Post Graduate Year One (PGY1) Residency Manual. 1 P a g e

Transcription

1 Post Graduate Year One (PGY1) Residency Manual 1 P a g e

2 Table of Contents Table of Contents Purpose and Philosophy... 4 Organizational Structure... 5 Program Outcomes, Goals, and Objectives... 6 Structure of Residency Experiences Benefits Health, Disability, and Professional Benefits Educational Benefits Other Benefits Paid Time Off (PTO) Expectations of the Resident Licensure Verification Professionalism Duty Hours Overtime/ Moonlighting Departmental Policies Applicable to Pharmacy Residents Residency Activities and Requirements Evaluation Process and Requirements Evaluations Documentation Requirement for Receiving a Certificate Appendices Appendix A: Orientation Checklist Appendix B: Evaluation Schedule Appendix C: Tracking Form Appendix D: Requirement Timeline Appendix E: Learning Experiences Case Conference Learning Experience: Counseling Learning Experience P a g e

3 Documentation Learning Experience Drug Information Learning Experience Fast Fact/InPharmation Newsletter Learning Experience Journal Club Learning Experience Formulary Process/Drug Monograph Learning Activities MUE Learning Experience Process Improvement Learning Experience Research Project Learning Experience Staffing Learning Experience Therapeutic Exchange Learning Experience Appendix F: Clinical On-Call Protocol Appendix G: PTO Request Procedures P a g e

4 Purpose and Philosophy Purpose The purpose of this residency is to develop a pharmacist with the skills and abilities to successfully practice as an acute care pharmacist, adjunct faculty member, and/or be prepared to pursue and complete PGY2 residency training. Philosophy The ASHP accreditation standard provides criteria that every program must meet in order to receive and maintain accreditation. Although the standard requires experiences in certain core areas, there is room for concentration in a practice area and for additional experiences. The mission of our program includes developing a core skill set in drug information and literature evaluation, pharmacotherapy evaluation and management, project based research and team functioning, presentation development and delivery, and direct patient interaction. 4 P a g e

5 Organizational Structure 5 P a g e

6 Program Outcomes, Goals, and Objectives The residency program will provide each resident with specific learning experiences designed to enable the resident to expand the scope of his/her practice skills. Outcomes R1 R2 R3 R4 R5 R6 E2 E7 Manage and improve the medication-use process. Provide evidence-based, patient-centered medication therapy management with interdisciplinary teams. Exercise leadership and practice management skills. (Overall Performance and Administration Rotation) Demonstrate project management skills. (Projects) Provide medication and practice-related education/training Utilize medical informatics. Exercise added leadership and practice management skills. Demonstrate additional competencies that contribute to working successfully in the health care environment. 6 P a g e

7 Outcome R1: Manage and improve the medication-use process. Goal R1.1: Identify opportunities for improvement of the organization s medication-use system. OBJ R1.1.1 (Comprehension) Explain the organization s medication-use system and its vulnerabilities to adverse drug events (ADEs). OBJ R1.1.2 (Analysis) Analyze the structure and process and measure outcomes of the medicationuse system. OBJ R1.1.3 (Evaluation) Identify opportunities for improvement in the organizations medication-use system by comparing the medication-use system to relevant best practices. Goal R1.2: Design and implement quality improvement changes to the organization s medication-use system. OBJ R1.2.1 (Comprehension) Explain the process for developing, implementing, and maintaining a formulary system. OBJ R1.2.2 (Evaluation) Make a medication-use policy recommendation based on a comparative review (e.g., drug class review, drug monograph). OBJ R1.2.3 (Synthesis) Participate in the identification of need for, development of, implementation of, and evaluation of an evidence-based treatment guideline/protocol related to individual and population-based patient care. OBJ R1.2.4 (Synthesis) Design and implement pilot interventions to change problematic or potentially problematic aspects of the medication-use system with the objective of improving quality. Goal R1.3: Prepare and dispense medications following existing standards of practice and the organization s policies and procedures. OBJ R1.3.1 (Evaluation) Interpret the appropriateness of a medication order before preparing or permitting the distribution of the first dose. OBJ R1.3.2 (Application) Follow the organization's policies and procedures to maintain the accuracy of the patient s medication profile. OBJ R1.3.3 (Application) Prepare medication using appropriate techniques and following the organization's policies and procedures. OBJ R1.3.4 (Application) Dispense medication products following the organization's policies and procedures. Goal R1.4: Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system. OBJ R1.4.1 (Characterization) Display initiative in preventing, identifying, and resolving pharmacyrelated patient care problems. Goal R1.5: Provide concise, applicable, comprehensive, and timely responses to requests for drug information from patients and health care providers. OBJ R1.5.1 (Analysis) Discriminate between the requesters' statement of need and the actual drug information need by asking for appropriate additional information. OBJ R1.5.2 (Synthesis) Formulate a systematic, efficient, and thorough procedure for retrieving drug information. OBJ R1.5.3 (Analysis) Determine from all retrieved biomedical literature the appropriate information to evaluate. OBJ R1.5.4 (Evaluation) Evaluate the usefulness of biomedical literature gathered. OBJ R1.5.5 (Synthesis) Formulate responses to drug information requests based on analysis of the literature. OBJ R1.5.6 (Synthesis) Provide appropriate responses to drug information questions that require the pharmacist to draw upon his or her knowledge base. 7 P a g e

