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VA Nebraska-Western Iowa Health Care System

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Clinical Training

Click here for an overview of the Grand Island Residency Schedule

Required Rotations

 Orientation: Drs. Lisa Bilslend and Jeremy McIntyre

  • 2-week rotation at start of residency
  • Introduction to VA and pharmacy practice
  • Review of policies (i.e. Service Commitment, Resident Leave, Resident Disciplinary Policy) and handbook
  • Introduction to residency schedule, expectations and evaluation system (PharmAcademic)
  • Review of longitudinal learning experiences
  • REAL Colors (“get-to-know-you” day with RPDs and residents from Omaha/Lincoln/Grand Island)
  • Physical Exam, clinical teaching training day (manual BPs, DM foot exams, review of patient teaching on formulary agents)
  • Resident-led Topic Discussions

Pharmacy Operations: Drs. Jamie Baldwin, Jennifer Redman, Norbert Wenzl, Greg Schaeffer

  • 4-week rotation toward the beginning of the residency
  • Opportunities:
    • Counsel patients after clinic visit with provider and educate patients daily on processes of the VA
    • Process electronic prescriptions—inpatient, outpatient, CBOC orders, CLC
    • Verify/Edit electronic prescriptions, prepare and dispense prescriptions (including those for traveling vets), medication package tracking through USPS
    • Answer pharmacy telephone calls
    • Prepare outpatient IV’s for infusion clinic/CLC
    • Daily patient care notes in CPRS
    • Supervise technicians
    • Daily maintenance of pharmacy records and Inventory maintenance
    • Experience with ScriptPro, TCG Fastpak, Pyxis
    • CLC functions—tray and cart checks, ward stock, controlled substance preps, unit dose preps
  • Staffing (commences after initial Pharmacy Operations rotation)
    • 8 hours every third week in outpatient/inpatient pharmacy during normal tour (the Friday prior to the Saturday shift)
    • Every third Tuesday from 4:30-6:30
    • Every third Saturday from 8:00-12:00

MTM/PACT Clinics: Drs. Lisa Bilslend, BCACP; Brent Bollwitt; Paula Carlson; Lourdes Heuermann, BCACP

  • PACT-1, PACT-2, PACT-3 (each is 4-weeks)  
  • Average about 8-15 patients per day per clinic: phone and face to face
  • Each rotation increases the complexity and number of patients seen. Residents are exposed to precepting students through topic discussions early in the year; in later rotations, residents directly precept APPE students. 
    • Lipid
    • HTN
    • Pharmacy Counseling/New Patient
    • Smoking cessation
    • Diabetes
    • Thyroid
    • CHF
    • Mental health
    • Pain Clinic (multidisciplinary)
    • Precepting students

Pain Rotation: Dr. Paula Carlson

  • 4-week rotation that occurs during the PACT-3 rotation
  • Multidisciplinary pain team meets each Thursday afternoon.       Average of 1-3 patients per clinic day. Patients are seen by interdisciplinary team (MD, Pharmacy, Behavioral Psychologist and Physical Therapist); each discipline helps to address pain from a different view point
  • Panel management: review patients at high risk for opioid overdose and offer appointments for naloxone education

Anticoagulation: Drs. Lisa Bilslend, BCACP; Brent Bollwitt

  • Anticoag-1, Anticoag-2 (each rotation is 4-weeks)
  • Average of 15-20 patients per day; face to face and phone clinic
  • The second rotation will increase the complexity and number of patients seen. Residents will also become much more involved in precepting APPE students (as available) and in panel management
  • Pharmacist-run anticoagulation clinic is responsible for all warfarin and DOAC management
    • New onset atrial fibrillation/VTE education and discussion of anticoag therapy
    • New warfarin education, initiation, adjustment of therapy
    • Empiric dose adjustments for drug-drug interactions
    • Conversion to/from DOAC therapy or conversion between DOACs as indicated (renal function, age, bleed risk, etc)
    • Peri-operative management of all anticoagulation therapy
    • Topic discussions with APPE students; precepting APPE students
    • Panel management: review of patients with active prescriptions for warfarin/DOAC, but no scheduled follow up
    • Participation in Medication Utilization Evaluation Tracking (MUET) for patient who may be inappropriately prescribed DOAC therapy (i.e. hx of mechanical heart valve replacement, impaired renal function, etc)

