Pharmacy & Residency Orientation

This learning experience is a four-week experience during which time residents receive comprehensive orientation to the pharmacy department, pertinent policies/procedures, and hands-on experience. A workable knowledge of the electronic health record is required for which residents complete approximately 24 hours of training and related competencies.

Clinical Monitoring

This learning experience is a three-week experience that provides a strong foundation in the core clinical monitoring areas (pharmacokinetic, anticoagulation, renal, TPN) that will be part of the resident’s operational and clinical learning experiences. Residents spend time learning, implementing, and intervening with clinical standard work to create a springboard for subsequent learning experiences.

Pharmacy Operations Onboarding

This learning experience is a three-week learning experience in which residents build upon previous learning experiences (Pharmacy & Residency Orientation and Clinical Monitoring). Residents begin to have more autonomy and learn the daily activities for the areas of operation they will staff throughout the residency program.

Cardiology

A learning experience in cardiology provides exposure to the subspecialties that make up cardiovascular care at Lancaster General Health. Multidisciplinary teams provide comprehensive care to the critically ill cardiac and heart failure population. Ensuring adherence to national consensus guidelines, appropriate and safe use of high-risk cardiovascular medications, and optimal medical, nursing and pharmacy staff education on cardiac pharmacotherapy are vital to providing an extraordinary experience for our patients. Heart failure medication adherence counseling improves our patients’ quality of life and reduce the potential for heart failure readmission.

Critical Care (MICU/SICU or Trauma Neuro Unit) (resident choice)

Critical Care – MICU/SICU

The advanced critical care learning experience exposes residents to an additional focus on ICU patients, expanding knowledge gained during the critical care trauma learning experience. Residents round with pulmonary intensivists in the MICU/SICU gain additional knowledge of medication management and disease states involving ICU patients. Residents also serve as the primary preceptor for any pharmacy students during their critical care learning experience. Learning opportunities are determined by the activities residents a completed in the critical care learning experience.

Critical Care - Trauma Neuro Unit

The Lancaster General Hospital Trauma Neurosurgical unit consists of 16 critical care beds where pharmacists participate in Intensivists model multidisciplinary trauma rounds. Residents round on trauma and neurosurgical patients when the trauma service is a consultant

Infectious Disease

The Infection Disease (ID) learning experience allows residents to develop a solid understanding of microbiology, pharmacokinetics, and pharmacodynamics of antimicrobials and antimicrobial stewardship. Residents interact with various departments such as infection control and microbiology, and are part of the Infectious Diseases rounding service and Antimicrobial Stewardship Program rounds. Responsibilities include but are not limited to: daily rounds, PK dosing, weekly topic discussions, in-servicing infection control nurses, ID journal club and/or 45-minute patient case presentation.

Internal Medicine

This learning experience involves rounding with physicians from the internal medicine hospital specialist group, providing drug information, therapeutic recommendations, detailed medication reconciliation, and patient counseling. Family Medicine residents are also involved in this rounding experience and provide additional opportunities for learning and teaching.

Management/Leadership

The management/leadership learning experience exposes residents to issues affecting overall pharmacy practice and operations, including specific current initiatives across the health system. Financial performance, human resource management, organizational systems, current topics in pharmacy practice, regulatory compliance, leadership development, and practice model considerations are among the topics covered

Residents also gain an understanding of the role of other members of the department’s management team, actively participating as a team member. Residents are exposed to interactions with hospital administrators and physician and nursing leaders. Additional focus on management skills and problem-solving techniques will be developed.

Medication Safety

LG Health is proud to be a leader in innovative medication safety technology and is dedicated to ensuring the safest and best practice care to our patients. Our health system continuously evaluates the medication use process and current automation utilizing evidence-based methodologies to facilitate safe patient care and process improvement devoted to strengthening our culture of safety.

Our medication safety learning experience introduces residents to patient safety initiatives, national patient safety goals, medication safety resources, automated technologies, medication error reporting, and adverse drug reaction surveillance. Residents are involved in bedside patient care which lessens the potential for harm and optimizes medication management strategies with high-risk medication therapies, such as anticoagulants.

Special Populations

The Special Populations learning experience offers the resident the option of selecting one of the following learning experiences to complete during their residency year: Care Connections, Decentralized Pharmacy Services, Emergency Medicine, Geriatrics, Oncology, Pediatrics or Transitions of Care (TOC). The resident must select one of these learning experiences to fulfill their special population requirement. For more detail of each of these learning experiences, please refer to the elective learning experience section. By fulfilling this requirement with one of these learning experiences, does not prohibit the resident from electing any of these other offerings for their elective options.

