Longitudinal Rotations

Ambulatory Care

Ambulatory Care is a required, longitudinal learning experience at Children’s of Alabama. During this experience, residents will rotate through three clinics (2 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
Renal transplant

Elective clinic options include:

Heart Transplant
Liver Transplant
Hematology/Oncology (various)
HIV (pediatric/adolescent/adult)
Infectious Diseases
Blood and Bone Marrow Transplant
IBD
Intestinal Rehab
Dialysis
Advanced experiences in required clinics
Additional experiences at resident request

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 12 weeks in each of the required clinics, and at least 8 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.

Code/Trauma Response

Code/trauma response is a required, longitudinal learning experience at Children’s of Alabama.  Patient codes may occur in any inpatient or outpatient unit in the hospital.  Trauma patients are housed in the emergency department. Some clinical pharmacists are responsible for providing code response for patients followed by his/her clinical team. Other patients are served by pharmacists from the main pharmacy or by the pharmacist/resident on call. 

At Children’s of Alabama, pharmacists respond to all codes and level 1 traumas.  Whenever possible, 2 code/trauma trained pharmacy personnel (at least one of which is a pharmacist) respond.  The pharmacist is responsible for calculating doses of, obtaining, preparing, and labeling doses of critical care medications.  The pharmacist ensures that the code/trauma team follows appropriate protocols for medication timing and sequencing, anticipates patient and provider needs so medications are ready when needed, and provides medication dose documentation support.  The pharmacist is also responsible for appropriate documentation and restocking of medications after the code/trauma event. 

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
• Create 2 or revise 4 existing learning modules for the pharmacy department
• Provide an ACPE-approved CE program to Children's of Alabama and UAB pharmacists.
   

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 Children's of Alabama 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 Children's of Alabama 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 to aid in inventory management.

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. Staffing assignments will be no more frequently than 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:

• Read Crucial Conversations and discuss with Director and Finance Supervisor at scheduled monthly meetings.
• Research and discuss interviewing techniques and what signs to look for in perspective candidates.
• Attend 3 Pharmaceutical Stewardship meetings.
• Attend 1 Pharmacoeconomics meeting.
• Discuss employee evaluations and progressive discipline.
• Complete travel budget for 2027.
• Attend 3 MET meetings.
  • Discuss 3 medication errors from the meetings with Director.
    • Causes and strategies to prevent.
• Discuss the pharmacy market and opportunities they may be presented with.
• Discuss drug shortage and mitigation strategies.
• Discuss 3 news articles that pertain to pharmacy finances (340B, GPO benefits, high dollar medications coming to market, etc.)
• Discuss the 340B program history and thoughts on its future landscape.
• Discuss the benefits of joining professional pharmacy organizations.
• Discuss the Alabama Board of Pharmacy.
  • How you can become involved
  • Impacts on our operation
  • Meeting attendance. Watch a meeting online.
• Participate in residency interviews.
• Completes assigned CBTs on workplace violence and diversity, equity, and inclusion.
• Report at least 3 ADRs. Discuss with a member of pharmacy leadership.
   

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.

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 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.