Residency Purpose Statement

PGY-1 pharmacy residency programs build on Doctor of Pharmacy (PharmD) education and outcomes to contribute to the development of clinical pharmacists responsible for medication-related care of patients with a wide range of conditions. Successful candidates will be eligible for board certification, and eligible for postgraduate year two (PGY2) pharmacy residency training.

Program Overview

The PGY-1 Pharmacy Residency program at Penn Medicine Lancaster General Health is a one-year program that offers a variety of experiences ranging from pharmacy operations and leadership to ambulatory and acute care clinical rotations. Pharmacy residents receive abbreviated rotation experiences in pharmacy operations, anticoagulation, and pharmacokinetics upon first starting at LG Health, and move on to six core rotations.

In addition, residents choose two elective rotations, and an additional elective rotation consisting of a special patient population (oncology, pediatrics, decentralized, geriatrics or transitions of care).

Five longitudinal learning experiences are required: Medication Information/Drug Use Policy, Ambulatory Patient Care, Research Project, Education & Professional Development, and Pharmacy Services (Operations and Clinical).

Our goal is to produce graduates who are confident, multi-faceted, health system-trained pharmacists.

Message from RPD

On behalf of the entire pharmacy department and our preceptors, thank you for your interest in Penn Medicine Lancaster General Health’s Post-Graduate Year-1 Pharmacy Residency Program. Our PGY-1 Pharmacy Residency Program is based on the philosophy that further learning and education are essential to developing into a well-rounded, independent pharmacist. The Pharmacy Department is dedicated to the pursuit of enhanced learning through mentoring and guidance of the individual resident. We help ensure your success on a daily basis and upon completion of the program.

We are excited you have chosen to consider our residency program. We offer a wide array of clinical, administrative and operational opportunities that allow residents flexibility in customizing their PGY-1 year to align with their future aspirations. We encourage you to explore our residency website as well as other information about Lancaster General Health and our community.

We welcome your questions. Please feel free to contact me.

Best regards in your residency pursuit,

Amanda E. Prusch, PharmD, BCPS, CPPS
PGY-1 Pharmacy Residency Program Director
Medication Safety Officer

717-544-5219
Amanda.Prusch@pennmedicine.upenn.edu

Required Learning Experiences

Cardiology

A learning experience in cardiology provides exposure to the subspecialties that make up cardiovascular care at Lancaster General Health. Multidisciplinary teams provide comprehensive care to the critically ill cardiac and heart failure population. Ensuring adherence to national consensus guidelines, appropriate and safe use of high-risk cardiovascular medications, and optimal medical, nursing and pharmacy staff education on cardiac pharmacotherapy are vital to providing an extraordinary experience for our patients. Heart failure medication adherence counseling improves our patients’ quality of life and reduce the potential for heart failure readmission.

Critical Care - Trauma

The Lancaster General Hospital Trauma Neurosurgical unit consists of 16 critical care beds where pharmacists participate in Intensivists model multidisciplinary trauma rounds. Residents round on trauma and neurosurgical patients when the trauma service is a consultant.

Pharmacy services include Propofol monitoring, hypertonic saline monitoring, anticoagulant monitoring, haloperidol QTc monitoring and pharmacy to dose vancomycin. Residents are exposed to critical care topics including traumatic brain injury, ICU sedation and pain management and neuromuscular blockade. Residents attend trauma meetings and patient case presentations.

Infectious Disease

The Infection Disease (ID) rotation allows residents to develop a solid understanding of microbiology, pharmacokinetics, and pharmacodynamics of antimicrobials and antimicrobial stewardship. Residents interact with various departments such as infection control and microbiology, and are part of the Infectious Diseases rounding service and Antimicrobial Stewardship Program rounds. Responsibilities include but are not limited to: daily rounds, PK dosing, weekly topic discussions, in-servicing infection control nurses, ID journal club and/or 45-minute patient case presentation.

Internal Medicine

This learning experience involves rounding with physicians from the internal medicine hospital specialist group, providing drug information, therapeutic recommendations, detailed medication reconciliation, and patient counseling. Family Practice residents are also involved in this rounding experience and provide additional opportunities for learning and teaching.

