Core Rotations
Hematology/Oncology
Hematology-oncology (heme-onc) is a required, five to six week learning experience at Children’s of Alabama. There are 24 hematology-oncology beds in the hospital housed on 8 Quarterback, although the service frequently overfills to other hospital units. The clinic has 23 rooms and 19 infusion chairs. The hematology-oncology service has 2 teams, the chemotherapy service and the hematology/oncology medical service.
The chemotherapy service includes an attending physician and a nurse practitioner. Typically, the chemotherapy service team will be responsible for the care of approximately 4 to 10 patients.
The hematology/oncology medical service includes an attending physician, a fellow physician, medical residents, oncology nurse practitioners, hematology nurse coordinator, a clinical pharmacy specialist, social workers, and pastoral care. Pharmacy residents and other health professionals in training also participate when assigned to the hematology-oncology service. Typically, the medical team will be responsible for the care of approximately 15 to 30 patients.
The resident will have the opportunity to gain knowledge on oncologic emergencies, complications of cancer treatment, sickle cell anemia and learn to develop and document monitoring plans for related medication management. Other major elements of this rotation component include processing oncology orders, fielding drug information questions, new diagnosis discharge troubleshooting and teaching, and preparing either a journal club presentation or a written drug information response.
Infectious Diseases (ID)
Infectious disease (ID) is a required, four week learning experience at Children’s of Alabama (COA). The ID team provides consult services to patients on various primary services at COA and the University of Alabama at Birmingham (UAB), so patients can be located anywhere at COA and occasionally at UAB. The ID outpatient service conducts clinic in clinic 7 in the McWane Building. The ID consult service includes an attending physician, an ID fellow-in-training physician, a PGY2 or PGY3 medical resident, and a clinical pharmacy specialist. Pharmacy residents, pharmacy students, and other health professionals in training also participate when assigned to the ID consult service. The ID outpatient service consists of the same practitioners that are on the consult team but also includes an outpatient nurse clinician. Typically, the ID consult service census will range from 6-15 patients per day.
In addition to evaluated objectives, the resident is expected to work within a multi-disciplinary team to:
- Identify medication related problems and follow up on detected drug therapy problems by alteration in therapy, initiation of new therapy, health education, referral to other sources of care, or other appropriate measures.
- Recommend and provide therapeutic drug monitoring and medication adjustment utilizing subjective and objective data
- Explain epidemiology, risk factors, clinical course and treatment of diseases identified above.
- Explain mechanism of action, pharmacokinetics, and therapeutics of anti-infectives used to treat most common infections
Other components of rotation consist of helping troubleshoot and plan discharge prescriptions, assessing weekly lab results that are faxed to the ID offices each week for outpatients, coordinating laboratory needs for scheduled clinic patients with the nurse clinician, coordinating with home health medication changes or needs, and presenting a pharmacotherapy topic in-service to the team. The pharmacy resident should be able to provide assessment and discharge management of patients that will be followed by the outpatient service. The resident is responsible for providing and documenting medication reconciliation for each patient seen either prior or day of discharge, or day they are seen in follow up ID clinic. Competency in assessment of medication compliance and OPAT are the core topics for the outpatient component of the rotation. The resident will also be expected to perform daily surveillance and monitoring related to antimicrobial stewardship.
Neonatal Intensive Care (NICU)
Neonatal Intensive Care (NICU) is a required, four week learning experience at Children’s of Alabama. There are 48 NICU beds in the hospital housed on the 6th floor of the Benjamin Russell Hospital for Children. The NICU is considered a level 4 NICU, which has the ability to perform ECMO, dialysis, all forms of advanced life support, all forms of advanced respiratory support, and houses all neonatal surgical sub-specialties. There are 2 teams (Harbert and Quarterback) comprised of: an attending physician, fellows, neonatal nurse practitioners, social workers, discharge planners, neonatal nutritionist, and clinical pharmacist. On occasion there will be a 4th year pharmacy student(s) from either Samford University or Auburn University, the primary nurse, and respiratory therapy. Typically, the NICU teams will each be responsible for the care of approximately 24 patients.
Residents will be required to provide the following activities:
- Daily patient profile review with identification and resolution of patient medication problems
- Daily rounding with the neonatal intensive care team
- Pharmacokinetic assessment/recommendations and documentation of activities and interventions in Sentri 7
- Provision of drug information to health care professionals
- Coordination of medication ordering, administration and distribution, working in conjunction with the inpatient pharmacy. This includes ensuring accuracy of nursing medication administration records to that of pharmacy medication profiles and daily updates as to changes in continuous infusions, TPNs, etc.
