Description of Rotations:
Medicine / Pulmonary Intensive Care
The Medical Critical Care / Pulmonary Teaching Service (MCCTS/PTS) is a multi-disciplinary teaching service consisting of a pulmonary/critical care board certified attending physician, internal medicine interns and residents, family medicine and surgical interns, medical students, a clinical pharmacy specialist, and a respiratory therapist. The average daily patient census for the MCCTS and PTS teams is ~35-45 patients, with most patients receiving mechanical ventilation. Disease states range from COPD exacerbations, community and hospital acquired pneumonias, drug overdoses, acute neurological events, sepsis resulting from various infections, pulmonary embolus, and adult respiratory distress syndrome, as well as many other disease states.
Surgery / Trauma Critical Care
The Surgery / Trauma Critical Care Teaching Service (SCCTS) is a multi-disciplinary teaching service consisting of a pulmonary/critical care board certified attending physician, an upper-level resident, a surgical intern, a clinical pharmacy specialist, and a respiratory therapist. The SCCTS team provides critical care consultative services to neurosurgical, general surgical, trauma, cardiothoracic, and vascular patients in the six intensive care units at a Level I Trauma Center. The average daily census for the SCCTS ranges from 15-30 patients depending on consultations, with all patients requiring mechanical ventilation. Disease states managed included closed head injuries including SAH/SDH, acute spinal cord injuries, sepsis resulting from a multitude of causes, adult respiratory distress syndrome, acute alcohol withdrawal, blunt trauma, aortic aneurysms, as well as many other disease states.
Cardiovascular Intensive Care
The Cardiovascular Service is non-teaching service consisting of a pulmonary/critical care board certified attending physician, physician assistants, a clinical pharmacy specialist, and a respiratory therapist. The team provides critical care consultative service to cardiothoracic surgery patients. The average daily census for the service ranges from 10-20 patients depending on consultations, with most patients requiring mechanical ventilation. Disease states managed included post-operative care of coronary artery bypass grafts and valve repair/replacement, sepsis resulting from a multitude of causes, as well as many other disease states.
Neonatal Intensive Care
The Neonatal Intensive Care Unit (NICU) rotation takes place in a 52-bed, level III NICU on the Memorial Campus of the Greenville Health System. The resident will be a part of 1 of 3 multidisciplinary teams comprised of an attending physician, a neonatal nurse practitioner, 1-2 pediatric medical residents, nursing, respiratory therapists, and a pharmacist. Topics commonly encountered and/or discussed throughout the rotation include apnea of prematurity, bronchopulmonary dysplasia (BPD), patent ductus arteriosus, congenital heart defects, diaphragmatic hernia, hyperbilirubinemia, intraventricular hemorrhage (IVH), mechanical ventilation of the premature infant, morbidity and mortality of premature infants, neonatal abstinence syndrome, necrotizing enterocolitis, neonatal sepsis, nutrition of the premature infant, respiratory distress syndrome (RDS), sedation/analgesia in premature infants, among others.
Pediatric Intensive Care
The Children’s Hospital at Greenville Memorial Hospital includes a new 12 bed Level I pediatric intensive care unit (PICU). The unit’s medical staff is composed of 3 pediatric intensivists and pediatric medical residents. The patient population is diverse. Services not covered at Greenville Memorial Hospital PICU include cardiovascular surgery, burns, and transplantation. Other specialty areas with children requiring intensive care are covered by this service. The resident is expected to monitor, assess and contribute to the drug therapy plans. In addition, the resident will develop a base knowledge of the differences in pediatric and adult critical care therapies.
The Pediatric Hematology/Oncology group at Greenville Health System Children's Hospital treats children from birth to age 21. All types of childhood cancer and blood disorders, including cogaulopathies, sickle cell disease, and other anemias and white blood cell diseases are diagnosed and treated by a multidisciplinary team. The PGY1 resident will function as an integral part of this medical team with the goal of developing an understanding for the clinical pharmacist’s role in the care of the hematology/oncology patient. Responsibilities include: Attend and actively participate in daily rounds as well as daily review of patients’ medication orders, progress notes, and pertinent laboratory/microbiology data. In addition, the resident will be expected to provide drug information to physicians, nurses, pharmacists and other health care professionals as well as perform daily therapeutic drug monitoring, and document pharmacokinetic recommendations in the patient’s chart. Potential topics for discussion include: hematologic malignancies, solid tumors, fever and neutropenia, oncologic emergencies, tumor lysis syndrome, sickle cell disease, ITP, and aplastic anemia.
