PGY2 Infectious Disease Pharmacy Residency

Infectious Diseases Services at Renown

Renown Health cares for a wide variety of common and rare infections due to its large catchment area, extensive trauma and oncology services, and Reno-Tahoe being an international tourist destination. The infectious diseases pharmacy team consists of three infectious diseases pharmacists and two PGY2 pharmacy residents each year.  Together they provide pharmacotherapy expertise for infectious diseases consulting physicians and Renown Health Infection Control and Prevention.  They also work in partnership with the Antimicrobial Stewardship Medical Director to provide antimicrobial stewardship services for the health-system.  The infectious diseases pharmacy team at Renown has developed extensive protocols and collaborative practice agreements that allow pharmacists to practice at the top of their licenses.

Four infectious diseases physician groups provide consulting services for Renown Health. They range from private practice to healthcare system-employed to university-based with medical residents and students. While the majority of the consulting groups focus on adults with infectious diseases, we also have one pediatric infectious diseases physician.  The consulting groups rely heavily on Renown’s infectious diseases pharmacists and residents to provide optimal care to patients.

The primary focus of the antimicrobial stewardship program at Renown Health is Renown Regional Medical Center; however, the program extends to Renown South Meadows Medical Center, Rehabilitation Hospital, Medical Group, and Home Care.  Epic Bugsy, an antimicrobial stewardship and infection prevention module in the electronic medical record, helps prioritize daily stewardship activities such as bug-drug mismatch, duplicate therapy, drug-lab mismatch, etc. Handshake stewardship occurs three days a week with the Medical Director.  These rounds are unique because they not only include chart review, but also physical examine and patient interview prior to making recommendations to providers in person.  The team works to educate, empower, and provide pharmacists tools to incorporate antimicrobial stewardship into their daily activities. Additionally, they collaborate with Infection Control and Prevention and Laboratory to align goals and initiatives throughout the organization.

Learning Experiences

Required Learning Experiences:

• Orientation
• Introduction to Infectious Diseases
• ID Consults #1
• ID Consults #2
• Longitudinal experiences
  • Antimicrobial Stewardship
  • South Meadows AMS
  • Ambulatory Care
  • Outpatient Infusion Center
  • Emergency Medicine Culture Follow-up
  • Infectious Diseases On-Call
  • Infection Prevention
  • Infectious Diseases Practice Management
  • Project
    
    

Elective Learning Experiences:

• Critical Care
• Emergency Medicine Antimicrobial Stewardship
• Pediatric Infectious Diseases
• Internal Medicine
• Oncology
  
  

Learning Experiences and Preceptors

Required Longitudinal Direct Patient Care Learning Experiences

Antimicrobial Stewardship with Kiya Mohadjer, PharmD, BCPS, BCIDP

This experience is designed to provide residents with a comprehensive inpatient antimicrobial stewardship direct patient care experience. The resident will participate and contribute in the antimicrobial stewardship service every other month for the duration of the residency year. There are two major components to this learning experience: pharmacist-driven antimicrobial stewardship and physician-assisted antimicrobial stewardship. The resident is expected to become proficient in both.

South Meadows Antimicrobial Stewardship with Adrienne Desens, PharmD, BCPS

One day a week, every other month, the resident will attend and participate in antimicrobial stewardship rounds at South Meadows Medical Center. South Meadows is a smaller, community hospital in the Renown Health System. The goal of this learning experience is for the resident to learn how to manage an antimicrobial stewardship at a facility that generally has fewer physician and pharmacy resources available than traditional tertiary care medical centers such as Renown Regional

Emergency Department Culture Follow-Up with Heather Townsend, PharmD, BCPS, BCCCP

The staffing service commitment is designed to ensure the resident gains experience and is able to function as an independent staff or clinical pharmacist. The resident will become competent in daily pharmacy operations, distributive functions, and clinical shifts by staffing in the central pharmacy for the first part of the residency year and then transitioning to clinical shifts after successful completion of training for anticoagulation, TPN, kinetics and the internal medicine and infectious diseases learning experiences.