- Attendance at all medical emergencies while onsite ("resident physicians" and level 1 traumas)
- To participate in the education and the precepting of 4th year pharmacy students (when on rotation)
- Clarification and verification of NICU orders
Nephrology
Nephrology is a required, four week learning experience at Children’s of Alabama. There are 12 nephrology beds in the hospital housed on 9 Harbert. There are 8 chairs in the pediatric outpatient dialysis unit. The nephrology service includes an attending physician, a nephrology fellow, a PGY2 or PGY3 medical resident, a primary care nurse and a clinical pharmacy specialist. Pharmacy residents and other health professionals in training also participate when assigned to the nephrology service. Typically, the nephrology team will be responsible for the care of approximately 6 inpatients, 15 outpatient hemodialysis patients and 16 peritoneal dialysis patients.
Orientation
Pharmacy orientation is a required, four week learning experience at Children’s of Alabama. The pharmacy department of COA provides pharmaceutical care services to inpatients in our 380-bed facility and clinic patients in our outpatient Ambulatory Care Center. Pharmacists in our department work from inpatient pharmacy, from satellites in Hematology/Oncology and Surgery, or in unit-based patient care areas. Orienting areas will include inventory, Pyxis and controlled substances. Training areas include the IV room, inpatient order verification, and inpatient production, including the PO area and emergency medication kit preparation. Residents will receive sterile product/parenteral training, including a state-wide parenteral certification training course. Residents will also complete pediatric advanced life support (PALS) and University of Alabama (UAB) institutional review board (IRB) training and certification. Most orientation experiences will take place during first (day) shift, however, experiences on second and third shifts may be included as time allows.
Pediatric Hospital Medicine (PHM)
Pediatric Hospital Medicine is a required, four week learning experience at Children’s of Alabama. Throughout the year, there are five interdisciplinary PHM teams that care for a variety of patients admitted throughout the hospital, but generally to the Dearth Tower, the Special Care Unit, and 10 Harbert (Neuro/Rehab/Ortho unit). Each of the teams include an attending physician, PGY2 or PGY3 medical resident(s), PGY1 medical intern(s), and medical students (MSIII or MSIV). Other disciplines on the team include a clinical pharmacist, pharmacy students, a nurse case manager, a social worker, a clinical nutritionist, and the primary nurse. Pharmacy residents and other health professionals in training also participate when assigned to the PHM service. Each PHM team has the capacity to care for up to 16 patients (80 patients for the service as a whole), and usual census is 10-12 patients/team.
In addition to patient care responsibilities, the resident is required to participate in any pertinent co-precepting responsibilities with pharmacy students on the PHM rotation. The resident may also have an opportunity to participate in the P3 Pediatric Pharmacy elective course offered by the Samford University McWhorter School of Pharmacy.
Pediatric Intensive Care (PICU)
Pediatric Intensive Care (PICU) is a required, four week learning experience at Children’s of Alabama. There are 24 PICU beds in the hospital housed on 7 Quarterback. The PICU medical team consists of an attending physician, critical care fellows, two nurse practitioners, four PGY2/PGY3 medical residents, and sometimes a medical student (MSIV). Other members of the PICU multidisciplinary team include a clinical pharmacist, clinical nutritionist, respiratory therapist, primary nurse, social worker, and sometimes other medical professional students. Pharmacy residents and other health professionals in training also participate when assigned to the nephrology service. Typically, the PICU team will be responsible for the care of approximately 24 patients.
Patients in the PICU include children of all ages, both previously healthy and those with underlying disease. Unique to this unit are patients on ventilators, continuous renal replacement therapy (CRRT), post-operative patients, investigational drug studies, the capability to provide extracorporeal membrane oxygenation (ECMO) and inhaled nitric oxide.
Pulmonary
Pulmonary is a required, four week learning experience at Children’s of Alabama. There are 24 pulmonary beds in the hospital housed on 10 Quarterback. The pulmonary service has two teams. The nurse practitioner team includes an attending physician, nurse practitioner, and nurse practitioner students. The medical resident service includes an attending physician, a pulmonary fellow, a PGY2 or PGY3 medical resident, a PGY1 medical intern, a nurse practitioner, a 4th year medical student and a clinical pharmacy specialist. Pharmacy residents and other health professionals in training also participate when assigned to the pulmonary service. Typically, each pulmonary team will be responsible for the care of approximately 30 patients.
