Residency
Medication Safety Rotation
Preceptor:
Carolyn Kowalchik, RPh, MS
Shantel Mullin, PharmD, BCPS
Jennifer Grover, PharmD, MPH
Site Description:
The University of Utah Hospitals & Clinics encompasses four hospitals, 14 retail pharmacies, and a multitude of clinics throughout the Salt Lake Valley. The primary site for this rotation is the University Hospital and the clinics contained in the main hospital building. This hospital is a 430 bed, level 3 trauma center. The majority of patients are adults, though we also serve newborns, very-low birth weight neonates in an ICU, and pediatric patients in the burn unit. The pharmacy serves all locations in the hospital 24 hours a day with a USP 797-compliant IV center, CPOE order verification, and Automed scanning and dispensing. Clinical pharmacy services are provided to all hospitalized patients for a minimum of 8 hours per day with expanded hours for newborn ICU and the emergency department.
Rotation Description:
This rotation is a reading, discussion, committee and project-based rotation. The resident will have opportunities to develop their understanding of medication safety issues in hospitals and clinics. Audits and projects will help the resident have a more clear understanding of their role in medication and patient safety in the health system.
RLS Goals:
R1.1 Identify opportunities for improvement of the organization's medication-use system.
- Explain the organization's medication-use system and its vulnerabilities to adverse drug events (ADEs).
- Analyze the structure and process and measure outcomes of the medication-use system.
- Identify opportunities for improvement in the organization's medication-use system by comparing the medication-use system to relevant best practices.
R1.2 Design and implement quality improvement changes to the organization's medication-use system.
- Participate in the identification of need for, development of, implementation of, and evaluation of an evidence-based treatment guideline/protocol related to individual and population-based patient care.
- Design and implement pilot interventions to change problematic or potentially problematic aspects of the medication-use system with the objective of improving quality.
- Explain the process for developing, implementing, and maintaining a formulary system.
- Make a medication-use policy recommendation based on a comparative review (e.g., drug class review, drug monograph).
R1.4 Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system.
- Display initiative in preventing, identifying, and resolving pharmacy-related patient-care problems.
R6.1 Use information technology to make decisions and reduce error.
- Explain security and patient protections such as access control, data security, data encryption, HIPAA privacy regulations, as well as ethical and legal issues related to the use of information technology in pharmacy practice.
- Exercise skill in basic use of databases and data analysis software.
- Successfully make decisions using electronic data and information from internal information databases, external online databases, and the Internet.
Activities Evaluated:
| Rotation Activity | RLS Goal | Teaching Methods |
| Attend ADR Committee and report on pharmacist involvement in PSN reporting & describe what can be done to prevent ADRs listed as "preventable". | R1.1 | M, F |
| Complete a project related to process improvement as identified by either the preceptor or the resident. Examples may be related to Joint Commission recommendations, observations made by the resident on other rotations, or review of the required readings. | R1.2, R6.1 | C, M, F |
| Complete a vaccine audit using the standardized tools available, and then develop a tool for one other process audit. These audits will be described graphically and verbally on a poster in the pharmacy department. | R6.1, R 1.2 | C, F |
| Attend Medication Safety Committee and present the quarterly update from ISMP after performing a gap analysis for our institution. The resident will also take minutes and develop the agenda for the monthly Med Safety Multidisciplinary meeting. | R1.1, R1.4 | C, F |
| Select one pharmacy process to observe over a period of times and then write a brief evaluation of when or how errors could occur with the process. This is presented with a flow-chart to the Inpatient Management Team. | R1.1 | C, M, F |
| The resident will spend at least 2 days working with the UUHC Quality and Patient Safety Office on CMS or other benchmarking measures. | R1.1 | C, M, F |
| Select one NPSG or JC-MM standard to evaluate for our institution. The results will be presented orally to the Inpatient Management Team. | R1.1, R1.2 | C, M, F |
Readings and Preparatory Work:
Joint Commission Medication Management Standards (JC-MM)
National Patient Safety Goals (NPSG)
Selected sections of To Err is Human
Selected chapters of Medication Safety: A Guide for Health Care Facilities
Selected sections of ASHP Best Practices http://www.ashp.org/bestpractices
Project/Presentation Description:
See activities list above.
Typical Daily/Weekly/Monthly Activities:
Monday: Meet with preceptor of the week to discuss projects at 8:30AM. The resident will meet with the hospital management team each Monday at 9:30AM.
Monday-Friday: The resident will then have time to read, plan projects, and execute the projects during the week. They will receive a list of meetings to attend at the beginning of the rotation.
Fridays at 3:30PM: The resident will summarize the work completed that week, review partial and final documents, discuss related topics or readings, plan projects for the coming week, and discuss progress and evaluations.
Evaluation:
The resident will receive feedback through verbal discussions and evaluation of knowledge, skills and abilities. The resident will receive written edits on their written projects (formative), verbal feedback on their participation in committees and progress on projects (formative), and a midpoint and final evaluation that will be done in person and then recorded in ResiTrak.
