PGY1 Applicants Please Note:  Prisma Health – Upstate will participate in PhORCAS (Pharmacy Online Residency Centralized Application Service).  No additional application materials are required outside of PhORCAS.

The Medical Teaching Service (MTS) experience creates a foundation for pharmacy residents on an inpatient general medicine service. The resident will be assigned to an MTS team consisting of an attending physician, medical residents, interns and students. The resident will:

• Attend patient care rounds and teaching rounds on a daily basis.
• Present developed therapeutic plans for each of their patients to the preceptor on a daily basis.
• Provide drug information services for the healthcare team.
• Write pharmacokinetic and therapeutic consult notes as necessary.
• Participate in journal club.

In addition, the resident will have the opportunity to conduct informal and/or formal educational services to physicians, nurses and pharmacists. Topics commonly encountered and/or discussed throughout the rotation include pneumonia, urinary tract infections, bacteremia/sepsis, chronic obstructive pulmonary disease, heart failure, venous thromboembolism, angina/myocardial infarction, stroke, seizure disorders, acute and chronic renal failure, peptic ulcer disease, gastroesophageal reflux disease, pancreatitis, hepatitis/cirrhosis, diabetes, anemia, fluid-electrolyte disorders, acid-base disorders, human immunodeficiency virus, dementia and liver disease.

The Family Medicine experience creates a foundation for pharmacy residents on an inpatient general medicine service. The Family Medicine Teaching Service (FTMS) consists of an attending physician, clinical pharmacist, medical residents, interns and students and serves the acute medical needs of patients during hospitalization. The resident will:

• Attend morning report and teaching rounds on a daily basis.
• Present developed therapeutic plans for each of their patients to the preceptor.
• Write pharmacokinetic and therapeutic consult notes as necessary.
• Provide drug information services for the healthcare team.
• Participate in topic discussions/journal clubs.
• Be actively involved with ongoing projects.
• Provide two formal presentations to the clinical service

Topics commonly encountered and/or discussed throughout the rotation will include both internal medicine and ambulatory care based topics. This rotation can be tailored to resident-specific interests/needs. In addition, the resident will have the opportunity to conduct informal and/or formal educational services to physicians, nurses and pharmacists.

The Hospitalists Service experience is an elective rotation for pharmacy residents on an inpatient general medicine service. The resident will be assigned to a portion of the Hospitalists Service (based on interest). The Hospitalists Service is comprised of seven day-shift physicians rounding on patients throughout the hospital, three pharmacists and students. As a member of the patient care team, each resident will work closely with the preceptor to provide pharmaceutical care. The resident will:

• Attend Grand Rounds each Friday morning.
• Present developed therapeutic plans for each of their patients to the preceptor on a daily basis.
• Independently round on patients daily.
• Provide drug information services for the hospitalists.
• Write therapeutic consult notes as necessary.
• Participate in journal club.

Topics commonly encountered and/or discussed throughout the rotation include internal medicine-based topics.

The Hematologic Malignancies/Adult Oncology rotation is an elective option for PGY-1 residents. This rotation involves the provision of direct pharmaceutical care to patients with a variety of hematologic malignancies including, but not limited to, leukemia, lymphoma and multiple myeloma. Based on patient census and the interest of the resident, bone marrow transplant and/or solid tumor pharmacotherapy may be included. The resident will obtain knowledge and experience as it relates to the general principles of oncology pharmacy practice, including oncologic supportive care issues.

The Ambulatory Care experience is a month long clinical experience, offered year round by the Prisma Health Department of Pharmacy Services. The purpose of this experience is to allow the PGY-1 resident to develop skills in optimizing patients’ medication therapy in a fast-paced ambulatory care setting. The resident will work in collaboration with other healthcare professionals to optimize patient care.

Residents will spend most of their time at the Anticoagulation Clinics across the Prisma Health campuses. The Anticoagulation Clinics are managed by clinical pharmacists and accept referrals from various practices throughout Greenville and the surrounding areas. Anticoagulants managed include warfarin, bridging anticoagulants (enoxaparin and fondaparinux), and the direct oral anticoagulants (apixaban, dabigatran, edoxaban, and rivaroxaban).

The resident may also have the opportunity to spend time at the Transitional Care Program (TCP) , Center for Family Medicine (CFM), and the Venous Thromboembolism Clinic (VTE Clinic).

• TCP visits focus on patients who have recently been discharged from the hospital. These patients are followed closely by the TCP team (physician, pharmacist, and nurse) through weekly visits for approximately 4 weeks to prevent further hospitalizations and ER visits.
• At CFM, the pharmacist works in a multidisciplinary diabetes clinic and sees complex patients with providers. The pharmacist also is available for consult during patient visits with medical residents and attending physicians. The pharmacist independently performs Annual Wellness visits and anticoagulation visits.
• At the VTE Clinic, a vascular specialist, pharmacist, and nurse see patients with acute and chronic VTE issues. Assessments may include medication selection, duration, and periprocedural plans.

