residency manual - vanderbilt university medical center

1

Pharmacy Postgraduate Year One

Residency Manual 2013 - 2014

Table of Contents

Section I Training Manual Page

1. Purpose and philosophy 2

2. Organization Structure 3

3. Program Goals 4

4. Residency Program Structure 5

5. Benefits 6

6. Verification of Licensure 7

7. Supervision and Work Ethic 7

8. Policy Access 7

9. Required experiences and activities 8-10

10. Tracking Form 11-12

11. Residency Project 13-17

12. Residency Project Worksheet 14

13. Past Residency Project List 16-17

14. Project/Activity Timeline 17

15. Evaluations 19-20

16. Documentation 21

17. Hospital Pharmacy Practice (Staffing) Overview 23-24

18. Self-Assessment Questions 25-26

Section II Schedules / Calendars

1. Evaluation Dates and Residency Council Schedule 27

2. Rotation Schedule (Draft) 28

3. Presentation Calendar 29

4. Orientation Discussion schedule 30-31

5. Orientation Checklist 32-34

6. Orientation Calendar 35

Section III Resident Portfolio

1. Presentations

2. Projects

3. Assignments

4. Evaluations

Section IV On-Call Procedures for 2013 - 14 36-38

2

Pharmacy Practice Residency Program:

Structure

Purpose and Philosophy

Departmental Organization Chart

Program Goals

Program Structure

Benefits

PURPOSE AND PHILOSOPHY

The purpose of this residency is to develop a pharmacist with the skills and abilities

to successfully practice as an acute care pharmacist, adjunct faculty member, and/or

be prepared to pursue and complete PGY2 residency training.

Philosophy

The ASHP accreditation standard provides criteria that every program must meet in

order to receive and maintain accreditation. Although the standard requires

experiences in certain core areas, there is room for concentration in a practice area

and for additional experiences. The mission of our program includes developing a

core skill set in drug information and literature evaluation, pharmacotherapy

evaluation and management, project based research and team functioning,

presentation development and delivery, and direct patient interaction.

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PROGRAM GOALS The residency program will provide each resident with specific learning/practice experiences designed to enable the

resident to expand the scope of his/her practice skills. Outcomes

R1 Manage and improve the medication-use process.

R2 Provide evidence-based, patient-centered medication therapy management with interdisciplinary teams.

R3 Exercise leadership and practice management skills. (Overall Performance and Administration Rotation)

R4 Demonstrate project management skills. (Projects)

R5 Provide medication and practice-related education/training

R6 Utilize medical informatics.

E2 Exercise added leadership and practice management skills.

E6 Provide drug information to health care professionals and/or the public.

E7 Demonstrate additional competencies that contribute to working successfully in the health care environment.

E8 Demonstrate additional competencies that contribute to working successfully in the health care environment (additional)

Patient Care

R2.10 Evaluate patients’ progress and redesign regimens and monitoring plans..

R2.11 Communicate ongoing patient information

R2.12 Document direct patient care activities appropriately.

R2.2 Place practice priority on the delivery of patient-centered care to patients.

R2.3 As appropriate, establish collaborative professional pharmacist-patient relationships.

R2.4 Collect and analyze patient information.

R2.5 When necessary, make and follow up on patient referrals.

R2.6 Design evidence-based therapeutic regimens.

R2.7 Design evidence-based monitoring plans.

R2.8 Recommend or communicate regimens and monitoring plans.

R2.9 Implement regimens and monitoring plans.

Practice Foundation Skills

R1.5 Provide concise, applicable, comprehensive, and timely responses to requests for drug information from patients, health care providers, and the public.

E8.1 Use approaches in all communications that display sensitivity to the cultural and personal characteristics of patients, caregivers, and health care colleagues.

E8.2/7.2 Communicate effectively.

E8.3/7.3 Balance obligations to oneself, relationships, and work in a way that minimizes stress.

E8.4/7.4 Manage time effectively to fulfill practice responsibilities.

R2.1 As appropriate, establish collaborative professional relationships with members of the health care team.

R3.1 Exhibit essential personal skills of a practice leader.

R3.3 Exercise practice leadership.

Practice Management

E1.1 Design, execute, and report results of investigations of pharmacy practice-related issues.

E2.2 Understand the pharmacy procurement process.

E2.6 Understand the process of managing the practice area's human resources.

E6.1* Participate in the organization’s formulary process.

E7.1 Identify a core library, including electronic media, appropriate for a specific practice setting.

E8.5 Make effective use of available software and information systems.

R1.1 Identify opportunities for improvement of the organization’s medication-use system.

R1.2 Design and implement quality improvement changes to the organization’s medication-use system.

R1.3 Prepare and dispense medications following existing standards of practice and the organization’s policies and procedures.

R1.4 Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system.

R3.2 Contribute to departmental leadership and management activities.

R4.1 Conduct practice-related investigations using effective project management skills.

R5.1 Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.

R6.1 Use information technology to make decisions and reduce error.

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STRUCTURE

Orientation (required) Core Rotations (required) Transitional Elective Rotations

(choose 6) Hospital Orientation Residency/RLS Computer Training Hospital Practice

Administration General Internal Medicine Critical Care (pick two) Surgical ICU Trauma ICU Medical ICU Pediatric ICU Nutrition

Hospital Pharmacy Practice Projects ASHP Midyear

Solid Organ Transplant Bone Marrow Transplant General Pediatrics Hematology/Oncology Nutrition Infectious Disease Critical Care Medicine Trauma Burn Surgical Geriatrics Coumadin Clinic HIV/AIDS Cardiology ICU Pediatrics NICU Pediatrics Informatics

Longitudinal (required)

Drug Information P&T MUE Journal Club Case Conference Hospital Pharmacy Practice Staffing (operational and clinical) Residency Project Seminars Therapeutic Exchange CE 60min Residency Project 15-30min Criteria Based Skill Assessments (CBAs)

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BENEFITS

Educational leave Full access to Biomedical Library

Books directly related to the residency (RD approval required) Lab coats are the responsibility of the resident, but

can be purchased through the hospital

15 days paid vacation & sick leave (Flex PTO) Select holidays

Travel & relocation expense directly related (moving company, rental, fuel, hotel) to the move –

up to $1500

Financial support and professional leave for the University of Tennessee

Annual Residency Program, the ASHP MYCM and the Annual Southeastern Residency Conference in Athens, GA

Life insurance Discounts at local merchants

Professional liability insurance supplied by the Medical Center

Limited financial support for presentations at Vanderbilt and outside the campus ( RD approval required) – depends on the

residents activities at the meeting (officer, presentation, etc.)

Health care coverage plan options All ACPE approved continuing education provided by the

Department of Pharmaceutical Services

Payment of Tennessee Board of Pharmacy license fee in June – license fee and professional tax.

We do not pay NABPLEX fees or for reciprocation of license to TN. We will pay for transfer of NABPLEX scores.

Immunizations and other health related costs required by the Medical Center

Photocopying directly related to residency House staff & hospital orientation programs

Office space & computer workstation Competitive stipend

Employee Assistance Program Employee Wellness Program

Concierge Service Membership in professional organizations is the

responsibility of the resident

Purchase of software, books, or other materials must be directly related to the achievement of residency objectives, and must be approved beforehand by the Residency Director.

