That dreaded “PC”: Keeping your Residency Program Healthy

1. That dreaded “PC”: Keeping your Residency Program Healthy Mark Sinnett, PharmD, FASHP Director, Clinical and Educational Services Montefiore Medical Center Bronx, New York

2. Principles of PGY1 Pharmacy Residencies Principle 1: The resident will be a pharmacist committed to attaining professional competence beyond entry-level practice. Principle 2: The pharmacy residency program will provide an exemplary environment conducive to resident learning. Principle 3: The resident will be committed to attaining the program’s educational goals and objectives and will support the organization’s mission and values. Principle 4: The resident’s training will be designed, conducted, and evaluated using a systems-based approach. Principle 5: The residency program director (RPD) and preceptors will be professionally and educationally qualified pharmacists who are committed to providing effective training of residents. Principle 6: The organization conducting the residency will meet accreditation standards, regulatory requirements, and other nationally applicable standards and will have sufficient resources to achieve the purposes of the residency program. Principle 7: The pharmacy will be organized effectively and will deliver comprehensive, safe, and effective services.

4. Montefiore Medical Center Bronx, New York

5. Montefiore Medical CenterThe University Hospital of the Albert Einstein College of Medicine ■ 4 Hospitals ~ 1400 beds ●Moses, Weiler and North Divisions ● Children’s Hospital at Montefiore (CHAM) ■~ 160 Primary care and specialty clinics ■~ 35 Ambulatory sites ■~ 1450 House staff ■~ 800 Medical students ■~ 2000-3000 Attending physicians (50% full time/50%, voluntary) ■Care Management Company ■ Emerging Health Information Technology (EHIT)

6. Montefiore Medical Center • Computerized Physician Order Entry • 50% decrease in prescribing errors • JCAHO National Patient Safety Goals • Unapproved abbreviations, LASA, maximum dosing protocols, allergy hard stops, etc • Control of non-formulary medication use • Bar coding at bedside • Department of Pharmacy • Ambulatory Care: Script-Pro, QS-1 • Pyxis point of use technology (Profile) • USP 797 clean rooms

7. Montefiore Medical Center – Department of Pharmacy Mission -Dedicated to Pharmaceutical Care focused on achieving positive patient outcomes through drug therapy. Pharmacy staff 65 staff pharmacists, 58 pharmacy specialists (technicians) 29 pharmacist managers including 6 executive managers, 9 supervisors, 14 clinical pharmacy specialists Affiliations with Long Island and St. John’s Universities, Touro College PGY1 Pharmacy Residency Implemented 1968, accredited 1975 > 100 residents completed program Currently over 14 learning experiences Managed administratively through Medical House Staff

8. Why do a residency? Outcome R1: Manage and improve the medication – use process. Outcome R2: Provide evidence-based, patient- centered medication therapy management withinterdisciplinary teams. Outcome R3: Exercise leadership and practice management skills. Outcome R4: Demonstrate project management skills. Outcome R5: Provide medication and practice-related education/training. Outcome R6: Utilize medical informatics . .

9. “Beware the Standard” Policies concerning professional, family and sick leave Customization of the residency program Self-evaluations Preceptor development Preceptor’s commitment to pharmacy practice Safe medication dispensing systems

10. Preceptor Commitment to Pharmacy 7.8 The pharmacy has personnel, facilities, and other resources to carry out a broad scope of pharmacy services (as applicable to the practice setting). Automated medication systems and software support a safe medication-use system. Computerized systems support a safe medication-use system.

11. Policies concerning professional, family, and sick leaves 2.7. Policies concerning professional, family, and sick leaves and the effect such leaves would have on the resident’s ability to complete the residency program are documented. • ●Discuss during interview • ●List or refer to in acceptance letter • ●Document in residency manual

12. Self-evaluation 4.1e.(2)(a, b) Regarding resident self-evaluations: (a) Each preceptor provides periodic opportunities for the resident to practice and document criteria-based, formative self-evaluation of aspects of their routine performance. (b) Each preceptor provides an opportunity for the resident to document a criteria-based, summative self-assessment of achievement of the educational goals and objectives assigned to the learning experience, completed on the same schedule as required of the preceptor by the assessment strategy. • ● Resident has to know that they know it • (or don’t know it) • ● Development of the resident’s confidence

