Elective Rotations

Advanced Hematology/Oncology

The Advanced Hematology-Oncology rotation (heme-onc II) is an elective, 2-6 week learning experience at Children’s of Alabama for pharmacy residents who have completed the heme/onc rotation and desire more time and focus in this area of practice.  The rotation will be a minimum of two weeks, but may be longer depending on resident interest and/or preceptor availability.  
The activities of the rotation occur on the inpatient unit. The purpose of this rotation is to further develop practice and clinical skills learned in the required heme-onc rotation.

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 and social workers are often present as well.  Service census ranges from 15 to 25 patients on average. During this rotation component, the resident will have the opportunity to gain knowledge on complications of cancer treatment and sickle cell anemia.  In addition to developing and applying a monitoring plan, the resident will provide and document therapeutic drug and anticoagulation monitoring services. Other components of this rotation consist of fielding drug information questions, preparing either a journal club presentation or a written drug information response, helping troubleshoot discharge prescription problems, application of best practice in handling hazardous medications, and processing oncology orders.

Advanced Infectious Disease and Antimicrobial Stewardship

The Advanced Infectious Disease rotation (ID-II) is an elective, 2-6 week learning experience at Children’s of Alabama for pharmacy residents who have completed the ID rotation and desire more time and focus in this area of practice.  The rotation will be a minimum of two weeks, but may be longer depending on resident interest and/or preceptor availability.  Similar to the required core rotation, there will be 2 ID teams providing care to both inpatients and outpatients at COA. For the ID-II elective, the resident will rotate through all aspect of the 3 major practice areas to provide advanced ID pharmacy clinical services.  In addition to providing services to the 2 practice areas (see core rotation description), 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. The resident will also be responsible to precepting 4th year pharmacy students while on this elective.

Good communication and interpersonal skills are vital to success in this experience.  The resident must devise efficient strategies for accomplishing the required activities in a limited time frame.  Although not specifically evaluated, 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 during the course of the elective.  Topic will be determined either by resident, preceptor or fellowship program director.

Advanced Neonatal Intensive Care Unit

The Advanced Neonatal Intensive Care rotation (NICU-II) is an elective, 2-6 week learning experience at Children’s of Alabama for pharmacy residents who have completed the NICU rotation but desire more time and focus in this area of practice.  The rotation will be a minimum of two weeks, but may be longer depending on resident interest and/or preceptor availability.  The focus of this rotation is to build on skills acquired in the NICU I rotation including continuing the provision of pharmaceutical care to the inpatient neonatal intensive care service.  Residents will be required to provide the following activities:

  • Daily patient profile review with identification and resolution of patient medication problems
  • Daily rounding with neonatal intensive care team
  • Pharmacokinetic assessment and recommendations
  • Provision of drug information to health care professionals. For the advanced NICU rotation, an in-service to nursing or physicians should be provided.
  • 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. For the advanced NICU rotation, more time should be spent verifying the orders for medications and facilitating drug delivery to ensure overall pharmaceutical care.
  • Attendance at all medical emergencies while onsite (“resident physicians” and traumas). For the advanced NICU rotation, the resident will 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

The Advanced Pediatric Hospital Medicine rotation (PHM-II) is an elective, 2-6 week learning experience at Children’s of Alabama for pharmacy residents who have completed the PHM rotation but desire more time and focus in this area of practice.   The rotation will be a minimum of two weeks, but may be longer depending on resident interest and/or preceptor availability.  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 dietitian, 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 family members, education of physicians and nurses, and education of pharmacy trainees; participation in the pharmacy department on-call program; and participation in organizational, pharmacy department, and nursing unit-based medication policy and continuous 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 GIPS rotation and will facilitate small group discussions at the weekly P3 Pediatric Pharmacy elective course offered by the Samford University McWhorter School of Pharmacy.

Advanced Pediatric Intensive Care Unit

The Advanced Pediatric Intensive Care Unit rotation (PICU-II) is an elective, 2-6 week critical care learning experience at Children’s of Alabama for pharmacy residents who have completed the PICU rotation but who desire more time and focus in this area of practice. The rotation will be a minimum of two weeks, but may be longer depending on resident interest and/or preceptor availability.  The focus of this rotation is to build on skills acquired in the PICU I rotation including continuing the provision of pharmaceutical care services to the 21-bed PICU patient population. 

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. 

In addition to having completed all of the PICU I learning experiences, 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).  In addition to patient care, the resident may have the opportunity to work with advance practice experience students to develop precepting skills, but due to the advanced nature of this rotation, the resident shall take more of the teacher role in this relationship.

Advanced Pulmonary

The Advanced Pulmonary rotation (Pulmonary-II) is an elective, 2-6 week learning experience at Children’s of Alabama for pharmacy residents who have completed the pulmonary rotation but who desire more time and focus in this area of practice.The rotation will be a minimum of two weeks, but may be up to six weeks in duration depending on resident interest and/or preceptor availability. 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 team 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 the pulmonary team receiving medications 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.

