Post Graduate Year Two (PGY2) Pharmacy Informatics · 4 | P a g e Purpose and Philosophy Purpose...

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Post Graduate Year Two (PGY2) Pharmacy Informatics

2014-2015

Residency Manual

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Table of Contents

Table of Contents Purpose and Philosophy................................................................................................................................ 4

Organizational Structure ............................................................................................................................... 5

Program Outcomes, Goals, and Objectives .................................................................................................. 6

Structure of Residency Experiences .............................................................................................................. 8

Benefits ......................................................................................................................................................... 9

Health, Disability, and Professional Benefits ............................................................................................ 9

Educational Benefits ................................................................................................................................. 9

Other Benefits ........................................................................................................................................... 9

Paid Time Off (PTO) ................................................................................................................................... 9

Expectations of the Resident ...................................................................................................................... 11

Licensure Verification ............................................................................................................................. 11

Professionalism ....................................................................................................................................... 11

Duty Hours .............................................................................................................................................. 11

Overtime/ Moonlighting ......................................................................................................................... 12

Departmental Policies Applicable to Pharmacy Residents ......................................................................... 12

Residency Activities and Requirements ...................................................................................................... 13

Evaluation Process and Requirements........................................................................................................ 19

Evaluations .............................................................................................................................................. 19

Documentation ....................................................................................................................................... 20

Requirement for Receiving a Certificate ..................................................................................................... 22

Appendices .................................................................................................................................................. 25

Appendix A: Orientation Checklist .......................................................................................................... 26

Appendix B: Evaluation Schedule 2014-2015 ......................................................................................... 29

Appendix C: Tracking Form ..................................................................................................................... 30

Appendix D: Requirement Timeline ........................................................................................................ 32

Appendix E: Learning Experiences .......................................................................................................... 33

Staffing Learning Experience............................................................................................................... 36

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Orientation…………………………………………………………………………………………………………………………………..40

Clinical Pharmacy Systems……………………………………………………………………………………………………………42

Clinical Systems…………………………………………………………………………………………………………………………….45

Clinical Rotation……………………………………………………………………………………………………………………………47

Clinical Decision Support………………………………………………………………………………………………………………50

Data Management……………………………………………………………………………………………………………………….53

Clinical Decision Support II…………………………………………………………………………………………………………..56

Medication Safety………………………………………………………………………………………………………………………..61

Technical Concepts……………………………………………………………………………………………………………………...64

EHR & Vendor Relations……………………………………………………………………………………………………………….68

Ambulatory Care………………………………………………………………………………………………………………………....71

Therapeutic Exchange Learning Experience………………………………………………………………………………...74

Appendix F: PTO Request Procedures .................................................................................................... 75

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Purpose and Philosophy

Purpose The purpose of a PGY2 pharmacy informatics residency is to prepare the pharmacist for practice in a pharmacy informatics position. Residency training is designed to provide the resident experience in applying informatics and technology to enhance care of the patient and support healthcare professionals. This is accomplished by staffing responsibilities, clinical rotations (if desirable) and working with a broad range of medication systems, health care professionals, and vendors. Residency training also offers other advantages:

• A competitive advantage in the job market – More and more employers recognize the value of residency training. A pharmacist who has completed a residency will have a clear advantage over applicants who have not.

• Networking opportunities – Many opportunities arise for residents to establish or expand their network of professional acquaintances and contacts including preceptors and other residents, especially in the informatics specialty area.

• Career planning – During the course of training, most residents gain a clearer understanding of the specific informatics setting which best suits him or her. Residency preceptors are committed to providing personal attention to assist each resident in further defining professional goals.

• Professional vision – Many programs also offer the opportunity to see how pharmacy is practiced in different parts of the country, by arranging for residents to visit other residency programs or by allowing residents to complete a portion of the residency at another site (for example, vendor rotation opportunity or didactic teaching or precepting opportunities if available).