Management and Leadership

The management/leadership learning experience exposes residents to issues affecting overall pharmacy practice and operations, including specific current initiatives across the health system. Financial performance, human resource management, organizational systems, current topics in pharmacy practice, regulatory compliance, leadership development, and practice model considerations are among the topics covered.

Residents also gain an understanding of the role of other members of the department’s management team, actively participating as a team member. Residents are exposed to interactions with hospital administrators and physician and nursing leaders. Additional focus on management skills and problem-solving techniques will be developed.

Medication Safety Learning Experience

LG Health is proud to be a leader in innovative medication safety technology and is dedicated to ensuring the safest and best practice care to our patients. Our health system continuously evaluates the medication use process and current automation utilizing evidence-based methodologies to facilitate safe patient care and process improvement devoted to strengthening our culture of safety.

Our medication safety learning experience introduces residents to patient safety initiatives, national patient safety goals, medication safety resources, automated technologies, medication error reporting, and adverse drug reaction surveillance. Residents are involved in bedside patient care which lessens the potential for harm and optimizes medication management strategies with high-risk medication therapies, such as anticoagulants.

Orientation / Pharmacy Operations (Part 1) Learning Experience

Our Orientation / Pharmacy Operations (Part 1) learning experience is a three-week experience during which time residents receive comprehensive orientation to the pharmacy department, pertinent policies/procedures, and hands-on experience. A workable knowledge of the electronic health record is required for which residents complete approximately 24 hours of training and related competencies.

Pharmacy Operations (Part 2) Learning Experience

Pharmacy Operations (Part 2) is a two-week learning experience in which residents build upon previous learning experiences (Orientation/Pharmacy Operations Part 1 and Clinical Monitoring). Residents begin to have more autonomy and learn the daily activities for the areas of operation they will staff throughout the residency program.

Clinical Monitoring

This experience provides a strong foundation in the core clinical monitoring areas (pharmacokinetic, anticoagulation, renal, TPN) that will be a part students’ operational and clinical learning experiences. Residents spend time learning, implementing, and intervening with clinical standard work to create a springboard for subsequent learning experiences.

Required Longitudinal Experiences

Ambulatory Care

This rotation focuses on the provision of pharmaceutical care to patients at our ambulatory practices with a pharmacist embedded in the practice site. The longitudinal experience gives residents experience with anticoagulation and chronic disease state management and opportunities to educate patients other health-care professionals. Residents have the opportunity to meet with patients for medication education and chronic disease state management through use of collaborative practice agreements. 

Ambulatory Care (Longitudinal) Offerings

Anticoagulation Locations
The Heart Group

Based at The Heart Group of Lancaster General Health, residents are exposed to anticoagulation management within a cardiology practice. This practice site is an option for the three to four-month required longitudinal anticoagulation experience.

The multidisciplinary office cares for patients in general cardiology, heart failure, electrophysiology, peripheral vascular disease, valvular heart disease, and cardiovascular risk reduction clinics. The office has an outpatient center for laboratory and cardiovascular testing.

Residents manage anticoagulation patients under a collaborative drug therapy management agreement, and have opportunities to meet directly with patients in the office for new visits and medication-related problems. Residents are also exposed to cardiovascular drug therapy monitoring and have opportunities to provide educational sessions to office staff.

Crooked Oak & Norlanco Regional Anticoagulation Clinic

This anticoagulation longitudinal learning experience option focuses on the care of patients on anticoagulation for the treatment or prevention of thrombosis. Residents spend approximately eight weeks at one site and then transition to the regional anticoagulation clinic for the remainder of the learning experience.

Residents develop the skills necessary to participate as an effective anticoagulation management services provider, providing direct patient education, point of care INR testing, and laboratory study evaluation. They will also adjust warfarin dosing using a collaborative drug therapy management agreement and monitor for adverse events.

As a collaborative member of the health care team, residents also work with providers to transition patients to and from the direct oral anticoagulants. They create care plans for periprocedural disruptions in anticoagulation therapy and present these plans for provider approval. Residents communicate with other ambulatory care providers, nursing, retail pharmacies, and family to disseminate information to ensure the safe and effective use of these high-risk anticoagulants during transitions in care. Residents educate providers, and other members of the interdisciplinary health care team, as called upon to improve the overall quality of care for our anticoagulated patients.

