North Alabama/ Huntsville Region

1. North Alabama/ Huntsville Region AUHSOP Clerkships

2. Huntsville/Madison County, Alabama • Population of 275,000 people • Home of NASA's Marshall Space Center • High-tech, family-oriented community with excellent public and private schools • High tech industries • Abundant cultural (symphony, ballet, Broadway plays, museums) • Outdoor activities (hiking in the foothills of the Appalachian Mountains, boating on area lakes and rivers, Robert Trent Jones Golf Course) • Great shopping, dining and entertainment

3. Rotation Sites • Huntsville Hospital • Huntsville Hospital Women and Children’s • UAB Family Medicine Clinic • Crestwood Hospital • Sunscript Pharmacy • Community Pharmacies (HSV and surrounding areas)

4. Majority of rotations are available at Huntsville Hospital

5. Huntsville Hospital • 901 bed hospital (including a Women and Children Hospital) • Non-profit community/teaching hospital which serves North Alabama/South Central TN • 575 physicians on staff representing 65 medical specialties • Serves all diseases except burn and solid organ transplant • Emergency department sees approximately 110,000 patient visits per year

6. Main Hospital Whole HH Campus Tram Women and Children's

7. Main Hospital UAB building • Auburn Faculty Offices Located • UAB Library • Your parking lot!!! Tram

8. The tram you will ride! It takes you from the Main Hospital to Women and Children’s and back!

9. Huntsville Hospital Women and Children’s Hospital Pediatric ER, 10 Bed Pediatric ICU, Level III Newborn Intensive Care 38 beds (intensive & progressive care), 40 bed Pediatric Unit and St. Jude’s Clinic Pediatric Emergency Department sees approximately 30,000 patient visits per year

10. Huntsville Hospital Pharmacy • Over 60 pharmacists • Decentralized (unit-based) services • 18 Clinical Specialists • 5 PGY1 Residents • 1 Ambulatory PGY1 emphasis resident • 1 Peds PGY1 emphasis resident • Nutrition/Pharmacokinetic Service: 24/7 • Pharmacy manages ALL vancomycin/ aminoglycoside orders on patients; can order labs, adjusts doses, etc • Pharmacy manages all enteral and parenteral feeds on patients; can order labs, insulin, adjust feeds as needed

11. HSP Rotation Huntsville Hospital

12. HSP Rotation • Huntsville Hospital (Mary Dang, Pharm.D) • The student will do everything that our unit-based pharmacist can do, except verify orders. They will evaluate and follow Nutrition/Pharmacokinetics patients, automatic vancomycin and aminoglycoside consults, warfarin dosing and management, automatic IV to PO conversions, automatic renal dose adjustments, medication teachings, nursing inservices, Adverse Drug Reactions follow-up and evaluation, medication reconciliation, JCAHO compliance, observe the effects of drugs in surgery (round with Certified Registered Nurse Anesthetist) , observe pharmacy automation (Pyxis and Omnicell Carousel), experiences in the IV room, write SOAP notes in the chart, and possibly more!

13. HSP Rotation • Crestwood Hospital(Marshall Robbins, Pharm.D.) • Acute care, 120-bed hospital in Huntsville • Objectives: 1. Use of pharmacy automation. 2. Clinical management of general medicine/surgery patients. 3. Management of daily tasks in hospital pharmacy. • 301-500 scripts per day with 3 RPh and 3 techs. • The student will learn nutritional support from a pharmacy based nutrition support service and kinetics service. IV admixture, MUE, ADR reporting and order entry will also be experiences provided. Patient teaching as well a drug information will also be provided on this rotation. • Develop MUE's for presentation to P&T committees. • Understand how to work up, compound and monitor patients on TPN.

14. Drug Information Rotation Huntsville Hospital

15. Drug Information Rotation • Huntsville Hospital (Richard Cramer, Pharm.D.) • Answer drug info questions, evaluate actual adverse drug reactions/events cases, prepare a drug new drug evaluation paper and summary for the Pharmacy and Therapeutics Committee, present a journal club, write a "new drug monitoring" spotlight, write a newsletter article, present an inservice, participate in Medication Use Evaluation program, and participate in JACHO issues

16. HH Medicine/Med Specialty Rotations

17. HH Medicine/Med Specialty Rotations • Adult Medicine (Kurt Wargo, Pharm.D., BCPS) • Round with UAB Internal Medicine physicians, residents, and medical students; assist in the determination of appropriate pharmacotherapy; answering drug information questions; give a patient/drug information presentation to the physicians and students • Cardiology/ Cardiovascular ICU (Sharon Baty, Pharm.D., Gregg Knowles, Pharm.D., Nikki Wargo, Pharm.D.) • CV step-down unit with about 25 beds and 3 cardiology step-down units with about 100 beds • Round with nurse practitioners, do PCI teachings and see Nutrition/ Pharmacokinetic patients • May spend a day observing in the cath lab and spend a day at the Heart Failure clinic • Will attend meetings with pharmacist and can help dispense study drugs if interested

