PGY1 Medication Safety Core Rotation

PGY1 Medication Safety Core Rotation Preceptor: Mike Wyant, RPh Hours: 0800 to 1730 M-F Contact: (541)789-4657, michael.wyant@asante.org General Description This rotation is a four week rotation in duration. You will work closely with the Medication Safety Coordinator during this rotation. You will learn about responsible event reporting, and how to analyze and categorize each event. You will be involved in developing policies, procedures, and employee education for various events. You will work with a variety of other health care professionals addressing medication safety from the individual to the institutional level. Staffing/Meeting Attendance Staffing: You are required to notify your primary preceptor/preceptor of the day of any scheduled staffing/project days As deemed necessary by your Residency Director and preceptor Your achievement of the goals of the residency is determined through assessment of your ability to perform the associated objectives. The table below demonstrates the relationship between the activities you will perform on the learning experience and the goals/objectives assigned to the learning experience. Topics for Discussion Understanding of the systems based approach to medication safety. Understand of the concept of a just culture. Discussion of second victims. Apparent Cause Analysis Root Cause Analysis Automation and technology High alert medications Look alike/sound alike medications Institute for Safe Medication Practices (ISMP) Best practices Educational Goals/Objectives Your achievement of the goals of the residency is determined through assessment of your ability to perform the associated objectives. The table below demonstrates the relationship between the activities you will perform on the learning experience and the goals/objectives assigned to the learning experience. 400-PH-0085 (07/13/2016) Page 1 of 11

Goals and Objectives Assessment Criteria 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. (Applying) Interact effectively with patients, family members, and caregivers. R1.1.2 Interactions are respectful and collaborative. Uses effective communication skills. Shows empathy. Empowers patients to take responsibility for their health. Demonstrates cultural competence. (Applying) Collect information on which to base safe and effective medication therapy. Collection/organization methods are efficient and effective. Collects relevant information about medication therapy, including: o History of present illness. o Relevant health data that may include past medical history, health and wellness information, biometric test results, and physical assessment findings. o Social history. o Medication history including prescription, non-prescription, illicit, recreational, and non-traditional therapies; other dietary supplements; immunizations; and allergies. o Laboratory values. o Pharmacogenomics and pharmacogenetic information, if available. o Adverse drug reactions. o Medication adherence and persistence. o Patient lifestyle habits, preferences and beliefs, health and functional goals, and socioeconomic factors that affect access to medications and other aspects of care. Sources of information are the most reliable available, including electronic, faceto-face, and others. Recording system is functional for subsequent problem solving and decision making.clarifies information as needed. Displays understanding of limitations of information in health records. (Analyzing) Analyze and assess information on which to base safe and effective medication therapy. Includes accurate assessment of patient s: R1.1.3 R1.1.4 400-PH-0085 (07/13/2016) Page 2 of 11

o health and functional status, o risk factors o health data o cultural factors o health literacy o access to medications o immunization status o need for preventive care and other services when appropriate o other aspects of care as applicable. Identifies medication therapy problems, including: o Lack of indication for medication. o Medical conditions for which there is no medication prescribed. o Medication prescribed or continued inappropriately for a particular medical condition. o Suboptimal medication regimen (e.g., dose, dosage form, duration, schedule, route of administration, method of administration). o Therapeutic duplication. o Adverse drug or device-related events or potential for such events. o Clinically significant drug-drug, drug-disease, drug-nutrient, drug-dna test interaction, drug-laboratory test interaction, or potential for such interactions. o Use of harmful social, recreational, nonprescription, nontraditional, or other medication therapies. o Patient not receiving full benefit of prescribed medication therapy. o Problems arising from the financial impact of medication therapy on the patient. o Patient lacks understanding of medication therapy. o Patient not adhering to medication regimen and root cause (e.g., knowledge, recall, motivation, financial, system). o Laboratory monitoring needed. o Discrepancy between prescribed medications and established care plan for the patient. GOAL R1.3 Prepare, dispense, and manage medications to support safe and effective drug therapy for patients. (Applying) Manage aspects of the medication-use process related to formulary R1.3.2 management. Follows appropriate procedures regarding exceptions to the formulary, if applicable, in compliance with policy. Ensures non-formulary medications are dispensed, administered, and monitored in a manner that ensures patient safety. 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. 400-PH-0085 (07/13/2016) Page 3 of 11

