2016-2017 PGY1 Pharmacy Residency Manual€¦ · 2016-2017 PGY1 Pharmacy Residency Manual ... A...

revised 2/9/2017

2016-2017

PGY1 Pharmacy Residency Manual

Community Regional Medical Center Department of Pharmacy Services

Fresno, California

revised 2/9/2017

TABLE OF CONTENTS

Topic Page Number

Section A Residency Requirements

3-6

Section B Residency Program General Information

Teaching Responsibilities Evaluation Policies and Procedures

Disciplinary Action Policies and Procedures Process / Timeline

Responsibilities and Expectations General Information

7 7-9 10 11

12-13 13-14

Section E Rotation Learning Descriptions -

Goals, Objectives and Expectations: Administration

Ambulatory Care Critical Care-Burn/Surgical, Medicine, Trauma

Neonatal Intensive Care Unit Emergency Medicine

Infectious Diseases (under revision) Internal Medicine Medication Safety

Operations Orientation

Pharmacy Informatics Quality Management / Performance Improvement

Transitions of Care Drug Information - Longitudinal

Research - Longitudinal

15-21 20-25 26-31 32-36 37-42 43-45 46-51 52-53 54-56

57 58-60 61-63 64-70 71-72 73-74

Section F Forms and Guidelines

Guidelines for Journal Club and Case Presentations Evaluations for Journal Club and Case Presentations

Resident Seminar Guidelines List of Proposed Residency Research Projects

Preceptor and Learning Experience Evaluations Chief Resident Responsibilities

75-76 77-78 79-80 81-84 85-86 87-89

Section G Clinical Pharmacy Services

Preceptor Information

89

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SECTION A – RESIDENCY REQUIREMENTS

Orientation Program and Residency meetings A formal orientation program for all residents is scheduled in July of each year. Attendance is mandatory. The orientation is designed to introduce the incoming residents to Community Regional Medical Center (CRMC) Pharmacy Services and to outline the expectations of the residency year. Residents must also attend the University of California, San Francisco (UCSF) Advanced Pharmacy Practice Experiences (APPEs) Preceptor Orientation, in order to serve as a co-preceptor.

Effective Communication Residents are expected to effectively communicate with other health care professionals in all methods of communication (e.g. verbal, phone, written, fax). Residents are expected to write progress notes in the medical record if they cannot reach the health care provider. Residents must give preceptors a minimum of 2 business days (48 hours) to review items. Preceptors may need a longer time frame and it is up to the resident to communicate with the preceptor.

Drug Information / Ask the Pharmacist Residents will become efficient in providing drug information through comprehensive literature searches. Residents will become familiar with various references to expedite information retrieval, including dosing, adverse effects, therapeutic classes and uses, formulary drugs and alternatives to non-formulary drugs. In addition, residents will apply their skills in a service called “Ask the Pharmacist” throughout their residency year. Each resident will take turns answering questions. The Clinical Manager and the Residency Program Director (RPD) are the contact persons for this service. Presentations Residents will participate in Journal Club, Case Presentations (or optional project), and Resident Seminars to enhance presentation skills. A minimum of 3 presentations to the pharmacy department per year is required.

Teaching Residents will be involved in various teaching activities, including in-services for the medical, nursing, and/or pharmacy staff, case presentations, precepting students, and providing continuing education lectures. Precept Pharmacy Students Residents will serve as co-preceptors with faculty members for University of California, San Francisco (UCSF), University of the Pacific (UOP), California Health Sciences University (CHSU), and other school of pharmacy students. Residency Research Project Each resident is expected to complete a research project, during their residency year, designed to improve pharmacy practice. A list of potential research projects will be provided to the residents. The residents can pick a project from the list, or discuss one directly with a preceptor, and submit his/her research proposal to the Residency Program Director, Director of Pharmacy Services and preceptor(s) for approval. All projects must include a cost savings component that must be monitored. At least one preceptor must be chosen as a co-investigator for the project. All projects must be presented at the ASHP Midyear Clinical Meeting Resident Poster Session and Western States Conference, presumed publishable in a peer reviewed journal, and a CRMC PDSA.

Project selection / Scope of projects/ Approval o Each year a list of potential projects will be generated and distributed to the residents for selection.

This will allow all residents an opportunity to review all potential projects. Projects may be submitted by Pharmacy Services staff members, Clinical Pharmacists, Residents, and others, as appropriate.

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o The Residency Preceptors will evaluate all project submissions for appropriateness and feasibility. o Many of the projects will be conducted in support of the CRMC Department of Pharmacy

Services. Residents participating in service projects originating in the Department of Pharmacy Services will follow the policies and procedures of the department.

o Each resident must submit a written research project proposal, which must be signed by the resident and preceptor and handed in to the RPD. An electronic version must also be emailed to the RPD.

Status Reports o Status reports will be emailed before the preceptor and resident meetings each month to the

project preceptor and RPD to be reviewed at the Residency Preceptor Meetings. o The resident will complete a Quarterly longitudinal project evaluation form (E-Value)

Project Completion o The project will be considered complete when the stated objectives have been met. A description

of the results (manuscript) of the project must be written and submitted no later than the final quarterly evaluation (June 10th) before the project is considered complete. A PDSA poster must also be completed by June 10th. Projects must be reviewed before submission by the preceptors / co-investigators. A residency certificate will not be awarded until the project is completed.

Operations All residents must participate in operational activities designed to ensure that residents gain operational experience and understand the distribution process. To achieve this, residents are scheduled approximately 30 hours per month, in the inpatient pharmacy. If a resident misses any days of the operations staffing component due to illness or time off, then they must make up the time. If making a switch, this must be conveyed to the inpatient supervisor and RPD, and ensure all ACGME requirements are upheld -see www.acgme.org The month of December (including ASHP Midyear) and the weekend of CSHP Seminar, October 27-30, 2016 are excluded. Journal Club and Case Presentation Discussions Residents will present one Journal Club (JC) and one Case Presentation (CP) during each Core Clinical rotation. It is mandatory to attend all resident JC and CP. Topics and format are up to the discretion of the preceptor. See the specific guidelines in section F. Residents are encouraged to attend student’s JC and CP, under the discretion of the preceptor. Manuscript for Publication Residents will prepare a manuscript of their Research Project in a format acceptable for publication in a peer reviewed journal. The topic of this manuscript will be determined by the resident and his/her Preceptor/RPD based on the resident's background, experience and goals. Editorial assistance by a preceptor is required. Deadline is June 10th to email this to the RPD. Pharmacy Services Documentation i-Vent Each resident will document his/her daily interventions as i-Vents in Epic. This is extremely important to the program to document a cost savings and improved patient care. A minimum requirement of 125 i-Vents per inpatient clinical rotation is required. IV-to-PO Conversion Residents are responsible for evaluating patients for possible conversion of IV medications to PO, in accordance with the IV-to-PO conversion policies and procedures (e.g. Nexium and Pepcid). This is also documented as an intervention in i-Vents in Epic.

http://www.acgme.org/

revised 2/9/2017

Certification for Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) Each resident is expected to successfully complete the BLS and ACLS curriculum within the first month of the residency. The goal is to ensure the resident is familiar with and capable of providing BLS, in the event of an emergency. ACLS is preferred prior to attending any Critical Care, or Emergency Medicine Rotations. Please access Healthstream Learning Center (HLC) or contact the Education Department to access course materials and information. Resident Meetings Residents will attend mandatory scheduled resident meetings to discuss upcoming resident events, other issues pertaining to the residency program, and actions/recommendations made at preceptor meetings, etc. Meetings will be scheduled by the Chief Resident / RPD on a monthly basis. Recruitment Each resident will assist with the residency recruitment efforts of the department. Each resident is a valuable source of information and advice for potential candidates. These are mandatory.

ASHP: Each resident is required to spend time providing information to interested parties during the ASHP Midyear Clinical Meeting. Residents will staff the residency showcase.

CSHP: Same as above.

Interviews: Time will be scheduled during the interview process for interviewees to interact with current residents. Resident interviews will be 2/1/18 and 2/6/18. Mark your calendars.

Western States Conference- Residents will help staff the recruitment table.

Pharmacy and Therapeutics (P&T) The Chief Resident is required to attend monthly P&T on the 4th Wednesday of each month (location may vary), and disseminate the information to the residents during the monthly resident meetings. Residents are required to attend, write a monograph and present at selected P&T meetings and/or Formulary Subcommittee meetings:

If medication is added to formulary, develop a concise, written summary of the monograph and final formulary decisions for inclusion in physician and pharmacy newsletters.

If medication is added to formulary, assist with implementation of formulary recommendations. This may require development and follow-up of a medication use evaluation, protocol/order set development, pilot trial implementation, optimizing medical informatics and/or developing additional health care provider education.

Contact the Clinical Manager or RPD with any questions.

Other Administrative Meetings Residents are encouraged to attend all meetings that the current preceptor attends. In addition, Residents may choose an additional year-long committee meeting to attend. Please ask RPD for a list. Newsletter Articles Residents will participate in writing for the CRMC Pharmacy Newsletter. A minimum of one Newsletter per year is required. Resident will select topic, with advice from preceptors or the Clinical Manager. Submissions and editing of the Pharmacy Newsletter articles are completed by the Clinical Manager. Residents will each choose a separate month for submission and inform the RPD of the dates. Resident Seminar Each resident will present one formal seminar during the residency program. See Section F for more information. Dates scheduled for presenting are 2/16/17, 2/23/17, and 3/2/17- (from 1600-1800)

Chief Resident Each resident will rotate through this position. See Section F for more details.

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Overtime - Is required to be conveyed to the RPD via email- with the reason why, as soon as it occurs. Please see RPD for more details.

Requirements for the Completion of the Residency Program

Residents are expected to satisfactorily complete all requirements of the CRMC Residency Program as

listed above, adhere to the ASHP Accreditation Standards, and Achieve (score of 5) all of the required

educational Outcomes, Goals and Objectives. Residents who achieve and complete the residency

requirements will receive their Residency Certificate as evidence of program completion.

Evaluation of the resident's progress in completing the requirements is done as part of the rotation and

quarterly evaluation tracking and review process.

The Resident Preceptor, in combination with the Residency Program Director and the Director of

Pharmacy Services, shall assess the ability of the resident to meet the requirements and work with the

resident to assure their satisfactory completion.

Completion of the Resident Research Project, subsequent manuscript, and PDSA.

Fulfillment of essential accountabilities as defined in the Pharmacist Resident Grad Intern Job Description

41561 and Pharmacist Resident Job Description 40741 under the Human Resources policy.

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SECTION B – RESIDENCY PROGRAM GENERAL INFORMATION Residency Program Director (RPD): Alice Robbins, PharmD, BCPS Clinical Manager: Leonard Valdez, PharmD, BCPS Preceptor: Individual assigned to train, educate, and evaluate the resident in their practice area of expertise. Also may serve as a preceptor by lecturing or mentoring special projects.

Teaching Responsibilities Purpose Residents will participate in the teaching activities of the Department of Pharmacy Services. The purpose of such activities is to develop and refine the resident's communication skills, to build confidence, and to promote the effectiveness of the resident as a teacher. Procedure Teaching responsibilities may include clinical and didactic teaching for pharmacy students, medical staff and residents, hospital personnel, and pharmacy departmental staff. All residents act as co-preceptors for UCSF, UOP, CHSU, or other schools of pharmacy students APPE’s (pharmacy student rotations). In addition, teaching activities may involve formal lectures, in-service presentations, or discussion sessions. Specific responsibilities will vary by service.

Residency Evaluation Policies and Procedures Resident’s Self-assessment Evaluation

Each resident will assess his or her progress for the rotation by completing the assigned electronic SELF Midpoint and Summative Evaluation form online at E-Value, 3 days prior to the scheduled evaluation meeting with the preceptor. Written comments exampling the objectives with qualitative comments (How you can improve) are mandatory. This teaches the art of self-reflection and self-assessment.

Resident's Evaluation of Preceptor and Rotation

Each resident will complete a Resident's Evaluation of the Preceptor and Rotation before the end of each rotation. These evaluations will be completed on E-Value.

Preceptor's Evaluation of the Resident’s Rotation Performance

Each Preceptor will review and electronically “sign off” on the resident’s SELF evaluation before completing their evaluation of the resident.

Each preceptor will complete an electronic Midpoint (for 6 week core clinical rotations) and Summative evaluation for each resident with mandatory qualitative comments (How can the resident improve).

The preceptor will review the resident’s self-evaluation, electronically sign off on it within E-Value, and then compare it with the preceptor’s evaluation.

The preceptor will discuss their evaluation with the resident to help improve their future performance and address any discrepancies with the resident’s self-evaluation.

After this discussion, the preceptor will submit the preceptor’s evaluation of the resident.

Residents will electronically “sign off” on the preceptors’ evaluation on their performance.

Evaluations will be completed and submitted on E-Value within 7 days of the scheduled deadlines. The RPD will review each resident’s self-evaluation and Preceptor’s evaluation of the resident and electronically sign off it has been reviewed.

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Quarterly Evaluations

Quarterly Longitudinal Evaluation Process for All Residents

The following longitudinal activities will be evaluated at least once each quarter: Operational Pharmacy Experience, Drug Information, and Residency Research Projects. These are completed by the respective preceptors / evaluators.

Each Preceptor will review and electronically “sign off” on the resident’s SELF evaluation before completing their evaluation of the resident.

Residents will electronically “sign off” on the preceptors’ evaluation on their performance.

Electronic evaluations must be completed on E-Value by the following dates (Subject to change): October 10, January 10, April 10, and June 10. By submitting the evaluation on these dates, the Residency Program Director (RPD) can incorporate these comments into the resident's quarterly evaluation.

Resident Quarterly Progress Report

All residents will complete a quarterly progress tracking report (electronically) detailing their residency activities for the designated time period, and email the report to the RPD.

The report includes progress made toward meeting goals and objectives established at the beginning of the residency year.

The quarterly report should also contain, in chronological order, a summary of the rotations completed by the residents in that quarter. Any comments the resident would like to make regarding their achievements toward these goals should also be included.

Each resident is responsible for performing a self-evaluation on their Longitudinal Experiences on E-Value. This includes the Operational Pharmacy Experience, Drug Information, and Residency Research Projects.

The resident will submit the quarterly progress report to the RPD and the self-evaluations to E-Value by the dates designated below, or as requested. The quarterly progress report will be reviewed by the RPD and applied towards the preparation of the resident's quarterly evaluation. The RPD has the option to add a summary of overall progress.

Residency Program Director Quarterly Evaluations

The RPD will evaluate the resident quarterly based upon the resident's progress and tracking report, and overall residency performance. This evaluation will also take into account the rotation evaluations from prior preceptors. This report will evaluate the progress towards meeting goals and objectives established by the resident and RPD at the start of the residency year.

The quarterly report will be discussed with the resident and electronically signed by both the RPD and the resident.

Resident Quarterly Progress Report and Quarterly Evaluation Submission Dates

Quarter Resident Quarterly Report Submission Date (subject to change) 1st Qtr: July 1 - September 30 October 10 2nd Qtr: October 1 - December 31 January 10 3rd Qtr: January 1 - March 30 April 10 4th Qtr: April 1 - June 30 June 10

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Compliance with the Evaluation Policy

Residents must comply with the evaluation policy. This is essential for the advancement of the resident and the residency program. Failure to comply with this policy will be addressed and may result in disciplinary action by the RPD.

Summary of Residency Evaluation Responsibilities Residents Submit all Electronically (E-Value)

1. Rotation Residency Learning System (RLS)-based self-assessment –Midpoint and Summative. 2. Rotation evaluation of the preceptor and rotation. 3. Quarterly progress report and Quarterly Longitudinal Evaluations on Operations, Drug Information, and

Research Projects.

Preceptors (Submit all Electronically) (E-Value): 1. RLS-based resident rotation evaluations –Midpoint and Summative with qualitative commentary. 2. Case Presentations and Journal Club Evaluations - each preceptor that attends is individually responsible

for completing this on E-Value. 3. Quarterly longitudinal evaluations for those preceptors in: Operations (Student Coordinator), Drug

Information (Clinical Manager), and Research (Preceptor specific). Residency Program Director

1. Quarterly evaluation of resident, tracking progress of all educational goals and objectives. 2. Review and sign off all evaluations

Definition of Evaluation Scores:

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Resident Disciplinary Action Summary Residents are expected to conduct themselves in a professional manner at all times and to follow all relevant CRMC and Residency Program policies. Disciplinary action will be taken if a resident:

Does not follow policies and procedures of CRMC, Department of Pharmacy Services, or Residency Program

Does not present him/herself in a professional manner

Does not earn satisfactory progress on any of the residency goals or objectives

Does not make adequate progress towards the completion of residency requirements (e.g. project, manuscript, lecture, seminar)

Performs gross negligence

Resident Disciplinary Action Policies and Procedures Please see Human Resources Policies and Procedures in Lucidoc

Corrective Action Policy 10005

Enforcement and Discipline 21665

Performance Evaluation 10057: Exempt employees, RN's, LVN's and Pharmacists have an introductory period of 6 months from the date of employment. Failure of an employee to meet acceptable standards of performance and/or behavior during the introductory period will result in termination. Employees in their introductory period are not eligible to utilize the grievance procedure.

Other related and pertinent policies specific to the Residency Program are also found in Lucidoc under:

Human Resources Leave of Absence – Pregnancy Policy 10021

Human Resources Leave of Absence – Personal Leave 21124

Human Resources Family and Medical Leave Act / California Family Rights Act Policy 10045

Human Resources Employee License/Certificate 10037

Resident Guidelines for Leave of Absence 18275

Pharmacist Resident Job Description, Job Code 40741- regarding resident licensure

Pharmacist Resident Grad Intern Job Description, Job Code 41561- regarding resident licensure

Resident Candidate Selection 18273

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Process / Timeline

July

1. Make arrangements for NAPLEX and CPJE exams (if not done already). 2. The resident, in conjunction with his/her potential project preceptor(s), will identify a

research project from the list of possible projects provided to the residents. A written summary of the project's goals, methods, and anticipated impact on services, signed by the project preceptor must be submitted to the residency director by August 1st.

3. Planned “Research Day” where residents get Institutional Review Board (IRB) training. June 30th, UCSF building, room TBD from 10:30 - 11:30 AM

August

1. Residents make final decision and submit proposal on residency projects by August 1. 2. Choose dates for submission of Newsletter article, P&T monograph submission and

presentation to P&T (and preceptor) and communicate these to the Clinical Manager and RPD.

September

1. Residents present the following information for research projects: Background information, Hypothesis, Methods, Objectives / Outcomes, Statistics, Data collection tools, Timeline for completion, in preparation for IRB.

2. Start IRB submission forms (see Research Day in July). 3. Deadline for IRB submission: Completed by September 15th for IRB review on 1st

Thursday of October. 4. Complete “Needs Assessment” for Resident Seminar by September 15. Then choose a

topic, date and mentor for Resident Seminar.

October 1. ASHP Abstract Deadline (Aug 15 to Oct 1) (see www.ashp.org for details). 2. Topic and date for Resident Seminar due on October 1st

or by timeline set by UCSF 3. CSHP Seminar 10/27/16 – 10/30/16 (Disneyland).

November

1. Begin data collection following IRB approval. 2. Resident Seminar documentation due TBD. If you need review, submit to Dr. Assemi

earlier for ACPE requirements (see page 80 for more information). 3. Present ASHP poster to preceptors as a Friday Seminar. 4. Prepare and print poster for ASHP Clinical Midyear Meeting.

December

1. Present posters at ASHP Clinical Midyear Meeting 12/4-12/8/16 (Las Vegas). 2. Continue data collection. 3. Reminder to work on Resident Seminar Draft and discuss with a preceptor.