Mini Learning Experience

This is a 3 week concentrated session during the month of February. Residents may select from one of the following electives: Ambulatory Care: Specialty Pharmacy Services, Care Connections, Decentralized Pharmacy Services, Geriatrics, HIV, Inpatient Diabetes or Pain Management.

Orientation / Pharmacy Operations (Part 1) Learning Experience

Our Orientation / Pharmacy Operations (Part 1) learning experience is a three-week experience during which time residents receive comprehensive orientation to the pharmacy department, pertinent policies/procedures, and hands-on experience. A workable knowledge of the electronic health record is required for which residents complete approximately 24 hours of training and related competencies.

Pharmacy Operations (Part 2) Learning Experience

Pharmacy Operations (Part 2) is a two-week learning experience in which residents build upon previous learning experiences (Orientation/Pharmacy Operations Part 1 and Clinical Monitoring). Residents begin to have more autonomy and learn the daily activities for the areas of operation they will staff throughout the residency program.

Clinical Monitoring

This experience provides a strong foundation in the core clinical monitoring areas (pharmacokinetic, anticoagulation, renal, TPN) that will be a part students’ operational and clinical learning experiences. Residents spend time learning, implementing, and intervening with clinical standard work to create a springboard for subsequent learning experiences.

Ambulatory Care

These learning experiences focus on the provision of pharmaceutical care to patients at our ambulatory practices with a pharmacist embedded in the practice site. The longitudinal experiences give residents experience with anticoagulation and chronic disease state management and opportunities to educate patients and health-care professionals. Residents have the opportunity to meet with patients for medication education and chronic disease state management through use of collaborative practice agreements.

Anticoagulation

This is a four to five month learning experience completed at the Crooked Oak Anticoagulation Clinic that focuses on the care of patients on anticoagulation for the treatment or prevention of thrombosis. Residents develop the skills necessary to participate as an effective anticoagulation management services provider, providing direct patient education, point of care INR testing, and laboratory study evaluation. They will also adjust warfarin dosing using a collaborative drug therapy management agreement and monitor for adverse events. As a collaborative member of the health care team, residents also work with providers to transition patients to and from the direct oral anticoagulants. They create care plans for periprocedural disruptions in anticoagulation therapy and present these plans for provider approval. Residents communicate with other ambulatory care providers, nursing, retail pharmacies, and family to disseminate information to ensure the safe and effective use of these high-risk anticoagulants during transitions in care.

Chronic Disease State Management - Walter L. Aument Family Health Center

This chronic disease state management is a four to five month longitudinal learning experience completed at the Walter L. Aument Family Health Center practice focuses on the provision of pharmaceutical care to patients at a downtown Lancaster practice site with an embedded clinical pharmacist. The practice is an academic site run by family medicine residents and attending physicians, allowing for significant collaboration and education. The patient population is varied and includes underserved and Spanish-speaking patients.

Residents have the opportunity to meet with patients for medication education and chronic disease state management through use of collaborative drug therapy management agreements. A majority of time is spent on diabetes management. However, residents become familiar with many common chronic and acute disease states seen in the outpatient setting (i.e. hypertension, dyslipidemia, venous thromboembolism, atrial fibrillation, asthma, COPD).

Drug Information

This yearlong longitudinal learning experience exposes residents to all aspects of the development of medication-related policies and procedures and the evaluation of medications for formulary reviews. Residents are actively involved in performing a medication use evaluation and in providing ongoing drug information. Residents have opportunities to make formal presentations at Formulary and Pharmacy and Therapeutics committee meetings.

Pharmacy Operations

This learning experience covers the provision of pharmaceutical services to all patients at LG Health. The focus is on the medication use process including, but not limited to: computerized provider order entry, order verification, preparation, distribution, and monitoring of medications.

Following orientation, residents are responsible for all duties assigned to the position, verifying, preparing and dispensing medications following existing standards of practice as well as LG Health’s policies and procedures. Each resident fulfills this requirement by completing the following hour requirement: one evening shift every third week; one weekend every third week (or its equivalent); and a four-hour IV room staffing requirement each month.

Clinical Operations

Rapid Administration of Antimicrobials by Infectious Diseases Specialist (RAIDS) is a yearlong longitudinal learning experience. The RAIDS initiative targets streamlining appropriate antibiotic therapy for blood cultures positive with S. aureus and certain resistant organisms in a timely manner.

