Pharmacy Practice at Paoli Hospital

General pharmacy practice

(7 weeks)
Preceptors: Marissa Hadley, PharmD, BCPS; Alyssa Moore, PharmD

Pharmacy practice and orientation is a required seven-week rotation beginning the date of hire. This rotation will allow for the resident to become familiar not only with the layout of Paoli Hospital, but also with the staff, each satellite's intricacies and the pharmacy system. During this rotation, the resident will observe and participate in technician responsibilities, such as IV admixture, medication filling/delivery, restocking Pyxis process, ordering, pre-packing unit dose medications and compounding. The resident will also observe and participate in pharmacist duties, as this will encompass the majority of their responsibilities. These include, but not limited to, learning policy/procedures of Main Line Health (MLH), Epic (clinical system), non-formulary drug reviews, therapeutic substitutions, daily reports and chemotherapy. Also, included during this time is two-day Main Line Health Orientation as well as Main Line Health Culture of Safety Training. Good communication and interpersonal skills are vital to success in this experience. The resident must devise efficient strategies for accomplishing the required activities in a limited time frame.

Internal medicine

(5 weeks)
Preceptor: Andrea Lordan, MS, PharmD, BCPS

The internal medicine rotation is a required five-week rotation that will give the resident a basic understanding of disease states encountered in adult internal medicine. This rotation will stress the application of therapeutics in patient care and require the resident to develop skills in proper drug therapy selection, patient monitoring, pharmacokinetics, patient education, drug administration and delivery of pharmaceutical care to hospitalized patients. Core content will be covered via patient experiences, discussion of reading materials and/or case presentations. During this Internal Medicine rotation, the resident will round on the telemetry floor, medical/surgical floor and orthopedic floor. Common disease states in which the resident will be expected to gain proficiency through literature review, topic discussion and/or direct patient care experience include but are not limited to congestive heart failure, stroke, acute myocardial infarction, atrial fibrillation, common infectious diseases, chronic/acute renal failure, COPD, thromboembolic disease, diverticulitis, ulcerative colitis and orthopedic topics.

Adult critical care/trauma

(5 weeks)
Preceptor: Kiyo Yoda, PharmD

The adult critical care/trauma rotation is a required five-week rotation that provides experience in a variety of disease states found in the critical care setting. The resident will have experiences which will improve their understanding of the diagnosis, pathology, pathophysiology and pharmacotherapy of the critically ill patient. The Intensive Care Unit (ICU) is a 16-bed unit comprised of medical and surgical intensive care patients. The daily ICU interdisciplinary rounds focusing on medical or cardiac patients are typically led by the ICU director or a Critical Care Hospitalist. The trauma interdisciplinary rounds are led by Jefferson Health System Trauma Surgeons twice a week on trauma patients only. In addition to rounding, other typical daily activities include: patient profile review and identification of and resolution of any medication related issues (ex. IV-PO, vancomycin levels), laboratory data monitoring for appropriate dosing of drug therapy (ex. renal dosing, antimicrobial cultures & sensitivities), evaluation of medication regimens for appropriateness and cost-effectiveness, proactive involvement in drug therapy management, monitoring and reporting adverse drug reactions. The resident will demonstrate the ability to effectively communicate with health-care professionals by presenting information in a practical, logical, well-organized and timely manner.

Infectious diseases

(5 weeks)
Preceptor: Deena Rojek, BS, PharmD; Lisa Case, PharmD

The infectious diseases rotation is a required five-week rotation in which the resident will design, recommend, monitor and evaluate patient-specific therapeutic regimens which will concentrate on proper antimicrobial selection based on knowledge gained during infectious disease rounds with Paoli Hospital's infectious disease physicians, along with analyzing microbiology and laboratory values, utilizing the pharmacology, pharmacokinetics, pharmacodynamics and therapeutics. The resident will develop problem solving skills and participate in antimicrobial stewardship activities which include appropriate selection, dosing, route and duration of antimicrobial therapy. The resident will utilize the following stewardship strategies including formulary restrictions and pre-authorizations, streamlining or de-escalation of therapy, dose optimization, parenteral to oral conversions, prospective audit with intervention and feedback and education based on clinical guidelines and pathways.

Pharmacy practice management

(5 weeks)
Preceptors: Al Celidonio, RPh, Director of Pharmacy; Dan O'Loughlin, PharmD, Pharmacy Manager

The pharmacy practice management rotation is a required five-week rotation that places emphasis on issues of planning, structure, organization, leadership and philosophy of practice in an integrated health care system. The program helps build the resident's maturity, creativity, judgment and problem solving skills necessary in the development and management of progressive pharmacy programs. The pharmacy practice management rotation is designed to ensure that the pharmacy resident receives proper training and guidance regarding the myriad of pharmacy services and leadership skills necessary to be successful in today's multidisciplinary health care environment. The resident will work with the Director during this rotation. The resident will at times function as a supervisor in the various areas of the pharmacy.