Community Living Center (CLC): Dr. Amy Thompson BCGP, FASCP

  • CLC-1, CLC-2 (each rotation is 4-weeks)
  • Inpatient/long-term care floor (census usually in upper 30s to lower 40s; capacity of 55)
  • “Subacute” care, step down from more acute care setting
  • The second rotation is characterized by an increase in resident independence on the floor and increase in the number of patients for which the resident is responsible
  • Skilled nursing care, wound care, rehab
    • Hospice/palliative care wing (10 beds)
  • Long Term Care (opportunities vary depending on patient population)
    • Anticoagulation
    • Pharmacokinetics and drug monitoring
    • Infectious disease
    • Diabetes
    • Smoking cessation
    • Medication reconciliation
    • Drug regimen reviews (monthly)
    • Rounds
    • Pain management (end of life, post-op, etc)
    • Interdisciplinary team meetings
    • Drug Information

 Management: Dr. Jeremy McIntyre

  • 4-weeks (usually in February) – all residents complete at the same time
  • Attend NWI Pharmacy and Therapeutics Committee meetings quarterly
  • Prepare agendas and lead staff meeting
  • Management project (monograph, treatment guidelines or protocol update)

 

Longitudinal Learning Experiences 

Residency Project: Dr. Lisa Bilslend, BCACP

  • Residency project (preceptors and mentors will vary based on topic)
  • Required by ASHP
  • Residents will work with preceptors and mentors on site to develop a project. In some cases, the project may already be started when residents come on campus (“reverse order” projects). In this case, the resident would pick up where the other left off, then start a new one in January (for next-year’s class). This allows for the residents to ensure they have results to present.
    • Poster presentation at MidYear (optional, but encouraged)
    • Poster presentation at NWI Pharmacists’ Retreat (Spring)
    • Formal PowerPoint presentation at Midwest Residency Conference (May)
    • Manuscript (December/June)

Drug Information: Dr. Lisa Bilslend, BCACP

  • Presentations
    • Clinical Pearls (x2) – 30-minute topic review for preceptors and pharmacy students
    • Nursing presentation (x2) –10-15 minutes on disease state or guideline update, etc
    • NWI Journal Club (x1)
    • NWI Patient Case (x1)
    • Group patient presentations     
      • Diabetes Forum (required)
      • Chronic Pain Forum (optional)
      • Substance Abuse Residential Recovery Treatment Program (SARRTP) Forum (part of Mental Health elective)
    • Other opportunities as they arise (i.e. local COP, Nebraska Pharmacists Association, Technician Retreat, Pharmacist Retreat, etc)
  • Newsletters
    • Your VA Pharmacy News (written for patients) and Therapeutic Capsule (written for healthcare providers)
    • Write one article for each newsletter
    • Collaborate with residents from Lincoln and Omaha
  • Students
    • Participate in student cases monthly
    • Precept students in the PACT and anticoagulation clinics
    • Topic review to students (monthly)
  • Medication Utilization Evaluation
    • Usually a group project – could be all NWI or just GIVA depending on the size

 Professional Growth: Dr. Lisa Bilslend, BCACP

  • Quarterly meetings with RPD to assess strengths, areas for improvement, short/long-term goals and any changes to the program to ensure the needs and interests of the resident are being met
  • Quarterly meetings with NWI management team and other NWI residents (budget, organizational chart, hiring process, etc)
  • Attend Formulary Action Team meetings monthly

 Other Online Opportunities (longitudinal)

  • Teaching certificate course – online (optional)
  • Creighton Cardiology Course/Certificate – online (optional)

Elective Learning Experiences

ELECTIVES

  • Three rotation blocks (12 weeks) – up to 4 weeks may be spent offsite
  • May complete at Grand Island, Omaha or Lincoln campuses

Grand Island Elective - Mental Health Clinic: Dr. Kristen Bishop

  • 4-week elective
  • 10-15 patients in both face to face and phone clinics
  • Post-Deployment Clinic – some primary care (same as PACT rotations) however veterans are usually younger
  • Mental Health
    • Benzodiazepine tapers
    • Metabolic monitoring
    • Smoking cessation
    • Antidepressant titration/cross-taper
  • Substance Abuse Residential Rehabilitation Treatment Program (SARRTP)
    • 30-day inpatient treatment program
    • Medication reconciliation on admission
    • Education session for SARRTP veterans (monthly)
  • Opportunity to shadow at OVA in the PICU, as available

