Staffing Rotation - Bronson Healthcare

Staffing Rotation

Staffing

PGY1 - Pharmacy (43400)

Faculty: Katie Adrian

Site: Bronson Methodist Hospital

Status: Active Required

Description:

Preceptor: Katie Adrian, Pharm.D., BCPS, adriank@bronsonhg.org

Time Requirement:

Residents are required to staff every 4th weekend and every 4th Friday evening (offset by two weeks, not back to back) 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 duty hour 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 pharmacist is responsible for ensuring safe and effective medication use. Routine responsibilities include: order verification, checking EMS bags, verifying packaging, compounding, and batch preparation. The resident will work closely with other members of the inpatient pharmacy staff to complete the above tasks. Additional responsibilities related to the unit dose area as well as the IV room will also be required such as completing consults, checking chemotherapy, and answering drug information questions. 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, discharge medication reconcilation review, filgrastim and epoetin monitoring, etc. Residents will be expected to increase their independence level each quarter, and should be staffing independently midway through the second quarter.

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, 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

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 robot products (lot and expiration date)
  • Preparation of chemotherapy (including differences between clinic and admission, order entry of premedications)
  • Logging of narcotic waste
  • Dispensing and documentation of dialysate
  • Miscellaneous product preparation (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
  • Discharge medication reconcilation review
  • Antibiotic review
  • Vaccine assessments
  • Perform patient education as necessary (warfarin, rivaroxaban, dabigatran, apixaban, enoxaparin, fondaparinux, etc)

Expected progression of the resident:

Length of time the resident spends in each of the phases will be personalized based upon the resident's abilities. Typical progression is as follows.

Quarter 1: Residents will be expected to perform all the required staffing tasks with oversight from their supervising pharmacist. Residents should be practicing order verification and all the other central pharmacy tasks, with independence level depending on licensure status.

Quarter 2: Residents should be fully licensed and will begin staffing independently, but it is expected they will still have questions on some routine tasks. The resident's comfort level and competence will be assessed each quarter to determine if additional exposure to a specific area is warranted.

Quarter 3: Resident should be staffing independently, with limited questions on routine tasks. The resident's comfort level and competence will continue to be assessed to determine if additional exposure to a specific area is warrented.

Quarter 4: The resident should be able to fully function as a pharmacist in all staffing roles by the end of Quarter 4.

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 coordinating the training of 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 maintain a Michigan intern license and work with direct supervision by a pharmacist when performing any pharmacist duties in order to remain within their scope of practice. Residents will not staff independently until they are fully 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 IVents 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 Learners:

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

  • Complete all required 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 comorbidities, high-risk medication regimens, and multiple medications following a consistent patient care process process

 

OBJ R1.1.7

(Cognitive - 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

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

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

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

Apply aseptic technique when compounding sterile preparations

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

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

Review active medication orders for therapeutic duplication

Review and analyze laboratory/diagnostic data as necessary

Review IV administration guidelines for appropriateness of IV medications

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

OBJ R1.3.2

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

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

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

 

OBJ R1.3.3

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

Demonstrate ability to differentiate which IV medications can/cannot be "pushed" by pharmacy technicians

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)

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

(Cognitive - 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 Demonstrate ability to direct pharmacy technicians when necessary

Document all pertinent patient information in the form of I-Vents for subsequent follow-up by decentralized pharmacists

OBJ R3.1.2

(Cognitive - 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

(Cognitive - 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:

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

Summative Evaluation

Residents

Each Resident Taking this Learning Experience

Ending and Quarterly if Needed

Summative Evaluation

Residents

Each Resident Taking this Learning Experience

25.00%

Summative Evaluation

Residents

Each Resident Taking this Learning Experience

50.00%

Summative Evaluation

Residents

Each Resident Taking this Learning Experience

75.00%