Explanation of Time Off: Residents (Exempt Status) o Fifteen vacation days are accrued over the course of the year. Ten (10) vacation days are available for

use and must be taken during the year. Each resident must sign up for and take no less than one week of

vacation time prior to January 15 of the residency year. (Residency Director may approve alterations in

certain situations). In general, a maximum of five (5) of the 15 days accrued may be paid out to each

resident at the completion of the residency (these may be used during the year for extraneous

circumstances if deemed appropriate by the Residency Director). Vacation may not be taken during

ASHP Midyear Meeting or SERC meeting days, or scheduled holidays/weekends in the staffing

component of the residency. Vacation requested for June is discouraged and will be reviewed on a case

by case basis by the Residency Director. Residents may not be absent more than 5 days from any

rotation experience (professional leave/personal/vacation) unless approved by the Residency Director.

o Requests for vacation days should be submitted to the Residency Director via electronic mail at least 4

weeks in advance for priority consideration. Requests made after the 4 week cut-off will be handled on a

case-by-case basis in order to ensure appropriate staffing. All requests will receive a response within 2

business days. If for some reason the Residency Director is not available, the responsibility for reviewed

vacation requests will be delegated to the Residency Coordinator.

o 12 Sick Days are accrued over the course of the year. Refer to the hospital/department policy for details.

o Seven (7) Holidays (July 4th

, Labor Day, Thanksgiving Day, Christmas Eve, Christmas Day, New

Year’s Day, Memorial Day) and 3 personal days are accrued over the course of the residency year.

These must be taken. If required to work a holiday, the holiday is to be taken on an alternate day within

30 days of accrual. Residents will agree with rotation preceptor if the resident is to work the actual

holiday or take an alternate day as the holiday. If the resident is scheduled on the pharmacy staffing

schedule for a holiday, that shift prevails. The department also recognizes the day after Thanksgiving

and New Year’s Eve in the department staffing rotation and these are handled and scheduled per

department policy.

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LICENSURE VERIFICATION

Pharmacy licensure in Tennessee is a requirement for pharmacy practice residents at VUMC. The residency

program director will confirm that each resident has taken the NABPLEX and the Tennessee pharmacy law

exam, or will take the Tennessee law exam upon transfer of NABPLEX scores from another state, or already

had a valid Tennessee pharmacy license. Upon notification of successful completion of the NABPLEX and/or

law exam the resident will provide documentation of licensure to the residency program director. The resident

will provide the department the licensure certificate for display during the resident’s year at VUMC. Licensure

must be obtained no later than July 31 of the residency year.

SUPERVISION AND WORK ETHIC

The resident is expected to achieve the objectives of the Residency Program related to both administrative and

professional practice skills. The resident reports to and is supervised by the rotation preceptor and the residency

director. During staffing, the resident is under the supervision of the pharmacist in charge.

Hours of practice vary according to the requirements set forth by the preceptor and director. The resident is

expected to be present in body, mind, and spirit at all assigned activities of the service they are currently a part

of, including medical staff rounding, education classes, and administrative activities. It is not uncommon for the

resident to be assigned duties that require work overnight or that may continue during days away from the

hospital. Although these assignments will be frequent, they will not be beyond the expectations of other

pharmacy professionals’ duties. An eight hour day is a minimum requirement for physical presence on site

during assigned work days.

The work of the Department is the resident’s most important commitment. Working outside the residency

program (moonlighting) is strongly discouraged, particularly at the beginning of the residency. Should posted

time be available inside the Department, the resident will be paid at a competitive staff pharmacist rate. To work

overtime, the resident must be trained in the area. Extra work moonlighting and overtime work must be

approved by the Residency Director, and hours worked will be reported on a monthly basis by each resident.

The ACGME duty hour requirements are to be followed at all times.

Additional Policies Applicable to Pharmacy Residents Should

be reviewed at the following websites:

Vanderbilt Human Resources WebSite: http://hr.vanderbilt.edu/

VUMC Website: http://vumcpolicies.mc.vanderbilt.edu

VUH Pharmacy Residency Policy: http://vumcpolicies.mc.vanderbilt.edu/E-

MANUAL/Hpolicy.nsf/AllDocs/A09FD26D92F6770886257289005AB35F

http://hr.vanderbilt.edu/

http://vumcpolicies.mc.vanderbilt.edu/

http://vumcpolicies.mc.vanderbilt.edu/E-MANUAL/Hpolicy.nsf/AllDocs/A09FD26D92F6770886257289005AB35F

http://vumcpolicies.mc.vanderbilt.edu/E-MANUAL/Hpolicy.nsf/AllDocs/A09FD26D92F6770886257289005AB35F

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Pharmacy Practice Residency:

Activities/Requirements

Residency Experience Synopses

Tracking Form for requirement completion

Residency Project Requirement Overview and Timeline

Residency Project Description Worksheet

Completed Residency Project List (1999-2013)

Suggested Timeline for Requirements Completion

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RESIDENCY EXPERIENCE ACTIVITIES

Out-of-State Conferences:

ASHP Midyear: Usually occurs the first week of December. Residents should start registration process for this meeting in

August.

Southeastern Residency Conference:

This is usually in April or May in Athens, Georgia. Registration begins in January/February and Abstract submission deadline is

usually around February 10. Residents are responsible for meeting these registration deadlines. Residents are to confirm these

deadlines and register in early January. Information for this conference can be found at:

http://www.rx.uga.edu/main/home/ce/programs-and-seminars/serc.asp#dates

Hospital Pharmacy Practice:

The residents will practice in a guided hospital practice scheduled every fourth weekend, selected holidays and one evening per week.

The resident will gain experience in the IV room, Central dispensing area, Narcotic Room procedures, and responsibilities of the

pharmacist in charge as well assist with clinical consults and dashboard monitoring.

Journal Club:

This is a longitudinal activity. Residents will sign up to formally present two current pharmacotherapy related studies during the

residency year. This will include a self-evaluation and a formal evaluation. Resident attendance is required at all sessions. The primary

goal of journal club is to exercise skills in critical thinking and literature evaluation.

Case Conference:

This is a longitudinal activity. Residents will sign up to formally present two case presentations during the residency year. The cases

presented should revolve around pharmacotherapy topics and include primary literature and be a case in which the resident was

directly involved. This will include a self-evaluation and a formal evaluation. PowerPoint is used for this presentation. Resident

attendance is required at all sessions.

Seminars:

Two formal presentations by each resident will be conducted during the residency year:

One of these will be a Therapeutic Exchange slot. This presentation should be a pharmacotherapy topic that includes

some controversy and/or is a hot topic in pharmacotherapy. This is a 60 minute CE presentation. This is not just a

review of a disease state. Primary literature is to be used as a guiding force to put this presentation together. This is to be

prepared and presented with MS Power Point. This will include a self-evaluation and a formal evaluation. Presentation

objectives and Title are to be submitted by July 15th to Gayle Lane. Self-assessment questions (~5 questions for the

audience) will are due by August 1st to Gayle Lane.

The second formal presentation will be a 10-15 minute presentation of the resident’s residency project. This includes

several practice sessions then the formal presentation with feedback/evaluation from preceptors and residents during

practice and attendees at SERC.

These presentations will be presented to the pharmacy department and other guests. Resident attendance is required at all sessions.

Pharmacy and Therapeutics Committee:

Each resident will attend one P&T committee meeting and related subcommittees during the residency year. A drug monograph will

be written and presented during this experience. This will be assigned by the P&T Pharmacist. Drug monographs require review and

presentation of primary literature. A 10 minute power point presentation will be prepared that focuses on the drug’s place in therapy,

with a literature supported comparison and analysis of efficacy, safety and cost of the drug and its competitors. An opinion should be

outlined with recommendation for formulary status. This will be presented to the P&T Committee. As new agents are constantly be

approved by the FDA, monographs will be assigned as they come to the attention of the P&T Committee. A resident will have

approximately 30 days to prepare the monograph once assigned.

Newsletter/Fast Facts:

Each resident will make two (2) Fast Facts contributions to the newsletter.

