Glendale Adventist Medical Center - Adventist Health
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Description of Available Rotations

Required Block Learning Experiences:

Clinical Pharmacy Services
In a series of three 4-week rotations, the resident will play a crucial role in the clinical pharmacy services provided by the hospital.  The series includes experiences in Nutrition Support, Oral Anticoagulation, and Pharmacokinetic monitoring.  The goal of the nutrition support rotation is to maximize patient benefit from parenteral nutrition, minimize potential complications from these therapies, and to insure a cost-effective approach to nutrition.

The anticoagulation rotation will provide the resident with exposure and training on the use and monitoring of all formulary anticoagulants.  During this time the resident will become proficient in the use of all anticoagulant medications in hospitalized patients.  The resident will, on a daily basis follow all inpatients receiving warfarin as to become comfortable with the dosing, monitoring and education associated with the drug. The resident will also complete one nursing or staff in-service on anticoagulation.  

The Pharmacokinetic rotation is designed to develop the resident’s knowledge and skills in drug dosing, interpreting serum concentrations, calculating pharmacokinetic parameters, identifying and making appropriate adjustments to regimens, and monitoring patients for drug toxicity. Significant time will be spent on vancomycin and aminoglycoside monitoring, in addition to other medications that warrant appropriate PK/PD targets.

Critical Care
This six week rotation is designed to provide residents with a broad training experience in managing acutely ill internal medicine patients admitted for diverse and complex medical management. Pharmacy residents assume the responsibilities of staff clinical pharmacists, including attending rounds, monitoring patients, providing inservice education to nurses and medical staff, documenting clinical activities and precepting pharmacy students.

Infectious Disease
This six week rotation will expose residents to interesting and complex infectious diseases. Residents will follow select patients and critically analyze their therapy plan. Residents and preceptors will play a major role within our Antibiotic Stewardship Program, rounding daily with the ID physician. The resident and preceptor will spend time reviewing and making recommendations regarding patients' antibiotic regimens. All pending and completed interventions will be logged into our clinical performance dashboard- Quality Compass.

Emergency Department
During this 6 week long rotation, residents will provide pharmacist support to the fast paced Emergency Department. One of the main responsibilities of this rotation is to provide physicians with an accurate and complete medication history for all admitted patients. The resident should identify and resolve any potential issues with patients' medications and provide patient education when need be.  Residents will work closely with preceptors to understand the workflow of the ED and become a solid source of drug knowledge to the physicians and nurses of the department.  

Family Medicine Services
During this 6 week long learning experience, residents will work closely with our Family Medicine medical residents in the inpatient setting as the main pharmacist rounding and helping them handle their patient case load. This rotation comes later in the year when you have gained enough experience and confidence to work independently. You will be expected to work up patients, attend rounds, make interventions, educate the medical residents on drug topics, and be the main source of pharmacy drug information to the medical residents. 

Family Practice Clinic
The Family Practice Clinic is a 6 week long outpatient clinic experience where you will again work closely with the Family Medicine medical residents on their follow-up appointments they arrange with their patients. Again you will be a source of drug information helping them handle their case load. Other experiences include working in the Pain Management clinic and attending the Geriatric Long Term Care follow-up appointments.      

Longitudinal Learning Experiences: (Year long)

Pharmacy Operations
The primary purpose of the Pharmacy Operations rotation is to gain experience in various aspects inpatient hospital pharmacy practice.  Once licensed and trained, the resident will be capable of acting as an independent pharmacy practitioner. Residents will gain experience working as a staff pharmacist to evaluate and screen physician’s orders, dispense medications, and provide clinical services in accordance with State and Federal Pharmacy Law by working one weekend per month.

Drug Information
Residents will develop a working knowledge the current healthcare environment. Through completion of projects, residents will be exposed to several aspects of drug information and hospital policy. Residents will work with preceptors to accomplish projects such as: medication use evaluations, formulary management, disease state management guidelines, medication error reduction, proposal development, and cost containment strategies. 

Pharmacy Management
During the Pharmacy Management learning experience, residents will have the opportunity to learn about the unique challenges facing hospital pharmacy management in today’s complex healthcare environment. Residents will carry out focused projects under the guidance of the department director and other members of the leadership team. These projects include but are not limited to:  policy determination, medication safety, budget and expense planning, coordinating department meetings, implementing and refining services, and managing department employees. There will also be opportunities to attend hospital administrative meetings and present reports related to the above mentioned projects.  

Project Management
All residents are required to participate in completing a longitudinal research project. The objective is to provide residents with the experience of developing, implementing, and presenting original research. Residents will meet regularly with their designated preceptors to fine tune the project and ensure adhearance to deadlines.  Residents must prepare an abstract for the Western States Residents Conference, as well as a final manuscript intended for potential publication. The completed project will be presented at the Western States Residents Conference and at a campus poster session sponsored annually by the Department of Clinical Pharmacy. Additional information is available in the Residency Manual.

Electives: (4 weeks)

Informatics
These days, information systems and automation technologies are critical in providing quality patient care and seemless operations throughout any medical center. The Pharmacy Informatics rotation will expose the resident to the various information systems and how these relate to each other at a Corporate Level. Residents will learn what is involved with maintaining, enhancing, upgrading, and providing staff support for these systems. The resident will be assigned projects based on the preceptor's current operational objectives and initiatives.

Home Infusion
This unique rotation will expose residents to home infusion pharmacy which specializes in parenteral nutrition and IV medications patients administer at home. Residents will evaluate home infusion orders for appropriateness and will help coordinate the logisitics of drug delivery and administration.

Medication Safety
Medication safety is a priority of any health care system. This rotation gives the resident an opportunity to work closely with our Medication Safety Officer on any current projects or initiatives related to medication safety. Activities include but are not limited to: developing safety initiatives, providing education inservices, developing quarterly Medication Error Report, presenting reports/initiatives at P&T committee meetings, attending Medication Error Reduction Plan (MERP) meetings.

Nephrology
The nephrology rotation allows residents to work alongside one of our hospital nephrologists as the main pharmacy reference helping with patient case load. The resident will ensure all medications are renally dose appropriately and that all interventions made are accurately followed through with. Residents will shadow the physician in the hemodialysis clinic and review patient medication profiles for appropriateness.

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