Rotation Offerings

Core Rotations 

Adult Internal Medicine: 

The practice site for this rotation is a high-level telemetry unit where the pharmacy practice resident will encounter patients with hypertension, diabetes mellitus, asthma/chronic obstructive pulmonary disease, coronary artery disease, various renal and hepatic diseases, gastrointestinal diseases, congestive heart failure, thromboembolic diseases, and various infectious diseases. The resident will be part of a multi-disciplinary team and will interact daily with attending physicians, resident physicians, licensed independent practitioners, nurses, case managers and other ancillary clinical staff.  

Cardiac Intensive Care: 

The experience in the CICU (Cardiac ICU) is designed to provide the Pharmacy Practice Resident with an opportunity to be directly involved in the management, selection, and monitoring of pharmacotherapy in critically ill cardiac patients. The disease states encountered may include, but may not be limited to the following: acute coronary syndrome, ischemic heart disease, acute and chronic heart failure, thromboembolic disorders, dysrhythmias, hypertensive urgency, endocarditis, sternal wound infections, open heart surgery and related post-operative complications. 

Emergency Department Medicine: 

The rotation will include hands-on experience in day-to-day operations of the emergency department. The resident will be an active member of the team working along side of attending doctors, medical interns/residents, physician assistants, advanced practice nurses and respiratory therapists. The resident's primary will focus will be on the pharmacologic care and management of patients during their stay in the emergency room. The resident will be the primary drug resource for the department and patients, involved in drug treatment consults, attend codes/traumas, and present weekly drug education to emergency medication technicians. 

Surgical Intensive Care (ICU I): 

Attend daily work and attending rounds with the intensive care team serving as the team's primary source of drug information and actively participate in the management of each patient's drug therapy. Monitor the progress of-each patient by evaluating lab data, appropriate physical findings, vital signs and other clinical symptoms. Exercise insight and expertise to anticipate, prevent, detect and manage adverse drug reactions and drug interactions. Anticipate therapeutic controversies and formulate appropriate alternatives. 

Medical Intensive Care (ICU II): 

Residents will continue to refine their skills in the critical care environment. Residents must complete ICU I in order to be eligible for ICU II. The MSICU is composed of 22 mixed medical/surgical beds for critically ill patients. The resident is a part of the multidisciplinary pulmonary medicine team caring for patients of the medical ICU service. The resident will attend daily work and attending rounds with the intensive care team serving as the team's primary source of drug information and actively participate in the management of each patient's drug therapy. Monitor the progress of-each patient by evaluating lab data, appropriate physical findings, vital signs and other clinical symptoms. Exercise insight and expertise to anticipate, prevent, detect and manage adverse drug reactions and drug interactions. Anticipate therapeutic controversies and formulate appropriate alternatives. 

Inpatient Hematology/Oncology: 

The practice site for this rotation is the inpatient oncology ward (8-1). The resident will function as a member of the multidisciplinary team and provide care to patients with a wide variety of malignant diseases. Residents will identify drug-related problems resulting from antineoplastic drugs or the underlying disease and develop and implement therapeutic strategies. Throughout the rotation, residents will participate in supportive care including pain management, infectious complications, nausea and vomiting, and metabolic disorders that frequently complicate the course of the disease. The rotation will provide a generalized experience in medication and disease state management dealing with oncology patient population. 

Neonatal Intensive Care: 

The rotation will include experience in the Neonatal ICU (NICU) with the ultimate goal of developing proficiency in providing total pharmaceutical care to this patient population. Saint Francis Hospital and Medical Center’s NICU is a 28-bed Level III Neonatal Intensive Care Unit (NICU), located on the fourth floor of the Patient Care Tower. It is a designated tertiary care facility that provides comprehensive care to critically ill newborn infants. The NICU provides intensive medical, surgical and nursing care, state of the art electronic monitoring, life support systems and a complete range of diagnostic and therapeutic capabilities. The NICU treats major newborn disorders such as: prematurity, respiratory distress syndrome, congenital malformations, metabolic disorders, drug withdrawal, necrotizing enterocolitis and birth asphyxia. The unit is staffed by a full complement of experienced nurses, neonatal nurse practitioners and physician assistants and board certified neonatologists, as well as respiratory therapists, pharmacists, occupational therapists, social workers and case managers. The resident will focus on the pharmacologic management of neonatal sepsis, patent ductus arteriosis, respiratory distress syndrome and neonatal pharmacokinetics. 