Adult Internal Medicine
The Medical Teaching Service (MTS) experience creates a foundation for pharmacy practice residents on an inpatient general medicine service. The resident will be assigned to a MTS team consisting of an attending physician, medical residents, interns, and students. The resident will attend patient care rounds and teaching rounds on a daily basis and present developed therapeutic plans for each of his/her patients to the preceptor on a daily basis, provide patient counseling on medications and disease-states, obtain medication histories, write pharmacokinetic and therapeutic consult notes as necessary, participate in journal club, and give two formal presentations to the preceptor. In addition, the resident will have the opportunity to conduct informal and/or formal educational services to physicians, nurses, and pharmacists. Topics commonly encountered and/or discussed throughout the rotation include pneumonia, urinary tract infections, bacteremia/sepsis, chronic obstructive pulmonary disease, heart failure, venous thromboembolism, angina/myocardial infarction, stroke, seizure disorders, acute and chronic renal failure, peptic ulcer disease, gastroesophageal reflux disease, pancreatitis, hepatitis/cirrhosis, diabetes, anemia, fluid-electrolyte disorders, acid-base disorders, human immunodeficiency virus, dementia, and liver disease.
The Infectious Diseases Consult Service is utilized by all of the various services in Greenville Memorial Hospital to participate in the care of patients with difficult-to-manage infectious diseases. The service is a multi-disciplinary team consisting of an infectious disease attending physician, internal medicine residents, medical students, and a pharmacist. Disease states commonly encountered include pneumonia (community and hospital acquired), urinary tract infections, bacteremia/sepsis, hepatitis/cirrhosis, human immunodeficiency virus, osteomyelitis, endocarditis, sexually transmitted diseases, opportunistic infections, meningitis, and various fungal infections.
The Cardiology Teaching Service (CTS) experience is an elective rotation. CTS directly admits patients and accepts consults from various services at the Greenville Memorial Hospital campus to manage a broad scope of cardiovascular conditions. This rotation is designed to provide a basic overview of the acute and chronic management of commonly encountered adult cardiovascular diseases. CTS provides medical, as well as interventional management as treatment approaches. The resident will be assigned to a team consisting of an attending physician, medical resident(s), intern(s) and student(s). Disease states encompass: STEMI, NSTEMI/UA, CHF exacerbations, arrhythmias, anticoagulation, hypertensive crises, interventional cardiology, and others.
The Vascular Teaching Service (VTS) clinical rotation is a floor and ICU experience that gives pharmacy residents an opportunity to design, monitor, and evaluate evidence-based patient-specific therapies for vascular surgery patients at Greenville Memorial Hospital. There is one VTS, consisting of a vascular surgery attending, a vascular surgery fellow, 1-2 upper level surgery residents, an intern (a 1st year surgery resident), a medical student, a physicians assistant, and a PharmD. The VTS rotation will focus on care of post-operative vascular surgery patients in the ICU, as well as on the 3C floor. The resident will also provide drug information and in-services to surgical residents/students, as well as participate in daily pharmacotherapy topic discussions and journal clubs.
Adult Internal Medicine – Hospitalists Service
The Hospitalists Service experience is an elective rotation for pharmacy practice residents on an inpatient general medicine service. The resident will be assigned to a portion of the Hospitalists Service (based on interest). The Hospitalists Service is comprised of seven day-shift physicians rounding on patients throughout the hospital, two pharmacists, and students. As a member of the patient care team, each resident will work closely with the preceptor to provide pharmaceutical care. The resident will attend grand rounds each Friday morning, present developed therapeutic plans for each of his/her patients to the preceptor on a daily basis, independently round on patients daily, provide patient counseling on medications and disease-states, obtain medication histories, write therapeutic consult notes as necessary, participate in journal club, and give formal presentations to the preceptor. In addition, the resident will have the opportunity to conduct informal and/or formal educational services to physicians, nurses, and pharmacists. Topics commonly encountered and/or discussed throughout the rotation include internal medicine-based topics. This rotation can be tailored to resident-specific interests.
Adult Internal Medicine - Inpatient Anticoagulation Service
The Anticoagulation Service experience is an elective rotation for pharmacy practice residents. The resident will work closely with the preceptor to provide pharmaceutical care to patients receiving heparin, enoxaparin, and warfarin. The resident will attend grand rounds each Friday morning, present developed anticoagulation therapeutic plans for each of his/her patients to the preceptor on a daily basis, independently round on patients daily, provide patient counseling on medications and disease-states, obtain medication histories, write therapeutic consult notes as necessary, participate in journal club, and give a formal presentation to the clinical pharmacy preceptors. In addition, the resident will have the opportunity to conduct informal and/or formal educational services to physicians, nurses, and pharmacists. Topics commonly encountered and/or discussed throughout the rotation include anticoagulation-based topics.
The GHS Drug Information Service responds to clinical queries from pharmacy, medicine, and nursing staff. The scope of drug information consults is quite diverse, and may include patient-related therapy decisions, protocol/order set development, clinical research and/or investigational drug inquiries, and adverse drug reaction monitoring in any given month. In addition, the Drug Information Service provides support for the GHS Pharmacy and Therapeutics Committee by reviewing and preparing drug formulary reviews, medication usage evaluations, meeting agenda/minutes, and other relevant meeting materials as appropriate.
