The Hematologic Malignancies/Adult Oncology rotation is an elective option for PGY2 residents. This oncology and stem cell transplant rotation encompasses both inpatient and outpatient teaching areas at Prisma Health – Upstate and surrounding outpatient clinics. Residents will round with the stem cell transplant/heme multi-disciplinary team in the mornings at the main hospital. The team consists of an hem/onc attending physician, an oncology nurse practitioner, and an oncology pharmacist. After rounds, a variety of opportunities are available. Example services include ambulatory oncology pharmacy, specialty retail oncology pharmacy, supportive care oncology, and research oncology pharmacy. Multiple opportunities for research, drug information, and presentation are available on rotation.
The Prisma Health – Upstate Antimicrobial Stewardship Program (ASP) is a coordinated system level program that promotes appropriate use of antimicrobial therapy, reduces microbial resistance, decreases the spread of infections caused by multidrug-resistant organisms, and improves patient outcomes. The program is led by an ID trained pharmacist and an ID physician.
Residents on this rotation will complete active stewardship review and make patient specific recommendations to the primary teams, provide education to various services regarding antimicrobial stewardship topics, and complete antimicrobial stewardship related quality improvement projects for the system.
Topics focused on during this rotation include:
The Cardiovascular Critical Care Attending Service is a non-teaching, multi-disciplinary service comprised of a pulmonary/critical care board certified attending physician, respiratory therapist, nurse practitioner, and a clinical pharmacy specialist. This team provides management for post-operative cardiovascular or thoracic surgery patients in a 25-bed CVICU. Disease states managed include post-operative care of coronary artery bypass grafts and valve repair/replacement, sepsis resulting from a multitude of causes, pain management as well as many other disease states.
The Emergency Medicine rotation will provide the resident an opportunity to care fora wide range of patients from those with minor injuries to the critically ill at the Greenville Memorial Medical Campus. This rotation will expose the resident to the essential roles of the pharmacist in the Emergency Trauma Center; including optimization of medication use through interaction with the Emergency Medicine team, order review, drug therapy monitoring, participation in high-risk procedures, monitoring use of high-risk medications, medication preparation and dispensing, providing of drug information and obtaining medication histories.
The Infectious Diseases Consult Service is utilized by all of the various services in at the Prisma Health – Upstate Greenville Memorial Medical Campus to participate in the care of patients with difficult to manage infectious diseases. The service is a multi-disciplinary team consisting of an infectious disease attending physician, internal medicine residents, medical students, and a pharmacist. Disease states commonly encountered include pneumonia (community and hospital acquired), urinary tract infections, bacteremia/sepsis, hepatitis/cirrhosis, human immunodeficiency virus, osteomyelitis, endocarditis, sexually transmitted diseases, opportunistic infections, meningitis, and various fungal infections.
The Medical Critical Care/Pulmonary Teaching Service (MCCTS/PTS) is a multi-disciplinary teaching service consisting of a pulmonary/critical care board certified attending physician, internal medicine interns and residents, family medicine and medical students, a clinical pharmacy specialist and a respiratory therapist. The average daily patient census for the MCCTS and PTS teams is about 35-45 patients, with most patients receiving mechanical ventilation. Disease states range from COPD exacerbations, community and hospital acquired pneumonias, drug overdoses, acute neurological events, sepsis resulting from various infections, pulmonary embolus and adult respiratory distress syndrome, as well as cardiac arrest and many other disease states.
The Neonatal Intensive Care Unit (NICU) rotation takes place in a 52-bed, level III NICU on theGreenville Medical Memorial Campus. The resident will be a part of 1 of 3 multidisciplinary teams comprised of an attending physician, a neonatal nurse practitioner, 1-2 pediatric medical residents, nursing, respiratory therapists, and a pharmacist.
