Longitudinal Rotations

Ambulatory Care

Ambulatory Care is a required, longitudinal learning experience at Children's of Alabama.  During this experience, residents will rotate through four clinics, spending at least 10 weeks in each of the three required clinics, and at least 7 weeks in their elective clinic.  The experience requires clinic attendance by the resident, regardless of concurrent rotation responsibilities, one morning or afternoon per week (dependent on the current clinic) from approximately August through June.  Additional rotation requirements, such as patient teaching, clinic team meetings, and camp attendance, may require resident participation outside the weekly clinic setting.

The focus of this rotation is the provision of pharmaceutical care to pediatric patients receiving chronic outpatient care at the Children’s of Alabama Ambulatory Care Center.  Patient care in the clinic setting is a multidisciplinary approach.  Depending on the clinic setting, disciplines on the team include attending physicians, fellow physicians, nurse practitioners, nurses, nurse coordinators, clinical pharmacists, clinical nutritionists, respiratory therapists, social workers, counselors, psychologists, child life therapists, access and retention coordinators, nursing assistants, and access facilitators. Pharmacy students may also be involved in clinic in a shadowing capacity.

The clinical pharmacy specialist on the clinic team is responsible for identification and resolution of medication related problems, ensuring safe and effective medication use by outpatients, collaboration with decentralized and community pharmacists to assure timely and cost-effective medication availability; education of patients and their family members and of other team members; serving as a source of drug information to the team; and participation in 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 in the clinic throughout the learning experience.  Patients residents will care for during required components of this rotation include those with leukemia, cystic fibrosis, and pre-and post-renal transplant patients. Patients range in age from infants to young adults.  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 and for successfully interviewing and educating pediatric patients and their families.

Anticoagulation

Anticoagulation is a required, longitudinal learning experience at Children's of Alabama.  During this rotation, the pharmacy resident is responsible for identifying and resolving medication therapy issues related to anticoagulation therapy for patients covered under the on-call component of the residency program.  The resident will work toward assuming care of all covered patients receiving anticoagulation therapy throughout the learning experience.  The resident will provide and document therapeutic drug monitoring and counseling services for covered patients requiring monitoring including, but not limited to, unfractionated heparin (UFH), enoxaparin, and warfarin.  The resident is responsible for providing and documenting education to patients who will be discharged receiving anticoagulation.  Education and documentation must be provided no later than the day of discharge. 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. 

Drug Information

The drug information rotation is a required, longitudinal learning experience at Children's of Alabama. The focus of this rotation is the provision of drug information to the hospital’s pharmacy, nursing, and medical staff.  Some examples of the types of drug information provided include in-services, articles for the pharmacy newsletter, responses to specific drug information questions, and medication utilization evaluations.  Residents will be required to provide the following services (assignments may change based resident’s needs):

  • Write 2 drug information articles for the pharmacy newsletter
  • Respond to any drug information questions assigned during the year, providing formal written responses to at least two drug information requests.
  • Complete one medication utilization evaluation
  • Complete 3 drug class reviews and/or drug monographs
  • Complete 2 learning modules for the pharmacy department
  • Provide 1 CE to be presented twice at COA and once at UAB.

Pharmacokinetics

Clinical pharmacokinetics is a required, longitudinal learning experience at Children's of Alabama. The primary purpose of this rotation is to allow the resident to gain confidence in his/her knowledge in the specific area of pharmacokinetics and have the opportunity to integrate those skills into practice throughout the year.  This will also allow the resident to gain sufficient practice time to develop independent patient problem-solving skills and enhance overall experience in this area.

While practicing at the health system, the resident will be part of the clinical team that includes attending physicians, medical fellows and residents, nurses and nurse practitioners.  The resident will be expected to cooperate and interact with each member of the team and become a resource for each of them. By becoming a trusted member of the team and gaining confidence in his/her ability to function as the pharmacists for everyone on the team and our patients, the resident will become a vital component of the health care team.

The pharmacy resident is responsible for identifying and resolving medication therapy issues for patients receiving medications on COA pharmacokinetic service and will work toward assuming care of all designated patients (includes all patients without a clinical pharmacist designated to the team).  The resident will provide and document therapeutic drug monitoring services for patients followed and will be responsible for making recommendations for care.  Documentation must be completed on the day service was provided.  Throughout the longitudinal experience, the resident will be required to complete a 10-12 week orientation and training process, pass a pharmacokinetics competency exam with at least a score of 85% (must be completed by October 1st of each residency year), participate in clinical call every 3rd week (rotating with co-residents), and staff every 3rd weekend.  Residents are expected to complete a weekly log of time spent each call week on pharmacokinetic responsibilities.  The purpose of this is to determine cumulative time spent each week so that it can be evaluated quarterly, and so that the preceptor and RPD can determine if clinical rotation responsibilities are hindered due to patient volume of PK call.  On average the resident can expect anywhere between 5-20 patients per day for pharmacokinetic monitoring.  It will be the responsibility of the on call resident to find suitable coverage in case of approved absences (PTO, conference, interviews). 