8 OBJ R1.5.7 (Evaluation) Assess the effectiveness of drug information recommendations. Outcome R2: Provide evidence-based, patient-centered medication therapy management with interdisciplinary teams. Goal R2.1: As appropriate, establish collaborative professional relationships with members of the health care team. OBJ R2.1.1 (Synthesis) Implement a strategy that effectively establishes cooperative, collaborative, and communicative working relationships with members of interdisciplinary health care teams. Goal R2.2: Place practice priority on the delivery of patient-centered care to patients. OBJ R2.2.1 (Organization) Choose and manage daily activities so that they reflect a priority on the delivery of appropriate patient-centered care to each patient. Goal R2.3: As appropriate, establish collaborative professional pharmacistpatient relationships. OBJ R2.3.1 (Synthesis) Formulate a strategy that effectively establishes a patient-centered pharmacist-patient relationship. Goal R2.4: Collect and analyze patient information. OBJ R2.4.1 (Analysis) Collect and organize all patient-specific information needed by the pharmacist to prevent, detect, and resolve medication-related problems and to make appropriate evidencebased, patient-centered medication therapy recommendations as part of the interdisciplinary team. OBJ R2.4.2 (Analysis) Determine the presence of any of the following medication therapy problems in a patient's current medication therapy: (1) Medication used with no medical indication; (2) Patient has medical conditions for which there is no medication prescribed; (3) Medication prescribed inappropriately for a particular medical condition; (4) Immunization regimen is incomplete; (5) Current medication therapy regimen contains something inappropriate(dose, dosage form, duration, schedule, route of administration, method of administration); (6) There is therapeutic duplication; (7) Medication to which the patient is allergic has been prescribed; (8) There are adverse drug or device relatedevents or potential for such events; (9) There are clinically significant drug-drug, drug-disease, drug-nutrient, or drug-laboratory test interactions or potential for such interactions; (10) Medical therapy has been interfered with by social, recreational, nonprescription, or nontraditional drug use by the patient or others; (11) Patient not receiving full benefit of prescribed medication therapy; (12) There are problems arising from the financial impact of medication therapy on the patient; (13) Patient lacks understanding of medication therapy; (14) Patient not adhering to medication regimen. OBJ R2.4.3 (Analysis) Using an organized collection of patient-specific information, summarize patients health care needs. Goal R2.5: When necessary, make and follow up on patient referrals. OBJ R2.5.1 (Evaluation) When presented with a patient with health care needs that cannot be met by the pharmacist, make a referral to the appropriate health care provider based on the patient s acuity and the presenting problem. OBJ R2.5.2 (Synthesis) Devise a plan for follow-up for a referred patient. Goal R2.6: Design evidence-based therapeutic regimens. OBJ R2.6.1 (Synthesis) Specify therapeutic goals for a patient incorporating the principles of evidence-based medicine that integrate patient-specific data, disease and medication-specific information, ethics, and quality-of-life considerations. 8 P a g e

9 OBJ R2.6.2 (Synthesis) Design a patient-centered regimen that meets the evidence-based therapeutic goals established for a patient; integrates patient-specific information, disease and drug information, ethical issues and quality-of-life issues; and considers pharmacoeconomic principles. Goal R2.7: Design evidence-based monitoring plans. OBJ R2.7.1 (Synthesis) Design a patient-centered, evidence-based monitoring plan for a therapeutic regimen that effectively evaluates achievement of the patient-specific goals. Goal R2.8: Recommend or communicate regimens and monitoring plans. OBJ R2.8.1 (Application) Recommend or communicate a patient-centered, evidence-based therapeutic regimen and corresponding monitoring plan to other members of the interdisciplinary team and patients in a way that is systematic, logical, accurate, timely, and secures consensus from the team and patient. Goal R2.9: Implement regimens and monitoring plans. OBJ R2.9.1 (Application) When appropriate, initiate the patient-centered, evidence-based therapeutic regimen and monitoring plan for a patient according to the organization's policies and procedures. OBJ R2.9.2 (Application) Use effective patient education techniques to provide counseling to patients and caregivers, including information on medication therapy, adverse effects, compliance, appropriate use, handling, and medication administration. Goal R2.10: Evaluate patients progress and redesign regimens and monitoring plans. OBJ R (Evaluation) Accurately assess the patient s progress toward the therapeutic goal(s). OBJ R (Synthesis) Redesign a patient-centered, evidence-based therapeutic plan as necessary based on evaluation of monitoring data and therapeutic outcomes. Goal R2.11: Communicate ongoing patient information. OBJ R (Application) When given a patient who is transitioning from one health care setting to another, communicate pertinent pharmacotherapeutic information to the receiving health care professionals. OBJ R (Application) Ensure that accurate and timely medication-specific information regarding a specific patient reaches those who need it at the appropriate time. Goal R2.12: Document direct patient care activities appropriately. OBJ R (Analysis) Appropriately select direct patient-care activities for documentation. OBJ R (Application) Use effective communication practices when documenting a direct patientcare activity. OBJ R (Comprehension) Explain the characteristics of exemplary documentation systems that may be used in the organization s environment. Outcome R3: Exercise leadership and practice management skills. Goal R3.1: Exhibit essential personal skills of a practice leader. OBJ R3.1.1 (Characterization) Practice self-managed continuing professional development with the goal of improving the quality of one s own performance through self-assessment and personal change. OBJ R3.1.2 (Characterization) Demonstrate pride in and commitment to the profession through appearance, personal conduct, and association membership. OBJ R3.1.3 (Characterization) Act ethically in the conduct of all job-related activities. 9 P a g e

