Neonatal Intensive Care:

The rotation will include experience in the Neonatal ICU (NICU) with the ultimate goal of developing proficiency in providing total pharmaceutical care to this patient population. Saint Francis Hospital and Medical Center has a 28-bed Level III Neonatal Intensive Care Unit (NICU), located on the fourth floor of the Patient Care Tower. It is a designated tertiary care facility that provides comprehensive care to critically ill newborn infants.. The NICU provides intensive medical, surgical and nursing care, state of the art electronic monitoring, life support systems and a complete range of diagnostic and therapeutic capabilities. The NICU treats major newborn disorders such as: prematurity, respiratory distress syndrome, congenital malformations, metabolic disorders and birth asphyxia. The unit is staffed by a full complement of experienced nurses, neonatal nurse practitioners and physician assistants and board certified neonatologists, as well as respiratory therapists, pharmacists, occupational therapists, social workers and case managers. The resident will focus on the pharmacologic management of neonatal sepsis, patent ductus arteriosis, respiratory distress syndrome and neonatal pharmacokinetics.

Women's Health:

The rotation will include experience in the high-risk antepartum unit as well as the well-mother and well-child units with the ultimate goals of providing total pharmaceutical care to this population of patients. The rotation will focus on the pharmacology management of medical conditions encountered during pregnancy including premature labor, premature rupture of membrane, gestational diabetes, pregnancy-induced hypertension, and medication use during pregnancy and lactation.

Medication Safety:

This rotation will provide the resident knowledge and experience to identify, develop and implement safe medication practices. The resident will gain knowledge through reading articles and publications on mediation safety. The knowledge will then be applied to develop and implement initiatives to improve the medication use system. The resident will be an active member of the Medication Safety Taskforce and all associated subcommittees. The resident will receive ample opportunity to contribute to medication occurrence reporting, measurement, and performance improvement indicators, as well as program specific indicators (e.g. high-risk medications), direct “nursing medpass” observations and quality assurance reporting.

Anticoagulation:

The Section of Hematology/Oncology provides an anticoagulation service for outpatients who are taking warfarin (Coumadin), heparin and low molecular weight heparin (LMWH). The service aims to: Provide outpatient management of appropriately screened patients with deep venous thrombosis (DVT) therefore avoiding unnecessary hospital admissions. Provide anticoagulation and monitoring for patients with atrial fibrillation, artificial heart valves, deep venous thrombosis, pulmonary embolus, strokes and cardiomyopathy. Monitor and manage pregnant women with deep venous thrombosis as well as those women who require anticoagulation to prevent deep venous thrombosis while pregnant. Provide expertise in testing and management of patients with tendencies to develop blood clots (hypercoagulable states) as well as in patients with bleeding tendencies. Provide education to patients and their families. The anticoagulation service is located on the Saint Francis Hospital and Medical Center's campus on the 2nd floor of the Cancer Center and is staffed by nurses and pharmacists.

Behavioral Health:

Saint Francis provides a broad range of behavioral health programs and services. These services include a Clinical Assessment Center, In-patient Care and Out-patient Services for children, adolescents and adults, Detoxification Services, Brief Treatment Service, Dual-Diagnosis Treatment, and Substance Abuse Rehabilitation. The resident will provide clinical pharmacy services to these clinical areas and gain insight into the pharmacologic treatment of patients with mental illnesses.

Family Medicine:

Typically a one-week experience to give the pharmacy practice resident exposure to the style of patient care within a family practice setting. Additionally, the resident's experience will focus on appropriate and ethical relationships with the pharmaceutical industry.

Infectious Disease Clinic:

The training sites for this rotation are the Adult Medicine Clinics of the Burgdorf/Fleet Health Center and the Gengras Ambulatory Care Center. The resident will have an opportunity to provide clinical pharmacy services relating to the drug therapy management of HIV and hepatitis C to patients encountered at both sites.

Hematology/Oncology:

The practice site for this Hematology/Oncology rotation is the inpatient oncology ward (8-1) and the Cancer Center at the Saint Francis Hospital. The Hematology/Oncology department is staffed by a multi-disciplinary health care team consisting of attending physicians, medical residents, hem/onc fellows, physician assistants, registered nurses, nurses aides, registered dietitian, social workers and clinical pharmacists. The patient population consists of cancer patients with a variety of co-morbid problems.

The goal of this rotation will be to provide a generalized experience in medication and disease state management dealing with cancer patients. Residents will learn how to overcome various barriers in order to provide quality patient care and achieve positive disease outcomes for varied patient population.

Adult Internal Medicine:

The practice site for this rotation is Patient Care Unit 10-9, which is a high-level telemetry unit where the pharmacy practice resident will encounter patients with hypertension, diabetes mellitus, asthma/chronic obstructive pulmonary disease, coronary artery disease, various renal and hepatic diseases, gastrointestinal diseases, congestive heart failure, thromboembolic diseases, and various infectious diseases. The resident will be part of a multi-disciplinary team and will interact daily with attending physicians, resident physicians, licensed independent practitioners, nurses, case managers and other ancillary clinical staff.

Managed Care:

Established in 1997, The Pharmacy Group, LLC, is a healthcare consulting and education company with diverse expertise in all facets of managed care pharmacy programs. This firm provides creative solutions to healthcare providers, managed care organizations and pharmaceutical companies on managing the pharmacy benefit and improving the utilization of pharmaceuticals.

Radiopharmacy:

Cardinal Health Nuclear Pharmacy Services operates a centralized radiopharmacy. The radiopharmacists compound and dispense radiopharmaceuticals based on prescription orders. We deliver directly to nuclear medicine departments and private clinics that perform diagnostic imaging and therapeutic dosing. The orders are filled on a unit dose basis. Due to the nature of the short-lived isotopes and compounded radiopharmaceuticals, they are prepared and delivered overnight. This is considered the first run. A second run is prepared and sent out by 0900. The rest of the day consists of other preparations and processing orders for the next day.

