Download HMC-APPE-Descriptions

Penn State Milton S. Hershey Medical Center
Advanced Pharmacy Practice Experience (APPE) Descriptions
APPE:
Page:
Adult Medicine
Surgical Services
Infectious Diseases
Antimicrobial Stewardship
Cardiology
Heart and Vascular Care
Adult Oncology
General Pediatrics
Pediatric Intensive Care
Pediatric Hematology/Oncology
Neonatal Intensive Care
Neuro-Critical Care
Medical Intensive Care
Surgical/Anesthesia Intensive Care
Kidney/Pancreas/Liver Transplantation
Investigational Drug Services
Ambulatory Care: Anticoagulation Clinic
Ambulatory Care: Transitions of Care
Pharmacy Informatics
Hospital Pharmacy Practice
Medication Safety and Quality
Emergency Medicine
Retail Pharmacy
Hospital Pharmacy Administration
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Adult Medicine Experience
Preceptors:
Sesi Whaley, Pharm.D., BCPS
(717) 531-8521 (pager: 4250)
Phone: (717) 531-0003, ext.284222
[email protected]
Tom Vissering, BS, RPh, MBA
[email protected]
Morgan Myers, Pharm.D.
[email protected]
Tom Boyd, BS, RPh
[email protected]
Description
The Adult Medicine is an integrated acute care inpatient rotation focusing on FCM and Internal Medicine
(IM) services. Rounding and interacting with medical team members and topic discussions focused in
FCM and IM services will strengthen students’ foundation in pharmacotherapy and disease state
management while giving them experience caring for patients in acute care inpatient adult medicine. The
FCM team consists of an attending physician, one senior, one to two residents, and nurse practitioners.
The Internal Medicine team consists of an attending physician, one senior, one resident, and one to two
medical students and/or physician assistants.
Orientation
Orientation will be completed on the first day of the rotation. The preceptor will assign the student to FCM
or IM team and discuss the organization of the team. Introductions to the FCM or IM team will be made
during the orientation. The responsibilities, learning objectives, and schedule for daily activities will be
reviewed on orientation.
Learning Objectives (LO)
1. Develop working relationship with the entire medical team (e.g. medical, nursing, and care
coordinator) and provide recommendations for patient during his/her stay in hospital and
transition care
2. Develop baseline knowledge in the management of common adult disease states in acute care
inpatient setting
3. Demonstrate ability to evaluate and analyze laboratory values commonly seen in acute care
medicine patients
4. Demonstrate ability to interview patients for obtaining appropriate medication history and
providing focused teaching and medication discharge counseling
5. Design pharmacotherapeutic plan for acutely ill medicine patients by critically thinking,
comprehensively analyzing, and prioritizing care
6. Integrate knowledge learned in school with new information ascertained in rotation into clinical
practice
7. Design pharmacotherapeutic plan based on patient’s specific clinical situation
8. Construct pharmacokinetic dose adjustment and monitoring
9. Demonstrate competency in formal presentation and written communication
10. Discuss and show understanding for topics reviewed during rotation
11. Recognize adverse drug reaction and report appropriately
12. Document interventions
Responsibilities/Activities
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1. Act professionally and present pharmacy positively at all times
2. Function as the pharmacy intern for the assigned FCM or IM team. This will include making
recommendation as deemed appropriate and following up on any necessary monitoring
parameters on all patients being cared for by that team
3. Pre-round on patients and identify pharmacotherapeutic interventions with preceptor prior to
patient care round daily
4. Attend daily patient care rounds (Monday through Friday) with the FCM or IM team and be
prepared to contribute on pharmacotherapeutic issues for each patient being followed by the
team
5. Monitor appropriateness of all medications (e.g. indication, dosage, duration, route, etc.) on all
patients daily. This includes performing pharmacokinetic calculations on all appropriate
medications (aminoglycosides, vancomycin, digoxin, theophylline, phenytoin, etc.). Discuss any
serious concerns with your preceptors promptly
6. Monitor dose and appropriateness of warfarin indication
7. Perform accurate medication history and provide focused-teaching and discharge counseling to
patients
8. Provide patient education to patients who are newly started on oral anticoagulation in hospital if
applicable
9. Investigate and follow up on all Adverse Drug Reactions (ADRs) or Medication Errors (MEs). This
includes completing our online patient occurrence report and if necessary, reporting to MedWatch
10. Independently complete mandatory readings and review suggested readings in order to discuss
patient cases and/or disease state management topics. Several readings may be assigned
throughout the rotation
11. Turn in up to two typed progress notes on select patients weekly. These notes are to follow the
SOAP format. Your preceptor will review them weekly and provide feedback as necessary
12. Discuss patient case with your preceptor at least two times weekly. Therapeutic or disease state
topics to be discussed will reflect patients who are being followed
13. Prepare and present one typed topic discussion
14. Provide an in-service to your medical team if applicable. This is to be set up early in your rotation
to accommodate your team’s schedule as well as your preceptor
15. Provide a journal club presentation. The article to be reviewed is to be recent (within the last 6
months), pertinent to your select subpopulation, and a controlled clinical trial
16. Present and present one 30-minute formal patient case presentation at the end of your rotation
Evaluations
Preceptor will provide weekly informal evaluations to the student. A formal midpoint and final evaluation
will be discussed. Feedback will also be provided following journal club and any presentations.
Rotation Hours
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Students are reminded that this clerkship will be their primary responsibility while students are in the
hospital. Significant time commitments may be required to complete their assigned workload. There is no
guarantee that students will be able to leave by any set time each day. Students should keep this in mind
if they plan on scheduling outside employment, as needing to be at a job will not be an acceptable excuse
for leaving.
Topic Discussions:
 Will mostly be covered
o Infectious diseases
 Antibiotic, antifungal review
 Common disease states: IE, UTI, CAP, HCAP/VAP, SSTI, abdominal infection,
SBP, C. difficile
o Nephrology
 Acute kidney injury
 Electrolyte disorders
 Iron deficiency anemia
o Endocrine disorders
 Thyroid disorder
 Adrenal disorder
 DKA
o Gastrointestinal tract
 GI bleed
 Liver failure and complications

Alternatives (if time allows)
o CNS
 Seizure, Parkinson’s disease, Alzheimer’s disease, depression, insomnia
o Heart
 Heart failure, angina, hypertension
o Pulmonary
 COPD, asthma
o Gastrointestinal tract
 Pancreatitis
o Nephrology
 Acid-base, chronic kidney disease
o Endocrine disorders
 Diabetes
o Vascular
 Deep Vein Thrombosis (DVT)/ Pulmonary Embolism (PE), PVD, gout
o GU tract
 Urinary incontinence, BPH
o Joint disorders
 Rheumatoid arthritis, osteoarthritis, osteoporosis
o Geriatric topics
o Toxicology
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Surgical Services Experience
Preceptors:
Lydia Watkin, PharmD
[email protected]
Description
The Surgical Services experience is an integrated acute care inpatient rotation focusing on various
surgical subspecialty services. Rounding and interacting with surgical team members and topic
discussions focused in the supportive care of these services will strengthen students’ foundation in
pharmacotherapy and disease state management while giving them experience caring for patients in the
acute care inpatient setting.
Orientation
Orientation will be completed on the first day of the rotation. The responsibilities, learning objectives, and
schedule for daily activities will be reviewed on orientation.
Learning Objectives
 Develop working relationship with the entire surgical team (e.g. physician, nursing, and care
coordinator) and provide recommendations for patient during his/her stay in hospital and transition
care
 Develop baseline knowledge in the supportive care of adult surgical patients in the acute care
inpatient setting
 Demonstrate ability to evaluate and analyze laboratory values commonly seen in acute care surigcal
patients
 Demonstrate ability to interview patients for obtaining appropriate medication history and providing
focused teaching and medication discharge counseling
 Design pharmacotherapeutic plan for acutely ill surigcal patients by critically thinking,
comprehensively analyzing, and prioritizing care
 Integrate knowledge learned in school with new information ascertained in rotation into clinical
practice
 Design pharmacotherapeutic plan based on patient’s specific clinical situation
 Construct pharmacokinetic dose adjustment and monitoring
 Demonstrate competency in formal presentation and written communication
 Discuss and show understanding for topics reviewed during rotation
 Recognize adverse drug reaction and report appropriately
 Document interventions
Responsibilities/Activities

Act professionally and present pharmacy positively at all times

Function as the pharmacy intern for the assigned surgical team. This will include making
recommendation as deemed appropriate and following up on any necessary monitoring parameters
on all patients being cared for by that team

Pre-round on patients and identify pharmacotherapeutic interventions with preceptor prior to patient
care rounds daily

Attend daily patient care rounds (Monday through Friday) assigned team and be prepared to
contribute on pharmacotherapeutic issues for each patient being followed by the team
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
Monitor appropriateness of all medications (e.g. indication, dosage, duration, route, etc.) on all
patients daily. This includes performing pharmacokinetic calculations on all appropriate medications
(aminoglycosides, vancomycin, digoxin, theophylline, phenytoin, etc.). Discuss any serious concerns
with your preceptors promptly