Research Project:

Each resident will conduct a research project over the course of the residency year. This project will include idea development,

literature review, study design, IRB submission, data collection, data analysis, data interpretation, oral presentation and a written

manuscript. The written manuscript is to include identification of an appropriate journal for potential submission and the following of

the instruction to authors for that journal. The manuscript must be written and submitted in final form prior to completion of

residency. The manuscript must be reviewed by the project mentor(s) and approved by the residency director.

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MUE: Each resident will complete one medication use evaluation during the residency year. These are assigned in the first or second quarter

of the year and depending on the scope of the MUE chosen may be conducted individually or in pairs. Findings are to be summarized

in a 10 minute power point presentation with recommendations of the most appropriate course of action based on the findings to the

P&T Committee and/or appropriate committee.

Recruitment:

Residents will assist in the resident recruitment and candidate selection process.

Therapeutic Exchange:

This is a weekly conference held at noon on Thursdays by the pharmacy department for pharmacists and technicians to obtain

continuing education hours. Attendance by residents is strongly encouraged throughout the year.

Block Rotations:

There are 10 block rotation periods during the PGY1 residency year. Each block rotation period is approximately 4 weeks in duration.

A minimum of 7 of the seven rotation periods must be completed in clinical patient care rotations. All residents must complete the

following four required rotations: administration, internal medicine, two critical care rotations in either surgical or trauma intensive

care. Nutrition can be used for one critical care requirement if desired by the resident. During block rotations, residents will fulfill

many of the clinical core requirements of the residency as well as develop interest areas through selected rotations. Rotation

requirements may vary based on preceptor. Criteria based assessments should be reviewed at the outset of each rotation by resident

and preceptor to assure completion of all requirements by the end of the residency year.

Medical Center Educational Programs:

Noon conferences, departmental grand rounds, and other educational conferences are offered throughout VUMC. These are posted in

the Vanderbilt publications. Residents are encouraged to attend various conferences related to specific rotations.

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RESIDENCY EVALUATION TRACKING FORM

RESIDENT: _________________

(Indicate date of completion in box)

SUMMATIVE EVLAUATIONS

Rotation Period Rotation 1 Rotation 2 Rotation 3 Rotation 4 Rotation 5 Rotation 6 Rotation 7

Preceptor’s Evaluation

Resident Self-Assessment

Preceptor/Rotation Eval

LONGITUDINAL EVALUATIONS

Hospital Practice Quarter 1 Quarter 2 Quarter 3 Quarter 4



Preceptor/Rotation Eval.

Residency Project



Preceptor/Rotation Eval

Training Plan Progress

Residency Council Report

Resident Training Plan Self Assess

PRESENTATIONS

Case Presentations #1 #2



Formal Presentations #1 #2

Therapeutic Exchange/Seminar SERC

Therapeutic Exchange/Seminar Self-Assessment

JOURNAL CLUB/DRUG INFORMATION

Journal Club #1 #2



DI Questions #1 #2 #3 #4 #5 #6

DI Researched Question Eval

Resident Self-Assessment ***Turn in to corresponding preceptor during rotation

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PHARMACEUTICAL CARE/FOUNDATION SKILLS

Drug Therapy or Practice Related Problem Solving #1 #2



Patient Counseling #1 #2



Documentation #1 #2



PROJECTS

Title Proposal IRB Data Collection Presentation Manuscript

MEDICATION USE EVALUATION

Topic Proposal Data Collection Report Presentation

P&T MONOGRAPH

Topic Written Presented Evaluated

Newsletter/Fast Fact

#1 #2

Direct Patient Care

#1

Sterile Product Preparation*

*Per Dept. Competency Procedures

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RESIDENCY PROJECT

A project, administered by the resident and mentored by a primary preceptor, is

required of all residents. The project is to be of benefit to the individual, the

Department, and to the institution. There is to be a significant amount of literature

review, project design, data gathering, statistical evaluation, writing, and reporting

done by the resident. The end product is a presentation at the Southeastern

Residency Conference and a written manuscript suitable for publication in the

pharmacy refereed journal, written in according to the Instructions for Authors of

the American Journal of Health-System Pharmacists or selected journal

requirements. Residency project ideas will be submitted by the Department to the

residents early in the year. Deadlines are set for initial submission of project plans.

Projects must be evaluated for feasibility and approved by the residency director /

research committee before performing the project. One preceptor will be selected

for each project who will act to facilitate the project, mentor the resident, and who

shares responsibility for meeting deadlines, submission of applications for research

(IRB, etc.), presentations and manuscript development and submission. The project

plan submitted should be binding to the resident and to the preceptor(s) involved.

Project designs will be reviewed by the research committee. The committee will

serve as a consultant and advisor for the residency project.

Project Deadline Schedule:

Preceptor ideas due July 10

Project topic/title selected August 23

Study Protocol and data collection form complete October 4

IRB submission completed November 8

Project data collection complete March 5

Data analysis complete April 1

First manuscript draft May 30

Final revisions completed June 16

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Residency Project Description Worksheet

2013-14

_________________________________________________________________

Resident: Project Advisor:

Date of Initiation: Date of Completion:

Responsible Investigators:

Department(s) Involved:

Key Personnel to Obtain Approval From:

Question to be Answered:

Expected Outcomes of the Study:

Rationale for the Study:

Defining Measurements:

Data that will be Collected:

Databases to Study or Create:

Data Analysis:

Description of Results:

Benefit to the Resident:

Benefit to the Department:

Likelihood of Publication:

Commitments: _________________ ____________________ __________

Resident Preceptor Other

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Past Residency Projects 1999 – 2013

Year Resident Title Comment

1998 - 1999 Darryl McGuire, Jr. Evaluation of Empiric Treatment of Community Acquired Pneumonia

*

1999 - 2000 Leigh Black Assessment of Pharmacists Knowledge and Attitudes Regarding Pain Management

* Submitted for publication

D’Andrea Forbish-Skipwith

Study of Dietary Supplement Use Among Medicine Patients

*

2000 2001 Amy Maulsby Potts Preparing and Modeling Pharmacy Analysis Techniques in a Managed Care Plan Physician Order Entry - Vanderbilt Health Systems

* ◊

2001 – 2002 Carly Feldott Pharmacist Involvement in a Managed Care Clinic Setting – A Focus on Asthma Disease Management, Cost Management, and Practitioner Prescribing Patterns

*

Lisa Izlar The Usage of Prophylactic Antibiotics in Coronary Artery Bypass Surgery

*

Kimberly Moyers Pharmaceutical Care in an Epilepsy Clinic *

Jill VonDielingen The Role of Pharmacists in Disease State Management (Diabetes Focus) in a Managed Care Setting

*

2002 – 2003 Marty Baker Reestablishment of an Institutional Antibiogram Phase I: Identifying Trends in Resistance

*◊

Christie Buchanan Pharmaceutical Intervention Improves Efficiency for High Risk Dyslipidemic Patients Compared to Usual Care – Part I

*◊

Lindy Taylor Factors and Issues to Consider in the Assessment of Adverse Drug Events among Hospitalized Patients

*◊ To be published in AJHP

November 2006

Karen Wilson Preventing Medication Errors with Smart Infusion Technology

*◊ Published in AJHP Jan

2004

2003 – 2004 James A. Carr Pharmaceutical Intervention Improves Efficiency for High Risk Dyslipidemic Patients Compared to Usual Care – Part II

*◊☼ To be submitted

Brian Fontenot Development and Implementation of a Pharmacy Discharge Counseling Service for the Patients of Vanderbilt Children’s Hospital

*◊☼

Brandy Greene Vancomycin Utilization Following Computerized Prescriber Order Entry (CPOE) Intervention