Practice Management

Management is a required, longitudinal learning experience at Children's of Alabama. The focus of this rotation is to provide the opportunity for the development in leadership, operational and financial management, and administrative skills necessary for the successful completion of the management practice rotation.   Skills will also be developed in planning, organizing, implementing, and monitoring and evaluating.   Residents will be required to provide the following services:

  • Perform compliance audits (anticoagulation and controlled substance usage)
  • Attend Crucial Conversations class (must register in Children’s University).
  • Evaluate the medications on one order set for appropriateness for the Order set Review Committee.
  • Attend 3 Pharmaceutical Stewardship Committee meetings
  • Discuss resources to keep updated on trends and changes within pharmacy and healthcare with the Director of Pharmacy.
  • Discuss current changes to laws and regulations and their affect on the Department of Pharmacy with the Director of Pharmacy.
  • Discuss the governance of the health care system with the Director of Pharmacy.
  • Research Myers/Briggs personality types and discuss
  • Research interviewing techniques and discuss
  • Participate in residency interviews
  • Research regulatory and safety requirements for the COA Department of Pharmacy and have a discussion with the Director of Pharmacy.
  • Report at least 5 adverse drug events in the Patient Safety Reporting System (PSR)
  • Have a budget discussion with the Director of Pharmacy
  • Prepare the travel budget
  • Attend 3 pharmacy policy and procedure meetings
  • Revise/write one policy or standard operating procedure.
  • Present revised policy/standard operating procedure at policy and procedure meeting.
  • Review one ISMP Quarterly Action Agendas (www.ISMP.org)
  • Attend 3 Medication Evaluation Team (MET) meetings
  • Research 2 medication errors
  • Attend 3 Medication Safety meetings
  • Submit Thanksgiving, Christmas and New Year’s pharmacokinetic coverage schedule
  • Perform a self-evaluation on at least 3 assignments

Project Management

The Residency Project is a required, longitudinal learning experience at Children's of Alabama. During this experience, residents will complete a major residency project over a period of approximately 10 months.  Project topics are submitted annually to the residency program director (RPD) by preceptors willing to serve as project preceptor for that residency year.  Alternately, a resident may propose a project topic, but is responsible for securing a preceptor willing to precept their suggested topic.  All topics submitted must be approved by the RPD and the residency advisory committee (RAC).  Topics must involve either pharmacy-related medical research, evaluation or development of pharmacy department policies and procedures, or development and evaluation of a service to benefit Children’s of Alabama patients.  

During this rotation, the pharmacy resident is responsible for selecting a residency project (with guidance from the RPD and proposed project preceptors) and submitting the topic selected to the RPD for approval and assurance of lack of overlap with other concurrent residents’ projects.   The resident must then research and submit a written project idea proposal to the RPD and project preceptor.  The resident must complete University of Alabama (UAB) institutional review board (IRB) training and work to obtain any necessary funding or approval for the project to be conducted, including IRB approval. 

Additionally, the resident must submit a formal abstract of the project and perform a formal presentation of the project results at the Pediatric Pharmacy Association (PPA) residency showcase.  Additional practice presentations at Children’s and/or with other local residents will be arranged as appropriate prior to the PPA showcase.  Finally, the resident is expected to submit a final write-up of the project, including results, to the RPD and project preceptor in a manuscript form suitable for publication.  The resident and project preceptor are encouraged to pursue publication of this manuscript.

Staffing

Staffing is a required, longitudinal learning experience at Children's of Alabama.The focus of this rotation is to provide the opportunity for the development of various traditional processing and dispensing skills. Skills will also be developed in operating procedures and the utilization of pharmacy electronic programs, both of which are needed to fulfill the rotation.  The pharmacy resident is responsible for assuming dispensing roles in the central pharmacy for oral and IV medication production and dispensing.  The pharmacy resident will work towards full proficiency in all staffing positions in the central pharmacy with the ability to fill any staff opening by the end of the rotation.

Staffing assignments will be every 3rd weekend (clinical pharmacokinetics component), every 3rd Thursday from 4pm – 10pm (non-clinical component), and other days assigned by the RPD (clinical and non-clinical components) to total no more than 20 additional weekday shifts during the residency year.