February

1. Abstracts due for Western States Conference. 2. Start writing the manuscript of the Resident Research Project. 3. Resident Seminars presented 2/16/17, 2/23/17, and 3/2/17 -locations TBD. 4. Next residency class interviews –keep your schedule open (2/2/17 and 2/7/17).

April/May

1. Finish data collection. 2. Prepare statistical results. 3. Present at Western States Conference (May 23 - May 26, 2017) at Paradise Point Hotel 4. Prepare research manuscript.

June

1. Prepare for end of year. 2. June 10th -Final submission of all required materials (Manuscript, PDSA poster etc.)

http://www.ashp.org/

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Responsibilities and Expectations Professional Conduct It is the responsibility of all residents of Community Regional Medical Center (CRMC) and the profession of pharmacy to uphold the highest degree of professional conduct at all times. The resident will display an attitude of professionalism in all aspects of his/her daily practice. Time Management Each resident will learn time management techniques during their residency year. One area to highlight is adding “buffer” times to deadlines. This will allow adequate time for review of a project by a preceptor or outside party, as well as allowing time to make changes to a project. Dress Code All residents are expected to dress in appropriate professional attire when present in the institution or attending any function as a representative of CRMC. Men are expected to wear a collared shirt. All residents are expected to wear a clean, white, full length lab coat when in patient care areas (except the Emergency Department). Open-toed shoes are not to be worn within CRMC facilities. Attire should conform to the dress code stated in the CRMC policy and procedures in Lucidoc. Any specific problems with dress attire will be addressed by the resident's Preceptor or Residency Program Director. Patient Confidentiality Patient confidentiality will be strictly maintained by all residents. Any consultations concerning patients will be held in privacy with the highest concern for the patients' and families' emotional as well as physical well-being. All residents will undergo Health Insurance Portability and Accountability Act (HIPPA) training during orientation and abide by HIPPA regulations during practice. Employee Identification Badges All employees (including residents) are required to wear his/her identification badge at all times within CRMC facilities. Attendance

Residents are expected to attend all functions as required by the Residency Program, the RPD, and preceptors. The residents are responsible for their assigned operational pharmacy practice duties, and for assuring that these commitments are met in the event of an absence.

If a resident is scheduled for operational pharmacy practice for a weekend shift and calls in sick, he/she must make up the absence by working an additional weekend, or switching with a co-resident.

Residents are expected to complete all their work relating to patient care before leaving the facility. Residents are required to be on-site for a minimum of 8 hours per day.

Days Off requests should be discussed in advance with the involved preceptor and the RPD at least 2 business days in advance to assure that residency responsibilities can be fulfilled.

An excused absence is defined as a sick leave or professional leave. This must be discussed with and signed off by the rotation preceptor and RPD.

Residents are encouraged to attend UCSF pharmacy student presentations (Big Talks) scheduled at UCSF building, but are not mandatory.

Prior to licensure Verbal Orders Please be advised that under current pharmacy law, if a resident is NOT a CA licensed pharmacist or have a CA Intern license, they cannot take verbal orders. Only licensed personnel (whether it be CA licensed pharmacists

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or CA licensed interns) can take verbal orders. If a resident has a CA Intern License, then they can take verbal orders, but it must be co-signed by the preceptor, or a licensed pharmacist.

Notes in the Chart: Residents can leave progress notes in the patient chart, but it must be reviewed by the preceptor before placing in Epic, per the preceptor’s discretion. If the resident is not licensed, the resident must complete an I-vent, communicate to the preceptor that an I-vent has been completed, and the preceptor will copy this into a progress note.

General Information Benefits

Resident Base Stipends: $23.00/hr, approximately $47,840/yr, not including overtime on weekends.

Paid time off (PTO): Accrued PTO time includes personal days, vacation days, sick days, and holidays. PTO includes personal days, vacation days, sick days, and holidays.

Holidays: Residents are expected to work on some designated holidays.

Funds for Professional Meetings: There are adequate funds available to compensate the residents attending CSHP Seminar, ASHP Midyear, and Western States Residency Conference.

Health Insurance: Health insurance (medical, dental and vision) is effective Day 1 of the residency.

Long Term Disability: Coverage equal to 50% of your salary with elective for higher coverage.

Term Life Insurance: $10,000 effective the first of the month following 30 days of employment. CRMC Employee Identification Cards

Identification of CRMC employees is necessary in order to promote recognition and communications among employees, students, patients and visitors.

While at CRMC, all employees are required to wear identification cards in a manner such that name, picture, and department are clearly visible. The ID card issued by Human Resources is the official ID card for all employees, and the employee is the only individual authorized to wear his/her ID card.

It is the responsibility of an employee who has lost his/her ID to have it replaced. The ID card is the property of CRMC, and must be surrendered upon termination of employment.

Residents are required to report the loss of their ID cards to Human Resources.

Employee ID cards will be replaced by Human Resources at a cost of $5.00. This cost will be paid for by the resident losing the card.

Any employee reporting to work at CRMC without his/her official I.D. card must punch out, go home and acquire it.

Parking

Each resident will have access to free parking in the CRMC parking structure with badge access.

Time Off Requests Requests for Days Off

Requests for days off must be emailed to the Preceptor and Residency Program Director 2 business days in advance, at minimum. The RPD must approve.

In order to maximize your learning experience in each rotation, residents are limited to 2 PTO days off per rotation, under the discretion of the preceptor or RPD.

Sick Leave

If a resident needs to take sick time, the resident must email/text/call the preceptor and notify the RPD in writing (via email).

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Resident Holidays (8) The following are CRMC holidays. Residents can work Holidays if specifically requested by their preceptor (and approved by the RPD). Residents may also choose to work to save their PTO by staffing in the Inpatient Pharmacy. A resident may submit for time off on a holiday. The holidays are deducted from PTO.

New Year's Day President’s Day Memorial Day Independence Day Labor Day Thanksgiving Day Day after Thanksgiving Christmas Day

Photocopying

Copies made are only for use in the residency program.

Residents may use the Department of Pharmacy Services photocopy machines located in the CRMC inpatient Pharmacy.

Pharmacy Licensure for Residents

All residents must have a current and valid California intern license and subsequent Pharmacist license.

Pharmacist licensure is required before October 1. For more information, please see ASHP PGY1 Standard 1.5 and Resident Pharmacist Job Description, Job Code 40741 regarding resident licensure and HR policy 10037 on Employee License/Certificate.

Once licensed, a Pharmacy Resident must obtain a new employee badge (to reflect their current job description).

Elective Rotation requests Rotation requests for Electives, or request for changes must be requested at least one month prior to the start of the rotation. This is to allow adequate preparation by the preceptor to accommodate any requests or changes. Office Offices for residents are located at CRMC in the second floor annex. Please ask RPD for the code. Outside Employment Policy (Moonlighting)

The residency program is considered the primary priority of each resident.

Outside employment is discouraged, but if desired, must not interfere with the resident’s responsibilities or requirements.

The responsibilities of the resident do not correspond with the normal 9:00 AM to 5:00 PM scheduled forty-hour work week. At times, extra hours of coverage (weekends, evenings) are necessary to maintain residency requirements. Fluctuations in workload, unusual service demands or patient loads, or cross-coverage may all determine the hours of the residents’ service.

Working additional hours for CRMC in Operations outside of the residency program is considered outside employment. All outside employment must be approved by the RPD.

You must comply with ASHP duty hours: http://www.ashp.org/DocLibrary/Accreditation/Regulations-Standards/Duty-Hours.aspx

Pagers Residents will be held financially responsible for their assigned pagers (in case of loss, damage due to neglect, etc.). Pagers must be turned in at the termination of the residency.

http://www.ashp.org/DocLibrary/Accreditation/Regulations-Standards/Duty-Hours.aspx

http://www.ashp.org/DocLibrary/Accreditation/Regulations-Standards/Duty-Hours.aspx

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SECTION E – ROTATION GOALS/OBJECTIVES AND EXPECTATIONS Administration Rotation -Operational Activities PGY1 Resident Expectations and Responsibilities Preceptor: Tim Lopez, PharmD, Inpatient Pharmacy Manager Office: Inpatient Pharmacy Contact Information: Office General Description This portion (1 out of 4) is part of the core Administration Rotation, which is 4 weeks in length. Under the general management of the pharmacy manager, provide advanced and specialized administrative services to a department or division. Perform a variety of duties that require detailed functional and organizational knowledge. Coordinate administrative processes and assume a lead role on administrative projects. Goals and Objectives to be Taught and Formally evaluated:

Goals and Objectives Activities

Competency Area R3: Leadership and Management

Goal 3.2 Demonstrate management skills Objective R3.2.1

(Understanding) Explain factors that influence departmental planning.

Look up and review regulatory compliance guidelines/statutes related to:

Joint Commission National Patient Safety Goals (NPSG) Joint Commission Medication Management (MM) Title 22, California Board of Pharmacy Pharmacist in

Charge Inpatient Self Assessment

Centers for Medicare/Medicaid Services (Conditions of Participation).

Board of Pharmacy Hospital Self-Assessment Board of Pharmacy Sterile Compounding Self-Assessment

Objective R3.2.2

(Understanding) Explain the elements of the pharmacy enterprise and their relationship to the healthcare system.

Develop a patient safety tool that can be used to proactively identify potential failures for a new process or workflow.

This Safety Search Tool will help facilitate the identification of potential latent failures before a new process is established so that fail-safes, warnings, and/or redundancies can be incorporated into the workflow to mitigate the risk of patient harm.

Objective R3.2.3

(Applying) Contribute to departmental management.

The resident will identify areas for improvement for the organization after reviewing these guidelines/statutes in Objective R3.2.1

The resident will recommend and write up a design to implement the changes.

Objective R3.2.4

(Applying) Manages one’s own practice effectively.

Able to complete assigned tasks on time.

Learn to communicate effectively and ask questions for clarification.

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Administration Learning Activities – Medication Safety PGY1 Resident Expectations and Responsibilities Preceptor: Curtis Takemoto, Pharm. D., Medication Safety Specialist Office: Medication Safety Specialist Office- Basement Hours: 0800-1600 (Monday through Friday) Pager: General Description This portion (1 out of 4) is part of the core Administration Rotation, which is 4 weeks in length. The activities will emphasize the importance of the ASHP Standards and Goals and Objectives for an ASHP accredited residency program, how medication safety not only impacts the practices of pharmacists but also nurses and allied health staffs. Goals and Objectives:

To understand the foundation of medication safety principles to facilitate patient safety.

To understand how interdisciplinary relationships involving medication safety are vital to patient care.

Understand the intercalation of the culture of safety and regulatory compliance.

Understand that medication safety issues involve at all levels within the organization. Goals and Objectives to be Taught and Formally evaluated:


Competency Area R2: Advancing Practice and Improving Patient Care

Goal R2.1 Demonstrate ability to manage formulary and medication-use processes, as applicable to the organization.

Objective R2.1.3

(Analyzing) Identify opportunities for improvement of the medication-use system

Review of trigger tool and evaluation of potential medication safety events

Objective R2.1.4

(Applying) Participate in medication event reporting and monitoring.

Identify medication errors, close calls (near misses) and adverse drug reactions

Enter and Evaluate Incident Reporting Intranet System (IRIS) reports and follow up

Data analysis and develop medication error report for CRMC Medication Management Committee (MMC), Community Behavioral Health Center (CBHC) and Fresno Heart and Surgical Hospital (FHSH) Medication Event Subcommittee report (bi-monthly to monthly)

Multidisciplinary Case reviews (e.g. intense care reviews, root cause analysis) per occurrence


Goal R3.1 Demonstrate leadership skills

Objective R3.1.1

(Applying) Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership

Participation on multidisciplinary teams/committees to provide information on medication event data, including numbers, trending and plans for correction


Goal 3.2 Demonstrate management skills

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Objective R3.2.1


Explain how medication safety affects planning of a pharmacy department

Discuss the impact medication safety has on processes in areas including but not limited to work flow, formulary management, and use of technology

Objective R3.2.2


Learn Leadership activities o How to use the organization political and decision

making structure to accomplish a goal o Who to ask, how to identify stakeholders, how to

conduct meetings

Learn the impact of how medication safety practices influence patient care outside of pharmacy services

Objective R3.2.4


Able to complete assigned tasks on time

Able to manage the diverse medication safety issues from many other sites that are listed under CRMC

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Administration Rotation - Clinical Pharmacy Manager (CPM) Activities PGY1 Resident Expectations and Responsibilities Preceptor: Leonard Valdez, PharmD, BCPS, Clinical Pharmacy Manager Office: CRMC Pharmacy Administration Contact Information: Office work cell phone General Description This portion (1 out of 4) is part of the core Administration Rotation. The activities will emphasize the use of collaborative, multidisciplinary approaches to manage the medication formulary, manage the drug budget, and oversee/develop clinical pharmacy services; participating on multidisciplinary committees and workgroups to promote and provide clinical pharmacy services; developing strategies to promote pharmacist professional growth; and learn supervisor role in relation to overseeing the activities of the clinical pharmacy specialists. Goals and Objectives to be Taught and Formally evaluated:



Goal R2.1 Manage and improve the medication-use process

Objective R2.1.1

(Creating) Prepare a drug class review, monograph, treatment guideline, or protocol

Conduct new medication monograph/formulary; review of automatic therapeutic substitution protocols; drug class review

Objective R2.1.2

(Applying) Participate in a medication –use evaluation

Conduct medication use evaluations as dictated by safety and/or cost issues; conduct annual formulary review

Objective R2.1.3


Develop therapeutic guideline/protocols and provide recommendations in response to MUE findings

Objective R2.1.4

(Applying) Participate in medication event reporting and monitoring

Review the medication event reporting system, learn the purpose and outcomes to event reporting that promote medication safety

Competency Area R3: Exercise leadership and practice management skills


Objective R3.1.1


Complete group assignments; learn group task assigning and accountability; facilitate administration related workgroups

Objective R3.1.2

(Applying) Apply a process of on-going self-evaluation and personal performance improvement

Explain and discuss strategies for self –evaluation, self-reflection, and self-awareness and time management skills

Goal R3.2 Demonstrate management skills

Objective R3.2.1

(Understanding) Explain factors that influence departmental planning

Explain what a pharmacy clinical manager and/or clinical coordinator does and their role and influence in the department

Objective R3.2.2

(Understanding) Explain the elements of pharmacy enterprise and their relationship to the healthcare system

Learn Leadership activities –how to use the organization political and decision making structure to accomplish a goal –who to ask, how to identify stakeholders, how to conduct meetings

Objective R3.2.3:


Discuss restructuring of clinical pharmacy services, utilizing current staffing model to expand clinical services Discuss the importance of Manager On-Call; duties affiliated with the process; manager impromptu decision making

Objective R3.2.4:


Prioritize and complete assigned projects within agreed timeframe; maintain balance between projects and assignments

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Projects assigned during this rotation Lead topic discussions on leadership and management articles; medication evaluation use projects, performance and quality improvement project; review all past P&T therapeutic interchanges and recommend updates (see drug formulary document); other projects to be determined Preceptor interactions for activities Daily: Beginning of the day and anytime between 0800-1630

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Administration Rotation - Residency Program Activities PGY1 Resident Expectations and Responsibilities Preceptor: Alice Robbins, PharmD, BCPS, Residency Program Director, Professional Development Specialist Office: 2nd floor Annex Contact Information: Office or webnotify General Description

This portion (1 out of 4) is part of the core Administration Rotation, which is 4 weeks in length. The activities will emphasize the importance of the ASHP Standards and Goals and Objectives for an ASHP accredited residency program, how a residency program is run, and related financials. Professional Development will also be discussed, and how this relates to the Department of Pharmacy Services.

Goals and Objectives:

To understand the activities of an RPD in ensuring all ASHP accreditation standards are being upheld by reviewing and discussing in depth the ASHP Standards, Goals and Objectives

To learn budgetary and financial aspects of the residency program

To be able to explain the importance of recruitment and retention related to Professional Development

Goals and Objectives to be Taught and Formally evaluated:




Objective R3.1.1

(Applying) Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership.

Complete assigned projects as a team

Objective R3.1.2

(Applying) Apply a process of on-going self-evaluation and personal performance improvement.

Explain and discuss strategies for self –evaluation, self-reflection, and self-awareness and time management skills. Will share an example of a performance evaluation.

Goal 3.2 Demonstrate management skills Objective R3.2.1


Explain what an RPD does

Explain the importance of recruitment and retention

Objective R3.2.2


Learn Leadership activities –how to use the organization political and decision making structure to accomplish a goal –who to ask, how to identify stakeholders, how to conduct meetings.

Objective R3.2.3


Discuss the importance of a business proposal and may involve writing one

Discuss Budgets and financial issues for the Residency program and cost center. Review time cards, p-card reconciliation. Exercise in creating a budget.

Objective R3.2.4


Complete assigned projects

Projects assigned during this rotation:

1. Review Residency website for any errors or improvement and provide a document with all proposed revisions

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2. Review Residency Manual for any errors or improvement and provide a document with all proposed revisions

3. Lead topic discussion on leadership article 4. Other project(s) to be determined

Preceptor interactions for activities Daily: Beginning of the day and anytime between 0800-1630 Expected progression of resident responsibility on the Core Pharmacy Administration experience: Day 1: 0800 Preceptors provides orientation to the rotation with items specific for their portion on

their scheduled day. Week 1-2 Preceptors will introduce residents to different baseline topics, processes and assign

projects. Residents will attend all meetings on the calendar to give insight to what the Pharmacy Leadership team members do on a daily basis.

Week 3-4 Preceptors assign projects to the resident that incorporates the information provided. Residents to provide updates on their progress and share results from the projects assigned.

Expected progression of resident responsibility on the Elective Pharmacy Administration experience: Day 1: 0800 Preceptor provides background information on advanced topics, processes and projects. Week 1-2 Preceptors will expect residents to independently completed advanced projects.

Residents will attend all meetings on the calendar and be expected to take on tasks or help with work that is given to the preceptor.

Week 3-4 Residents continue to complete projects assigned and must complete or sign off their progress to the preceptor.

[The length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident’s progression in the current rotation and where the rotation occurs in the residency program] Evaluation Strategy for all components of the Administration Rotation E-Value will be used for documentation of formal evaluations. For formative evaluations, resident and preceptor will independently complete the Midpoint evaluations. After both have completed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self-assessment. The same will take place for the Summative (Final) Evaluation.

What type of evaluation Who When

Summative Preceptor End of learning experience

Summative Self Evaluation Resident End of learning experience

Preceptor, Learning Experience Evaluations Resident End of learning experience

Time and Attendance

o The resident is expected to arrive in the morning to allow for adequate time with preceptor before patient care activities. The resident may leave once all daily activities are complete; however, an 8 hour day is expected.

o Overtime will not be granted except in extreme cases. o Preceptor should be notified of all time off requests/meetings during rotation as soon as possible per

residency guidelines. Meetings should not be scheduled during patient care activities.

