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Orientation and Intro to Kinetics and Anticoagulation Services

Orientation and Intro to Kinetics and Anticoagulation Services

PGY1 - Pharmacy (43400)

Faculty: Katie Adrian

Site: Bronson Methodist Hospital

Status: Active


Preceptors: Katie Adrian, Pharm.D., BCPS (adriank@bronsonhg.org)

General Description:

This six-week rotation is designed to orient the resident to Bronson Methodist Hospital and the Department of Pharmacy, and to train them on the various pharmacist staffing roles. During the rotation, the resident will be exposed to the general functioning of the inpatient pharmacy, the daily activities of pharmacy technicians and pharmacists (centralized and decentralized), as well as become acclimated to the hospital environment. Meetings with the RPD and various members of the Residency Advisory Committee will be held throughout the orientation period to discuss expectations, requirements as described in the Residency Manual and the ASHP Accreditation Standard, the evaluation strategy to be used during the residency, and personal goals for the program. Residents should be observing each staffing area during the week they are assigned there. Depending on their licensure status, they will be expected to begin performing pharmacist duties, including signing in to Epic to practice order verification, with preceptor oversight.

Activities Overview:

Refer to the Pharmacy Resident Orientation Checklist (provided to each resident during their first week) for a detailed listing of the activities to be completed during this experience. These skills and activities will be continually reinforced and evaluated through the longitudinal Staffing experience. Week 1: Attend various required meetings, Pharmacy Department orientation including overview of the general schedule for orientation. Continue working on competencies if not already completed during the Administration rotation. Continue working on projects Week 2: Begin training in central pharmacy (unit dose, and IV room). Week 3: Continue training in central pharmacy. Week 4-5: Continue training in central pharmacy. Week 6: Exposure to specialty areas (Peds, NICU, MICU)

Expected progression of the resident:

During orientation, the resident will be training in unit dose and the IV room on first and second shift. During weeks 2 and 3 of central pharmacy training the resident is expected to shadow their pharmacist preceptor for the first couple of days, and then (depending on licensure) will be expected to begin practicing the various central pharmacy tasks with oversight from their preceptor. During weeks 4 and 5 the resident should be working on becoming more independent, but will still have preceptor oversight. Depending on the resident's comfort level and licensure status, the preceptor may not always be "at the elbow" for questions. During week 6, the resident will be shadowing a clinical pharmacist on the Pediatric, NICU, or MICU floors to learn and apply the various clinical functions they will apply on their clinical shifts.

Evaluation Strategy:

The resident will receive on-going, regular formative verbal feedback throughout the Orientation experience. As a formative self evaluation, during the fourth or fifth week the resident will be asked to assess his/her performance to that point and identify an area he/she most needs to improve in. The resident will formulate, in writing, an action plan for performance improvement in that area. This assessment will be discussed with the preceptor, who will in turn provide verbal and written feedback on the resident's self assessment. This assessment will also be shared with the preceptor for the longitudinal Staffing Rotation to facilitate customization of that rotation. At the completion of the rotation the resident and preceptor will independently complete the Summative Evaluation, then will meet and compare the evaluations prior to cosigning. The resident will also complete the Learning Experience Evaluation and a Preceptor Evaluation for each preceptor. The formative self evaluation with preceptor feedback, as well as the completed Orientation Checklist, signed by the preceptor, will be uploaded to PharmAcademic.

Expectation of Learners:

Expectations of Residents:

The pharmacist is responsible for ensuring safe and effective medication use for all patients admitted to the hospital. Routine responsibilities include: verifying orders, checking medications, checking Pyxis fill and cart fill, and compounding parenteral nutrition (PN) formulas, IV admixtures, and chemotherapy. The resident will be trained to complete all of the above tasks. The resident will also be trained to perform monitoring and dosing of various medications including aminoglycosides, vancomycin, heparin, and warfarin according to BMH protocols, policies and procedures.

If not completed during the Administration rotation, the resident will work with the RPD and preceptors to develop a customized Development Plan, choose a hospital or community committee upon which to serve throughout the residency year, and select a topic for his/her major research project. Additionally, the resident should be actively pursuing Michigan pharmacist and controlled substance licensure during the Orientation rotation if not already obtained.




Goal R1.1

In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients, including those with multiple comorbidities, high-risk medication regimens, and multiple medications following a consistent patient care process.

OBJ R1.1.7

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

Demonstrate proper use of the Navigators in Epic to document ongoing target drug monitoring

Demonstrate the ability to document a progress/consult note using the proper template/format and including all the necessary documentation points

Select the proper mechanism for documentation based on target audience and need for follow up (sticky note vs Ivent vs progress note)

Goal R1.3

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

OBJ R1.3.1

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

Assess patient chart for drug interactions

Assess patient’s allergies

Demonstrate ability to prepare oral compounds according to Bronson recipes

Demonstrate ability to use tube station and ability to send medications secure if needed

Properly initial and label all patient-specific medications

Question medications during dispensing for appropriateness (medications that seem odd, doses that seem inaccurate, medications that usually come from Pyxis medstations, etc.)

Review and analyze laboratory/diagnostic data as necessary

Understand and apply aseptic technique when compounding sterile preparations

Verify that medications ordered have been approved for use on Bronson formulary

Verify the 5 rights: right patient, right drug, right dose, right route, right time

OBJ R1.3.2

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

Assess active orders for therapeutic duplication and modify orders according to Bronson policy

Assess antibiotics and other qualifying medications for renal dose adjustment

Demonstrate ability to understand IV administration guidelines for appropriateness of IV medications ordered

Evaluate approved drug use criteria for appropriate antibiotic use

Evaluate enoxaparin dosing based on pharmacy guidelines

Institute therapeutic interchanges for medications not carried by Bronson pharmacy and approved by PNT committee for automatic substitution

Order appropriate laboratory draws based on policies and procedures (TPN dosing, heparin dosing, warfarin dosing, etc.)

Understand instances when use of patient’s home medications are appropriate/inappropriate

Understand policy regarding borrowing medication from or sending medication to other organizations and demonstrate procedure for logging transaction

OBJ R1.3.3

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

Check accuracy of medications dispensed, including correct patient identification, medication, dosage form, label, dose, number of doses, expiration dates, and properly repackaged and relabeled medications, including compounded medications (sterile and nonsterile)

Demonstrate ability to ensure all ancillary labeling is present on select medications (double check, hazardous waste, black box warning, etc.)

Effectively prioritize work load and organize work flow Understand which IV medications can/cannot be “pushed” by pharmacy technician and ensure that all medications that cannot are prepared by a pharmacist Utilize EPIC Dispense Prep and Check system in IV room and unit dose (for oral liquids) to verify accurate technician preparation

Verify packaging by pharmacy technician for accuracy prior to adding to inventory





Summative Evaluation

All Preceptors

Each Resident Taking this Learning Experience

Ending and Quarterly if Needed