 Grand Island Elective - Home-Based Primary Care: Dr. Jamie Baldwin

  • 4- week elective
  • Primary care based out of the veteran’s home; about 90 veterans enrolled in this program
  • Weekly interdisciplinary team meetings
  • Perform the quarterly chart reviews
  • Anticoagulation management
  • Drug information, formulary management
  • In-home visits for new admissions to the program

 Grand Island Elective - Oncology/Infusion: Norbert Wenzl, RP

  • 2- week elective
  • Infusion clinic in north clinic; CLC IVs and other infusions
  • Compound IV infusions for the clinic and CLC, supervise technicians
  • Verify Chemo orders
  • Provide education to new starts, as available
  • Nursing/Pharmacy education project
  • Opportunity to shadow at Omaha VA (large volume infusion clinic), as available

 Grand Island Elective – Specialty Clinics: Dr. Lisa Bilslend

  • 2- week elective
  • Grand Island has several specialty clinics: wound/foot care, ortho, urology, respiratory, physical therapy, eye, derm, nutrition
  • Provides the resident with exposure to the various clinical settings and allows opportunity for drug information to the providers

 Other Grand Island Electives

  • Builds on the foundation provided in the required/initial rotational experiences
    • CLC-3
    • Anticoag-3
    • PACT-4

 Omaha Elective - Internal Medicine: Dr. Mike Ehle, BCPS

  • 4- week elective
  • Traditional inpatient, acute-care experience
    • Daily rounds
    • Follow 10-20 patients
    • Drug information
    • Antibiotic dosing (renal dose adjustments)
    • PharmacoKinetics
    • Anticoagulation
    • Order processing
    • Medication reconciliation
    • Patient counseling

 Omaha Elective - Cardiology: Dr. Michaela Hrdy

  • 2-4- week elective
  • Cardiology team from Creighton provides services at the Omaha VA
    • Twice daily rounds
    • Weekly participation in Congestive Heart Failure (outpatient) clinic

 Omaha Elective – Inpatient Psych: Drs. Teri Gabel, BCPP; Mandi Herdzina, BCPC, BCPP

  • 2-4- week elective
  • Daily rounds with the inpatient psych team
  • Clozapine clinic

 Lincoln Elective – Telepharmacy: Drs. Susan Stone, BCACP; Becky White, CACP

  • 2- week elective
  • Telepharmacy service is available at three of our CBOC (satellite clinic) locations – Holdrege, Norfolk, Shenandoah
  • Medication therapy management services over web-cam technology

 

Residency Certificate Minimum Requirements:

  •  Twelve (12) months of full time experience
  • The resident must be present for at least 75% of required rotation days, unless there are extenuating circumstances. If the resident misses more than 25% (for reasons other than attending interviews for future jobs / PGY2s) in one rotation, the resident may be required to complete additional time on that rotation. This additional time may be added to the time of the 12-month residency commitment period or be taken away from elective rotation times, as determined by the RPD and preceptor.
  • Completion of all management projects
    • i.e. treatment guideline, protocol/policy update or monograph
    • schedules, etc
  • Completion of all Rural Health Training Initiative (RHTI) assignments
  • Completion of all Education/In-service projects and presentations:
    • Two NWI Presentations (one Journal Club, one patient case)
    • Two Clinical Pearl Topic Discussions
    • Two Nursing Presentations
    • Group patient forums: DM forum (x1)
    • NWI Newsletter publications (one article for each newsletter – two total)
    • Rotation-specific projects, including elective rotations
      • Topic discussions for students (PACT, anticoag, MHC)
      • SARRTP forum
    • Completion of MUE
  • Residency Project completion
    • Final manuscript related to project
    • Project presentation to VA staff (via poster presentation at NWI RP retreat)
    • PowerPoint Presentation at Regional Conference (MPRC – Omaha)
  • Completion of all summative, learning, and preceptor evaluations
  • At least 90% of the goals/objectives marked as achieved for residency (AchR = 5)
    • Residents must achieve all the objectives of a goal before it will be the goal will be marked as AChR.
    • At least 4 on all other objectives
    • At least 3/5 marked on all objectives in elective rotations
    • No objective marked as 2/5 at the end of any rotation

Contact

Lisa Bilslend, Pharm.D, BCACP
Residency Program Director
Grand Island VA, Neb.,
308-382-3660 Ext. 92678
lisa.bilslend@va.gov

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