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Ambulatory Care Rotation PGY1 Resident Expectations and Responsibilities Preceptors: Giovanni Lares, PharmD, BCACP (office ) Vy Tran, PharmD (office ) Hours: Monday and Friday: 7am – 3:30pm Tuesday, Wednesday, Thursday: 9am – 5:30pm General Description Ambulatory Care is a core rotation and can be taken as an elective rotation for the Community Regional Medical Center PGY1 pharmacy residency program. The Ambulatory Care Clinical Pharmacy Clinic, located at the Deran Koligian Ambulatory Care Center (ACC), is part of the ACC Internal Medicine Clinic. The ambulatory care clinical pharmacists, pharmacy residents, and students through a collaborative drug therapy and disease management agreement work as part of the interdisciplinary team that also includes the attending physicians, medical residents, interns, students, nurses, nurse practitioners, and physician assistants. The ambulatory care clinical pharmacy program focuses primarily on the following areas: anticoagulation, chronic pain, diabetes management, smoking cessation, hypertension, and dyslipidemia, but also provides pharmaceutical care support for both internal medicine clinic and other specialty clinics. The pharmacy residents, under the supervision of the ambulatory care clinical pharmacists, are expected to participate in the management of chronic drug therapies and disease states, document all patient encounters in the medical charts, and provide education to patients as well as the clinical staff. They are also expected to identify and make recommendations for drug-related problems and cost-effective therapy. Development of time management, organizational, communication, and interview skills are essential for a successful experience in the ambulatory care pharmacy rotation. Disease States Common disease states in which a resident will be expected to gain knowledge and proficiency through self-directed learning, literature review, topic discussions and/or direct patient care experience include, but are not limited to: cardiovascular, cerebrovascular, diabetes, pain management, asthma, COPD, thyroid diseases, peptic ulcer disease, GERD, osteoarthritis, rheumatoid arthritis, gout, psychiatric disorders, dermatology, and infectious diseases. Goals and Objectives to be Taught and Formally evaluated:


Competency Area R1: Patient Care

Goal R1.1 In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients…following a consistent patient care process

Objective R1.1.1

(Applying) Interact effectively with health care teams to manage patients’ medication therapy.

Work in an interdisciplinary team in the internal medicine clinic. Make medication recommendations, discuss patients with residents and attendings as needed.

Objective R1.1.2

(Applying) Interact effectively with patients, family members, and caregivers.

Conduct patient interviews, counsel patients/caretakers on medications and their indications during clinic visits, via phone and upon request.

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Objective R1.1.3

(Analyzing) Collect information on which to base safe and effective medication therapy.

Review patient information, formulate pharmacotherapeutic plans to discuss with preceptors. Conduct medication reconciliation at all clinic visits. Identify, evaluate, document, and recommend appropriate action for adverse drug events

Objective R1.1.4

(Analyzing) Analyze and assess information on which to base safe and effective medication therapy.

Review medications for drug-drug/drug-disease/drug-lab interactions, duplicate therapy, side effect; medication therapy monitoring; adherence; patient education level

Objective R1.1.5

(Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans).

Provide appropriate medication dose adjustments, monitoring, and follow up plan based on patient disease progression and current medication therapy Order or perform laboratory tests as appropriate to evaluate drug therapy

Objective R1.1.6

(Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions.

Review chart for plan implemented at previous visit, make sure new plan is in line with continuity of care.

Objective R1.1.7

(Applying) Document direct patient care activities appropriately in the medical record or where appropriate.

Document all patient clinic encounters (face-to-face and via phone) in the progress note via SOAP format.

Objective R1.1.8

(Applying) Demonstrate responsibility to patients.

Incorporate patient’s needs and preferences into therapeutic plan, alert other providers of any pressing issues and refer when necessary.

Goal R1.2 Ensure continuity of care during patient transitions between care settings.

Objective R1.2.1

(Applying) Manage transitions of care effectively.

Refer patients to other health care professionals as appropriate Write concise organized progress notes documenting medication therapy management activities for inclusion into the medical record for other health care providers to review Communicate to appropriate health care providers to ensure optimal continuity of patient care and accessibility of medications (i.e. Patient pharmacy, prior authorizations, medical clearance for procedures, etc)

Competency Area R4: Teaching, Education, Dissemination of Knowledge

Goal R4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public.

Objective R4.1.1

(Applying) Design effective educational activities.

Complete and discuss patient case studies covering ambulatory care topics (anticoagulation, diabetes, chronic pain management, hypertension, hyperlipidemia, smoking cessation, and heart failure) as time permits during the rotation Biweekly clinical pearl presentations to peers, students, and preceptors accompanied by a handout (maximum of 2 double-sided pages)

Objective R4.1.2

(Applying) Use effective presentation and teaching skills to deliver education

Objective R4.1.3

(Applying) Use effective written communication to disseminate knowledge

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Objective R4.1.4

(Applying) Appropriately assess effectiveness of education

A journal club on a recently published scientific study applicable to the practice site (e.g. ambulatory care management, chronic disease state management therapeutics) accompanied by copies of the article and a summary handout (maximum of 1 single-sided page)

GOAL R4.2 Effectively employs appropriate preceptors’ roles when engaged in teaching.

Objective R4.2.1

(Analyzing) When engaged in teaching, select a preceptor role that meets learners’ educational needs.

Serve as a preceptor when student is assigned on same rotation. Lead case discussions. Students may present patients to resident depending on license status and resident comfort level.

Objective R4.2.2

(Applying) Effectively employ preceptor roles, as appropriate

Preceptor interactions for patient care activities Daily: 0830 - 1200 Chart reviews, discussion with the resident, and follow-up phone calls to patients

1315 - 1730 See patients in clinic Expected progression of resident responsibility on the Core Ambulatory Care experience: Day 1: 0800 Preceptor provides orientation to service, hospital, nursing floors, and reviews

Ambulatory Care learning activities and expectations. Week 1-2 Resident works up patients in clinic and presents to preceptor prior to patient care

activities. Preceptor will attend and participate in patient care activities to model pharmacist’s role in clinic.

Week 3-4 Resident continues to work up patients on the team and presents to preceptor prior to patient care activities. Preceptor may attend and participate in patient care activities to coach the resident to take on more responsibilities as the primary pharmacist in clinic. In addition, if there is a pharmacy student on the team, the resident will take on responsibility of a co-preceptor role.

Week 5-6 Resident continues to work up patients in clinic and presents to preceptor prior to patient care activities. Preceptor may attend and observe the resident’s participation in patient care activities, and/or may expect a summary report from the resident on recommendations made by the resident, updates on patients, and student progress. Preceptor will always be available via pager, phone or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the pharmacist in the clinic.

Expected progression of resident responsibility on the Elective Ambulatory Care experience: Day 1: 0800 Additional ambulatory-care-related projects and/or presentations will be assigned. Week 1-2 Resident works up patients in clinic and presents to preceptor prior to patient care

activities. Week 3-4 Resident continues to work up patients on the team and presents to preceptor prior to

patient care activities. Preceptor may attend and participate in patient care activities to coach the resident to take on more responsibilities as the primary pharmacist in clinic. Resident will also be given more clinically-relevant administrative work, including but not limited to, reviewing new referrals, completing and submitting prior authorizations, and revision of patient educational materials. In addition, if there is a pharmacy student on the team, the resident will take on responsibility of a co-preceptor role.

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[The length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident’s progression in the current rotation and where the rotation occurs in the residency program] Evaluation Strategy E-Value will be used for documentation of formal evaluations. For formative evaluations, resident and preceptor will independently complete the Midpoint evaluations. After both have completed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self-assessment. The same will take place for the Summative (Final) Evaluation.


6 week core rotation

Formative (Midpoint) Self Evaluation Resident End of week 3

Formative (Midpoint) Preceptor End of week 3




4 week elective rotation




Time and Attendance

o The resident is expected to arrive in the morning to allow for adequate time with preceptor before patient care activities. The resident may leave once all daily activities are complete; however, an 8 hour day is expected.



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Critical Care Rotation (Burn/Surgery, Medicine, or Trauma) PGY1 Resident Expectations and Responsibilities Preceptors: Burn/Surgery - Melissa Reger, PharmD, BCPS (Pager / Office ) Medicine Blue / Gold - Tou Bee Thao, PharmD, BCPS (Pager / Office ) Linda Kimura, PharmD, BCPS (pager / Office ) Trauma - Ann Vu, PharmD, BCPS (Pager 488-0502 / Office )

General Description

The Critical Care Rotation is a core rotation for the Community Regional Medical Center PGY1 pharmacy residency program. Each resident will choose one area of critical care before the start of the residency program, on a first come, first served basis. There are six mixed medical-surgical intensive care units (ICU: 4 South/ Cardiovascular Unit, 4 North, Neuro Critical Care, 5 South, 5 North and the Burn Unit). Approximate average medicine ICU (MICU) daily census of 12 patients per team (2 MICU teams – MICU Blue and MICU Gold), surgical ICU (SICU) daily census of 5 - 10 patients, trauma ICU (TICU) daily census of 10 - 20 patients and Burn daily census of 5 - 10 patients. Rotations are associated with academic medical or surgical teams in a “closed” ICU setting. Thus patients are cared for by an intensivist-run critical care medicine service or a surgical service with multidisciplinary input from nursing, pharmacy, respiratory therapy, dietary, physical therapy, social work and others. Disease States

Understand and be able to effectively discuss ICU disease states and pharmacotherapy. Common disease states in which a resident will be expected to gain knowledge and proficiency through self-directed learning, literature review, topic discussions and/or direct patient care experience include, but are not limited to: o Cardiovascular dysfunction (e.g. hypertensive emergency, shock syndromes, hemodynamics, acute

coronary syndromes, heart failure, cardiac arrest); o Respiratory dysfunction (e.g. asthma exacerbations, chronic obstructive pulmonary disease,

pulmonary embolism, acute respiratory distress syndrome); o Metabolic and endocrine derangement (e.g. fluid and electrolyte management, nutrition support,

renal failure, diabetic ketoacidosis, adrenal insufficiency, acid/base disorders); o Infectious diseases (e.g. pneumonia, severe sepsis, others); o Gastrointestinal dysfunction (e.g. gastrointestinal bleeding, stress ulcer prophylaxis, liver failure and

complications); o Nervous system (e.g. seizure disorders, intracranial hemorrhages, subarachnoid hemorrhages, pain

and sedation, neuromuscular blockade).

Trauma and Burn/Surgery topics (in addition to or in replacement of the above topics- per preceptor discretion)

o Traumatic brain injury, spinal cord injury, post-trauma vaccinations, drug/food interactions, patient-controlled analgesia (PCA), compartment syndrome, antibiotic prophylaxis (in the operating room (OR)), blunt vascular injury, open fracture management, burn wound management.

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Objective R1.1.1


Establish collaborative working relationship with members of a multidisciplinary health care team Learn appropriate strategies to implement different types of recommendations (e.g. via intern versus resident versus fellow versus attending physicians) Adjust recommendations based on additional information provided at point of care Serve as drug information resource:

Discriminate between requestor’s statement of need and the actual drug information need by asking for appropriate additional information

Identify urgency of question, appropriate literature resource, and appropriate method of response

Evaluate the utility of the literature gathered and formulate a response based on highest quality, applicable literature

Follow up on patient-specific outcomes of drug information provided

Objective R1.1.3

(Applying) Collect information on which to base safe and effective medication therapy

Review patient past medical history, current compliance, radiology results, laboratory results, vital signs, etc. to:

Identify and prioritize patient problem list (commonly organized by organ system)

Identify potential drug-induced problems

Develop therapeutic care plan (pharmaceutical and non-pharmaceutical) to treat high-priority problems

Evaluate follow-up medication levels, laboratory values and/or vitals and modify therapeutic plan as needed

Review patient medication profiles for:

Medications used with no medical indication

Medical conditions for which there is no medication prescribed

Appropriate medication selection and dosing for allergies, co-morbidities and drug-drug interactions

Appropriate prescribing (i.e. correct dose, dosage form, duration, schedule, route of administration, method of administration, etc.)

Therapeutic duplications

Drug-drug interactions, drug-nutrient interactions and/or drug-device interactions (including social, recreational, nonprescription or nontraditional medications potentially used prior to admission)

Anticipated duration of therapy

Necessary monitoring parameters

Compliance with institution’s medication formulary

Cost-effectiveness considerations

Objective R1.1.4

(Analyzing) Analyze and assess information on which to base safe

Design a patient-centered regimen to achieve evidence-based therapeutic goals

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and effective medication therapy

Design a patient-centered monitoring plan to ensure achievement of therapeutic goals, redesign care plan as necessary based on monitoring data and therapeutic outcomes

Identify high priority recommendations and appropriate time course to intervene

Anticipate health care team therapeutic disagreements and develop convincing, evidence-based arguments in support of recommendations

Objective R1.1.5

(Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans)

Manage patients on clinical pharmacy service (vancomycin, aminoglycosides, TPN, and warfarin) and provide recommendations for dosing regimen and when levels need to be ordered

Be prepared to discuss recommendations for addressing problems with preceptor prior to morning rounds with team

Review patients progress on current regimen and formulate appropriate therapeutic plan changes based on patient’s individual response

Objective R1.1.6

(Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions

Provide recommendations with team after discussion and approval from preceptor

Follow up after rounds to ensure any agreed upon changes have been implemented

Objective R1.1.7

(Applying) Document direct patient care activities appropriately in the medical record or where appropriate

Categorize and document interventions appropriately in iVents and/or progress notes

Document assessment of current therapy and recommendations as needed for patients managed on clinical pharmacy service (vancomycin, aminoglycosides, TPN, and warfarin).

Objective R1.1.8


Ensure all identified patient care and medication related issues are the primary priority. Ensure these are addressed and resolved by the end of the day. If cannot be resolved, ensure that any outstanding issues are communicated to appropriate individuals (MD, RN, pharmacist, etc.) prior to leaving for the day.

GOAL R1.2 Ensure continuity of care during patient transitions between care settings. Objective R1.2.1


Ensure appropriate patient sign-outs with the appropriate covering pharmacist

For pharmacy consults, ensure good communication with the appropriate covering pharmacist with the consult sheets as well as in iVents

Competency Area R3: Demonstrate Leadership Skills GOAL R3.1 Demonstrate leadership skills Objective R3.1.1


Speak during ICU rounds to communicate any recommendations, speak with nurses, respiratory therapists, etc. to collect information as well medication education.

Maintain professionalism at all times on service

Objective R3.1.2

(Applying) Apply a process of on-going self-evaluation and

Self-identify areas of improvement and discuss with preceptor on a weekly basis

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personal performance improvement.

Competency Area R4: Teaching, Education, Dissemination of Knowledge GOAL R4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public.

Objective R4.1.1


Accurately define the educational need with regard to target audience (e.g. individual vs. group) and learning level (e.g. health care professional vs. patient) when replying to or presenting drug information questions

Select and present a patient case, journal club and/or topic discussions with content that is relevant, thorough, evidence-based (using primary literature where appropriate), and timely and reflects best practices

Objective R4.1.2

(Applying) Use effective presentation and teaching skills to deliver education.

Demonstrate rapport with learners (e.g. medical team, nurses, students, pharmacists)

Engage the audience with use of effective supplementary materials

Summarize important clinical practice implications at appropriate times throughout journal club, patient case and/or topic discussions

Objective R4.1.3

(Applying) Use effective written communication to disseminate knowledge.

Write progress notes and/or iVents in the medical chart that are clear, concise and free of errors

Note appropriate citations and references on presentations and responses to drug information

GOAL R4.2 Effectively employs appropriate preceptors’ roles when engaged in teaching

Objective R4.2.1

(Analyzing) When engaged in teaching, select a preceptors’ role that meets learners’ educational needs

Identify and implement the four preceptor roles as appropriate for the learner and the activity (direct instruction, modeling, coaching and facilitation)

Objective R4.2.2


Model skills, including “thinking out loud”, so that learners can “observe” critical-thinking skills

Coaches, including effective use of verbal guidance, feedback and questioning as needed when reviewing medication related topics with learners

Preceptor interactions for rounding services -(these are guidelines and may be modified as needed by the preceptor) Burn/Surgery: Daily: 0830 Pre-rounds with resident

0930 Team Rounds -will vary depending on the OR schedule and other responsibilities of the SICU and Burn teams

After rounds-TBD Preceptor office hours: See topic discussion schedule (provided on day 1) for list of dates/times of topic discussions, and preceptor is available at other times as needed for reviewing progress notes, patient updates, etc.

MICU: Daily: 0800 Pre-rounds with resident 0930 Team Rounds

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TBD Preceptor office hours: See topic discussion schedule (provided on day 1) for list of dates/times of topic discussions, and preceptor is available at other times as needed for reviewing progress notes, patient updates, etc.

TSS-ICU: Daily: 0830 Pre-rounds with resident

0930 Team Rounds -will vary depending on the OR schedule and other responsibilities of the trauma team

After rounds-TBD Preceptor office hours: See topic discussion schedule (provided on day 1) for list of dates/times of topic discussions, and preceptor is available at other times as needed for reviewing progress notes, patient updates, etc.

Expected progression of resident responsibility on the Critical Care 6-week core experience: Day 1: Preceptor provides orientation to service, hospital, nursing floors, and reviews Critical

Care learning activities and expectations. Week 1-2: Resident works up patients on the team and presents to preceptor prior to team

rounds. Preceptor will attend and participate in team rounds to model pharmacist’s role on the team.

Week 3-4 Resident continues to work up patients on the team and presents to preceptor prior to team rounds. Preceptor may attend and participate in team rounds to coach the resident to take on more responsibilities as the primary pharmacist on the team. In addition, if there is a pharmacy student on the team, the resident will take on responsibility of a co-preceptor role.

Week 5-6: Resident continues to work up patients on the team and presents to preceptor prior to team rounds. Preceptor may attend and observe the resident’s participation in team rounds, and/or may expect a summary report from the resident on recommendations made by the resident, updates on patients, and student progress. Preceptor will always be available via pager, phone or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the pharmacist on the team.

Expected progression of resident responsibility on the Critical Care 4-week elective or repeat of previously passed core Critical Care experience: Day 1: Preceptor provides orientation to service, hospital, nursing floors, and reviews Critical

Care learning activities and expectations. Week 1-2: Elective: Resident works up patients on the team and presents to preceptor prior to

team rounds. Preceptor will attend and participate in team rounds to model pharmacist’s role on the team.

Repeat of Previously Passed Core: Resident is expected to be the primary pharmacist. Resident works up patients on the team and presents to preceptor prior to team rounds. Preceptor may attend, participate and/or observe in team rounds to coach the resident as the primary pharmacist on the team. Resident will be learning advance topic discussions not previously discussed during their core rotation. If there is a pharmacy student on the team, the resident will take on responsibility of a co-preceptor role. Preceptor will always be available via pager, phone or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the primary pharmacist on the team.

Week 3-4 Elective: Resident continues to work up patients on the team and presents to preceptor prior to team rounds. Preceptor may attend, participate and/or observe in team rounds

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to coach the resident to take on more responsibilities as the primary pharmacist on the team. If there is a pharmacy student on the team, the resident will take on responsibility of a co-preceptor role. Preceptor may expect a summary report from the resident on recommendations made by the resident, updates on patients, and student progress. Preceptor will always be available via pager, phone or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the pharmacist on the team.

Repeat of Previously Passed Core: Resident is expected to be the primary pharmacist. Resident continues to work up patients on the team and presents to preceptor prior to team rounds. Preceptor may attend, participate and/or observe in team rounds to coach the resident as the primary pharmacist on the team. Resident will continue to learn advance topic discussions not previously discussed during their core rotation. If there is a pharmacy student on the team, the resident will take on responsibility of a co-preceptor role. Preceptor will always be available via pager, phone or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the primary pharmacist on the team.

[The length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident’s progression in the current rotation and where the rotation occurs in the residency program] Evaluation Strategy E-Value will be used for documentation of formal evaluations. For formative evaluations, resident and preceptor will independently complete the Midpoint evaluations that are Qualitative and Quantitative. After both have completed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self-assessment. The same will take place for the Summative (Final) Evaluation.












