Rotations (PGY-1)

The administration rotation will provide residents with the opportunity to become familiar with policy development and review, the role of the pharmacy leader in ensuring patient safety, management techniques and budgeting. Residents will participate in various meetings on organizational and departmental levels. They will also work with the pharmacy director at Morristown Medical Center or Overlook Medical Center.

This critical care rotation emphasizes the understanding and management of problems specifically related to critically ill medical patients. Identification of patient problems and application of clinical therapeutics to the critically ill patient will be stressed. Specific topics discussed include hemodynamic and physiologic monitoring, pharmacokinetic monitoring and infectious problems in critically ill patients.  During the critical care rotation, residents will round with the medical team in a 10-bed MICU at Morristown Medical Center or 20-bed MICU and 10-bed CCU at Overlook Medical Center.

The infectious diseases rotation will take place at Overlook Medical Center or Morristown Medical Center. Residents will follow patients on the Infectious Diseases Consult Service and participate in the daily rounds with the ID team. During this rotation, residents will learn evidence- and guideline-based pharmacotherapeutic approaches for the treatment of common infectious disease conditions, and will also perform pharmacokinetic monitoring of antimicrobials.

The internal medicine rotation is available at Morristown Medical Center or Overlook Medical Center. At Morristown Medical Center residents will round with one of the three Morristown Academic Hospitalist Associates (MAHA) teams, consisting of a faculty hospitalist, PGY-3 "junior attending,” two interns and medical students. At Overlook Medical Center residents will round with the Medical Education team consisting of a faculty internist, PGY-3 “junior attending,” two interns and medical students. Residents will expand their knowledge by identifying the etiology, pathophysiology, and evidence-based treatments of common diseases such as diabetes, hypertension, stroke, alcohol withdrawal, cardiac arrhythmias and pneumonias.

This is a one-month rotation that will orient residents to the operations of a hospital pharmacy. Residents will be able to perform all the duties of a staff pharmacist at the completion of this rotation. Duties include, but are not limited to, profiling and dispensing medications, preparing IV solutions, providing drug information to patients and health care professionals, and completing clinical interventions. This rotation will incorporate the staffing requirement that will continue throughout the year.

The anticoagulation clinic, located at 435 South Street in Morristown, NJ, manages more than 50 patients. This service is provided every Monday from 9:00am to Noon. Clinical functions performed by the pharmacist include evaluating appropriateness of anticoagulation therapy, ordering and monitoring pertinent laboratory tests and performing appropriate dosing recommendations and adjustments for initiation and maintenance therapy. The pharmacist plays a vital role in providing patient education, assisting in refill authorizations, screening for side effects, drug-drug interactions and signs of disease recurrence.

The transition of care practice addresses patients who were recently discharged from the hospital for any diagnosis or had an emergency room visit. The pharmacy resident, under the supervision of the clinical pharmacist, conducts medication reconciliation in the clinic, addresses barriers and provides disease state education. Medical and pharmacy residents are taught together how to conduct proper medication reconciliations and identify barriers/issues that led to the admission.

The purpose of the cardiothoracic surgery rotation is to develop the resident’s skills in the identification and resolution of pharmacotherapeutic issues in care of cardiothoracic surgery patients. The resident will be responsible for identifying and resolving medication therapy issues for patients and will work toward assuming care of all patients on two units throughout the learning experience. The resident will actively participate in daily multidisciplinary rounds in CPACU and CVICU at Morristown Medical Center.

The cardiology rotation is designed to give residents an opportunity to experience various cardiology settings from the outpatient clinic (heart failure) to critical care areas (CCU, CVICU, cardiothoracic ICU). Responsibilities of this rotation include, but are not limited to, daily attending rounds in the CCU, identification and resolution of any medication-related issues, evaluation of medical regimens for appropriateness and patient counseling. Upon completion of this rotation, residents will better understand the role clinical pharmacists play in the management of acute care cardiology.

Residents will have the opportunity to apply and expand pharmacotherapeutic knowledge through a variety of ways in an ED setting. They will be responsible for collecting and assessing patient information, reviewing medication orders, performing medication reconciliation, patient counseling, evaluating antimicrobial culture results, providing drug information and making recommendation to the ED team, reporting adverse drug events, acting as a liaison between pharmacy and the ED, and participating in a variety of patient codes.

The world of computers intersects with patient care. During this rotation residents will learn the various systems of the pharmacy and how each can be used to impact patient safety and improve outcomes. The rotation is suitable for all residents but can be especially useful for candidates interested in outcomes research, automation, quality improvements, hospital financials and pharmacy operations. Residents will learn critical thinking skills and lateral thinking techniques with respect to using technology to solve problems.

This is a six-month longitudinal rotation designed to introduce residents to investigational drug services and clinical research design. Emphasis will be placed on understanding the role of clinical research trials in the drug development process. The role of the pharmacist in protocol development; investigational drug storage, preparation, and dispensing; regulatory, clinical, and administrative functions; and patient and staff education will be the central focus.

This rotation will provide residents with the knowledge and experience to identify, develop and implement safe medication practices. Residents will have an opportunity to develop and implement initiatives to improve medication use systems. They will also work with the medication safety officer and other leaders of Atlantic Health System focused on medication safety.

The overall goal of this one-month rotation in neonatal critical care is to enhance residents' competency in neonatal pharmacotherapy and to develop a philosophy of practice regarding the role of the clinical pharmacist as a member of the health care team. Residents will participate in the drug use decision-making process, develop clinical pharmacokinetic skills needed to ascertain the unique pharmacokinetic characteristics of this patient population, and refine nutritional knowledge specific to the neonatal patient.