*◊☼

Natalie Kittrell Parks Protocol for Diagnosing and Treating Relative Adrenal Insufficiency

*◊☼

2004 - 2005 Paige Fuller Validation of an Innovative Computerized Vancomycin Dosing Nomogram Utilized by a Tertiary Care Teaching Hospital

◊☼

Shivani Patel Complications of Corticosteroid Therapy for Adrenal Insufficiency in Critically Ill Trauma Patients

◊☼*

Hayley Rector Assessment of an Alcohol Withdrawal Prevention Protocol

◊☼*

Katie Smith Glover Appropriate Use of Patient-Controlled Analgesia Infusion Devices

◊☼*

2005 - 2006 Jennifer Gray Effect of Bisphosphonates on Fracture Rates in Renal Transplant Patients

*

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Matt Conley Impact of Pharmacist Interventions on the Medication Use Process

*

Kim Kelly Snodgrass Effects of Sympathetic Blockade on Outcomes in the Acutely Injured Patient

**

Stacie Soja Implementation and Reliability Testing of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in Trauma Patients

**

2006 - 2007 Lindsay Dyer High Dose Antioxidant Therapy in Acutely Injured Trauma Patients

**

Nikki Lokker Lubcke Parents and OTC Medications: Do Literacy and Numeracy Impact Product Use?

**

Mindy Mann Leach Vasopressin Use in Trauma Patients with Severe SIRS **

Kanan Shah Out-of-hospital medication errors: A six-year analysis of the poison control national database

*

2007 - 2008 Erin Bedard Neal Improvement of an Automated ADE Surveillance Tool for Warfarin

*

Alyson Gibson WIlder

Effect Of Subcutaneous Administration Of Insulin Glargine On Insulin Infusion Requirements In Critically Ill Burn Patients

*

Erika Hunt Hasford The Pharmacokinetics of Gamma Glutamyl Cysteine in Rats

*

Jon Aston Vancomycin Failure in Patients with Methicillin-Resistant S. aureus Nosocomial Pneumonia

**

2008 - 2009 Zac Cox Effects of a CPOE Clinical Decision Support Tool on the empiric Dosing and Monitoring of Tobramycin and Amikacin

**

Chris Peryam Antibiotic Administration Timing: Impact of Clinical Decision Support and Barcode Technology

*

Ashley Quintili Pain Control in the Postoperative Patient Population *

Darby Siler Impact of Extended Infusion Piperacillin/tazobactam on susceptibility patterns of gram negative organisms

**

2009 - 2010 Travis Fleming The Effect of Pre-operative Clopidogrel Use on Bleeding Outcomes in Cardiovascular Surgery Patients

*

Monica Hanson Reliability of Preliminary BAL Culture Results in Critically Ill Surgical and Trauma Patients

*

Amy Pennington Myers

Developing a Warfarin Training Program *

Kelli Rumbaugh Acid suppression medications and the risk of hospital acquired pneumonia in ICU patients

*

2010 - 2011 Jon Pouliot The Role of a Computerized Epidural Ordering Advisor in Reducing Administration of Concomitant Inappropriate Medications

*

Allison Palmer Evaluation of a Modified Cefepime Dosing Regimen in ICU Patients

*

Christi Parker The Incidence of Adrenal Insufficiency in Cardiac Surgery Patients Induced with Etomidate

*

Angela Loo Analysis of C. difficile Infection Management at a Tertiary Care Academic Medical Center

*☼◊

2011 - 12 Paul Moore Effects of antioxidant supplementation on the incidence of atrial arrhythmias in trauma patients at a level I trauma center

*

Megan Hames Analysis of empiric antibiotic coverage in neutropenic leukemia patients at a tertiary care, academic medical center

*

Michelle Huber Delirium and pain in the post operative cardiac surgery patient: a retrospective review

*

Jenna Faircloth Evaluation of the efficacy of management for occluded *

17

enteral access

2012 - 13 Emily Bullington Incidence of refeeding syndrome with the initiation and advancement of parenteral nutrition

*

Juliana Kyle Open fracture prophylactic antibiotic protocol compliance and outcomes at an academic level I trauma center.

*

Jeremy Moretz Bleeding and the use of direct thrombin inhibitor anticoagulation in patients listed and evaluated for cardiac transplant.

*

Amory Cox Scott Review of pharmacist impact through a vancomycin pharmacokinetic consult service in an academic medical center

*

*Presented at the Southeastern Residents Conference in Athens, GA

**Published in a medical journal ◊ Presented at the ASHP Residency Poster Presentation ☼ Presented at the UHC Poster Presentation

18

RESIDENT REQUIREMENT/ACTIVITY TIMELINE** (For Guidance Purposes Only; Dates are subject to change based on individual resident goals/assigned tasks) **This may not be all inclusive – watch your residency requirements tracking form!**

July Baseline self-assessment (Entering resident interest and preference information)

Select and Develop 60 minute CE Presentation

Dates for Journal Club, Case Presentation Selected, CE Presentation

August Project topic/preceptor confirmed

Project literature review and bibliography completed and submitted.

MUE topic selected and timeline for completion established.

Register for ASHP Midyear Meeting

September Project design/Methods write-up complete

Project Proposal Presentation –IRB submissions

If taking a poster to MYCM, investigate deadlines for abstract submission

How many Criteria Based Assessments have you completed? Pace yourself!

Evaluate where you stand with longitudinal assignments (P&T Monograph, MUE)

If you have not started your MUE – start now!

October Project Proposal completion and submitting to IRB, establish timeline for project data collection

and analysis etc.

Are you working on your MUE? Just checking!!!

Recruitment Showcases

Case Presentations and Journal Clubs

November MUE timeline established and confirmed.

If taking a poster to MYCM need to complete slide by mid-November.

Recruitment Showcases


Résumé preparation and interview skills

December ASHP Midyear – UHC Posters, showcase

January Register for SERC and Prepare SERC abstract

February Complete and submit SERC abstract

Wind up data collection for project

Case presentations and journal clubs


Are you on track with your MUE?

March Project: begin organizing data – analyze data - results

April Pre-SERC project presentation I, II, III, IV, SERC


May Project manuscript – first draft completed May 15th

June Final Project manuscript due June 15

All Criteria Based Assessment Requirements completed by June 15.

All requirements fulfilled no later than June 20.

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Evaluation Process and Requirements

Evaluation Process Description

Resident Documentation Requirements

20

EVALUATIONS

An essential component of developing the skills of a resident is frequent two-way feedback between residents

and preceptors. The preceptors, program director, and residents will frequently provide feedback to one another via formal

evaluation. Evaluation will occur as described below:

a. Rotation Summative Evaluations: Due no later than 5 days after the end of the previous rotation period (5

business days). This is a written evaluation of the resident’s performances in meeting the objectives of each

rotation. The resident and preceptor will review these evaluations together. The resident will also complete a

preceptor and rotation evaluation and a self-evaluation. Additionally, the resident will complete selected

criteria assessment instrument’s as a self-evaluation to be discussed with appropriate preceptor and/or

program director.

b. Pharmacy Practice Quarterly Evaluation (Staffing/Project): PP is a longitudinal evaluation where a written

evaluation of the resident’s progress is completed. Rotation and preceptor evaluations must also be completed

on a quarterly basis for these experiences.

c. Criteria Based Assessments: evaluations of selected activities will be completed as a self-evaluation as well as

a designated preceptor will evaluate the resident.