Monitor dose and appropriateness of warfarin indication

Perform accurate medication history and provide focused-teaching and discharge counseling to
patients

Provide patient education to patients who are newly started on oral anticoagulation in hospital if
applicable

Investigate and follow up on all Adverse Drug Reactions (ADRs) or Medication Errors (MEs). This
includes completing our online patient occurrence report and if necessary, reporting to MedWatch

Independently complete mandatory readings and review suggested readings in order to discuss
patient cases and/or disease state management topics. Several readings may be assigned
throughout the rotation

Provide a journal club presentation. The article to be reviewed is to be recent (within the last 6
months), pertinent to your select subpopulation, and a controlled clinical trial

Present and present one 30-minute formal patient case presentation at the end of your rotation
Evaluations
Preceptor will provide weekly informal evaluations to the student. A formal midpoint and final evaluation
will be discussed. Feedback will also be provided following journal club and any presentations.
Rotation Hours
Students are reminded that this clerkship will be their primary responsibility while students are in the
hospital. Significant time commitments may be required to complete their assigned workload. There is no
guarantee that students will be able to leave by any set time each day. Students should keep this in mind
if they plan on scheduling outside employment, as needing to be at a job will not be an acceptable excuse
for leaving.
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Infectious Diseases Experience
Preceptor:
Jihye Kim, Pharm.D., BCPS
GOALS
Upon completion of the infectious diseases rotation the student will be proficient in providing
pharmaceutical care to patients inflicted with a variety of infectious diseases. The student will be an
effective, contributing member of the Infectious Disease Consult Service, providing drug information and
treatment recommendations as needed or requested.
OBJECTIVES
1. Data Collection and Interpretive Skills (15%)
o Students will be able to efficiently collect and interpret patient past medical history, admitting
diagnosis and reason for infectious disease consultation, prior antimicrobials used, laboratory and
microbiology data, imaging studies, susceptibility information, drug levels, and other relevant tests
as well as input from other healthcare providers/consult services. Data will be collected from
daily review of the patient’s medical record, and communication with other health care providers.
o
Students will review patients with their preceptor on a daily basis. Patient problems are to be
researched independently prior to meeting with their preceptor. However, during patient
discussions, students will have opportunity to ask questions and confirm their patient care plan
with their preceptor. In addition, patient discussions will help students learn to prioritize medical
problems, present patient information concisely and in an organized manner as well as develop a
monitoring plan for appropriate follow-up.
2. Drug Therapy Critique and Planning (15%)
o Students will become proficient in developing and implementing pharmaceutical care plans
specifically tailored to the infectious disease needs of their patients. This may include:
o Evaluating appropriateness of antimicrobials (drug choice is appropriate given patient’s
infection, dose/frequency are appropriate given patient’s severity of infection, age,
weight, hepatic/renal function, etc)
o Assessing response to drug therapy (daily evaluation by the ID team, vitals, cultures,
susceptibilities, etc)
o Recognizing toxicities of drug therapy (daily lab follow-up, drug monitoring, patientspecific complaints, etc)
o Assessing risk for drug-drug and drug-food interactions
o Anticipates additional information, risk vs. benefits, and alternative therapy
o Recommending changes to drug therapy based upon toxicities, new test results,
susceptibilities, etc.
o Students will be able to individualize patient’s drug therapy by applying pharmacokinetics,
pharmacodynamics as well as therapeutic drug monitoring principles.
o
Students will identify, anticipate, resolve (where appropriate) and report drug interactions,
adverse drug reactions and medication errors. Reports will be reviewed by the preceptors prior to
submission in the incident reporting system.
o
Students will be able to apply pharmacoeconomic principles to their patients’ drug therapy,
specifically related to PSHMC formulary restrictions and therapeutic alternatives. Student will be
familiar with the PSHMC antimicrobial formulary and antibiogram and be familiar with use of
restricted antimicrobials
3. Communication and Professional Behavior (15%)
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o
o
o
o
Students will become proficient in verbally communicating with other health-care providers on the
patient care team, including physicians, nurses, and pharmacy colleagues.
Students will maintain appropriate, professional attire and behavior in patient care areas at all
times.
Students will maintain a professional relationship with all members of the infectious diseases
team as well as their patients and patients’ families.
Students will respect patient confidentiality and patient’s rights at all times.
4. Performance in Clinical Setting (15%)
o Students will be able to establish a working relationship with the infectious diseases team. They
will be actively involved in patient care and will learn to apply their knowledge as well as
diplomacy/tact to communicate their recommendations to the team.
o Students will respond to all questions/concerns from the infectious diseases team in a timely
manner. Students will be able to take initiative in regards to patient care, being a productive
member of the team, and learning about infectious diseases
ATTENDANCE/REQUIRED MEETINGS (5%)
o Arrive to your rotation around between 7-7:30am Mondays thru Friday
o Attend weekly Case Conference every Wednesday from 4-5:30pm and Infectious Diseases
Consult Service Journal Club every 3rd Friday from 12:30-1:30pm
o Attend monthly pharmacy journal club (every other Tuesday of the month). Students will present
at least once during the rotation.
o Attend daily rounds with the infectious diseases team until rounds end (MD students are allowed
to leave early if rounds continue beyond 5pm, no such time restriction for Pharm.D students)
o Attend microbiology rounds every Tuesday from 11-11:45am. Additional time in the microbiology
laboratory may be possible under the discretion of the preceptor.
o Answer questions posed by the infectious disease team in a timely manner (confirm answer with
your preceptor first!)
TOPIC DISCUSSIONS (10%)
o Students are expected to participate in at least two topic discussions every week guided by the
preceptor. The content and presentation style of these topics is flexible and is tailored to the
interest of the student. Required readings and references will be provided ahead of time. The
student is expected to have completed all the readings and be prepared for the discussions.
o Additionally, students may be asked to present infectious disease and/or antimicrobial therapy
related topic(s) to their preceptor and/or the infectious disease team. The preceptor(s) will
determine the content of these topic(s), format and number of presentations presented by the
student.
Sample topics for discussion:
 Principles of infectious diseases and antimicrobial therapy
 Infective endocarditis
 C. difficile infection
 Fungal Infections
 Heme / Onc / Other immunocompromised patients
 HIV/AIDS, opportunistic infections
 Intra-abdominal Infections
 Pneumonia
 Meningitis
 Osteomyelitis / Skin & Soft Tissue Infections
 STDs
 Tuberculosis
 UTIs
 Ophthalmologic infections
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Surgical prophylaxis
Viral infections
Antibiotic drug class reviews
Clinical use of antifungals
Antimicrobial pharmacodynamics
Antimicrobial resistance
PATIENT DISCUSSIONS (10%)
o The patient load on the infectious disease team can vary widely- from 6-18+ per day. Students
are responsible for close work-up and monitoring of up to 8 patients at a time. The preceptor will
determine the progression of the patient load. The preceptor on the ID service will determine
appropriate patients for the student to follow.
o The student will discuss all of their patients with their preceptor on a daily basis. Since the
infectious disease team rounding time varies, these discussions may be scheduled for either
early or late afternoon. Students are expected to be familiar with their patients, assess
appropriateness of antimicrobials, and develop a daily patient care plan PRIOR to meeting with
their preceptor
o The preceptor should be paged regarding any changes to the antimicrobial therapy prior to
making recommendations to the infectious diseases team
OTHER RESPONSIBILITIES (15%)
o Antimicrobial Stewardship activities will be an important part of the ID rotation. Students will
review patient cases and discuss possible interventions with the ASP pharmacist. When
possible, residents will join ASP rounds.
o The student will complete a midpoint evaluation between weeks 3 of the rotation.
o Additionally, the preceptor may request the student to complete other assignments, including
completion of small projects related to the management of infectious diseases.
o If there are any questions during infectious disease rounds that require immediate pharmacy
attention, page your preceptor or infectious disease pharmacy resident to address the problem
and formulate a plan.
o Infectious Disease Pharmacy Contacts
o Jihye Kim: Phone 7728, Pager 0371
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Antimicrobial Stewardship Program (ASP) Experience
Primary Preceptor:
Mark Lesher, PharmD, MBA, BCPS
Rotation Description
 This rotation provides an overview of the role and responsibilities of the antimicrobial stewardship
team. The objective of this rotation is to provide students with the opportunity to better understand
microbiology, antibiotic therapy, and infectious disease state management. Students will
participate in the patient selection, review, and intervention process.
Rotation Objectives
 Enhance knowledge and understanding of antimicrobials
o Including coverage, dosing, side-effects, and pharmacokinetics
 Develop an understanding of disease state management
 Develop the ability to evaluate antimicrobial therapy for appropriateness
 Gain experience in developing evidence-based medication regimens for empiric and targeted
therapy
 Gain experience with interpreting microbial cultures, imaging, and lab values to evaluate patient
clinical status
 Develop experience with providing dosing and monitoring recommendations for antimicrobial
therapy
 Enhance utilization of guidelines, clinical data, and resources to answer drug information
questions
 Develop verbal and written communication skills with healthcare professionals when providing
recommendations
 Develop competency in navigating and documenting interventions in antimicrobial stewardship
tools.
Student Activities
 Students will begin the rotation observing the process of patient selection, review, and
intervention and will then progress into participating and executing the daily workflow.
 Students will become an integral member of the ASP team and will participate in patient care
activities. Students will also engage in ID topic discussion.
Rotation Schedule/Workflow
 Prepare patient list
 ASP rounds for Adult and Peds ASP
 Attend microbiology rounds and ID fellow topic discussions
 Review patients and develop treatment plans