This rotation at Overlook Medical Center is designed to familiarize residents with the pharmacotherapeutic management of adult neuro-critical care patients. It will focus on the management of drug therapy for disease states such as acute ischemic stroke, subarachnoid hemorrhage, intracranial hemorrhage, cerebral edema, seizures and meningitis. Residents will monitor drug therapy and identify drug-related issues, such as appropriate selection and dosing of medications, drug interactions, therapeutic drug monitoring and adverse drug reactions. They will work collaboratively with physicians, including the neurointensivist and neurosurgeons, nurses, and other health care professionals to obtain relevant information and resolve issues related to drug therapy.

The oncology rotation takes place at the inpatient oncology unit at Morristown Medical Center. This rotation is intended to familiarize the resident with therapeutic management based on the diagnosis and staging of cancer in the inpatient and outpatient settings. Some topics covered will include etiology, oncologic emergencies, liquid malignancies, pain management and palliative care. The resident will work with physicians from all disciplines, nurses, social workers and care managers to optimize medication therapy for patients as well as provide medication education and counseling.

This rotation is designed to provide residents with a basic understanding of disease states and conditions commonly seen in pediatric patients. Emphasis will be placed on the therapeutic management of pediatric patients and the unique pharmacological/pharmaceutical requirements of these patients. The role of the clinical pharmacist in the selection and monitoring of drug use in pediatric patients will be stressed.

The general premise behind this academic/teaching rotation is to expose residents to the responsibilities associated with being a faculty member. This involves much more than just in-class interactions with students and lecture presentations. Most of the time will be spent developing materials, discussing ideas for implementation within courses and participating in administrative activities fundamental to a faculty position. The resident(s) will spend their time at Rutgers and FDU during the month to get a concept of how different universities teach. The rotation will be a collaborative process between faculty and resident with feedback provided to assist in self-directed learning.

This an acute care rotation will demonstrate the pharmacist’s impact on improving outcomes, reducing readmissions and improving patient quality of life. The resident will practice transitioning the patient to and from different settings for a core set of disease states, which will include, but not limited to cardiac, pulmonary, endocrine and infectious diseases. He or she will also have an opportunity to manage patients independently while working with physicians, nurses and other medical providers. Activities will include obtaining medication history, monitoring and optimization of therapy during hospital stays, reviewing medication reconciliation on discharge, assisting with access to medications, and providing patient education on medications and disease states.

During this rotation residents will round with the surgical team in the 22-bed SICU at Morristown Medical Center. The patient population consists of trauma, general surgical, neurology and neurosurgical patients. The team typically consists of one trauma attending, a surgical resident, a surgical intern, and one or two students. Common disease states in which residents will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care experience may include, but are not limited to: traumatic brain injury/intracranial hemorrhage, surgical antimicrobial prophylaxis, surgical infectious complications, fluid and electrolytes management, status epilepticus.

Senior pharmacy leadership will work closely with the resident to develop an administrative project. The project will be led by the resident, and presented at the American Society of Health System Pharmacists Midyear Meeting.

Past administrative projects (last two years):

• Optimization of a heparin calculator to improve accuracy of heparin titrations
• Hypoglycemic events associated with parenteral nutrition containing insulin
• Fixed four-factor prothrombin complex concentrate dosing versus weight-based dosing strategies
• Evaluation of the management of perioperative nausea/vomiting
• Evaluation of antibiotic duration for community-acquired pneumonia at discharge
• Alternatives to opioids in the emergency department
• Developing a pharmacy intensity scoring system to optimize oncology infusion center operations
• Evaluating the prevalence of medication-related readmissions in a community teaching medical center: a retrospective review

The pharmacovigilance rotation is a year-long longitudinal rotation at Morristown Medical Center. After review of foundational information on medication management and medication safety strategies,  residents will be assigned to either the Medication Event Review team or an Adverse Event monitoring project. Residents will work closely with the Medication Safety Team (pharmacy, nursing, medical and risk management representatives) to review medication events, identify patterns, make recommendations for system improvement and assist in the implementation when possible.

The research project provides an opportunity to complete a major research project and prepare a manuscript for publication during the one-year program. Residents will work with the residency advisor(s) and learn essential key points of research design.

Past research projects (last two years):

• Four-factor prothrombin complex concentrate (4F-PCC) versus andexanet alfa for direct oral anticoagulant (DOAC) reversal
• Evaluation of nurse-driven unfractionated heparin nomograms
• Use of direct oral anticoagulants following bioprosthetic surgical valve replacement
• Impact of blood polymerase chain reaction (PCR) panel in combination with antimicrobial stewardship intervention on time to optimal antimicrobial therapy in gram positive and negative bacteremia
• Impact of respiratory multiplex polymerase chain reaction testing on antibiotic utilization
• Risk factors associated with naloxone administration in patients receiving opioids and gabapentinoids
• Early identification of sepsis through pre-hospital point-of-care (POC) lactate measurement
• Antibiotic prescribing following an intensive care unit (ICU)-specific procalcitonin algorithm

According to American Society of Health System Pharmacists guidelines, each resident is required to complete a “staffing” component of the residency. Residents will gain proficiency in distribution skills, incorporation of clinical services and development of personnel management skills. They also will develop insight into the operations, policies and procedures of acute care facilities. Residents will be scheduled to staff every other weekend at Morristown Medical Center or Overlook Medical Center.

Organized by the Ernest Mario School of Pharmacy at Rutgers University, the Teaching and Learning Certificate Program prepares clinical educators, so they can inspire students and advance the pharmacy profession. Enrolled residents are required to attend a live, three-hour session once a month through the academic year (except December) and precept a Rutgers pharmacy student in the Intermediate Pharmacy Practice Experience (IPPE) for four weeks.