Counseling (evaluation preceptor = primary preceptor during that experience)

Documentation (evaluation preceptor = primary preceptor during that experience)

Problem solving (evaluation preceptor = primary preceptor during that experience)

Researched DI Questions (evaluation preceptor = primary preceptor during that experience)

Case Conferences (evaluation preceptor will be assigned)

Journal Club (evaluation preceptor will be assigned)

Therapeutic Exchange (evaluation preceptor will be assigned)

Monograph (evaluation preceptor will be assigned)

d. Residency Council Reports – a written evaluation based on period review by the residency council. This

evaluation examines overall progress, including integration of skills learned in separate rotations, non-rotation

objectives/experiences, progress on longitudinal requirements/rotations (residency project, criteria

assessments etc.) and any pertinent trends or information found in evaluations to that date. This report will

track resident progress by goal quarterly using the 5 point scale established in this programs residency

evaluation system. Progress of the resident’s strengths, weaknesses and career goals will be documented. To

satisfactorily complete the residency, the resident must have shown improvement over the course of the year

in both resident and preceptor scoring. For any goals in which less than a score of 3 is averaged, the resident

and program director will work together to develop individualized plans to assist in making progress in those

areas by residency end. If the resident does not work towards those plans and progress improvement,

residency completion with certificate may be compromised. On a quarterly basis, goals in which the resident

has scored an average of 5 for two consecutive quarters will be removed from further evaluation.

a. Progress on yearly goals/objectives

b. Acute Care progress (rotations)

c. Staffing

d. CBAs

e. Practice Mgmt: Inter-professional communications/relations

f. Practice Mgmt: Professional presentation (verbal communication, dress, style, content)

g. Practice Mgmt: Planning and Organizing/meeting deadlines

h. Enthusiasm/initiative/disposition

i. Status of: scheduled presentations, residency project, MUE, Performance Improvement, drug

information, criteria based assessments, time worked, time off

All evaluations are to be discussed personally between resident and preceptor. All evaluations (rotation summative on

resident, resident on preceptor and resident on rotation overall), CBAs, and self-assessments, should be forwarded to the

resident program director or designee in electronic format. A hard copy should be printed and signed by resident and

evaluator and maintained in the resident’s residency portfolio binder. The electronic database will document the

review by the residency program director.

21

RESIDENT DOCUMENTATION

Each resident will maintain/submit the following documentation:

1. Summative Self-Evaluation (Final Comments section): Required for each rotation, concentrated

experience, longitudinal experience. Due 5 business days after the completion of the previous

Rotation period.

Self -Assessment on progress of goals and objectives assigned to the learning experience.

Summary of how your residency goals and objectives were met/unmet during the rotation period.

Summary of your professional strengths and weaknesses during the rotation period.

As the year progresses, compare to previous time periods and always include what is a focus for

improvement for the next time period as well as what has been achieved.

2. Rotation and Preceptor evaluations will be submitted to the preceptor and then program director or designee

5 business days following the completion of the rotation or designated quarterly evaluation completion

dates. This should be presented to the preceptor the same day that the preceptor presents the block or

longitudinal evaluation to the resident. The preceptor must sign off on this in the evaluation database as

reviewed.

3. Many Criteria Based Assessments (CBAs) are to be initiated by the resident as opportunities are

encountered then evaluated with corresponding preceptor and then forwarded to the program director or

designee. Resident initiated CBAs:

Counseling

Documentation

Problem solving

Drug Information Researched Questions

Case Conferences (evaluation preceptor will be assigned)

Journal Club (evaluation preceptor will be assigned)

Therapeutic Exchange (evaluation preceptor will be assigned)

4. A record of interventions is to be compiled on an ongoing basis. Many preceptors request a list of these

pertaining to the rotation as part of the rotation summative evaluation.

5. Each resident will compile a residency notebook for the year to include: The contents is to include

suggestions/edits/drafts/final copies as worked on between resident and preceptor(s) as well.

1. Documents described above

2. All evaluations

3. In-services presented (handouts and outlines, slides)

4. Cases presented

5. Any education programs presented

6. MUEs, monographs, reports etc.

7. Written projects or proposals

*The contents of the residency notebook serve as documentation of activities completed during the residency

year. The residency yearbook is a permanent record which is the property of Vanderbilt University Medical

Center.*

22


Longitudinal Rotation Experience Descriptions

Hospital Pharmacy Practice (Staffing)

23

HOSPITAL PHARMACY PRACTICE (STAFFING)

(This is a guideline and will be dependent on staffing location assignment)

Expectations for Residents in First Quarter – Staffing Assignment

Orient to the Central Pharmacy and learn the procedures of both the unit dose area and the sterile

products preparation areas.

Adjust to the scheduling assignments and focus on being present and ready to work in the assigned area

at the assigned time. Stay in the work area during your entire shift and be available to focus on the work

at hand. Observe appropriate break time such as 30 minutes for lunch breaks. Learn to indicate any

scheduling adjustments on the posted pharmacist schedule such as swaps in assignments

Develop an understanding of the systems and processes and develop skills such as with CPOE order

processing (“VOP”).

Develop relationships with the Central Area team. Be careful to ask a more senior pharmacist before

making changes to work processes. Follow the established dress code and other workplace policies. Be

sensitive to the needs of the other staff in the area and do not routinely ask to leave early. Make sure that

work is caught up prior to leaving your assignment.

Begin to develop a broader view of the work place and rotate among the various stations (AcuDose

check or cart check, extemp prep, packaging machine, phones, tube station, IV Room, etc.) in order to

maintain and effective work flow and efficiency level.

Learn to collaborate with other staff members shift regarding work flow issues or whenever time may

become available to work on projects but remain available to return your focus to the work at hand

whenever workload increases.

Remain flexible and ask questions.

Work on Clinical Dashboards.

Once initial training is complete, primary assignment will be in the Unit Dose area.

Resident will check in with the pharmacist and technician mentors at the end of each weekend shift to

see if there are suggestions for improvement. If mentors are not working on the same weekend, resident

will check in with their mentors at the next available opportunity to discuss any questions.

Expectations for Residents in Second Quarter – Staffing Assignment

Demonstrate proficiency in all areas of the Central Pharmacy.

Demonstrate proficiency with systems and processes and manage the established levels of efficiency.

Demonstrate a broad view of the work place and rotate among the various stations maintaining effective

work flow and efficiency.

Primary assignment will be to float between the IV Room and Unit Dose areas

Work on Clinical Dashboards




Expectations for Residents in Third Quarter – Staffing Assignment

As above with more autonomy

Responsible for Clinical Dashboards

Expectations for Residents in Fourth Quarter – Staffing Assignment

Begin training in the Junior Pharmacist in Charge (PIC) role

24

The resident (junior) and the normal (senior) management person on the weekend will both be

designated as PIC. These two persons will work together to manage the personnel and workflow. The

normal management person can help teach the resident how to solve problems that arise during a shift.

The resident will not be in the float position unless scheduling dictates this as a need. However, part of

being PIC includes assessing both the unit dose and IV areas and helping in all areas.

The resident has an increased responsibility to keep in touch with the workflow and employees during

the shift. The resident should assure all work has been completed for the shift prior to approving anyone

to leave early (then check with the lead tech and check who is working in an overtime slot to help with

these decisions).

Communicate end of shift issues to the unit dose area evening pharmacist prior to leaving.

Personnel conflicts, staffing problems, catastrophes, occupational health issues will defer to the senior

management person designated for the weekend.




Continued responsibility of Clinical Dashboards

Expectations for Mentors

Check in with residents at the end of each weekend workday or as soon as possible after their weekend

to work to discuss their staffing and PIC roles and answer any questions that arise.

Observe and obtain direct feedback from pharmacists directly staffing with the residents during their

staffing and PIC roles and offer tips and suggestions for improvement.

