Residency

PGY1 Orientation Rotation

Preceptors

Shantel Mullin, PharmD, BCPS - Coordinating Preceptor
All Operational and Decentralized Clinical Pharmacists
Policy, Process, and Technology Expert Pharmacists and Technicians from across Pharmacy Services

Site Description:

The University of Utah Hospital is a level I trauma center that serves critical and acute care patients in 425 beds, and is a referral hospital for a 5-state region. Over 100 FTEs of pharmacy staff serve the patients of University Hospital, and the residents are a part of patient care and multi-disciplinary teams. The Huntsman Cancer Institute also serves patients with 50 inpatient beds, an infusion center, and several clinics. Clinics at the hospital and surrounding communities serve patients with pharmacy care both through retail pharmacies, MTM services, thrombosis services, and clinic-based services. The University Health Care system also includes a Drug Information Service.

Rotation Description:

Residents will learn the basics of University Health Care's pharmacy system, medication and departmental policies and procedures, and skills needed to serve as a clinical pharmacist during rotations and during staffing requirements during residency. Training focuses on organizational and department structure, workflow, resident and pharmacist responsibilities and requirements, and appropriately using technology for patient care, research, and other residency requirements.

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.

R1.3 Prepare and dispense medications following existing standards of practice and the organization's policies and procedures.

Interpret the appropriateness of a medication order before preparing or permitting the distribution of the first dose.
Follow the organization's policies and procedures to maintain the accuracy of the patient's medication profile.
Prepare medication using appropriate techniques and following the organization's policies and procedures.
Dispense medication products following the organization's policies and procedures.

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.

R2.4 Collect and analyze patient information.

Collect and organize all patient-specific information needed by the pharmacist to prevent, detect, and resolve medication-related problems and to make appropriate evidence-based, patient-centered medication therapy recommendations as part of the interdisciplinary team.
Determine the presence of any of the following medication therapy problems in a patient's current medication therapy: (1) Medication used with no medical indication; (2) Patient has medical conditions for which there is no medication prescribed; (3) Medication prescribed inappropriately for a particular medical condition; (4) Immunization regimen is incomplete; (5) Current medication therapy regimen contains something inappropriate (dose, dosage form, duration, schedule, route of administration, method of administration); (6) There is therapeutic duplication; (7) Medication to which the patient is allergic has been prescribed; (8) There are adverse drug or device-related events or potential for such events; (9) There are clinically significant drug-drug, drug-disease, drug-nutrient, or drug-laboratory test interactions or potential for such interactions; (10) Medical therapy has been interfered with by social, recreational, nonprescription, or nontraditional drug use by the patient or others; (11) Patient not receiving full benefit of prescribed medication therapy; (12) There are problems arising from the financial impact of medication therapy on the patient; (13) Patient lacks understanding of medication therapy; (14) Patient not adhering to medication regimen.
Using an organized collection of patient-specific information, summarize patients' health care needs.

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.

E7.5 Make effective use of available software and information systems.

Successfully search, retrieve, and manage electronic data from internal information databases, external online databases, and the Internet.
Exercise skill in the use of the organization's word-processing, spreadsheet, and presentation software.
Explain how an effectively functioning organizational information system is structured.

Activities Evaluated:

Rotation Activity	RLS Goal	Teaching Method
This part of resident training includes both general hospital orientation to safety and HIPAA training in addition to pharmacy-specific department training and testing. The resident learns CPOE, PharmNet verification and order entry, PowerChart, Omnicell, D-21 med checks, etc. in centralized and decentralized locations. Central operations training, IVC overview, NBICU pearls, patient care documentation, Med Reconciliation, policy and procedure overviews, scavenger hunts, etc.	R1.3, 6.1, E7.5	Instruction, Modeling, Coaching and Facilitation
Residents practice ADR and ADE reporting in the Patient Safety Net System. Residents review all MUE and guidelines for the hospital and discuss differences between the U and other organizations where they have worked or rotated. The residents participate in data collection around CMS core measures including pneumonia vaccine screening and documentation compliance.	R1.1	Instruction, Modeling, Coaching and Facilitation
Centralized and Decentralized Clinical Practice Training, Medication Reconciliation, Vaccine Screening process, Systems training, Therapeutic Plan development (PHARME), Efficiency training and practice, Staffing shift training, etc. Each resident will turn in samples of documentation, patient work-ups, and pass quizzes on staffing requirements.	R1.4, R2.4	Instruction, Modeling, Coaching and Facilitation
Customized training plan development, project planning, presentation planning, etc. occur during orientation. Residents will turn in documents that demonstrate the ability to use Microsoft Word, PowerPoint, Outlook and Excel during orientation.	E7.5	Instruction & Facilitation

Readings and Preparatory Work:

Residents will read the hospital and pharmacy department orientation manuals and checklists. Readings will be provided for specific in services such as the overview of infectious disease and pharmacodynamics with Don Alexander prior to the day of training by email. The residents will be asked to read articles for journal club, literature evaluation, and other activities. They will also determine their Meyers-Briggs and Color Code preferences.

Typical Daily/Weekly/Monthly Activities:

The orientation and training schedule will be Monday through Friday for the first 4 weeks of residency for the PGY1 resident. Days will start at 8 AM for classes and 7 AM for Clinical Practice training days. The first 2 weeks will largely be classes in the pharmacy conference room related to policies, procedures, staff expectations, technologies, resident expectations, meeting staff, etc. Some days will be spent in the computer training lab and in the residents' office. The clinical practice training days will occur in the second 2 weeks either in the central operations/order-verification area of the Hospital and on decentralized units/pharmacy satellites. Residents will be paired with a pharmacist expert/trainer for their training shifts. The residents will also train in a decentralized location on a weekend (2 day shifts), and at least 2 other weekend or swing shifts of their choice. Day shifts begin at 7 AM and swing shifts begin at 3 PM.

Evaluation Process:

The resident will receive oral feedback from preceptors as they learn each new skill or task. The resident will keep a portfolio of their training progress to turn in to the orientation coordinator weekly. The training manual contains check sheets for each centralized or decentralized preceptor to sign when the resident demonstrates the skills necessary to work in the assigned area. The resident will have a final summative evaluation after their training shifts are over and they have worked at least one regular staffing shift on their own. This summative evaluation will be face-to-face and include comments from pharmacists who have worked most with the resident. It will be recorded in ResiTrak.