Numerous Clinical Training Sites
The Barnes-Jewish Hospital Pharmacy Department organizational structure consists of 7 inpatient pharmacy managers supporting the Director of Pharmacy. This experience will provide the pharmacy resident with the opportunity to work closely with pharmacy administration to gain exposure and better understanding of managerial responsibilities. Core topics that will be emphasized during the rotation include pharmacy purchasing, lean processes, regulatory agencies and compliance, pharmacy budgeting, employee engagement, JCAHO, policy writing, creating staffing plans, and evaluation procedures.
Residents will provide ambulatory care services in the Primary Care Medicine Clinic as part of a multi-disciplinary team including medicine residents, medical students, attending physicians, nurses, dieticians, diabetes educators, and social workers. The medicine clinic provides care for approximately 3500 patients every month. Activities on rotation focus on optimizing and monitoring drug regimens in terms of appropriateness, clinical significance, and cost-effectiveness. Residents will also improve medication adherence and patient outcomes through caregiver and patient education. A wide range of diseases is encountered, with emphasis given to asthma, COPD, diabetes, hypertension, smoking cessation, vaccinations, and anticoagulation management. Opportunities exist for assisting in precepting Pharm.D. students and providing physician and nursing conferences. Center for Outpatient Health
Cardiothoracic Surgery Intensive Care Unit
The resident will attend daily rounds in a 21-bed cardiothoracic intensive care unit (CTICU). Opportunity is given for participating in the care of patients following cardiac and thoracic surgeries. The learning experience includes specialized therapies unique to the CTICU such as placement of ventricular assist devices, extracorporal membrane oxygenation (ECMO), heart transplantations and lung transplantations. Division of Cadiothoracic Surgery
Cardiac Intensive Care Unit / Cardiology
A 15-bed cardiac intensive care unit and a state of the art cardiac catheterization/ intervention/ electrophysiology laboratory provide the site for this rotation. The resident will attend daily rounds and will provide pharmaceutical care to patients in the CICU as well as drug information to the team. Patients cared for in this ICU include those with acute coronary ischemia, unstable dysrhythmias, acute heart failure, cardiomyopathies, and those awaiting heart transplantation. The focus of this rotation is the treatment of these disease states as well as general critical care topics. Division of Cardiology
Drug Information / Drug Policy
The resident will work in the Drug Information Center under the supervision of the Drug Information Clinical Pharmacists. Emphasis is placed on improving the clarity and accuracy of written and verbal responses to drug information questions. The site provides opportunities to refine drug information and scientific literature evaluation skills. The Center services the hospital and its affiliates and responds to 200-250 drug information inquiries per month. Involvement in additional drug policy projects is assigned by the Manager of Clinical Services. The resident will prepare and present a drug formulary review, be assigned a drug use evaluation topic and will attend meetings of the Pharmacy and Therapeutics Committee and its key subcommittees.
The resident will round with a physician in a large, metropolitan Level One Emergency and Trauma Center where over 95,000 patients per year receive care. Experience based in Trauma/Critical Care and Emergent Care provides an opportunity to learn about a variety of levels of care. Emphasis is placed on the emergent care of medical and surgical patients. Under the guidance of the preceptor, the resident will provide pharmaceutical care, patient education and serve as a drug information resource. Other activities include attending weekly emergency department conferences, teaching in the nurse fellowship program, providing resident inservices, and discussing toxicology cases. Division of Emergency Medicine
The resident will attend daily rounds with the inpatient pre/post heart transplant teams. The adult patient population includes patients with ischemic cardiomyopathy, non-ischemic cardiomyopathy, valvular cardiac diseases, congenital cardiac diseases, heart transplant and various implanted cardiac devices (left-ventricular assist, bi-ventricular assist, total artificial heart). Under the guidance of the preceptor, the resident will provide pharmaceutical care to patients served by the team and drug information to team members. The resident will attend interdisciplinary meetings and participate in the transplant medication teaching program. Knowledge of immunosuppressives and antimicrobial therapy is emphasized, as well as heart failure therapy, anticoagulation, general medicine pharmacotherapeutics and care of the post-heart transplant and post-device patients. Division of Cardiology | Heart Transplant Surgery at Barnes-Jewish Hospital