18. HH Medicine/Med Specialty Rotations • Critical Care (Ed Eiland, Pharm.D., BCPS, CGP, MBA) • 10 bed MICU, 30 bed RCU • Exposure to pharmacy practice in both a critical care unit (MICU) and medical/respiratory step-down unit (RCU) • Involvement in antimicrobial management including dosing, obtaining levels, and documenting in patient's chart • Involvement in nutritional support management including parenteral and enteral formulation calculations, lab monitoring, fluid management, and documenting in patient's chart • Observation of a verifying pharmacists and their function in collaboration with an automated dispensing system (Pyxis) • Familiarization with patient profile review and appropriate intervention strategies to improve patient outcomes • Collaborate with preceptor on formulary evaluation projects to be presented at the Pharmacy and Therapeutics Committee Meeting

19. HH Medicine/Med Specialty Rotations • Neurology ICU (Kelly Dixon, Pharm.D.) • 35 bed Neurological Unit and an 18 bed NICU and Stroke Treatment Center • Round with the dietician and charge nurse of NICU • Present inservices for nurses in the Emergency Room and NICU • Projects include auditing of meds not verified in the ER and participating in the Stoke Get with the Guidelines program • Participate in the ride along program with MedFlight. Medflight’s goal is to fly critically ill or ill patients to the closest appropriate facility. This activity is optional.

20. HH Medicine/Med Specialty Rotations • Surgery/Trauma ICU (Jerry Robinson, Pharm.D.) 25 bed STICU • Patient population includes trauma, general surgery, vascular surgery, and gastrointestinal surgery • Round with Trauma surgeons to provide multidisciplinary approach to patient care with close monitoring of antibiotic usage • Provide Nutrition Support and Pharmacokinetic services to all patients • Serve as resource for nurses concerning all aspects of medication management (including dosing, administration, supply)

21. HH Medicine/Med Specialty Rotations • Oncology (Matt Eckley, Pharm.D.) • Interpret and write/calculate chemotherapy orders • Discuss common oncology disease states • Discuss and manage supportive care issues in the oncology patient, eg. N/V, pain, fever/neutropenia, mucositis, GI complications, etc • Chemotherapy teaching • Respond to DI questions from the medical oncologists and oncology • nursing staff • Participate in care of outpatient pediatric oncology patients at St. Jude's affiliate clinic at HHWC

22. HH Medicine/Med Specialty Rotations • Rotate through all ICU settings (Floaters- Rob Nelson, Pharm.D., Ann Birkenstock, Pharm.D., Tripp Dixon, Pharm.D.) • During this rotation, one will be involved with many aspects of patient care in various areas of practice. Areas of practice include surgery, surgical Intensive Care (including trauma) , cardiology, neurology (NICU), and medicine floors. Some of these activities in any of these given areas include: • providing management of nutrition to patients (TPN, enteral) • dosing of various medications (antibiotics, renal dosing adjustments) • patient education (medication teachings, clarification of home medications) • evaluating medication usage for appropriateness and being an integral part of the medication and disease-state management of the patient • Clinical Specialists preceptors at HH are residency trained!

23. Primary Care Rotations UAB Family Medicine Clinic

24. Primary Care Rotations • UAB Family Medicine Clinic (Miranda Andrus, Pharm.D., BCPS) • See patients referred to Pharmacotherapy Clinic for diabetes, hyperlipidemia, hypertension, smoking cessation, noncompliance and other chronic diseases • Work with medical residents as they see patients in clinic (medication histories, pharmacotherapy recommendations, patient counseling, physical assessment) • Concentration is on management of chronic diseases using evidence based guidelines, patient counseling and SOAP note writing

25. Primary Care Rotations • UAB Family Medicine (Joyce Loyed, Pharm.D., CACP) • See patients referred to Pharmacotherapy clinic for anticoagulation, hyperlipidemia, diabetes • Review charts of nursing home patients and make pharmacotherapy recommendations to medical resident/attending physician • See patients with medical residents in clinic and perform medication histories, patient counseling, and provide pharmacotherapy recommendations

