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Pharmacy Rotations

Core Rotations – PGY1

Orientation
The PGY1 Orientation rotation is designed to allow the resident to begin to learn the workflow and role of the Yuma Regional Medical Center pharmacy department.

During the course of this rotation, the resident will be exposed to a number of different roles within the pharmacy department, as the resident may be required to staff one of these roles during the course of their PGY1 experience. The experiences the residents will be participating in include but are not limited to: Advanced Cardiac Life Support (ACLS) certification, Epic (Yuma Regional Medical Center’s electronic health record) training and staffing in the central pharmacy (order verification, checking of medications) and seeing patients in the Anticoagulation Clinic.

By the end of the rotation, it will be expected that the resident will have developed a solid foundation of the workflow in the Yuma Regional Medical Center inpatient pharmacy and begin to work as a pharmacist within the organization.

Internal Medicine I/II
The Internal Medication residency rotation is a one-month required learning experience at Yuma Regional Medical Center. This rotation allows the resident to be involved in the care of patients in the general medicine setting (medical/surgical), which includes a wide variety of disease states. Emphasis is made to enhance the resident’s knowledge of the pathophysiology, diagnosis, treatment and prevention of disease states and complications encountered in general medicine patients. The resident's primary responsibility is evaluation of medication therapy for patients. This includes identifying and resolving drug therapy problems, communication of the recommendations to appropriate healthcare providers, implementation of the follow-up plan and appropriate documentation in the patient chart and/or clinical pharmacy consult records. Residents will expand their pharmacotherapy knowledge through participation in topic discussions, literature searches, review of evidence-based guidelines and review of patient cases. Residents may be assigned additional projects during the rotation that will supplement their knowledge and improve medication use in the hospital.

Critical Care I/II
The Critical Care I rotation is a one-month required learning experience at Yuma Regional Medical Center. This rotation allows the resident to be directly involved in the care of patients in the 31-bed Intensive Care Unit (ICU) and 11-bed step down Multi-Organizational Service Unit (MOSU).

The pharmacy resident is responsible for the evaluation of all medication therapies associated with the care of patients in the ICU and MOSU. The resident will be responsible for keeping their own monitoring book of all patients in the ICU and MOSU during their rotation. This will allow the resident to monitor and follow as well as track the identification and resolution of drug therapy problems within their patient population, including, but not limited to, providing and documenting therapeutic drug monitoring services in patients receiving drugs requiring monitoring, including, but not limited to, aminoglycosides, vancomycin and TPN. As the resident gains experience, not only will they be expected to participate in multidisciplinary rounds each morning, but also to communicate recommendations to the health care team as appropriate. Being that the residents are ACLS certified, it will be expected that they attend all codes throughout hospital while on ICU service. Residents will expand their pharmacotherapy knowledge through participation in topic discussions, literature, review of evidence-based guidelines and review of patient cases with the preceptor and ICU intensivist physician. Residents may be assigned additional projects/presentations during the rotation that will improve their knowledge base and improve care to critical care patients.

Intensive Staffing
During this rotation, the resident will be assigned to staff different pharmacists’ shifts throughout the experience and it will be upon the resident to complete all assigned tasks for that shift. The main difference between this rotation and Internal Medicine, Critical Care and the longitudinal staffing will be that the resident will not be assigned to cover, or handle solely, the clinical support for a single unit, but rather the resident will take on the exact workload that would have been assigned to the pharmacist for that shift.

Infectious Disease
The Infectious Disease rotation is a five-week required learning experience at Yuma Regional Medical Center. This rotation allows the resident to be involved in the care and evaluation of hospitalized patients receiving antimicrobials or other medications pertaining to infectious disease. This includes: (1) identifying and resolving drug therapy problems; (2) communicating recommendations to the appropriate healthcare provider; (3) recommending or implementing a follow-up/monitoring plan; and (4) when necessary, appropriately documenting in the patient’s chart and/or clinical pharmacy consult records. Residents will expand their pharmacotherapy knowledge through participation in topic discussions, literature searches, review of evidence-based guideline, and review of patient cases. Residents may be assigned additional projects during the rotation that will supplement their knowledge and improve antimicrobial use in the hospital.

Student Preceptor
The Student Preceptor rotation is a required learning experience that is focused on the resident acting as a preceptor to an Introductory Pharmacy Practices Experiences (IPPE)/Advanced Pharmacy Practices Experiences (APPE) student assigned to Yuma Regional Medical Center for rotation. The length of this rotation will vary by student, as schools may have different lengths of rotations. This rotation will take place the spring portion of the resident’s year, generally after the resident has completed all tasks and experiences in the Midwestern University Clinical Educators Program (CEP). During this rotation, the resident will be able to use skills attained during the CEP, including, but not limited to, the creation of learning objectives, the four preceptor roles employed in practice-based teaching (direct instruction, modeling, coaching and facilitation), evaluation and feedback.

Ambulatory Care Infusion Center   
This four–week rotation takes place at the Yuma Regional Medical Center Cancer Center outpatient infusion center pharmacy. The pharmacy operates from 7:30 am to 5:00 pm, Monday through Friday. Specific resident hours will depend on which shift the resident is assigned that day. The clinical pharmacist in this area is responsible for providing comprehensive care to patients receiving outpatient infusion therapy. The pharmacists work with an interdisciplinary team to provide laboratory monitoring and appropriate drug therapy.
 