10 Goal R3.2: Contribute to departmental leadership and management activities. OBJ R3.2.1 (Synthesis) Participate in the pharmacy department's planning processes. OBJ R3.2.2 (Comprehension) Explain the effect of accreditation, legal, regulatory, and safety requirements on practice. OBJ R3.2.3 (Comprehension) Explain the principles of financial management of a pharmacy department. OBJ R3.2.4 (Synthesis) Prioritize the work load, organize the work flow, and check the accuracy of the work of pharmacy technical and clerical personnel or others. Goal R3.3: Exercise practice leadership. OBJ R3.3.1 (Synthesis) Use knowledge of an organization's political and decision-making structure to influence accomplishing a practice area goal. OBJ R3.3.2 (Comprehension) Explain various leadership philosophies that effectively support direct patient care and pharmacy practice excellence. OBJ R3.3.3 (Application) Use group participation skills when leading or working as a member of a committee or informal work group. OBJ R3.3.4 (Application) Use knowledge of the principles of change management to achieve organizational, departmental, and/or team goals. Outcome R4: Demonstrate project management skills. Goal R4.1: Conduct a practice-related project using effective project management skills. OBJ R4.1.1 (Synthesis) Identify a topic for a practice-related project of significance for pharmacy practice. OBJ R4.1.2 (Synthesis) Formulate a feasible design for a practice-related project. OBJ R4.1.3 (Synthesis) Secure any necessary approvals, including IRB and funding, for one's design of a practice related project. OBJ R4.1.4 (Synthesis) Implement a practice-related project as specified in its design. OBJ R4.1.5 (Synthesis) Effectively present the results of a practice-related project. OBJ R4.1.6 (Synthesis) Successfully employ accepted manuscript style to prepare a final report of a practice-related project. OBJ R4.1.7 (Evaluation) Accurately assess the impact, including sustainability if applicable, of the residency project. Outcome R5: Provide medication and practice-related education/training. Goal R5.1: Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public. OBJ R5.1.1 (Application) Use effective educational techniques in the design of all educational activities. OBJ R5.1.2 (Synthesis) Design an assessment strategy that appropriately measures the specified objectives for education or training and fits the learning situation. OBJ R5.1.3 (Application) Use skill in the four preceptor roles employed in practice-based teaching (direct instruction, modeling, coaching, and facilitation). OBJ R5.1.4 (Application) Use skill in case-based teaching. OBJ R5.1.5 (Application) Use public speaking skills to speak effectively in large and small group situations. OBJ R5.1.6 (Application) Use knowledge of audio-visual aids and handouts to enhance the effectiveness of communications. 10 P a g e

11 Outcome R6: Utilize medical informatics. Goal R6.1: Use information technology to make decisions and reduce error. OBJ R6.1.1 (Comprehension) Explain security and patient protections such as access control, data security, data encryption, HIPAA privacy regulations, as well as ethical and legal issues related to the use of information technology in pharmacy practice. OBJ R6.1.2 (Application) Exercise skill in basic use of databases and data analysis software. OBJ R6.1.3 (Evaluation) Successfully make decisions using electronic data and information from internal information databases, external online databases, and the Internet. Outcome E2: Exercise added leadership and practice management skills. Goal E2.2: Understand the pharmacy procurement process. OBJ E2.2.1 (Comprehension) Explain the processes and contractual relationships that form the structure of the department s medication procurement system. Goal E2.6: Understand the process of managing the practice area's human resources. OBJ E2.6.1 (Comprehension) Explain recruitment strategies for a specific position. OBJ E2.6.2 (Comprehension) Explain the process used to interview and recommend personnel for employment. OBJ E2.6.3 (Comprehension) Explain the importance of orientation and training for practice area personnel. OBJ E2.6.4 (Comprehension) Explain the components of an employee performance evaluation system. OBJ E2.6.5 (Comprehension) Explain the principles and application of a progressive discipline process. Outcome E7: Demonstrate additional competencies that contribute to working successfully in the health care environment. Goal E7.1: Use approaches in all communications that display sensitivity to the cultural and personal characteristics of patients, caregivers, and health care colleagues. OBJ E7.1.1 (Organization) Demonstrate sensitivity to the perspective of the patient, caregiver, or health care colleague in all communications. Goal E7.2: Communicate effectively. OBJ E7.2.1 (Analysis) Use an understanding of effectiveness, efficiency, customary practice and the recipient's preferences to determine the appropriate type of, and medium and organization for, communication. OBJ E7.2.2 (Complex Overt Response) Speak clearly and distinctly in grammatically correct English or the alternate primary language of the practice site. OBJ E7.2.3 (Application) Use listening skills effectively in performing job functions. OBJ E7.2.4 (Application) Use correct grammar, punctuation, spelling, style, and formatting conventions in preparing all written communications. 11 P a g e