Research

The research project learning experience exposes residents to the essential points of research design and develops research technique skills. Residents work to design, develop and implement a research project.

Medication Use Evaluation

The purpose of performing a Medication Use Evaluation (MUE) is to promote optimal medication therapy and ensure the therapy meets current standards of care. Residents have the opportunity to select a particular MUE of interest that aligns with the needs of the organization. Residents will present their MUE at the ASHP Mid-Year Clinical Meeting.

Education & Professional Development

This 12-month learning experience ensures residents are using the appropriate preceptor roles when engaged in teaching stakeholders, providing effective medication (practice-related) education to patients, HCP, students and the public, as well as developing self-evaluation and personal performance improvement skills.

This yearlong longitudinal learning experience, for pharmacy PGY1 residents, will cover the provision of pharmaceutical services to all patients at LG Health. The focus is on the medication use process including, but not limited to: computerized provider order entry, order verification, preparation, distribution, and monitoring of medications. The resident will verify, prepare and dispense medications following existing standards of practice as well as LG Health’s policies and procedures.

This learning experience encompasses (but is not limited to): formal/informal presentations, journal clubs, in-services, case presentations, layered learning models with other health care professionals, including students. While some of these may be associated with activities on other learning experiences, residents will be evaluated longitudinally on specific goals/objectives.

Professional Presentations

This 11-month learning experience encompasses the two major presentations that will be completed during the PGY1 year, including the Pharmacotherapy Grand Rounds and Morning Report. The resident will be required to pick the topic of interest for each presentation. Pharmacotherapy Grand Rounds will be presented for ACPE credit and Morning Report will be presented to the family medicine residents and pharmacy staff.

Ambulatory Care (Block)

Chronic Disease State Management (Norlanco or Crooked Oak)

This 4-5 week learning experience exposes residents to an area of direct patient interaction and provides opportunities to practice evidence-based medication. Residents work under collaborative drug therapy management agreements to care for diabetes, hypertension, and lipid patients at multiple sites to create personalized prevention plans. Residents are part of a medication adherence program designed specifically for patients who are not reaching their health outcome goal, discussing patients’ concerns with their current therapy. In addition, residents gain experience as a member of ambulatory care team, collaborating with a care manager, social worker, and the community health worker on high-risk patients.

Ambulatory Care (Longitudinal)

Chronic Disease State Management (Norlanco, Internal Medicine or Walter L. Aument Family Health Center)

Internal Medicine

This is an elective longitudinal learning experience that occurs for ½ day once a week. This learning experience exposes residents to direct patient care managing mainly diabetes, hypertension, and hyperlipidemia under collaborative drug therapy management agreements. The patient population at Internal Medicine are generally more complex due to their advanced age. Patients, who are not obtaining their health goals, are referred to the pharmacist for assistance in achieving health outcomes. Residents gain experience as a member of the ambulatory care team through collaboration with the providers, in addition to nurses, social workers and community health workers on high-risk patients.

Norlanco or Walter L. Aument Family Health Center

See description above in Elective and Required Learning Experiences respectively

Anticoagulation (The Heart Group or Crooked Oak)

The Heart Group

Based at The Heart Group of Lancaster General Health, residents are exposed to anticoagulation management within a cardiology practice. This practice site is an option for the three to four-month required elective anticoagulation experience.

The multidisciplinary office cares for patients in general cardiology, heart failure, electrophysiology, peripheral vascular disease, valvular heart disease, and cardiovascular risk reduction clinics. The office has an outpatient center for laboratory and cardiovascular testing.

Residents manage anticoagulation patients under a collaborative drug therapy management agreement, and have opportunities to meet directly with patients in the office for new visits and medication-related problems. Residents are also exposed to cardiovascular drug therapy monitoring and have opportunities to provide educational sessions to office staff

Crooked Oak

See description above in Required Longitudinal Experiences

Acute Care (Longitudinal)

The Acute Care Longitudinal learning experience is a 2 month learning experience in which the resident covers a variety of clinical inpatient duties on a weekly basis. The clinical inpatient duties include TOC Eliquis from ED, opioid stewardship, antimicrobial stewardship, and same day access clinic.

