Core Rotations

Hematology/Oncology

Pediatric hematology-oncology (heme-onc) is a required, 4-week learning
experience at
Children’s of Alabama.  The core activities of the rotation occur
on the inpatient unit.  The resident will migrate in a scheduled fashion among
2 major practice areas throughout the rotation to enable achievement of rotation
goals and objectives:

1. Inpatient chemotherapy service

This service represents 1 of 2 different inpatient heme-onc services.  It is managed by
1 attending physician and 1 nurse practitioner.  Service census ranges from 4 to 10
patients on average.  During this rotation component, the resident will have the
opportunity to gain knowledge of pediatric cancers and chemotherapy treatment and develop and apply a therapeutic monitoring plan. Other major elements of this rotation component include
processing oncology orders and responding to drug information questions.

2. Inpatient medical hematology-oncology service

This service is comprised of a full multi-disciplinary team present for rounds and represents the largest component of the rotation.  In addition to a pharmacist, the team includes 1 attending physician, 1 fellow physician, 3 medical residents, 2 nurse practitioners, 1 nurse educator, and various nursing and medical students.  Nutritionists, social workers, and pastoral care are often present as well.  Service census ranges from 15 to 30 patients on average. During this rotation component, the resident will have the opportunity to gain knowledge on oncologic emergencies, complications of cancer treatment, sickle cell anemia and learn to develop and document monitoring plans for related medication management. Other major elements of this rotation component include processing oncology orders, fielding drug information questions, new diagnosis discharge troubleshooting and teaching, and preparing either a journal club presentation or a written drug information response/

Infectious Diseases (ID)

Infectious disease (ID) is a required, 4 week learning experience at Children’s of Alabama.  The ID team provides care to both inpatients and outpatients at COA. The service provides care to pediatric patients at COA and University of Alabama at Birmingham (UAB) Hospital who have acute and chronic pediatric infectious diseases.   The patients seen on service range in age from newborns (including those with extreme prematurity) to young adults.  Severity of illness ranges from critically ill to those receiving follow-up in an outpatient setting.  The resident will rotate through all aspects of the 2 major practice areas to enable achievement of all rotation goals and objectives.

1. The ID consult team consists of one attending physician, an ID fellow-in-training physician, a PGY2 or PGY3 medical resident, and potentially medical students (MSIII or MSIV). Other disciplines on the team include the clinical pharmacy specialist and pharmacy students. This team is responsible for daily assessment of patients on various primary services at COA and UAB that request consultative services from ID.  Service census will range from 3-15 patients per day, and are located all over the hospital and occasionally at UAB medical center.  During this rotation component, the resident will have the opportunity to gain knowledge on basic pediatric ID disease states, including but not limited to meningitis, osteomyelitis, congenital infections, fungal infections and endocarditis.  In addition to developing, assessing and applying monitoring plans, the resident will provide and document therapeutic drug monitoring services for patients on their team including, but not limited to, aminoglycosides, vancomycin, antimycobacterial therapies, and antifungals..  Other components of rotation consist of fielding drug information questions, helping troubleshoot and plan discharge prescriptions, and presenting a pharmacotherapy topic inservice to the team.  The pharmacy resident should be able to provide assessment and discharge management of patients that will be followed by the outpatient service. The resident is responsible for providing and documenting medication reconciliation for each patient seen either prior or day of discharge, or day they are seen in followup ID clinic.

2. The ID outpatient service consists of the same practitioners that are on the consult team but also includes an outpatient nurse clinician. Major components of this rotation consists of assessing weekly lab results that are faxed to the ID offices each week for outpatients, coordinating laboratory needs for scheduled clinic patients with the nurse clinician, performing medication reconciliation and documenting in EMR, coordinating with home health medication changes or needs, and providing education to patients and caregivers regarding medications.  Competency in management of outpatients, assessment of medication compliance and OPAT are the core topics for the outpatient rotation.