12 Goal E7.3: Balance obligations to oneself, relationships, and work in a way that minimizes stress. OBJ E7.3.1 (Synthesis) Devise an effective plan for minimizing stress while attending to personal needs, maintaining relationships, and meeting professional obligations. Goal E7.4: Manage time effectively to fulfill practice responsibilities. OBJ E7.4.1 (Application) Use time management skills effectively to fulfill practice responsibilities. Goal E7.5: Make effective use of available software and information systems. OBJ E7.5.1 (Application) Successfully search, retrieve, and manage electronic data from internal information databases, external online databases, and the Internet. OBJ E7.5.2 (Application) Exercise skill in the use of the organizations word-processing, spreadsheet, and presentation software. OBJ E7.5.3 (Comprehension) Explain how an effectively functioning organizational information system is structured. 12 P a g e

13 Structure of Residency Experiences Orientation (required) Core Rotations (required) Transitional Elective Rotations (choose 6) Hospital Orientation Residency/RLS Computer Training Hospital Practice Hospital Pharmacy Practice Projects ASHP Midyear Longitudinal (required) Drug Information P&T MUE Journal Club x 2 Drug Information Pager every 4 weeks Formal Drug Information Responses x 4 Hospital Pharmacy Practice Staffing Operational every 4 th weekend Clinical On Call every 4 weeks Residency Project Seminars Therapeutic Exchange CE 60 min Case Conference x 2 Residency Project min Criteria Based Skill Assessments (CBAs) Documentation in EMR x 2 Process Improvement x 2 Patient Counseling x 2 Administration General Internal Medicine Critical Care (pick two) Surgical ICU Trauma ICU Medical ICU Pediatric ICU Nutrition Solid Organ Transplant Bone Marrow Transplant General Pediatrics Hematology Solid Tumor Oncology Nutrition Infectious Disease Critical Care Medicine Trauma Burn Surgical Geriatrics HIV/AIDS Cardiology ICU Pediatrics NICU Pediatrics Informatics 13 P a g e

14 Benefits Please refer to the Human Resources Page on the Vanderbilt University Website for more information: Health, Disability, and Professional Benefits Health care plan options, including an HMO plan Paid time off (PTO) including 7 paid Holidays (please see page 10 for more information regarding PTO during residency) Short Term Disability Life insurance Professional liability insurance supplied by the Medical Center Immunizations and all other health related costs required by the Medical Center Employee Wellness Program Educational Benefits Full access to the Biomedical Library Financial support and professional leave for the ASHP Midyear Meeting and the annual Southeastern Residency Conference. Other Benefits Travel and relocation expenses directly related to moving to Nashville (moving company, truck rental, fuel, hotel) up to $1500 Payment of Tennessee Board of Pharmacy license fee in June license fee and professional tax NAPLEX transfer fees Photocopying directly related to residency Office space & computer work station Employee Assistance Program ACPE approved continuing education provided by the Department of Pharmaceutical Services Discounts at local merchants Paid Time Off (PTO) 29 Days of PTO (paid time off) will be granted on the first day of the residency program PTO is used for vacation, holidays, sick days, and interview days if needed Due to the rigorous, educational nature of the residency training program, it is expected that residents minimize the use of PTO days (we suggest that residents use days of the 29 day PTO allotment throughout the year). 14 P a g e

15 Half of the residents will be assigned to work the week of Thanksgiving, and the other half will be assigned the week of Christmas. If you are not working the holiday, you are encouraged to use a week of your PTO for the holiday that you are off. Vacation may not be taken during ASHP Midyear Meeting or SERC meeting days, or scheduled holidays/weekends in the staffing component of the residency. Vacation requested for June is discouraged and will be reviewed on a case by case basis by the Residency Director. Residents may not be absent more than 5 days from any rotation experience (professional leave/personal/vacation) unless approved by the Residency Director and rotation preceptor. July 4 th, Labor Day, Thanksgiving Day, Christmas Eve, Christmas Day, New Year s Day, Memorial Day are paid holidays. Residents will be assigned to work 2 major and 1 minor holiday. If the resident is scheduled on the pharmacy staffing schedule for a holiday, that shift prevails. The department also recognizes the day after Thanksgiving and New Year s Eve in the department staffing rotation and these are handled and scheduled per department policy. If the resident is off for any holiday, then they must submit this time as PTO Refer to the PTO Request Procedure in the Appendix. This information is also covered in Policy AS Residency Practice Guidelines Manual/Hpolicy.nsf/AllDocs/A09FD26D92F AB35F 15 P a g e

16 Expectations of the Resident The resident is expected to achieve the objectives of the Residency Program related to both administrative and professional practice skills. The resident reports to and is supervised by the rotation preceptor and the residency director. During staffing, the resident is under the supervision of the pharmacist in charge. Licensure Verification Pharmacy licensure in Tennessee is a requirement for pharmacy practice residents at VUMC. The residency program director will confirm that each resident has taken the NAPLEX and the Tennessee pharmacy law exam, or will take the Tennessee law exam upon transfer of NAPLEX scores from another state, or already had a valid Tennessee pharmacy license. Upon notification of successful completion of the NABPLEX and/or law exam the resident will provide documentation of licensure to the RPD. The resident will provide the department the licensure certificate for display during the resident s year at VUMC. Licensure must be obtained no later than July 31 of the residency year. (Policy AS : Residency Practice Guidelines) Professionalism Hours of practice vary according to the requirements set forth by the preceptor and director. The resident is expected to be present in body, mind, and spirit at all assigned activities of the service they are currently a part of, including medical staff rounding, education classes, and administrative activities. The resident may be assigned duties that require work overnight or that may continue during days away from the hospital; however, these assignments will not be beyond the expectations of other pharmacy professionals duties. An eight hour day is a minimum requirement for physical presence on site during assigned work days. Duty Hours Resident work hours must comply with the current duty hour standards of the Accreditation Council for Graduate Medical Education (ACGME). Duty hours are defined as all clinical and academic activities related to the residency program that are performed on-site. Duty hours must be limited to 80 hours per week, averaged over a 4-week period. These duty hours include covering overtime shifts and moonlighting. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities averaged over a 4-week period. One day is defined as one continuous 24-hour period free from all residency activities. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods. Duty hours will be reported to the residency program director (RPD) on a monthly basis for review. 16 P a g e