The resident will attend daily multidisciplinary rounds on patients with a variety of hematologic malignancies including but not limited to leukemias, lymphomas and multiple myeloma. The resident will also gain exposure to patients with post-stem cell transplant complications. With the guidance of the preceptor, the resident will effectively communicate pharmacotherapeutic recommendations and drug information to the health care team. Obtaining knowledge and experience with oncologic supportive care issues such as infections in immunocompromised patients, tumor lysis syndrome, nausea and vomiting, pain management, mucositis/stomatitis, anemia and growth factor support will be emphasized. The resident will also gain experience in chemotherapy planning and order writing, as well as the management of chemotherapy-related toxicities. Ample opportunity to provide patient education will be provided. Resident attendance at the weekly Patient Review Conference, as well as other designated oncology meetings is expected. Divisions of Hematology and Oncology | Siteman Cancer Center
The resident will be an active rounding member of one of two, general infectious diseases consult teams. Under preceptor guidance, the resident will provide pharmacotherapeutic recommendations and conduct judicious therapeutic drug monitoring of the average 15-25 patients on service. The resident will participate in an active antibiotic approval program with the Division of Infectious Diseases at Washington University. Attendance at microbiology rounds, infectious diseases case conferences and infectious diseases didactic conferences is expected.
The resident will attend rounds with an internal medicine team which cares for patients that have a wide variety of disease states. Under the guidance of the preceptor, the resident will provide drug information to the team and pharmaceutical care to the team's patients. The resident assists in providing patient care services to other patients on the assigned nursing division. Opportunities exist for patient education, assessment and counseling. The resident will also assist in precepting PharmD students. Improving patient communication skills is an important activity for this rotation. Developing the resident's knowledge base will be emphasized. Department of Medicine
Investigational Drug Service
Residents will assist in the implementation of investigational drug studies including drug information, staff education, drug accountability, and data collection. Discussions will cover the history of human research, ethical conflicts, the role of pharmacists in development of new medications, research funding and study design. When available, the resident will observe the scientific review process for new studies, data safety monitoring and study approval by the Human Research Protection Office (IRB). If time can be scheduled, visits during the residency rotation will include the AIDS Clinical Trials Unit, Siteman Cancer Center, the Institute of Clinical and Translational Sciences , the Good Manufacturing Practices Center and the Center for Clinical Studies.
Kidney / Pancreas and Liver Transplantation
The resident will attend multidisciplinary rounds with the inpatient kidney/pancreas and liver transplant services. The organ transplant services perform approximately 220 kidney transplants, 85 liver transplants and 20 combined kidney-pancreas transplants per year. Under the guidance of the preceptor, the resident will provide pharmaceutical care to patients served by the team and drug information to team members. The resident will attend transplant assessment meetings and participate in the transplant medication teaching program. Knowledge of immunosuppressives and antimicrobial therapy is emphasized, as well as general medicine pharmacotherapeutics and care of the surgical patient. Transplantation Surgery | Barnes-Jewish Hospital Transplant Center
The resident will attend multidisciplinary rounds with the inpatient pulmonary transplant services. The resident will provide pharmaceutical care to the patients and drug information to the medical staff. Attendance at transplant assessment meetings and participation in the care of patients prior to transplantation is also expected. The patient population includes those with cystic fibrosis, COPD, pulmonary fibrosis, and other life-threatening lung diseases. The resident will also provide discharge counseling to new pulmonary transplant patients. Immunosuppressive and antibiotic therapy will be emphasized. Division of Pulmonary and Critical Care Medicine | Lung Transplant at Barnes-Jewish Hospital
The resident will attend multidisciplinary rounds on a 39 bed unit with oncology and hematology patients. Under the guidance of the preceptor, the resident is responsible for providing pharmaceutical care for the patients and drug information to the physicians, pharmacists, nurses and other supportive staff members. The resident makes recommendations for the patients in areas of supportive care, antimicrobial therapy and chemotherapy issues. Knowledge of different oncologic disease states and the chemotherapy used to treat these diseases will be stressed. The resident will assist in educating patients both during their stay and at discharge. Division of Oncology | Siteman Cancer Center
