Staffing Requirement

The residency encourages the resident to become independent and excel in ability by serving as a contributing staff member. The structure includes one 12-hour shift, one weekend a month and one holiday serving as the sole pharmacist.

Professional Meetings and Travel

Residents have the opportunity to attend at least two regional or national meetings, which most commonly include Midyear Clinical Meeting and Texas Society of Health-System Pharmacist, ALCALDE Conference.

Rotation Descriptions

Month long and longitudinal rotations that encompass both required and elective rotations.

A.    Family Practice

• The focus of the rotation is to develop communication skills with providers, nurses and patients and combine all skills learned during the residency to help patients and providers in Family Practice. Many patients have multiple disease states and this provides the resident the opportunity to evaluate patients as a whole on an outpatient basis. The resident will process orders, counsel patients, renew chronic medications and complete medication reconciliations with each patient. The resident will be available for providers to ask questions on treatment options, dosing and formulary options. There is the option to shadow providers during patient appointments and spend time with nursing case managers to get a full experience of the clinic and its operations.

B.    Outpatient Pharmacy

• The resident will focus on the procedures and operations of the Chickasaw Nation Medical Center Outpatient Pharmacy and Outlying Clinic Pharmacies. Staffing responsibilities include verifying medication orders, counseling patients on new medications, supervising technicians and clerks, and evaluating appropriateness of drug therapy or monitoring, site visit projects and observation. The resident should be able to independently staff in the outpatient pharmacy by the end of this learning experience. 

C.    Leadership and Management

• The resident will have involvement with leadership development opportunities and fundamentals of leadership through a yearlong longitudinal experience. The longitudinal leadership opportunity allows the resident to participate in topics ranging from Joint Commission Accreditation, strategic planning, medication use system and human resources. During this rotation, the resident will meet with the Chickasaw Nation Pharmacy Director one-on-one to discuss topics directly affecting the pharmacy department and develop ideas and possible solutions that will have an immediate impact on the department.

D.    Lipid and Anticoagulation Management Services

• The resident will learn to manage patients in both the anticoagulation (AMS) and lipid clinics based on current protocol and guidelines. Both the lipid clinic and AMS clinic operate Monday through Friday, averaging five patients and 20 patients, respectively. Activities will include performing finger sticks and operating the CoaguChek device for AMS clinic, ordering and monitoring labs for lipid clinic, ordering appropriate medications and documenting in the patient chart. Resident will also assist in precepting Advanced Pharmacy Practice Experience (APPE) students.

E.    Diabetes-Decentralized

• This rotation expands the outpatient pharmacy experience by allowing the resident to be responsible for processing prescriptions and counseling patients with diabetes and other endocrine conditions. The resident will also provide diabetes education in both group settings and one-on-one settings. This education will include medication information, lifestyle modifications, proper injection technique, monitoring, managing hypo/hyperglycemia and other topics as necessary. The resident will collaborate with many other health care professionals (providers, nurses, nutritionists, exercise physiologists, dental hygienists, etc.) to provide total care for Chickasaw Nation Department of Health (CNDH) patients with diabetes.

F.    Clinical Pharmacy Informatics

• The resident will learn about the field of informatics and how it relates to the management of pharmacy operations within the Chickasaw Nation. The resident will be introduced to multiple operating systems and databases, including: Resource and Patient Management System (RPMS), Electronic Health Record (EHR), VA FileMan, Visit Genereal Retrieval (VGRN)/Patient General Retrieval (PGEN), Pyxis and Becton Dickinson (BD) Carefusion software. Additionally, the resident will become acquainted with EHR note templates, data objects and medication quick orders. This longitudinal rotation occurs at least once a month throughout the residency year and include projects for the resident to complete.

G.    Inpatient Pharmacy

• The resident will learn to deliver optimal medication therapy outcomes for patients with various disease states. The resident will utilize policies and protocols established by the Chickasaw Nation Department of Health to provide responsible, pharmaceutical care for patients in the Medical/Surgical, OB/GYN and ICU settings. The resident will attend daily morning rounds and provide drug information as needed to providers. Chart review and analysis of patient data will be required for proper patient medication management. The resident will execute functions involving antibiotics, pharmacokinetics, pain management, parenteral nutrition and anticoagulation. Patient medication reconciliation, referrals and discharge counseling will be performed daily.

H.    Infectious Disease (ID)

• The ID rotation will broaden the resident’s understanding of infectious disease and the pharmacotherapy related to the treatment of such diseases. The resident will learn to pharmacokinetically dose the antibiotics that we have protocols in place for and monitor these antibiotics appropriately. Activities will also include the monitoring of patient lab parameters, cultures/sensitivities, responses and appropriateness.

I.    Project Management/Staffing

• A longitudinal project will be required by the resident. Examples of previous resident projects are: implementation of a transition of care pharmacy process in attempt to reduce readmissions for high risk patients, retrospective analysis of an over-the-counter fish oil product versus Lovaza for lipid clinic patients, and procalcitonin monitoring protocol for patients admitted with lower respiratory tract infections. Staffing requirements for the resident will be one weekend per month, one 12-hour shift per month and one holiday where the resident will be the sole pharmacist.

J.    Emergency Department (ED)-Decentralized

• The resident will spend most of their time providing discharge counseling for patients leaving the emergency department. The resident will work in the provider room with providers and have opportunities to answer drug information requests and make recommendations. The resident will also witness events (e.g. Codes, mock disasters) that occur in the emergency department during the rotation.

K.    Outlying Clinics

• This is an elective learning experience that focuses on the procedures and operations of the Chickasaw Nation Health System (CNHS) Outlying Clinic Pharmacies. Staffing in these clinics provide the resident an opportunity to observe the difference between working at an institution and operating in a smaller facility. This will also allow the resident to work in a pharmacy-based clinic that is not currently offered at Chickasaw Nation Medical Center, the Hypertension Medication Management Services (Hypertension Clinic). Some of the responsibilities will include verifying medication orders, counseling patients on new medications, supervising technicians and clerks, evaluating appropriateness of drug therapy or monitoring, discussion with senior site members, staffing pharmacy-based clinics, and developing relationships with other health care providers in the clinics.