Provide feedback to the resident from other staff members as appropriate regarding their work

performance.

Prepare the quarterly evaluations for the residents in regard to their overall experiences.

Expectation of Residents

Submit a report of activities learned, accomplishments, problems solved etc. as well as areas in need of

clarification or focus for the next weekend by Monday following your weekend worked.

25

Appendix

26

QUARTERLY RESIDENT TRAINING PLAN

SELF ASSESSMENT ASSISTANCE SHEET

If you want to grow personally and/or professionally you have to take an honest look at where you are before you can decide where

you want to go. A serious self-evaluation is very helpful if done on a regular interval basis. Prepare a summary of how your residency

goals and objectives were met/unmet during the rotation period, what were your professional strengths and weaknesses during the

rotation period and the progress you have made on longitudinal requirements (projects, criteria based assessments etc.) and an

assessment of personal/professional life balance.

The following questions facilitate a positive self-reflection and make the process more effective. These questions will be fuel for

helping you understand how progress is being made and what course corrections are necessary. They also open the door for some

serious career mentoring. You may want to discuss the answers you arrive at, or not. Most importantly, the questions may help you

discover the skills you need to achieve your goals.

Think about these types of questions when completing your progress review form. Use the Assessment FORM to complete this

exercise.

Career

1. What are my desired professional outcomes for the next year?

2. What are the most significant professional challenges for the next year?

3. What are the most significant professional opportunities for the next 3 to 5 years?

4. Who am I not working well with, and how can I make the relationship better?

5. What issues keep me up at night?

6. What have I learned about myself while working at my job?

7. What would I like to see my hospital modify?

8. What have I learned from my staff/co-workers and from working for my hospital?

9. What will I commit to make me better and to make those around me better?

Personal

1. What are the most valuable achievements/goals I attained in the past 4 months?

2. How can I improve the way I am dealing with the current challenges in my life?

3. What are my most significant personal goals for the next period?

4. What do I need to keep doing?

5. What would I like to change about myself?

6. What are my most significant personal challenges for the next period?

7. How am I treating the most important people in my life?

8. How could I treat the most important people in my life better?

9. How will I add joy to my life in the next period?

10. What do I wish for the future?

Preparing for my next step 1. Would I work better in a large or small organization?

2. Do I prefer working in a team environment or on my own?

3. Am I more comfortable following than leading?

4. Do I prefer to analyze situations and projects over actual implementation of an action plan?

5. Do I prefer to work with people or things?

6. How do I work under pressure?

7. Am I a good planner or idea person?

8. Am I a good listener?

9. Am I able to think quickly and articulate myself “on the spot”?

10. Am I able to make decisions in a timely manner?

11. Do I express myself well verbally and in writing?

12. What characteristics do I admire in others?

13. What do I enjoy most about my major?

14. What aspects of my current job do I enjoy? What do I dislike?

15. In the next five years what would I like to accomplish?

16. What level of responsibility do I hope to reach in the future?

17. How will I achieve my career goals? What skills, knowledge, and experience do I need?

28

@ Warfarin Sentri 7 back-up only for anticoag pharmacist; # Aminoglycoside Sentri 7 daily check at 2:30 to wrap-up non-covered patients. * Vancomycin Sentri 7 daily check at 2:30to wrap-up non

non-covered patients when TDM pharmacist unavailable. The @, #, and * residents will work together if necessary to complete the dashboards. If one of the residents is off, the other will check both

dashboards. On-call resident and Backup On Call Pharmacist covers when both preceptors and both residents are out.

Andy Bodiford

Jason Tomichek

Jennifer Hale

Meghan Caylor

Megan Perry Sarah Baggett PGY2 CC Jeremy Moretz

Juliana Kyle Anuj Thirwani Will Walker Megan Bodge

Liver 7/1- 10/4

Aug Heme/Onc-Jon

Card@ Med* MICU TICU SICU# HF Clin Systems LU/Acad Hematology

Sept Card@ Nutrition ID# TICU* Admin SOT HF Phm Systems Phm Systems

Pediatric BMT (Elective)

Oct TICU# MICU* NICU Cards@ Nutrition

Gen Peds CV surgery

Heart/Lung 10/7 – 1/17

ID Clin Rotation

Data Stds Intergrat

IDS (Elective)

Nov NICU Informatics Nutrition* Admin Cards@ ID# MCS CDS CDS Medical Oncology

Dec Project Month / Midyear Project Research

Project EP/Project

Jan MICU@ Admin SICU Med* ID# HIV- Outpt TICU

Renal/Panc 1/20 – 4/25

Data Mngt Data Mngt Pain/Symptom Management

Feb Med ID# SOT SICU* MICU@ Admin Cards Txplnt

Med Safety Med Safety Elective

Mar HemeOnc/BMT

Med* Cards@ ID# HemeOnc Mahsa

MICU CV Stepdown

CDS II CDS II ID Transplant

April HIV-Outpt TICU@ HemeOnc Jon

Nutrition SICU# Med* MICU

Txpant ID

4/28 – 6/30

Tech Concepts Med Safety II

Adult BMT

May Admin SICU MICU* SOT Med #1@ TICU# CV surgery AdminRx Vendor

LU Drug Info Clinic

June ID# Gen Peds Admin Gen Peds Med #2* Cards@ MCS Amb Care Elective Elective

29

Resident Presentation Series 2013-2014 Draft

PCR 12-1:00

Journal Club Resident Evaluator

August 27 Juliana Kyle

September 10 Megan Bodge Megan Hames

September 24

October 8

October 22

November 5

January 14

February 4

Feb 25

Mar 4

Mar 25

April 1

Apr 15 Jeremy Moretz Dan Johnson

May 6 Megan Bodge Mahsa Talbott

Case Conference Resident Evaluator

September 17 Jeremy Moretz Dan Johnson

September 17

October 15

October 15

November 19 Susan Hamblin

November 19 Megan Bodge Jon Aston

January 21

January 21

February 18

February 18 Juliana Kyle

March 18

March 18

April 8 Juliana Kyle Stefanie Bala

April 8

May 20

May 20

Therapeutic Exchange Resident Evaluator

August 22

August 29

September 5

September 12

September 19

September 26

Oct 3 Juliana Kyle Jennifer Gray

Oct 10 Jeremy Moretz Dan Johnson

Oct 17

June 5 Megan Bodge Research Preceptor

30

Orientation- First Week

Items you will need July 1:

Bring Car Registration; License Plate Number

Bring 2 forms of ID (Drivers License, Passport, Birth Certificate)

Copy of current Immunizations

Check book: cancelled check if you would like direct deposit; check to order lab coats

Pen

Monday, July 1 (Wear Walking Shoes; Picture will also be taken this day)

Tuesday, July 2

Wednesday, July 3

Time Activity

8:00 am-10 am Meet Gayle Lane (VUH B131) for pictures Name Badges (Pictures Again)

Distribute Computer access codes

Keys to office

Parking sign up (bring car registration)

Pagers

Take Website Pictures

10 am-1050 am David Gregory— Department and Residency Policy Review

11 am-12:30 pm Lunch and Tour - David Gregory, Gayle Lane

12:30 to 3:30 pm Meet with David (PCR B130 VUH) Write a brief biosketch each to be sent with picture and be posted on website

Complete Interest Inventory/Learning plan/Goals

Review Orientation Schedule

Staffing Orientation schedule and checklist

Time Activity

8-9 BLS Pre-work (for tomorrow) Here are a few details to help you prepare for class schedule for tomorrow, 7/3 @8 am: • It is imperative that you come prepared.