At all multi-disciplinary sites, the pharmacist is an integral part of the care team and may contribute by completing medication reconciliations and assessing risk factors, lab values, drug interactions, and adherence or cost issues. Pharmacist recommendations are discussed with the physician provider(s), and the pharmacist will either directly educate the patients on those changes or teach medical residents how to do so when applicable

The Ambulatory Care – Diabetes rotation is one of the ambulatory care options for the required ambulatory care experience. Residents will work both outpatient at various locations of Diabetes Self-Management Education and Support (DSMES) and inpatient at Greenville Memorial Hospital. Residents will participate in multidisciplinary diabetes clinics with obstetric, family medicine, or internal medicine providers in addition to collaborating with certified diabetes care and education specialists of various disciplines. Prisma Health DSMES provides care to all patients with diabetes across their lifetime so residents may be exposed to adults or children with Type 1, Type 2, or gestational diabetes. In addition to pharmacotherapy for diabetes, residents will gain experience in lifestyle medicine, insulin pumps, continuous glucose monitors, and remote patient monitoring. Inpatient care is focused on transitions of care, identifying barriers to successful outpatient glycemic management, and providing inpatient diabetes education. The resident will work closely with the preceptor to provide pharmaceutical care, diabetes education, and improve care delivery for patients with diabetes. Rotation goals include application of evidenced based medicine of diabetes pharmacotherapy, patient and family education, improving transitions of care, integrating diabetes technology, and improving resident oral and written communication skills.

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 multidisciplinary program is led by an ID trained pharmacist and an ID physician.

Residents on this rotation will complete targeted antimicrobial stewardship reviews 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:

• Fundamental antimicrobial stewardship principles
• Application of diagnostic testing performed in the microbiology laboratory
• Antimicrobial resistance
• Bloodstream infections
• Urinary tract infections/asymptomatic bacteriuria
• Respiratory infections

The Cardiology Teaching Service (CTS) experience is an elective rotation. CTS directly admits patients and accepts consults from various services at the Greenville Memorial Hospital campus to manage a broad scope of cardiovascular conditions. This rotation is designed to provide a basic overview of the acute and chronic management of commonly encountered adult cardiovascular diseases. CTS provides medical; as well as, interventional management as treatment approaches.

The resident will be assigned to a team consisting of an attending physician, medical resident(s), intern(s) and student(s). Disease states encompass STEMI, NSTEMI/US, CHF exacerbations, arrhythmias, anticoagulation, hypertensive crises, interventional cardiology and others.

The Cardiovascular Service is a non-teaching service consisting of a pulmonary/critical care board certified attending physician, physician assistants, a clinical pharmacy specialist and a respiratory therapist. The team provides critical care consultative service to cardiothoracic surgery patients. The average daily census for the service ranges from 10-20 patients depending on consultations, with most patients requiring mechanical ventilation. 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 Infectious Diseases Consult Service is utilized by all of the various services in 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 clinical on-call/pharmacokinetics longitudinal experience provides on-call and pharmacokinetics consult service at Prisma Health – Upstate. The on-call/pharmacokinetics consult service is designed to provide consistent clinical resources to GMMC healthcare providers in a timely manner. The resident will design, monitor and evaluate evidence-based patient-specific therapies involving clinical pharmacokinetics, drug information questions, investigational drug services, therapeutic outcomes program, clinical services cross-coverage and additional pharmacotherapy consults.

Provides support for the Prisma Health Pharmacy and Therapeutics Committee by reviewing and preparing drug formulary reviews, medication usage evaluations, meeting agenda/minutes and other relevant meeting materials as appropriate. During the rotation, the resident will gain an understanding of the organizations’ medication-use systems by applying medication safety principles and best practices.  This rotation will help equip residents to understand the complexity of medication safety and the need to identify and manage system failures to improve patient safety.

Residents will have the opportunity to learn about different types of medication errors, factors that contribute to medication errors, the severity of those errors, and the steps that go into their prevention.  Residents will also gain experience in collecting data on medication errors, analyzing the findings, communicating with other healthcare professionals and administrators through a reporting mechanism, and tracking and trending an area of failure and success.  Residents will share the information obtained through various means such as a hospital-wide performance improvement initiative.  Residents may also have the opportunity to attend pharmacy and therapeutics committee meetings, interdepartmental performance improvement meetings, and monthly hospital-wide medication error rate reporting discussions.

The resident will have the opportunity to explore a variety of areas within the medication-use system: computerized prescriber order entry (CPOE) systems, electronic health records (EHR), clinical decision support tools, automated dispensing machines, ‘smart’ infusion pumps, and bar code medication administration and medication error surveillance.

The goal of the Emergency Department Experience is to provide the resident opportunities to build upon knowledge and skills acquired during their critical care year and apply them in direct patient care activities in the Emergency Department setting. This experience will expose the resident to the essential roles of the pharmacist in the Emergency Trauma Center that may include optimization of medication use through interaction with the Emergency Medicine team, order review, drug therapy monitoring, monitoring the use of high-risk medications, medication preparation and dispensing, providing of drug information, and obtaining medication histories.

