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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 (3 required and 1 elective), providing pharmaceutical care to pediatric patients receiving chronic outpatient care at the Children’s of Alabama Ambulatory Care Center. 

Required clinic experiences are:

Cystic fibrosis clinic, Tuesday afternoons from 12:30-4:30 pm in clinic 6

HIV clinic, Friday mornings from 8:30 am – 12 pm in clinic 7

Renal transplant clinic, Monday mornings from 7:30-1130 am in clinic 7

Patient care in the clinic setting is a multidisciplinary approach.  Depending on the clinic setting, disciplines on the clinic 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 residents and other health professionals in training also participate when assigned to ambulatory care.  The number of patients seen in each clinic varies.  Patients range in age from infants to young adults. 

Residents will spend at least 10 weeks in each of the three required clinics, and at least 5 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. 

Anticoagulation

Anticoagulation is a required, longitudinal learning experience at Children’s of Alabama.  Patients receiving anticoagulants may be on any inpatient service in the hospital and may be housed on any unit. Each clinical pharmacist is responsible for providing anticoagulation consultation/assessment for patients followed by his/her clinical team. The clinical pharmacist/resident on call will provide anticoagulation consultation/assessment for patients on a medical service that does not have a clinical pharmacist.  Weekend/holiday anticoagulation consultation/assessment duties fall upon the clinical pharmacist/resident covering kinetics, unless the clinical pharmacist on the patient’s service is available.

At Children’s of Alabama, pharmacists provide formal anticoagulation consults for every inpatient receiving anticoagulants (including: warfarin, enoxaparin, direct oral anticoagulants (DOACs), argatroban, and non-CRRT/ non-ECMO/ non-MCSD heparin or bivalirudin infusions) or a treatment or prophylactic indication continuing for 24 hours or more.   Anticoagulation consultation responsibilities include monitoring for therapeutic dosing of anticoagulants using relevant laboratory measurements, patient education, monitoring for adverse effects, monitoring plan and dosing recommendations, and appropriate documentation of consult related activities no later than the day of patient discharge.  

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 (PK) is a required, longitudinal learning experience at Children’s of Alabama.  Patients receiving antimicrobials requiring therapeutic drug monitoring (TDM) may be on any inpatient service in the hospital and may be housed on any unit. Each clinical pharmacist is responsible for providing PK consultation/assessment for patients followed by his/her clinical team. The clinical pharmacist/resident on call will provide PK consultation/assessment for patients on a medical service that does not have a clinical pharmacist.  On average the on-call pharmacist/resident can expect anywhere between 5-10 patients per day for PK monitoring.  Weekend/holiday PK consultation/assessment duties fall upon the clinical pharmacist/resident covering kinetics, unless the clinical pharmacist on the patient’s service is available. On average the weekend/holiday on-call pharmacist/resident can expect anywhere between 20-40 patients per day for PK monitoring. 

At Children’s of Alabama, pharmacists provide formal PK consults inpatients receiving antimicrobials requiring TDM (including vancomycin, amikacin, gentamicin, tobramycin, itraconazole, Posaconazole, and voriconazole).  PK consultation responsibilities include TDM medication dosing, reviewing/interpreting relevant laboratory values, making recommendations for change of dose or interval, communicating/implementing a plan for subsequent laboratory monitoring, and appropriate documentation of consult related activities on the day the service is provided.  

Pharmacy Operations

The pharmacy operations rotation is a required, longitudinal learning experience at Children’s of Alabama (COA).  The pharmacy department of COA provides pharmaceutical care services to inpatients in our 380-bed facility and clinic patients in our outpatient Ambulatory Care Center.  Pharmacists in our department work from inpatient pharmacy, from satellites in Hematology/Oncology and Surgery, or in unit-based patient care areas. Services provided by the pharmacy department at COA include medication preparation and delivery, decisions about medication selection, dosages, routes and methods of administration, medication therapy monitoring, and the provision of medication-related information for other healthcare professionals and patients. Our pharmacy staff respond to codes and level 1 traumas, as well as other emergencies when called upon. The Pharmacy department uses robotic technology in intravenous compounding and inventory management. 

During this learning experience, residents will complete COA new hire orientation, where they will receive general hospital legal, regulatory, and safety training.  Residents will then orient through and fully train in various traditional dispensing areas of the pharmacy.  Orienting areas will include inventory, investigational, and PedsRx Pharmacy Solutions outpatient pharmacy.  Training areas include the IV room, inpatient order verification, PYXIS and controlled substances, operating room, and inpatient production, including the PO area.  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 orientation experiences will take place during first (day) shift, however, experiences on second and third shifts may be included as time allows.  Staffing experiences include first and second shift. Staffing assignments will be every 3rd weekend, every 3rd Thursday, and other days as assigned to total no more than 20 additional staffing days.

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

Project management 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.  Practice presentations 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.