Philosophy The ASHP accreditation standard provides criteria that every program must meet in order to receive and maintain accreditation. This program follows the ASHP - approved PGY2 Informatics Residency Outcomes, Goals, and Objectives. Beginning in December 2007, the requirement for this residency program was altered to be consistent with ASHP to solely consider candidates who have successfully completed a PGY1 residency. While this program follows ASHP standards, a strength of this program is the flexibility to tailor the program to meet the informatics needs and interests of each individual resident. The mission of our program includes developing a core skill set in pharmacy informatics and fully understanding the intersection of technology, patient care and professional practice. The program also offers a unique opportunity to work closely with the primary vendor of the institution to learn about the vendor perspective.

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Organizational Structure

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Program Outcomes, Goals, and Objectives

The residency program will provide each resident with specific learning experiences designed to enable

the resident to expand the scope of his/her practice skills.

Required Goals

R1.1 Demonstrate understanding of basic pharmacy informatics principles, standards and

best practices.

R1.2 Evaluate opportunities for improving patient outcomes by improving the safety and

quality of the medication- use system through the application of informatics principles,

standards, and best practices.

R1.3 Evaluate opportunities for improving operational efficiencies in order to better serve

patient and health professional needs through the application of informatics principles,

standards, and best practices.

R2.1 Evaluate the validity of information and knowledge in the organization’s technology

and automation systems.

R2.2 Assure that all patient-specific, medication-specific, and evidence-based

pharmacotherapy information required to support effective medication-related

decisions is readily available in a useful format to members of interdisciplinary, patient-

centered teams.

R3.1 Assure the accurate and efficient flow of data between the organization’s technology

and automation systems.

R3.2 Support efforts to assure the interoperability of technology and automation systems

that interface with those of outside organizations.

R3.3 Guard the confidentiality and security of health data stored in the health care

organization’s database.

R3.4 Demonstrate additional competencies that contribute to working successfully in the

health care environment.

R4.1 Demonstrate additional competencies that contribute to working successfully in the

health care environment (additional)

R4.2 Demonstrate a working knowledge of currently available automated technology for order processing.

R4.3 Demonstrate a working knowledge of currently available automated devices for the safe and efficient distribution and dispensing of medications.

R4.4 Demonstrate a working knowledge of currently available technology or automation for the safe and efficient administration of medications.

R4.5 Demonstrate a working knowledge of currently available automated technology for documenting medication administration.

R4.6 Demonstrate a working knowledge of currently available electronic surveillance systems for effects monitoring.

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R4.7 Demonstrate a working knowledge of currently available pharmacy inventory management systems.

R4.8 Demonstrate a working knowledge of emerging technology and automation systems that assist with the medication-use system.

R4.9 Contribute to resolution of identified operational problems.

R5.1 Contribute to planning for acquisition and implementation of significant technology or automation initiatives involving the pharmacy department.

R5.2 Participate in the implementation of a technology or automation system.

R5.3 Participate in contingency planning.

R5.4 Report the findings of a technology or automation system project.

R6.1 Demonstrate the personal skills and abilities of a pharmacy informatics leader.

R6.2 Represent the pharmacy informatics perspective in interactions with the information technology staff, other health care staff, and/ or technology and automation vendors.

R6.3 Demonstrate the technical skills essential to the role of a pharmacy informaticist.

R6.4 Represent pharmacy informatics concerns in strategic planning for the implementation, use, and maintenance of technology and automation systems.

E1.1 Design, execute, and report results of investigations of pharmacy informatics-related issues.

E2.1 Serve as an expert resource for the management of a specific technology or automation system.

E3.1 Understand faculty roles and responsibilities. (optional)

E3.2 Exercise teaching skills essential to pharmacy faculty. (optional)

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Structure of Residency Experiences Orientation (4 weeks) Core Rotations (4 weeks) Transitional Elective Rotations

1. Medical Center

Orientation

2. Residency/RLS

3. Computer Training

4. Hospital Practice

/Central Pharmacy

& Satellites

5. Staffing Orientation

1. Clinical Pharmacy Systems Management (CPOE, Pharmacy System, Documentation System, Automated Dispensing Devices)

2. Clinical Decision Support

3. Clinical Rotation

4. Data Management & Smart Pumps

5. Medication Safety

6. Technical Concepts

7. Clinical Systems

1. ASHP

Midyear

2. Residency

Project

1. System Alerts

2. Outpt Pharmacy Automation & e-Prescribing

3. Web based pharmacy application

4. Med Carousel Technology 5. Pharmacy Interventions

6. Evidence Based Medicine/Order Sets

7. Medication Safety II

8. Clinical Decision Supt II

9. EHR /Vendor Relations

Longitudinal

Topic &/or Case Presentation (2)