Infectious Diseases On Call with Kiya Mohadjer, PharmD, BCPS, BCIDP

The staffing service commitment is designed to ensure the resident gains experience and is able to function as an independent staff or clinical pharmacist. The resident will become competent in daily pharmacy operations, distributive functions, and clinical shifts by staffing in the central pharmacy for the first part of the residency year and then transitioning to clinical shifts after successful completion of training for anticoagulation, TPN, kinetics and the internal.

Ambulatory Care with Adrienne Desens, PharmD, BCPS

The staffing service commitment is designed to ensure the resident gains experience and is able to function as an independent staff or clinical pharmacist. The resident will become competent in daily pharmacy operations, distributive functions, and clinical shifts by staffing in the central pharmacy for the first part of the residency year and then transitioning to clinical shifts after successful completion of training for anticoagulation, TPN, kinetics and the internal.

Outpatient Infusion Center with Ian Ferrari, PharmD, BCPS

The staffing service commitment is designed to ensure the resident gains experience and is able to function as an independent staff or clinical pharmacist. The resident will become competent in daily pharmacy operations, distributive functions, and clinical shifts by staffing in the central pharmacy for the first part of the residency year and then transitioning to clinical shifts after successful completion of training for anticoagulation, TPN, kinetics and the internal.

Required Longitudinal Non-Direct Patient Care Learning Experiences

Infection Prevention with Adrienne Desens, PharmD, BCPS and Courtney Lujan, PharmD, BCPS

Infection Prevention is a longitudinal learning experience designed to focus on preventing and stopping the spread of infections in the healthcare setting.  The resident will become proficient in risk factors, prevention, ongoing process improvement, and education of healthcare associated infections. The resident is expected to participate as an integral member of the multi-disciplinary Infection Prevention team by providing evidence-based medication information, drug information services, and clinical insight to healthcare associated infection cases. This learning experience focuses on identifying opportunities to prevent.  The resident will also spend at least one week with the Infection Prevention Team. 

The primary goal of the learning experience is to develop the administrative (i.e. non-patient care) skills needed to be a successful Infectious Diseases Pharmacy Clinical Specialist. The resident will attend, assist with developing the agenda, and provide content for presentation at the monthly Infection Prevention and Antimicrobial Stewardship Meeting. In addition, journal club will be evaluated on this experience.

Project with Kiya Mohadjer, PharmD, BCPS, BCIDP

The resident is expected to conduct an infectious diseases related research project that is relevant to patient care at Renown Health.  The preceptor must approve any documents prior to them being submitted for approval or publication (i.e. institutional review board, poster presentation, Western States Conference, etc.).  The pharmacy resident is responsible for developing a hypothesis, designing, and implementing the project.  Additionally, the resident will analyze any data collected, present the results, and submit a manuscript for publication.

Required Concentrated Direct Patient Care Learning Experiences (6 weeks each)

Orientation with Jessica Thompson, PharmD, BCPS, BCIDP

The goal of the rotation is to become familiar with the residency program and the organization's policy and procedures, work environment, and coworkers.  Additionally, the resident will be oriented to all longitudinal learning experiences during this time.  It is expected that the resident already has a solid foundation of general clinical pharmacy skills as evidenced by completion of an ASHP accredited PGY1 residency.

Introduction to Infectious Diseases with Kiya Mohadjer, PharmD, BCPS, BCIDP

As the first learning experience specific to infectious diseases, the resident is expected to develop a foundation of common pathogens, antimicrobials, and infectious diseases. The resident will also be introduced to antimicrobial stewardship activities and operations at Renown Regional and South Meadows Medical Centers. In addition, the resident will spend a week in microbiology and a week in infection prevention and control.

Consults #1 with Kiya Mohadjer, PharmD, BCPS, BCIDP

The resident will round with the Renown and UNR Infectious Diseases Consulting groups and gain experience and knowledge of more advanced infectious diseases topics and cases.  The preceptor will model and coach the resident on this experience. The goal is for the resident to build and develop relationships with the infectious diseases consulting physicians and learn how to provide care to more complicated infectious disease states by the preceptor

Consults #2 with Kiya Mohadjer, PharmD, BCPS, BCIDP

Similar to Consults #1, the resident will round with the Renown and UNR Infectious Diseases Consulting groups; however, the resident is now expected to function independently on rounds and provide expert level recommendations to the providers. The preceptor will facilitate the experience and be available for patient case discussion and feedback as needed.

