Description of Available Rotations

Core Rotations

Core Rotations are mandatory for all residents to complete. These rotations encompass ASHP CAGOs and must be achieved to successfully graduate from Adventist Health Glendale's PGY-1 Pharmacy Residency Program. Each core rotation is a minimum of four (4) weeks.

Orientation

Orientation is a seven (7) week rotation at the beginning of the residency year where residents will be introduced to the hospital and pharmacy department. Residents will gain familiarity with the hospital’s policies and procedures, pharmacy operations, and transition into the residency program. Throughout the rotation, residents will complete all requirements mandated by the hospital and pharmacy department.

Residents will be given the opportunity to meet with the current residents during this time. There is an overlap of the residency classes to ensure a smooth transition.

After the two (2) week orientation, residents will begin their Pharmacy Operations training for the remaining five (5) weeks of Orientation under the direct supervision of residency preceptors. During this time, residents will be oriented to hospital pharmacy operations which includes, but not limited to, computerized physician order entry (CPOE), oversight of dispensing, and medication automation.

Clinical Pharmacy Services (CPS)

Clinical Pharmacy Services (CPS) is a fifteen (15) week block comprised of four (4) rotations: Infectious Diseases, Nutrition Support, Inpatient Anticoagulation, and Drug Monitoring. Each learning experience will provide intense training in different areas of pharmacy. This rotation is designed to challenge residents to provide comprehensive care through various clinical services offered at Adventist Health Glendale. The goal of this rotation is for residents to develop their own clinical practice and manage patients in a safe, effective manner. To facilitate this, the last three (3) weeks of this rotation will be designated as “Clinical Week” which requires each resident to manage the entire shift independently for either the East or West Tower.

• CPS: Infectious Disease–Infectious Diseases (ID) is a five (5) week learning experience within the Clinical Pharmacy Services rotation that focuses on the management of all patients on antimicrobial agents (excluding critical care patients). Residents will learn diverse and complex infectious disease states, while strengthening their understanding of the medications used to treat such conditions. This learning experience will focus on two main elements: dosing antibiotics and Antimicrobial Stewardship Program (ASP). Residents will work closely with all physicians but especially ID teams by staying in constant communication and attending ID rounds.
• CPS: Nutrition Support–Nutrition Support is a five (5) week learning experience within the Clinical Pharmacy Services rotation that focuses on our Basal Bolus Insulin Program (BBIP) and Total Parenteral Nutrition (TPN) management. Under pharmacy-driven protocol, BBIP provides a unique platform for residents to independently manage insulin regimens for patients enrolled in this service. Residents will gain a thorough understanding of glycemic management and work closely with the nurses to ensure safe and effective therapy for patients. Residents will be taught to manage all adult TPN patients from initiation to discontinuation. Residents will work with registered dietitians, nurses, and physicians to provide collaborative care in the nutritional support of their patients.
• CPS: Inpatient Anticoagulation–Inpatient Anticoagulation is a one (1) week learning experience within the Clinical Pharmacy Services rotation that provides intense training on a variety of anticoagulants that pharmacy has been tasked to monitor. These agents include warfarin, heparin, enoxaparin, and direct-oral anticoagulants.
• CPS: Drug Monitoring–Drug Monitoring is a one (1) week learning experience in the Clinical Pharmacy Services rotation that provides intense training on various protocols. These protocols include renal dose adjustment, weight-based dosing, IV to PO conversion, drug level monitoring, high risk medication review, and pharmacotherapy consults.
• CPS: Clinical Week–Clinical Week will be the last three (3) weeks of the Clinical Pharmacy Services learning experience. Residents will be assigned to either East or West tower. Residents will provide comprehensive pharmacy services learned within the past 12 weeks of this learning experience to their assigned patient list. Residents are expected to be able to manage their own practice with minimal supervision from the preceptor(s).

Critical Care

Critical Care, designated as ICU, is a six (6) week rotation focusing on the management of critically ill patients. Adventist Health Glendale has three (3) critical care units: Intensive Care Unit (ICU), Cardiac ICU, and Surgical ICU. Each unit holds 10-12 patients with a typical census of 50-70%. Residents will be exposed to a diverse range of complex acute disease states commonly seen in critical care medicine. Residents will learn to efficiently assess patients to provide comprehensive pharmacy support to the multidisciplinary team comprised of intensivists, nurses, dietitians, social workers, respiratory therapists, and other healthcare providers. Residents will actively participate in ICU multi-disciplinary rounds (MDR) daily and become an integral part of the team.

General Medicine

General Medicine, also known as Family Medicine Service (FMS), is a four (4) week rotation that will allow residents to work independently with our Family Medicine team composed of a physician attending and medical residents. Residents will represent our department and provide pharmacy support to the FMS team to optimize care for patients enrolled into their service. The FMS service enrolls a diverse patient population with a typical patient load that ranges from ten to twenty patients throughout the hospital in varying levels of acuity.