26. Primary Care Rotations Pediatrics-Huntsville Hospital

27. Primary Care Rotations • Pediatrics- HH Women and Children’s (Lea Eiland, Pharm.D., BCPS) • Round with the UAB Pediatric Inpatient Team (Pediatric Attending, Family Medicine residents, UABSOM medical students) • Develop patient profiles, make pharmacotherapy recommendations to medical team, patient discharge counseling, educate other healthcare professionals; provide a patient presentation and journal club to other pharmacists and students • Attend morning report and pediatric grand rounds • Opportunities to see newborn nursery, sickle cell clinic and pediatric ICU/ Neonatal ICU setting

28. Primary Care Rotations • Tut Fann State Veterans Home Pharmacy (Lynn Sponsler, R.Ph.) • 150 bed nursing home for veterans • Bubble pack, unit dose dispensing, consultations • Familiarity of pharmacy practice in the federal government setting

29. Primary Care Rotations • Gadsden, AL • Goodyear Medical Clinic (Ginger Barron, R.Ph.) • Physician-office type practice, disease state management specializing in managed care, chart reviews, outcomes research and patient education, ~300 scripts per day

30. Huntsville Community Rotations • Kroger Pharmacy (Debbie Collette, Pharm.D.) • Immunizations in fall • CVS (Charlotte Morris, R.Ph.) • Medical Arts Pharmacy (Lynda Staggs, R.Ph) • Compounding, consulting, MTMS • Huntsville Compounding Pharmacy (Jim Gillespie, R.Ph.) • Compounding • Sunscript (Tasha Van Bibber, Pharm.D.) • Long-term care pharmacy; assisted living dispensing • Handles coumadin and pharmacokinetics/antibiotic dosing for all home patients

31. Outside HSV Community Rotations • Albertville, AL- Bishop’s Pharmacy (Tim Bishop, R.Ph.) • Albertville, AL- Discount Pharmacy- (Norman Spear, R.Ph.) • Rainsville, AL- Rainsville Drugs and Compounding Pharmacy (Wade Phillips, Pharm.D.)

32. Electives • Infectious Disease (HH- Ed Eiland, Pharm.D., BCPS, CGP, MBA) • Familiarization with infectious diseases in a critical care unit - Medical Intensive Care Unit (MICU) • Familiarization with infectious diseases on a step-down unit - Respiratory Care Unit (RCU) • Dosing of Anti-Infective Agents and Follow-Up • Involvement with the development of antibiograms (hospital-wide and unit-specific) • Attendance at Anti-Infective Subcommittee Meeting • Exposure to Antimicrobial Stewardship Program • Involvement in outcomes research (IRB approved studies) • Potential partnering on poster presentations at state-wide and national pharmacy meetings

33. Electives • Neonatal ICU (Lindsay Lester, Pharm.D.) -Round with Neonatal Clinical Specialist in Intensive and Progressive Care Nurseries -Develop patient profiles, make pharmacotherapy recommendations, education nursing staff -Topic discussions an various neonatal disease states and pharmacotherapeutic interventions -Present clinical inservice and journal clubs to W&C Pharmacy Staff, Residents, and students

34. Electives • Pediatric ICU (Melissa O’Neill, Pharm.D.) -Round with multidisciplinary pediatric ICU team (Pediatric Intensivists, Pediatric Nurses, Respiratory Therapists, Nutritionalists) -Review patient profiles, make pharmacotherapy recommendations to the medical team, review nutrition and kinetics, provide medication counseling to patients and families -Provide education to other healthcare professionals -Presentation to pharmacists on pediatric topic -Provide a patient presentation and journal club to other pharmacists and students

35. Electives • Hospital Pharmacy Management, HH (David Collette, Pharm.D.) • Activities may include JCAHO activities, educational activities to nurses, MD, pharmacists, newsletter, data collection (QA, compliance), drug study (daptomycin), AlSHP stuff (if interested), some nutrition/kinetics and more! • Pharmacy Administration, Crestwood Hospital (Huntsville) (Marshall Robbins, Pharm.D.) • Activities include patient profile review with therapeutic plan/intervention workup, Nutrition Support, Pharmacokinetics, IV Admixture experience, Hospital Pharmacy Management and Operations, MUE Write Up and Informal Drug Information Assignments, one presentation to staff (Pharmacy and/or Nursing)

36. Electives • IT/Medication Safety (HH- Pam Schindler, Pharm.D./ Michele Durda, Pharm.D.) • Work with existing databases and the clinical pharmacy staff to ensure that appropriate reports are being generated in a timely manner • Review and upload documents to the pharmacy webpage, the RX for nursing and RX for MDs webpages • Participate in training activities for pharmacists, residents, and technicians. These training activities will be associated with various technical initiatives in the pharmacy and may include preparing educational material, testing systems or training material, and presenting training modules.

37. Electives • Any medical specialty- cardiology, neurology, surgery/trauma, medicine, oncology, etc at Huntsville Hospital • Any Community Pharmacy in region