• Per American Heart Association guidelines, students will have 2 attempts at each testing station (1 written exam, 3 skills

tests). You must repeat the whole course if unable to pass each test within 2 attempts. • A BLS study guide is available on our website www.vanderbiltcpr.com.

• Visit our website www.vanderbiltcpr.comfor a map and directions to our office. We have a hard location to find so please

print and use the map.

• The course is scheduled to last 3.5 hours. Please make plans to be available for the duration of the course.

9-12 N Additional Orientation (PCR B130 VUH) Veritas/Medication Safety – Carly Feldott (9:00)

Distribute Residency Manuals (David Gregory)

Review Rotation Schedules (David Gregory)

12 to 1 pm Lunch on Own

1 - 3 RLS Overview- David Gregory

3-5 Citi Training (On your Own)- or complete BLS Prework

Time Activity

8:11:30 am BLS Training

11:30-12:30 Lunch on Your Own

12:30-1 Check in with David

1-3:30 Eskind Library Orientation (David or Gayle will walk you here)

http://www.vanderbiltcpr.com/

http://www.vanderbiltcpr.com/

31

Thursday, July 4th

Holiday OFF

Friday, July 5

July 8th

Hospital Orientation: You Make a Difference 8:00-4:15

July 9th

Hospital Orientation: Hearts & Minds 8:00-4:15

July 10th

and 11th

Computer Training with Philip Stewart

July 12th

: Presentation and Other Residency Requirements with Erin Neal

July 15th

– July 24th Operational Staffing Hands-On Training (Molly Knostman)

July 25th to July 31st Clinical and Resident Responsibilities Hands-On Training

Time Activity

8-11 am Quantifi, Med Use Policy, Monograph, MUE, TE Expectations (Bob)

11-12:30 Ken Sinclair- Department Compliance –Annual Requirements (PCR B130

12:30-1:30 Lunch

1:30- 4:30 Work on Your Therapeutic Exchange or Complete CitiTraining

32

Pharmacy Resident

Orientation Checklist

2013-2014

Central Pharmacy

Orientation Checklist Orientation Items Resident Initials Trainer Initials Date Reviewed

General Daily work flow Unit Dose Area Times and associated tasks

Review Pharmacist Shift slots and associated duties Pharmacist in charge IV/Central UD Float Central UD IV/TPN

Review how to read/interpret staffing schedule

Review daily Technician slots and associated responsibilities

Procurement Process Storeroom Staff Storeroom Responsibilities Storage locations: walk in fridge, storeroom, Med Carousels, PakPlus room Over fill cart, IV/TPN room

Med Carousel/Connect Rx Process Log In code given Pull on demand pick Review of AcuDose/Cartfill Process Pharmacist Scan process Acceptance of AcuDose zones

AcuDose Fill Process AcuDose Orientation with Frank Ray Checking AcuDose Doses AcuDose Log-in and Filling AcuDose Machines Narcotic Check in Narcotic Room

Medication Error Recording Process in the Central Area Internal Errors External Errors

Narcotic Room Procedures CII Safe Log-in and orientation with Charity Prater Checking process Discrepancy resolution Narcotic orders attachment in HMM (patient specific)

Cart Fill Process Pull process from Med Carousel Check Process Catch-up Doses Delivery of meds to patient specific med drawers

Look alike – Sound alike medications

Extemp Process Set up/Filling Process Checking Process

Non-Sterile Compounding area Orientation to Area What type of products made Who to ask if questions PCCA

Order Processing (Vopping) in Central Areas Central order processes for What to send to the ED

Resident:________________

33

How to Clarify an order (resident pager list/operator)

Crash Carts 6 month expiration Red Locks Charges ED Trays

Specific References: Psych book, IV reference manual etc. Blood Factor book, Clozaril, MSDS, etc.

Borrow/Loan policy and procedures

Unit dose packaging TadPoles Bar coding Responsibilities of Pharmacy Unit Dose Packaging Options How to check items in Pak Plus

Tube system policy and procedures Tube System Competency Check List

*Outpatient prescriptions, Stallworth and Psych Hospital Procedures on weekends (cover on first weekend)

IV/TPN/IDS Room Orientation Checklist Orientation Items Resident Initials Trainer Initials Date Reviewed

General workflow and distribution of responsibilities amongst pharmacists and technicians

How to find things in the IV room

IV preparation policy and procedures Set up of IV Preparations and Batches Reconstitution of vials Preparation of syringes, PB, LVP and checking these Storage of medications prior to delivery Delivery Schedule

Sterile products preparation check off

Call for medications

Review of how we meet USP 797

Latex allergy policy and procedures

Review of IV resources: how to determine compatibilities, expirations, Vandy IV manual, IV room website , latex website

Narcotic Preparation and wastage Log sheets Wastage record Record of RX number in patient maintenance

Standard Time Schedules

Investigational Drug Area

TPN Area

Outpatient Areas Orientation Checklist Orientation Items Resident Initials Trainer Initials Date Reviewed

Review of what and where all outpatient pharmacy services are located, hours, key persons

**Indigent Med Program: policy and procedures – please learn the process of who is eligible, what the policy is, how patients are approved, how much medication can be dispensed.

34

**Sample pharmacy: policy and procedures, location, products available, how it works, who pays for it, and why we offer this service, how to look up formulary for this

Process for prior authorization etc. of high cost drugs and our policy/procedure for handling these (identify main agents etc.)

How we manage the purchase, distribution and charging of medications used in the clinics Medicare/TNcare issues What are the toughest problems in clinic medication reimbursement

Coumadin Clinic – Tommy and Suzanne **Who is serviced/eligible **How to enroll a patient (Starpanel) – please walk the resident through the Starpanel process How information is communicated/documented Policy and Procedures/Protocol CC follows Staff involved in clinic Standards of care in regards to anticoagulation History of the service at Vanderbilt Credentials involved and structure of providing this service Quality assurance/improvement in this area

Order Processing: Orientation Checklist Orientation Items Resident Initials Trainer Initials Date Reviewed

Orient to satellites Locations Areas serviced by each Hours

Order clarifications

Work flow

Pharmacist and technician responsibilities

Adverse Drug Reaction reporting , Medication Error reporting

Customer Service Focus

Intervention Documentation

Telephone Courtesy/Etiquette

IV medication administration policy and chart

Meds/Devices brought from home

PCA Pump Policy

DI Resources: Micromedex, Lexi-Comp, Kings, Facts & Comp, Up to Date, Trissell’s, Pubmed

Alaris GuardRails for IV pumps

How to use phone and beeper system

Dashboards (Will do with Blair, Pratish, and Erin ) Orientation Items Resident Initials Trainer Initials Date Reviewed

Warfarin

Aminoglycoside

Heparin

Consults

36

VUH PGY1 Pharmacy Resident On-Call and Weekend Staffing Responsibilities On-Call/Drug Information Pager: 835-0687

Kinetics Consult Pager: 831-6560

** PGY1 Pharmacy Residents work on site at VUH every 3rd

weekend. Weekend duties will alternate between Weekend Staffing and Clinical On-Call roles every 3 weeks. Each weekend there will be two residents on site

- one serving in the Weekend Staffing role, and the other in the Clinical On-Call role. **

Definitions: Weekend Staffing Resident— performs operational staffing role

On Call Resident (Clinical on Call)--performs mostly clinical functions (some staffing)

Monday- Friday Saturday, Sunday

7:00 am Weekend Staffing Resident staffs

from 7 am- 3:30 pm.

8:00 am On Call Resident rolls the DI pager to their

personal pager on Monday (24 hrs/day) until

the next Monday at 8 am.