(Creating) Prepare a drug class review, monograph, treatment guideline, or protocol. Displays objectivity. Effectively synthesize information from the available literature. Applies evidenced-based principles. Consults relevant sources Considers medication-use safety and resource utilization. Uses the appropriate format. Effectively communicates any changes in medication formulary, medication usage, or other procedures to appropriate parties. Demonstrates appropriate assertiveness in presenting pharmacy concerns, solutions, and interests to internal and external stakeholders The need identified is an important one for care of the health system s patient population Treatment guideline reflects careful consideration of systematically developed best evidence as described in Clinical Practice Guidelines: Directions for a New Program published by the Institute of Medicine Treatment guideline reflects consideration of new and emerging data Treatment guideline reflects consideration of the culture of the health system Guideline/protocol is fully implemented Outcome information is provided to the prescribers/providers Judgment of outcome information is accurate Judgment of outcome information gives appropriate weighting to humanistic as well as clinical and economic outcomes (Applying Participate in a medication-use evaluation. Uses evidence-based medicine to develop criteria for use. Demonstrates a systematic approach to gathering data. Accurately analyzes data gathered. Demonstrates appropriate assertiveness in presenting pharmacy concerns, solutions, and interests to internal and external stakeholders. Implements approved changes, as applicable. Recommendation is based on a thorough review of pertinent literature Recommendation is presented in the appropriate format Recommendation is objective (Analyzing) Identify opportunities for improvement of the medication-use system. Appropriately identifies problems and opportunities for improvement and analyzes relevant background data. Accurately evaluates or assists in the evaluation of data generated by health information technology or automated systems to identify opportunities for improvement. R2.1.1 R2.1.2 R2.1.3 400-PH-0085 (07/13/2016) Page 4 of 11

Uses best practices to identify opportunities for improvements. When needed, makes medication-use policy recommendations based on a review of practice (e.g., National Quality Measures, ISMP alerts, Joint Commission Sentinel Alerts). Demonstrates appropriate assertiveness in presenting pharmacy concerns, solutions and interests to internal and external stakeholders. Explain the concept of system error Explain the definitions of the various terms associated with adverse drug events (e.g., medication misadventure, medication error, adverse drug reaction, error, accident, systems error, individual error, latent error). State sources of information on the design, implementation, and maintenance of safe medication-use systems. Explain the meaning of the term culture of safety Explain methods for analyzing processes within a medication-use system (root cause analysis, failure mode and effect analysis) Exercise skill in process-mapping, a type of flowchart depicting the steps in a process, with identification of responsibility for each step and the key measures Explain how to categorize medication errors using the ASHP Guidelines on Preventing Medication Errors in Hospitals Explain how to categorize medication errors using the National Coordinating Council for Medication Error Reporting and Prevention s medication index for categorizing errors Explain how to categorize medication errors using one s own institution s categorization methodology Explain the role of the MUE in measuring outcomes of the medication-use process Explanation provides accurate definition of terms associated with adverse drug events Explanation of organization s medication-use system is clear and accurate Explanation reflects understanding of the health system s medication-use process as a system Accurately states sources of information on the design, implementation, and maintenance of safe medication-use systems Explanation reflects understanding of system error Explanation reflects understanding of human factors error Cites the potential contribution of automation and technology to preventing medication misadventures at the departmental and at the organizational levels Cites the potential contribution of automation and technology to the occurrence of medication misadventures at the departmental and organizational levels (Applying) Participate in medication event reporting and monitoring. Effectively uses currently available technology and automation that supports a safe medication-use process. R2.1.4 400-PH-0085 (07/13/2016) Page 5 of 11

Appropriately and accurately determines, investigates, reports, tracks and trends adverse drug events, medication errors and efficacy concerns using accepted institutional resources and programs Explain the importance of continually reassessing medication-use policies Exercise skill in the revision of a policy or procedure when necessitated by the implementation of a change in a medication use process Accurately identifies the components of a formulary system Accurately describes the approval process for establishing a formulary Accurately describes the role of committees in addressing formulary issues Accurately describes how formularies are revised and maintained Accurately describes the health system s procedures regarding exceptions to the formulary Accurately describes the health system s process for making additions and deletions to the formulary Accurately describes how pharmacoeconomic principles are used in the formulary decision process Accurately describes how the health system communicates formulary decisions to prescribers GOAL R2.2 Demonstrate ability to evaluate and investigate practice, review data, and assimilate scientific evidence to improve patient care and/or the medication use system. (Analyzing) Identify changes needed to improve patient care and/or the medicationuse systems. R2.2.1 Appropriately identifies problems and opportunities for improvement and analyzes relevant background data. Determine an appropriate topic for a practice-related project of significance to patient care Uses best practices or evidence based principles to identify opportunities for improvements Accurately evaluates or assists in the evaluation of data generated by health information technology or automated systems to identify opportunities for improvement. (some statements from the objective R2.1.4 above may apply here) (Creating) Develop a plan to improve the patient care and/or medication-use system. Steps in plan are defined clearly. Applies safety design practices (e.g., standardization, simplification, human factors training, lean principles, FOCUS-PDCA, other process improvement or research methodologies) appropriately and accurately Plan for improvement includes appropriate reviews and approvals required by department or organization, and includes meeting the concerns of all stakeholders. R2.2.2 400-PH-0085 (07/13/2016) Page 6 of 11