Blood and Marrow Transplant (BMT)

The Blood and Marrow Transplant (BMT) rotation is an elective, 2-6 week learning experience at Children’s of Alabama. The rotation will be a minimum of two weeks, but may be longer depending on resident interest and/or preceptor availability. The focus of this rotation is the provision of complete pharmaceutical care services to the BMT patient population. The BMT unit is an eight bed inpatient unit and a four bed outpatient clinic. The patients include mostly hematology/oncology patients and patients with various immunodeficiencies.

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 outpatient clinic 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 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.  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 outpatient clinic. In addition, the resident will maintain current medication administration schedules for all outpatients and provided the patient/family with an updated copy with any medication or dosage change in clinic.

Cardiology (CCU) and Heart Transplant

The Cardiology (CCU) and Heart Transplant Unit rotation is an elective, 2-6 week learning experience at Children’s of Alabama. The rotation will be a minimum of two weeks, but may be longer depending on resident interest and/or preceptor availability. The focus of this rotation is the provision of complete pharmaceutical care services to the cardiac patient population. The CCU unit is a 15 bed inpatient unit.  Inpatients include congenital heart defects, heart failure, pre and post heart transplant care.  Clinic patients are post-transplant patients or patients in heart failure on the wait list for heart transplant.

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 outpatient clinic 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 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.  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 outpatient clinic. In addition, the resident will maintain current medication administration schedules for all outpatients and provided the patient/family with an updated copy with any medication or dosage change in clinic.

Cardiovascular Intensive Care (CVICU) 

The Cardiovascular Intensive Care Unit (CVICU) rotation is an elective critical care learning experience at Children’s of Alabama. The rotation will be a minimum of ten work days but may be longer depending on resident interest and/or preceptor availability. There are currently 20 available beds in the CVICU with 2 rounding day teams and 1 rounding evening team. Each rounding team includes the attending physician and nurse practitioner with other disciplines such as a pharmacist, respiratory therapists, clinical dieticians and the primary nurse joining as able. The focus of this rotation is to gain basic understanding of the pharmacy services provided to patients within a cardiac intensive care unit.

The clinical pharmacist on the team is responsible for ensuring safe and effective medication use for all patients, including: order verification, pharmacokinetic consults, anticoagulation consults, participation in day/evening rounds, serving as a source of drug information, collaboration with central pharmacists to ensure medication availability, education of patients and family, education of staff (physicians, nurse, etc.), and participation in codes/traumas.

The resident pharmacist is responsible for identifying and resolving medication therapy issues for patients and will work toward assuming care of all patients within the CVICU throughout the learning experience. The resident will provide and document therapeutic drug monitoring services (pharmacokinetics, anticoagulation, etc.). The resident will act as a drug information resource for team members and provide discharge teaching for patients and their families with proper documentation in the electronic medical record. In addition, the resident will assist in order verification and provide code/trauma response during the time that they are based on the unit.

Emergency Department

Pediatric Emergency Department (ED) is an elective, 2-4 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 Hospital Emergency Department. The division provides 24 hour on-site coverage, and faculty members are specialized in pre-and in-hospital emergency care and resuscitation and trauma services. Special services include: Critical Care Transport, Poison Control and Injury Prevention, and Concussion Clinic.

Medication orders from the ED are processed through main pharmacy, and no clinical pharmacist is assigned to this area.  A pharmacist and pharmacy technician trained in code/trauma response responds to all level-one codes and traumas in the ED.  During day shift on weekdays, the responding pharmacist is one of the critical care pharmacists.  On other shifts, an inpatient pharmacist responds.

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 liason 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.

Good communication and interpersonal skills are vital to success in this experience.  The resident must devise efficient strategies for accomplishing the required activities in a limited time frame.  Since no pharmacist works daily in this area, a non-pharmacist preceptor is utilized.  Therefore, 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).

Investigational Drug Studies

The Investigational Drug Studies rotation is an elective, 2-4 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 pharmacist is responsible for ensuring proper medication storage, documentation, preparation
and dispensation for all medications administered to patients enrolled in a hospital approved medication study.  The focus of this rotation is to help the resident understand the importance
and relevance of study medication research in pediatrics.  The investigational study pharmacy will provide hands-on dispensing of study medications while instructing on the hospital, state, federal and institutional statues governing research. Throughout the rotation, the obligations of the research pharmacy and significance of each task assigned will be emphasized.   Self-motivation and interpersonal skills are essential to this experience. 

Regional Poison Control Center (RPCC)/Toxicology

The Regional Poison Control Center (RPCC) rotation is an elective, 2-4 week learning experience at Children’s of Alabama.  The RPCC has been a long term commitment of COA to the citizenry of Alabama since 1958. The RPCC was the 14th center established in the United States, during a time period 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 RPCC has provided 24/7, toll free access of life saving information since 1978. The RPCC 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 RPCC serves the entire State of Alabama as the only certified statewide center by the Alabama Department of Public Health. The 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 RPCC 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.

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 managing 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.

The focus of this rotation for pharmacy residents is to provide triage, treatment recommendations and follow up with the public exposed to various poison and healthcare professions caring for poisoned patients, regardless of age, throughout the state of Alabama.  Residents will listen to exposure calls, make hospital follow-ups, and will consult with healthcare professionals to make treatment recommendations on poison exposures.