17 Overtime/ Moonlighting The work of the Department is the resident s most important commitment; however, residents working extra shift hours in a staffing role for pharmacist pay is permitted. To work overtime, the resident must be trained in the area. The resident must notify the RPD of all overtime/moonlighting shifts for approval prior to scheduling the shift. The extra hours worked must not interfere with residency related activities. Moonlighting outside of Vanderbilt is strongly discouraged. However, if the resident chooses to moonlight outside of Vanderbilt, all activity must be disclosed via the VUMC conflict of interest disclosure process. The extra hours worked must not interfere with residency related activities. ALL work hours must not exceed the 80-hour limit set forth by ACGME. The resident must notify the RPD of all overtime/moonlighting shifts for approval prior to scheduling the shift. Departmental Policies Applicable to Pharmacy Residents Vanderbilt Human Resources Website: VUMC Website: VUH Pharmacy Residency Policy: MANUAL/Hpolicy.nsf/AllDocs/A09FD26D92F AB35F 17 P a g e

18 Residency Activities and Requirements Rotations There are 10 rotations during the PGY1 residency year. Each rotation period is approximately 4 weeks in duration. All residents must complete the following four required rotations: administration, internal medicine, and two critical care rotations. Nutrition can be used for one critical care requirement if desired by the resident. No more than one-third of the twelve-month PGY1 pharmacy residency program may deal with a specific patient population or practice area (e.g., critical care, oncology, cardiology). Rotation requirements may vary based on preceptor. Criteria based assessments should be reviewed at the outset of each rotation by resident and preceptor to assure completion of all requirements by the end of the residency year. Hospital Pharmacy Practice The residents will practice in a guided hospital practice scheduled every fourth weekend, selected holidays and one evening per week. The resident will gain experience in the IV room, Central dispensing area, and the Narcotic Room as well as learn the responsibilities of the pharmacist in charge as well assist with clinical consults and dashboard monitoring. The second half of the year the resident will be exposed to the satellite pharmacy during their evening staffing requirement. Clinical Pharmacy On-Call Service The On-Call Resident provides a resource to help with pharmacy consults (kinetics, etc) after regular business hours and also with drug information questions 24/7 for one-week every 4 weeks. The resident will be on call every fourth week. Out-of-State Conferences ASHP Midyear o Registration begins in August; residents are responsible for meeting these registration deadlines. o Residents must also register for the UHC meeting and present a poster at the UHC resident poster session. o It is required that all residents attend a minimum of 10 hours of lectures/seminars. Southeastern Residency Conference: o End or April or early May in Athens, Georgia o Registration begins in January/February and abstract submission deadline is in February; residents are responsible for meeting registration deadlines. 18 P a g e

19 Journal Club The purpose of the Journal Club assignment is for the resident to present a current pharmacotherapy related study to members of the Department of Pharmaceutical Services, including, but not limited to, other residents, students, and clinical preceptors. The Journal Club experience will be a discussion between the pharmacy resident and the members of the audience, with full audience participation expected. Residents are expected to lead Journal Club for the department twice in their residency year. All residents are required to attend. Refer to the Journal Club Learning Experience in Appendix X for full details and requirements. Case Conference The purpose of Case Conference is for the resident to present an interesting clinical case in which they directly participated in the patient s care. They are to present members of the Department of Pharmaceutical Services, including, but not limited to, other residents, students, and clinical preceptors. All residents are required to attend. Cases should be focused on pharmacotherapy topics and include primary literature in reference to the case. Refer to the Case Conference Learning Experience in Appendix X for full details and requirements. Continuing Education Presentations Two formal presentations by each resident will be conducted during the residency year: Therapeutic Exchange: This is a 60 minute CE presentation that includes some controversy and/or is a hot topic in pharmacotherapy. This is not just a review of a disease state. Primary literature is to be used as a guiding force to put this presentation together. Presentation objectives and title are to be submitted one month prior to your assigned presentation date. Refer to the Therapeutic Exchange Learning Experience in Appendix X for full details and requirements. Residency Project: This is a minute presentation of the resident s research project. This includes several practice sessions and then a formal presentation with feedback/evaluation from preceptors and residents during practice and attendees at SERC. This will also be presented in conjunction with the other residents to be a complete 60 minute CE presentation for the department. Refer to the Research Project Learning Experience in Appendix X for full details and requirements. 19 P a g e