Practice management is a longitudinal rotation designed to provide a basic overview of administrative aspects of managing a large pharmacy department in a complex medical system. The experiential component of this rotation focuses on actual projects, teams and PI activities currently underway rather than theoretical activities. The rotation is intended to provide the resident with “hands on” experience in identifying and resolving administrative and clinical problems, forming and functioning within a teamwork environment and developing new pharmacy initiatives, to name only a few. In addition, the resident becomes knowledgeable about key administrative responsibilities including planning, budgeting, medication safety and management structures within a large complex pharmacy department.
GHS Center for Internal Medicine is located on Memorial Medical Center’s campus. Other sub-specialty clinics include: Dermatology, Cardiology, Pulmonary, Endocrinology, Nephrology, Rheumatology, Urology and Gastroenterology. The Diabetes Education Program is also available by referral and is staffed by a dietician, pharmacist, and charge nurse. The Anticoagulation Clinic, Heart Failure Clinic and Smoking Cessation Clinic are other services offered to internal medicine clinic patients and are managed by our clinical pharmacy specialists, also on a referral basis. This rotation will increase the resident’s knowledge and experience in providing primary care to patients in an internal medicine setting. The resident will develop skills in obtaining medication histories, assessing medication appropriateness, interviewing patients and caregivers, developing patient care plans, monitoring and evaluating medication use, providing pharmacotherapeutic recommendations, and communicating drug information to patients and health care professionals.
The Family Medicine Teaching Service (FMTS) experience is an elective rotation that provides pharmacy practice residents with the opportunity to gain exposure in a transition of care model through inpatient and outpatient practice environments. The FTMS is a multi-disciplinary teaching service consisting of an attending physician, clinical pharmacist, medical residents, interns, and students and serves the acute medical needs of patients during hospitalization. The Center for Family Medicine (CFM) provides follow-up for both acute hospitalizations and chronic disease state management within the outpatient setting. The resident will be expected to attend morning report and teaching rounds on a daily basis and present developed therapeutic plans for each of his/her patients to the preceptor, write pharmacokinetic and therapeutic consult notes as necessary, provide drug information services for the healthcare team, participate in topic discussions and journal clubs, and be actively involved with ongoing projects. Additionally, the resident will have the opportunity to gain experience in ambulatory care through pharmacy case management and pharmacotherapy clinics at the CFM. Topics commonly encountered and/or discussed throughout the rotation will include both internal medicine and ambulatory care based topics. This rotation can be tailored to resident-specific interests/needs.
Longitudinal On-Call / Clinical Pharmacokinetics Consult Service
The clinical on-call / pharmacokinetics longitudinal experience provides on-call and pharmacokinetics consult service at Greenville Memorial Hospital. The on-call / pharmacokinetics consult service is designed to provide consistent clinical resources to GMH healthcare providers in a timely manner. The resident will design, monitor, and evaluate evidence-based patient-specific therapies involving clinical pharmacokinetics, drug information questions, investigational drug services, therapeutic outcomes program, clinical service cross-coverage, and additional pharmacotherapy consults.
Academician Preparation Program (Teaching Certificate)
GHS residents will obtain a teaching certificate through The South Carolina College of Pharmacy Academician Preparation Program (APP). This program is designed for residents who are interested in enhancing skills needed in an academic environment. The purpose of the APP program is to prepare pharmacy residents to serve as educators, either in full-time or adjunct faculty positions. Each resident is assigned a full-time faculty member as a mentor for this program. Many of requirements for this certificate are already present in many residency programs
The pediatric units of the Children’s Hospital have 44 inpatient beds. The typical patient population includes pulmonary, infectious diseases, inborn errors of metabolism, newly diagnosed diseases, post-Pediatric Intensive Care Unit patients, and others. The pharmacy resident is expected to monitor, assess, and contribute to the drug therapy plans. In addition, questions from the pediatric medical residents and nursing staff would be addressed by the pharmacy resident.
The Metabolic Support Consult Service is utilized by all of the various services in Greenville Memorial Hospital to participate in the care of patients with difficult-to-manage enteral and parenteral nutrition support. Residents will perform initial nutrition support consultations, recommend therapeutic goals, develop individualized nutritional regimens including type of support, route, formulation, and provide follow-up to optimize the patients’ nutritional care. Disease states and topics often encountered will include protein malnutrition (Kwashiorkor), protein-calorie malnutrition (marasmus), obesity, vitamin and mineral deficiencies, short bowel syndrome, acid-base and fluid-electrolyte disturbances, metabolic syndromes, enterocutaneous fistulas, pancreatitis, and nutrition in critically ill patients.
Greenville Health System provides the most extensive emergency services in the Upstate, including a Level I Trauma Center, Children’s Emergency Center, Chest Pain Center, Congestive Heart Failure / Stroke Center, Intermediate Care / Critical Care Emergency Services. The emergency medicine experience provides clinical services to variety of disease states, which may include stroke, diabetic ketoacidosis, burns, trauma, poisonings/overdoses, and drug withdrawal. Residents will understand concepts surrounding medications used in a code situation, high-dose steroids, thrombolytics, and antibiotics. They may deal with issues such as conscious sedation, motor vehicle accidents, trauma codes, and adherence in homeless patients, alcoholism, drug addiction, post-exposure prophylaxis, and obtaining medication histories.