Time and Attendance

o The resident is expected to arrive in the morning to allow for adequate pre-rounding time with preceptor before rounds. The resident may leave once all daily activities are complete; however, an 8 hour day is expected.

o Overtime will not be granted except in extreme cases involving patient care. o Preceptor should be notified of all time off requests/meetings during rotation as soon as possible per


revised 2/9/2017

Neonatal Intensive Care Unit Learning Activities: PGY1 Resident Expectations and Responsibilities Preceptors: Harlan Husted, PharmD, BCPS (Pager / Office ) Tsung-Chi (George) Lien, M.S., PharmD, BCPS (Pager / Office ) Laurie Covarrubias, PharmD (Pager / Office ) Hours: M-F 0800 – 1630 General Description Neonatal Intensive Care Unit (NICU) is either an elective, four week or a core, six week learning experience at Community Regional Medical Center. There are 84 NICU beds in the hospital. There is one NICU teaching team, which includes an attending physician, a PGY2 or PGY3 medical resident, a PGY1 medical intern, and medical students (MSIII or MSIV). Other disciplines on the team include the clinical pharmacy specialist, pharmacy students, a respiratory therapist, a clinical dietician and the primary nurse. Non-teaching teams are primarily hospitalist-based and pharmacists work regularly with them to identify and resolve medication-related problems for all patients.

The pharmacy resident is responsible for identifying and resolving medication therapy issues for patients and will work toward assuming care of all patients on the unit throughout the learning experience. The resident will provide and document therapeutic drug monitoring services for patients on their team receiving drugs requiring monitoring including, but not limited to, aminoglycosides, erythropoietin alfa, and vancomycin. Documentation must be completed on the day service was provided. The resident is responsible for providing and documenting discharge medication education to patients on their team who are pending discharge. Education and documentation must be provided no later than the day of discharge. The resident is responsible for completing non-formulary drug consults, within 48 hours of the request.

Good communication and interpersonal skills are vital to success in this experience. The resident must devise efficient strategies for accomplishing the required activities in a limited time frame.

Disease States Common disease states in which the resident will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care experience include, but are not limited to:

Cardiovascular disorders o Anatomic complications/surgical interventions, patent ductus arteriosus, transposition of great

vessels, hypoplastic left heart, Tetrology of Fallot

Critical care pharmacotherapy o Vasopressor agents, glycemic control, respiratory therapy (including ventilator support and

types), Neonatal Resuscitation Protocol, reversal agents and extravasation management

Gastrointestinal disorders o Gastroschisis/omphalocele, short-gut syndrome, nutrition overview including breast-feeding,

impact of medications on pregnancy/lactation, fortified nutritional supplements and total parenteral nutrition

Infectious diseases o Sepsis, meningitis, necrotizing enterocolitis, immunizations

Organ dysfunction o Retinopathy of prematurity, anemia of prematurity

Respiratory disorders o Apnea of prematurity, bronchopulmonary dysplasia/chronic lung disease, persistent pulmonary

hypertension

revised 2/9/2017





Objective R1.1.1


Accurately gather, organize, and analyze patient specific information on assigned patients prior to pre-rounds with preceptor. For non-teaching services, review profiles to identify medication-related problems to discuss with hospitalist.

Actively participate in NICU teaching service team rounds daily. For non-teaching services, call or meet with each hospitalist covering services to resolve issues. (May round with them when feasible)

Compose an accurate, concise progress note documenting direct patient care activities within time frame to be useful.

Complete consults for non-formulary drugs, recommending formulary, cost-effective alternative drug therapy to health care providers when possible.

Provide and document therapeutic drug monitoring services for patients receiving drugs requiring monitoring including, but not limited to, aminoglycosides, vancomycin and erythropoietin.

Identify and report medication events (ADE or medication errors). May be initiated by pharmacy personnel or by other health care professionals.

Participate in MUE activities or other outcome measures for patients on service

Objective R1.1.3


Prepare patient work-ups by utilizing available medical information from the electronic health record, bedside flow charts, discussion with patient care staff and from medical team rounding.

Identify active issues that can be treated with medication therapy and be prepared to evaluate the efficacy of treatment.

Utilize available literature to support medication dosing regimens and therapeutic decisions.

Objective R1.1.4


Demonstrate knowledge of therapeutic principles related to neonatal intensive

care unit medicine topics, including but not limited to:

o Congenital heart defects

o Nutrition support

o Persistent pulmonary hypertension of the newborn

o Respiratory distress syndrome

o Sepsis and Meningitis

Given a patient’s medical history (symptoms, physical examination, laboratory

values, current medications, and diagnosis) identify:

o Significant active and inactive medical problems

o Medications used with no medical indication

o Medical conditions missing medication therapy

o Inappropriate medication therapy regimen (i.e., dose, therapeutic

duplication, route of administration, drug allergy etc.)

o Patient’s caregivers’ comprehension of medication regimen

o Non-adherence to medication regimen

revised 2/9/2017

o Financial issues that may impact medication therapy

o Develop plans for medication therapy, including sustainable access to

needed discharge medications, medication therapy goals, monitoring

parameters, and potential side effects

Assess and facilitate optimization of current drug therapy based upon patient-

specific variables

Objective R1.1.5


Develop plans for medication therapy, including dosage adjustments based on

patient age and weight changes, availability of commercially-available products,

administration to patient based on intravenous/injection site or enteral access,

medication therapy goals, monitoring parameters, and potential side effects

Objective R1.1.6



specific variables

Objective R1.1.7


Concisely, clearly, and effectively document any interventions, assessments and

recommendations as a new i-Vent (minimum of 125 for the rotation)

Objective R1.1.8


Provide medication information to patient’s caregiver in a culturally-sensitive

manner free of bias or judgment, with respect to the infant’s critical or social

status.

Assist the rounding team with providing discharge medications by acting as an

intermediate between the inpatient and outpatient pharmacy with respect to the

patient and their insurance coverage and/or ability to pay.

Provide discharge medication counseling to the patient’s caregiver.

Goal R1.3 Prepare, dispense, and manage medications to support safe and effective drug therapy for patients.

Objective R1.3.1

(Applying) Prepare and dispense medications following best practices and the organization’s policies and procedures.

Provide rounding team with appropriate medication recommendations based on

product availability, formulary adherence, and accommodate conversion to

outpatient medication management.

Prepare and oversee preparation of injectable medications in accordance with

hospital policies and adherence to USP 797 guidelines, including proper

documentation and logging.

Prepare and oversee preparation of extemporaneous-compounded enteral and

topical medications in accordance with hospital policies, including proper

documentation and logging.

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Objective R1.3.3

(Applying) Manage aspects of the medication-use process related to oversight of dispensing.

Identify appropriate dosage forms for inpatient and discharge medications

Provide consultation when appropriate to inpatient staff and patient care-givers

Research availability of dosage forms, including recipes for extemporaneous

compounding and prolonged stability, using appropriate references and citations.

Oversee the dispensing and preparation of medications by pharmacy technicians

in the NICU satellite, if licensed to do so under California Pharmacy Law.


Goal R4.2 Effectively employs appropriate preceptors’ roles when engaged in teaching

R4.2.1 (Analyzing) When engaged in teaching, select a preceptors’ role that meets learners’ educational needs.

Precept pharmacy students (when applicable):

o Serve as pre-rounding preceptor

o Facilitate or lead topic discussions

o Assist the student in following up on patient issues following rounds

o Identify and implement the four preceptor roles as appropriate for the

student and the activity (direct instruction, modeling, coaching and

facilitation)

R4.2.2 (Applying) Effectively employ preceptor roles, as appropriate

Effectively model the role of the preceptor with pharmacy students (when

applicable)

Provide and receive effective feedback

Preceptor Interaction for rounding services

Daily: 0800 Assignment delegation for daily tasks 1000 Pre-rounding with resident

1100 Team rounds with resident and team 1300 – 1630 Preceptor office hour available for topic discussions, reviewing progress notes,

patient updates, etc. Expected progression of resident responsibility on this learning experience: Four Week Elective Day 1 Preceptor to review NICU learning activities and expectations with resident. Week 1 Resident to work up assigned patients and present to preceptor prior to team rounds.

Preceptor will attend and participate in team rounds (modeling pharmacist’s role on the health care team).

Weeks 2-3 Resident to work up assigned patients and present to preceptor prior to team rounds. Preceptor may attend and participate in team rounds (coaching the resident to take on more responsibilities as the pharmacist on the team).

Week 4 Resident to work up assigned patients and present to preceptor prior to team rounds. Preceptor may attend and observe the resident’s participation in team rounds, and/or may expect a summary report from the resident regarding rounding activities and use of recommendations made by the resident. Preceptor will always be available for questions and will follow patients independently to monitor resident skill development in all aspects of the learning experience (facilitating the resident as the pharmacist on the team).

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Six Week Core Rotation Day 1 Preceptor to review NICU learning activities and expectations with resident. Week 1 Resident to work up assigned patients and present to preceptor prior to team rounds.

Preceptor will attend and participate in team rounds (modeling pharmacist’s role on the health care team).

Weeks 2-4 Resident to work up assigned patients and present to preceptor prior to team rounds. Preceptor may attend and participate in team rounds (coaching the resident to take on more responsibilities as the pharmacist on the team).

Week 5-6 Resident to work up assigned patients and present to preceptor prior to team rounds. Preceptor may attend and observe the resident’s participation in team rounds, and/or may expect a summary report from the resident regarding rounding activities and use of recommendations made by the resident. Preceptor will always be available for questions and will follow patients independently to monitor resident skill development in all aspects of the learning experience (facilitating the resident as the pharmacist on the team).

[The length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident’s progression in the current rotation and where the rotation occurs in the residency program]

Evaluation Strategy E-value will be used for documentation of formal evaluations. For formative evaluations, resident and preceptor will independently complete the Midpoint evaluations that are Qualitative and Quantitative. After both have completed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self-assessment. The same will take place for the Summative (Final) Evaluation.












Time and Attendance




revised 2/9/2017

Emergency Medicine Rotation PGY1 Resident Expectations and Responsibilities

Preceptor(s): Mallory A. Cruz, PharmD, BCPS (Pager 7 / Office ) Katie Trousil, PharmD, BCPS (Pager / Office ) Francisco Ibarra, PharmD (Pager / Office ) Hours: Variable, between the hours of 0700 - 1900 General Description Emergency Medicine (EM) is a core rotation for the Community Regional Medical Center PGY1 pharmacy residency program. The primary goal of this rotation is to provide a clinical pharmacy practice environment for the resident to apply the clinical, communication, and teaching skills necessary to interact in a multidisciplinary emergency medicine environment. The practice environment will require daily interactions with physicians, mid-level practitioners, nursing staff, pharmacy staff, and other healthcare professionals as necessary to optimize pharmacotherapy for patients. The major challenges for this rotation is the dynamic and often chaotic environment in the emergency department, time management, and experiencing a broad variety of patients and disease states. Common disease states in which a resident will be expected to gain knowledge and proficiency through self-directed learning, literature review, topic discussions and/or direct patient care experience include, but are not limited to: Disease States

Disease States

Cardiovascular Acute Coronary Syndrome (ACS) Congestive Heart Failure (CHF) Cardiopulmonary Resuscitation (CPR)/Advance Cardiac Life Support (ACLS) Dysrhythmias Hypertensive Crisis

CNS Cerebrovascular Accidents (CVA) Traumatic Brain Injury (TBI) Meningitis Seizures Migraines Endocrine Adrenal insufficiency Hyperglycemic Crisis Myxedema coma Thyrotoxicosis GI Appendicitis Cholecystitis Constipation/Diarrhea Gastrointestinal Bleeding Pancreatitis Ulceration

Pulmonary Asthma Chronic Obstructive Pulmonary Disease (COPD) Pneumonia Pulmonary edema Pulmonary embolus (PE) Rapid Sequence Intubation (RSI)

Renal Urinary Tract Infection (UTI) vs. pyelonephritis Renal calculi Toxicology Acetaminophen Alcohol Aspirin Opiates Sympathomimetics/Hallucinogenics

(amphetamines/phencyclidine/cocaine) Tricyclic antidepressants Antidotes

Decontamination

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Objective R1.1.1


Actively participate and interact appropriately with the health care team during codes

Assist with nursing medication therapy and drug administration questions

Use effective communication skills to verbally communicate drug information to the health care team

Use effective verbal communication skills to discuss and make recommendations regarding a patient’s medication therapy with the health care team, including considerations of benefits/risks, alternative therapies, and patient specific factors

Objective R1.1.2


Interact with patients, their families, and the health-care team in a culturally-sensitive manner.

Effectively utilize an unskilled and/or skilled interpreter for patient interviews and education

Conduct medication reconciliation with patient or caregiver

Objective R1.1.3


Collect all information applicable to work up patients admitted to the Emergency Department. This includes, but is not limited to, the following:

o Identify, list and prioritize the significant active medical problems

o Pertinent past medical or social history

o Medication list prior to and during current hospitalization

o Adverse events, response to therapy

o Patient’s drug plan or coverage, patient adherence

Accurately collect all pertinent information to manage pharmacy consults for the Emergency Department patients.

Identify, list and prioritize the significant active and inactive medical problems significant to ED visit and possible hospital admission that may require drug therapy adjustments in the ED setting

Utilize drug information sources to assist with medication therapy decisions

Identify and discuss the significance and incidence of common adverse reactions, predisposing patient risk factors, and strategies for minimizing or avoiding them

Identify the drug class and its mechanism of action

Objective R1.1.4


Given a patient’s medical history (symptoms, physical examination, laboratory values, current medications, and diagnosis) identify:






o Patient’s comprehension of medication regimen



revised 2/9/2017

Assess and facilitate optimization of current drug therapy based upon patient-specific variables

Analyze and assess the appropriate parameters (physical, lab, etc.) for monitoring the progress of drug therapy for the stated disease states

Assess the effects of drugs on physically measurable parameters and laboratory test results

Predict and establish the therapeutic and toxic endpoints of therapy

Critically analyze medical literature

Objective R1.1.5


Develop plans for medication therapy, including sustainable access to needed discharge medications, medication therapy goals, monitoring parameters, potential side effects, and negotiated strategies to facilitate patient adherence

List and discuss risks versus benefits and considerations important in selecting appropriate drug(s) for a given disease state

Identify the drug of choice, dose, frequency, and duration of therapy as well as alternative drug or treatment choices for a given disease state

Identify, list and assess the appropriate parameters (physical, lab, etc.) for monitoring the progress of drug therapy for the stated disease states

Identify the effects of drugs on physically measurable parameters and laboratory test results; order follow up labs per pharmacy protocols

Select and utilize appropriate biopharmaceutic (dosage form, palatability, cost, etc.) and pharmacokinetic (t½, elimination, etc.) parameters to establish a drug regimen

Objective R1.1.6



specific variables

Perform follow-up on recommendations as applicable

Objective R1.1.7


Document direct patient care activities appropriately in the medical record or

where appropriate (i.e. posting a pharmacy consult progress note)


recommendations as a new i-Vent

(minimum of 125- per residency requirements)


Objective R1.2.1


Assist with medication reconciliation process upon admission and/or discharge

o List of current medications and/or supplements and their dosing

regimens

o List of pertinent past medication(s) and supplement(s)

o List and describe allergies, adverse side effects and drug interactions

o When applicable, elicit a description of any symptoms from the

patient that may relate to drug allergies/sensitivities, incorrect

drug/supplement administration, or drug interaction

o Social history, including cultural aspects (e.g. health beliefs,

expectations of drug therapy, healing traditions, language barriers),

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which may impact health-care, medication delivery, and patient

compliance or adherence

Document direct patient care activities appropriately in the medical record or where appropriate (i.e. posting a pharmacy consult progress note)

Concisely, clearly, and effectively document any interventions, assessments and recommendations as a new i-Vent (minimum of 125- per residency requirements)

Assess patient adherence and reliability

Communicate with the inter-professional team to ensure safe and appropriate transfer or discharge

Goal R1.3 Prepare, dispense, and manage medications to support safe and effective drug therapy for patients

Objective R1.3.1:

(Applying) Prepare and dispense medications following best practices and the organization’s policies and procedures.

Identify, clarify, verify and correct any medication order errors before preparing or permitting distribution of first dose

Prepare and dispense intravenous medications using appropriate techniques, following organizations policies and procedures

Prepare and affix medication labels, ensures the integrity of the medication dispensed

Provide any necessary written or verbal counseling on the administration of the medication upon delivery


GOAL R2.1: Demonstrate ability to manage formulary and medication-use processes, as applicable to the organization

Objective R2.1.4


Describe the Adverse Drug Event documentation and reporting system within the

institution (Incident Reporting Intranet System - IRIS)

Report any adverse events per institutional reporting policies and procedures

(IRIS)


recommendations as a new i-Vent


Competency Area R3: Demonstrate Leadership Skills

Goal R3.1: Demonstrate leadership skills

Objective R3.1.1


Character: Demonstrate pride in and commitment to the profession through appearance and professional personal contacts

Act ethically in the conduct of all job-related activities

Demonstrate effective workload and time management skills

Use effective communication skills and styles through oral and written presentations

Take over responsibilities as the primary pharmacist on service (if repeating as an elective rotation)

Objective R3.1.2


Conduct periodic self-assessments to practice self-directed learning and

professional development

Effectively use a self-evaluation system for developing professional direction,

goals and plans


revised 2/9/2017


Objective R4.1.1

(Applying)

Design effective

educational

activities.

Prepare for and participate in topic discussions with preceptor; lead at least two

topic discussions with pharmacy students (if applicable)

One formal journal club presentation to pharmacy department

One formal case presentation to pharmacy department

Provide drug information to the house staff, nurses, and other health-care professionals (informal and formal presentations as required)

Objective R4.1.2


Use effective oral communication skills during journal club presentation and case presentation

Use effective oral communication skills when providing drug information to

other health-care professionals as needed

Demonstrate competence in counseling patients on medications and/or devices

and adherence (compliance)

Explain the indication for each medication , common side effects and strategies

to mitigate them, customizing education to patients vs. healthcare professionals

R4.1.3 (Applying) Use effective written communication to disseminate knowledge.

Use effective written communication skills to put together educational handouts, including but not limited to: journal club handout, case presentation handout, formal written drug information responses, and, educational nursing handouts

Contribute to the students’ evaluations

Set up a time and date for journal club and case presentations

Email chief resident to notify pharmacy department at least one week in advance of presentation date; journal club article should be available one week in advance of presentation



Precept pharmacy students (when applicable), serve as

co-preceptor, facilitate/lead topic discussions

Contribute to students’ evaluations

Instruct, model, coach and facilitate, when appropriate

R4.2.2 (Applying) Effectively employ

preceptor roles, as appropriate.

Preceptor Interactions - Variable and resident-specific. Expected progression of resident responsibility on the Core Emergency Medicine experience: Day1 @ 1000 Preceptor provides orientation to service, hospital, nursing floors, and reviews Emergency

Department learning activities and expectations. Week 1-2 Resident works up patients and presents to preceptor. Preceptor will attend and participate in

patient care activities to model pharmacist’s role. Week 3-4 Resident continues to work up patients and presents to preceptor. Preceptor will attend and

participate in patient care activities to coach the resident to take on more responsibilities as the primary pharmacist. In addition, if there is a pharmacy student on the team, the resident will take on the responsibility of a co-preceptor role.

Week 5-6 Resident continues to work up patients and presents to preceptor. Preceptor will attend and observe the resident’s participation in patient care activities to facilitate and/or may expect a summary report from the resident on recommendations made by the resident, updates on

revised 2/9/2017

patients, and student progress. Preceptor will always be available via pager, vocera, or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the pharmacist.

Expected progression of resident responsibility on the Elective Emergency Medicine experience: Day1 @1000 Resident will be oriented on any changes to the workflow since they were last on the rotation. Week 1-2 Resident will be expected to independently participate in patient care activities; as well as take

on the responsibility of a co-preceptor role if there is a pharmacy student on the team. Depending on the resident progress, the preceptor may attend and observe the resident’s participation in patient care activities to and/or may expect a summary report from the resident on recommendations made by the resident, updates on patients, and student progress.