20 Pharmacy and Therapeutics Committee The resident will review the ASHP Statement of the Pharmacy and Therapeutics Committee and the Formulary System to gain an understanding of the process for developing, implementing, and maintaining a formulary system. The Vanderbilt Medications Formulary Management policy will be reviewed to provide an understanding of Vanderbilt-specific formulary management. One drug monograph will be assigned to each resident throughout the year, usually as part of the administration rotation. The resident will be responsible for formulating an evidence-based written medication monograph. The monograph will be presented at a P&T Committee meeting or subcommittee meeting as appropriate. A minute PowerPoint presentation with a recommendation for the drug s place in therapy should be prepared. Refer to the Monograph Learning Experience in Appendix X for full details and requirements. Newsletter/Fast Facts The purpose of the Fast Fact assignment is for the resident to provide information about a pharmacyrelated topic that could be of use and educational value to the Department of Pharmaceutical Services. The Fact Fast should highlight a new topic and provide practical information to pharmacists and/or pharmacy technicians. The Fast Fact will be published in the InPharmation newsletter, which is published at the end of each month. Each resident will provide two Fast Facts during the year, typically one in the fall and one in the spring. Refer to the Fast Facts Learning Experience in Appendix X for full details and requirements. Research Project Each resident will conduct a research project over the course of the residency year. This project will include idea development, literature review, study design, IRB submission, data collection, data analysis, data interpretation, oral presentation and a written manuscript. The written manuscript is to include identification of an appropriate journal for potential submission and the following of the instruction to authors for that journal. The manuscript must be written and submitted in final form prior to completion of residency. The manuscript must be reviewed by the project mentor(s) and approved by the residency director. Refer to the Research Project Learning Experience in Appendix X for full details and requirements. MUE Each resident will complete a minimum of one medication use evaluation during the residency year. These are assigned in the first month of the residency. Findings are to be summarized in a 10 minute power point presentation with recommendations of the most appropriate course of action based on the findings to the P&T Committee and/or appropriate committee. Refer to the MUE Learning Experience in Appendix X for full details and requirements. 20 P a g e

21 Process Improvement The purpose of the Process Improvement is for the resident to identify opportunities for improvement of the organization s medication use system and act on how to change the process. The process improvement activity is an all-inclusive activity including both identifying the process issue and working to rectify the problem or change processes in order to prevent future issues. The resident will be responsible for identifying and completing two process improvement activities throughout the year. These can be completed at any during the residency year and may be identified in any practice setting the resident is actively participating in. Drug Information Questions The purpose of the Drug Information activity is for the resident to formally answer a drug information question posed during rounds or other clinical activities. The resident is to use primary literature to construct a written response to the drug information question. The resident is required to construct four formally written drug information questions throughout the course of the residency year. It is up to the resident to identify the drug information question, construct a formal response, and work with a preceptor to evaluate the response. Documentation- Learning Experience Coming Soon. Patient Counseling- Learning Experience Coming Soon. Recruitment Residents will assist in the resident recruitment and candidate selection process at Midyear and during the month of February, 21 P a g e

22 Evaluation Process and Requirements Evaluations An essential component of developing the skills of a resident is frequent two-way feedback between residents and preceptors. The preceptors, program director, and residents will frequently provide feedback to one another via formal evaluation. Evaluation will occur as described below: 22 P a g e a. Rotation Summative Evaluations: Due no later than 7 working days after the end of the previous rotation period. This is a written evaluation of the resident s performances in meeting the objectives of each rotation. The resident and preceptor will review these evaluations together. The resident will also complete a preceptor and learning experience evaluation. b. Pharmacy Practice Quarterly Evaluations: Longitudinal experiences will require a quarterly summative evaluation where a written evaluation of the resident s progress is completed. Learning experience and preceptor evaluations must also be completed on a quarterly basis for these experiences. c. Criteria Based Assessments: Evaluations of selected activities will be completed by both a preceptor and the resident. Counseling Documentation Problem solving Researched Drug information questions Case Conferences Journal Club Therapeutic Exchange Monograph d. Residency Council Reports : A written evaluation based on period review by the residency council. This evaluation examines overall progress, including integration of skills learned in separate rotations, non-rotation objectives/experiences, progress on longitudinal requirements/rotations (residency project, criteria assessments, etc.) and any pertinent trends or information found in evaluations to that date. Progress of the resident s strengths, weaknesses and career goals will be documented. To satisfactorily complete the residency, the resident must have shown improvement over the course of the year in both resident and preceptor scoring. For any goals in which less than a score of 3 is averaged, the resident and program director will work together to develop individualized plans to assist in making progress in those areas by residency end. If the resident does not work towards those plans and progress improvement, residency completion with certificate may be compromised. On a quarterly basis, goals in which the resident has scored an average of 5 for two consecutive quarters will be removed from further evaluation.

23 All evaluations are to be discussed personally between resident and preceptor. All evaluations (rotation summative on resident, resident on preceptor and resident on rotation overall), CBAs, and selfassessments should be forwarded to the resident program director or designee in electronic format. A hard copy should be printed and signed by resident and evaluator and maintained in the resident s residency portfolio binder. The electronic database will document the review by the residency program director. Documentation Each resident will maintain/submit the following documentation: 1. Summative Self-Evaluation: Required for each rotation, CBA, and longitudinal experience. Each evaluation is due 7 working days after the completion of the previous rotation period. 2. Rotation and Preceptor evaluations will be submitted to the preceptor and then program director or designee within 7 working days following the completion of the rotation or designated quarterly evaluation completion dates. This should be presented to the preceptor the same day that the preceptor presents the block or longitudinal evaluation to the resident. The preceptor must sign off on this in the evaluation database as reviewed. 3. Criteria Based Assessments (CBAs) are to be initiated by the resident as opportunities are encountered then evaluated with corresponding preceptor. The evaluation is documented in resitrak. Resident initiated CBAs: Counseling Documentation Problem solving Drug Information Researched Questions Case Conference Journal Club Therapeutic Exchange 4. A record of interventions is to be compiled on an ongoing basis and documented in Quantifi. Many preceptors request a list of these pertaining to the rotation as part of the rotation summative evaluation. 23 P a g e