Longitudinal Rotations – PGY1


Preceptor Development
The Preceptor Development rotation is a required longitudinal experience that is focused on the resident acting as a preceptor to an Introductory Pharmacy Practices Experiences (IPPE)/Advanced Pharmacy Practices Experiences (APPE) student assigned to Yuma Regional Medical Center for rotation. The length of this rotation will vary by student, as schools may have different lengths of rotations. This rotation will take place the spring portion of the resident’s year, generally after the resident has completed all tasks and experiences in the Midwestern University Clinical Educators Program (CEP). During this rotation, the resident will be able to use skills attained during the CEP, including, but not limited to, the creation of learning objectives, the four preceptor roles employed in practice-based teaching (direct instruction, modeling, coaching and facilitation), evaluation and feedback.

Staffing
The staffing residency rotation is a longitudinal required learning experience at Yuma Regional Medical Center. It is broken down into four quarterly evaluation periods. Each resident will be assigned to work (staff) weekends in the Inpatient Pharmacy on a rotating basis. This rotation teaches practical aspects of pharmaceutical care and drug distribution in the hospital setting. The purpose of working as a staff pharmacist is to gain experience and improve skills in the medication use process. Understanding the process is part of leadership in the profession. Pharmacists must have a thorough understanding of the medication ordering/delivery system utilized by the institution to be completely successful. Residents will work with both the unit-dose and IV admixture systems. There will always be a preceptor available to assist the resident with any questions that arise during evenings and weekends. Residents should never hesitate to contact any of the pharmacists that they are working with to discuss patient-specific drug-related problems. Any time a pharmacy resident rotates through a decentralized shift, he/she is expected to maintain his/her presence on the nursing patient care unit as much as possible to build rapport between the pharmacy departments as well as other clinical disciplines.

Research
This is a longitudinal experience that will be completed during the course of the residency and will include the conduction of a Medication Use Evaluation (MUE) and research project. Appropriate processes will be followed (i.e., seeking Institutional Review Board (IRB) approval) when necessary. The MUE will be presented in poster format at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting. The research project will be presented as a platform presentation at the Western States Conference. Prior to completion of the residency, a manuscript suitable for publication will be written explaining the resident’s research.

Pain and Palliative Care
The Palliative Care/Pain Management longitudinal rotation is a 12-month experience in which the resident will appropriately integrate the timely assessment, treatment and monitoring of patients with acute chronic cancer and chronic non-cancer pain, as well as gain an understanding of the complexity of end-of-life issues and non-pain symptom management. The resident will learn to distinguish the important physiological, psychological and emotional differences associated with the three main areas of pain: palliative, acute and chronic, and how this knowledge plays a critical role in the perception, assessment and treatment of pain in a community hospital and outpatient setting. The resident will act as part of an integrated, collaborative healthcare team by making recommendations on patient-specific pain and non-pain symptom management plans and act as a source of education and information for other healthcare professionals (including, but not limited to, nursing, physical therapy and case management).

Anticoagulation
The anticoagulation management rotation is a year-long longitudinal required experience for all PGY1 residents at Yuma Regional Medical Center. Each resident is required to staff the Yuma Regional Medical Center Anticoagulation Clinic (ACC) once every two weeks on a Thursday. This rotation teaches direct patient care in an ambulatory setting that is managed entirely by pharmacists. Residents will gain experience with medication therapy management for patients taking warfarin as well as in performing monitoring activities to assess efficacy and potential toxicity of warfarin therapy. Residents will learn how to effectively communicate with patients and refine their interviewing/counseling skills. Residents will be able to apply their pharmaceutical expertise by responding appropriately to drug information questions from patients and other providers. Residents will also become proficient at documenting patient care activities in EPIC according to the Yuma Regional Medical Center anticoagulation guidelines and protocol. Residents will always have an anticoagulation pharmacist staff member in the adjacent office who will be available for consultation and feedback as needed.  

Management
The Pharmacy Practice Management rotation will explore pharmacy leadership and management, covering key operational and strategic topics at the departmental, enterprise and professional practice levels.

The learning experience will involve discussion, independent research, participation in meetings and completion of projects requiring analysis and application of concepts learned.

Upon completion of the learning experience, the resident will achieve an understanding of the breadth and complexity of pharmacy management, effective leadership and management skills, factors shaping healthcare and the practice of pharmacy now and into the future, and the importance of accountability, engagement and continuous effort towards improvement in the delivery of pharmaceutical care.

Elective Rotations – PGY1


Pediatrics/Neonatal
The Pediatrics / NICU residency rotation is a 1 month elective learning experience at Yuma Regional Medical Center. The resident’s primary responsibility is the evaluation of medication therapy of patients being treated for medical conditions related to: pediatrics and neonatology. Emphasis is made to enhance the resident’s knowledge of the pathophysiology, diagnosis, treatment, and prevention of disease states and complications encountered in pediatric and neonatal patients.

Family Medicine Clinic
The Family Medicine rotation is a one-month elective learning experience at Yuma Regional Medical Center. This rotation allows the resident to be directly involved in the care of patients in the YRMC Family Medicine Clinic. As part of this rotation, the resident will be asked to evaluate patients for medication adherence, drug-drug interactions (DDI), duplication of therapy, efficacy of drug therapy as well as other aspects of the patient as a whole. The resident will be expected to apply and make recommendations supported by nationally recognized guidelines and be able to individualize treatment for patients.
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