11:30 am On Call Resident assists with clinical

responsibilities from 11:30am-3:30pm (unless transition time is adjusted based on the

clinical workload and on a collaborative

decision made by the lead clinical pharmacist

and the pharmacist in charge in Central)

3:30 pm Fridays:

On Call Resident staffs from 3:30-7 pm

On Call Resident rolls the PK pager to

their personal pager and responds to any

new consults and follows up with any

consults if requested to do so by clinical

specialists.

On Call Resident staffs from 3:30 pm-

7 pm.

4:00pm On Call Resident rolls the PK pager to their

personal pager and responds to any new

consults and follows up with any consults if

requested to do so by clinical specialists.

6:30 pm

11:00 pm See below for specifics

37

VUH Pharmacy PGY1 Resident Weekend Staffing

The weekend staffing responsibilities are meant to provide the resident with longitudinal experience with processing orders,

verifying extemporaneous preparations, answering phone calls, and maintaining effective and efficient work flow. The second half

of the residency year will also incorporate IV Room experience into the weekend staffing responsibilities.

Every 6 weeks, each resident staff in the Pharmacy and perform strictly staffing responsibilities from 7 am to 3:30 pm.

The week following the resident’s staffing weekend, they will receive one half day (4 hours) off on the Monday following

the call weekend. The time off must be taken on Monday or it will be forfeited unless prior approval is received from the

Residency Program Director.

VUH Pharmacy PGY1 Resident Clinical Call

The On-Call Resident (Clinical On-Call) provides a resource to help with pharmacy consults (kinetics, etc.) after regular business

hours and on weekends and also with drug information questions 24/7 for one-week every 6 weeks. When residents are not available

(orientation, Midyear, SERC, etc.) the Backup On-Call Clinical Pharmacist will fill this role.

I. On-Call Resident Role on Weekdays (Monday through Friday)

a. Drug Information: At 8 am on Monday morning of the call week, the on-call resident will roll the Drug Information pager

to their personal pager. Calls should be referred to the responsible patient care area Clinical Pharmacist during business

hours unless the Clinical Pharmacist is off. For all other patient care areas and after hours, the on-call resident will be

available to medical, nursing and pharmacy staff for drug information questions as needed.

1. Drug information questions received when Resident is on-site should receive initial follow-up within 15 minutes

of page being received. When off-site, the Resident should respond for initial follow-up within 30 minutes of the

page being received.

2. The Backup On-Call Pharmacist should be contacted if any issues arise or guidance is needed.

3. All drug information calls should be documented on the drug information documentation form.

b. Consults: The Therapeutic Drug Monitoring (TDM) pharmacist (or designee) will manage consults until 4pm on weekdays.

1. At 4 pm Monday through Thursday, the On-call Resident will roll the consult pager to their personal pager.

2. From 4 pm until 11pm each day, when a page is received for a pharmacokinetics consult, the On-call Resident will

ensure that the patient is appropriately dosed and covered until the next morning, when the TDM pharmacist (or

designee) can address the consult.

3. The Backup On-Call Pharmacist should be contacted if any issues arise or guidance is needed.

c. Dashboards: Residents on specific rotations are generally assigned to certain dashboards. The On-call Resident

occasionally covers dashboards for clinical pharmacists and residents during the week when requested to do so due to lack

of adequate coverage.

II. On-Call Resident Role on Weekends

a. Clinical Responsibilities: From 11:30 am to 3:30 pm, the On-call Resident provides support to the lead clinical pharmacist,

who is responsible for the management of weekend clinical functions. From 3:30 pm to 11 pm, the resident is still

responsible (as on weekdays) for new consults and any levels returning that evening which the clinical lead pharmacist has

asked them to address.

1. Consults:

i. On Friday afternoon the on-call resident will roll the kinetics pager to their personal pager at 3:30 pm.

ii. On Saturday and Sunday, the lead clinical pharmacist should roll the consult pager to their personal pager

from 7 am until 3:30 pm, when it can then be rolled to the on-call resident. The on-call resident will

respond to consults via the kinetics pager from 3:30 pm to 11 pm on Friday, Saturday and Sunday.

iii. The Backup On-Call Pharmacist should be contacted if any issues arise or guidance is needed.

38

2. Dashboards: Weekend dashboard responsibilities include the aminoglycoside, vancomycin and anticoagulation

alerts in the “Weekend” tab of the dashboard. These responsibilities are generally shared between clinical

pharmacists and resident and will be delegated by the lead clinical pharmacist.

3. Drug Information: The On-call Resident will be available to medical, nursing and pharmacy staff for drug

information questions 24/7 as needed.

i. Drug information questions received when Resident is on-site should receive initial follow-up within 15

minutes of page being received. When off-site, the Resident should respond for initial follow-up within

30 minutes of the page being received.

ii. The Backup On-Call Pharmacist should be contacted if any issues arise or guidance is needed.

i. All drug information calls should be documented on the drug information documentation form.

b. Staffing Responsibilities: The on-call resident will transition from clinical to staffing duties from 3:30 pm to 7 pm on

Saturday and Sunday. Based on the clinical workload and on a collaborative decision made by the lead clinical pharmacist

and the pharmacist in charge in Central, the on-call resident may need to remain focused on clinical responsibilities beyond

the 3:30 pm transition time. The Resident will, at a minimum, cover for meal breaks in the Central Pharmacy. After 7 pm,

the resident is free to leave after any remaining dashboards activities are completed.

III. Backup to On-Call Resident Role

The Backup On-Call Pharmacist provides oversight and guidance to the on-call resident when needed. The Backup Clinical

Pharmacist should be readily available to the on-call resident 24/7 during the call week via pager or phone. The Backup On-Call

Pharmacist serves as a preceptor for the on-call function and mentors each resident to the appropriate level that is individualized to

each resident. When residents are not available (orientation, Midyear, resident conferences, etc.), a Clinical Pharmacist will perform

the on-call responsibilities but will not work additional weekends.

IV. Other Key Clinical Call Points

Residents may swap call weeks with each other. The Backup On-Call Pharmacist for the weeks involved and Molly

Knostman should be notified when this occurs.

The on-call resident is not required to come in on unassigned holidays.

Transplant consults and drug information questions should always be directed to or discussed with the respective transplant

pharmacist.

o Liver Transplant: Christie Truscott 615-496-0086

o Renal/Pancreas Transplant: Stefanie Bala 615-587-1340 and TBA

o Heart/Lung Transplant: Jennifer Gray 615-484-3129

o Solid Organ Transplant PGY2 Resident: TBA

If anticoagulation or other consults are received by the on-call resident, they should ensure the patient is appropriately

managed until the next morning, when the inpatient anticoagulation or other pharmacist can address the consult.

From 4 pm to 11 pm (3:30 pm to 11 pm on Friday, Saturday and Sunday), the on-call resident is not responsible for writing

consult notes in StarPanel. They should amend the consult request to acknowledge the consult, note any immediate changes

that are made to the patient’s therapy, and state that pharmacy will be following and a consult note will be written the

following day. If it is an existing consult patient, the on-call resident may need to amend an existing consult note if

requested to do so by a Clinical Pharmacist when following up on that patient after hours for that Clinical Pharmacist.

Pages received from the PREDICT program go to voice mail in the 5-GENE mailbox. To access the voice mail, call 936-

0000 and press the # key. Enter the mailbox # of 54363 and the password of 543631. Messages should be responded to

within 1 business day.

The week following the resident’s call week and weekend, they will receive one half day (4 hours) off on the Monday

following the call weekend. The time off must be taken on Monday or it will be forfeited unless prior approval is received

from the Residency Program Director.

If the on-call resident receives a consult for drugs other than vancomycin, an aminoglycoside, or warfarin, they should

contact the Backup On-Call Pharmacist for advice on how to proceed if they are unsure.