Assistance with PGY1 MUE projects

Newsletter Fast Fact (1) optional

Hospital Pharmacy Practice (staffing)

Residency Project (1)

Therapeutic Exchange (1 CE) or equivalent

Residency Project Presentation

Automation Project

Project Management

*Elective Clinical Rotations Available:

Solid Organ Transplant

Bone Marrow Transplant

Infectious Disease

General Pediatrics

ICU Pediatrics

NICU Pediatrics

BMT/Onc Pediatrics

Nutrition

Critical Care

Medicine

Trauma

Burn

Surgical

Geriatrics

Coumadin Clinic

HIV/AIDS

Cardiology

*At the request of resident to gain experience in a particular clinical area. No more than one 4 week rotation is

recommended, however, exceptions may be made. Ideally, informatics will be incorporated into the clinical rotation when

possible.

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Benefits

Please refer to the Human Resources Page on the Vanderbilt University Website for more information:

http://hr.vanderbilt.edu/benefits/benefitspackage.php

Health, Disability, and Professional Benefits Health care plan options, including an HMO plan

Paid time off (PTO) including 7 paid Holidays (please see page 10 for more information regarding PTO during residency)

Short Term Disability

Life insurance

Professional liability insurance supplied by the Medical Center

Immunizations and all other health related costs required by the Medical Center

Employee Wellness Program

Educational Benefits Full access to the Biomedical Library

Financial support and professional leave for the ASHP Midyear Meeting and the annual Southeastern Residency Conference.

Other Benefits Travel and relocation expenses directly related to moving to Nashville (moving company, truck

rental, fuel, hotel)—up to $1500

Payment of Tennessee Board of Pharmacy license fee in June—license fee and professional tax

NAPLEX transfer fees

Photocopying directly related to residency

Office space & computer work station

Employee Assistance Program

ACPE approved continuing education provided by the Department of Pharmaceutical Services

Discounts at local merchants

Paid Time Off (PTO) 29 Days of PTO (paid time off) will be granted on the first day of the residency program

PTO is used for vacation, holidays, sick days, and interview days if needed

Due to the rigorous, educational nature of the residency training program, it is expected that

residents minimize the use of PTO days (suggest that residents use 10-15 days of the 29 day PTO

allotment throughout the year).

If you are not working the holiday, you are encouraged to use a week of your PTO for the

holiday that you are off.

http://hr.vanderbilt.edu/benefits/benefitspackage.php

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Vacation may not be taken during ASHP Midyear Meeting or SERC meeting days, or scheduled

holidays/weekends in the staffing component of the residency. Vacation requested for June is

discouraged and will be reviewed on a case by case basis by the Residency Director.

Residents may not be absent more than 5 days from any rotation experience (professional

leave/personal/vacation) unless approved by the Residency Director and rotation preceptor.

July 4th, Labor Day, Thanksgiving Day, Christmas Eve, Christmas Day, New Year’s Day, Memorial

Day are observed holidays. Residents will be assigned to work 2 major and 1 minor holiday. If

the resident is scheduled on the pharmacy staffing schedule for a holiday, that shift prevails. The

department also recognizes the day after Thanksgiving and New Year’s Eve in the department

staffing rotation and these are handled and scheduled per department policy. If the resident is

off for any holiday, then they must submit this time as PTO

Refer to the PTO Request Procedure in the Appendix.

This information is also covered in Policy AS201420-20.20 Residency Practice Guidelines

http://vumcpolicies.mc.vanderbilt.edu/E-

Manual/Hpolicy.nsf/AllDocs/A09FD26D92F6770886257289005AB35F

http://vumcpolicies.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/A09FD26D92F6770886257289005AB35F

http://vumcpolicies.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/A09FD26D92F6770886257289005AB35F

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Expectations of the Resident

The resident is expected to achieve the objectives of the Residency Program related to both

administrative and professional practice skills. The resident reports to and is supervised by the rotation

preceptor and the residency director. During staffing, the resident is under the supervision of the

pharmacist in charge.