As a whole, the clinical pharmacy specialist on all of these teams is responsible for ensuring safe and effective medication use for all patients followed by the team, including active participation in work and attending rounds when available; collaboration with decentralized pharmacists to assure timely medication availability; education of patients and their family members, education of physicians and nurses, and education of pharmacy trainees; participation in the pharmacy department on-call program; and, participation on organizational, pharmacy department and nursing unit-based medication policy and continuous quality improvement committees.. In addition to evaluated objectives, the resident is expected to work within a multi-disciplinary team to:

  • Identify medication related problems and follow up on detected drug therapy problems by alteration in therapy, initiation of new therapy, health education, referral to other sources of care, or other appropriate measures.
  • Recommend solutions to identified problems
  • Recommend and provide therapeutic drug monitoring and medication adjustment utilizing subjective and objective data
  • Explain epidemiology, risk factors, clinical course and treatment of diseases identified above.
  • Explain mechanism of action, pharmacokinetics, and therapeutics of anti-infectives used to treat most common infections

 Neonatal Intensive Care (NICU)

The neonatal intensive care (NICU) rotation is a required, 4-week learning experience for pharmacy residents at Children’s of Alabama. There are 48 NICU beds, housed on 1 floor. The NICU is considered a level 4 NICU, which has the ability to perform ECMO, dialysis, all forms of advanced life support, all forms of advanced respiratory support, and houses all neonatal surgical sub-specialties. There are 2 teams comprised of: an attending physician, fellows, neonatal nurse practitioners, social workers, discharge planners, neonatal nutritionist, and clinical pharmacist. On occasion there will be a 4th year pharmacy student(s) from either Samford University or Auburn University, the primary nurse, and respiratory therapy.

The clinical pharmacy specialist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team, including active participation in work and attending rounds daily; collaboration with centralized pharmacists to assure timely medication availability; education of physicians and nurses and education of pharmacy trainees; participation in the pharmacy code and trauma call; and, participation on organizational, pharmacy department and nursing unit-based medication policy and continuous quality improvement committees.

Residents will be required to provide the following activities:

  • Daily patient profile review with identification and resolution of patient medication problems
  • Daily rounding with the neonatal intensive care team
  • Pharmacokinetic assessment/recommendations and documentation of activities and interventions in Sentri 7
  • Provision of drug information to health care professionals
  • Coordination of medication ordering, administration and distribution, working in conjunction with the inpatient pharmacy. This includes ensuring accuracy of nursing medication administration records to that of pharmacy medication profiles and daily updates as to changes in continuous infusions, TPNs, etc.
  • Attendance at all medical emergencies while onsite ("resident physicians" and level 1 traumas)
  • To participate in the education and the precepting of 4th year pharmacy students (when on rotation)
  • Clarification and verification of NICU orders

Nephrology

The renal rotation is a required, 4 week learning experience at Children’s of Alabama. The focus of this rotation is the provision of complete pharmaceutical care services to the nephrology patient population. The patients include inpatients on the nephrology service and patients in the outpatient dialysis unit with various renal disorders.

The clinical pharmacy specialist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team and those in the dialysis unit, including active participation in work and attending rounds daily; collaboration with decentralized pharmacists to assure timely medication availability; education of patients and their family members, education of physicians and nurses, and education of pharmacy trainees; participation in the pharmacy department pharmacokinetics on-call program; and, participation on organizational, pharmacy department and nursing unit-based medication policy and continuous quality improvement committees.

The pharmacy resident is responsible for identifying and resolving medication therapy issues for patients and will work toward assuming care of all patients on the service and in the dialysis unit throughout the learning experience.  The resident will provide and document therapeutic drug monitoring services for patients on their team receiving drugs requiring monitoring and renal dose adjustments, including, but not limited to, aminoglycosides and vancomycin.  Documentation must be completed on the day service was provided. The resident will also be responsible for educating patients and their families on medications prior to hospital discharge and in the dialysis unit.

Additional observation and learning opportunities incorporated into this rotation may include, but are not limited to, shadowing with hemodialysis and peritoneal dialysis nurses, shadowing with the nephrology nutritionist, attendance/observation at Quality Assessment Performance Improvement (QUAPI), Comprehensive Interdisciplinary Patient Assessment (CIPA), and transplant selection meetings.

Orientation

Orientation is a required, 6 – 8 week learning experience at Children’s of Alabama.  During this experience, residents will complete two days of new hire orientation at Children’s of Alabama (COA), where they will receive general hospital legal, regulatory, and safety training.  Residents will then train in and orient through various traditional dispensing areas of the pharmacy.  Residents will receive and be expected to read and understand all pharmacy department policies and procedures, as required of new hire pharmacists.

Training areas include the IV room, inpatient order verification, PYXIS and controlled substances, operating room, and inpatient production, including the PO area.  Orienting areas will include inventory, investigational, and PedsRx Pharmacy Solutions outpatient pharmacy.  Residents will be trained in chemotherapy techniques and will also receive sterile product/parenteral training, including a state-wide parenteral certification training course.  Residents will also complete pediatric advanced life support (PALS) and University of Alabama (UAB) institutional review board (IRB) training and certification.  Most training experiences will take place during first (day) shift, however, experiences on second and third shifts may be included as time allows.