Care Connections*

This learning experience focuses on the provision of pharmaceutical care to patients within an innovative, intensive, and temporary primary care medical home for high-risk patients. Residents work collaboratively with the Care Connections team members (patient care navigators, social workers, case managers, nurses, nurse practitioners and physicians) to enhance medication management. Residents shadow various team members, meeting with patients in the office and their homes. A majority of time is spent on transition of care, medication reconciliation, and medication education. However, warfarin management and chronic disease state management will also be activities in which residents are involved. Residents also educate Care Connections team members on various pharmacy-related topics.

Critical Care – MICU/SICU or Trauma Neuro Unit (resident choice)

Critical Care – MICU/SICU

The advanced critical care learning experience exposes residents to an additional focus on ICU patients, expanding knowledge gained during the critical care trauma learning experience. Residents round with pulmonary intensivists in the MICU/SICU gain additional knowledge of medication management and disease states involving ICU patients. Residents also serve as the primary preceptor for any pharmacy students during their critical care learning experience. Learning opportunities are determined by the activities residents a completed in the critical care learning experience.

Critical Care - Trauma Neuro Unit

The LGH Trauma Neurosurgical unit consists of 16 critical care beds where pharmacists participate in Intensivists model multidisciplinary trauma rounds. Residents round on trauma and neurosurgical patients when the trauma service is a consultant.

Pharmacy services include Propofol monitoring, hypertonic saline monitoring, anticoagulant monitoring, haloperidol QTc monitoring and pharmacy to dose vancomycin. Residents are exposed to critical care topics including traumatic brain injury, ICU sedation and pain management and neuromuscular blockade. Residents attend trauma meetings and patient case presentations.

Decentralized Pharmacy Services*

This learning experience is a 4-5 week experience in which the resident will develop and enhance their skills necessary to function as a decentralized clinical pharmacist. The focus will be on the different clinical responsibilities/duties of the various decentralized pharmacist positions. Discharge medication reconciliation and medication use process including, but not limited to: computerized provider order entry, order verification, preparation, distribution, and clinical monitoring of medications. The resident will be responsible for all duties assigned to the scheduled decentralized pharmacist position. The resident will verify, prepare and dispense medications following existing standards of practice as well as LGH's policies and procedures.

Emergency Medicine

The 4-5 week learning experience is available as an elective to expose residents to acute care medicine within a busy emergency department (ED) that serves both urban and rural populations. As Lancaster County's preferred emergency medicine provider and only Level 1 Trauma Center in Lancaster County, more than 100,000 patients visit LGH’s ED for a variety of health concerns yearly. The pharmacy resident will be exposed to patients in the Main ED, PATH, Trauma/Resuscitation, and Fast Care Pediatrics areas. The learning experience will strengthen fundamental pharmacy practice knowledge and skills in a vast range of topics while exposing the resident to medicine in a fast-paced setting.

Family Medicine

This learning experience focuses on the provision of pharmaceutical care to patients admitted to our Family and Community Medicine service. Residents are actively involved in teaching Family Medicine residents. Emphasis is placed on the management of drug therapy in patients with multiple medical problems and viewing the whole patient. Pharmaceutical care services include: reviewing patient medication profiles, resolving medication problems, completing medication reconciliation, providing pharmacokinetic consults, providing patient education and counseling, teaching during daily team rounds, and providing drug information services to the health care team. There is also an emphasis on transition of care.

Geriatrics*

The geriatrics learning experience exposes residents to caring for the older adult population in a wide array of settings. Residents work closely with geriatricians rounding in primary care, long term care, and in-patient settings, as well as within an interdisciplinary team. Areas of focus include: geriatric disease states, review and participation in advanced care planning, and end of life discussions. Residents participate in journal clubs, in-services, and case presentations.

HIV

This 3 week learning experience will provide exposure to HIV pharmacotherapy in both the inpatient and outpatient sectors. The resident will participate in patient care at Comprehensive Care Clinic and also manage HIV-related pharmacotherapy at LGH. This learning experience will consist of clinic and ID/HIV-AIDS specific topic discussions on a weekly basis. The disease states commonly encountered at Comprehensive Care Clinic include diabetes, hypertension, and hyperlipidemia and are often co-visits with the nutritionist. The ID clinical pharmacy specialist will serve as the primary preceptor. The resident will review profiles of patients on antiretroviral therapy and engage in daily follow-up to address pharmacotherapeutic plans.