Applies evidence-based principles, if needed. Develops a sound research or quality improvement question realistic for time frame, if appropriate. Develops a feasible design for a project that considers who or what will be affected by the project. Identifies and obtains necessary approvals, (e.g., IRB, funding) for a practicerelated project. Uses appropriate electronic data and information from internal information databases, external online databases, and appropriate internet resources, and other sources of decision support, as applicable Plan design is practical to implement and is expected to remedy or minimize the identified opportunity for improvement. Analyses and measurements reflect clear understanding of the differences between structure, process, and outcomes Choices of techniques and tools for analyzing structure and process and measuring outcomes are appropriate Structure, process, and outcomes are accurately analyzed Problem identified for improvement is of significance in the medication-use system Design of intervention is practical to implement As designed, the intervention offers an approach that can be expected to remedy or minimize the problem Plan for implementation is well thought out and includes meeting the concerns of all stakeholders Assessment of outcomes of implementation accurately reflects measurement of quality indicators (Applying) Implement changes to improve patient care and/or the medication-use system. Follows established timeline and milestones. Implements the project as specified in its design. Collects data as required by project design. Effectively presents plan to appropriate audience (e.g., accurately recommends or contributes to recommendation for operational change, formulary addition or deletion, implementation of medication guideline or restriction, or treatment protocol implementation). Plan is based upon appropriate data. Gains necessary commitment and approval for implementation Effectively communicates any changes in medication formulary, medication usage, or other procedures to appropriate parties. Demonstrates appropriate assertiveness in presenting pharmacy concerns, solutions, and interests to external stakeholders. Change is implemented fully. R2.2.3 400-PH-0085 (07/13/2016) Page 7 of 11

Competency Area R3: Leadership and Management GOAL R3.1 Demonstrate leadership skills. (Applying) Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership. Demonstrates effective time management. Manages conflict effectively. Demonstrates effective negotiation skills. Demonstrates ability to lead interprofessional teams. Uses effective communication skills and styles. Demonstrates understanding of perspectives of various health care professionals. Effectively expresses benefits of personal profession-wide leadership and advocacy. When leader keeps the group focused on meeting its purpose and responsibilities When the leader prepares an effective agenda for meeting When the leader meets the site needs for the meeting When the leader writes effective minutes or notes When the leader supplies information from the meeting to appropriate individuals When the leader when needed, uses consensus-building skills as follows: (1) Assesses the desirability of group input; (2) Identifies the type of decision needed (debatable, exploratory, negotiated, routine, emergency decisions); (3) Selects appropriate tools for group action (i.e., brainstorming, procedure setting, individual polling, etc.); (4) Provides a clear definition of the problem (What is the problem? How did we get here? What are the effects of the problem?); (5) Communicates a clear understanding of who has the responsibility for the decision; (6) Uses effective communication and open-ended questions for producing ideas (What results do we want? What solutions can we think of?); (7) Selects an appropriate size of group for decision making; (8) Provides a means for effectively testing different alternatives relative to the problem (What decision is best for us?); (9) Elicits ideas from others on how to make change go smoothly; (10) Facilitates commitment to the decision; (11) Presents an honest commitment to the group decision-making process (Who will do what by when? Where? How?); (12) Obtains agreement on the procedures and methods for decision making prior to deliberation of the issue; (13) Offers ideas; (14) Asks key or clarifying questions; (15) Keeps the group focused on the task; (16) Summarizes the discussion and decisions When the leader manages group dynamics When a member participates actively and positively in the meeting When a member makes required decisions appropriately and without hesitation When a member remains focused on the main issues When a member does one's share of the work R3.1.1 400-PH-0085 (07/13/2016) Page 8 of 11

