VA Sierra Nevada Health Care System

Ambulatory Care

Residents will learn to independently care for patients in the setting of a pharmacist- managed ambulatory care clinic. Residents will hone their skills at managing patients referred by their primary care providers for follow-up of chronic disease states – including, but not limited to hypertension, dyslipidemia, diabetes, the metabolic syndrome and thyroid disorders. The primary role of this clinic to reduce overall cardiovascular risk in the ambulatory patient population.

Anticoagulation Clinic

The Anticoagulation Clinic provides a longitudinal experience over the course of the residency year. Each resident will have one assigned preceptor for supervision, feedback, and note cosignature throughout the year. The Anticoagulation Clinic is primarily telephone based, however the resident will also have experience with individual (face to face) visits, which tend to have greater complexity. By the end of the residency, the resident should be able to manage anticoagulation patients in a variety of settings independently.

Community Living Center

The rotation involves providing comprehensive pharmaceutical care in an interdisciplinary inpatient care team. The Transitional Care Unit (TCU) is a unique setting which cares for patients from a variety of care categories including long term care, palliative care, rehabilitation care, and sub-acute care. Activities will focus on learning to write comprehensive drug regimen reviews, monthly review notes as a consultant pharmacist would perform, as well as participation in weekly interdisciplinary team rounds, and discharge responsibilities. Didactic discussions and readings on geriatrics topics including pharmacology, chemical restraints, MDS, falls, etc. will take place regularly, and the resident will be expected to complete at least one in-service presentation. In addition, the resident will participate in wound care clinic weekly.

Infectious Disease

Residents work in collaboration with infectious disease specialists within the VA and at Renown Regional Medical center.  These dual sites provide residents with the opportunity to see infectious disease care in both chronic and acute care settings.  Residents round daily with both the medical and infectious disease teams.  Speciality outpatient clinics include a hepatitis C clinic and travel clinic.  Our antibiotic stewardship program provide hands on experience in the management of antibiotic therapy to minimize the development of antibiotic resistance and ensure appropriate antibiotic specturm coverage.

Intensive Care Unit

Work with the ICU pharmacist(s), ICU medical residents and attending, ICU nurses, in taking care of ICU Medical and Telemetry patients.  Round daily with Medical ICU team. Evaluate patient information, including laboratory values, disease states, and medications, to ensure standard of care, VA guidelines and formulary, and standard processes, i.e. consults and documentation of use of high alert medications, are being followed. Document your interventions in the Computerized Patient Record System (CPRS).  Present your patients (disease, drugs, labs, etc.) daily to your preceptor.  Provide drug information to members of the healthcare team and patients when necessary. Perform the duties necessary to staff the ICU by the end of the rotation, this includes order entry, discharge medication processing, and counseling patients on discharge and if they have any medication questions while in the hospital.

Medicine

Work with the medicine pharmacist, medical residents and attending, 2C floor nurses, in taking care of medical and surgical patients. Round daily with 2C Medical team. Evaluate patient information, including laboratory values, disease states, and medications, to ensure standard of care, VA guidelines and formulary, and standard processes, i.e. consults and documentation of use of high alert medications, are being followed. Document your interventions in the Computerized Patient Record System (CPRS). Be prepared to present your patients (disease, drugs, labs, etc.) at all times to your preceptor. Provide drug information to members of the healthcare team and patients when necessary. Perform the duties necessary to staff 2CM by the end of the rotation, this includes order entry, discharge medication processing, and counseling patients on discharge and if they have any medication questions while in the hospital.
Swing Shift 2 week portion: Work with swing pharmacist, medical residents and attendings for entire hospital and triage. Evaluate patient information, including laboratory values, disease states, and medications, to ensure standard of care, VA guidelines and formulary, and standard processes, i.e. consults and documentation of use of high alert medications, are being followed. Document your interventions in the Computerized Patient Record System (CPRS).

Mental Health

The mental health rotation provides comprehensive pharmaceutical care to mental health patients in both acute inpatient and ambulatory care settings.  Experience in the following areas will be provided during the rotation: outpatient and inpatient psychotropic medication management, clozapine clinic, and metabolic syndrome clinic.  The rotation consists of weekly topic discussions, medication education groups, involvement in addictive disorders treatment and intensive case management programs, and tobacco cessation clinic.  The rotation may incorporate other related topics according to individual interests.

Oncology & Research

This rotation involves providing pharmaceutical care to oncology patients in the outpatient and inpatient settings. Also, this rotation involves participation in the investigational drug program, R&D Committee and other research situations.

This rotation may incorporate other related topics according to individual interests.

Pharmacoeconomics

The resident will develop skills in the practical application of pharmacoeconomic principles to the VA healthcare environment and in research design and methodologies to assess pharmaceutical-related economic, clinical, and humanistic health outcomes. In addition, the resident will spend time with Pharmacy Management attending planned meetings during the learning experience related to strategic planning, Chiefs Calls, budgetary planning, financial management, accreditation/regulatory, safety, EPRP, etc.

Electives:

• Advanced ICU
• Advanced Medicine
• Advanced ID
• Advanced Pharmacoeconomics
• Cardiology
• Mental Health
• Nuclear Medicine
• Pediatrics
• Rheumatology
• Women’s Health
• Many others based on resident interest