Pharmacy Residency Program - PGY2 Pain Management & Palliative Care - Central Arkansas Veterans Healthcare System
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Central Arkansas Veterans Healthcare System

 

Pharmacy Residency Program - PGY2 Pain Management & Palliative Care

Michael Chandler
Michael Chandler, PharmD, BCPS
PGY2 Pain Management and
Palliative Care Residency Director

Pharmacy Residency

This program is accredited by the American Society of Health System Pharmacists

This residency site agrees that no person at this site will solicit, accept, or use any ranking-related information from any residency applicant.


Program Purpose
PGY2 pharmacy residency programs build on Doctor of Pharmacy (Pharm.D.) education and PGY1 pharmacy residency programs to contribute to the development of clinical pharmacists in specialized areas of practice. PGY2 residencies provide residents with opportunities to function independently as practitioners by conceptualizing and integrating accumulated experience and knowledge and incorporating both into the provision of patient care or other advanced practice settings. Residents who successfully complete an accredited PGY2 pharmacy residency are prepared for advanced patient care, academic, or other specialized positions, along with board certification, if available.


Requirements to Receive Residency Certificate

Satisfactory completion of all rotations and required activities: If a rotation is not satisfactorily completed, appropriate remedial work must be completed as determined by the preceptors and program director.

  • Completion of 2088 hours of training
  • Compliance with all institutional and departmental policies
  • Completion of all assignments and projects as defined by the preceptors and Residency Program Director
  • Completion of a residency project with a draft manuscript submitted in AJHP format to the Residency Program Director no later than the day of the Residency Research Conference
  • Two major disease or treatment-related presentations (i.e. Grand Rounds) as well as presentation of the research project results at the CAVHS Residency Research Conference
  • Attend at least one professional state or regional meeting and one national meeting (must be pharmacy-related) as approved by the RPD and Chief of Pharmacy
  • Participate in recruiting activities for the residency
  • Contribute to optimal patient care and achieve the mission and goals of CAVHS and the Pharmacy Service
  • Demonstrate appropriate storage of all research-related data and documents at the end of the year.
  • Staffing requirements:
    • Each resident will be required to practice as a pharmacist in a designated pharmacy operations area throughout the year.
    • Residents will be assigned to a pharmacy operations area (inpatient or outpatient) based on the current needs of Pharmacy Service.
    • PGY2 residents will be scheduled for pharmacy operations staffing every 3 to 4 weekends and on two minor Federal holidays during the year. This may be less often based on the current needs of pharmacy service.
    • PGY2 residents will be given priority for dual-appointment pay when funding is available. Dual-appointment provides pharmacist level pay for staffing and is obtained through an application process.

Palliative Care

The Palliative Care rotation combines both inpatient and outpatient experiences throughout this experience.

The outpatient learning experience provides the Palliative Care PGY2 resident with hands-on practice with in the Hospice/Palliative Care clinic. This is an experience in which the resident will participate in the provision of pharmaceutical care to outpatients followed by the Hospice/Palliative Care team at the Little Rock campus.

This rotation allows for daily opportunities to provide specialized pharmaceutical care in the outpatient Palliative Care Clinic as well as the pharmacy-run pain clinic. The rotation is designed to give the Palliative Care PGY2 resident the opportunity to provide clinical pharmacy services for patients as a part of an interdisciplinary team, both providing recommendations for treatment as well as patient counseling as well as serving as the provider in treating chronic pain.

The Palliative Care Clinic follows approximately 50-100 patients at any one time. It is an interdisciplinary team that follows patients both in clinic as well as coordinates with home Hospice.

The pharmacy-run pain clinic meets 2 days per week. In this clinic, we follow patients with chronic pain (both malignant and non-malignant pain) that require frequent follow up. The resident’s role in this clinic is to evaluate symptom management (i.e. pain), make adjustments and appropriately schedule the patient for either phone or face to face follow up. This is a challenging patient population with a variety of disease states as well as those with a history of substance abuse. The resident will function with the preceptor for part of the month and will work toward working independently throughout the month.

The Palliative Care inpatient portion of this experience provides the Palliative Care PGY2 resident with hands-on practice with on the Hospice/Palliative Care ward. The residents will participate in the provision of pharmaceutical care to inpatients followed by the Hospice/Palliative Care team at the Little Rock campus.

This allows for daily opportunities to provide specialized pharmaceutical care on the inpatient ward (6E). The rotation is designed to give the Palliative Care PGY2 resident the opportunity to provide clinical pharmacy services for patients as a part of an interdisciplinary team, both providing recommendations for treatment as well as patient counseling.