Emergency medicine

(5 weeks)
Preceptor: Sean Young, PharmD, BCPS

The emergency medicine rotation is a required five-week rotation. At Paoli Hospital, the ED averages over 30,000 patient visits annually and is compromised of three rapid evaluation rooms, 21 acute beds, five fast track beds and two trauma bays. Paoli is a Level II trauma center and is the only trauma accredited hospital in Chester County. During this rotation, the pharmacy resident will be responsible for establishing a relationship and working with the ED personnel to identify, prevent and resolve many different types of medication issues. The resident will provide both cognitive and dispensing services to the ED. The dispensing functions will include review of medication orders generated for ED patients and fulfillment of medication orders as needed. The cognitive functions will include medication list management, patient counseling/education, decisions about patient care, assisting with traumas/codes, developing educational materials and providing drug information as needed.

Transitions of Care

(5 weeks)
Preceptor: Kelly Butler, PharmD

The transitions of care rotation is a required five-week rotation that will focus on improving processes that occur during a patient’s transition from hospital to home to help prevent avoidable readmissions. The first area of focus will be following all admitted congestive heart failure (CHF) patients and providing education to them on their medications and lifestyle modifications to manage their CHF diagnosis. Residents will work along-side case management to ensure patients can afford any newly prescribed medications. The second area of focus in the transitions of care program is performing a discharge medication reconciliation on patients at high-risk for readmission based on a scoring system used in their electronic medical record. The resident will review patient’s discharge medications to ensure correct medications and dosages are prescribed on discharge based on any changes made to their medication regimen during their hospitalization. This rotation will require the resident to develop skills in patient counseling and also develop skills in interacting with prescribers regarding the appropriateness of patient’s medications.

Medication safety

(4 weeks)
Preceptor: Alyssa Moore, PharmD

The medication safety rotation is an elective four-week rotation designed to assist the resident in identifying ways to improve the medication use system and minimize the risk of adverse drug events. The resident will participate in various initiatives which will positively impact medication safety in a community hospital setting. The resident will become familiar with strategies utilized in medication safety through projects, meetings and communication tools.

Outpatient hematology/oncology

(4 weeks)
Preceptors: Joe Stuccio, RPh, MS, Julie Paris, PharmD

The outpatient hematology/oncology rotation is an elective four-week rotation that focuses on developing the resident's knowledge base and skill set in providing care for the ambulatory oncology patient. The rotation provides an opportunity for the resident to practice clinical pharmacy in a medical oncology clinic setting and interact with a multidisciplinary team in the provision of evidence-based treatment and supportive care. The resident will also learn the role of the infusion pharmacist by reviewing chemotherapy regimens, preparing and dispensing chemotherapy.

Pharmacy informatics/information technology

(4 weeks)
Preceptors: Heather Troup, PharmD; Pharmacy IT staff

The pharmacy informatics/information technology rotation is an elective four-week rotation which exposes the resident to Main Line Health System’s medication-use system by applying pharmacy informatics principles, standards and best practices including computerized physician order entry, electronic medical records automated dispensing cabinets, etc. The resident will gain basic understanding of the language and concepts of information technology by working closely with the Pharmacy System Administrator and the pharmacy informatics specialists.

Cardiology

(4 weeks)
Preceptor: Kelly Butler, PharmD

The cardiology rotation is an elective four-week rotation in which the Paoli residency program has teamed up with the Cardiology Consultants of Philadelphia (CCP) — Main Line Division. The physician practice is located conveniently across the street from Paoli Hospital and consists of multiple physicians, nurse practitioners and physician assistants. The resident will divide their time between the cardiologists and nurse practitioners who are on site each day. The resident will also have the opportunity to spend time in the cardiac cath lab with the interventionalist. Paoli Hospital is recognized nationally for quality in cardiac care and offers a broad range cardiovascular services. After completing the rotation, the resident will have gained a better understanding of the pharmacology, pharmacokinetics, pharmacodynamics of cardioactive drugs, be able to discuss the pathophysiology of cardiac disease, explain the role of the ECG in diagnosis and drug monitoring of cardiac disease and understand the use of other basic cardiac diagnostic tests including physical assessment of the cardiovascular system, as well as the appropriate use of interventional procedures.

Antimicrobial stewardship

(4 weeks)
Preceptor: Deena Rojek, PharmD; Lisa Case, PharmD

The antimicrobial stewardship rotation is an elective four-week rotation designed to develop the resident’s clinical knowledge and skills in recommending and promoting the appropriate use of antimicrobials in the hospital setting and to incorporate evidence-based pharmaceutical care to improve patient outcome. The resident will gain valuable experience in designing initiatives and programs to improve antimicrobial use. The resident will participate in antimicrobial stewardship rounds with the lead physicians for antimicrobial stewardship at Paoli Hospital.