Inpatient Diabetes

This 3 week learning experience is a focused learning experience on patients admitted to Lancaster General Health with high risk prior to admission insulin treatments (U500, insulin pump), high risk admission diabetes conditions (Diabetic Ketoacidosis / Hyperglycemic Hyperosmolar Non-Ketotic Syndrome), or difficult to manage glycemic control patients (repetitively low glucoses). Time will also be spent counseling patients that are being discharged on new start insulin.

Investigational Drug Services

The Investigational Drug Service learning experience is a 4-5 week learning experience focusing on the role of an Investigational Drug Service (IDS) pharmacist in supporting clinical trials in a variety of practice settings (e.g., outpatient offices, inpatient units, hospital-based infusion center) and disease-states (e.g. hematology/oncology, cardiology, neurology, orthopedics, genomics, etc.). This learning experience offers the opportunity to become familiar with how the IDS ensures that clinical drug trials are conducted in a safe and efficient manner, and provides a general overview of the research framework of the organization. During the learning experience, there will be an opportunity to review study protocols for all phases of drug development, review regulatory requirements related to clinical trials and investigational products (IP), develop an understanding of best practices of an IDS, and interact with various members of the research teams across the institution. The learning experience will also include the opportunity to become familiar with the role of the Institutional Review Board (IRB). Additional learning opportunities will be assessed and provided per resident interest.

Oncology*

The Adult Hematology/Oncology learning experience is a 4-5 week learning experience with inpatient and outpatient exposure. Residents round with an oncologist on the inpatient oncology unit and provide pharmaceutical care to outpatients at the Ann B. Barshinger Cancer Institute. Residents strengthen their knowledge and understanding of prevalent topics in hematology/oncology, including principles of chemotherapy, and treatment of solid tumors and hematologic cancers. Residents also participate in oncology supportive care, including counseling patients as part of the pharmacy managed epoetin program. The learning experience also teaches residents how to evaluate complex chemotherapy regimens and provide chemotherapy teaching to patients. The Cancer Institute pharmacy allows residents to gain practical experience in the prevention of chemotherapy medication errors and chemotherapy preparation using safe handling practices.

Pain Management

During this 4-5 week learning experience, residents complete pharmacy pain consults requested by provider, provide counseling, and review patients on opioid agonist/antagonist therapy and make recommendations for nasal naloxone. Residents also participate in rounds on opioid tolerant postoperative spine patients, attend and opioid-related meetings (spine care management, drug and alcohol taskforce).

Pharmacy Informatics

The informatics learning experience is a 4-5 week learning experience focusing on e-Health (Epic) and other closely integrated technical applications within the pharmacy.

The resident will have the opportunity to develop familiarity with Willow e-Health applications and see how changes or updates to the system are incorporated into workflow and ancillary medication systems. There will be a focus in not only maintenance support of the e-Health and Omnicell applications, but also involvement in all of the phases of projects applicable. During this learning experience, there will be daily interaction with the e-Health analysts to help support new build, updates, and requests from the pharmacy. There will also be regular interaction with pharmacy end users identifying opportunities for operational improvements related to technology. The learning experience will also focus on collaboration with other operational supervisors to coordinate changes and enhancements to workflow.

Pediatrics*

As an active member of a pediatric hospitalist team, residents increase their proficiency in providing pharmaceutical care to the general pediatric patient. Topic discussions and patient care experiences enhance residents’ understanding of the management of common pediatric disease states. Additional experiences include journal club, experience at Lancaster General Health’s Women & Babies Hospital, and attendance of pediatric-related meetings.

Teaching Certificate (Longitudinal)

Residents can elect to complete a Teaching Certificate through Shenandoah University

Specialty Pharmacy Services

This 3 week or longitudinal learning experience will allow the resident to become exposed to specialty pharmacy services at LGH including operations related to handling and processing specialty prescriptions, gain familiarity with specialty pharmacy accreditation, conduct outreach for patients prescribed specialty medications, and partner with clinical pharmacists caring for patients initiating specialty medications. The resident will also have exposure to monitoring of departmental metrics involving specialty pharmacy services.

Transition of Care (TOC)*

LGH is dedicated to the safe and successful transition of discharged patients back into the community. During the Transition of Care learning experience, residents participate as collaborative team members, working closely with nurses and physicians to improve outcomes for patients being discharged from the hospital. The heart of this experience is ensuring accuracy of the discharge medication list and high-risk medication evaluation and counseling. Residents develop skills to educate providers, and other members of the interdisciplinary health-care team, to improve the overall quality of the transition process.

*Resident’s choice of 1 of the 7 noted above to fulfill special populations elective