Transition of Care

Transition of Care (TOC) is a twelve (12) week rotation comprised of five (5) learning experiences: Emergency Medicine, Multidisciplinary Rounds, Discharge Pharmacy, Outpatient Pharmacy, and Ambulatory Anticoagulation Clinic. This rotation is designed to expose and train residents in all facets of Transition of Care.

• TOC: Emergency Medicine (Designated as E1)–Emergency Medicine is the 1^stcomponent of the TOC rotation. During these three (3) weeks, residents will interview patients/caregivers or contact that patient’s outpatient pharmacy/long-term care facility in the Emergency Department (ED) to perform home medication reconciliation. If patient/caregiver is not available, residents will learn to utilize other resources to gather the information. Residents will also learn to triage all direct and overnight admissions to ensure these patients’ home medication lists are accurate. Residents will also provide pharmacy support to the ED staff which includes physicians, nurses, social workers, etc.
• TOC: Multidisciplinary Rounds (Designated as MDR)–Multidisciplinary Rounds, commonly referred to as MDR, is the 2^ndcomponent of the TOC rotation. During this one (1) week, residents will gain insight into discharge planning. The MDR team is composed of nurses, case manager, social worker, pharmacist, and the primary physician. Residents will conduct daily rounds on an assigned unit and manage all facets of inpatient care (i.e. medication adjustments, ASP, etc.). There will be a strong emphasis on discharge planning during these rounds.
• TOC: Discharge Pharmacy (Designated as M5)–Discharge Pharmacy, commonly referred to as M5, is the 3^rdcomponent of the TOC rotation. During these three (3) weeks, residents will work closely with our physicians and nurses to ensure patients are being discharged on optimized drug regimens by conducting discharge medication reconciliations. Residents will also play an active role in heart failure management by optimizing medication management for congestive heart failure (CHF). Residents will also evaluate pharmacological intervention strategies in preventing falls in high fall risk patients. Lastly, residents will further reinforce medication reconciliation skills by conducting timely completion of long-term acute care (LTAC) admission medication histories for patients admitted to our Transitional Care and Rehabilitation Units.
• TOC: Outpatient Pharmacy (Designated as SMD)–Outpatient Pharmacy, commonly referred to as Satellite Medication Dispensing (SMD), is the 4^thcomponent of the TOC rotation. During these two (2) weeks, residents will gain various outpatient pharmacy experiences which includes filling and dispensing medications, order verification, bedside delivery and consultations, prescribing/refill authorizations under collaborative practice agreement, specialty pharmacy, and prior authorizations and appeals. Residents will also play a role in our post-discharge care, including phone calls to the patients and their pharmacies to ensure continuity of care.
• TOC: Ambulatory Anticoagulation Clinic (Designated as ACC)–Ambulatory Anticoagulation Clinic (ACC) is a three (3) week rotation focusing on the ambulatory care side of pharmacy practice and the last component of TOC. Ambulatory care settings offer patients a middle ground between inpatient and outpatient service. At ACC, ambulatory care pharmacists manage patient’s anticoagulation, mainly warfarin. Residents will conduct patient interviews to gather information and optimize medication regimens. Residents may also play an active role in the management of DOAC regimens by assessing patient information and evaluation appropriateness of medication.

Intravenous (IV) And Sterile Compounding

Intravenous (IV) and Sterile Compounding is a four (4) week rotation designed to provide ample training in both the sterile compounding and non-sterile compounding IV room. Residents will learn to manage the sterile IV compounding room and gain experience in parenteral medications utilized in the hospital, including chemotherapy, outpatient infusion center (OPIC), and neonatal intensive care unit (NICU) orders. Residents will gain experience in compounding medications and conducting final checks of others’ work using BD IV preparations. Residents must demonstrate the ability to successfully compound ten (10) items during the rotation. Residents will also learn to manage tasks outside the IV room which includes working with pre-mix medications and oral syringes.

Longitudinal Rotations

Longitudinal Rotations are mandatory for all residents to complete. These yearlong rotations take place concurrently with Core and Elective Rotations. These rotations encompass ASHP CAGOs and must be achieved to successfully graduate from the PGY-1 Pharmacy Residency Program.

Pharmacy Operations

Pharmacy Operations: Weekend A

Pharmacy Operations: Weekend B

Adventist Health Glendale currently uses Cerner for our Computerized Physician Order Entry (CPOE). Pharmacy Operations is a longitudinal learning experience designed to train residents on various Cerner applications and work towards becoming competent staffing pharmacists. Residents will develop advanced practice skills in managing drug therapy for a variety of diseases, as well as build proficiency in communication with other healthcare professionals. This longitudinal rotation will expose residents to several aspects of the pharmacy operations including medication usage evaluation, target drug implementation, formulary management, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards, disease state management guidelines, and quality improvement projects. Residents will help cite the potential contribution of automation and technology to medication misadventures at the departmental and organizational levels.