Week 3-4 Resident will be expected to take over responsibilities as the primary pharmacist on service. Preceptor will always be available via pager, Vocera, phone, or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the pharmacist.













Time and Attendance

o Preceptor should be notified of all time off requests/meetings during rotation as soon as possible per residency guidelines. Meetings should not be scheduled during patient care activities.

o Overtime will not be granted except in extreme cases.

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Infectious Diseases / Antimicrobial Stewardship Rotation PGY1 Resident Expectations and Responsibilities Preceptor: Marisa Méndez, PharmD, MPH, BCPS Office ( (ext ) General Description The Infectious Diseases (ID) Service is a consulting service. Hospitalized patients are seen at the request of the primary physicians (private or teaching service). Patient population includes adults and pediatrics located in an area of CRMC - rehabilitation floor, medical/surgery units, step down units, intensive care units. Consultations are provided by the residents and students on the ID service under the guidance and supervision of the ID attending physician. The ID Service consists of the attending physician, ID pharmacist, ID/Pulmonary-Critical Care fellow(s), medical and pharmacy residents and students. This section is under revision. Disease States The resident will be expected to gain knowledge and proficiency in the principles of infectious diseases through self-directed learning, literature review, topic discussions and/or direct patient care experience including, but not limited to:

A. Signs and symptoms consistent with infection B. Disease states which can mimic infection C. Host factors which may predispose patients to infection D. The most likely anatomic sites for infectious processes E. Common pathogens and symptoms associated with infection for each of the following sites:

central nervous system, lung, heart, abdomen, genitourinary, skin/soft tissue, bone, intravenous catheter site

F. All common bacteria on the basis of Gram stain (e.g. Gram-positive versus Gram-negative, rod versus cocci) and oxygen requirements (aerobic versus anaerobic)

G. Signs, symptoms, complications, and monitoring parameters in HIV positive patients H. Monitoring parameters in a patient with infectious disease(s) I. For a given antimicrobial agent identify the drug class, mechanism of action, therapeutic and

toxic endpoints, adverse effects, dosing and administration considerations, monitoring, biopharmaceutic (dosage form, palatability, cost, etc.), pharmacokinetic and pharmacodynamic parameters.

Activity Goals Covered

Identify adverse effects associated with drug therapy and make necessary interventions

Complete online Incident Reporting Intranet System (IRIS) report on all medication errors, adverse drug reactions resulting from medication administration or causing admission to the hospital

Identify relevant literature to support therapeutic recommendations

Assist pharmacy in clarifying medication orders written by medical team, and answering medication questions about patients on the team

R1.1 R1.4 R1.5

revised 2/9/2017

Monitor assigned patients on ID Medical Service and formulate a drug regimen and appropriate monitoring parameters based on patient specific characteristics (as described below)

Review patient medication profiles for: Medications used with no medical indication; Medical conditions for which there is no medication prescribed; Appropriate medication selection and dosing for allergies, comorbidities and drug-drug interactions; Appropriate prescribing (i.e. correct dose, dosage form, duration, schedule, route of administration, method of administration, etc.); Therapeutic duplications; Drug-drug interactions, drug-nutrient interactions and/or drug-device interactions (including social, recreational, nonprescription or nontraditional medications potentially used prior to admission); Anticipated duration of therapy; Necessary monitoring parameters; Compliance with institution’s medication formulary; Cost-effectiveness considerations

Design a patient-centered regimen to achieve evidence-based therapeutic goals (considered all items listed above)

Design a patient-centered monitoring plan to ensure achievement of therapeutic goals. Redesign care plan as necessary based on monitoring data and therapeutic outcomes

Establish collaborative working relationship with members of a multidisciplinary health care team

Assist in providing pharmacokinetic monitoring for services without a designated clinical pharmacist and document recommendations appropriately

Appropriately select direct patient-care activities for documentation

Attend daily rounds; actively participate in patient discussions and present therapeutic recommendations

Provide patient education and drug information to ID service

Communicate patient information to other clinical pharmacist specialists if patients are transferred to another service

R2.1 R2.2 R2.3 R2.4 R2.6 R2.7 R2.8 R2.9 R2.10 R2.11 R2.12

Outcome R3: Exercise leadership and practice management skills

Take over responsibilities as the primary pharmacist on service

Conduct periodic self-assessments to practice self-managed professional development

Character: Demonstrate pride in and commitment to the profession through appearance and professional personal contacts; Act ethically in the conduct of all job-related activities

Not formally evaluated

Outcome R5: Provide medication and practice-related education/training

Prepare for and participate in topic discussions with preceptor; lead at least two topic discussions with pharmacy students (if applicable)



Set up a time and date for journal club and case presentations; email chief resident to notify pharmacy department at least one week in advance of presentation date; journal club article should be available one week prior to presentation date

Perform Med Checks on a regular basis and document as i-Vents

Document all therapeutic interventions in i-Vents

Educational activities (journal clubs, case presentations, in-services, topic discussions): Identify current controversies in literature (journal club) or in a

R5.1 E7.4

revised 2/9/2017

specific patient care (case presentation); Identify relevant literature; Critically evaluate literature and how they add information/clarity to area of controversy; Use public speaking skills to effectively communicate educational goals; Use audio-visual aids and handouts to enhance communication of educational goals

Precept pharmacy students (when applicable): Serve as pre-rounding preceptor; Facilitate/Lead topic discussions; Assist the student in following up on patient issues following rounds; Identify and implement the four preceptor roles as appropriate for the student and the activity (direct instruction, modeling, coaching and facilitation); Contribute to the students’ evaluations

Preceptns for rounding services Daily activities are dependent on the time of rounds with the team, which is dependent on the attending physician. In general rounds will be in the afternoon on Monday and as listed below on Tuesday through Friday, depending on the atending. : 0900 or 1100 Pre-rounds with resident 1030 or 1300 Team Rounds

Office hours: The preceptor does not have set office hours, but is always available to the resident via

BOTH on the resident’s progression in the current rotation and where the rotation occurs in the residency rogram]













Time and Attendance

o Preceptor should be notified of all time off requests/meetings during rotation as soon as possible per residency guidelines. Meetings should not be scheduled during patient care activities.

o Overtime will not be granted except in extreme cases.

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Internal Medicine Rotation PGY1 Resident Expectations and Responsibilities Preceptor: Nicole Lu, PharmD, BCPS (pager / Office ) General Description Internal Medicine (IM) is a core rotation for the Community Regional Medical Center PGY1 pharmacy residency program, and is a rotation that all residents will experience early in the residency year. The patients on the IM service are located in various areas of the hospital. IM is part of the teaching service with UCSF, and consists of Teams A, B, and C. Team D is the Family Practice service. Each Team is on-call every 4 days. Each team consists of an attending physician, a PGY2 or PGY3 medical resident, 2-3 PGY1 medical interns, and may have medical students. Clinical Pharmacists, Pharmacy residents, and Pharmacy students are also part of the team. Most teams will round in the morning starting from 9-10 AM, and may meet in the Team Rounding Rooms or on the floors. All rounding rooms are located on the 5th Floor Annex. The major challenges for this rotation is time management, experiencing a broad variety of patients and disease states, how to work up a patient, and learning how to communicate pertinent information in a clear and concise manner. Disease States Common disease states in which a resident will be expected to gain knowledge and proficiency through self-directed learning, literature review, topic discussions and/or direct patient care experience include, but are not limited to:

1. Cardiovascular disorders

Atrial fibrillation

Heart failure

Hyperlipidemia

Hypertension

Myocardial infarction

Stroke 2. Endocrinology disorders

Diabetes mellitus

Thyroid disorders 3. Gastrointestinal/ Liver disorders

Ascites

Cirrhosis

GERD/PUD

Esophageal varices

Hepatic encephalopathy

Hepatitis

Hepatorenal syndrome

Pancreatitis

Spontaneous bacterial peritonitis

4. Infectious Diseases

Bacteremia/Endocarditis

Bone and joint infections

HIV/Opportunistic infections

Meningitis

Pneumonia

Skin and soft tissue infections

Urinary Tract Infections 5. Pharmacokinetics/Drug monitoring

Aminoglycosides

Vancomycin

Warfarin 6. Renal disorders

Acute renal failure

End stage renal disease 7. Respiratory disorders

Asthma

Chronic obstructive pulmonary disease

Cystic fibrosis 8. Thrombosis/thromboembolism

Deep venous thrombosis

Pulmonary embolism

revised 2/9/2017





Objective R1.1.1


Pre-round with IM preceptor daily

Actively participate in patient discussion during daily IM team rounds, make pharmacotherapeutic recommendations, and contribute drug information

Interact with the health-care team in a culturally-sensitive manner.

Communicate with the inter-professional team to ensure safe and appropriate medication management

Objective R1.1.4


Demonstrate knowledge of therapeutic principles related to IM topics,

including but not limited to:

o Cardiovascular disorders

o Endocrinology disorders o Gastrointestinal/Liver disorders o Infectious diseases o Pharmacokinetics/Drug monitoring o Renal disorders o Respiratory disorders o Thrombosis/thromboembolism

Given a patient’s medical history (symptoms, physical examination,

laboratory values, current medications, and diagnosis) identify:




o Inappropriate medication therapy regimen (i.e., dose,

therapeutic duplication, route of administration, drug allergy

etc.)



o Review of discharge medications, medication therapy goals,

monitoring parameters, and potential side effects

Objective R1.1.5


Develop pharmacotherapeutic plans for medication therapy, including

medication therapy goals, monitoring parameters, and potential side

effects

Perform pharmacokinetic calculations for patients on vancomycin and aminoglycosides to predict effective and safe doses

Monitor drug levels for patients on medications with a narrow therapeutic window and recommend dose adjustments to the medical team if necessary

Objective R1.1.6

(Applying) Ensure implementation of therapeutic regimens and monitoring plans

Assess and facilitate optimization of current drug therapy based upon patient-specific variables

revised 2/9/2017

(care plans) by taking appropriate follow-up actions.

Follow up to ensure recommendations are implemented appropriately (i.e. correct drug, dose, route, frequency, and duration are ordered) and in a timely manner

Objective R1.1.7


Concisely, clearly, and effectively document any interventions, assessments and recommendations as a new i-Vent (minimum of 125 per residency requirements)

Documenting ADE’s/medication errors via the IRIS system as they arise

Objective R1.1.8


For all patients, ensure all identified medication-related issues are resolved by the end of the day. If cannot be resolved, ensure that any outstanding issues are communicated to the IM residents or evening pharmacists for follow up as needed prior to leaving for the day

Be a patient advocate by informing IM team regarding pertinent patient information that affects medication management (i.e. medications have been administered or withheld inappropriately by medical staff, or patient refusing medications)



Objective R4.1.1


Prepare for and participate in topic discussions with preceptor (and pharmacy students if present)

Provide at least one in-service to the IM team

Prepare and present one formal journal club presentation to pharmacy department

Prepare and present one formal case presentation to pharmacy department

Objective R4.1.2


Educational activities (journal clubs, case presentations, in-services, topic

discussions) include:

o Identify current controversies in literature (journal club) or in a specific

patient case (case presentation)

o Identify relevant literature

o Critically evaluate literature and assess how the literature

adds information/ clarity to areas of controversy

o Use public speaking skills to effectively communicate educational goals

o Use audio visual aids and handouts to enhance communication of

educational goals

Evaluate and critique drug literature, new drug information and published

protocols, evaluate study design strengths and weaknesses, and develop

conclusions on how literature may change disease state management

Provide drug information to other health-care professionals as needed


Contribute to students’ evaluations (when applicable)



revised 2/9/2017

R4.1.4 (Applying) Appropriately assess effectiveness of education

Respond to follow up questions from presentations (journal clubs, case presentation, in-services, topic discussions) and drug information questions in a timely manner.




o Serve as co-preceptor


o Assist the student in following up on patient issues after rounds

o Assist the student in their preparation for journal club or big talk

presentations



facilitation)

R4.2.2 (Applying) Effectively employ preceptor roles, as appropriate


o Serve as co-preceptor


o Assist the student in following up on patient issues after rounds

o Assist the student in their preparation for journal club or big talk

presentations



facilitation)

Provide positive as well as constructive feedback to students during

formative and summative student evaluations in collaboration with IM

preceptor

Take over responsibilities as the primary pharmacist on service (especially if

repeating as an elective rotation)

Preceptor interactions for rounding services Daily: 0900 Pre-rounds with resident 0930 Team Rounds

1400-1600 Preceptor office hours available for topic discussions, reviewing progress notes, patient updates, etc.

Expected progression of resident responsibility on the Core Internal Medicine experience: Day 1 Preceptor provides orientation to service, hospital, nursing floors, and reviews IM

learning activities and expectations. Week 1-2 Resident works up patients on the team and presents to preceptor prior to team

rounds. Preceptor will attend and participate in team rounds to model pharmacist’s role on the team.

Week 3-4 Resident continues to work up patients on the team and presents to preceptor prior to team rounds. Preceptor may attend and participate in team rounds to coach the resident to take on more responsibilities as the primary pharmacist on the team. In addition, if there is a pharmacy student on the team, the resident will take on responsibility of a co-preceptor role.

revised 2/9/2017

Week 5- Resident continues to work up patients on the team and presents to preceptor prior to team rounds. Preceptor may attend and observe the resident’s participation in team rounds, and/or may expect a summary report from the resident on recommendations made by the resident, updates on patients, and student progress. Preceptor will always be available via pager, phone or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the pharmacist on the team.

Expected progression of resident responsibility on the Elective Internal Medicine experience: Day 1 Preceptor provides orientation to service, hospital, nursing floors, and reviews IM

learning activities and expectations. If resident is taking the rotation for a 2nd time as an elective, the resident will be oriented on any changes to the workflow since they were last on the rotation.

Week 1-2 Resident works up patients on the team and presents to preceptor prior to team rounds. Preceptor will attend and participate in team rounds to model pharmacist’s role on the team.

Week 3-4 Resident continues to work up patients on the team and presents to preceptor prior to team rounds. Preceptor may attend and participate in team rounds to coach or observe the resident to take on more responsibilities as the primary pharmacist on the team, and/or may expect a summary report from the resident on recommendations made by the resident, updates on patients, and student progress. In addition, if there is a pharmacy student on the team, the resident will take on responsibility of a co-preceptor role. Preceptor will always be available via pager, phone or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the pharmacist on the team.













revised 2/9/2017

Time and Attendance o The resident is expected to arrive in the morning to allow for adequate pre-rounding time with preceptor

before rounds. The resident may leave once all daily activities are complete; however, an 8 hour day is expected.



revised 2/9/2017

Medication Safety Rotation Learning Activities PGY1 Resident Expectations and Responsibilities Preceptor: Curtis Takemoto, PharmD, Medication Safety Specialist Office: Medication Safety Specialist Office-Basement Hours: 0800-1600 (Monday through Friday) Pager: General Description The Medication Safety Rotation is an elective rotation for the Community Regional Medical Center PGY1 pharmacy residency program. Activities will emphasize concepts including but not limited to:

Introduction to Just Culture and Safety Culture

Risk management and error prevention /minimization

Reporting and analyzing medication related events (e.g. medication errors, adverse drug reactions)

Interdisciplinary systems approaches to address medication and patient safety

Policy development and revision Goals and Objectives:

To understand the foundation of medication safety principles to facilitate patient safety.

To understand how interdisciplinary relationships involving medication safety are vital to patient care.

Understand the intercalation of the culture of safety and regulatory compliance.

To inculcate the concepts of Just Culture, medication and patient safety throughout the CRMC licensed facilities.




Objective R2.1.3


Review medication events reports daily and as assigned by Risk Management from all areas listed under CRMC licensure.

Identify trends in any specific area(s) involving the medication events.

Presentation of events and trending to the pertinent committees.

Review and evaluate the medication event data from CRMC, FHSH and CBHC.

Assist in the annual revision of the Medication Error Reduction Plan (MERP) for CRMC and FHSH.

Assist in the development of the annual revision of the Corporate Look Alike Sound Alike document.

Objective R2.1.4

(Applying) Participate in medication event reporting and monitoring

Daily use of trigger tool document.

Identify medication events, near miss (close call) events and adverse

drug reactions (ADRs).

Enter and evaluate medication events into the Incident Reporting

Intranet System (IRIS) and perform follow up activities.

Participate in Multidisciplinary Case Reviews (e.g. intense case reviews,

root cause analysis (RCA))

Preceptor interactions for activities Daily: Beginning of the day and anytime between 0800-1600

revised 2/9/2017

Expected progression of resident responsibility on the Elective Medication Safety experience: Day 1: 0800 Preceptor provides background information on advanced topics, processes and projects. Week 1-2: Preceptor will expect resident to independently complete advanced projects. Resident

will attend all meetings on the calendar and be expected to take on tasks or help with work that is given to the preceptor.

Week 3-4 Resident continue to complete projects assigned and must complete or sign off their progress to the preceptor.

[The length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident’s progression in the current rotation and where the rotation occurs in the residency program] Evaluation Strategy E-Value will be used for documentation of formal evaluations. For final evaluations, resident and preceptor will independently complete the final evaluations. After both have completed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self-assessment.





Time and Attendance

o The resident is expected to arrive in the morning to allow for adequate time with preceptor. The resident may leave once all daily activities are complete; however, an 8 hour day is expected.



revised 2/9/2017

Operations Rotation / Longitudinal Learning Experience PGY1 Resident Expectations and Responsibilities Preceptor: Lynn Almodovar, PharmD, BCPS (cell / Office Keith Walsh, PharmD (pager / Office ) Avo Arikian, PharmD, BCPS (pager / Office General Description

All residents are required to have an active pharmacy license in the state of California.

Each resident will train with an assigned preceptor. Basic training will take place during the first month of the residency.

At the conclusion of the basic training period, the preceptor and the resident will mutually determine if the resident is ready to function independently as a pharmacist.

If the resident is not ready to function independently at the conclusion of the training period, the following actions will occur:

1. A list of deficiencies will be developed by the preceptor. 2. A specific plan will be outlined by the preceptor and the RPD to provide additional

training/experience in the area(s) of weakness which are identified by the preceptor and the resident.

3. A copy of this plan will be forwarded to the Inpatient Pharmacy Manager of the area as well as the RPD.

4. Progress will be re-evaluated on a weekly basis.

Once the resident is deemed competent, he/she will function in the shifts designated by the preceptor for the remainder of the residency.

Each resident will gain pharmacy operations experience as a pharmacist in the inpatient pharmacy, will be scheduled on weekends, and will be paid overtime (OT). Residents will not receive time off during the week for their weekend shift. If a resident missed one of the operations weekend shifts due to illness or time off, then they must make up the time.

Residents are permitted to work additional shifts within the Department of Pharmacy Services if approved ahead of time. These shifts may not interfere with any of the resident’s rotation OR residency requirements. If a resident chooses to work additional shifts, he/she should inform his/her Residency Program Director and complete a moonlighting form. Residents may not work additional shifts when they are the primary clinician for any service.





Objective R1.1.3

(Applying) Collect information on which to base safe and effective medication therapy

Perform order entry and order verification. Prospective medication review upon order entry or order verification Clarify orders with providers, escalating to administrator-on-call if needed

Objective R1.1.4

(Analyzing) Analyze and assess information on which to base safe and effective medication therapy

Document interventions (i-Vents). Document Adverse Drug Event (ADE) and medication errors in Incident Reporting Intranet System (IRIS). Document pharmacy-managed protocol activities appropriately (monitoring sheets, i-Vents)

revised 2/9/2017

Objective R1.1.5

(Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans)

Manage patients on clinical pharmacy service (vancomycin, aminoglycosides, TPN and warfarin)

Objective R1.1.6

(Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions

Ensure recommended plan is implemented effectively for the patient per pharmacy consult protocol

Objective R1.1.7

(Applying) Document direct patient care activities appropriately in the medical record or where appropriate

Document interventions in iVents and progress notes

GOAL R1.3 Prepare, dispense, and manage medications to support safe and effective drug therapy for patients.

