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LEARNING SITES

NUMEROUS CLINICAL TRAINING SITES

Administration
The Barnes-Jewish Hospital Pharmacy Department organizational structure consists of inpatient pharmacy managers and directors who support the executive director of pharmacy. This experience is designed to provide the resident with the opportunity to work closely with pharmacy administration to gain exposure and understanding of managerial responsibilities. Core topics that will be emphasized during the rotation include pharmacy purchasing, pharmacy budgeting, staffing planning, lean processes, employee engagement, employee evaluation procedures, policy writing, and regulatory agencies/compliance.

Ambulatory Care
The Primary Care Medicine Clinic provides care for approximately 3500 patients every month, including those with multiple disease states and serious complications. The resident will collaborate with a multi-disciplinary team including medicine residents, attending physicians, nurses, dieticians, diabetes educators, and social workers to achieve optimal patient outcomes. A wide range of diseases are encountered, with an emphasis given to anticoagulation management, asthma, chronic obstructive pulmonary disease, diabetes, hypertension, smoking cessation, and immunizations. Rotational activities focus on optimizing and monitoring drug regimens in terms of appropriateness, clinical significance, and cost-effectiveness. The resident will work to improve medication adherence and patient outcomes through caregiver and patient education. Opportunities exist for assisting in precepting student pharmacists and providing physician and nursing education.

Antimicrobial Stewardship
The resident will be an active member of the Barnes-Jewish Hospital Antimicrobial Stewardship Program (ASP) and will be responsible for identifying and resolving all antimicrobial therapy-related issues for patients assigned to their review under preceptor guidance. Assigned patients may include those being covered by the handshake ASP service and/or those covered by prospective audit and feedback. Attendance at weekly antimicrobial stewardship workgroup meetings as well as system-level stewardship meetings that occur during the rotation is expected. Division of Infectious Diseases | Antimicrobial Stewardship Program

Cardiac Intensive Care Unit (CICU)
The resident will attend daily rounds and provide pharmaceutical care and drug information for patients in the 15-bed CICU. The CICU includes a state-of-the-art cardiac catheterization/intervention/electrophysiology laboratory; patients cared for in this ICU include those with acute coronary ischemia, acute heart failure, cardiomyopathies, unstable arrhythmias, 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

Cardiothoracic Surgery Intensive Care Unit (CTICU)
The resident will attend daily rounds and provide pharmaceutical care and drug information for patients in a 36-bed CTICU. Residents will participate in the care of patients following cardiac, vascular, and/or thoracic surgery. This learning experience includes exposure to specialized therapies unique to the CTICU such as placement of ventricular assist devices, extracorporeal life support (ECLS), heart transplantation, and lung transplantation. Division of Cardiothoracic Surgery

Drug Information
The drug information center at Barnes-Jewish Hospital services the hospital and its affiliates and responds to approximately 200-250 drug information inquiries per month. The resident will work to refine drug information and literature evaluation skills with an emphasis placed on the clarity and accuracy of written and verbal responses to drug information questions. Additional rotation involvement includes drug policy projects, preparation and presentation of a drug formulary review, preparation and presentation of a drug use evaluation, and attendance at the Pharmacy & Therapeutics (P&T) Committee and key subcommittee meetings.

Emergency Medicine
The emergency department at Barnes-Jewish Hospital is a level one emergency and trauma center, comprehensive stroke center, and certified STEMI center with over 90,000 patients receiving care each year. The resident will provide pharmaceutical care, patient education, and serve as a drug information resource with an emphasis placed on the emergent care of medical and surgical patients. Additional rotation involvement includes attendance at weekly emergency department conferences, in-service presentations to nursing and/or medical residents, and the possibility to round with the toxicology service or EMS providers. Division of Emergency Medicine

General Infectious Diseases
The resident will become an active member of one of the two teaching general infectious diseases consult teams and will provide pharmacotherapeutic recommendations and conduct judicious monitoring of all assigned patients on service. Attendance at microbiology case conference, infectious diseases case conference, and infectious diseases didactic conferences that occur during the rotation is expected. Division of Infectious Diseases | Antimicrobial Stewardship Program

