Elective Rotations
Advanced Hematology/Oncology
Hematology-oncology (heme-onc) is an elective two to six week learning experience at Children’s of Alabama for residents who have completed the core heme-onc rotation but desire more time in this practice area. There are 24 hematology-oncology beds in the hospital housed on 8 Quarterback, although the service frequently overfills to other hospital units. The hematology-oncology service has 2 teams, the chemotherapy service and the hematology/oncology medical service.
Typically, the chemotherapy service team will be responsible for the care of approximately 4 to 10 patients.
Typically, the medical team will be responsible for the care of approximately 15 to 30 patients.
The resident will have the opportunity to expand knowledge on oncologic emergencies, complications of cancer treatment, sickle cell anemia and learn to develop and document monitoring plans for related medication management for less commonly seen disease states. 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.
Advanced Infectious Disease and Antimicrobial Stewardship
Infectious disease (ID) is an elective two to six week learning experience at Children’s of Alabama for residents who have completed the core ID rotation but desire more time in this practice area. The ID team provides consult services to patients on various primary services at COA and the University of Alabama at Birmingham (UAB), so patients can be located anywhere at COA and occasionally at UAB. The ID outpatient service conducts clinic in clinic 7 in the McWane Building. Typically, the ID consult service census will range from 6-15 patients per day.
In addition to providing patient care services as in the core rotation, the ID elective will focus on protocol/policy development, medical staff education (fellows and nursing), as well as antimicrobial stewardship involvement and/or development of new clinical services within the ID division. ID fellow education is a critical component of the advanced ID elective. The resident will be expected to present one formal lecture on infectious disease pharmacotherapy. Topic will be determined either by the resident, preceptor, or fellowship program director. During the ID II rotation, the resident may have the opportunity to work with advance practice experience Pharm.D. students to develop precepting skills. Due to the advanced nature of this rotation, the resident shall take more of the teacher role in this relationship.
Advanced Neonatal Intensive Care Unit
Neonatal Intensive Care (NICU II) is an elective two to six week learning experience at Children’s of Alabama for residents who have completed the core NICU rotation but desire more time in this practice area. There are 48 NICU beds in the hospital housed on the 6th floor of the Benjamin Russell Hospital for Children. 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 (Harbert and Quarterback) and typically, the NICU teams will each be responsible for the care of approximately 24 patients.
In comparison to the core rotation, for the advanced rotation, the resident should:
- Provide an in-service to nursing or physicians
- Spend more time verifying orders for medications and facilitating drug delivery to ensure overall pharmaceutical care
- Lead the “resident physician”/trauma as well as perform the necessary post-event duties (charge for the medications, re-stock the code/trauma bag, etc.)
Advanced Pediatric Hospital Medicine
Pediatric Hospital Medicine is an elective two to six week learning experience at Children’s of Alabama for residents who have completed the core PHM rotation but desire more time in this practice area. There are five interdisciplinary PHM teams that care for a variety of patients admitted throughout the hospital generally to the Dearth Tower, the Special Care Unit, and 10 Harbert (Neuro/Rehab/Ortho unit). Each PHM team has the capacity to care for up to 16 patients (80 patients for the service as a whole) and the usual census is 10-12 patients per team.
During the PHM II rotation, the resident may have the opportunity to work with advance practice experience Pharm.D. students to develop precepting skills. Due to the advanced nature of this rotation, the resident shall take more of the teacher role in this relationship.
Advanced Pediatric Intensive Care Unit
Pediatric Intensive Care (PICU II) is an elective two to six week learning experience at Children’s of Alabama for residents who have completed the core PICU rotation but desire more time in this practice area. There are 24 PICU beds in the hospital housed on 7 Quarterback. Typically, the PICU team will be responsible for the care of approximately 24 patients.
In addition to daily PICU responsibilities, the resident will be required to provide an in-service to nursing or physicians on a pharmacy related PICU topic, as well as attend all medical emergencies while onsite (“resident physicians” and traumas). During the PICU II rotation, the resident may have the opportunity to work with advance practice experience Pharm.D. students to develop precepting skills. Due to the advanced nature of this rotation, the resident shall take more of the teacher role in this relationship.
Advanced Pulmonary
Pulmonary is an elective two to six week learning experience at Children’s of Alabama for residents who have completed the core pulmonary rotation but desire more time in this practice area. There are 24 pulmonary beds in the hospital housed on 10 Quarterback. The pulmonary service has two teams. The nurse practitioner team and the medical resident service. Typically, each pulmonary team will be responsible for the care of approximately 30 patients.
During the Pulmonary II rotation, the resident may have the opportunity to work with advance practice experience Pharm.D. students to develop precepting skills. Due to the advanced nature of this rotation, the resident shall take more of the teacher role in this relationship.
Alabama Poison Information Center (APIC)
Alabama Poison Information Center (APIC) is an elective, two to four week learning experience at Children’s of Alabama. The APIC has been a long-term commitment of COA to the citizenry of Alabama since 1958. The APIC was the 14th center established in the United States, during a time when serious morbidity and mortality was attributed to poison ingestion in children and adults. Since its inception, the Center engaged in providing the most accurate and rapid poison information to only physicians in the early years and then to both the professional and general public. The APIC has provided 24/7, toll free access of life saving information since 1978. The APIC is a fully certified poison center by the American Association of Poison Control Centers. Throughout the years of dedicating substantial resources to developing a quality professional staff, quality assurance programs, data surveillance and research, 800 number access and state of the art informational resources, the APIC serves the entire State of Alabama as the only certified statewide center by the Alabama Department of Public Health.