Ambulatory Care Rotations 

Anticoagulation: 

The section of Hematology/Oncology provides an anticoagulation service for outpatients who are currently prescribed warfarin, heparin and low molecular weight heparin (LMWH). This rotation will allow the resident the opportunity to: 

  •  Provide outpatient management of appropriately screened patients with risks for developing or who were previously diagnosed with a deep venous thrombosis (DVT). 
  • Provide anticoagulation and monitoring for patients with atrial fibrillation, artificial heart valves, deep venous thrombosis, pulmonary embolus, strokes and cardiomyopathy. 
  • Monitor and manage pregnant women with deep venous thrombosis as well as those women who require anticoagulation to prevent deep venous thrombosis while pregnant. 
  • Provide expertise in testing and management of patients with tendencies to develop blood clots (hypercoaguable states) as well as in patients with bleeding tendencies. 
  • Provide education to patients and their families. 

The anticoagulation service is located at the Saint Francis Hospital and Medical Center's main campus on the 2nd floor of the Cancer Center and is staffed by nurses and pharmacists. 

Infectious Disease Clinic: 

The training sites for this rotation are the Adult Medicine Clinics of the Burgdorf/Fleet Health Center and the Gengras Ambulatory Care Center. The resident will have an opportunity to provide clinical pharmacy services relating to the drug therapy management of HIV and hepatitis C to patients encountered at both sites.   

Ambulatory Care (Gengras Adult Medical Clinic): 

During this experience, the resident will be exposed to medication and disease state management in the Gengras Adult Medical Clinic primary care setting. The ultimate goal of this rotation is to aid in the development of proficiency in pharmaceutical care skills. 

Disease states encountered include but are not limited to; diabetes, hypertension, hyperlipidemia, asthma, COPD, smoking cessation and hepatitis C management. The resident will be expected to draw upon foundation skills and didactic knowledge and practically apply this to the patient care setting. Residents will develop and refine their critical thinking skills, further develop written and verbal communication skills, and ultimately develop competency in ambulatory pharmacy practice. It is expected that the resident will gain the ability to anticipate, recognize, monitor, solve and document patient-related therapeutic problems by applying the principles of appropriate drug therapy. The resident will gain insight into billing models for ambulatory care practice. 

Outpatient Oncology: 

The practice site for this Hematology/Oncology rotation is the inpatient oncology ward (8-1) and the Cancer Center at the Saint Francis Hospital. A multi-disciplinary health care team consisting of attending physicians, medical residents, hematology/oncology fellows, physician assistants, registered nurses, nurse’s aides, registered dietitians, social workers and clinical pharmacists staff the Hematology/Oncology department. The patient population consists of cancer patients with a variety of co-morbid conditions. 

The goal of this rotation will be to provide a generalized experience in the medication and disease state management of cancer patients. Residents will learn how to overcome various barriers in order to provide quality patient care and achieve positive disease outcomes for varied patient populations. 

Investigational Drug Service: 

The role of the Investigational Drug Service (IDS) is to oversee the acquisition, accountability, storage, security, packaging, labeling, and safe distribution of study drugs and dissemination of appropriate drug information relating to investigational agents. The IDS supports investigators who conduct clinical research at Saint Francis Hospital and Medical Center (SFHMC). The majority of clinical research at SFHMC is conducted in the Cancer Center. The main objective of the IDS rotation is to give the Resident a working knowledge of the Pharmacy Department’s involvement in clinical drug trials. By the end of the rotation, the Resident will develop an understanding of the importance and complexity of clinical drug research.  Topics covered will include, but not necessarily limited to, the following: 