The focus of this rotation is the provision of knowledge of COA pharmacy operating procedures and skills using pharmacy electronic programs, both of which are needed during staffing requirements and clinical rotations.  During this rotation, residents will also meet with longitudinal rotation preceptors (including, but not limited to pharmacokinetics, anticoagulation, management, and drug information) for initial orientation and training assignments as applicable for these rotations.

Pediatric Hospital Medicine (PHM)

General medicine on the Pediatric Hospital Medicine service is a required, 4 week learning experience at Children’s of Alabama. Throughout the year, there are multiple interdisciplinary teaching teams that care for a variety of general medicine patients. Each of the teaching teams includes an attending physician, PGY2 or PGY3 medical resident(s), PGY1 medical intern(s), and medical students (MSIII or MSIV). Other disciplines on the team include a clinical pharmacist, pharmacy students, a nurse case manager, a social worker, a clinical nutritionist, and the primary nurse.

The clinical pharmacist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team, including active participation in daily medical rounds; education of patients and their caregivers, medical staff, and pharmacy trainees; participation in the pharmacy department on-call program; and participation in organizational, pharmacy department, and nursing unit medication policy and quality improvement committees.

The pharmacy resident is responsible for providing pharmaceutical care to all patients on their assigned team. This includes identifying and resolving medication therapy issues, assisting with transitions of care, providing patient education, and documenting therapeutic drug monitoring services. Additionally, the resident is required to participate in any pertinent co-precepting responsibilities with pharmacy students on the general pediatrics rotation. The resident may also have an opportunity to participate in the P3 Pediatric Pharmacy elective course offered by the Samford University McWhorter School of Pharmacy, as the preceptor allows.

Pediatric Intensive Care (PICU)

The Pediatric Intensive Care Unit (PICU) rotation is a required, 4 week critical care learning experience at Children’s of Alabama. The focus of this core rotation is to provide pharmaceutical care services to the 22-bed PICU patient population and the interdisciplinary team. The PICU medical team consists of an attending physician, critical care fellows, two nurse practitioners, four PGY2/PGY3 medical residents, and sometimes a medical student (MSIV). Other members of the PICU multidisciplinary team include a clinical pharmacist, clinical nutritionist, respiratory therapist, primary nurse, social worker, and sometimes other medical professional students.  The patients include children of all ages, both previously healthy and those with underlying disease.  Unique to this unit are patients on ventilators, continuous renal replacement therapy (CRRT), post-operative patients, investigational drug studies, the capability to provide extracorporeal membrane oxygenation (ECMO) and inhaled nitric oxide.

The clinical pharmacy specialist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the unit, including active participation in daily rounds helping to identify and resolve any medication related problems.  As a clinical pharmacist daily collaboration with centralized pharmacists is necessary to assure timely medication availability and delivery; education of patients and their family members, education of physicians and nurses, and education of pharmacy trainees; participation in the pharmacy department on-call program; and, participation on organizational, pharmacy department and nursing unit-based medication policy and continuous quality improvement committees.

The pharmacy resident is responsible for identifying and resolving medication therapy issues daily for patients and will work toward assuming care of all patients on the unit throughout the learning experience.  The resident will provide and document therapeutic drug monitoring services for patients on their team receiving drugs requiring monitoring including, but not limited to, aminoglycosides and vancomycin. The resident is responsible for providing and documenting education to patients/families on their team who will be discharged receiving anticoagulation. 

Pulmonary

The pulmonary rotation is a required, 4 week learning experience at Children’s of Alabama. The focus of this rotation is the provision of complete pharmaceutical care services to the pulmonary patient population. The patients include inpatients on the pulmonary service and patients in the outpatient pulmonary clinics with various pulmonary disorders.

The clinical pharmacy specialist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team, including active participation in nurse practitioner and medical resident rounds daily; collaboration with decentralized pharmacists to assure timely medication availability; education of patients and their family members, education of physicians and nurses, and education of pharmacy trainees; participation in the pharmacy department pharmacokinetics on-call program; and, participation on organizational, pharmacy department and nursing unit-based medication policy and continuous quality improvement committees.

The pharmacy resident is responsible for identifying and resolving medication therapy issues for patients and will work toward assuming care of all patients on the service throughout the learning experience.  The resident will provide and document therapeutic drug monitoring services for patients on their team receiving drugs requiring monitoring, including, but not limited to, aminoglycosides and vancomycin.  Documentation must be completed on the day service was provided. The resident will also be responsible for educating patients and their families on medications prior to hospital discharge and facilitating the discharge process.