Neonatal Intensive Care (NICU)

(4 weeks)
Preceptor: Lindsay Fitzpatrick, PharmD, BCPPS

The neonatal intensive care unit (NICU) rotation is an elective four-week rotation in which the resident will spend time at Lankenau Medical Center. This is a level III NICU that provides quality care for critically ill infants. It is staffed by fellowship trained neonatologists and advanced practice providers (CRNPs and PAs) who are affiliated with the Children’s Hospital of Philadelphia (CHOP). The resident will participate in weekly interdisciplinary rounds. The resident will participate in various projects with the preceptor to optimize the efficiency and safety of the medication use system for neonatal patients.

Drug information

Preceptor: Kiyo Yoda, PharmD

The drug information is a longitudinal rotation. Residents will be responsible for providing comprehensive, evidenced-based medication information. The residents are expected to respond to drug information requests in a timely manner and document all details of the interventions. Residents will have an on-call schedule to handle after hour calls. Inquiries will not be limited to health care professionals and may include requests from patients and their caregivers. Responses should be tailored to the appropriate language level dependent on the background of the requestor. As part of the longitudinal experience, residents will be responsible for reviewing and evaluating journal and final presentations of APPE students and will also be required to prepare and present two formal journal clubs per resident. Finally, a minimum of two newsletter articles must be submitted to be included in the MLHS Pharmacy Newsletter.

Pharmacy and therapeutics committee

Preceptors: Al Celidonio, RPh, Director of Pharmacy; Andrea Lordan, MS, PharmD, BCPS

The Pharmacy and Therapeutics Committee (P&T) is a longitudinal rotation. The Main Line Health P&T Committee has three primary functions: formulary maintenance, safe medication use and medication use evaluation. The P&T Committee is also responsible for the development of all drug distribution and administration policies and procedures including all new or updated Main Line Health System pre-printed/computerized physician order entry physician order forms if medications are listed. Residents are responsible to provide support to the P&T Committee and its subcommittees in the form of transcription of meeting minutes, written drug monographs, medication use evaluations and formulary reviews. Interpretation of medical literature, cost analysis, pharmacy budget and patient safety issues will be analyzed. Residents will be given the opportunity to utilize presentation skills through meeting participation.

Nursing-pharmacy medication safety committee (formerly CQI)

Preceptor: Al Celidonio, RPh, Director of Pharmacy

The Nursing-Pharmacy Medication Safety Committee, formerly CQI Committee, is a longitudinal rotation. The Nursing-Pharmacy Medication Safety Committee reviews all medication administration events (similarities, trends and process issues) to ensure that patients are receiving on admission, and throughout their hospital stay, the most appropriate, safe and effective drug therapy for their clinical condition. Meeting attendance is required and documentation of meeting agenda topics is required. The resident will present their own quarterly improvement ideas that are shared with the committee. The resident may be asked to share an Institute for Safe Medication Practice article that can have some impact if initiated system-wide.

Staffing/pharmacy services

Preceptor: Marissa Hadley, PharmD, BCPS

The staffing/pharmacy services is a longitudinal rotation. The resident will work in the main dispensing pharmacy as assigned. This rotation will begin after the pharmacy orientation rotation and will end on June 30th of the residency year. Rotation activities allow the resident to assimilate and integrate a variety of practice skills developed within the pharmacy department in order to function effectively as an acute care pharmacy practitioner in varied different hospital settings during his or her professional career. The rotation will assist the resident in developing good communication and interpersonal skills, devising efficient strategies for accomplishing the required activities in the given time frame and at the completion of this longitudinal rotation, the resident will be able to function as a staff pharmacist in various areas of the pharmacy.

Pharmacy residency research project

Preceptor: Al Celidonio, RPh, Director of Pharmacy
Preceptor Advisors-TBD

The residency research project is a longitudinal rotation. The project may be in the form of original research, a problem-solving exercise or development, enhancement or evaluation of some aspect of pharmacy operations or patient care services. As a component of the project, the resident will submit the project as a work in progress for poster presentation at the ASHP Midyear Meeting. Alternatively the resident may have the project completed for the ASHP Midyear Meeting. Attendance/Podium Presentation at the Eastern States Residency Conference held in the Spring generally in early May will also be required. The resident may complete the original work presented for the ASHP Midyear Meeting or do a new project. The Eastern States Residency Conference is a forum where residents share experiences and expertise. Each resident will make a presentation on his or her residency project, which will be evaluated by the Residency Director and/or coordinating preceptor(s). Residents will also be reviewed by their peers and other preceptors attending the program.