 Mini patient presentation/discussion of a selected, complicated patient
 Follow up on interventions and documentation
 Research and prepare drug information questions
 Review of interesting journal articles or clinical studies
Student Responsibilities
 Review patient profiles and evaluate antimicrobial therapy
 Follow up and document interventions in Powerchart and Medmined
 Attend microbiology rounds and ID fellow topic discussions
 Prepare for patient and topic discussions
 Provide timely responses for drug information questions
 Develop and present a journal club article on an antimicrobial clinical study
 Review literature and clinical data for unfamiliar terminology, disease states, and antimicrobial
therapy
 Adhere to HIPPA confidentially policies for patient protected health information
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Adult Cardiology Acute Care Experience
Preceptor:
Phone number:
Pager number:
Fax number:
Sallie Young Johnson, PharmD, BCPS (AQ-Cardiology)
717-531-5826
(In hospital) 4311, ext: 3414; (Out-of-hospital) 531-4311, ext 3414
717-531-0335
The Cardiology rotation will expose the student to the diagnosis and treatment of adult patients with
cardiovascular disorders. The Cardiology Service is composed of two rounding teams; acute care
cardiology and heart failure/heart transplant. The clinical mission is to provide quality, cost effective care
utilizing the latest in cardiac technology and research. The Cardiology teams will care for patients in the
Heart and Vascular Intensive Care Unit (HVICU), the Heart and Vascular Care Unit (HVCU), Heart and
Vascular Progressive Care Unit (1st Floor), and related procedural units (cardiac catheterization lab,
Heart and Vascular Outpatient Unit (HVOU), Clinical Decision Unit (CDU).
Orientation to the service will include direct introduction to the current team on service (e.g. physicians,
physician assistants, nurses, and/or transplant coordinators), formal review of rotation responsibilities,
and scheduling of planned topic discussions. Over the first few days, common pharmacotherapeutic
practices will be reviewed. Topic discussions during the rotation will further review pertinent literature and
guidelines.
Students will present a journal club to the preceptor and later to the other students on rotation if time
permits. The student will also have a formal patient case presentation including a detailed discussion of
the primary disease state.
Formal grading will following student’s institutional policy but at minimum will include a midpoint and final
evaluation.
Student responsibilities:
1) Providing comprehensive pharmaceutical care to the Cardiology service.
2) Follow all patients on the cardiology service with drug therapy monitoring to include appropriate
medication, clinical indication, dose, route, side effects, drug-drug interactions, drug-nutrient
interactions, duplication of therapy, allergy status, and IV to PO conversion where applicable. Follow
all pertinent lab values, serum drug levels and microbiology findings.
3) Pre-rounding on patients and identification of pharmacotherapeutic interventions with preceptor prior
to or during patient-care rounds.
4) Attendance and active participation in Cardiology rounds. Typically take place Monday–Friday
8:30am – 12:30pm.
5) Two formal presentations to the pharmacy department (e.g. journal club, patient case presentation)
6) Documentation of medication errors, adverse drug reactions and clinical interventions on the service.
Disease States/Topics (May include, but not limited to the following)
Acute Coronary Syndromes
Acute and Chronic Heart Failure
Anticoagulation
Atrial fibrillation/flutter (AFib/Aflutter)
Heparin-Induced Thrombocytopenia
Hypertension
Hyperlipidemia
Ventricular arrhythmias (VT/VF)
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Heart and Vascular Care Units Experience
Primary preceptor:
Jennifer Morrow, PharmD
Contact information:
Email: [email protected]
Phone: 717-531-0003 ext. 310513
Rotation Overview:
The Heart and Vascular care units are comprised of cardiology, cardiothoracic surgery, and vascular
surgery patients across the spectrum of intensive care, intermediate care, and acute care beds. During
this rotation the student will interact with members of the multi-disciplinary team on daily rounds.
Orientation will be provided on the first day to introduce the student to members of the interdisciplinary
team, review of responsibilities, scheduling, and an introduction to the computer system.
Responsibilities:
Act professionally and present pharmacy positively at all times
Communicate effectively and professionally with medical professionals, students, and patients
Arrive in time to adequately prepare for rounds and collect patient information, such as:
o Chief complaint
o History of present illness
o Past medical history
o Home medications
o Allergies
o Microbiology reports
o Daily progress notes
o Lab values
o Pertinent studies
Attend daily patient care rounds and be prepared to contribute to pharmacotherapeutic issues for
each patient being followed. This may include, but is not limited to:
o Collect home medication list
o Follow drug levels
o Ensure proper antimicrobial use
o Evaluate appropriateness of all medications
o Monitor for drug interactions
o Investigate and follow-up on any adverse drug reactions or medication errors
o Renal dose adjustments
o IV-to-PO evaluations
Be prepared to present patients briefly to preceptor prior to rounds
Document patient care activities and interventions appropriately
Independently complete all readings and assignments in a timely manner
Prepare and present one formal topic discussion
Prepare and present journal club based on an article that is relevant to the patient population
Prepare and present a formal patient case presentation
Complete assigned competencies
Rotation topics (may include but are not limited to):
Heart failure
Hypertension
Anticoagulation
Electrolyte disorders
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Infectious diseases
Renal insufficiency
Diabetes
Stress ulcer prophylaxis
Evaluations
Students will be provided with weekly informal evaluations. A formal midpoint and final evaluation will be
discussed. Feedback will also be provided following journal club and any other presentations.
*Please note that this rotation is the primary responsibility of the student during the assigned time block.
Students are not guaranteed to be done by a given time. Leaving for work is not a valid excuse.
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Adult Oncology Acute Care Experience
Preceptor:
Phone number:
Pager number:
Fax number:
Jeffrey Sivik, PharmD, BCOP
531-7477
(In hospital) 4311, ext: 3029; (Out-of-hospital) 531-4311, ext 3029
531-0053
Description
The rotation in Adult Hematology/Oncology is an inpatient acute care rotation. The student will be given
the opportunity to expand their knowledge base to include a variety of medical oncology or malignant
hematology disorders and non-malignant hematological disease states and the supportive
pharmacotherapeutic care associated with these disorders. Notably, there is a stem cell transplantation
student rotation available that requires previous experience with hematology rotation as a student that is
advanced practice clinician (PA or CRNP) based. Specifically, the student will be given a significant
opportunity to expand their pharmacotherapeutic skills in chemotherapy, infectious diseases and pain
management.
Orientation to the service will include direct introduction to the current multidisciplinary team on service
(e.g. physicians, nurses, care coordination team), formal review of rotation responsibilities, scheduled
topic discussions and a brief review of pharmacotherapeutic practices specific to the Penn State Cancer
Institute services. In addition, students are encouraged to attend Oncology-specific learning opportunities
including Oncology Grand Rounds held on Thursdays at 7:45AM (T-2500). However, this requires
advance planning for pre-rounding as many attending physicians may start “walk” rounds prior to “sit
down” rounds.
Student will receive verbal feedback daily assessing their performance. Students will be evaluated
formally as per school requirements, but at minimum a mid-point formal assessment should be expected.
A final formal rotation will be completed on the final day of the rotation. Students also receive
participation grades for journal club (noting evaluation assessments that may be school specific for their
selected journal club). A written evaluation is also provided for the students’ final case/topic presentation.
Objectives:
1. Establish competency in the supportive pharmacology of patients with medical oncology or
hematology disorders.
2. Develop a baseline knowledge base in Medical Oncology/Hematology disease states.
3. Understand the pharmacology, mechanism of action, toxicity, clinical use and clinically relevant
drug interactions of the chemotherapeutic agents used in these patient populations.
4. Improve skills in pharmacokinetic dose adjustments.
5. Improve skills in formal presentations.
Responsibilities
1. Provision of comprehensive pharmaceutical care to the selected Adult Hematology/Oncology
service (Hematology, Oncology, or Stem Cell Transplantation).
2. Perform pre-rounding on patients and identify pharmacotherapeutic interventions with preceptor
prior to walk rounds. [R1.4, R2.4, R2.6, R2.7, R2.10, R.2.11, R6.1]
3. Attend and participate in daily patient care “sit down” rounds. (Mon-Wed Fri rounds at 8:15AMSCT 8:35AM- Hematology, 8:55 AM- Oncology, Thurs starting at 9:15AM). [R1.4, R2.1, R2.8,
R2.11]
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4. Attend and participate in scheduled journal club presentations and case/topic presentations. The
student will be responsible for formal presentations to the pharmacy department to include two of
the following: journal club, patient case presentation, or topic presentation.[R5.1]
5. Participate in selected discussions with the preceptor, including leading the discussion of at least
one topic. [R5.1]
6. Document medication errors, adverse drug reactions, and clinical interventions that occur while
on service. [R2.12, R6.1]
7. Prepare a drug monograph or drug class review for presentation at P&T Committee [R5.1].
8. Provide pharmacy in-services to the hematology/oncology resident/nursing staff as needed.
[R5.1]
Disease States/Topic Discussions- including, but not limited to:
Disease State Topics:
Hematology:
Acute Leukemias (AML, ALL)
Chronic leukemias (CML, CLL)
Lymphomas (non-Hodgkin’s lymphoma [NHL], Hodgkin’s [HD])
Multiple Myeloma (MM)
Aplastic Anemia (AA)
Idiopathic Thrombocytopenic Purpura (ITP)
Myelodysplastic Syndrome (MDS)
Oncology:
Lung Cancer (Non-small cell, small cell)
Colorectal Cancer
Prostate Cancer
Melanoma
Kidney Cancer
Breast Cancer
Testicular Cancer
Supportive Care Topics:
Oncologic Emergencies
 Includes a brief review of SIADH, Hypercalcemia of malignancy, SVC syndrome, spinal cord
compression, tumor lysis syndrome
Febrile Neutropenia
Myeloid Growth Factors
Chemotherapy Induced Nausea/Vomiting
Pain Management
Anticoagulation in Oncologic Patients
Specialized Topics (BMT rotation):
Bone Marrow Transplant- Overview
Graft Versus Host Disease
Stem Cell Transplant in AML, ALL, NHL, HD, MM, CML, CLL, AA/MDS
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General Pediatrics Experience
Preceptors:
Carrie Cake, BS
Kimberly Cimarelli, PharmD
Misgana Gebreslassie, PharmD
Robert Hu, BS, PhD
Han Lee-Hain, BS
Kevin Mulieri, PharmD
Huong Nguyen, PharmD
Catherine Rejrat, PharmD, BCPS
Lindsay Trout, PharmD
The rotation in General Pediatrics is a specialized elective rotation. Students will be exposed to a variety