24 5. Residency Notebook: The resident will maintain both a hardcopy and an electronic residency notebook which shall be a complete record of the resident s program activities. The notebook should include the following: Orientation Checklist All residency-based evaluations including: o Entering Interest form o Goal-based evaluations o Summative (by preceptor and self-evaluations) o Preceptor evaluations o Learning experience evaluations o Custom evaluations o Customized training plans A record of all educational in-services and seminars presented o Outlines and/or lecture slides o Evaluation of in-service or seminar where applicable o Any edits that you received Residency Project Materials o Proposal o IRB submission o Data collection & analysis o Final manuscript o Any edits that you received Any formulary reviews, written drug information responses or other completed assignments *The contents of the residency notebook serve as documentation of activities completed during the residency year. The residency yearbook is a permanent record which is the property of Vanderbilt University Medical Center.* 24 P a g e

25 Requirement for Receiving a Certificate Upon successful completion of all program requirements and compliance with all conditions of the residency program, Vanderbilt University Medical Center will award the resident a certificate indicating successful completion of the residency program. All of the following criteria must be satisfied to successfully complete the program: Completion of a residency research project that is approved by the program director and submission of a formal write-up in manuscript format by June 1 of the academic year. Completion of the required number of formal presentations (Journal Club, Therapeutic Exchange and Case Presentation, MUE). Satisfactory completion of all rotations as determined by the primary preceptor for the rotation Completion of the required number of Competency Based Assessments (Drug Information, Counseling, Documentation). A minimum of 75% of all residency objectives marked as Achieved for Residency by preceptors or residency program director. Completion of the residency notebook. Residents who fail to complete all program requirements and/or do not comply with all conditions of the residency program shall not be awarded a certificate of completion. 25 P a g e

26 Appendices A: Orientation Checklist B: Evaluation Schedule C: Requirements Tracking Form D: Requirement Timeline E: Learning Experiences F: Clinical On-Call G: PTO Request Procedure 26 P a g e

27 Appendix A: Orientation Checklist Resident: Pharmacy Resident Central Pharmacy Orientation Items Resident Initials Trainer Initials Date Reviewed General Daily work flow Unit Dose Area Times and associated tasks Review Pharmacist Shift slots and associated duties Pharmacist in charge IV/Central UD Float Central UD IV/TPN Review how to read/interpret staffing schedule Review daily Technician slots and associated responsibilities Procurement Process Storeroom Staff Storeroom Responsibilities Storage locations: walk in fridge, storeroom, Med Carousels, PakPlus room Over fill cart, IV/TPN room Med Carousel/Connect Rx Process Log In code given Pull on demand pick Review of AcuDose/Cartfill Process Pharmacist Scan process Acceptance of AcuDose zones AcuDose Fill Process AcuDose Orientation with Frank Ray Checking AcuDose Doses AcuDose Log-in and Filling AcuDose Machines Narcotic Check in Narcotic Room Medication Error Recording Process in the Central Area Internal Errors External Errors Narcotic Room Procedures CII Safe Log-in and orientation with Charity Prater Checking process Discrepancy resolution Narcotic orders attachment in HMM (patient specific) Cart Fill Process Pull process from Med Carousel Check Process Catch-up Doses Delivery of meds to patient specific med drawers Look alike Sound alike medications Extemp Process Set up/filling Process Checking Process Non-Sterile Compounding area Orientation to Area What type of products made Who to ask if questions PCCA Order Processing (Vopping) in Central Areas Central order processes for 27 P a g e

28 What to send to the ED How to Clarify an order (resident pager list/operator) Crash Carts 6 month expiration Red Locks Charges ED Trays Specific References: Psych book, IV reference manual etc. Blood Factor book, Clozaril, MSDS, etc. Borrow/Loan policy and procedures Unit dose packaging TadPoles Bar coding Responsibilities of Pharmacy Unit Dose Packaging Options How to check items in Pak Plus Tube system policy and procedures Tube System Competency Check List *Outpatient prescriptions, Stallworth and Psych Hospital Procedures on weekends (cover on first weekend) IV/TPN/IDS Room Orientation Items Resident Initials Trainer Initials Date Reviewed General workflow and distribution of responsibilities amongst pharmacists and technicians How to find things in the IV room IV preparation policy and procedures Set up of IV Preparations and Batches Reconstitution of vials Preparation of syringes, PB, LVP and checking these Storage of medications prior to delivery Delivery Schedule Sterile products preparation check off Call for medications Review of how we meet USP 797 Latex allergy policy and procedures Review of IV resources: how to determine compatibilities, expirations, Vandy IV manual, IV room website, latex website Narcotic Preparation and wastage Log sheets Wastage record Record of RX number in patient maintenance Standard Time Schedules Investigational Drug Area TPN Area Outpatient Areas Orientation Items Resident Initials Trainer Initials Date Reviewed Review of what and where all outpatient pharmacy services are located, hours, key persons **Indigent Med Program: policy and procedures please learn the process of who is eligible, what the policy is, how patients 28 P a g e