Objective R1.3.1

(Applying) Prepare and dispense medications following best practices and the organization’s policies and procedures

Complete IV validation testing (aseptic technique, written tests). Compound IVs if needed.

Objective R1.3.2

(Applying) Manage aspects of the medication-use process related to formulary management

Check medications prior to delivery to patients (Pyxis, first doses, IVs). Check medication trays (anesthesia trays, crash cart trays, Rapid Sequence Intubation (RSI) kits)

Objective R1.3.3

(Applying) Manage aspects of the medication-use process related to oversight of dispensing

Perform pharmacist checker responsibilities. Ensure all medications are appropriately dispensed before leaving the pharmacy

Competency Area R3: Demonstrate Leadership Skills GOAL R3.1 Demonstrate leadership skills Objective R3.1.1


Integrate as an effective team member within pharmacy operations

Objective R3.1.2

(Applying) Apply a process of on-going self-evaluation and personal performance improvement

Accurately summarizes own strengths and areas for improvement (in knowledge, values, qualities, skills, and behaviors). Effectively use a self-evaluation process for developing professional direction, goals and plans. Demonstrate ability to use and incorporate constructive feedback from others

Competency Area R4: Teaching, Education, Dissemination of Knowledge GOAL R4.2 Effectively employs appropriate preceptors’ roles when engaged in teaching

Objective R4.2.1

(Analyzing) When engaged in teaching, select a preceptors’ role that meets learners’ educational needs

May teach or precept students in operations workflow, if applicable

revised 2/9/2017

Objective R4.2.2


May teach or precept students in operations workflow, if applicable

Expected progression of resident responsibility on the Operational experience: Week 1: Preceptor(s) provide orientation and tour of inpatient pharmacy and facility with introduction

and orientation to EPIC, Talyst, and Community Forum. Resident observes and participates in the process of Pyxis fill and delivery. Start working on required HLCs.

Week 2-4: Resident will progress to checking medication trays (anesthesia trays, crash cart trays, RSI kits).

Resident will orient to IV room workflow and perform aseptic technique competency test. Resident continues to learn the navigation, search, verification and retrieval of orders in Epic. Residents begin learning process of order clarification, dose adjustment, therapeutic substitution or intervention. Resident will begin participating in pharmacy approved protocols of pharmacokinetic dosing and warfarin monitoring. If licensed, resident will verify and enter orders independently in Epic. Continue progress on required HLCs.

Quarterly: Resident will complete all required HLCs within the first 60 days. Resident will continue progress

in regards to EPIC verification and order entry ability, problem solving, organizational skills, and checking functions in regards to drug delivery system. Resident will progress in covering various operational pharmacy shifts as licensure allows.






Quarterly Longitudinal Self Evaluation Resident Quarterly

Quarterly Longitudinal Evaluation Preceptor Quarterly

Time and Attendance

o The resident is expected to arrive on time for their scheduled shift. o Overtime will not be granted except in extreme cases. o Preceptor should be notified of all time off requests/meetings during rotation as soon as possible per

residency guidelines.

revised 2/9/2017

Orientation Learning Experience PGY1 Resident Expectations and Responsibilities Preceptor: Alice Robbins, PharmD, BCPS, Residency Program Director Office: 2nd Floor Annex Hours: 0800-1600 First day Orientation Phone: General Description The activities during orientation will give you the background skills and tools to facilitate your residency year and Chief Resident Role.

Day 1 orientation includes: o New hire orientation paperwork and CMC related policies o Meet and Greet with Pharmacy Services Department o Overview of Residency Manual and Program o Assignments of Chief Resident o Discussion of ASHP Standards, Goals and Objectives o Discussion on E-Value o Inpatient training schedule / Staffing schedule and expectations o Pager assignments and pager courtesy o Discussion of pharmacist licensure and Epic access o Tour of facility

Introduction to Pharmacy Conference room calendar and scheduling

Pharmacy Workgroups tab

Health Stream Learning Center (HLC) for competencies, ACLS and BLS

IRB class for residency research project

UCSF preceptor training for precepting students

UCSF CPE Resident Seminar orientation in preparation for CPE requirements

Resident Mixer with other residents from the Central Valley

Operations training (see Operations Rotation for more information) Goals and Objectives and Evaluation Strategy: no ASHP Goals or Objectives will be formally evaluated during the Orientation Activity Time and Attendance




revised 2/9/2017

Pharmacy Informatics Rotation PGY1 Resident Expectations and Responsibilities Preceptor: Janie Hatai, PharmD, FCSHP, Epic Willow Analyst Office: Community Support Administration Bldg, 2nd floor Hours: 0700-1530 (Monday through Friday) Phone: Other ad hoc preceptor(s) involved:

Michelle Chang, PharmD, Epic Willow Analyst

David Lennon, PharmD, Epic Willow Analyst

Wayne Sanchez, CPhT, Epic Willow Analyst

Wung Xiong, , CPhT, Epic Willow Analyst

Jack Buchanan, Manager, IS Clinical Support Group

James Moore, Epic Clarity Analyst

General Description The informatics rotation is a 4 week block elective rotation in which the resident becomes familiar with medication use information systems of the pharmacy and medical center. The activities will emphasize the basic understandings that will include, but are not limited to:

Informatics project management and technology assessment which includes: o Computerized Prescriber Order Entry (CPOE) system o Pharmacy Order Entry and Verification system o Bar-coded Medication Administration (BCMA) system

Integrated electronic health record (EHR) design and maintenance

Clinical decision support

Automation/technology Goals and Objectives

To provide exposure to clinical informatics at Community Medical Centers (CMC) and insight into the principles of Pharmacy Informatics and Health Information Technology (HIT)

To understand reasons for patient security and privacy in regard to electronic data and systems.

To understand the general structure of various medication use systems of CMC and Pharmacy Services, including databases and decision support to help reduce patient risk

To provide effective medication and practice-related education, training or guidance to end users Goals and Objectives to be Taught and Formally evaluated:




Objective R2.1.3


Help to identify opportunities for improvement within CMC medication use systems

Identify, design, and implement if possible a pilot project to change a problematic or potentially problematic aspect of the medication use system with the objective of improving the quality of patient safety

revised 2/9/2017

Elective Goals and Objectives to be TAUGHT (not formally evaluated):


Competency Area E2: Added Leadership and Practice Management Skills

Goal E2.1 Apply leadership and practice management skills to contribute to management of pharmacy services.

Objective E2.1.2

(Applying) Contribute to the development of a new pharmacy service or to the enhancement of an existing service.

Help identify educational material to enhance the effectiveness for patient safety and outcomes

Daily Preliminary Troubleshooting as identified in Issue Tracker software

Troubleshoot Willow Grow team items as they arise

Objective E2.1.4

(Applying) Contribute to the financial management of the department.

Daily Medication List Maintenance

Troubleshoot BCMA issues (e.g. CRMC contact: Gil Ramirez)

Goal E2.2 Contribute to the management and development of pharmacy staff.

Objective E2.2.2

(Applying) Contribute to orientation, staff development, and training activities for practice area personnel.

Attend Meetings including but not limited to: o Willow Build Team Meeting with Epic TS - weekly o CRMC and Willow Build Team Meeting – monthly o CCMC and Willow Build Team Meeting – monthly o FHSH and Willow Build Team Meeting – monthly o CRMC Medication Management Committee Meeting – monthly o CCMC Medication Management Committee Meeting – monthly o FHSH Medication Management Committee Meeting – monthly o Willow Grow Team Meeting - monthly o Epic Meetings as indicated o Other meetings regarding automation as indicated

Review sections of the Epic Willow build utilizing the Epic training companions as determined by the resident’s preceptor

Preceptor interactions for patient care activities Daily: Beginning of the day and anytime between:

0730 - 1600 Expected progression of resident responsibility on the Pharmacy Informatics Elective experience: Day 1: 0730 Preceptor provides orientation to rotation, office space, and reviews Pharmacy

Informatics learning activities and expectations. Access to IT programs and environments are validated. Additional reading material is provided.

Week 1-2: IT Manager provides resident with IT Overview. Preceptors meet with resident to review EHR build. Resident will read section(s) applicable to EHR build review prior to meeting with preceptor. Resident trained on HEAT and attends meetings in which preceptors attend to get an idea of the topics IT pharmacists are involved with. Resident gains insight about Excel vLookup and pivot tables, if needed, and how it can make the data easier to analyze.

Week 3-4 Preceptors assign projects to the resident that incorporates the information provided. Other non-EHR review including but not limited to Pyxis and Alaris Smart Pumps as time allows.

revised 2/9/2017

[The length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident’s progression in the current rotation and where the rotation occurs in the residency program] Evaluation Strategy for all components of the Pharmacy Informatics Rotation E-Value will be used for documentation of formal evaluations. For final evaluations, resident and preceptor will independently complete the final evaluations. After both have completed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self-assessment.





Time and Attendance




revised 2/9/2017

Quality Management / Performance Improvement Rotation - Elective PGY1 Resident Expectations and Responsibilities Preceptors: Jennifer Trytten, PharmD, BCPS, CJCP; Amy Royston, PharmD, BCPS, CPHQ Office: , Fresno, CA 93721 (Amy)

Fresno, CA 93710 (Jennifer) Hours: 0700-1530 (Monday through Friday) Phone: (Amy) / (Jennifer) General Description The Quality Management/Performance Improvement (QM/PI) rotation is a 4 week block elective rotation in which the resident becomes familiar with quality improvement planning and measurement in a complex medical center. Activities will largely target health care process improvement and may include medication safety, infection control, and Health Care Associated Conditions. The activities will emphasize basic understanding that include, but are not limited to:

Performance improvement models (e.g. PDSA, DMAIC);

Data collection and analysis techniques associated with quality management;

Risk mitigation strategies (e.g. Failure Mode and Effects Analysis, Root Cause Analyses);

Public reporting and pay-for-performance metrics;

Regulatory compliance (especially related to National Patient Safety Goals and Quality Assurance Performance Improvement (QAPI) standards);

Performance improvement processes and tools (LEAN, project charters)

Development of appropriate metrics Goals and Objectives

To provide exposure to quality management and performance improvement activities, especially as related to patient safety;

To provide exposure to processes required for identification, pursuit, measurement and refinement of quality improvement initiatives;

To understand the regulatory requirements for quality measurement and performance improvement;

To understand the general structure of quality and patient safety reporting at Community Regional Medical Center;

To develop multidisciplinary relationships to foster collaborative quality and performance improvement initiatives.

revised 2/9/2017




Goal R2.1 Demonstrate ability to evaluate and investigate practice, review data, and assimilate scientific evidence to improve patient care and/or the medication use system.

Objective R2.2.1

(Analyzing) Identify changes needed to improve patient care and/or the medication-use systems.

Identify performance improvement opportunities based on regulations, public reporting and pay-for-performance initiatives.

Define scope of performance improvement work through baseline data analysis, DMAIC, brainstorming and/or RCA techniques, as appropriate.

Objective R2.2.2

(Creating) Develop a plan to improve the patient care and/or medication-use system.

Formalize project scope with a project charter. Utilize appropriate project management tools and techniques (e.g. Lean strategies) for development of project.

Objective R2.2.3

(Applying) Implement changes to improve patient care and/or the medication-use system.

Implement performance improvement work based on regulations, public reporting and pay-for-performance initiatives.

Objective R2.2.4

(Evaluating) Assess changes made to improve patient care or the medication-use system.

Identify and develop monitoring strategies to assess effectiveness of quality and performance improvement efforts.

Competency Area R3 Leadership and Management

Goal 3.1 Demonstrate leadership skills

Objective R3.1.1


Facilitate and lead multidisciplinary performance improvement work.

Objective R3.1.2


Seek feedback regarding facilitation of multidisciplinary performance improvement work.

Goals and objectives to be TAUGHT (not formally evaluated):



Goal R1.1 In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients…following a consistent patient care process.

Objective R1.1.5


Identify performance improvement opportunities based on regulations, public reporting and pay-for-performance initiatives.

Define scope of performance improvement work through baseline data analysis, DMAIC, brainstorming and/or RCA techniques, as appropriate.

Objective R1.1.6


.Activity is being created / under revision

Objective R1.1.8


Attend meetings including but not limited to:

Quality/Patient Safety Committee (CRMC) – monthly

Medication Management Committee (CRMC) – monthly

Quality Council (Corporate) – monthly

revised 2/9/2017

Nursing Professional Practice Committee (Corporate) – monthly

Core Measure Workgroups (CRMC) – monthly

Practice and Compliance Meeting (CRMC) - monthly


Goal 4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public.

Objective R4.1.1


Develop educational material to enhance quality and performance improvement projects.

Objective R4.1.2


Deliver educational material to enhance quality and performance improvement projects.

Objective R4.1.3

(Applying) Use effective written communication to disseminate knowledge.

Deliver educational material to enhance quality and performance improvement projects.

Objective R4.1.4

(Applying) Appropriately assess effectiveness of education.

Seek feedback regarding effectiveness of educational materials.

Expected progression of resident responsibility on the Elective Quality Management / Performance Improvement Rotation experience: Day 1: 0800 Preceptor provides background information on advanced topics, processes and projects. Week 1-2 Preceptor will expect resident to independently completed advanced projects. Resident

will attend all meetings on the calendar and be expected to take on tasks or help with work that is given to the preceptor.

Week 3-4 Resident continue to complete projects assigned and must complete or sign off their progress to the preceptor

[The length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident’s progression in the current rotation and where the rotation occurs in the residency program] Evaluation Strategy for all components of the Quality Management/Performance Improvement (QM/PI) Rotation E-Value will be used for documentation of formal evaluations. For final evaluations, resident and preceptor will independently complete the final evaluations. After both have completed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self-assessment.





Time and Attendance




revised 2/9/2017

Transitions of Care Rotation PGY1 Resident Expectations and Responsibilities Preceptor: Tamar K. Lawful, PharmD, (Pager /Office ) General Description Transitions of care (TOC) is a core rotation for Community Regional Medical Center PGY1 pharmacy residency program. The patients on the TOC service are located on the 4th floor Cardiac Progressive Care Unit (CPCU). TOC is part of the interdisciplinary CPCU discharge team consisting of Community Hospital Medical Group (CHMG) physicians, CPCU nurses, Home Health nursing liaison, Case Managers, Social Workers, and dietician. Clinical Pharmacist, Pharmacy residents, and Pharmacy students are also part of the team. The discharge team first rounds from 9-915AM to briefly discuss potential discharges; then again from 1-2PM to discuss patients in detail. The major challenges for this rotation are time management, exposure to a broad variety of patients and disease states, and learning how to communicate pertinent information in a clear and concise manner. Disease States Common diseases in which a resident will be expected to gain knowledge and proficiency through self-directed learning, literature review, topic discussions and/or direct patient care experience include, but are not limited to:

Cardiovascular disorders o Atrial fibrillation o Heart failure o Hyperlipidemia o Hypertension o Myocardial infarction o Stroke

Endocrinologic disorders o Diabetes mellitus

Respiratory disorders o Asthma o Chronic obstructive pulmonary disease o Pneumonia

Thrombosis/thromboembolism o Deep venous thrombosis o Pulmonary embolism





Objective R1.1.1


Pre-round with TOC preceptor daily

Participation in TOC discharge team rounds daily

Interact with patients, their families, and the health-care team in a culturally-sensitive manner.

Communicate with the inter-professional team to ensure safe and appropriate discharge

Notify TOC pharmacy technician of post discharge PCP appointments that need to be scheduled; or schedule these appointments in the absence of the TOC pharmacy technician

revised 2/9/2017

Objective R1.1.2


Demonstrate brief yet effective negotiation techniques with patients to

increase positive behavioral changes.

Interact with patients, their families, and the health-care team in a

culturally-sensitive manner.

Effectively utilize an unskilled and/or skilled interpreter for patient

interviews and education

Conduct medication reconciliation with patient or caregiver

Provide discharge medication counseling to the patient and/or their

caregiver

Provide telephone follow-up with patients or their caregiver per the

transitions of care service protocol. Information to be obtained and/or

discussed in a timely manner during a telephone encounter may include:

o List of current medications and/or supplements and their dosing

regimens

o List and description of allergies, adverse side effects and drug

interactions.

o Assessment of symptoms

o Social history, including cultural aspects (e.g. health beliefs,

expectations of drug therapy, healing traditions, language barriers),

which may impact health-care, medication delivery, and patient

compliance or adherence

o Patient adherence

o Patient reliability

o Questions or concerns the patient or caregiver may have regarding

their medications or self-care

Objective R1.1.3


Identify readmission risk criteria and significant active and inactive

problems to address while patient is on service and under pharmacy

resident’s care

Perform an initial patient encounter to assess risk for readmission, review

accuracy of medication reconciliation, provide education as needed, and

inform patient of post-discharge telephone follow up

Work up and follow hospitalized patients assigned to the Transitions of

Care service. This includes, but is not limited to, the following:

o Identify, list and prioritize the significant active and inactive medical

problems

o Identify, assess and facilitate optimization of current drug therapy

based upon patient-specific variables such as medical history,

medication list prior to and during current hospitalization, response to

therapy, adverse events, lifestyle, patient’s drug pan or coverage, and

adherence

o Identify barriers to discharge such as the need to obtain insurance

coverage, a primary care physician, transportation, and housing

Objective R1.1.4

(Analyzing) Analyze and assess

Demonstrate knowledge of therapeutic principles related to transitions of

care medicine topics, including but not limited to:

revised 2/9/2017

information on which to base safe and effective medication therapy.

o Congestive heart failure

o Chronic Obstructive Pulmonary Disease

o Deep venous thrombosis

o Diabetes mellitus

o Pneumonia

o Pulmonary embolism

o Non-ST segment elevation myocardial infarction

o ST segment elevation myocardial infarction

Given a patient’s medical history (symptoms, physical examination,

laboratory values, current medications, and diagnosis) identify:






o Patient’s comprehension of medication regimen



o Develop plans for medication therapy, including sustainable access to


parameters, potential side effects, and negotiated strategies to

facilitate patient adherence

Assess and facilitate optimization of current drug therapy based upon

patient-specific variables

Objective R1.1.5


Develop plans for medication therapy, including sustainable access to


parameters, potential side effects, and negotiated strategies to facilitate

patient adherence

Objective R1.1.6


Assess and facilitate optimization of current drug therapy based upon

patient-specific variables

Objective R1.1.7


Concisely, clearly, and effectively document any interventions, assessments

and recommendations as a new i-Vent

(minimum of 125 per residency requirements)

Objective R1.1.8

(Applying) Demonstrate

Deliver discharge medications to patient’s bedside on day of discharge

revised 2/9/2017

responsibility to patients.


caregiver.

Conduct post-discharge follow-up phone calls to patient


Objective R1.2.1


Communicate with the inter-professional team to ensure safe and

appropriate discharge

Notify TOC pharmacy technician of post discharge PCP appointments that

need to be scheduled; or schedule these appointments in the absence of the

TOC pharmacy technician

Deliver discharge medications to patient’s bedside on day of discharge


caregiver



Objective R2.1.4


Describe the Adverse Drug Event documentation and reporting system

within the institution (Incident Reporting Intranet System - IRIS)

Report any adverse events per institutional reporting policies and

procedures (IRIS)

Concisely, clearly, and effectively document any interventions, assessments

and recommendations as a new i-Vent


Competency Area R3: Demonstrate Leadership Skills

Goal R3.1: Demonstrate leadership skills

Objective R3.1.1


Conduct periodic self-assessments to practice self- manage professional

development

Character: Demonstrate pride in and commitment to the profession

through appearance and professional personal contacts

Act ethically in the conduct of all job-related activities

Take over responsibilities as the primary pharmacist on service (if repeating

as an elective rotation)



Objective R4.1.1

(Applying) Design

effective educational

activities.