of pediatric disease states. Students will be given a multitude of opportunities to develop their pediatric
pharmacotherapy knowledge and participate in pharmacokinetic monitoring.
Objectives
1. Develop baseline knowledge of common pediatric disease states.
2. Understand the pharmacology, mechanism of action, side effects and clinical use of medications
commonly used to treat pediatric disease states.
3. Advance abilities to develop evidence based treatment plans and effective drug information skills.
4. Improve formal presentation skills.
5. Improve interpersonal and teamwork skills.
Responsibilities
1. Monitor patients daily prior to patient rounds. At a minimum, an updated medication list (including
current medications and medications prior to admission) and drug levels should be obtained prior
to medical rounds.
2. Attend and participate in daily patient care rounds as part of the medical team.
3. Attend and participate in selected discussions with the preceptors, including leading the
discussion of at least one topic.
4. Attend and participate in scheduled journal club presentations; the student will be responsible for
presenting one journal club during their rotation.
5. Prepare and present a formal patient case & disease state.
6. Provide pharmacy in-services for the pharmacy, nursing or medical staff as needed.
7. Document medication errors, adverse drug reactions, and clinical interventions that occur while
on service.
Disease States (May include but are not limited to the following)
Asthma
Bronchiolitis/RSV
Cellulitis
Community Acquired Pneumonia
Croup
Cystic Fibrosis
GERD
Hypertension
Immunizations
Kawasaki Disease
Meningitis
Osteomyelitis
Otitis Media
Seizures/Ketogenic Diet
Streptococcal pharyngitis
Urinary Tract Infections
Viral encephalitis
16
Students are reminded that this APPE will be their primary responsibility while here and that
significant time commitments may be required to complete their assigned workload. There is no
guarantee that students will be able to leave by any set time each day. Students should keep this
in mind if they plan on scheduling outside employment, as needing to be at a job will not be an
acceptable excuse for leaving.
17
Pediatric Intensive Care Experience
Preceptor:
Phone number:
Pager number:
Fax number:
Lindsay C. Trout, Pharm.D.
(In hospital) 7719
(Out-of-hospital) 717-531-4311 pgr # 2213
717-531-0682
Rotation Description
The rotation in Pediatric Intensive Care is a highly specialized elective rotation. This atmosphere
will provide the student with exposure to a variety of pediatric surgical and medical services such
as cardiology, neurology, pulmonary, GI, hematology/oncology, cardiothoracic, trauma,
neurosurgery and other various surgical specialties. Additionally, the student will be given a
significant opportunity to expand their pediatric pharmacotherapeutic skills in the ICU in nutrition,
pain management, sedation and infectious diseases.
Orientation to the service will include direct introduction to the current multidisciplinary team on
service (e.g. physicians, nurses, dietician, social workers), formal review of rotation
responsibilities, scheduling of planned discussions and a brief introduction of service-specific
pharmacotherapeutic practices.
Objectives
1. Establish competency in the supportive care of pediatric critical care patients.
2. Develop a baseline knowledge base in Pediatric/Pediatric Critical Care disease states.
3. Understand the pharmacology, pharmacokinetics, side effects, dosing, and drug
interactions of the agents used in these patient populations.
4. Improve skills in pharmacokinetic dose adjustments.
5. Improve skills in formal presentation.
Responsibilities
1. Monitor patients daily prior to patient rounds. At least an updated medication list (current
medications and medications prior to admission) and drug levels should be obtained prior
to medical rounds
2. Attend and participate in daily patient care rounds. (Daily at approximately 8:00AM).
3. Attend and participate in selected discussions with the preceptor, including leading the
discussion of at least one topic.
4. Attend and participate in scheduled journal club presentations.
5. Prepare and present a formal case report including disease state discussion.
6. Provide pharmacy in-services for the pharmacy, nursing or medical staff as needed.
7. Document medication errors, adverse drug reactions, and clinical interventions that occur
while on service.
Disease States (may include but not limited to the following)
ICU sedation/paralysis
ICU acquired infections
ICU prophylaxis
Trauma
Head injury
Meningitis
Congenital heart disease and repair
Respiratory distress syndrome
Bronchiolitis
Pneumonia
Sepsis
Fluids & electrolytes
18
Parenteral Nutrition
Enteral nutrition
Diuretics
Status asthmaticus
Status epilepticus
Blood gas interpretation
Poisoning/overdose
19
Pediatric Hematology/Oncology Experience
Preceptor:
Phone number:
Pager number:
Fax number:
Kevin M. Mulieri, B.S., Pharm.D.
531-7020
(In Hospital): 4311, ext: 3154;
(Out of Hospital): 531-4311, ext: 3154
531-0682
The rotation in Pediatric Hematology/Oncology is a highly specialized elective rotation. The student will
be given the opportunity to expand their knowledge base to include a variety of pediatric solid and liquid
tumors, hematological disease states, stem cell transplantation, and the supportive pharmacotherapeutic
care associated with these disorders. Additionally, the student will be given significant exposure to
pharmacotherapeutic issues with pediatrics, chemotherapeutics, infectious diseases and pain
management.
Objectives:
1. Establish competency in the supportive pharmacotherapy of pediatric patients with hematologic and
oncologic disorders.
2. Develop a baseline knowledge base in Pediatric Hematology/Oncology disease states.
3. Understand the pharmacology, mechanism of action, toxicity, and clinical use of the
chemotherapeutic agents used for pediatric oncologic disorders.
4. Improve skills in pharmacokinetic dose adjustments.
5. Improve skills in formal presentations.
Responsibilities
1. Providing comprehensive pharmaceutical care to the Pediatric Hematology/Oncology service.
2. Pre-rounding on patients, and identification of pharmacotherapeutic interventions with preceptor prior
to patient-care rounds.
3. Attendance, and active participation in Pediatric Hematology/Oncology multidisciplinary rounds. Mon
– Fri: 8:30 – 12:00.
4. Two formal presentations to the pharmacy department (e.g. journal club, patient case presentation)
5. Minimum of two disease-state presentations to preceptor.
6. Documentation of medication errors and adverse drug reactions on the service.
7. Providing pharmacy inservices to the pediatric resident/nursing staff as needed.
8. Gain exposure to compounding of chemotherapeutic agents as time permits.
20
Disease States (May include but not limited to the following)
Acute Lymphoid Leukemia (ALL)
Hodgkin’s Lymphoma
Various Brain Tumors
Osteosarcoma
Rhabdomyosarcoma
Wilm’s Tumor
Tumor Lysis Syndrome
Sickle Cell Anemia
Hemophilia A and B
Stem Cell Transplantation
Acute Myeloid Leukemia (AML)
Non-Hodgkin’s Lymphoma
Neuroblastoma
Ewing’s Sarcoma/PNET
Idiopathic Thrombocytopenic Purpura
Neutropenic Fever
Antiemetic Therapy
Anticoagulation Therapy
Aplastic Anemia
Graft versus Host Disease
Students are reminded that this clerkship will be their primary responsibility while here and that significant
time commitments may be required to complete their assigned workload. There is no guarantee that
students will be able to leave by any set time each day. Students should keep this in mind if they plan on
scheduling outside employment, as needing to be at a job will not be an acceptable excuse for leaving.
21
Neonatal Intensive Care Experience
Preceptor:
Email:
Phone number:
Phone number:
Fax number:
Catherine E. Rejrat, PharmD, BCPS
[email protected]
717.531.0003, ext 280473
(In hospital) x4311, pager #0726
(Out of hospital) 717.531.4311, pager #0726
717.531.0335
Rotation Description
The rotation in Neonatal Intensive Care is a highly specialized elective rotation. The Neonatal Intensive
Care Unit is a 42 bed unit which is split between two neonatal rounding teams. The student will be given
the opportunity to attend and participate in daily neonatal rounds and expand their knowledge base to
include a variety of disease states affecting neonates and the pharmacotherapy used to treat them.
Additionally, the student will be given a significant opportunity to expand their pediatric
pharmacotherapeutic skills in the NICU in nutrition, pain management, sedation and infectious diseases.
Objectives
1. Understand the pharmacokinetic differences between neonates, pediatric and adult patients.
2. Identify disease states which affect neonates.
3. Understand the pharmacology, mechanism of action, side effects and clinical use of the
medications used to treat neonatal disease states.
4. Improve skills in pharmacokinetic dose adjustments.
5. Evaluate medical literature and respond to drug information questions (verbally and/or written)
6. Improve formal presentation skills.
7. Improve interpersonal and teamwork skills.
Responsibilities
1. Monitor patients daily prior to rounds for appropriate medication use. At a minimum, an updated
medication list and drug levels should be obtained prior to rounds.
2. Attend and actively participation in daily patient care rounds as part of the medical team, which
begin at 0900 Monday through Friday.
3. Attend and participate in discussions with preceptor; students will be expected to lead at least
one topic discussion during the rotation.
4. Attend and participate in scheduled journal club presentations; the student will be responsible for
presenting one journal article during their rotation.
5. Prepare and present a formal case presentation.
6. Provide pharmacy in-services for the pharmacy, nursing or medical staff as needed
7. Document medication errors, adverse drug reactions, and clinical interventions that occur while
on service.
Disease States (May include but are not limited to the following)
Apnea of prematurity
Necrotizing enterocolitis
Anemia of prematurity
Neonatal sepsis/chorioamnionitis
Bronchopulmonary dysplasia
Parenteral nutrition
Cardiac defects
Patent ductus arteriosus
ECMO
Pharmacokinetic dosing
Electrolyte abnormalities
Persistent pulmonary hypertension
Enteral nutrition
Respiratory distress syndrome
Group B Streptococcal infections
Retinopathy of prematurity
Hypoxic ischemic encephalopathy
Sedation/analgesia
Hyperbilirubinemia
Seizures
Immunizations
22
Neuro-critical Care Experience
Preceptor:
Phone number:
Pager number:
Fax number:
Cynthia Halas, Pharm.D.
531-5940
(In hospital): 4311, ext: 3143; (Out of hospital): 531-4311, ext: 3143
531-0642
The rotation in the NCCU is a highly specialized elective rotation. The student will be given the
opportunity to expand their knowledge base to include neurosurgical disorders such as head trauma,
spinal cord injuries, deep brain stimulators, tumor resections, aneurysms, and gamma knife surgery.
Neurology disorders include ischemic and hemorrhagic strokes, multiple sclerosis, myasthenia gravis,
TIAs, Guillain-Barre and seizures and the supportive pharmacotherapeutic care associated with these
disorders.
Objectives:
6. Establish competency in the supportive care of critical care patients with neurological or
neurosurgical disorders.
7. Develop a baseline knowledge base in Neurological/Neurosurgical disease states.
8. Understand the pharmacology, pharmacokinetics, side effects, dosing, and drug interactions of
the agents used in these patient populations.
9. Improve skills in kinetic dose adjustments.
10. Improve skills in formal presentation.
