PGY1 Pharmacy Residency Manual. Community Regional Medical Center Department of Pharmacy Services Fresno, California

2016-2017 PGY1 Pharmacy Residency Manual Community Regional Medical Center Department of Pharmacy Services Fresno, California Page 1 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 Section E Rotation Learning Descriptions - Goals, s 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 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 7 7-9 10 11 12-13 13-14 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 75-76 77-78 79-80 81-84 85-86 87-89 Section G Clinical Pharmacy Services Preceptor Information 89 Page 2 revised 2/9/2017

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 coinvestigator 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. Page 3 revised 2/9/2017

o o o The Residency Preceptors will evaluate all project submissions for appropriateness and feasibility. 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. 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 10 th ) 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 10 th 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. Page 4 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 4 th 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. Page 5 revised 2/9/2017

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 s. 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. Page 6 revised 2/9/2017

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. Page 7 revised 2/9/2017

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 Page 8 revised 2/9/2017

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: Page 9 revised 2/9/2017

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 Page 10 revised 2/9/2017

Process / Timeline 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. July 3. Planned Research Day where residents get Institutional Review Board (IRB) training. June 30 th, UCSF building, room TBD from 10:30-11:30 AM August September October November December February April/May June 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. 1. Residents present the following information for research projects: Background information, Hypothesis, Methods, s / 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 15 th for IRB review on 1 st Thursday of October. 4. Complete Needs Assessment for Resident Seminar by September 15. Then choose a topic, date and mentor for Resident Seminar. 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 1 st or by timeline set by UCSF 3. CSHP Seminar 10/27/16 10/30/16 (Disneyland). 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. 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. 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). 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. 1. Prepare for end of year. 2. June 10 th -Final submission of all required materials (Manuscript, PDSA poster etc.) Page 11 revised 2/9/2017

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). Opentoed 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 Page 12 revised 2/9/2017

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). Page 13 revised 2/9/2017

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. Page 14 revised 2/9/2017

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 s to be Taught and Formally evaluated: Goals and s Activities Competency Area R3: Leadership and Management Goal 3.2 Demonstrate management skills R3.2.1 (Understanding) Explain factors that influence Look up and review regulatory compliance guidelines/statutes related to: departmental planning. 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 R3.2.2 Develop a patient safety tool that can be used to proactively identify potential failures for a new process or R3.2.3 R3.2.4 (Understanding) Explain the elements of the pharmacy enterprise and their relationship to the healthcare system. (Applying) Contribute to departmental management. (Applying) Manages one s own practice effectively. 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. The resident will identify areas for improvement for the organization after reviewing these guidelines/statutes in R3.2.1 The resident will recommend and write up a design to implement the changes. Able to complete assigned tasks on time. Learn to communicate effectively and ask questions for clarification. Page 15 revised 2/9/2017

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 s 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 s: 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 s to be Taught and Formally evaluated: Goals and s Activities 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. R2.1.3 (Analyzing) Identify opportunities for improvement of the medication-use system Review of trigger tool and evaluation of potential medication safety events R2.1.4 (Applying) Participate in medication event reporting Identify medication errors, close calls (near misses) and adverse drug reactions and monitoring. 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 Competency Area R3: Leadership and Management Goal R3.1 Demonstrate leadership skills R3.1.1 (Applying) Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership Competency Area R3: Leadership and Management Goal 3.2 Demonstrate management skills Participation on multidisciplinary teams/committees to provide information on medication event data, including numbers, trending and plans for correction Page 16 revised 2/9/2017

R3.2.1 R3.2.2 R3.2.4 (Understanding) Explain factors that influence departmental planning. (Understanding) Explain the elements of the pharmacy enterprise and their relationship to the healthcare system. (Applying) Manages one s own practice effectively. 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 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 Able to complete assigned tasks on time Able to manage the diverse medication safety issues from many other sites that are listed under CRMC Page 17 revised 2/9/2017

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 s to be Taught and Formally evaluated: Goals and s Activities Competency Area R2: Advancing Practice and Improving Patient Care Goal R2.1 Manage and improve the medication-use process R2.1.1 (Creating) Prepare a drug class review, monograph, treatment Conduct new medication monograph/formulary; review of automatic therapeutic substitution protocols; drug class review R2.1.2 R2.1.3 guideline, or protocol (Applying) Participate in a medication use evaluation (Analyzing) Identify opportunities for improvement of the medication-use system (Applying) Participate in medication event reporting and monitoring R2.1.4 Competency Area R3: Exercise leadership and practice management skills Goal R3.1 Demonstrate leadership skills (Applying) Demonstrate personal, R3.1.1 interpersonal, and teamwork skills R3.1.2 critical for effective leadership (Applying) Apply a process of ongoing self-evaluation and personal performance improvement Goal R3.2 Demonstrate management skills (Understanding) Explain factors that R3.2.1 influence departmental planning (Understanding) Explain the elements R3.2.2 of pharmacy enterprise and their R3.2.3: R3.2.4: relationship to the healthcare system (Applying) Contribute to departmental management. (Applying) Manages one s own practice effectively. Conduct medication use evaluations as dictated by safety and/or cost issues; conduct annual formulary review Develop therapeutic guideline/protocols and provide recommendations in response to MUE findings Review the medication event reporting system, learn the purpose and outcomes to event reporting that promote medication safety Complete group assignments; learn group task assigning and accountability; facilitate administration related workgroups Explain and discuss strategies for self evaluation, self-reflection, and self-awareness and time management skills Explain what a pharmacy clinical manager and/or clinical coordinator does and their role and influence in the department 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 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 Prioritize and complete assigned projects within agreed timeframe; maintain balance between projects and assignments Page 18 revised 2/9/2017

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 Page 19 revised 2/9/2017

Administration Rotation - Residency Program Activities PGY1 Resident Expectations and Responsibilities Preceptor: Alice Robbins, PharmD, BCPS, Residency Program Director, Professional Development Specialist Office: 2 nd 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 s 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 s: 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 s 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 s to be Taught and Formally evaluated: Goals and s Activities Competency Area R3: Leadership and Management Goal R3.1 Demonstrate leadership skills R3.1.1 (Applying) Demonstrate personal, interpersonal, and teamwork skills Complete assigned projects as a team R3.1.2 critical for effective leadership. (Applying) Apply a process of ongoing self-evaluation and personal performance improvement. Goal 3.2 Demonstrate management skills (Understanding) Explain factors that R3.2.1 influence departmental planning. R3.2.2 R3.2.3 R3.2.4 (Understanding) Explain the elements of the pharmacy enterprise and their relationship to the healthcare system. (Applying) Contribute to departmental management. (Applying) Manages one s own practice effectively. Explain and discuss strategies for self evaluation, self-reflection, and self-awareness and time management skills. Will share an example of a performance evaluation. Explain what an RPD does Explain the importance of recruitment and retention 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. 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. 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 Page 20 revised 2/9/2017

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. Page 21 revised 2/9/2017

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 selfdirected 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 s to be Taught and Formally evaluated: Goals and s Activities 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 R1.1.1 (Applying) Interact effectively with health care teams to manage Work in an interdisciplinary team in the internal medicine clinic. Make medication recommendations, discuss patients with R1.1.2 patients medication therapy. (Applying) Interact effectively with patients, family members, and caregivers. residents and attendings as needed. Conduct patient interviews, counsel patients/caretakers on medications and their indications during clinic visits, via phone and upon request. Page 22 revised 2/9/2017