Chronic Disease State Management Locations

Downtown Family Medicine

This rotation focuses on the provision of pharmaceutical care to patients at a downtown Lancaster practice site with an embedded clinical pharmacist. The practice is an academic site run by family medicine residents and attending physicians, allowing for significant collaboration and education. The patient population is varied and includes underserved and Spanish-speaking patients.

Residents have the opportunity to meet with patients for medication education and chronic disease state management through use of collaborative drug therapy management agreements. A majority of time is spent on diabetes management. However, residents become familiar with many common chronic and acute disease states seen in the outpatient setting (i.e. hypertension, dyslipidemia, venous thromboembolism, atrial fibrillation, asthma, COPD).

Drug Information / Medication Use Policy

This yearlong longitudinal rotation exposes residents to all aspects of the development of medication-related policies and procedures and the evaluation of medications for formulary reviews. Residents are actively involved in performing a medication use evaluation and in providing ongoing drug information. Residents have opportunities to make formal presentations at Formulary and Pharmacy and Therapeutics committee meetings.

Pharmacy Operations

This learning experience covers the provision of pharmaceutical services to all patients at LG Health. The focus is on the medication use process including, but not limited to: computerized provider order entry, order verification, preparation, distribution, and monitoring of medications.

Following orientation, residents are responsible for all duties assigned to the position, verifying, preparing and dispensing medications following existing standards of practice as well as LG Health’s policies and procedures. Each resident fulfills this requirement by completing the following hour requirement: one evening shift every third week; one weekend every third week (or its equivalent); and a four-hour IV room staffing requirement each month.

Clinical Operations

This yearlong learning experience has two major areas of focus: Medication Therapy Management (MTM) and Rapid Administration of Antimicrobials by Infectious Diseases Specialist (RAIDS).

The rotation exposes residents to active medication therapy management (MTM) programs through our partnership with various payers. Residents conduct comprehensive medication reviews (CMRs) and targeted medication reviews (TMR) through patient interviews, and communicate recommendations to the appropriate provider for review. The RAIDS initiative targets streamlining appropriate antibiotic therapy for positive S. aureus blood cultures in a timely manner.

Major Research Project

The research project learning experience exposes residents to the essential points of research design and develops research technique skills. Residents work to design, develop and implement a research project.

Education & Professional Development

This 12-month learning experience ensures residents are using the appropriate preceptor roles when engaged in teaching stakeholders, providing effective medication (practice-related) education to patients, HCP, students and the public, as well as developing self-evaluation and personal performance improvement skills.

This yearlong longitudinal rotation, for pharmacy PGY-1 residents, will cover the provision of pharmaceutical services to all patients at LG Health. The focus is on the medication use process including, but not limited to: computerized provider order entry, order verification, preparation, distribution, and monitoring of medications. The resident will verify, prepare and dispense medications following existing standards of practice as well as LG Health’s policies and procedures.

This learning experience encompasses (but is not limited to): formal/informal presentations, journal clubs, pharmacotherapy grand rounds, morning report, in-services, case presentations, layered learning models with other health care professionals, including students. While some of these may be associated with activities on other learning experiences, residents will be evaluated longitudinally on specific goals/objectives.

Elective Learning Experiences

Ambulatory Care (Block)

Care Connections

This rotation focuses on the provision of pharmaceutical care to patients within an innovative, intensive, and temporary primary care medical home for high-risk patients. Residents work collaboratively with the Care Connections team members (patient care navigators, social workers, case managers, nurses, nurse practitioners and physicians) to enhance medication management. Residents shadow various team members, meeting with patients in the office and their homes. A majority of time is spent on transition of care, medication reconciliation, and medication education. However, warfarin management and chronic disease state management will also be activities in which residents are involved. Residents also educate Care Connections team members on various pharmacy-related topics.

Chronic Disease State Management
Locations Offered: Norlanco or Crooked Oak

The Ambulatory Care Clinical learning experience exposes residents to an area of direct patient interaction and provides opportunities to practice evidence-based medication. Residents work under collaborative drug therapy management agreements to care for diabetes, hypertension, and lipid patients at multiple sites to create personalized prevention plans. Residents are part of a medication adherence program designed specifically for patients who are not reaching their health outcome goal, discussing patients’ concerns with their current therapy. In addition, residents gain experience as a member of ambulatory care team, collaborating with a care manager, social worker, and the community health worker on high-risk patients.