Licensure Verification

Pharmacy licensure in Tennessee is a requirement for pharmacy practice residents at VUMC. The

residency program director will confirm that each resident has taken the NAPLEX and the Tennessee

pharmacy law exam, or will take the Tennessee law exam upon transfer of NAPLEX scores from another

state, or already had a valid Tennessee pharmacy license. Upon notification of successful completion of

the NABPLEX and/or law exam the resident will provide documentation of licensure to the RPD. The

resident will provide the department the licensure certificate for display during the resident’s year at

VUMC. Licensure must be obtained no later than July 31 of the residency year. (Policy AS201420-20.20:

Residency Practice Guidelines)

Professionalism

Hours of practice vary according to the requirements set forth by the preceptor and director. The

resident is expected to be present in body, mind, and spirit at all assigned activities of the service they

are currently a part of, including medical staff rounding, education classes, and administrative activities.

The resident may be assigned duties that require work overnight or that may continue during days away

from the hospital; however, these assignments will not be beyond the expectations of other pharmacy

professionals’ duties. An eight hour day is a minimum requirement for physical presence on site during

assigned work days.

Duty Hours

Resident work hours must comply with the current duty hour standards of the Accreditation Council for

Graduate Medical Education (ACGME). Duty hours are defined as all clinical and academic activities

related to the residency program that are performed on-site. Duty hours must be limited to 80 hours per

week, averaged over a 4-week period. These duty hours include covering overtime shifts and

moonlighting. Residents must be provided with 1 day in 7 free from all educational and clinical

responsibilities averaged over a 4-week period. One day is defined as one continuous 24-hour period

free from all residency activities. Adequate time for rest and personal activities must be provided. This

should consist of a 10-hour time period provided between all daily duty periods. Duty hours will be

reported to the residency program director (RPD) on a monthly basis for review.

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Overtime/ Moonlighting

The work of the Department is the resident’s most important commitment; however, residents working

extra shift hours in a staffing role for pharmacist pay is permitted. To work overtime, the resident must

be trained in the area. The resident must notify the RPD of all overtime/moonlighting shifts for approval

prior to scheduling the shift. The extra hours worked must not interfere with residency related

activities.

Moonlighting outside of Vanderbilt is strongly discouraged. However, if the resident chooses to

moonlight outside of Vanderbilt, all activity must be disclosed via the VUMC conflict of interest

disclosure process. The extra hours worked must not interfere with residency related activities. ALL

work hours must not exceed the 80-hour limit set forth by ACGME. The resident must notify the RPD of

all overtime/moonlighting shifts for approval prior to scheduling the shift.

Departmental Policies Applicable to Pharmacy Residents

Vanderbilt Human Resources Website: http://hr.vanderbilt.edu/

VUMC Website: http://vumcpolicies.mc.vanderbilt.edu

VUH Pharmacy Residency Policy: http://vumcpolicies.mc.vanderbilt.edu/E-

MANUAL/Hpolicy.nsf/AllDocs/A09FD26D92F6770886257289005AB35F

http://hr.vanderbilt.edu/

http://vumcpolicies.mc.vanderbilt.edu/

http://vumcpolicies.mc.vanderbilt.edu/E-MANUAL/Hpolicy.nsf/AllDocs/A09FD26D92F6770886257289005AB35F

http://vumcpolicies.mc.vanderbilt.edu/E-MANUAL/Hpolicy.nsf/AllDocs/A09FD26D92F6770886257289005AB35F

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Residency Activities and Requirements

Rotations

There are 11 rotations during the PGY1 residency year. Each rotation period is approximately 4 weeks in

duration. All residents must complete the following required rotations: orientation, pharmacy systems,

clinical systems, clinical rotation, CDS, data management, medication safety, technical concepts, and a

clinical rotation. Rotation requirements may vary based on preceptor. Criteria based assessments should

be reviewed at the outset of each rotation by resident and preceptor to assure completion of all

requirements by the end of the residency year.

