Orientation/Pharmacokinetics - Bronson Healthcare

Orientation/Pharmacokinetics

Orientation and Introduction to Pharmacokinetics/Anticoagulation Services Rotation

Preceptors: Katie Adrian (adriank@bronsonhg.org)

General Description:

This six-week rotation is designed to orient the resident to Bronson Methodist Hospital and the Department of Pharmacy. The first two days of orientation will be spent at general Bronson Methodist Hospital Orientation. During the remainder of 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.

Expectations of Residents:

The resident will be trained to verify orders, check medications, check medication carts, and to compound total parenteral nutrition (TPN) formulas, IV admixtures, and chemotherapy. The resident will also be trained to perform monitoring and dosing of various medications including aminoglycosides, vancomycin, heparin, and warfarin according to BMH policy.

The resident will be exposed to the Residency Learning System and the Residency Advisory Committee, and will complete the ASHP Entering Interests Form and Entering Objective-Based Self-Evaluation to help the residency program director (RPD) and preceptors, along with the resident, begin to develop an individualized Development Plan. The resident will also choose a committee within the hospital upon which they will serve throughout the residency year. The resident will also be required to complete all computerized and written hospital and departmental competencies required for employment as well as an End User Practical Assessment (EUPA) for the Epic EMR.

During the orientation period, the resident will be given ideas for a residency research project and encouraged to offer additional/alternative project ideas. Residents should also be actively pursuing pharmacist and controlled substance licensure in the State of Michigan if not already complete.

Activities Overview

Refer to the Pharmacy Resident Orientation Checklist (found on the H: Drive within the Orientation Information.Forms folder within the Residency Learning System folder) 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: Hospital orientation, Pharmacy Department orientation including overview of the general schedule for orientation, and Residency orientation including an overview of the residency manual. Begin working on competencies.

Week 2: Epic training. Continue department/residency orientation and working on competencies. Attend various required meetings.

Week 3: Continue department/residency orientation. Continue practicing in Epic, complete EUPA. Complete competencies. Begin training in central pharmacy. Attend various required meetings.

Week 4-5: Continue training in central pharmacy. Attend various required meetings.

Week 6: Exposure to specialty areas (Peds, NICU, MICU)

Objectives to be TAUGHT and FORMALLY EVALUATED

Goals and Objectives

Activities to Facilitate Professional Growth

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 co-morbidities, high-risk medication regimens, and multiple medications following a consistent patient care process.

OBJ R1.1.7

(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
  • Select the proper mechanism for documentation based on target audience and need for follow up (sticky notes vs Ivent vs progress note)
  • Demonstrate the ability to document a progress/consult note using the proper template/format and including all the necessary documentation points

Goal R1.3

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

OBJ R1.3.1

(Applying) Prepare and dispense medications following best practices and the organization’s policies and procedures.
  • Verify the 5 rights: right patient, right drug, right dose, right route, right time
  • Verify that medications ordered have been approved for use on Bronson formulary
  • Review and analyze laboratory/diagnostic data as necessary
  • Review active medication orders for therapeutic duplication
  • Assess patient’s allergies
  • Assess patient chart for drug interactions
  • Question medications during dispensing for appropriateness (medications that seem odd, doses that seem inaccurate, medications that usually come from Pyxis medstations, etc.)
  • Understand and apply aseptic technique when compounding sterile preparations
  • Understand which IV medications can/cannot be “pushed” by pharmacy technician and ensure that all medications that cannot are prepared by a pharmacist
  • Demonstrate ability to prepare oral compounds according to Bronson recipes
  • Properly initial and label all patient-specific medications
  • Ensure all ancillary labeling is present on select medications (double check, hazardous waste, black box warning, etc.)
  • Demonstrate ability to use tube station and ability to send medications secure if needed

OBJ R1.3.2

(Applying) Manage aspects of the medication-use process related to formulary management.
  • Assess antibiotics and other qualifying medications for renal dose adjustment
  • Evaluate enoxaparin dosing based on pharmacy guidelines
  • Review IV administration guidelines for appropriateness of IV medications ordered
  • Assess active orders for therapeutic duplication and modify orders according to Bronson policy
  • 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.)
  • Evaluate approved drug use criteria for appropriate antibiotic use
  • 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

(Applying) Manage aspects of the medication-use process related to oversight of dispensing.
  • Effectively prioritize work load and organize work flow
  • 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)
  • Verify packaging by pharmacy technician for accuracy prior to adding to inventory
  • Utilize EPIC Dispense Prep and Check system in IV room and unit dose (for oral liquids) to verify accurate technician preparation

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.