Responsibilities:
9. Provide comprehensive pharmaceutical care to the Neurocritical Care service patients.
10. Pre-rounding on patients with preceptor, identification of pharmacotherapeutic interventions with
preceptor prior to team rounds.
11. Attendance and active participation in multidisciplinary rounds. Mon-Fri: 8:30am to 11:00am.
12. Two formal presentations to pharmacy department (journal club, patient case presentation).
Group journal club discussion participation.
13. Minimum of two disease state topic discussions to preceptor.
14. Documentation of medication errors and adverse drug reactions as needed.
15. Providing pharmacy inservices to the residents/nursing staff as needed.
16. Patient discharge counseling as needed.
17. Attend any scheduled inservices, topic discussions, and lectures.
Disease State Topics: (May include but not limited to)
Nutrition
Sedation/analgesia/delirium
Neuromuscular Blocking Agents
Electrolyte imbalances
Ischemic stroke
Hemorrhagic stroke
23
SAH
Cerebral salt wasting
Neurostorming
Traumatic brain injury
Myasthenia Gravis
Multiple Sclerosis
Guillian Barre
Sepsis/Severe Sepsis/Septic Shock
Acid-base disorders
Antibiotics in the ICU
Vasopressors
Seizures
Mechanical Ventilation
Hypothermia Protocol
GI bleeding
Basic Toxicology
Withdrawal Syndromes (alcohol and opioids)
Stress Ulcer Prophylaxis
Glycemic Control in the ICU patient
Students are reminded that this clerkship will be their primary responsibility while here and that significant
time commitments may be required to complete their assigned workload.
24
Medical Intensive Care Unit (MICU)
Preceptor:
Phone number:
Pager number:
Fax number:
Kimberly Keefer, Pharm.D., BCPS
531-7528
(In hospital): 4311, ext: 1279; (Out of hospital): 531-4311, ext: 1279
531-0335
The rotation in the MICU is a specialized elective rotation. This rotation will provide students the
opportunity to work with a comprehensive group of practitioners in order to observe and assist in treating
a wide range of critical care issues. The student will be given the opportunity to expand their knowledge
base to include medical intensive care disease states. They will attend daily rounds to ensure optimal
medication usage. During this month they will learn to collect home medications, follow drug levels,
ensure proper antimicrobial usage, and monitor for drug interactions. Communication skills will be
developed by effectively and professionally communicating with health care providers, patients, and
families.
Rotation Hours:
Rounds begin at 8 AM daily. Students are expected to arrive in ample time to evaluate their assigned
patients. Patients will be assigned based on student’s comfort level and experience.
Objectives:
1. Establish competency in the supportive care of critical care patients focused on the Medical
Intensive Care Unit.
2. Develop a baseline knowledge of Medical Intensive disease states.
3. Understand the pharmacology, pharmacokinetics, side effects, dosing, and drug interactions of
the agents used in these patient populations.
4. Improve skills in kinetic dose adjustments.
5. Improve skills in formal presentation.
Responsibilities:
1. Arrive in time to adequately prepare for rounds. Collect patient specific data including (but not
limited to): chief complaint, HPI, past medical history, home medications, allergies, and
microbiology reports. A data collection form will be provided to assist in collecting this data.
2. Attend and participate in daily interdisciplinary patient rounds.
3. Effectively and professionally communicate recommendations and ongoing patient information to
health care providers.
4. Utilize both guideline/literature information and patient specific data to support recommendations.
5. Provide comprehensive pharmaceutical care to the Medical Intensive service patients.
6. Two formal presentations to pharmacy department (journal club, patient case presentation).
Group journal club discussion participation.
7. Minimum of two disease state topic discussions to preceptor.
8. Documentation of medication errors and adverse drug reactions as needed.
9. Document direct patient care activities appropriately.
10. Providing pharmacy inservices to the residents/nursing staff as needed.
11. Attend any scheduled inservices, topic discussions, and lectures.
25
Disease State Topics: (May include but not limited to):
Nutrition
Sedation/analgesia/delirium
Neuromuscular Blocking Agents
Vasopressors
DVT/PE treatment options
Appropriate prophylaxis (DVT, Stress Ulcer, etc)
Electrolyte imbalances
Sepsis/Severe Sepsis/Septic Shock
Acid-base disorders
Antibiotics in the ICU
Mechanical Ventilation
GI bleeding
Basic Toxicology
Withdrawal Syndromes (alcohol and opioids)
Stress Ulcer Prophylaxis
Glycemic Control in the ICU patient
Pulmonary Hypertension
Renal Failure
Liver Failure
Students are reminded that this clerkship will be their primary responsibility while here and that significant
time commitments may be required to complete their assigned workload.
Evaluation
Weekly informal evaluations
One midpoint evaluation
Final evaluation
26
Surgical/Anesthesia Intensive Care Unit Experience
Rotation Preceptor:
Ashley L. Quintili, Pharm.D., BCPS
Contact information:
Email: [email protected]
Office: 717-531-0003 (extension: 287499)
Pager: 1646
Cell: 814-935-5079
Rotation Goals and Objectives:
The Surgical/Anesthesia ICU is a 30 bed unit that is split into two primary services: trauma and
anesthesia. This rotation will provide the student the opportunity to work with a comprehensive group of
practitioners in order to observe and assist in treating a wide range of critical care issues. They will attend
daily rounds to ensure optimal medication usage. During this month they will learn to collect home
medications, as well as, follow drug levels, ensure proper antimicrobial usage, and monitor for drug
interactions. In addition, they will enhance their communication skills through opportunities to effectively
and professionally communicate to health care providers, patients, and families.
Rotation Hours
Rounds begin at 8:30 daily. Students are expected to arrive in ample time to evaluate their assigned
patients. Patients will be assigned based on student’s comfort level and experience.
Rotation Responsibilities/objectives
Arrive in time to adequately prepare for rounds. Collect patient specific data including (but not limited to)
chief complaint, HPI, past medical history, home medications, allergies, and microbiology reports
(updates). (Goals R2.2, R2.4, R2.6)
Prepare and implement evidence based therapeutic and monitoring plans. Utilize both guideline/literature
information and patient specific data to support recommendations. (Goals R2.4, R2.6, R2.7, R2.8, R2.10)
Evaluate patient progress and redesign regimens and monitoring plans (R2.10)
Place practice priority on the delivery of patient-centered care to patients (R2.2)
Attend and participate daily in interdisciplinary patient rounds (Goals R2.1, R2.3, R2.5, R2.9, R2.10,
R2.11, R2.12)
As appropriate, establish collaborative professional relationships with members of the health care team
(R2.1)
Effectively and professionally communicate recommendations and ongoing patient information to health
care providers.
(Goals R2.1, R2.3, R2.8, R2.9, R2.11, R2.12)
Provide concise, applicable, comprehensive, and timely responses to requests for drug information from
patients/family and health care providers (Goal R1.5)
Identify and resolve issues concerning renal dosing and pharmacokinetic issues (Goals R2.4, R2.6, R2.7,
R2.8, R2.9, R2.10, R2.12)
Document direct patient care activities appropriately (R2.12)
Provide effective medication and practice-related education, training, or counseling to patients,
caregivers, health care professionals, and the public. (R5.1)
Lead topic discussions. When possible, students should utilize other literature to supplement assigned
reading (Goals R1.5, R5.1)
Rotation Content (May include but not limited to the following)
SIRS/Sepsis/Septic Shock
Complications from Sepsis
Sedation/analgesia/delirium
27
Traumatic brain injury (TBI)
 Seizure treatment/prophylaxis
Hemodynamics
 Goals
 Medications
Fluids/Electrolyte/Nutrition monitoring
Appropriate prophylaxis (DVT, Stress Ulcer, etc)
DVT/PE treatment options
Infectious issues
 Nosocomial infections
 Antimicrobial Stewardship (Appropriate antibiotic prophylaxis/treatment)
 Post-operative drug therapy
Acute renal failure and renal replacement therapies
Acid-base disorders
Mechanical Ventilation
Hypothermia Protocol
Withdrawal Syndromes (alcohol and opioids)
Method of Evaluation
Weekly informal evaluations
One midpoint evaluation
Final evaluation
28
Kidney/Pancreas/Liver Transplantation Rotation Experience
Preceptor:
Tracy M. Valania, Pharm.D.
Phone number:
531-7950
Pager number: 0399; (Out of Hospital): 531-4311, ext: 0399
Fax number:
531-0642
The Solid Organ Transplantation rotation is a highly specialized elective
rotation is to familiarize the student with the disease states relating to
transplantation and current trends in safe, effective pharmacotherapy.
multidisciplinary team including physicians, residents, nurse coordinators,
social workers, nurses, and students.
rotation. The intent of this
kidney, pancreas, and liver
The transplant team is a
pharmacy clinical specialist,
The orientation to the rotation will include an introduction to the multidisciplinary team including the
transplant coordinators, interns, residents, transplant attendings, social workers, and nephrology
attending and/or fellow. The orientation will also include a review of the responsibilities and expectations
for the rotation. A calendar will be provided during the first week that will outline meeting times and
responsibilities.
Finally, during the first 1-2 weeks of rotation a review of the common
immunosuppressant medications and protocols will be provided.
The student will be provided informal verbal feedback on an ongoing basis. A midpoint evaluation will be
conducted utilizing the school specified format. A final written evaluation will be completed on the last day
of the rotation utilizing the school specified format.
Responsibilities:
1. Provide comprehensive pharmaceutical care to the Solid Organ Transplant team
2. Provide drug information and act as a resource of medication related information to the medical staff
3. Pre-round on all patients covered by the Transplant service; prior to patient care rounds, identified
pharmacotherapeutic interventions will be discussed with preceptor
4. Attendance and active participation on daily Transplant rounds
Monday,
Tuesday, Wednesday, and Friday at 9 am; Thursday at 10am otherwise notified
5. Provide patient education on discharge medications for the transplant patients as needed following an
orientation.
6. Complete one written SOAP note per week: identifying pharmacotherapeutic interventions, treatment
recommendations, and monitoring plan to be reviewed by preceptor
7. Prepare and present two formal presentations to the pharmacy department (e.g. topic discussion,
journal club, patient case presentation)
8. Provide informal education and formal in-services to the transplant coordinators, medical team,
pharmacy staff and students, nursing staff, or social work as needed
9. Documentation of medication errors, adverse drug reactions, and clinical interventions
10. Provide preceptor a list of drug information questions answered
11. Attend Transplant grand rounds when available
12. Attend Transplant related meetings with preceptor
13. Independently review suggested readings to discuss patient cases and/or therapeutic topics
14. Inform preceptor of time off and other time away from the office.
Disease states/Topics (may include but are not limited to)
 Immunology basics