Ambulatory Care (Longitudinal) – Elective

The Heart Group (see details in Ambulatory Care Longitudinal Required)

Chronic Disease Management (See details in Ambulatory Care Elective – Chronic Disease State Management)

  • Locations Offered: Crooked Oak, Internal Medicine or Norlanco

Downtown Family Medicine (see details in Ambulatory Care Elective)

Regional Anticoagulation Clinic
The clinic care for patients on anticoagulation for the treatment or prevention of thrombosis. Residents develop skills to participate as an effective anticoagulation management provider. Residents will provide direct patient education, perform point of care INR testing, evaluate appropriate laboratory studies, adjust warfarin dosing using collaborative drug therapy management agreements, and monitor for adverse events. As a collaborative member of the health care team, residents work with providers transitioning patients to and from direct oral anticoagulants.

Critical Care – MICU/SICU

The advanced critical care learning experience exposes residents to an additional focus on ICU patients, expanding knowledge gained during the critical care trauma rotation. Residents round with pulmonary intensivists in the MICU/SICU gain additional knowledge of medication management and disease states involving ICU patients. Residents also serve as the primary preceptor for any pharmacy students during their critical care rotation. Learning opportunities are determined by the activities residents a completed in the critical care rotation.

Family Medicine

This learning experience focuses on the provision of pharmaceutical care to patients admitted to our Family and Community Medicine service. Residents are actively involved in teaching Family Medicine residents. Emphasis is placed on the management of drug therapy in patients with multiple medical problems and viewing the whole patient. Pharmaceutical care services include: reviewing patient medication profiles, resolving medication problems, completing medication reconciliation, providing pharmacokinetic consults, providing patient education and counseling, teaching during daily team rounds, and providing drug information services to the health care team. There is also an emphasis on transition of care.

Geriatrics*

The geriatrics learning experience exposes residents to caring for the older adult population in a wide array of settings. Residents work closely with geriatricians rounding in primary care, long term care, and in-patient settings, as well as within an interdisciplinary team. Areas of focus include: geriatric disease states, review and participation in advanced care planning, and end of life discussions. Residents participate in journal clubs, in-services, and case presentations.

Oncology *

The Adult Hematology/Oncology learning experience is a four-week rotation with inpatient and outpatient exposure. Residents round with an oncologist on the inpatient oncology unit and provide pharmaceutical care to outpatients at the Ann B. Barshinger Cancer Institute. Residents strengthen their knowledge and understanding of prevalent topics in hematology/oncology, including principles of chemotherapy, and treatment of solid tumors and hematologic cancers. Residents also participate in oncology supportive care, including counseling patients as part of the pharmacy managed epoetin program. The rotation also teaches residents how to evaluate complex chemotherapy regimens and provide chemotherapy teaching to patients. The Cancer Institute pharmacy allows residents to gain practical experience in the prevention of chemotherapy medication errors and chemotherapy preparation using safe handling practices.

Pain Management

During this four-week rotation, residents complete pharmacy pain consults requested by provider, provide counseling, and review patients on opioid agonist/antagonist therapy and make recommendations for nasal naloxone. Residents also participate in rounds on opioid tolerant postoperative spine patients, attend and opioid-related meetings (spine care management, drug and alcohol taskforce).

Pediatric*

As an active member of a pediatric hospitalist team, residents increase their proficiency in providing pharmaceutical care to the general pediatric patient. Topic discussions and patient care experiences enhance residents’ understanding of the management of common pediatric disease states. Additional experiences include journal club, experience at Lancaster General Health’s Women & Babies Hospital, and attendance of pediatric-related meetings.

Research

Residents can elect this two-week learning experience in addition to their yearlong commitment toward their longitudinal research project.

Transition of Care*

Lancaster General Health is dedicated to the safe and successful transition of discharged patients back into the community. During the Transition of Care learning experience, residents participate as collaborative team members, working closely with nurses and physicians to improve outcomes for patients being discharged from the hospital. The heart of this experience is ensuring accuracy of the discharge medication list and high-risk medication evaluation and counseling. Residents develop skills to educate providers, and other members of the interdisciplinary health-care team, to improve the overall quality of the transition process.

*Resident’s choice of 1 of the 5 noted above to fulfill special populations elective

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