Elective Learning Experiences* (Select 3, 4 weeks each)

Critical Care with Mike Thuyns, PharmD, BCPS, BCCP, BCCCP or Zack Marcus, PharmD, BCCCP

Critical Care is designed to provide a well-rounded experience of intensive care medicine and medical emergencies.  The resident is to focus on the care of adult patients in the intensive care units at Renown Regional (Sierra, Roseview, and/or Tahoe ICUs). The resident is expected to bring their infectious diseases expertise to the multi-disciplinary critical care team. While on rotation the resident is expected be an integral member of a multidisciplinary team by providing evidence-based medication information and applying it to therapeutic approaches. In addition to rounding the resident also assumes responsibility for the patient's medication related care, which include pharmacokinetic antibiotic dosing, anticoagulation dosing and monitoring, and formulating parenteral nutrition solutions. The resident is also expected to precept and mentor pharmacy students and PGY1 residents.

Oncology with Lauren Zion, PharmD, BCPS, BCOP

This learning experience is designed to focus on the care of oncology patients and their medical problems with an emphasis in infectious diseases. Due to the relative complexity of this patient population, it is generally assigned to residents in the second half of the year.  The resident is expected to participate as an integral member of a multi-disciplinary team on the cancer nursing unit by providing evidence-based medication information and therapeutic interventions.  The resident will serve as a pharmacy and infectious diseases resource for the team by providing drug information services and serving as a liaison with any consulting infectious diseases service.  The resident is responsible for all aminoglycoside and vancomycin dosing per pharmacy protocol.  Lastly, the resident will attend at least one tumor board and Beacon meeting, and complete at least one quality improvement project pertaining to the interphase of infectious diseases and oncology pharmacy. 

Pediatric Infectious Diseases with Carol Vollmer-Johnson, PharmD, BCPPS

Pediatrics is designed to focus on the care of pediatric patients and their medical problems with an emphasis in infectious diseases.  The resident is expected to participate as an integral member of a multi-disciplinary team in the PICU and general pediatric floor by providing evidence-based medication information and applying it to therapeutic approaches.  The resident will serve as a pharmacy and ID resource for the team.  The resident will also be responsible for all aminoglycoside and vancomycin dosing per pharmacy protocol in the maternal- child areas.  Lastly, the resident will observe at least one cystic fibrosis clinic during the rotation.

Emergency Department Antimicrobial Stewardship with Heather Townsend, PharmD, BCPS, BCCCP

Throughout this learning experience, the resident will be tasked with developing, implementing, and/or managing an antimicrobial stewardship program focused on the ED.  The ED is uniquely positioned to affect antimicrobial prescribing in both the outpatient and inpatient settings.  In the outpatient setting, it is important to recognize and address increasing rates of antimicrobial resistance throughout the community.  For inpatients, it is well documented that initial antimicrobial use in the ED is imperative for positive patient outcomes and may affect hospitalist prescribing. The goal of this learning experience is for the resident to develop, implement, and/or manage an antimicrobial stewardship program focused on the ED and to develop effective precepting skills.  This experience will run jointly with the Emergency Medicine PGY2 Resident's Antimicrobial Stewardship/Infectious Diseases experience. The Emergency Medicine Resident and Infectious Diseases Resident will co-precept each other for their assigned experiences, with 50% of the time being spent on ID/stewardship, and 50% spent on emergency medicine.

Internal Medicine with Michelle Barcelon, PharmD, BCCP

This elective is designed for residents that may have general medicine responsibilities in their post-residency career.  As such, it is generally assigned to residents in the second half of the year to refresh skills that were obtained during the resident's PGY1 residency.  The experience will be tailored to the needs of the resident but will likely include multi-disciplinary team rounds with a hospitalist, precept pharmacy students and residents, and complete an antimicrobial stewardship related project (new service, medication utilization evaluation, etc), participation in UNR internal medicine morning report.  The resident is expected to bring their expertise in infectious diseases to all aspects of this learning experience. 

*Other elective learning experiences may be developed based on resident interest and preceptor availability.