Hospital Pharmacy Practice

The residents will practice in a guided hospital practice scheduled every fourth weekend, selected

holidays and one evening per week. The resident will gain experience in the IV room, Central dispensing

area, and the Narcotic Room as well as learn the responsibilities of the pharmacist in charge as well

assist with clinical consults and dashboard monitoring. The second half of the year the resident will be

exposed to the satellite pharmacy during their evening staffing requirement.

Informatics On-Call

The On-Call person provides a resource to help with pharmacy informatics issues 24/7. The resident will

be on-call usually 4-5 days per month depending on the rotation roster and calendar month.

Out-of-State Conferences

ASHP Midyear

o Registration begins in August; residents are responsible for meeting these registration

deadlines.

o Residents must also register for the UHC meeting and present a poster at the UHC

resident poster session.

o It is required that all residents attend a minimum of 10 hours of lectures/seminars.

Southeastern Residency Conference:

o End or April or early May in Athens, Georgia

o Registration begins in January/February and abstract submission deadline is in February;

residents are responsible for meeting registration deadlines.

o http://www.rx.uga.edu/main/home/ce/programs-and-seminars/serc.asp#dates

http://www.rx.uga.edu/main/home/ce/programs-and-seminars/serc.asp#dates

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Journal Club

The purpose of the Journal Club assignment is for the resident to present or assist the pharmacy student

or resident in creating an optimal journal club experience of a current informatics related study to

targeted members of the Health I.T. team, including, but not limited to, other residents, students, and

clinical preceptors. The Journal Club experience will be a discussion between the pharmacy

resident/student and the members of the audience, with full audience participation expected. Residents

are expected to lead Journal Club for the department once in their residency year. All residents are

required to attend.

Topic Presentation

The purpose of topic presentation is for the resident to present an interesting topic in which they

directly participated. They are to present members of the Health I.T. team or Pharmacy Product Group,

including, but not limited to, other residents, students, and clinical preceptors. All residents are

required to attend. Presentation should be focused on informatics topics and include primary literature

in reference to the case. Refer to the Case Conference Learning Experience in Appendix X for full details

and requirements.

Continuing Education Presentations

Two formal presentations by each resident will be conducted during the residency year:

Therapeutic Exchange: This is a 60 minute CE presentation that includes some controversy

and/or is a hot topic in informatics or pharmacotherapy. Primary literature is to be used as a

guiding force to put this presentation together. Presentation objectives and title are to be

submitted one month prior to your assigned presentation date. Refer to the Therapeutic

Exchange Learning Experience in Appendix X for full details and requirements.

Residency Project: This is a 10-15 minute presentation of the resident’s research project.

This includes several practice sessions and then a formal presentation with

feedback/evaluation from preceptors and residents during practice and attendees at SERC.

This will also be presented in conjunction with the other residents to be a complete 60

minute CE presentation for the department. Refer to the Research Project Learning

Experience in Appendix X for full details and requirements.

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Newsletter/Fast Facts (optional)

The purpose of the Fast Fact assignment is for the resident to provide information about a pharmacy-

related topic that could be of use and educational value to the Department of Pharmaceutical Services.

The Fact Fast should highlight a new topic and provide practical information to pharmacists and/or

pharmacy technicians. The Fast Fact will be published in the InPharmation newsletter, which is

published at the end of each month. Each resident will provide two Fast Facts during the year, typically

one in the fall and one in the spring. Refer to the Fast Facts Learning Experience in Appendix X for full

details and requirements.

Research Project

Each resident will conduct a research project over the course of the residency year. This project will

include idea development, literature review, study design, IRB submission, data collection, data analysis,

data interpretation, oral presentation and a written manuscript. The written manuscript is to include

identification of an appropriate journal for potential submission and the following of the instruction to

authors for that journal. The manuscript must be written and submitted in final form prior to completion

of residency. The manuscript must be reviewed by the project mentor(s) and approved by the residency

director. The resident will have a mentor identified for interactions and guidance during the year. Refer

to the Research Project Learning Experience in Appendix X for full details and requirements.

Recruitment

Residents will assist in the resident recruitment and candidate selection process at Midyear and during

the month of February.