Residents will be assigned to either Weekend A or B. There isno differencebetween the weekends except for staff. The responsibilities and duties are the same regardless of the weekend. Residents will switch weekends halfway through the residency year (after winter holidays).

Pharmacy Management

Pharmacy Management is a yearlong learning experience that will introduce residents to pharmacoeconomic principles, operations management, and strategic planning for the pharmacy department. Residents will complete management-focused projects under the guidance of the pharmacy management team.

This longitudinal rotation is defined by each of the four (4) separate Resident Responsibilities which were designed to enhance leadership skills throughout the year. During Orientation, the exiting residency class will transition the new residents to their roles. Thereafter, at the end of each quarter, the role will be transitioned from resident to coresident.

• Pharmacy Management: Chief Resident–The Chief Resident is the lead resident that will serve as the liaison between residents and the residency team (preceptors and management). The Chief Resident is the correspondent to relay messages to and from the residents. The Chief Resident will work closely with the Residency Program Coordinator to facilitate the schedule and activities of the residency. It is the responsibility of the Chief Resident to keep the entire residency team on the same page in regard to meetings, deadlines, events, schedules, etc. The Chief Resident is responsible for coordinating the mandatory professional events (refer to Section XI. Professional Events).
• PHarmacy Management: Antimicrobial Stewardship (ASP) Resident–The Antimicrobial Stewardship (ASP) Resident will play an active role in the Antimicrobial Stewardship Program. The ASP Resident will work closely with the Clinical Coordinator, the Physician Champion for Infectious Diseases, and the Lead Infectious Diseases Pharmacist to monitor and report antimicrobial use at Adventist Health Glendale.
• Pharmacy Management: Operations Resident–The Operations Resident will serve as an assisting supervisor for inpatient pharmacy operations. The Operations Resident will work directly with the Inpatient Operations Supervisor and Manager to assist in projects, audits, and/or inspections. It is the responsibility of the Operations Resident to help manage the workflow of the pharmacy.
• Pharmacy Management: Student And Intern Managing Resident –The Student and Intern Managing Resident will assist all pharmacy students and interns at Adventist Health Glendale. Working with the Experiential Education Liaison, the Student and Intern Managing Resident will ensure a positive learning experience for pharmacy students rotating at Adventist Health Glendale. Working with the Intern Pharmacist Coordinator, the Student and Intern Managing Resident will facilitate mentorship and integration of the interns into our pharmacy team. Responsibilities may include, but not limited to, involving interns with research, mentoring them when selecting APPE rotation(s), and guiding them through application/interview process if they are applying to residency.

Pharmacy Educational Services

Pharmacy Educational Services is a yearlong learning experience designed to offer residents the experience of providing drug information services in a health system organization. This longitudinal rotation provides diverse opportunities to provide education throughout our hospital and improve clinical practice. Residents will work closely with the Clinical Coordinator to develop and implement pharmacy policies and protocols. Residents will gain experience providing and presenting drug information to various hospital committees and staff. Residents will also work with our Adventist Health (AH) corporate office to complete projects. Residents will be paired with project preceptors as mentors to help guide the successful completion of assignments. All projects assigned are at the discretion of the Clinical Coordinator.

This longitudinal rotation has an additional component which is the teaching certificate with one of our affiliated pharmacy universities.

Project and Research Management

As part of ASHP’s requirement for PGY-1 Pharmacy Residency Programs, residents will participate and complete a longitudinal research project. This rotation allows residents to explore original and innovative areas in pharmacy that will contribute to the department and the profession. Residents will discuss potential areas of research with the Residency Director and Residency Program Coordinator during the Orientation rotation. Residents will be assigned project preceptor(s) who will assist and guide them through their research, providing feedback throughout the year. Residents will also be paired with our pharmacy interns to provide support in data collection. Residents are expected to independently manage their own projects, which includes developing methodology, collecting, and analyzing data, and adhering to deadlines. Residents will gain experience with the Institutional Review Board (IRB) procedure for research approval. The residents are responsible for keeping their project preceptor(s), Residency Program Coordinator, and Director informed about their progress throughout the year.

In May, residents will present their original research at the Western States Conference (WSC). This includes submitting an abstract and the final presentation for acceptance to the conference.

Elective Rotation

The goal of the elective rotation is to allow residents to pursue their area of interest(s) and expand their knowledge. Therefore, if there is an area of interest not listed below, our program allows residents to create their own elective rotation. To do so, residents must inform the Residency Program Coordinator and Director who will identify a physician to champion the new elective.

Most elective rotations are precepted by non-pharmacists, but rather physicians who are specialists in the area. Therefore, these physician preceptors heavily rely on our residents to provide pharmacy support during their respective learning experiences.

Available Elective Rotations:

Advanced Critical Care

Advanced Infectious Diseases

Behavioral Medicine

Cardiology

Neonatal Intensive Care Unit (NICU)

Nephrology

Neurology

Oncology

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