13. Who are they?

14. Customized plans for the Resident 4.2b.(1) The RPD and, when applicable, preceptors customize the training program for the resident based upon an assessment of the resident’s entering knowledge, skills, attitudes, and abilities and the resident’s interests including accounting for discrepancies in assumed entering capabilities. • ●Strength of a residency lies mainly in the preceptors • ● Evaluate and document strengths and weakness: •  throughout the learning experience •  during quarterly assessments and the RAC •  be bothverbal and written •  be honest…..frequently

15. Preceptor Development 4.3c.RPD utilizes a plan for improving the quality of preceptor instruction based on an assessment of residents’ written evaluations of preceptor performance and other sources. Myth: A clinical specialist = residency preceptor

16. Clinical Practitioner Facilitating Coaching Modeling Instruction Resident

17. Preceptor Development • 4.3c.RPD utilizes a plan for improving the quality of preceptor instruction based on an assessment of residents’ written evaluations of preceptor performance and other sources • ● Development of a preceptor: •  RLS training •  Resident evaluations? •  Schools of Pharmacy •  Residency Program Director, e.g., Residency “Pearls” •  Preceptor self evaluation

18. Preceptor Commitment to Pharmacy 5.9 Each preceptor has a record of contribution and commitment to pharmacy practice characterized by a minimum of four of the following. Record of improvements in and contributions to the respective area of advanced pharmacy practice. Appointments to appropriate drug policy and other committees of the department/organization. Formal recognition by peers as a model. A sustained record of contributing to the total body of knowledge in pharmacy practice through publications in professional journals and/or presentations at professional meetings. Serves regularly as a reviewer of contributed papers or manuscripts submitted for publication .Demonstrated leadership in advancing the profession of pharmacy through active participation in professional organizations at the local, state, and national levels. Demonstrated effectiveness in teaching.

19. Purpose of a Residency Outcome R1: Manage and improve the medication – use process. Outcome R2: Provide evidence-based, patient- centered medication therapy management withinterdisciplinary teams. Outcome R3: Exercise leadership and practice management skills. Outcome R4: Demonstrate project management skills. Outcome R5: Provide medication and practice-related education/training. Outcome R6: Utilize medical informatics . .

20. Vision for pharmacists’ responsibilities “Pharmacists will apply their time to direct, interdisciplinary patient care to ensure the best use of medicines by individual patients” • Reviewing individual patients’ medication orders for safety and effectiveness and taking corrective action as indicated. • Collaboratively managing medication therapy for individual patients. • Educating patients and caregivers about medications and their use. • Leading continuous improvements in the medication-use process. • Leading the interdisciplinary and collaborative development of medication-use policies and procedures. • Preparing medications in the doses and dosage forms needed. • Distribution of medications to inpatients and outpatients. AJHP 2007; 64:1320-30

21. Vision for leadership • “Strong leadership will be required to provide and sustain comprehensive professional vision for pharmacy departments” • Lead·er \lē-dər\ Function: noun 1: something that leads: as a: a primary or terminal shoot of a plant cplural :(1): something for guiding fish into a trap b: 1: a person who leads: a (1): a person who directs a military force or unit (2): a person who has commanding authority or influence AJHP 2007; 64:1320-30

22. Concluding thoughts… There are over > 160 standards for a PGY1 residency ASHP considers residency accreditation as ongoing quality improvement Programs are surveyed against an optimal standard ASHP Long-Range Vision for the Pharmacy Work Force in Hospitals and Health Systems

23. ASHP Long-Range Vision for the Pharmacy Work Force in Hospitals and HealthSystems Am J Health-Syst Pharm. 2007; 64:1320-30

24. Change: It’s HERE! Even those who fancy themselves the most progressive will fight against other kinds of progress, for each of us is convinced that our way is the best way. - Louis L'Amour (1908-1988) The Lonely Men We must become the change we want to see. - Mahatma Gandhi –Indian Philosopher (1869-1948)