MUE

Each informatics resident will assist with a minimum of one medication use evaluation during the

residency year. These are assigned to PGY1 in the first month of the residency. Findings are to be

summarized in a 10 minute power point presentation with recommendations of the most appropriate

course of action based on the findings to the P&T Committee and/or appropriate committee. Refer to

the MUE Learning Experience in Appendix X for full details and requirements.

Medical Center Education Programs

Noon conferences, DBMI lectures, and other education conferences are offered throughout VUMC.

These are posted in Vanderbilt publications and via email notifications. The resident is strongly

encouraged to attend these whenever possible. Noon conferences, DBMI lectures, and other education

conferences are offered throughout VUMC. These are posted in Vanderbilt publications and via email

notifications. The resident is strongly encouraged to attend these whenever possible.

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Hospital Pharmacy Practice

The resident will practice in a guided hospital practice scheduled for every fourth weekend and selected

holidays. The resident will gain experience in IV Room & Sterile Products, Central dispensing, narcotic

room, and responsibilities associated with Pharmacist in Charge.

(This is a guideline and will be dependent on staffing location assignment. The PGY2 resident will have a

similar staffing experience model as the PGY1 residents, however, depending on the PGY2 prior staffing

experience, goals and objectives may be adjusted as needed to ensure staffing competency of the PGY2

resident. It is an expectation that informatics resident will provide oversight to the PGY1 residents in

dispensing roles and clinical monitoring roles when PGY1 and PGY2 residents are staffing

simultaneously).

Expectations for Residents in First Quarter – Staffing Assignment

Orient to the Central Pharmacy and learn the procedures of both the unit dose area and the sterile products preparation areas.

Adjust to the scheduling assignments and focus on being present and ready to work in the assigned area at the assigned time. Stay in the work area during your entire shift and be available to focus on the work at hand. Observe appropriate break time such as 30 minutes for lunch breaks. Learn to indicate any scheduling adjustments on the posted pharmacist schedule such as swaps in assignments

Develop an understanding of the systems and processes and develop skills such as with CPOE order processing (“VOP”).

Develop relationships with the Central Area team. Be careful to ask a more senior pharmacist before making changes to work processes. Follow the established dress code and other workplace policies. Be sensitive to the needs of the other staff in the area and do not routinely ask to leave early. Make sure that work is caught up prior to leaving your assignment.

Begin to develop a broader view of the work place and rotate among the various stations (AcuDose check or cart check, pharmacy labels on Zebra, extemp prep, packaging machine, phones, tube station, IV Room, etc.) in order to maintain and effective work flow and efficiency level.

Learn to collaborate with other staff members shift regarding work flow issues or whenever time may become available to work on projects but remain available to return your focus to the work at hand whenever workload increases.

Remain flexible and ask questions.

Once initial training is complete, primary assignment will be in the IV Room/Sterile Products or the Unit Dose area – may flex depending on staffing requirements.

Resident will check in with the pharmacist and technician mentors at the end of each weekend shift to see if there are suggestions for improvement. If mentors are not working on the same weekend, resident will check in with their mentors at the next available opportunity to discuss any questions.

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Expectations for Residents in Second Quarter – Staffing Assignment

Demonstrate proficiency in all areas of the Central Pharmacy.

Demonstrate proficiency with systems and processes and manage the established levels of efficiency.

Demonstrate a broad view of the work place and rotate among the various stations maintaining effective workflow and efficiency.

Primary assignment will be to float between the IV Room and Unit Dose areas

Begin to observe the Pharmacist in Charge (PIC) role


Expectations for Residents in Third Quarter – Staffing Assignment

Begin training in the Junior Pharmacist in Charge (PIC) role

The resident (junior) and the normal (senior) management person on the weekend will both be designated as PIC. These two persons will work together to manage the personnel and workflow. The normal management person can help teach the resident how to solve problems that arise during a shift.

The resident will not be in the float position unless scheduling dictates this as a need. However, part of being PIC includes assessing both the unit dose and IV areas and helping in all areas.

The resident has an increased responsibility to keep in touch with the workflow and employees during the shift. The resident should assure all work has been completed for the shift prior to approving anyone to leave early (then check with the lead tech and check who is working in an overtime slot to help with these decisions).