29 are approved, how much medication can be dispensed. **Sample pharmacy: policy and procedures, location, products available, how it works, who pays for it, and why we offer this service, how to look up formulary for this Process for prior authorization etc. of high cost drugs and our policy/procedure for handling these (identify main agents etc.) How we manage the purchase, distribution and charging of medications used in the clinics Medicare/Tenncare issues What are the toughest problems in clinic medication reimbursement Coumadin Clinic Tommy and Suzanne **Who is serviced/eligible **How to enroll a patient (Starpanel) please walk the resident through the Starpanel process How information is communicated/documented Policy and Procedures/Protocol CC follows Staff involved in clinic Standards of care in regards to anticoagulation History of the service at Vanderbilt Credentials involved and structure of providing this service Quality assurance/improvement in this area Order Processing: Orientation Checklist Orientation Items Resident Initials Trainer Initials Date Reviewed Orient to satellites Locations Areas serviced by each Hours Order clarifications Work flow Pharmacist and technician responsibilities Adverse Drug Reaction reporting, Medication Error reporting Customer Service Focus Intervention Documentation Telephone Courtesy/Etiquette IV medication administration policy and chart Meds/Devices brought from home PCA Pump Policy DI Resources: Micromedex, Lexi-Comp, Kings, Facts & Comp, Up to Date, Trissell s, Pubmed Alaris GuardRails for IV pumps How to use phone and beeper system Dashboards (Will do with Blair, Pratish, and Erin ) Orientation Items Resident Initials Trainer Initials Date Reviewed Warfarin Aminoglycoside Heparin Consults 29 P a g e

30 Appendix B: Evaluation Schedule P a g e

31 Appendix C: Tracking Form SUMMATIVE EVALUATIONS Rotation Rotation 1 Rotation 2 Rotation 3 Rotation 4 Rotation 5 Preceptor s Evaluation Resident Self-Assessment Learning Experience Rotation Rotation 6 Rotation 7 Rotation 8 Rotation 9 Rotation 10 Preceptor s Evaluation Resident Self-Assessment Learning Experience LONGITUDINAL EVALUATIONS Quarter 1 Quarter 2 Quarter 4 Quarter 4 Hospital Practice (Staffing) Preceptor s Evaluation Resident Self-Assessment Learning Experience Residency Project Preceptor s Evaluation Resident Self-Assessment Learning Experience Training Plan Progress Residency Council Report Resident Training Plan Self Assess CASE PRESENTATIONS #1 #2 Preceptor s Evaluation Resident Self-Assessment Learning Experience JOURNAL CLUB #1 #2 Preceptor s Evaluation Resident Self-Assessment Learning Experience THERAPEUTIC EXCHANGE Preceptor s Evaluation Resident Self-Assessment Learning Experience 31 P a g e

32 DRUG INFO QUESTIONS DI #1 DI #2 DI #3 DI #4 Preceptor s Evaluation Resident Self-Assessment Learning Experience PROBLEM SOLVING #1 #2 Preceptor s Evaluation Resident Self-Assessment Learning Experience PATIENT COUNSELING #1 #2 Preceptor s Evaluation Resident Self-Assessment Learning Experience DOCUMENTATION #1 #2 Preceptor s Evaluation Resident Self-Assessment Learning Experience MONOGRAPH Preceptor s Evaluation Resident Self-Assessment Learning Experience OTHER REQUIREMENTS (WITHOUT FORMAL EVAUALTIONS) Fast Fact #1 Fast Fact #2 SERC Presentation Manuscript Project Requirements Proposal IRB Data Collection Presentation Report/Manuscript Research Project MUE 32 P a g e

33 Appendix D: Requirement Timeline (For Guidance Purposes Only; Dates are subject to change based on individual resident goals/assigned tasks) **This may not be all inclusive watch your residency requirements tracking form!** July August September October November December January February March April May Baseline self-assessment (Entering resident interest and preference information) Select and Develop 60 minute CE Presentation Dates for Journal Club, Case Presentation Selected, CE Presentation Project topic/preceptor confirmed Project literature review and bibliography completed and submitted. MUE topic selected and timeline for completion established. Register for ASHP Midyear Meeting Project design/methods write-up complete Project Proposal Presentation IRB submissions If taking a poster to MYCM, investigate deadlines for abstract submission How many Criteria Based Assessments have you completed? Pace yourself! Evaluate where you stand with longitudinal assignments (P&T Monograph, MUE) If you have not started your MUE start now! Project Proposal completion and submitting to IRB, establish timeline for project data collection and analysis etc. Are you working on your MUE? Just checking!!! Recruitment Showcases Case Presentations and Journal Clubs MUE timeline established and confirmed. If taking a poster to MYCM need to complete slide by mid November. Recruitment Showcases How many Criteria Based Assessments have you completed? Pace yourself! Résumé preparation and interview skills ASHP Midyear UHC Posters, showcase Register for SERC and Prepare SERC abstract Complete and submit SERC abstract Wind up data collection for project Case presentations and journal clubs How many Criteria Based Assessments have you completed? Pace yourself! Are you on track with your MUE? Project: begin organizing data analyze data - results Pre-SERC project presentation I, II, III, IV, SERC How many Criteria Based Assessments have you completed? Pace yourself! Project manuscript first draft completed May 15th June Final Project manuscript due June 15 All Criteria Based Assessment Requirements completed by Jun P a g e