GOAL R3.2 Demonstrate management skills. (Applying) Contribute to departmental management. Helps identify and define significant departmental needs. Helps develop plans that address departmental needs. Participates effectively on committees or informal workgroups to complete group projects, tasks, or goals. Participates effectively in implementing changes, using change management and quality improvement best practices/tools, consistent with team, departmental, and organizational goals. Fully describes two or more approaches to managing practice that facilitate interdisciplinary patient-centered care and pharmacy practice excellence R3.2.3 Teach Not Evaluate Competency Area R4: Teaching, Education, Dissemination of Knowledge GOAL R4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public. (Applying) Design effective educational activities. R4.1.1 Accurately defines learning needs (e.g., level, such as healthcare professional vs patient, and their learning gaps) of audience (individuals or groups). Defines educational objectives that are specific, measurable, at a relevant learning level (e.g., applying, creating, evaluating), and that address the audiences defined learning needs. Plans use of teaching strategies that match learner needs, including active learning (e.g., patient cases, polling). Selects content that is relevant, thorough, evidence-based (using primary literature where appropriate), and timely, and reflects best practices. Includes accurate citations and relevant references, and adheres to applicable copyright laws. (Applying) Use effective written communication to disseminate knowledge. Writes in a manner that is easily understandable and free of errors. Demonstrates thorough understanding of the topic. Notes appropriate citations and references. Includes critical evaluation of the literature and advancement in knowledge or summary of what is currently known on the topic. Develops and uses tables, graphs, and figures to enhance reader s understanding of the topic when appropriate. Writes at a level appropriate for the reader (e.g., physicians, pharmacists, other health care professionals, patients, public). Creates one s own work and does not engage in plagiarism. R4.1.3 400-PH-0085 (07/13/2016) Page 9 of 11

Communication A. Daily as necessary with preceptor B. E-mail: Residents are expected to read e-mails at the beginning, middle and end of each day at a minimum for ongoing communication. This is appropriate for routine, non-urgent questions and problems. C. Office extension: Appropriate for urgent questions pertaining to patient care. D. Pager: Residents to page preceptor for urgent/emergency situations pertaining to patient care E. Personal phone number: Provided to resident at time of learning experience for emergency issues Expected Progression of resident responsibility on this learning experience Expand this to a four week rotation Day 1: Preceptor to review learning activities and expectations with resident. Week 1: Resident to review safety newsletters and articles selected by preceptor. Preceptor to teach safety concepts including but not limited to Apparent Cause Analysis, Root Cause Analysis, Failure Mode Effects Analysis, and Responsible Event Reporting. Resident will review best practices by the Institute for Safe Medication Practices. Week 2: Resident to author a safety bulletin on a relevant topic. Preceptor and Resident will review patient charts and investigate reported safety events. When necessary, Resident and Preceptor will collaborate with other hospital departments to determine root causes. Week 3: Resident to participate in an Apparent Cause Analysis (ACA). If no ACA is currently in progress Resident will thoroughly review at least 2 prior ACA s. Week 4: Resident will review a Root Cause Analysis (RCA) in conjunction with Risk Management. By the end of week 4 the Resident shall have participated in the Medication Safety Council meeting and the Patient Safety Council meeting. This may occur earlier than week 4 depending on scheduling. Evaluation Strategy The preceptor will provide both written and verbal formative feedback during the course of the rotation. Additional customized assessments and/or snapshots may be conducted at the discretion of the preceptor or directive of the RPD to assess the resident s skill in a particular area. Pharm Academic will be used for documentation of scheduled evaluations (both formative and summative per the chart below). The resident and preceptor will independently complete the evaluations. The resident and preceptor will then compare and discuss the evaluations. This discussion will provide feedback both on performance of the activities and resident self-assessment skills. Following discussion, preceptor will provide documentation of the discussion and correlation of resident self-assessment on the preceptor evaluation prior to submitting evaluation in Pharm Academic. Evaluations will be completed no later than due date specified below. 400-PH-0085 (07/13/2016) Page 10 of 11

What Who When Summative Preceptor End of rotation Preceptor/Learning Experience Evaluation Resident End of rotation Content of the Evaluation The preceptor is expected to grade the resident on the following scale: NI (Needs Improvement): o Resident needs a more exposure and additional formal evaluation on the topic, likely in two separate rotations. o Will be accompanied by actionable feedback from the preceptor. o Example: The resident s therapeutic plans are not appropriately evidence based; more guideline or primary literature consultation is recommended to improve the recommendations for patients with MRSA pneumonia SP (Satisfactory Progress) : o Resident is doing what they need to be doing, considering the place they are in the program, but the preceptor does not yet feel that they have achieved the goal. o Will be accompanied by actionable feedback from the preceptor. o Example: The resident s analysis of the patient problem list is insufficient; the resident does not actively question the presence of each order to determine its appropriateness. Ach (Achieved) : o Resident is doing what would be expected of a resident at or near the end of his or her program or comparable to a pharmacist with a year of time spent working. o Does not mean that the resident cannot improve, but it means that the resident would not likely benefit much from further additional formal evaluation. Timing of the Evaluation At the end of the learning experience (preferably on the final day, if able) a member of the preceptor team will be expected to discuss the evaluation with a copy of the evaluation in hand of the learning experience with the resident to help clarify any potential misunderstandings and to ensure that residents get the most out of the feedback provided. 400-PH-0085 (07/13/2016) Page 11 of 11