The resident is expected to observe the process of the whole operation starting with the first run and finishing up with the afternoon set up for the next day. He/she will observe the compounding of the radiopharmaceuticals, quality control procedures, the mathematics involved, and proper DOT processing for transport, while following safe radiation safety practices. The ultimate goal is to see how nuclear pharmacy fits into the overall health care system. This will be completed by a visit to a nuclear medicine department.

Practice Management:

This rotation includes management experiences related to all pharmacy services and programs located throughout the Saint Francis Care system. Financially, pharmacy services have been combined under one budget for most of the system with the exception of the Portland Behavioral Health campus located in Portland Connecticut.

The department of pharmacy is a support department with a focus on customer service. A great deal of effort has been expended to develop strong relationships and affiliations system-wide. This rotation will focus on identifying appropriate tools to use to enhance these relationships through communications and a “systems-thinking” approach. Knowledge of regulations, both state and federal, as they pertain to pharmacy operations will be stressed throughout the rotation along with Joint Commission on Hospital Accreditation standards. Performance improvement with a focus on outcomes and measurement is an integral part of this rotation. The integrated pharmacy services provided at Saint Francis are noted below:

There will be exposure to all regulatory aspects of pharmacy practice management for an integrated health care system. Specifically the resident will review pharmacy and DEA licenses, and controlled drug certificate requirements for the following facilities:

Cardiac Intensive Care:

The experience in the CICU (Cardiac ICU) is designed to provide the Pharmacy Practice Resident with an opportunity to be directly involved in the management, selection, and monitoring of pharmacotherapy in critically ill cardiac patients. The disease states encountered may include, but may not be limited to the following: acute coronary syndrome, ischemic heart disease, acute and chronic heart failure, thromboembolic disorders, dysrhythmias, hypertensive urgency, endocarditis, sternal wound infections, open heart surgery and related post-operative complications.

Drug Information/Policy:

The primary goal in this longitudinal rotation is to assist the resident in gaining proficiency in responding to drug information requests, both formal and informal. Drug information requests involve daily questions, preparation of materials for DTM meeting (formulary monograph reviews), and preparation of newsletters and informational documents for hospital personnel. The resident will also participate in activities involving drug policy, namely, participation in drug usage evaluations, DTM meetings and policy and procedure development, where applicable.

Medical Intensive Care:

Attend daily work and attending rounds with the intensive care team serving as the team's primary source of drug information and actively participate in the management of each patient's drug therapy. Monitor the progress of-each patient by evaluating lab data, appropriate physical findings, vital signs and other clinical symptoms. Exercise insight and expertise to anticipate, prevent, detect and manage adverse drug reactions and drug interactions. Anticipate therapeutic controversies and formulate appropriate alternatives.

Surgical Intensive Care:

Attend daily work and attending rounds with the intensive care team serving as the team's primary source of drug information and actively participate in the management of each patient's drug therapy. Monitor the progress of-each patient by evaluating lab data, appropriate physical findings, vital signs and other clinical symptoms. Exercise insight and expertise to anticipate, prevent, detect and manage adverse drug reactions and drug interactions. Anticipate therapeutic controversies and formulate appropriate alternatives.

Ambulatory Care:

The ultimate goal of this rotation is to aid in the development of proficiency in pharmaceutical care skills. During this longitudinal experience, the resident will be exposed to medication and disease state management in a primary care setting. The resident will be expected to draw upon foundation skills and didactic knowledge and practically apply this to the patient care setting. Residents will develop and refine their critical thinking skills, further develop written and verbal communication skills, and ultimately develop competency in ambulatory pharmacy practice. The longitudinal style of this rotation will give the resident the chance to integrate elements of practice over time, develop independent problem-solving skills, and have the time to build confidence in this setting. It is expected that the resident will gain the ability to anticipate, recognize, monitor, solve and document patient-related therapeutic problems by applying the principles of appropriate drug therapy.

Pharmaceutical Industry:

Bristol-Myers Squibb Company (BMS) is a pharmaceutical and related health care products company whose mission is to extend and enhance human life by providing the highest-quality pharmaceuticals and health care products.

This rotation will include exposure and experiences related to the pharmaceutical research industry at BMS. Most will occur in Wallingford, CT. There may be some activities in New Brunswick and/or Lawrenceville, NJ. This rotation will focus on providing an overview of the departments and processes required to bring a compound to market. These processes will be put into a perspective with respect to FDA, GCP and ICH guidelines.

There will be exposure the following segments of the pharmaceutical research industry:

• Clinical Discovery
• Clinical Supply Operations
• Drug Discovery
• Drug Safety and Pharmacovigilance
• Global Development Operations
• Outcomes Research
• Regulatory Affairs
• Statistics

Pharmacy Service:

The Department of Pharmacy provides a broad range of clinical pharmacy services. The pharmacy employs a staff of over 90 professional and technical individuals. The pharmacy serves inpatients and outpatients at two main campuses. Clinical services are decentralized at both sites, and pharmacists are actively involved in general internal medicine, cardiology, medical/surgical intensive care, neonatal intensive care, hematology/oncology, women and children's services, behavioral health, medication safety, and various primary care settings. Medication distribution is highly automated, and prescriber-order entry is utilized system-wide. The mission of the Department of Pharmacy is to provide efficient, cost-effective, and clinically excellent patient-directed pharmaceutical care to all customers in the Saint Francis community through dedication, education, and continuous quality improvement. The resident will participate in a longitudinal (precepted) pharmacy service experience to aid integration of overall pharmacy operations and our contemporary clinical pharmacy services.

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