Medicine Critical Care
The resident will attend rounds in one of two medical intensive care units (MICU). Under the guidance of the preceptor, the resident will provide pharmaceutical care to patients in the MICU and drug information to the team. Knowledge of pharmacotherapy in critical care and interpretation of invasive hemodynamic monitoring data will be emphasized. Division of Pulmonary and Critical Care Medicine
Neurosurgery / Neurology Intensive Care
The resident is responsible for working with the neurology residents, neurology fellows and neurology attending to identify, prevent, and resolve medication therapy issues for patients in this practice setting. Common diseases encountered include stroke / cerebrovascular disease, multiple sclerosis, Parkinson’s disease, movement disorders, epilepsy, migraines, Alzheimer’s disease, myasthenia gravis, demyelinating polyneuropathy, and infectious disease involving central nervous system. Department of Neurology | Department of Neurosurgery
The resident will be involved in patient care during all perioperative stages, including preoperative, intraoperative, and postoperative periods. The learning experience includes specialized therapies unique to perioperative patient care such as surgical antibiotic prophylaxis, perioperative beta-blocker therapy, intraoperative medication use management, analgesia, hemostasis, postoperative nausea and vomiting, and intra- and postoperative hemodynamic support. In addition, the resident will have the opportunity to observe the intraoperative management of a diverse surgical population; local, regional, and general anesthesia; conscious sedation; neuromuscular blockade; and pharmacologic reversal. The resident will provide drug information and education to a multidisciplinary perioperative services staff, participate in adverse drug reaction monitoring and reporting, and take an active role in enhancing medication safety in the perioperative setting. Department of Surgery | Department of Anesthesiology
Stem Cell Transplant Unit
The resident will attend multidisciplinary rounds in a 31-bed stem cell transplant unit, which performs approximately 375 stem cell transplants per year. In addition to managing transplant patients, the resident will have the opportunity to round on patients with a variety of hematologic malignancies including, but not limited to leukemias, lymphomas, and multiple myeloma. Obtaining knowledge and experience with chemotherapy planning, order writing, and oncologic supportive care issues will be emphasized. Under supervision of the preceptors, significant input into selection, dosing and monitoring of antiemetic, analgesic, immunosuppression, and antimicrobial therapy is expected. Ample opportunity for patient interaction, assessment, and education is provided. Critically ill patients, including those receiving mechanical ventilation and vasopressor support, are cared for in the unit. Division of Hematology and Oncology | Siteman Cancer Center
Surgery / Critical Care / Burn / Trauma
The STBICU is a 36-bed surgery, trauma and burn intensive care unit and therefore this site will provide an excellent opportunity to learn about the management of critically ill patient populations whose primary acute problems are surgical or traumatic in nature. Given that certain pathophysiologic derangements are common across the ICU disciplines, this rotation will also help to build and solidify understanding of fundamental ICU topics. Under the guidance of the preceptor, the resident will contribute to the multi-disciplinary care of critically ill patients by participating in daily rounds and applying critical thinking skills to establish assessments and plans for drug therapy. Numerous opportunities are available to the resident to provide drug information to various members of the ICU team and also to enhance their learning by attending multidisciplinary conferences focused on the care of surgical and trauma ICU patients.
Acute and Critical Care Surgery
Transplant Infectious Diseases
Residents round with the transplant infectious diseases consult team dedicated specifically to the care of stem cell transplant, solid organ transplant and leukemia/lymphoma patients. On average, the service covers approximately 8-15 patients. Under preceptor guidance, residents monitor drug therapy, provide treatment recommendations and drug information, and participate in the antibiotic stewardship program. Attendance at microbiology rounds, infectious diseases case conferences, and infectious diseases didactic conferences is expected. Division of Infectious Diseases.
Pictured above left to right: Inpatient Staff Pharmacist, Terry Burton, RPh; Outpatient Staff Pharmacist, Connie Cervantes, RPh; Pharmacy Student Mario Coronado.