Topics commonly encountered and/or discussed throughout the rotation include apnea of prematurity, bronchopulmonary dysplasia (BPD), patent ductus arteriosus, congenital heart defects, diaphragmatic hernia, hyperbilirubinemia, intraventricular hemorrhage (IVH), mechanical ventilation of the premature infant, morbidity and mortality of premature infants, neonatal abstinence syndrome, necrotizing enterocolitis, neonatal sepsis, nutrition of the premature infant, respiratory distress syndrome (RDS), sedation/analgesia in premature infants, among others.
The Neurocritical Care service at Greenville Memorial Medical Campus is a multi-disciplinary teaching service consisting of neurointensivists, nurse practitioners, a clinical pharmacy specialist, and medical students/interns/residents. This clinical rotation will provide exposure to various neurological disease states including acute ischemic stroke, intracerebral hemorrhage, status epilepticus, meningitis, intracranial hypertension, toxic encephalopathy, cerebral venous sinus thrombosis, and neuromuscular emergencies. Students will be responsible for designing and monitoring drug regimens for these critically ill patients. Other services provided by the student may include researching drug information for the team as requested, pharmacokinetic evaluation / dosing, and patient education as needed.
The Pediatric Hematology / Oncology group at Prisma Helath – Upstate Children’s Hospital treats children from birth to age 21. All types of childhood cancer and blood disorders, including coagulopathies, sickle cell disease, and other anemia’s and white blood cell diseases are diagnosed and treated by a multidisciplinary team. The resident will function as an integral part of this medical team with the goal of developing an understanding for the clinical pharmacist’s role in the care of the hematology/oncology patient. Responsibilities include: Attend and actively participate in daily rounds as well as daily review of patients’ medication orders, progress notes, and pertinent laboratory/microbiology data. In addition, the resident will be expected to provide drug information to physicians, nurses, pharmacists and other health care professionals as well as perform daily therapeutic drug monitoring, and document pharmacokinetic recommendations in the patient’s chart. Potential topics for discussion include: hematologic malignancies, solid tumors, fever and neutropenia, oncologic emergencies, tumor lysis syndrome, sickle cell disease, ITP, and aplastic anemia.
The Children’s Hospital at Greenville Memorial Medical Campus includes a 12 bed Level I pediatric intensive care unit (PICU). The unit’s medical staff is composed of 3 pediatric intensivists and pediatric medical residents. The patient population is diverse. Services not covered at Greenville Memorial Medical Campus PICU include cardiovascular surgery, burns, and transplantation. Other specialty areas with children requiring intensive care are covered by this service. The resident is expected to monitor, assess and contribute to the drug therapy plans. In addition, the resident will develop a base knowledge of the differences in pediatric and adult critical care therapies.
The preceptorship experience gives pharmacy residents an opportunity to participate as the direct preceptor / mentor for a pharmacy student’s clinical rotation while at Prisma Health – Upstate. It is designed to develop the resident’s clinical preceptorship and mentorship skills through direct precepting of pharmacy students, designing an individualized student curriculum, conducting pharmacotherapy discussions, and providing feedback/evaluations to students.
Residents are required to be primarily responsible for at least one major project. The goal of this assignment is to gain experience in various aspects of research methodology. The objectives of the major project include defining a research idea, protocol development, submission to the Institutional Review Board (IRB), data collection, data analysis, and presentation/publication of results. The residents are required to present their projects at the Southeastern Residency Conference (SERC) which occurs yearly at the end of April.
The Surgery/Trauma Critical Care Teaching Service (SCCTS) is a multi-disciplinary team consisting of a general surgery/critical care board certified attending physician, an upper-level surgical resident, a surgical intern, medical students, and a clinical pharmacist. The SCCTS is often consulted to manage neurosurgical, general surgery, trauma, and vascular patients in the five intensive care units at a Level 1 Trauma Center.
The average daily census for the SCCTS ranges from 15-25 patients depending on consultations, with all patients requiring mechanical ventilation. Disease states managed included traumatic brain injuries, acute spinal cord injuries, sepsis resulting from a multitude of causes, adult respiratory distress syndrome, acute alcohol withdrawal, blunt trauma, aortic aneurysms and many other surgical disease states. In addition to these surgical disease states, a variety of other medical disease states will be encountered while on the rotation.