 Transplant pharmacotherapy review
 Transplant infectious risks
 Cytomegalovirus (CMV)
 Pneumocystis jiroveci pneumonia (PCP)
 Fungal infections and antifungals
 Antibiotic review
 Acute and chronic liver disease
Acute and chronic kidney disease
including renal replacement therapies
29
Investigational Drug Services Experience
Preceptor: Alyse Fazzi, Pharm.D., Heather Heisey, R.Ph., & Amy Kane, Pharm.D.
Phone number: 531-4976
Pager number: 2036
Fax number: 531-5705
The Investigational Drug Service experience will allow the student to gain knowledge of pharmacy
involvement in the clinical research process in a medical center. The student will be exposed to a variety
of different topics related to clinical trials. The rotation focuses on care for patients enrolled in
Investigational clinical trials, as well as the role of the pharmacy in successfully initiating, maintaining
study drug, dispensing study drug, and caring for these patients.
Objectives:
The student will be able to:
1. Define an investigational drug
2. Define the essential elements of a study protocol
3. Discuss the roles and responsibilities of the principal investigator & study coordinator
4. Explain the role of the FDA in launching an investigational new drug (IND) & the process for
obtaining an IND#.
5. Define Phase I through Phase IV clinical trial requirements
6. Demonstrate an understanding of investigational drug procurement, accountability, inventory,
storage controls, & drug return requirements
7. Utilize patient randomization procedures
8. Participate in the monitoring/audit activities performed by pharmaceutical company sponsors or
Contract Research Organization
9. Define the role of the Contract Research Organization
10. Discuss the purpose of an Institutional Review Board and Human Subjects Protection Office
11. Observe an Institutional Review Board Meeting
12. Understand the institutional and departmental policies controlling the use of investigational drugs
at Hershey Medical Center.
13. Utilize the NCI document for investigational drug accountability, define the NCI required forms,
and explain the responsibility of the pharmacy as defined by NCI
14. Discuss the elements of informed consent and patient confidentiality
15. Understand the budget process involving study protocols – prepare a study quote
16. Explain the responsibilities of the Investigational Drug Services Pharmacist
17. Assist in dispensing study drugs – performed continuously throughout the rotation
18. Identify issues to be considered when implementing an Investigational Drug study including
human & physical resources (MD, coordinator, pharmacy, lab, radiology, hospital, etc.), billing,
logistics (managing resources), institution's research structure
19. Complete the pharmacy set-up of a study from sponsor initiation, to development of the protocol
summary, to the training of pharmacy staff
20. Handle drug returns from patients and drug returns to the sponsor
21. Initiate a new investigational drug study
22. Close a drug study
At the time of the discussion of italicized objectives, a written summary detailing the information to be
discussed will be submitted to the preceptor.
30
Responsibilities:
1. Write at least one protocol summary
2. Inservice pharmacy staff on study procedures.
3. Follow any/all inpatients on study drug protocols.
4. Present an IDS patient case to pharmacy staff/students.
5. Observe chemotherapy/study drug preparation.
6. Spend ~1/2 day with a study coordinator.
7. Meet with a study monitor / conduct monitoring visit.
8. Attend an IRB meeting.
9. Participate in IDS Budget Process
10. Provide a summary of rotation experience and comment on recommendations for
improving the experience.
11. Attend pharmacy student journal clubs and presentations.
12. Completion of the CITI training course
Special Projects:
To be determined
Topic Discussions:
 Tuskeegee Trials
 Research incident at Johns Hopkins
 Others as applicable
Disease States (will include but not limited to the following)
Gene Therapy Topics, Oncology, Infectious Diseases, Cardiology, and others as apply to current study
populations
Suggested Readings will be provided as applicable to the rotation.
31
Ambulatory Care: Anticoagulation Clinic Experience
Preceptors:
Elizabeth Bittner, R.Ph., Amy Foltz, R.Ph., Frank Herrmann, R.Ph.,
Paul Kocis, Pharm.D., Gretchen Richardson, Pharm.D.,
Natalie Treese, Pharm.D.
Phone number: 531-5312
Pager number: 0861
Fax number:
531-0854
Goals: By the completion of the Anticoagulation Clinic rotation, a student
will be able to:












Describe the role of an anticoagulation clinic
Discuss warfarin pharmacology
Discuss clinical indications for warfarin therapy
Identify potential drug interactions with warfarin
Describe the dietary impact of foods on warfarin
Discuss PT/INR testing methods, calculations and results
Discuss the principles of warfarin management
Identify the signs, symptoms and treatment options of embolic and hemorrhagic
events and warfarin side effects
Educate a patient on warfarin therapy
Communicate with a patient by telephone regarding warfarin therapy
Discuss the indications, dosing and administration technique for LMWH
Identify other anticoagulant agents and their indications
Required Responsibilities/Activities:
 Attend all pharmacy student and resident journal clubs and presentations
 Perform daily readings as required for next day review with preceptor
 Perform telephone communications and review common disease states with
patients regarding warfarin therapy
 Perform educational sessions on warfarin therapy with patients
 Present a formal case presentation using PowerPoint (reserve projector with the
Administrative Assistant at least 1 week prior to your presentation)
 Answer drug information questions as requested
 Observe a cardioversion procedure, HMC laboratory devices and pacemaker
clinic
 Other duties as assigned by preceptor
32
Ambulatory Care: Transitions of Care Experience
Preceptors: Michele Haydo, Pharm.D, BCACP and Ritu Light, PharmD
Contact Information:
Email: [email protected]
Email: [email protected]
Phone: 717-531-0003 x281921
Phone: 717-531-0003 x284265
Pager: 2813
Pager: 5990
Rotation Overview: Transitions of care is commonly described as the shift from one health care setting
to another. Continuity and coordination of care needs to be maintained among all health care providers
involved in the patient’s care (i.e. hospital health care providers, primary care physician, pharmacist, etc.).
It is important to provide education and assistance to patients and their families along the continuum of
care to ensure their understanding of the patient’s care plan. Pharmacists play an integral role in the
transition of care by providing medication education, assisting in the transfer of information to the patient
and other providers, and ensuring patient follow up with the care plan. During this rotation, the student
will have the opportunity to experience transitions of care for various patient populations.
Objectives:
After completion of the transitions of care rotation the student should be able to:
 Perform a thorough medication reconciliation and recommend changes as identified
 Provide patient/caregiver medication education through both face to face and telephone
interactions
 Describe the general pathophysiology, etiology and treatment guidelines of heart failure and
stroke
 Provide patient/caregiver disease education
 Apply the Beers criteria to patient specific populations and make recommendations for safer
alternatives when necessary
 Work collaboratively as part of a patient centered medical home to improve overall patient care
Required Responsibilities/ Activities
 Perform face to face and telephone follow up for heart failure and stroke patients
 Participate in chronic disease management through Care Management patient follow up
 Participate with the outpatient retail pharmacy medication discharge program and ACC discharge
patient follow up
 Present a journal club article
 Perform daily readings required for next day review with preceptor
 Present a formal patient case presentation using PowerPoint
 Answer drug information questions as requested
 Prepare and contribute to weekly topic discussions
 Attend pharmacy student and resident journal clubs and patient case presentations
 Other duties as assigned by preceptor
Topic Discussions/Suggested readings
 Heart failure guidelines
 Stroke guidelines
 Beers Criteria
 Chest Guidelines regarding anticoagulation
 New anticoagulants
 Warfarin pharmacology and therapeutics
 Other disease states/topics as they present during rotation
33
Pharmacy Informatics Experience
Preceptor:
Dwayne Gallagher, PharmD
Contact Information: [email protected]
The Pharmacy Informatics rotation, with a strong multidisciplinary focus, will introduce the student to
many of the benefits and challenges of information technology in the healthcare environment. The
student will be exposed to the strategic nature of technology decisions in the care of
patients. Specifically, the student will learn about the medication process within a clinical information
system. Examples include the use of computerized provider order entry (CPOE), electronic prescribing,
pharmacy information systems, pharmacy automation, and nursing documentation. Additional topics will
include technology essentials, database structure and design, patient confidentiality, data security, project
management, system testing, user training, system maintenance, and support.
Objectives
 Define and review the growing fields of Clinical Informatics and Pharmacy Informatics
 Review benefits and risks of a clinical information system, including the components of CPOE and
documentation
 Understand & Develop Process workflows for physicians, nurses and pharmacists related to
medication use.
 Participate in the use of the clinical information system with physicians, nurses and pharmacists
 Understand & Participate in Project Management
 Review database design and structure.
 Review technology essentials such as hardware, domains, networking, interfaces, and software
platforms
 Review confidentiality, privacy and security or patient data
 Participate in the maintenance and support of all medication management aspects of a clinical
information system
 Review and describe the benefits and design of Clinical Decision Support (e.g. order sets, interaction
checking, dose checking, rules, and alerts)
 Participate in the testing of the clinical information system in various domains
 Attend and participate in decision making committees for the clinical information system (e.g. Clinical
Integration, Pharmacy Team, Pharmacy & Therapeutics Committee)
 Design and/or create a report to assist in patient care or management activities
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Hospital Pharmacy Practice Experience
Preceptor:
Phone:
Email:
Ron Lay, MS, RPh
717-531-3948
[email protected]
Student Responsibilities:
Work with pharmacists and pharmacy technicians in a variety of patient care areas, including but not
limited to medicine, surgical, intensive care, pediatric, and parenteral products.
Gain experience in the preparation, packaging, and dispensing of sterile and non-sterile medications in
the inpatient hospital working environment.
Attendance in selected meetings with pharmacy administration.
Preparation of, and participation in the pharmacy department’s biweekly pharmacy and resident and
student journal club.
Answer drug information questions.
Preparation of and/or revision of department of pharmacy policies and procedures.
Preparation of a medication monograph for a drug formulary review.
Additional activities as assigned by preceptor .
Students are reminded that this experience will be their primary responsibility while here and that
significant time commitments may be required to complete their assigned workload. There is no
guarantee that students will be able to leave by any set time each day. Students should keep this in mind
if they plan on scheduling outside employment, as needing to be at a job will not be an acceptable excuse
for leaving.
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Medication Safety and Quality Pharmacy Experience
Rotation Preceptor:
Lisa Hanlon Wilhelm, BS Pharm, RPh
Contact information:
Email: [email protected]
Office: 717-531-1038
Pager: 717-531-8521 pager 0724
Cell: 717-421-2340
Rotation Description:
The Medication Safety and Quality rotation will help students become familiar with the key strategies
utilized in an academic tertiary care hospital and outpatient clinics to improve medication safety. The
rotation is designed to expose pharmacy students to medication safety nomenclature, key principles,
tools, and available resources. The student will participate in several activities designed to improve the
student’s working knowledge and experience with medication safety concepts. The rotation will enable
the student to apply knowledge in pharmacy practice settings to improve medication safety for patients.
Rotation Goals and Objectives
1. Develop an understanding of a systems-based approach to improving medication-use safety.
2. Explain the role of data in improving the medication-use process.
3. Describe the types of error reporting processes that exist and their corresponding limitations.
4. Participate in the institution’s error and risk reduction strategies.
5. Summarize Joint Commission (TJC) and other related regulatory and accreditation standards and
how they relate to medication safety.
6. Discuss technology’s role in medication safety and explain the possible shortcomings and
unintended consequences.
7. Explain methods and tools such as root cause analysis (RCA), failure modes and effects analysis
(FMEA), and Lean Six Sigma used to improve medication safety.
8. Describe the concepts of “Culture of Safety” and “Just Culture”.
9. Compare medication safety resources.
Rotation Hours
Generally 0830 – 1700 daily however, times may vary depending upon rotation needs/meetings.
Occasionally meetings may be earlier and/or later than the above mentioned times.
Rotation Responsibilities
1. Complete orientation to the organization’s pharmacy operations and clinical activities.
2. Shadowing of various clinicians in order to experience the full spectrum of medication safety
activities including but not limited to: pharmacist, pharmacy clinical specialist, pharmacy
technician, nurse, clinical informatics, and pharmacy and organizational leadership.
3. Participate in medication safety and quality meetings as assigned by preceptor.
4. Complete and present a medication safety journal article review.
5. Complete assigned readings and participate in topic discussions with preceptor.
6. Prepare and lead at least one medication-related topic discussion.