Prepare for and participate in topic discussions with preceptor; lead at least

two topic discussions with pharmacy students (if applicable)



Objective R4.1.2


Educational activities (journal clubs, case presentations, in-services, topic

discussions):

o Identify current controversies in literature (journal club) or in a specific

patient care (case presentation)

o Identify relevant literature

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o Critically evaluate literature and how they add information/

clarity to area of controversy

o Use public speaking skills to effectively communicate educational goals

o Use audio visual aids and handouts to enhance communication

educational goals

Evaluate and critique the drug literature, new drug information and

published protocols and point out strengths and weaknesses and develop

conclusions for their role in disease state management

Provide drug information to other health-care professionals as needed


Contribute to the students’ evaluations






o Serve as pre-rounding preceptor


o Assist the student in following up on patient issues following rounds



facilitation)

Preceptor Interactions-Variable and resident-specific. Daily: 0730-0900: Chart review, follow-up phone calls 0900-0915: Discharge team rounding 0915 -1130: Pre-round with resident, topic discussion, medication reconciliation

1300-1400: Discharge rounds with resident and discharge team 1400-1600: Follow up phone calls to patients, discharge counseling, medication reconciliation, patient updates Expected progression of resident responsibility on the Core Transitions of Care experience: Day1: 0800 Preceptor provides orientation to service, hospital, nursing floors, and reviews Transitions of

Care learning activities and expectations. Week 1-2 Resident works up patients and presents to preceptor prior to rounds and patient care activities.

Preceptor will attend and participate in patient care activities to model pharmacist’s role. Week 3-4 Resident continues to work up patients and presents to preceptor prior to rounds and patient

care activities. Preceptor may attend and participate in patient care activities to coach the resident to take on more responsibilities as the primary pharmacist. In addition, if there is a pharmacy student on the team, the resident will take on the responsibility of a co-preceptor role.

Week 5-6 Resident continues to work up patients and presents to preceptor prior to rounds and patient care activities. Preceptor may attend and observe the resident’s participation in patient care activities, and/or may expect a summary report from the resident on recommendations made

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by the resident, updates on patients, and student progress. Preceptor will always be available via pager, phone, or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the pharmacist.

Expected progression of resident responsibility on the Elective Transitions of Care experience: Day1: 0800: Preceptor provides orientation to service, hospital, nursing floors, and reviews Transitions of

Care learning activities and expectations. If resident is taking the rotation for a 2nd time as an elective, the resident will be oriented on any changes to the workflow since they were last on the rotation.

Week 1-2: Resident works up patients and presents to preceptor prior to rounds and patient care activities. Preceptor will attend and participate in patient care activities to model pharmacist’s role. If resident is taking the rotation for a 2nd time as an elective, the resident will be expected to independently attend rounds and participate in patient care activities; as well as take on the responsibility of a co-preceptor role if there is a pharmacy student on the team.

Week 3-4: Resident continues to work up patients and presents to preceptor prior to rounds and patient care activities. Preceptor may attend and participate in patient care activities to coach the resident to take on more responsibilities as the primary pharmacist. In addition, if there is a pharmacy student on the team, the resident will take on the responsibility of a co-preceptor role.

Resident continues to work up patients and presents to preceptor prior to rounds and patient care activities. Preceptor may attend and observe the resident’s participation in patient care activities, and/or may expect a summary report from the resident on recommendations made by the resident, updates on patients, and student progress. If resident is taking the rotation for a 2nd time as an elective, the resident will be expected to take over responsibilities as the primary pharmacist on service. Preceptor will always be available via pager, phone, or cell for questions, and may follow patients independently to monitor resident skill development in all aspects of the learning experience to help facilitate the resident as the pharmacist.









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Time and Attendance




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Drug Information Longitudinal Learning Experience PGY1 Resident Expectations and Responsibilities Rotation Evaluator: Leonard Valdez, PharmD, BCPS, Clinical Pharmacy Manager General Description The Drug Information Longitudinal Experience will be formally evaluated over the residency year during the quarterly evaluations. Listed below is a table that describes the various activities that will be documented and evaluated. Goals and Objectives to be Taught and Formally evaluated:



GOAL R1.3 Prepare, dispense, and manage medications to support safe and effective drug therapy for patients.

Objective R1.3.2

(Applying) Manage aspects of the medication-use process related to formulary management.

Identify medication for which formulary addition evaluation is needed (dependent on institutional needs at the time).


Goal 2.1 Demonstrate ability to manage formulary and medication-use processes, as applicable to the organization.

Objective R2.1.1

(Creating) Prepare a drug class review, monograph, treatment guideline, or protocol.

Formulate an evidence-based written medication monograph according to institutional template. Evaluation should include comparison to comparable medications currently available on formulary. Monograph must culminate in a final recommendation for inclusion in the formulary (i.e. add, do not add or add with restrictions). If inclusion is recommended, procedures for safe medication addition must be developed and emphasized.

Formulate a concise, verbal summary of monograph and formulary recommendations to required medical staff committees as well as Pharmacy and Therapeutics Committee.

If medication is added to formulary, develop a concise, written summary of the monograph and final formulary decisions for inclusion in physician and pharmacy newsletters.

Objective R2.1.2

(Applying) Participate in a medication-use evaluation.


Objective 2.1.3



Objective 2.1.4


Reporting in IRIS

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Objective R4.1.1


Write a physician/pharmacy newsletter article o Timely topics are determined in collaboration with clinical

preceptors, clinical manager and/or residency director. o Formulate a concise, evidence-based, written article for distribution

to prescribers and pharmacy staff.

Objective R4.1.2


Respond to requests for drug information via “Ask the Pharmacist” service

Questions originate from institution’s health care providers.

Formulate a concise, evidence-based written response to question.

Response is posted on Pharmacy Department website for viewing by institution’s health care providers.


Identify specific question of interest (may differ from stated need by requestor). Clarify and narrow the question as much as possible.

Formulate a strategy to identify appropriate literature to address the question. Involves applying knowledge of standard primary, secondary and tertiary references.

Formulate a strategy to identify the most applicable literature amongst that gathered in search strategy.

Evaluate the utility of identified literature to answering specific drug information questions.

Formulate an appropriate evidence-based response to the question in a format appropriate to the specific task.

R4.1.4 (Applying) Appropriately assess effectiveness of education

Present a seminar lecture

Timely topics are determined in collaboration with clinical preceptors, clinical manager and/or residency director.

Define learning objectives for the educational activity and method for assessment of achieving these objectives.

Use public speaking skills to communicate educational goals to a large group.

Use audio-visual aids and handouts to enhance communication of the educational goal.

Evaluation Strategy for Drug Information Longitudinal Experience E-Value will be used for documentation of formal evaluations. For final evaluations, resident and preceptor will independently complete the final evaluations. After both have completed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self-assessment.


Quarterly Self Evaluation Resident Quarterly

Quarterly Summative Preceptor, Resident Quarterly

Quarterly Summative RPD Quarterly

Preceptor, Learning Experience Evaluations

Resident End of learning experience

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Research Project Learning Description -Longitudinal Rotation PGY1 Resident Expectations and Responsibilities Preceptors: Will be specific to the research project.

General Description The Research Project is a longitudinal learning experience for residents to gain experience in conducting a practice-related project using effective time management skills. Residents will learn the process in which a project is designed, the approval process through multidisciplinary departments, how to collect various forms of data, and perform statistical analysis. It may also include various teaching opportunities, in-services to various departments, and collaborating in a multidisciplinary process. Residents will have the opportunity to present their research findings in regional and national conferences.




Goal R2.1 Demonstrate ability to evaluate and investigate practice, review data, and assimilate scientific evidence to improve patient care and/or the medication use system.

Objective R2.2.1

(Analyzing) Identify changes needed to improve patient care and/or the medication-use systems.

The residents can choose a project from the list or submit his/her own research proposal to the RPD and preceptors for approval.

Objective R2.2.2

(Creating) Develop a plan to improve the patient care and/or medication-use system.

Each resident must submit a written research project proposal and design of the study, which must be signed by the resident and preceptor and handed in to the RPD. An electronic version must also be emailed to the RPD

An IRB application will be completed before the study commences.

Residents will learn time and project management skills to complete the research project.

Objective R2.2.3

(Applying) Implement changes to improve patient care and/or the medication-use system.

All projects must be presented at the ASHP Midyear Clinical Meeting and Western States Conference, presumed publishable in a peer reviewed journal, and a CRMC “PDSA” must be submitted.

Objective R2.2.4

(Evaluating) Assess changes made to improve patient care or the medication-use system.

Identify and develop monitoring strategies to assess effectiveness of quality and performance improvement efforts.

Objective

R2.2.5 (Creating) Effectively develop and present, orally and in writing, a final project report.

All projects must be presented at the ASHP Midyear Clinical Meeting and Western States Conference, presumed publishable in a peer reviewed journal, and a CRMC “PDSA” must be submitted.

Preceptor interactions for guidance

Meetings must be made in advance with the specified preceptor / co-investigator(s)

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Evaluation Strategy for Research Project Longitudinal Experience E-Value will be used for documentation of formal evaluations. For final evaluations, resident and preceptor will independently complete the final evaluations. After both have completed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self-assessment.


Quarterly Self Evaluation Resident Quarterly

Quarterly Summative Preceptor, Resident Quarterly

Quarterly Summative RPD Quarterly

Preceptor, Learning Experience Evaluations

Resident End of learning experience

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SECTION F – FORMS AND GUIDELINES

Residency Guidelines for Journal Club (JC) and Case Presentations (CP) The intent of Journal Club is to review how the article will impact clinical practice. In order to do this, you need to critically evaluate the article against current clinical practice and use your judgment if this will change or impact clinical practice. **These are guidelines for both JC and CP and may be changed under the discretion of the preceptor**

Topic to be chosen and announced 1 week PRIOR to the presentation, by the Chief Resident, to allow time for preceptors to review and participate.

Journal Club and Case Presentations will be held on the 3rd and 5th weeks, respectively, of the core rotation on Tuesday or Wednesday from 12:30-1:30 pm. If there is a resident on Ambulatory care rotation or there are conflicting meetings, then the times and dates may change.

Due to time constraints, do not go over your 30 minute allotted time (20 minutes maximum to present and 10 minutes for questions)***** You will be timed.

Please be courteous and be aware if there is another meeting scheduled afterwards. Journal Club (JC) 15 minutes to present and 15 minutes for questions = 30 minutes maximum

Article must be from a peer-reviewed journal.

Article must be published within the last 3-6 months.

Topic must be related to the current rotation.

Email a copy of the article to CRMC_RX with the date/time 1 week before presentation.

A handout must accompany the presentation—optional per preceptor.

One journal club to be presented per Core clinical rotation. Case Presentations (CP) or New Drug presentation –Power Point presentation 20 minutes to present and 10 minutes for questions = 30 minutes maximum (Think of the presentation as “The use of ____in the treatment of ____”, or like “clinical pearls”)

3 - 5 minutes for patient case.

15 minutes on topic/disease state and a literature review.

10 Minutes for questions.

**Topic to be approved by rotation preceptor and reviewed prior to the actual presentation***

Handout of Power Point slides to be provided

One case presentation OR new drug presentation per Core clinical rotation. Choice of cases: must be a narrow topic

1. Rare or interesting disease states – Broad disease states are NOT appropriate (Examples: Lung cancer, hepatic encephalopathy, Community Acquired Pneumonia, Pulmonary Embolism). Broad disease states must have a focus.

If disease states are chosen, then focus on the evaluation of the treatments available or treatment-induced side effects. Examples are: -Lung Cancer: Non-standard of care treatment or severe chemotherapy induced side effects -Hepatic Encephalopathy: Treatment controversies or lactulose versus antibiotics. -Pulmonary embolism: Treatment with LMWH vs. unfractionated heparin for thrombolytic therapy.

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Narrow topic examples are: Pulmonary hypertension, cryptococcal meningitis, tetanus, disseminated histoplasmosis, ethylene glycol overdose, heparin induced thrombocytopenia with thrombosis.

2. New Drug or Controversial Treatments

Examples are: Use of Aspirin for VTE prophylaxis in orthopedic patients, or Phenytoin versus Levetiracetam for Post-traumatic brain injury early seizure prophylaxis.

Literature Evaluation

The best 2 – 3 studies from primary literature should be presented.

Resident should evaluate the articles and formulate conclusions for each and then apply those to the patient case.

Articles should be clinically relevant to the case. **Upon discretion of the preceptors, case presentations or journal club will be repeated with a new case or new article if done inadequately**

Alternative project presentation guidelines Discussion: suggestion to replace a Case Presentation (CP) with a project.

Rationale: resident will serve as an extension to help their preceptor complete a rotation appropriate project

that adds value to the resident’s learning experience and institutional practice.

Resident will continue to present on the project instead of a normal CP during scheduled CP times. Current CP

rules will apply: Power Point presentation, 20 minute time limit, and preceptors will complete

evaluations. Project must be something that can be completed during the time on rotation, before week 5

(normal CP times).

Process:

Will consider this alternative after a minimum of 2 CP per year, based on resident’s performance. If the resident exhibits exceptional CP skills on their first one, then the resident may not have to complete the second one. This will provide flexibility.

The resident will not be provided this option for Rotation 1 (to evaluate performance and determine baseline presentation skills).

If a resident wants to pursue this option, the resident must complete an email “request” to the Preceptor and RPD for documentation.

o Request must be completed either before the rotation begins or during week 1 of the rotation. o Request will include at minimum: Title, topic, rationale or objectives for project.

RPD and preceptor will have a discussion before a decision is made. The RPD will notify the resident of the decision.

Preceptors can require CP on their rotation (preceptor preference). Other Information: Chief Resident will send an email out to all preceptors, residents and other pharmacists to attend the presentation (send email to CRMC_RX and CRMC Clinical Pharmacy Specialists distribution lists)

Copies of the journal club articles will be made available to preceptors and guests at least 1 week prior to

the presentation (pdf attachments are appreciated).

All residents and preceptors are expected to complete the evaluations and submit them electronically on E-Value.

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**Example only – will be completed online at E-Value****

COMMUNITY REGIONAL MEDICAL CENTER CLINICAL PHARMACY

EVALUATION OF PRESENTATIONS FOR JOURNAL CLUB AND CASE PRESENTATIONS

Speaker___________________________________________________Date _________________________ Topic_______________________________________________________________________________________ Strongly Agree Agree Not Sure Disagree Strongly Disagree

Speaker (s): 1. Was audible, articulate and spoke at an appropriate rate 5 4 3 2 1 N/A 2. Did not display any distracting mannerisms 5 4 3 2 1 N/A 3. Demonstrated good eye contact and body language 5 4 3 2 1 N/A 4. Presented the information in an interesting manner 5 4 3 2 1 N/A 5. Was knowledgeable about the topic 5 4 3 2 1 N/A 6. Was organized in presenting the information 5 4 3 2 1 N/A 7. Encouraged discussion/clarification to verify understanding 5 4 3 2 1 N/A 8. Responded precisely and appropriately to questions 5 4 3 2 1 N/A 9. Presented information in self-assured manner 5 4 3 2 1 N/A 10. Exhibited interest and enthusiasm for topic 5 4 3 2 1 N/A 11. Topic was focused 5 4 3 2 1 N/A

Content: 12. Was appropriate for the topic (fit the title) 5 4 3 2 1 N/A 13. Was appropriate for the time allotted 5 4 3 2 1 N/A 14. Was relevant and timely 5 4 3 2 1 N/A 15. Patient presentation was appropriate for the topic 5 4 3 2 1 N/A

16. Patient-specific therapeutics were considered 5 4 3 2 1 N/A

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17. Included critical evaluation of the literature 5 4 3 2 1 N/A 18. Was accurate, thoroughly researched and well referenced 5 4 3 2 1 N/A 19. Good understanding of literature/studies and clinical application 5 4 3 2 1 N/A

of article. Format: 20. There was a smooth introduction to the presentation 5 4 3 2 1 N/A 21. The case was well-integrated into presentation 5 4 3 2 1 N/A 22. Handout and/or AV material complemented presentation 5 4 3 2 1 N/A 23. Presentation came to an appropriate conclusion and closure 5 4 3 2 1 N/A OVERALL RATING 5 4 3 2 1

Please provide complimentary and constructive remarks on the bottom of this page

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Resident Seminar Guidelines Each resident will present one formal Resident Seminar during the residency program. The goal of the Resident Seminar is to expand the resident's communication skills, critical evaluation of literature, and formal presentation techniques. The Resident Seminar topic will be chosen by the resident, with guidance from a Preceptor/Mentor, (who will ensure the integrity of the seminar is intact, must be consulted with and approve all aspects of the Resident Seminar), and involve a therapeutic or practice management topic that fits the needs of the department. This will be done with a “needs assessment”. The resident will be responsible for identifying and requesting a preceptor for their seminar. Together, the preceptor and resident will choose a timeline for seminar completion, in accordance with ACPE requirements. The location of the seminar will be at the discretion of the RPD. The CE seminar will be in conjunction with the UCSF School of Pharmacy, and the resident will work with the UCSF PEP for ACPE CE accreditation of their seminar. Please see table with timelines for reference on page 80 (will be updated) and contact Mitra Assemi to schedule an appointment for requirements in July. The objectives of the Resident Seminar include the following:

1. Critical evaluation of the literature. 2. Advancement of presentation, teaching, and communication skills. 3. Provision of continuing education for pharmacists and other health care professionals. 4. Development of skills in responding to audience questions and comments. 5. Familiarization with different audiovisual equipment and techniques.

The length of the Resident Seminar will be 50 minutes, with 10 minutes afterwards reserved for questions and/or comments from the audience.

Each Seminar will incorporate a patient case to exemplify the objectives of the seminar.

Each Seminar will require a slide or handout pertaining to dosing considerations for drug therapy

Each resident will receive a critique of the seminar from a minimum of two preceptors who will evaluate the presentation on the basis of content, presentation style, and overall quality. The resident must request the preceptors at least one day in advance of the seminar. The evaluations will be handed to the preceptors picked by the resident, and will be discussed with the resident immediately after the presentation.

The audience will also be encouraged to submit written comments to the resident using the seminar evaluation form provided. Preceptors will complete evaluations via E-Value.

The title of all the Resident Seminars will be submitted to the RPD by October 1st of each year.

Residents will present their seminars during the month of February. The RPD will schedule the time.

All residents are required to attend all of the Resident Seminar series. After the Seminar:

1. Review the audience evaluation forms with your seminar preceptor. 2. Audience Evaluations will be completed electronically. 3. UCSF will collate evaluations and send to the resident and RPD.

Seminar presentation room -Residents are to assume that no podium or microphone will be provided. It is strongly suggested to visit your presentation room before you present.

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Task to be completed by CRMC Description Deadline

1. Meet with UCSF Fresno PEP

Program Director to discuss CPE

requirements, process and timeline

Discuss requirements for ACPE CPE activity accreditation and

the approved learning objectives; how to write appropriate

post-test questions; disclosing conflict(s) of interest; and

strategies for ensuring an interactive, active-learning

environment.

July 2016

Met w/ CRMC residents 6/30/16 @ 1430.

*2a. Conduct CPE needs assessment

and forward results to UCSF PEP

Program Director, Mitra Assemi

(mailto: and

cc: Tia Desplancke (

)

Determination and documentation of CPE topic needs of CRMC

pharmacist staff. Examples include development, distribution,

collection & tabulation of a survey; staff meeting minutes;

conducting & documenting focus groups of pharmacy

management/staff; documenting a new licensing or

accreditation (e.g. The Joint Commission) requirement dictating

a new need; evidence-based or best practices documentation

dictating a new need. Needs assessment for each session must

align with learning objectives pre-approved for the RSS CPE.