Arkansas Home Hospice

The Arkansas Hospice rotation learning experience provides the Palliative Care PGY2 resident with hands-on practice with in the Hospice/Palliative Care clinic. This is an experience in which the resident will participate in the provision of pharmaceutical care to outpatients followed by Arkansas Hospice. The resident will attend rounds with the healthcare team at St. Vincent's HealthCare Center, make home visits with the nurses, and attend interdisciplinary team meetings with the regional teams as well as organizational meetings

Acute Pain Management – SICU

Acute pain management is a 1 month learning experience at Central Arkansas Veterans Healthcare System (CAVHS). This rotation allows the provision of pharmaceutical care to patients admitted to the surgical intensive care unit (SICU).

The resident will provide pharmaceutical care for inpatients with post-surgical pain related issues. Responsibilities of the resident focus on the management of pharmacotherapy with an emphasis on pain management related supportive care and pain medication regimens. The rotation allows the resident the opportunity to apply pharmacy related concepts to patient care as a member of an interdisciplinary team.

The resident will be responsible for identifying, preventing, and resolving medication therapy issues for patients and serving as a drug information resource for the team. This will include, but is not limited to, developing pharmaceutical care plans for patients with complicated medical histories, screening medications for appropriate indications and dosing, proactively identifying drug interactions, monitoring pain medication use, medication recommendation when switching to oral medications from a PCA and ensuring appropriate use of bowel regimens as indicated. Other learning activities may include but are not limited to in-services, case presentations, journal clubs, medication use evaluation, topic discussions and other projects as they arise.

The resident will be proactively involved in the medication use process. This includes assisting nursing service with medication-related issues and working to promptly solve problems that impede the appropriate delivery of medications to optimize outcomes. Good communication and interpersonal skills are necessary to promote efficient function of the team. The resident will be expected to communicate their findings and recommendations to the appropriate clinician(s). The resident may also be responsible for day-to-day supervision of pharmacy students in conjunction with the preceptor

UAMS Cancer Institute (CI) Palliative Care

The UAMS CI Palliative Care rotation learning experience provides the Palliative Care PGY2 resident with hands-on practice with in the outpatient treatment of symptoms in the Palliative Care Clinic, specifically with patients with cancer. This is an experience in which the resident will participate in the provision of pharmaceutical care to outpatients followed by the UAMS Palliative Care Team at the UAMS campus.

This rotation allows for daily opportunities to provide specialized pharmaceutical care in the outpatient UAMS CI Palliative Care Clinic. The rotation is designed to give the Palliative Care PGY2 resident the opportunity to provide clinical pharmacy services for patients as a part of an interdisciplinary team, both providing recommendations for treatment as well as patient counseling as well as providing follow-up counseling when appropriate. This rotation may be set up as a year-long longitudinal experience depending on the clinic needs and resident preference.

Recitation - Longitudinal

Recitation is a longitudinal teaching experience where the resident is responsible for a section of approximately 15 to 20 P2 or P3 pharmacy students from University of Arkansas for Medical Sciences College of Pharmacy. The PGY2 resident facilitates the learning experience of these students through direct teaching as well as patient case presentations. The resident is responsible for evaluating student performance. The resident performance is evaluated through observation by experienced faculty as well as student evaluations. The Ambulatory Care Resident will complete the requirements for a teaching certificate at the University of Arkansas for Medical Sciences.

Oncology

Hematology/Oncology and Supportive Care is a 1-month learning experience at Central Arkansas Veterans Healthcare System (CAVHS). CAVHS’s inpatient oncology unit houses 17 beds and the outpatient infusion clinic houses 14 beds. There are 5 hematology/oncology staff physicians and 2 Advanced Practice Nurses practicing at CAVHS as well as a number of hematology/oncology fellows associated with the University of Arkansas for Medical Sciences Hematology/Oncology Fellowship.

The resident will provide pharmaceutical care for inpatients and outpatients with hematology/oncology and supportive care issues. Responsibilities of the resident focus on the management of pharmacotherapy with an emphasis on oncology-related supportive care and chemotherapeutic regimens. The rotation allows the resident the opportunity to apply pharmacy-related concepts to patient care as a member of a multi-disciplinary health care team.

The resident is responsible for identifying, preventing and resolving medication therapy issues for patients and serving as a drug information resource for the team. This will include, but is not limited to, developing pharmaceutical care plans for patients with complicated medical histories as well as for those on high-risk medications, performing pharmacokinetic and pharmacodynamics assessments, screening medications for appropriate indications and dosing, and proactively identifying drug interactions. Other learning activities may include but are not limited to in-services, case presentations, journal clubs, topic discussions, and other projects that may arise.