  • Federal regulation governing human subject research (CFR, FDA) 
  • Ethics of research, including attendance at an IRB meeting and CITI training 
  • Good Clinical Practice in drug research as defined by ICH-E6 
  • Joint Commission standards as they relate to investigational drugs 
  • Pharmacy Department Policies and Procedures relating to investigational drugs 
  • Protocol review including setting up distribution procedures for new studies 
  • Developing drug data sheets for investigational agents 
  • Dispensing investigational agents for ongoing trials 
  • Preparing for monitor visits and clinical trial audits 
  • Clinical oncology questions and chart reviews that pertain to the research patient 

Other Rotations 

Medication Safety (required): 

This rotation will provide the resident with knowledge and experience to identify, develop and implement safe medication practices. The resident will gain knowledge through reading articles and publications on mediation safety. The knowledge will then be applied to develop and implement initiatives to improve the medication use system. The resident will be an active member of the Medication Safety Taskforce and all associated subcommittees. The resident will receive ample opportunity to contribute to medication occurrence reporting, measurement, and performance improvement indicators, as well as program specific indicators (e.g. high-risk medications), direct "nursing medpass" observations and quality assurance reporting. 

Toxicology: 

This practice site for this rotation will be primarily set in the emergency department. The resident will be working directly with the hospital toxicologist. The resident will also be involved in the hospital medication safety and exposure clinic. 

Behavioral Health/Substance Abuse: 

Saint Francis provides a broad range of behavioral health programs and services. These services include a Clinical Assessment Center, In-patient Care and Out-patient Services for children, adolescents and adults, Detoxification Services, Brief Treatment Service, Dual-Diagnosis Treatment, and Substance Abuse Rehabilitation. The resident will provide clinical pharmacy services to these clinical areas and gain insight into the pharmacologic treatment of patients with mental illnesses. 

Practice Management (required): 

This rotation includes management experiences related to all pharmacy services and programs located throughout the Saint Francis Hospital and Medical Center system. The department of pharmacy is a support department with a focus on customer service. A great deal of effort has been expended to develop strong relationships and affiliations system-wide. 

This rotation will focus on identifying appropriate tools to use to enhance these relationships through communications and a "systems-thinking" approach. Knowledge of regulations, both state and federal, as they pertain to pharmacy operations will be stressed throughout the rotation along with Joint Commission on Hospital Accreditation standards. Performance improvement with a focus on outcomes and measurement is an integral part of this rotation. 

The resident will meet once or twice monthly with a member of the pharmacy management team throughout the 12 month residency program. Each pharmacy manager will review their areas of practice and specific responsibilities as noted below. Learning about federal, state and regulatory practice standards, pharmacy department policies and procedures, compliance with human resource policies, clinical tools for monitoring and maintaining patient care, and budget management of personnel, equipment and drug inventory will be the primary goals of this longitudinal rotation. The resident will attend various administrative, department, medical center and corporate meetings. Responsibilities may include: meeting attendance and presentations, data collection and analyses, benchmarking activities, revising or developing policies and/or procedures, and participation in various management activities. 

Drug Information/Policy (required): 

The primary goal in this longitudinal rotation is to assist the resident in gaining proficiency in responding to drug information requests, both formal and informal. Drug information requests involve daily questions, preparation of materials for DTM meeting (formulary monograph reviews), and preparation of newsletters and informational documents for hospital personnel. The resident will also participate in activities involving drug policy, namely, participation in drug usage evaluations, DTM meetings and policy and procedure development, where applicable. 

Pharmacy Service (required): 

The Department of Pharmacy provides a broad range of clinical pharmacy services. The pharmacy employs a staff of over 100 professional and technical individuals. The pharmacy serves inpatients and outpatients at two main campuses. Clinical services are decentralized at both sites, and pharmacists are actively involved in general internal medicine, cardiology, medical/surgical intensive care, neonatal intensive care, hematology/oncology, women and children's services, behavioral health, medication safety, and various primary care settings. Medication distribution is highly automated, and computerized prescriber-order entry (CPOE) is utilized system-wide. The mission of the Department of Pharmacy is to provide efficient, cost-effective, and clinically excellent patient-directed pharmaceutical care to all customers in the Saint Francis community through dedication, education, and continuous quality improvement. The resident will participate in a longitudinal (precepted) pharmacy service experience to aid integration of overall pharmacy operations and our contemporary clinical pharmacy services.