November 11, 2016

*Items 2a, b, and c must be

submitted together)

*2b. Determine topic and

corresponding speaker for each 60

minute (1 contact hour) CPE and

confirm date, time and location with

Tia Desplancke

NOTE: must indicate whether or not a meal or refreshments will

be served in advance of or after the activity.

Meals/refreshments may not be served during the activity, but

can be made available in the back of/outside the room prior to

or after an activity.

November 11, 2016

*2c. Submit the following

documentation for each CPE activity

to Tia Desplancke

1. Title of CPE activity (2b)

2. Corresponding speaker’s name and title(s) (e.g., PharmD)(2b)

3. Conduct needs assessment and submit results to Dr. Assemi

(2a)

November 11, 2016

3. Each speaker to submit the

following documentation to Tia

Desplancke

1. Electronic copy of current CV

2. Completed “Speaker Information Form

3. Completed “Faculty Disclosure Form”

60 days prior to 1st scheduled

CPE activity

By Dec 16t, 2016 for all presenters

4. Submit the following

documentation for each CPE activity

to Tia Desplancke

1. 5 post-test questions (must measure attainment of the

learning objectives)

2. an electronic copy of the activity handout and PowerPoint

presentation for participants

45 days prior to first scheduled

CPE activity

By Jan 2, 2017 for all presenters

5. Each participant must login to NABP

e-profile to create an ID and

preregister in the course to receive

ACPE credit

1. All participants must login to create an e-profile and ID prior

to attending scheduled CPE activity:

http://www.nabp.net/programs/cpe-monitor/cpe-monitor-

service/cpe-monitor-log-in/

2. To receive credit participants must provide their ID to UCSF

on the day of the activity on the sign in sheet.

10 days prior to first scheduled

CPE activities

By Feb 6, 2017 for all presenters

6. Upon completion of activity, return

original sign-in sheet to Tia

Desplancke (

)

Evaluations are completed

electronically, and are required along

with original documents when

submitting for CPE credit. Tia to pull

speaker evals from Qualtrics.

No later than 3 days after

conclusion of the CPE activity

By Feb 19th for Feb 16th activity

By Feb 26th for Feb 23rd activity

By Mar 5th for Mar 2nd activity

http://www.nabp.net/programs/cpe-monitor/cpe-monitor-service/cpe-monitor-log-in/

http://www.nabp.net/programs/cpe-monitor/cpe-monitor-service/cpe-monitor-log-in/

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Research projects for 2016-2017 ***all must include a cost savings component*** Administration:

1. Development and implementation of comprehensive medication safety plan for pharmacy services. Preceptor: Curtis Takemoto

2. Clinical Pharmacy Services Quality Assurance program for Vancomycin and aminoglycosides-which includes monitoring and standardized basic training program. Preceptors: Leonard Valdez, Marisa Méndez and Alice Robbins

Ambulatory Care / Inpatient: Preceptors: Giovanni Lares and Vy Tran

1. Incidence of venous thromboembolism among inpatients with chronic liver disease at CRMC 2. Effect of free medications at hospital discharge on patient outcomes 3. Incidence of thrombosis in patients with new heart valves with lower INR goal 4. Effectiveness of a Pharmacist involvement in a Smoking-Cessation Program 5. Identifying and Quantifying Ambulatory Care Pharmacists Interventions in the Amb Care Setting

Critical Care: Preceptor: Melissa Reger (Burn/Surgery)

1. Evaluation of IVC filter use on DVT prophylaxis and rate of complications and associated costs (heparin infusions, lab costs).

2. Incidence of VTE events in the face of appropriate prophylaxis in trauma, surgery and burn patients and associated costs (heparin infusions, lab costs).

3. Assessment of IV acetaminophen intake in hospitalized patients (MUE) 4. Limiting of epogen use in acute renal failure- a cost savings analysis. 5. Safety and timing of chemical VTE prophylaxis in patients with traumatic brain injury (does early VTE

prophylaxis lead to a higher incidence of rebleeding?) 6. Correlation of anti-Xa levels and incidence of VTE in Burn patients (funding required) 7. Blood utilization in THA/TKA patients that have received tranexamic acid. 8. Incidence of bacteremia with TPN with a new line vs. used line 9. Audit of TPN prescribing practice similar to one performed prior: are our patients achieving nutrition

goals with pharmacist vs. physician prescribing 10. Mortality benefit/blood product utilization in trauma patients receiving tranexamic acid as part of the

massive transfusion protocol (continuation of Teresa’s project). 11. Vitamin D levels in burn patients should we be supplementing? Adverse effects from low vitamin D

levels? 12. Evaluation of safety and efficacy of FEIBA in trauma patients (continuation of Dr. Hubbard project) 13. Vancomycin/aminoglycoside/antibiotic dosing protocol in burn patients

Preceptor: Tou Bee Thao and Linda Kimura

1. Retrospective review of the efficacy and safety of FEIBA in reversing coagulopathy in warfarin associated

intracerebral hemorrhages.

2. Retrospective review of efficacy of phenytoin versus levetiracetam for seizure prophylaxis in

spontaneous intracerebral hemorrhages (and/or subarachnoid hemorrhages).

3. Evaluation of the safety and efficacy of 3% hypertonic saline to maintain serum sodium levels above 140 in aneurysmal subarachnoid hemorrhage patients

4. Evaluation of vancomycin dosing in critically ill patients on continuous renal replacement therapy 5. Evaluation of alteplase for the treatment of massive pulmonary embolism

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Joint IM/Critical Care: Preceptors: Nicole Lu and Tou Bee Thao 6. Evaluation of the cost effectiveness post implementation of the Remodulin Hospital Access Program

(RHAP) 7. Evaluation and identification of pulmonary arterial hypertension patient risk factors that increase

hospital readmission rates. For future directions: discuss possible solutions to decrease readmission

rates

Preceptor Ann Vu: 1. Efficacy and safety of 7.5% hypertonic saline as primary therapy for management of intracranial

hypertension. 2. Safety and efficacy of valproic acid for refractory agitation in the ICU (after traumatic brain injury). 3. Evaluation on the impact of antipsychotic use for delirium in the ICU. 4. Consult with preceptor for additional project ideas.

Joint ED/Critical Care: Preceptors: Ann Vu, Gillian Pineda and Leonard Valdez 5. Safety and efficacy of liposomal bupivacaine for pain management of rib fractures (Dr. Parks) 6. Retrospective review of the efficacy and safety of FEIBA versus FFP in reversing non-warfarin associated

supra-therapeutic INR (Dr. Hubbard) Emergency Medicine: Preceptors: Gillian Pineda and TBD

1. Collaboration with Dr. Ann Vu, our Trauma ICU Pharmacist: Retrospective review of the efficacy and safety of fixed-dose FEIBA in reversing non-warfarin associated life-threatening bleeds.

2. Collaboration with Dr. Harlan Husted, our NICU Pharmacist: Safety of propofol use in pediatric patients. 3. Safety and efficacy of 3% hypertonic saline boluses versus continuous infusion in symptomatic, severe

hyponatremia. 4. Medication use evaluation (MUE) of propofol in procedural sedation (specifically, was an analgesic agent

used in combination with propofol)? a. Develop and implement usage guidelines for procedural sedation.

5. Medication use evaluation of hyperinsulinemia euglycemia therapy in calcium channel blocker or beta blocker overdose.

a. Develop and implement usage guidelines for calcium channel blocker or beta blocker overdose. 6. MUE of calcium gluconate or calcium chloride in hyperkalemia.

a. Develop and implement usage guidelines for hyperkalemia. 7. Consult with preceptor(s) for additional project ideas.

Infectious Diseases: Preceptor Marisa Méndez

1. Develop and implement clinical pathway for infectious diseases process. 2. Evaluation of impact of antimicrobial stewardship program. 3. Review of antimicrobial stewardship policy/procedure compliance. 4. Consult with preceptor for additional research project ideas.

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Internal Medicine: Preceptor Nicole Lu 1. Targeted medication use evaluations: appropriateness of use, safety, and cost effectiveness. Develop

and implement usage guidelines. Possible medications for review:

Filgrastim/pegfilgrastim

Dabigatran

Rivaroxaban

Stress ulcer prophylaxis - (Alice Robbins co-preceptor)

DVT prophylaxis (Alice Robbins co-preceptor)

TPN/PPN

Factor VII (Novoseven)

Rasburicase

2. Monitor safety and order accuracy of heparin infusions (pharmacy accuracy of nomogram completion, nursing adherence to nomogram, bleeding and thrombosis outcomes).

3. Appropriate use of antibiotics and steroids in asthma/COPD exacerbation. 4. Develop order set for management of hypertensive urgency/emergency. 5. Develop order set for management of cirrhotic patients including management of ascites, SBP, hepatic

encephalopathy, and variceal hemorrhage. 6. Evaluate the appropriateness of phenytoin dosing and management (Alice Robbins co-preceptor). 7. Consult with preceptor for additional research project ideas.

Neonatal Intensive Care Unit: Preceptors Harlan Husted and George Lien

1. Implementation of a pharmacy-managed erythropoietin protocol service in a neonatal intensive care unit (NICU).

a. Develop an official protocol to manage EPO therapy in the neonatal population to allow a pharmacist to adjust dosage, monitor and order pertinent labs and to discontinue EPO therapy once eligibility criteria is satisfied.

b. Evaluate the cost-savings benefit to implementing this clinical pharmacy service in terms of drug cost utilization in patients not satisfying eligibility criteria, increasing/reducing lab draw frequency and assessing physician satisfaction scoring.

2. Implementation of a pharmacy-managed total parenteral nutrition protocol in a NICU. a. Develop an official protocol to manage TPN therapy in the neonatal population to allow a

pharmacist to evaluate and adjust nutrient dosages, monitor and order pertinent labs and to ensure adherence to ASPEN nutrition guidelines.

b. Evaluate the cost-savings benefit to implementing this clinical pharmacy service in terms of drug cost utilization in patients not satisfying eligibility criteria, increasing/reducing lab draw frequency and assessing physician satisfaction scoring.

c. Secondary goal to survey need for expansion of this service to the pediatric population at CRMC. 3. Improving pediatric medication safety in a primarily adult-population regional medical center

a. Review recommendations from Institution of Safe Medical Practices (ISMP), American Academy of Pediatrics (AAP), American Society of Health-System Pharmacists (ASHP) and compile common measures to improve pediatric and infant medication safety

b. From the information collected, identify some of the most common pediatric medication errors reported and identify outcomes and costs associated with those outcomes

c. Review CMC data from 2008 onward (when California Children’s Services approved NICU expansion) for IRIS data, safe practices, staff education, capital equipment purchased to gauge increase in medication errors in pediatric/infant population and safety measures to reduce those numbers.

d. Pathways: Conduct a survey of all CCS-approved hospitals (180 as of May 2014) with similar bed size/patient population to see what safety measures implemented in past 5 years, possible number of adverse events reported or prevented, types of education, specialist recruitment, equipment, etc.

revised 2/9/2017

e. Pathways: Assess the value of implementing measures, in terms of cost to institution to prevent errors, mitigate risk/damages, assess multidisciplinary staff comfort in different areas of competency and support of pediatric/infant populations.

f. Goal of study is 2-fold: Present poster of strategies that other facilities have implemented to improve specific population safety, gauging performance of those strategies and offer guides on feasible implementation at other facilities, with potential cost-risk/benefit component assessed.

g. Potential for publication to medical journals as an editorial/how-to guide, or case report type article.

Transition of Care: Preceptor Tamar Lawful

1. Cost Savings Associated with Transition of Care Pharmacy Interventions. 2. Analysis of Medication Discrepancies at Hospital Discharge

revised 2/9/2017

*Example only – will be completed on line at E-Value**** PRECEPTOR AND LEARNING EXPERIENCE EVALUATION

Resident:

Preceptor:

Learning Experience: Evaluation Period: through

Please check one of the following for each category.

1 - ALWAYS 2 - FREQUENTLY 3 - SOMETIMES 4 - NEVER

Part 1 - Evaluation of the Preceptor

1

2

3

4

1.

The preceptor was a pharmacy practice role model.

2.

The preceptor gave me feedback on a regular basis.

3.

The preceptor's feedback helped me improve my performance.

4.

The preceptor was available when I needed him or her.

5.

When possible, the preceptor arranged the necessary learning opportunities to meet my objectives.

6.

The preceptor displayed enthusiasm for teaching.

7.

The preceptor gave clear explanations.

8.

The preceptor asked questions that caused me to do my own thinking.

9.

The preceptor answered my questions clearly.

10.

The preceptor modeled for me, coached my performance, or facilitated my independent work as appropriate.

11.

The preceptor displayed interest in me as a resident.

12.

The preceptor displayed dedication to teaching.

Comments:

2/9/2017 updated AR

Please check one of the following for each category. 1 - CONSISTENTLY TRUE 2 - PARTIALLY TRUE 3 - FALSE

Part II: Evaluation of the Learning Experience

1

2

3

1.

I understood the objectives for this learning experience prior to beginning.

2.

The learning opportunities afforded me during this learning experience matched the objectives specified for this experience.

3.

Resources I needed were available to me.

4.

I feel that the preceptor's assessment of my performance on the objectives was fair.

5.

I was encouraged to further develop my ability to self-assess during this learning experience.

6.

This learning experience provided me opportunities to provide pharmaceutical care in a responsible way to my patients.

What were the strengths of this learning experience? What were the weaknesses of this learning experience? What suggestions can you make to improve this learning experience?

Resident's Signature/Date Preceptor's Signature/Date Forward completed evaluation to Residency Program Director

2/9/2017 updated AR

Chief Resident Responsibilities: Each resident will rotate through this role. The Chief Resident role will encourage leadership, practice management skills, and practice responsibilities for the residency program. The Chief Resident will act as the liaison between the residents and the RPD to help clarify issues and understand all policies and procedures of the residency program. Responsibilities will vary depending on the period. If a resident leaves the residency program before the end of the year, the Chief Resident Responsibilities will be divided and assigned amongst the remaining residents by the RPD. General Responsibilities - All Year for Each Chief Resident

Coordinate changes in the resident rotation schedule with the RPD and residents

Coordinate and schedule Resident on the RX Conference Room Calendar, and disseminate the information -please email an announcement to CRMC_RX, CRMC Clinical Pharmacy Specialists, pharmacy students on rotations (or student coordinator who will email the students), and RPD with the dates and topics

Set up laptop and projector for Friday Seminars and Resident Case Presentations. Assistance with Student presentations may be requested.

Prepare agenda, take minutes, and schedule monthly resident meetings with the RPD

Ensure co-residents are on time for deadlines for projects, conferences, Seminar, etc. A weekly email with a calendar of events is required.

Responsible for collecting signatures on attendance sheets at all educational functions related to the residency program, or student program (JC, CP, and lunch seminars) and filing it in the Education binder in the RX conference room. Ensure the topic / speaker is entered on the form.

Helps with any E-Value issues

Notify RPD to order office supplies as needed, and keep the resident office orderly and neat

Chief Resident is responsible for attending P&T each month and disseminating the information at the monthly Resident Meetings or via email

Check “Ask the Pharmacist” web page on Community Forum daily and keep track of which resident’s turn it is to answer the question.

Reminds co-residents to review P-cards monthly. Period 1 (July 1 –October 31): Specific Responsibilities will include:

General responsibilities listed above

Organize resident contact information for the RPD

Coordinate and take group and individual resident photos for website in July (and preceptors)

Ensure resident chooses a research project with a cost-savings component, writes a proposal, and submits to IRB

Ensure residents choose a Seminar topic and date

Prepare a lecture list and schedule for Lunch Seminars through the end of November, and email list to RPD for entry into E-Value (and email distribution lists above)

Schedule residents to present Midyear posters to preceptors before end of November as a Lunch Seminar

Ensure that all residents submit their ASHP abstracts on time (recommend all residents submit abstracts at the same time to ensure your posters will be close to each other at ASHP)

Help coordinate training for E-Value software program

Help plan resident recruitment, and responsible for CSHP Seminar residency showcase

2/9/2017 updated AR

o Ensure all residents are current members of CSHP and change their local chapter to Sierra Society of Health System Pharmacists (SSHP) for the duration of the residency

o Ensure all residents are registered for the CSHP conference and coordinate travel arrangements

o Responsible for the set up and breakdown of the residency showcase - decorations, folders, advertisements for residency program, residency recruitment poster, and giveaways. Arranges for delivery of materials and reshipment if needed

o Responsible for taking photos of the residents at the residency showcase for website

Make appointment for UCSF CE accreditation of the Resident Seminar, if not already completed

Period 2 (November 1-February 28) Specific Responsibilities will include:

General responsibilities listed above on previous page

Ensure all residents prepare and coordinate printing of their posters for Midyear

Help RPD with residency recruitment activities before and at Midyear o Responsible for the set up and breakdown of the residency showcase at Midyear -decorations,

folders, advertisements for residency program, residency recruitment poster, and giveaways. Arranges for delivery of materials and reshipment if needed

o Responsible for taking or ensuring there are photos of each resident with their poster, and residency showcase for website

o Ensure all residents are members of ASHP, registered to go to ASHP Midyear Clinical Meeting, and coordinate travel plans with RPD (typically done in July with collaboration with Chief Resident Period 1)

Organization and communication for the Resident Open House -ensure office is clean and rug shampooed

Prepare a lecture list and schedule for lunch seminars, from January to June (please coordinate with period 3 Chief Resident for date of pre-WSC presentation)

Ensure residents are ready for their Resident Seminars in February

Help plan and coordinate the Resident Seminar

Residency Interviews: o Help RPD coordinate the schedules of incoming resident candidates for interviews o Provide the tour of CRMC facilities o Help coordinate plans with RPD, candidates, and current residents o Responsible for meeting with co-residents to evaluate residency candidates, summarize

comments and scores, and final group consensus / submission of evaluation forms to RPD

Ensure WSC abstract submission and WSC registration

Period 3 (March 1-June 30th) Specific Responsibilities will include:

General responsibilities listed above on previous page

Coordinate WSC registration and travel plans with RPD

Schedule a “pre WSC” presentation to the preceptors by the end of April during the Lunch Seminar (work with Chief Resident for period 2)

Coordinate with SSHP CE board member to present WSC presentation in May

Ensure all deadlines and materials for CE submission are completed by each resident

Ensure ALL deadlines (evaluations, submission of manuscript, submission of PDSA project, etc.) and “end of year items” have been met for residents before end of year (see below)

Responsible for “end of resident year” items

2/9/2017 updated AR

o Responsible for gathering all pagers and badges o Empty all desks, and remove all personal belongings and files o Schedule exit interviews for each resident and RPD

Ensure that the Resident office is clean -floors are vacuumed, refrigerator is cleaned and de-iced, microwave is cleaned, and all work surfaces are clean

Help plan end of residency year (graduation) party

Help RPD with tasks needed for next year’s class SECTION G – CLINICAL PHARMACY SERVICES Preceptor Information -please see website at: https://www.communitymedical.org/For-Healthcare-Professionals/Residencies-Fellowships/Residencies/Community-Regional-Pharmacy/Preceptors Clinical Pharmacy Services

Clinical pharmacists are available to provide consultations concerning treatment plans, drug dosing, adverse drug effects, etc. Please refer to the in-house telephone and pager list.

https://www.communitymedical.org/For-Healthcare-Professionals/Residencies-Fellowships/Residencies/Community-Regional-Pharmacy/Preceptors

https://www.communitymedical.org/For-Healthcare-Professionals/Residencies-Fellowships/Residencies/Community-Regional-Pharmacy/Preceptors

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