The resident will be proactively involved in the medication use process. This includes assisting nursing service with medication-related issues and working to promptly solve problems that impede the appropriate delivery of medications to optimize outcomes. Good communication and interpersonal skills are necessary to promote efficient function of the team. The resident will be expected to communicate their findings and recommendations to the appropriate clinician(s). The resident may also be responsible for day-to-day supervision of pharmacy students in conjunction with the preceptor.

Mental Health Clinic

The Mental Health Clinic is an elective learning experience at Central Arkansas Veterans Healthcare System (CAVHS) located at the Towbin Medical Center location in North Little Rock.  During this rotation, the resident will work primarily with one clinical pharmacy specialist in psychiatry who operates as a part of a larger interdisciplinary Behavioral Health Integration Project (BHIP) team consisting of psychiarists, advance nurse practitioners, social workers, nurses, etc.

The primary focus will be mental health medication management in the outpatient setting, which includes designing, implementing, and monitoring appropirate pharmacotherapy regimens tailored to each individual patient.

The resident will become familiar with other mental health services that are integral to patient care, including individual/group psychotherapies, substance abuse treatment programs, Post Traumatic Stress Disorder treatment programs, and others.  The resident will provide direct patient care in outpatient clinics, including the Mental Health Clinic (initial and follow-up), as well as video telehealth clinics provided to various Community-Based Outpatient Clinics (CBOCs) around the state.  By the end of the experience, the resident will be able to manage a full clinic day and provide comprehensive medication therapy management independent of the preceptor.

Pharmacy Pain eConsult Service

The Pharmacy Pain eConsult Service is an electronic consult service that services CAVHS, both inpatient as well as outpatient. The consultation may be performed by e-Consult, face to face, telehealth or other means appropriate to provide optimal care of pain condition. Patient may be contacted for additional information by reviewer. The following services are provided, including: opioid dosing conversions, opioid tapering, drug screen interpretation, non-opioid pharmacotherapy recommendation, opioid pharmacotherapy recommendations. Consults are completed within 72 hours and include an extensive chart review with written recommendations.

Emergency Department Pain Management

The ED Pain Management elective is a longitudinal experience where the PGY2 Pain/Palliative resident is "on-call" for the year for emergent pain related needs in the emergency department.  The resident will aid in selection of pain medications and associated medications for patients in the ED, counsel on newly prescribed pain medications, identify patients who are good candidates for Opioid Overdose Education and Naloxone Distribution (OEND) and educate providers on pain stewardship best practices.

Anti-Craving Clinic/SUD/Homeless DOM

The Anti-Craving clinic is a new service, started and lead by a PGY2 Pain/Palliative resident.  This service offers 2 groups, including SUD (substance use disorders) as well as a Homeless group.  Both groups are led by the resident, where different pain and mental health topics will be discussed, recommendations made, and meetings held with both the preceptor as well as the provider.  This is a longitudinal elective that offers the resident independence but also collaboration with other Interdisciplinary Team Members. 

Pharmacy Pain Management Clinic

The Pharmacy Pain Management Clinic is a one-month rotation that will expose the resident to the role of the pharmacist serving as the primary provider of pain management for Veterans at CAVHS. The resident will participate in the provision of pharmaceutical care to outpatients followed in the Pharmacy Pain Management Clinic. This rotation is designed to give the resident the opportunity to provide clinical pharmacy services as a part as the primary provider of pain management, both providing recommendations for treatment as well as patient counseling, and providing follow-up counseling when appropriate in treating chronic non-malignant pain. The clinic is located at the North Little Rock VA site.

Patients are enrolled in the clinic through the Pharmacy Pain Management eConsult, where a plan is developed regarding pain management. The patient is then seen face-to-face, where the plan is discussed.  The patient can be followed in this clinic up to 6 months or until pain is stable, at which time the patient then returns to consulting provider as listed in collaborative practice agreement.

Interdisciplinary Pain Team Clinic

The pain service at CAVHS includes pharmacy as a key part of the interdisciplinary pain team.  Pharmacy is embedded in multiple areas, including: multiple CBOCs (Community-Based Outpatient Clinics), neurosurgery clinic, PMRS pain clinic and SUD clinic.  This will be an interdisciplinary experience with a great amount of patient interaction, team planning, and collaboration. 


STORM Review Team (longitudinal)

High risk patients are reviewed by a portion of the pain board, including mental health and Pain Clinical Pharmacy Specialists and the PGY2 Pain/Palliative Care residents.  This is a weekly review team and includes collaboration with other Pain Board members and discliplines and provides the resident with the opportunity to develop the skills necessary to evaluate high risk patients and make appropriate recommendations, while collaborating with others.