7. Complete one root cause analysis (RCA) on a medication error.
8. Complete other projects as assigned by preceptor.
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Rotation Content (May include but not limited to the following)
Reporting, metrics, and data analysis
Human factors engineering
Systems theory
RCA and FMEA
High-Alert medications
Technology and automation in medication safety
Culture of Safety and Just Culture
Teamwork and Communication
Lean and Six Sigma methodologies
Second Victim Theory
Regulatory and Accreditation Standards
Method of Evaluation
Weekly informal evaluations
One midpoint evaluation
Final evaluation
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Emergency Medicine Experience
Preceptor:
Michael Lehr, B.A., Pharm.D.
John Nahas, Pharm.D., BCPS
Phone: (717) 531-0003 ext. 311507
Fax:
(717) 531Email: [email protected]
[email protected]
Description:
This Emergency Medicine rotation will familiarize students with the key skills utilized by a clinical
pharmacist in the Emergency Department (ED). The student will have the opportunity to participate in the
essential key roles and objectives that a pharmacist completes daily in the ED, which includes medication
reconciliation in order to optimize medication therapy for patients being admitted to the hospital or being
discharged home from the ED, drug therapy monitoring, toxicology, patient education, participation in
high-risk procedures including resuscitation and other time-dependent emergencies, medication
preparation, and drug information. This will be completed by working with an interdisciplinary team in
order to optimize medication therapy management and improve patient care. Students will be exposed to
a wide scope of patient acuity from ambulatory to the critically ill.
Hours:
Monday through Friday: 10am – 6:30pm
Objectives:
1. Complete medication history/reconciliation activities for both pediatric and adult patients.
2. Review medication profiles and pertinent laboratory data for assigned patients in the
emergency department setting for appropriateness of therapeutic regimens, and drug
interactions.
3. Monitor drug therapy for efficacy and toxicity using data obtained from the medical chart,
medical staff, and patient or patient’s family.
4. Prevent and identify clinically significant drug interactions and adverse drug reactions.
5. Utilize available resources to retrieve requested drug information in a timely manner.
6. Attend and participate in all medical and traumatic emergencies under the supervision of the
clinical pharmacist/preceptor.
7. Display effective communication skills when interacting with other health care professionals.
8. Under the supervision of a clinical pharmacist, prepare dosage forms upon request for
emergent situations.
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9. Participate in emergency medicine initiatives and assist in ensuring and monitoring
compliance with guidelines.
10. Gain an understanding of common ED disease states and their treatments.
Atrial Fibrillation/ACS
Headache/Migraine
Infectious Disease
Diabetic Ketoacidosis
Anticoagulation
Toxicology
Status Asthmaticus
Pain
Rotation Goals:
8. Complete and discuss assigned medication histories/reconciliations with the clinical
pharmacist. In a timely fashion, correct any order discrepancies to ensure safe and
appropriate use of medications.
9. Complete and discuss all assigned readings on time as assigned by preceptor. Prepare and
lead at least one topic discussion on a relevant emergency medicine topic.
10. Perform disease-state or medication education to applicable patients.
11. Attend and participate in scheduled discussions with preceptor.
12. Attend and participate in scheduled journal club presentations.
13. Prepare and present a formal case report including disease state discussion.
14. Prepare a “pharmacy corner” bulletin board article for presentation in the ED.
15. Document all pharmacotherapy interventions made on patients.
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Retail Pharmacy Program Experience
Preceptor:
Phone:
Email:
Patty Seeley, RPh
(717) 531-0003 ext. 289263
[email protected]
Description:
The department of pharmacy provides outpatient pharmacy services at multiple on-campus sites. These
include:
 Multiple on-campus locations providing acute retail pharmacy services with a focus on
patients being seen in on-campus clinics and being discharged from the inpatient hospital.
 Mail order pharmacy services for employees of the Medical Center
 The “Rx to Go” program for inpatients being discharged from the hospital. This program
provides discharge prescription medications and pharmacist counseling at the patient
bedside prior to leaving the hospital.
Responsibilities/ Activities
Accurately evaluating, preparing, and dispensing medications in an outpatient pharmacy environment.
Providing patient/caregiver medication education through face to face conversations, telephone
interactions and/or at the patient bedside prior to discharge from the inpatient hospital.
Preparation of, and participation in the pharmacy department’s biweekly pharmacy and resident and
student journal club.
Assisting with the discharge medication reconciliation process for hospitalized patients.
Facilitating patient access to prescription assistance programs for qualified patients.
Answering drug information questions.
Other duties as assigned by preceptor.
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Hospital Pharmacy Administration Experience
Preceptor: Vince Lacroce, Pharm.D.
Description:
The Hospital Pharmacy Administration is designed to provide the student experiences within multiple
facets of pharmacy management and leadership. The Administrative Director of Pharmacy serves as the
principle preceptor. The preceptor is the learning resource for the student and coordinates and delegates
activities. The student is expected to function independently to accomplish goals and assignments.
Activities are structured to allow for interaction with other disciplines within the Institution as well as the
Pharmacy leadership team members.
Rotation Objectives:
1. Understand the overall medication management systems in place within the organization.
2. Describe the use of automation within the department and how the use of technology has
impacted (positively or negatively) patient care. Examples of technology include automated
dispensing cabinets, robotics, bar coding technology, smart pump technology, and computerized
prescriber order entry.
3. Discuss the role of formulary management within the pharmacy. Specific areas of discussion
should include formulary selection process, ordering, procurement, drug shortages, and recalls.
4. Understand the process for detecting drug diversion within a large hospital setting. Specific
areas of discussion may include methodology for detecting drug diversion, processes for
addressing known drug diversion, and regulatory requirements regarding controlled substances
5. Understand the processes for development of policy and procedure. Understand the methods in
place to ensure compliance with policy and procedure
6. Describe the hospital’s and pharmacy’s budgetary process. Relate these discussions to the
organization’s financial goals.
7. Describe important components of human resource management.
8. Discuss and understand the various regulatory agencies that govern pharmacy practice (The
Joint Commission, CMS, FDA, DEA, boards of pharmacy, etc.
9. Participate in the development of or enhancement of a clinical service.
10. Describe methods of staff development
11. Understand the process for reporting adverse drug events (medication errors and adverse
drug reactions) within the institution.
12. Understand the process for evaluating medication errors within the institution
13. Describe the role of quality assurance programs within the department and within the
organization.
14. Discuss various styles of leadership.
15. Demonstrate effective communication skills (written and verbal).
16. Understand the importance of teamwork and effective multidisciplinary project management.
17. Understand the challenges faced by current pharmacy managers and department leaders.
18. Describe motivational methods that these leaders use in their everyday practice.
STUDENT RESPONSIBILITIES:
The student will be integrated into the daily activities of the Leadership team. These activities will
include attending specific meetings and participating in major departmental initiatives. Every effort will
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be made to cover all of the above objectives, however, those most in line with the Departmental and
organizational priorities at the time of the rotation will take precedent. Throughout the rotation the
student will receive projects that contribute to the resolution of current Departmental issues and/or the
achievement of Departmental strategic initiatives.
The student will meet with the following individuals and be able to understand their roles within the
Department:
1.
2.
3.
4.
5.
6.
7.
Medication Safety and Compliance Specialist:
Administrative Director of Pharmacy
Manager, Pharmacy Business Operations
Pharmacy Informatics Specialist
Operations Coordinator
Directors of Inpatient, Outpatient, and Clinical Pharmacy Services
Inpatient Managers
Assignments
8. Complete a leadership related journal article/topic review and present to Department Leadership
team
9. Develop/Modify and implement at least 1 policy and procedure.
10. Attend at least one Best Practice meeting for managers and supervisors
11. Attend Departmental Leadership meetings and staff meetings
12. Attend Organizational meetings as determined by the Administrative Director of Pharmacy
13. Sit in on recruitment interviews, if the opportunity presents itself during the month.
14. Attend meetings with pharmaceutical sales representatives.
15. Participate in strategic planning workgroups as assigned
16. Attend Nurse Practice Council and other organizational meetings as assigned
17. Spend time shadowing each of the leadership team within the Department
18. Other duties as assigned.
Required Readings will be assigned and be relevant to contemporary pharmacy leadership issues.
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