Heart Transplantation
The resident will attend daily rounds with the inpatient pre/post heart transplant teams. The population cared for includes patients with ischemic cardiomyopathy, non-ischemic cardiomyopathy, valvular cardiac diseases, congenital cardiac diseases, heart transplantation and various implanted cardiac devices (left ventricular assist, bi-ventricular assist, total artificial heart). The resident will provide pharmaceutical care to patients served by the team and drug information to team members. 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 patient. Attendance at interdisciplinary meetings and participation in the transplant medication teaching program are expected. Division of Cardiology | Heart Transplant Surgery at Barnes-Jewish Hospital

Hematologic Malignancies
The resident will attend daily rounds on patients with a variety of hematologic malignancies including, but not limited to, leukemias, lymphomas and multiple myeloma. Additionally, the resident will gain exposure to patients with post-stem cell transplant complications. The resident will be expected to effectively communicate pharmacotherapeutic recommendations and drug information to the healthcare 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, chemotherapy order writing, and the management of chemotherapy-related toxicities and have the opportunity to attend weekly patient review conference and other designated oncology meetings. Divisions of Hematology and Oncology | Siteman Cancer Center

Internal Medicine
The resident will attend rounds with one of eight internal medicine teaching teams which cares for patients that have a wide variety of disease states. The resident will develop an interactive role with the medicine team by providing drug information and patient-specific pharmaceutical care to the team's patients. Opportunities exist for patient education, assessment, and counseling. Emphasis will be placed on improving patient communication skills and developing the resident’s knowledge base. Department of Medicine

Investigational Drug Service
The resident will assist in the implementation of investigational drug studies including drug information, staff education, drug accountability, and data collection. Discussions during rotation will cover the history of human research, ethical conflicts, the role of pharmacists in developing 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 institutional review board.

Kidney / Pancreas / Liver Transplant
The resident will attend multidisciplinary rounds with the inpatient kidney/pancreas or liver transplantation services. The resident will provide pharmaceutical care to patients served by the team and service as a drug information resource for 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. Section of Abdominal Transplant Surgery | Barnes-Jewish Hospital Transplant Center

Lung Transplant
The resident will attend rounds with inpatient pulmonary transplantation services and provide pharmaceutical care to 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 served includes those with cystic fibrosis, chronic obstructive pulmonary disease, pulmonary fibrosis, and other life-threatening lung diseases. The resident will also be expected to provide discharge counseling to new pulmonary transplant patients. Knowledge of immunosuppressives and antimicrobial therapy is emphasized. Division of Pulmonary and Critical Care Medicine | Lung Transplant at Barnes-Jewish Hospital

Maternal-Fetal Medicine
The resident will attend rounds with the multidisciplinary high-risk obstetrical service and provide pharmaceutical care for antepartum and postpartum patients with obstetrical complications as well as coexisting conditions including diabetes, maternal and perinatal infection, autoimmune disorders, cardiac disease, and thromboembolic disorders. Additional discussions will include maternal and placental physiology, teratology, obstetric anesthesia, labor/delivery, and lactation/breastfeeding. Opportunities exist for educating patients, attending OB/GYN conferences, and providing in-services for physicians and nurses. Division of Maternal-Fetal Medicine and Ultrasound

Medical Oncology
The resident will round on a 32-bed unit with oncology and hematology patients and will be responsible for providing pharmaceutical care for the patients and drug information to the providers, pharmacists, nurses, and other supportive staff members. Key recommendations made are in the areas of supportive care, antimicrobial therapy, and chemotherapy management. Knowledge of different oncologic disease states and the chemotherapy used to treat these diseases will be emphasized. The resident will assist in educating patients both during their stay and at discharge. Division of Oncology | Siteman Cancer Center

Medicine Intensive Care Unit (MICU)
The resident will provide pharmaceutical care to patients and drug information to the team in one of three MICUs. Residents on the MICU rotation will build and/or solidify understanding of fundamental ICU topics via participating in daily rounds and applying critical thinking skills to establish assessments and plans for drug therapy. Numerous opportunities are available to provide drug information and education to members of the ICU team and enhance one’s knowledgebase by attending multidisciplinary conferences focused on the care of MICU patients. Division of Pulmonary and Critical Care Medicine