The APIC is located in the McWane building. Center staff includes nurse and pharmacist specialists in poison information (certified by national examination and sponsored by the American Association of Poison Control Centers). The management team includes a doctoral credentialed environmental toxicologist director, a medical toxicology boarded medical director, and an emergency medicine boarded pediatrician assistant medical director. Advanced level consultation is available from this team beyond the initial level of contact to our center staff and is provided on a 24/7 basis.
Staff at the APIC center will handle over 100,000 poison calls per year (resulting in ~34,000 human exposures with over 60,000 follow-up calls). A vital component of this quality professional service is a statewide educational program designed to heighten public and professional awareness of the center, to inform parents and caregivers of the best preventive actions, and to provide continuing education for healthcare professionals on the assessment, triage, and management of poisoned patients. Advanced Hazmat Life Support courses, grand rounds on topics in clinical toxicology, medical toxicology consultations and other educational/clinical services are provided. Special emphasis is placed upon providing such education and service to rural, traditionally underserved areas of the state. In fact, over the last 10 years, the APIC has teamed with Healthy Child Care Alabama, a statewide network of public health nurses who are assigned counties in the state to provide preventive health education. The collaboration has resulted in significant increases in the awareness of rural area citizens. The work in primary prevention continues to be an integral component of our center and augments the effectiveness of the informational services provided.
Blood and Marrow Transplant (BMT)
Blood and bone marrow transplant (BMT) is an elective, two to six week learning experience at Children’s of Alabama. There are 8 inpatient and 4 outpatient BMT beds in the hospital housed on 8 Harbert. The patients include mostly hematology/oncology patients and patients with various immunodeficiencies. Typically, the medical team will be responsible for the care of approximately 5-10 inpatients and the outpatient clinic.
Cardiology
Cardiology is an elective, two to six week learning experience at Children’s of Alabama. Residents will divide their time on this rotation between the Cardiovascular Care Unit (CCU) and Cardiovascular Intensive Care Unit (CVICU). In addition, residents on this rotation will have the opportunity to spend in the heart transplant clinic. There are 15 CCU beds in the hospital housed on 8 Harbert. Typically, the CCU team will be responsible for the care of approximately 8-12 patients.
There are 20 beds in the CVICU housed on 4 Quarterback. The CVICU has 2 rounding day teams and 1 rounding evening team. Typically, the CVICU team will be responsible for the care of approximately 14-20 patients. In addition to daily responsibilities, the resident will lead topic discussions and attend all medical emergencies in the unit while onsite.
Emergency Department
Pediatric Emergency Department (ED) is an elective, two to four week learning experience at Children’s of Alabama. The Pediatric Emergency Medicine Department provides a statewide and regional referral site for complex emergency problems and acute tertiary care for the state's major pediatric trauma and medical center at the Children's of Alabama Emergency Department. The division’s faculty members are specialized in pre-and in-hospital emergency care and resuscitation and trauma services. The Children’s of Alabama ED has more than 70,000 visits yearly and provides 24-hour care for children presenting with illness or injury. It is recognized as the major provider in the state of Alabama for specialized care of life-threatening traumatically injured and burned children. The Emergency Department participates in a community-based emergency plan established by the Birmingham Regional Emergency Medical Services System. The ED also works in conjunction with the Regional Poison Control Center housed within Children’s of Alabama.
The emergency department is located on the 1st floor of the Benjamin Russell Hospital for Children and is composed of 53 beds (47 patient rooms, 4 resuscitation/trauma rooms, one minor procedure room and a pelvic examination room).
The pharmacy resident is responsible for identifying and resolving medication therapy issues through review of new medication orders. In addition, the resident will act as a drug information resource for other health care providers in the ED and provide code/trauma response during the time that they are based on the unit. The resident will serve as liaison between the ED and central pharmacy, as well as between the ED and the floor should patients be admitted, to assist in the medication reconciliation process.
Since no pharmacist works daily in this area, to participate in this elective the resident must be at a point in their training where they are capable of independent practice, as determined by the Residency Program Director (RPD) in coordination with the Residency Advisory Committee (RAC). The resident also must have completed code/trauma response training and be capable of independent code/trauma response (with technician support).
Investigational Drug Studies
The investigational drug study rotation is an elective, two to six week learning experience at Children’s of Alabama. The investigational study pharmacy works with multiple disciplines to provide evidence-based, patient-centered investigational medication therapy management. The investigational study pharmacy provides hands-on dispensing of study medications. Patients may be located on any inpatient unit or outpatient clinic. Patients range in age from newborns to adults.
The investigational study pharmacist is responsible for ensuring proper medication storage, documentation, preparation, and dispensation for all medications administered to patients enrolled in an Institutional Review Board approved medication study. The pharmacist will also provide drug information and education to healthcare professionals as well as patients and caregivers about investigational medications.
Medication Safety
The medication safety rotation is an elective, two to six week learning experience at Children’s of Alabama. The focus of this rotation is resident involvement in organization-wide efforts to improve patient and medication safety and to provide staff development and training in medication use improvement.
The medication safety/performic improvement pharmacist is responsible for design, data collection, aggregation and analysis, and improvement of pharmacy and hospital processes that affect perceptions of care, patient outcomes, and cost. They are involved in and contribute to hospital-wide Performance Improvement and Patient Safety efforts. They work collaboratively to improve the quality of care and services at Children’s.
