Staffing Rotation - Bronson Healthcare

Staffing Rotation

Staffing

PGY1 - Pharmacy (43400)

Preceptors: Adrian, Katie

Description:

Preceptor: Katie Adrian, Pharm.D., BCPS, AMU/EMCU Pharmacist: (989) 751-1692 

Email: adriank@bronsonhg.org

Time Requirement:

Residents are required to staff every 4th weekend, every 4th Friday evening, and one holiday (Thanksgiving, New Year's Day, or Memorial Day) to complete a minimum of 360 hours of staffing. Note that the two week Clinical Pharmacy rotation is included in the 360 hours of staffing, also.

If a resident wishes to trade weekends with another resident, the trade must be approved by the Residency Program Director. In addition, if a resident wishes to pick up additional staffing shifts, they must do so in a way that does not violate ASHP guidelines. For example, if a resident wishes to pick up an evening shift and must return in the morning, they must leave early enough to allow for 10 hours to lapse between the time they leave and the time they return. 

General Description:

The staffing rotation is a longitudinal, 12 month experience which is designed to familiarize residents with duties and responsibilities associated with the central inpatient pharmacy. The resident will work closely with other members of the inpatient pharmacy staff to complete tasks related to preparation and dispensing of medications. Additional responsibilities related to the unit dose area as well as the IV room will also be required such as  checking crash carts/EMS bags, verifying packaging, compounding, batch preparation, etc. Residents will also be required to utilize their clinical knowledge to complete order verification and dosing of medications (heparin, warfarin, argatroban, vancomycin, aminoglycosides, total parenteral nutrition, etc.) as well as to perform other clinically-driven tasks including but not limited to: renal dose adjustments, platelet monitoring, I-Vent follow up, vaccine assessments, metformin and IV contrast monitoring, filgrastim and epoetin monitoring, etc.

Summary of Activities and Expectations of Residents:

 

Unit Dose:

 

  • Medication dispensing (patient-specific medications, pyxis fill medications, cart fill medications)
  • Cart/box/bag verification (EMS bags, intubation boxes, crash carts, pediatric transport boxes, narcotic boxes, etc)
  • Medication compounding
  • Preparation of batch products
  • Verification of medication packaging (packager, blister packs, liquid packaging)
  • Verification of barcodes in Kit Check
  • Verification of barcodes in Talyst
  • Verification and logging of narcotic waste
  • Logging narcotic inventory into CII safe
  • 2nd verification of chemotherapy orders/blue cards

IV Room:

  • Proper garbing and handwashing techniques
  • Media fill testing and finger glove testing
  • Sterile product dispensing
  • Utilization of dispensing queue
  • Verification of medication stability (time, base, etc)
  • Verification of single or multiple use vial and proper dating
  • Utilization of proper ancillary labels as indicated
  • Chemotherapy dispensing
  • Inventory of Pyxis
  • Preparation of batch products
  • Verification of TPNs and justification of limits (NICU, pediatric, adult)
  • Verification of TPN additives during compounding by technician
  • Verification of TPN compounder subsequent to technician setting up for the day
  • Verification of Intellifill products (lot and expiration date)
  • Preparation of blue cards and order entry for chemotherapy (including differences between clinic and admission, order entry of pre-medications)
  • Logging of narcotic waste
  • Dispensing and documentation of dialysate
  • Miscellaneous product preparation (methacholine, hydroxyurea)

Clinical (Q Shift):

  • Medication dosing (vancomycin, aminoglycosides, total parenteral nutrition, heparin, argatroban, warfarin, etc)
  • Follow up on and address issues with open I-Vents
  • Assess patients for renal dose adjustments
  • Monitoring of heparin/LMWHs and platelets
  • Filgrastim monitoring
  • Epoetin monitoring
  • Metformin and IV contrast monitoring
  • Vaccine assessments
  • Perform patient education as necessary (warfarin, rivaroxaban, dabigatran, apixaban, enoxaparin, fondaparinux, etc)

Training/Orientation:

Residents will receive training in all three of the aforementioned areas (unit dose, IV room, clinical) during their residency orientation period. The preceptor for the rotation will be responsible for training the residents. A training checklist will be provided to ensure that all responsibilities and duties expected of the resident over the course of the year are addressed during the orientation period.

Residents who are not yet licensed by the Michigan Board of Pharmacy will work alongside the preceptor and complete duties within their scope of practice. Residents will not staff independently until they are licensed in the state of Michigan.

Evaluation Strategy:

Evaluations will occur on a quarterly basis (4 formal evaluations per year) and on an as needed basis based on the needs of the individual resident. Residents will be responsible for self-assessing their abilities and progress along the course of the rotation. Both the resident and the preceptor will complete an identical evaluation. Upon completion, the resident and preceptor will compare their evaluations and address differences in the evaluations on a case-by-case basis.

