NUMEROUS CLINICAL TRAINING SITES
The Barnes-Jewish Hospital Pharmacy Department organizational structure consists of 7 inpatient pharmacy managers supporting the Executive 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 are encountered, with emphasis given to asthma, COPD, diabetes, hypertension, smoking cessation, vaccinations and anticoagulation management. Opportunities exist for assisting in precepting student pharmacists and providing physician and nursing education.
The resident will be an active member of the Barnes-Jewish Hospital Antimicrobial Stewardship Program and will be responsible for identifying and resolving all antimicrobial therapy-related issues for patients assigned to their review under preceptor guidance. Emphasis will be placed on regulatory requirements and the Core Elements for Hospital Antimicrobial Stewardship with related specific small project(s) to be assigned. Attendance at weekly antimicrobial stewardship workgroup meetings as well as BJC-system level stewardship meetings that occur during the rotation is expected. Division of Infectious Diseases | Antimicrobial Stewardship Program
Cardiothoracic Surgery Intensive Care Unit
The resident will attend daily rounds with one of two cardiothoracic surgery intensive care unit (CTICU) teams. Opportunity is given for actively participating in the care of patients following cardiac, thoracic and vascular surgeries. The learning experience includes management of basic cardiac surgeries such as coronary artery bypass grafting and valve replacements/repairs. It also introduces residents to specialized therapies unique to the CTICU such as placement of ventricular assist devices, extracorporeal membrane oxygenation (ECMO), heart transplantations and lung transplantations. Division of Cardiothoracic 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 immunosuppression 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 the hospital’s antimicrobial stewardship 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. Division of Infectious Diseases
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, and the Center for Clinical Studies.
Kidney/Pancreas and Liver Transplantation
The resident will attend multidisciplinary rounds with the inpatient kidney/pancreas transplant service, rounding with both surgeons and nephrologists. In 2016, the organ transplant services perform 211 kidney transplants and 9 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. Transplant Surgery | Barnes-Jewish Hospital Transplant Center
The resident will attend multidisciplinary rounds with the liver transplant service, providing care in critical care, progressive care, and acute care settings. In 2016, the organ transplant services performed 80 liver transplants. 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. Transplant Surgery | Barnes-Jewish Hospital Transplant Center
The pulmonary transplant service performs over 90 lung transplants annually which offers residents the opportunity to provide comprehensive multidisciplinary care to pre- and post-transplant patients in critical care, progressive care, and acute care settings. In addition to post-transplant care, the inpatient service emphasis in-depth critical thinking skills surrounding immunosuppressive agents, antimicrobial therapy, and life-threatening lung diseases. The resident will have significant direct patient care interactions through obtaining medication histories, participation in daily bedside rounds, and providing post-transplant education and discharge counseling. Attendance at pre-transplant assessment meetings, post-transplant discharge rounds, and participation in the care of all pre- and post-transplant patients admitted to the service is expected for a well-rounded and comprehensive experience. Division of Pulmonary and Critical Care Medicine | Lung Transplant at Barnes-Jewish Hospital
The resident will attend daily rounds with the multidisciplinary high-risk obstetrical service. Almost half of the 4,000 deliveries annually at Barnes-Jewish Hospital are high-risk pregnancies. Under the guidance of the preceptor, the resident will 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 inservices for physicians and nurses. Division of Maternal-Fetal Medicine and Ultrasound
The resident will attend multidisciplinary rounds on a 32 bed unit with medical oncology and lymphoma patients. Under the guidance of the preceptor, the resident is responsible for providing pharmaceutical care for the patients and drug information to the physicians, nurse practictioners, pharmacists, nurses, and other supportive staff members. The resident makes recommendations for the patients in areas of supportive care, antimicrobial therapy and complications from treatment and/or malignancy. 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 NNICU service covers two units consisting of 44-beds. Patients are managed by two multidisciplinary teams consisting of an attending physician, neurointensive care fellow, neurology/emergency room residents, neurosurgery interns, nurse practitioners, nurses, dieticians, respiratory therapists, and a clinical pharmacist. In addition, the primary team (e.g. neurosurgery, neurology, trauma, etc.) collaboratively assists in the management of each patient’s care. Under the guidance of the preceptor, the resident will work as a member of one team 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
Comprised of 78 operating suites, over 100 anesthetizing areas, and performing over 40,000 surgical procedures a year, the perioperative experience will provide residents with the opportunity to be involved in patient care activities during the pre-, intra-, and post-operative phases of care. The learning experience includes specialized therapies unique to the perioperative patient such as general and regional anethsesia, antibiotic prophylaxis, perioperative beta-blockade, acute pain management, neuromuscular blockade and reversal, hemostasis, post-operative nausea/vomiting and hemodynamic support. Process improvement and medication safety are also emphasized. The resident will have ample opportunities to observe the perioperative management of surgical patients and gain medication use perspectives from a multidisciplinary team of clinicians, including nurses, certified nurse anesthetists, perfusionists, anesthesiologists, and surgeons. Department of Surgery | Department of Anesthesiology
A 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 participate in evaluating and observing patients with various mental health states through clinical assessment and daily monitoring in the inpatient setting. 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
Stem Cell Transplant Unit
The resident will attend multidisciplinary rounds on a stem cell transplant unit, which performs approximately 450 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. 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
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 and round with the transplant 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 (LVAD) patients. Under the guidance of the preceptor, the resident will provide pharmacotherapeutic recommendations and conduct judicious therapeutic drug monitoring of the patients on service. Attendance at microbiology rounds, infectious diseases case conferences, and infectious diseases didactic conferences is expected. Division of Infectious Diseases