatric unit (6B) is managed by one to two psychiatrists. The interdisciplinary treatment team includes the attending psychiatrist, a psychiatry resident, medical students, nursing staff, a clinical pharmacy specialist, and social workers. Suicide Prevention and Addiction Disorder Treatment Program (ADTP) staff are present as needed. The treatment team morning meeting occurs daily in a meeting room outside of the inpatient unit, and is immediately followed by rounds on the unit.

The PGY2 pharmacy resident is responsible for identifying and resolving medication therapy issues and documenting interventions appropriately. The goal will be for the resident to function independently by the conclusion of the 1st rotation, and to gain greater experience and consolidate what they have learned for the 2nd section of the rotation. The resident is expected to attend treatment team and rounds and offer recommendations as appropriate. They are also expected to provide assessment of medications on admission with documentation in the pharmacy interdisciplinary note, assessment and reconciliation of medications on discharge, as well as discharge counseling and documentation. Additionally, the resident is expected to become proficient in providing medication groups, electronic order verification for the unit, and completion of non-formulary consults. Documentation in the electronic chart is expected to be completed the same day of the patient encounter.

The Neurology rotation will consist of several different aspects, which include shadowing the Neurologist during clinic, assisting in drug monitoring, and serving as a drug information resource.

The pharmacy resident is responsible for  identifying and resolving medication therapy issues and documenting interventions appropriately.  The resident will be expected to serve as the medication specialist and drug information resource in this area. The goal will be for the resident to function independently by the conclusion of the rotation. It is recognized that the interdisciplinary team is of great importance, and the resident will be expected to function well with providers of other disciplines.

The Substance Abuse rotation will consist of several different aspects, which include becoming familiar with inpatient and outpatient detoxification procedures for both alcohol and opiate withdrawal, assisting in medication monitoring, meeting with patients as needed, providing presentations and answering drug information questions, and attending and participating in groups. As are available, the resident will be expected to take advantage of opportunities to learn (such as possibly spending time at a local methadone clinic, Northern Nevada Hopes,  and/or Alcoholics Anonymous or Narcotics Anonymous meetings).

The pharmacy resident is responsible for  identifying and resolving medication therapy issues and documenting interventions appropriately.  The resident will be expected to serve as the medication specialist and drug information resource in this area. The resident will also be expected to be proactive in identifying opportunities for improvement.  The goal will be for the resident to function independently by the conclusion of the rotation, although the pharmacist preceptor will continue to be available for questions.  It is recognized that the interdisciplinary team is of great importance, and the resident will be expected to function in a professional and mutually respectful manner with providers of other disciplines.

The Psychosocial Rehabilitation and Recovery Center (PRRC) is defined by the VA as an “outpatient multidisciplinary treatment program that provides mental health services for veterans suffering from severe and persistent mental illness (e.g. schizophrenia, schizoaffective mood disorder, bipolar disorder, major affective disorder, and PTSD) with significant functional impairment”.   This rotation will consist of visiting the home of the patient along with the PRRC team, assisting in medication group, and serving as a drug information resource for the team.

The pharmacy resident is responsible for  identifying and resolving medication therapy issues and documenting interventions appropriately.  The resident will be expected to serve as the medication specialist and drug information resource in this area. The goal will be for the resident to function independently by the conclusion of the rotation. It is recognized that the interdisciplinary team is of great importance, and the resident will be expected to function well with providers of other disciplines.

Obtaining the scope of practice is intended to be a concentrated experience, although utilizing the scope of practice and undergoing OPPE will occur throughout the year.  The resident is expected to work with the facility Clinical Coordinator and pharmacy Administrative Officer on submitting paperwork for the scope of practice. Once the scope of practice has been authorized, the resident is expected to prescribe and order labs only as authorized in the scope and by facility policy.

This longitudinal rotations lasts the duration of the residency. The resident is expected to work on projects throughout the year while on other rotations. The goal is to work on self-directed learning focusing on mental health and time management skills. Accommodations will be made for more time consuming rotations. The resident is responsible for preparing regular topic discussions.  Topic discussions are also expected with other pharmacy residents on the VISN Level. The resident will be expected to lead several of the discussions. On months the resident is not presenting, they are expected to create 3 case based questions. At least one power point or similar presentation will be prepared which  can be presented at a noon meeting for pharmacists and pharmacy students on rotation at the VA. This can be done at any time during the year.  The resident will be expected to complete a teaching certificate course through Roseman University, unless the resident already has a teaching certificate.  Additionally, the  resident is responsible for serving as preceptor for both PGY1 residents and pharmacy students on rotation while the clinical pharmacy specialist is on the same rotation.  The resident is also responsible for teaching the tobacco cessation medication class. Working with the ‘Pharmacy Week’ committee is also expected and additional assignments to complete pharmacy week are required.
 

The PGY2 project is an essential part of the PGY2 residency in psychiatric pharmacy. During the project, the resident will work closely with the Research Pharmacist, as well as their primary project preceptors.  The resident is expected to choose ideas for their project during orientation, and to work on further details of their project during August and September. The Research Pharmacist will provide guidance such as appropriate forms to submit to the IRB, assistance with abstract writing, and attention to deadlines. The resident will be expected to present their project at a minimum of 1 national meeting (ASHP or CPNP).

 

The purpose of the Pharmacoeconomics longitudinal experience is to provide the resident a variety of experiences in formulary management, population medication use monitoring, and budget oversight in the area of psychiatric pharmacy. The pharmacoeconomic rotation will be for Quarters 2-4. The rotation will start in October (the start of the fiscal year) as new projects will be available and the resident will have greater opportunities for contribution.

The pharmacy resident will be expected to actively engage in formulary management, medication use monitoring, and pharmacoeconomic initiatives in the area of mental health and neurology. In addition, the resident is also expected to participate at administrative meetings to assist in understanding the pharmacy benefit policy development processes.

To be determined based on interests of the resident.