I-Vent documentation will be utilized to monitor the resident's thought process when verifying orders and they will also be monitored for appropriateness of documentation. Every quarter, the preceptor will select at least three I- Vents documented by the resident in the previous 90 days for the resident to critically self assess. The preceptor will also assess the selected I-Vents independent from the resident. During the quarterly evaluation, the   preceptor and resident will compare their assessments and the preceptor will evaluate the resident's ability to self assess. 

 

In addition to I-Vent documentation and the preceptor's personal experience, the preceptor will ask for comments from several pharmacists and pharmacy technicians that have staffed with the resident to obtain an overall idea     of the resident's progress during the rotation.

Resources (Intranet Policies/Procedures)

  • Bronson Intranet --> Departments --> Pharmacy --> Pharmacy Documents
  • Bronson Intranet --> Manuals --> Bronson Methodist Hospital Manuals --> Pharmacy

Expectation of Residents:

Residents will be expected to complete the following prior to the end of the residency:

  • Complete all required weekend staffing shifts as well as one required holiday shift (minimum 360 hours of staffing)
  • Demonstrate complete competency in three staffing areas (unit dose, IV room, clinical) by demonstrating ability to perform all tasks listed in the General Description above
  • Complete all quarterly evaluations and submit in a timely fashion
  • Perform all staffing duties in a way that demonstrates compliance with Bronson's Standards for Excellence

 

Taught and Evaluated Objectives

Activities

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

Perform and document discharge counseling services if warranted

Perform and document patient education for key medications (warfarin, rivaroxaban, dabigatran, apixaban, enoxaparin, fondaparinux, etc)

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

Assess active medication orders for significant drug interactions

Assess antibiotics and other qualifying medications for renal dose adjustment

Assess patient allergies prior to verification of medications Demonstrate ability to perform nonsterile compounding of various compounded products

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

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)

Question medications during dispensing for appropriateness (medications that seem odd, doses that seem inaccurate, medications that usually come from Pyxis medstations, etc) Review active medication orders for therapeutic duplication Review and analyze laboratory/diagnostic data as necessary Review IV administration guidelines for appropriateness of IV medications

Understand and apply aseptic technique when compounding sterile preparations

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

Understand policy regarding borrowing medication form or sending medication to other organizations and understand procedure for logging transaction

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

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

OBJ R1.3.2

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

Evaluate approved drug use criteria for appropriate antibiotic use

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

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

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

 

OBJ R1.3.3

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

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

Properly initial and label all patient-specific medications, including appropriate ancillary labels (double check, hazardous waste, black box warning, etc.)

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

Understand which IV medications can/cannot be "pushed" by pharmacy technicians

Utilize EPIC Dispense Prep and Check system in IV room and unit dose (for oral liquids) to verify accurate technician preparation

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

Goal R3.1

Demonstrate leadership skills

 

OBJ R3.1.1

(Applying) Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership

Communicate critical lab values called by laboratory services to pharmacist assigned to dosing lab-driven medications (heparin, argatroban, etc.)

Communicate imperative medication-related issues directly to multidisciplinary team (physicians, nurses, dietitians, respiratory therapists, etc.) when warranted

Document all pertinent patient information in the form of I- Vents for subsequent follow-up by decentralized pharmacists Ensure that pharmacy technicians are staying on task and demonstrate ability to redirect them if necessary

OBJ R3.1.2

(Applying) Apply a process of on-going self-evaluation and personal performance improvement

Contribute constructive ideas for process improvement to appropriate personnel if warranted

Demonstrate ability to self assess progress throughout the rotation and take steps toward self improvement when needed

Goal R3.2

Demonstrate management skills

 

OBJ R3.2.4

(Applying) Manages one's own practice effectively

Demonstrate ability to effectively prioritize the workload in central pharmacy

Demonstrate ability to prioritize STAT and first dose orders above other miscellaneous tasks in central pharmacy Utilize learning opportunities fully to maximize personal and professional growth

Evaluations:

Evaluation

Evaluator

Evaluated

Timing

Summative Evaluation

All Preceptors

Each Resident Taking this Learning Experience

Ending and Quarterly if Needed

ASHP Learning Experience Evaluation

Residents

Learning Experience

Ending and Quarterly if Needed

ASHP Preceptor Evaluation

Residents

All Preceptors of this Learning Experience

Ending and Quarterly if Needed

Summative Evaluation

Residents

Each Resident Taking this Learning Experience

Ending and Quarterly if Needed