Neurosurgery / Neurology Intensive Care Unit (NNICU)
The resident will be responsible for working with neurology residents, fellows, and attendings to identify, prevent, and resolve medication therapy issues for patients in the NICU. The resident will attend multidisciplinary rounds with one of two NNICU teams where they will identify, prevent, and resolve medication therapy issues. Common diseases encountered include ischemic and hemorrhagic stroke, status epilepticus, dysnatremia, traumatic brain injury, myasthenia gravis, demyelinating polyneuropathy, and infectious diseases involving the central nervous system. Department of Neurology | Department of Neurosurgery

Perioperative Services
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 the perioperative patient such as general and regional anesthesia, surgical antibiotic prophylaxis, perioperative beta-blocker therapy, intraoperative medication use management, analgesia, hemostasis, postoperative nausea and vomiting, and intra- and postoperative hemodynamic support. acute pain management, neuromuscular blockade and reversal, hemostasis, post-operative nausea/vomiting and 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 SurgeryDepartment of Anesthesiology

Psychiatry
The 48-bed inpatient psychiatry unit services individuals with acute exacerbation of serious and persistent mental illnesses including but not limited to schizophrenia, bipolar disorder, major depression and substance use disorders. The resident will collaborate with one of five multidisciplinary psychiatry teams that focus on providing patient-centered mental healthcare in addition to general health maintenance for adults. The resident will collaborate with one of five multidisciplinary psychiatry teams that focus on providing patient-centered mental healthcare in addition to general health maintenance for adults with psychiatric, medical, and combined illness. Clinical practice includes modeling the ideology of maintaining hope for recovery and for the reduction of stigma against individuals challenged with mental illness. Department of Psychiatry

Solid Organ Transplant 7 on/7 off
During the weekday, the resident will attend daily rounds with the inpatient pre/post heart transplant teams and provide cross-coverage to other organ groups as needed. On an evening basis, the resident will perform medication reconciliations on newly admitted transplant patients and serve as a resource for transplant related questions from providers and pharmacists. 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 immunosuppression and antimicrobial therapy is emphasized, as well as heart failure therapy, anticoagulation, general medicine pharmacotherapy, care of the post-heart transplant and post-device patients and transitions of care.

Stem Cell Transplantation
The resident will attend rounds in a 32-bed stem cell transplantation unit which performs approximately 400 stem cell transplants per year in addition to CAR T-cell therapy administration. The resident will have the opportunity to round on both transplant patients and 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. Input into selection, dosing and monitoring of antiemetic, analgesic, immunosuppression, and antimicrobial therapy is expected. Division of Hematology and Oncology | Siteman Cancer Center

Surgery / Burn / Trauma Intensive Care Unit (SICU)
The SICU is a 36-bed surgery, burn, and trauma intensive care unit and provides an 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. 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. Department of SurgeryAcute and Critical Care Surgery

Transitions of Care
The resident will be actively involved in providing patient-centered care for patients transitioning across multiple healthcare levels, including outpatient to inpatient, inpatient to inpatient, and inpatient to outpatient transitions.  Daily activities include conducting and evaluating admission and discharge medication reconciliations, attending multidisciplinary discharge rounds, coordinating with healthcare providers to identify and alleviate barriers to discharge, and completing patient counseling sessions throughout admission and upon discharge.  Outpatient support will be provided through follow-up patient phone calls and communication of medication therapies with outpatient healthcare providers.  A wide variety of disease states will be encountered, with an emphasis placed on heart failure, COPD, and acute coronary syndromes.  Additional opportunities exist for providing in-services and medication education to the multidisciplinary team, attending pertinent committee meetings, and precepting pharmacy students.

Transplant Infectious Diseases
The resident will be an active member of the infectious diseases consult team dedicated specifically to the care of solid organ transplant patients, oncology patients (solid tumor, hematologic malignancies, and hematopoietic stem cell transplant) and left ventricular assist device patients. On average, the service covers approximately 30-40 patients daily. The resident is expected to monitor drug therapy, provide treatment recommendations and drug information, and participate in the antimicrobial stewardship program. Attendance at microbiology case conference, infectious diseases case conference, and infectious diseases didactic conferences that occur during the rotation is expected. Division of Infectious Diseases | Antimicrobial Stewardship Program

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