The goal of the Medicine Critical Care Rotation is to provide the resident opportunities to build upon knowledge and skills acquired during their PGY1/PGY2 years and apply them in direct patient care activities in the ICU setting. This is a multidisciplinary team consisting of a pulmonary/critical care board certified attending physician, emergency department residents, and a pharmacist. This experience will expose the resident to the essential roles of the pharmacist in the ICU that may include optimization of medication use through interaction with the team, order review, drug therapy monitoring, monitoring the use of high-risk medications, medication preparation and dispensing, providing of drug information, and obtaining medication histories.

The Neurocritical Care service is a multi-disciplinary teaching service consisting of neuro-intensivists, 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. Residents will be responsible for designing and monitoring drug regimens for these critically ill patients. Other services provided by the resident may include researching drug information for the team as requested, pharmacokinetic evaluation / dosing, and patient education as needed.

The Neonatal Intensive Care Unit (NICU) rotation is designed to teach the resident how to provide pharmaceutical care services for neonatal patients by applying population-based pharmacodynamic/pharmacokinetic principles and critical thinking skills. The rotation will focus on the neonatal disease states commonly seen at our institution and specific issues related to neonatal drug therapy and therapeutic monitoring. The resident will round with neonatologists, medical pediatric residents, neonatal nurse practitioners, and several other multidisciplinary services. The resident will

• Attend morning rounds on a daily basis
• Present detailed therapeutic plans for patients prior to rounds
• Provide drug information for the healthcare team
• Write therapeutic consult notes as needed
• Be actively engaged in any ongoing projects and topic discussions
• Conduct informal and/or formal educational services to the multidisciplinary team

The average daily census in the NICU is around 70 patients. The resident will be expected to round on an average of 20-30 patients daily. This rotation is one of the choices for the required pediatric rotation selection. By the end of the rotation, the resident is expected to have mastered how to provide clinical pharmacy services in a less familiar patient population with unique challenges.

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.

This service is a multi-disciplinary teaching service consisting of a pulmonary/critical care board certified attending physician, internal medicine residents, medical students, a clinical pharmacy, and a respiratory therapist. The average daily patient census for the PCCTS team is 15-20 patients, with most patients receiving mechanical ventilation. Disease states range from COPD exacerbations, community and hospital acquired pneumonias, drug overdoses, acute neurological events to sepsis resulting from various infections, pulmonary embolus, adult respiratory distress syndrome, as well as many other disease states

This rotation will provide the resident with exposure to care of the general pediatric inpatient.  This one-month experience is designed to develop the resident’s knowledge and skills in the pharmaceutical care of pediatric patients, with specific focus on the application of supportive care principles to this population.  Participation in the multidisciplinary team approach to the care of the pediatric patient will offer the resident experience in: designing and recommending therapeutic regimens, application of pharmacokinetic principles, healthcare team interaction, patient and family education, and provision of drug information to other members of the health care team.

This rotation is designed to provide a basic overview of administrative aspects of managing a large Pharmacy department in a complex medical system. The rotation consists of both longitudinal and focused experiences with various pharmacy leaders. The experiential component of this rotation focuses on actual projects, teams and PI activities currently underway rather than theoretical activities. The primary preceptor is the Director of Pharmacy Services. The rotation is intended to provide the resident with “hands on” experience in identifying and resolving administrative and clinical problems, forming and functioning within a team-work environment and developing new pharmacy initiatives to name only a few. In addition, the resident becomes knowledgeable about key administrative responsibilities including planning, budgeting, medication safety and management structures within a large complex pharmacy department.

The Inpatient Psychiatry rotation experience is an elective opportunity for pharmacy residents that covers pediatric, adult and geriatric patients with mental health diagnoses and often comorbid medical conditions. In this inpatient psychiatric setting, patient care is managed using a team-based approach that involves daily team interaction and direct patient care. Multidisciplinary team members include clinical pharmacy specialists, physicians, physician assistants, nurse practitioners, social workers, and nurses. As a teaching facility, the treatment team also includes a number of learners (students, residents and fellows) from a variety of disciplines.

The resident will round with 2 to 3 treatment teams on a daily basis, attend Grand Rounds, and provide optimal, evidence-based patient-centered care by:

Topics commonly encountered and discussed throughout the rotation include general medical health conditions in addition to mental health conditions such as thought, mood, behavioral, personality and substance use disorders. This rotation can be tailored to resident-specific needs/interests. In addition, the resident will have the opportunity to conduct informal and/or formal educational services to physicians.

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.

Throughout the rotation, the resident will have the opportunity to provide pharmaceutical care to critically ill patients on the Surgery Critical Care Teaching Service (SCCTS) at Greenville Memorial Hospital, an American College of Surgeons Verified Level 1 Trauma Center.  The SCCTS is a multi-disciplinary team consisting of a general surgery/critical care dual board certified attending physician, a critical care fellow, general surgery residents, emergency medicine residents, orthopedic surgery residents, medical students, and a clinical pharmacist. The SCCTS is often consulted to manage neurosurgical, general surgery, trauma, and vascular patients who require mechanical ventilation.

The average daily census for the SCCTS ranges from 15-20 patients depending on consultations. 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, necrotizing fasciitis, 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.