Communicate end of shift issues to the unit dose area evening pharmacist prior to leaving.

Personnel conflicts, staffing problems, catastrophes, and occupational health issues will defer to the senior management person designated for the weekend.


Expectations for Residents in Fourth Quarter – Staffing Assignment

Resident will be assigned as the PIC and make independent decisions regarding issues that arise with little assistance from the senior pharmacists. Residents should keep track of DI calls, extra tasks and problem solving they are involved with to review with his/her mentor.

Expectations for Mentors

Check in with residents at the end of each weekend workday or as soon as possible after their weekend to work to discuss their staffing and PIC roles and answer any questions that arise.

Observe the residents during their staffing and PIC roles and offer tips and suggestions for improvement.

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Provide feedback to the resident from other staff members as appropriate regarding their work performance.

Prepare the quarterly evaluations for the residents in regard to their staffing experiences.

Expectation of Residents

Submit a report of activities learned, accomplishments, problems solved etc. as well as areas in need of clarification or focus for the next weekend by Monday following your weekend worked.

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Evaluation Process and Requirements

Evaluations

An essential component of developing the skills of a resident is frequent two-way feedback between

residents and preceptors. The preceptors, program director, and residents will frequently provide

feedback to one another via formal evaluation. Evaluation will occur as described below:

a. Rotation Summative Evaluations: Due no later than 7 working days after the end of the

previous rotation period. This is a written evaluation of the resident’s performances in

meeting the objectives of each rotation. The resident and preceptor will review these

evaluations together. The resident will also complete a preceptor and learning experience

evaluation.

b. Quarterly Evaluations: Longitudinal experiences will require a quarterly summative

evaluation where a written evaluation of the resident’s progress is completed. Learning

experience and preceptor evaluations must also be completed on a quarterly basis for these

experiences.

c. Criteria Based Assessments: Evaluations of selected activities will be completed by both a

preceptor and the resident.

Case Conferences

Journal Club

Therapeutic Exchange

d. Residency Council Reports : A written evaluation based on period review by the residency

council. This evaluation examines overall progress, including integration of skills learned in

separate rotations, non-rotation objectives/experiences, progress on longitudinal

requirements/rotations (residency project, criteria assessments, etc.) and any pertinent

trends or information found in evaluations to that date. Progress of the resident’s strengths,

weaknesses and career goals will be documented. To satisfactorily complete the residency,

the resident must have shown improvement over the course of the year in both resident

and preceptor scoring. For any goals in which less than a score of 3 is averaged, the resident

and program director will work together to develop individualized plans to assist in making

progress in those areas by residency end. If the resident does not work towards those plans

and progress improvement, residency completion with certificate may be compromised. On

a quarterly basis, goals in which the resident has scored an average of 5 for two consecutive

quarters will be removed from further evaluation.

All evaluations are to be discussed personally between resident and preceptor. All evaluations (rotation

summative on resident, resident on preceptor and resident on rotation overall), CBAs, and self-

assessments should be forwarded to the resident program director or designee in electronic format. A

hard copy should be printed and signed by resident and evaluator and maintained in the resident’s

residency portfolio binder. The electronic database will document the review by the residency program

director.

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Documentation

Each resident will maintain/submit the following documentation:

1. Summative Self-Evaluation: Required for each rotation, CBA, and longitudinal experience. Each

evaluation is due 7 working days after the completion of the previous rotation period.

2. Rotation and Preceptor evaluations will be submitted to the preceptor and then program director or

designee within 7 working days following the completion of the rotation or designated quarterly

evaluation completion dates. This should be presented to the preceptor the same day that the

preceptor presents the block or longitudinal evaluation to the resident. The preceptor must sign off

on this in the evaluation database as reviewed.

3. Criteria Based Assessments (CBAs) are to be initiated by the resident as opportunities are

encountered then evaluated with corresponding preceptor. The evaluation is documented in

ResiTrak. Resident initiated CBAs:

Case Conference

Journal Club


4. Residency Notebook: The resident will maintain both a hardcopy and an electronic residency

notebook which shall be a complete record of the resident’s program activities. The notebook

should include the following:

Orientation Checklist

All residency-based evaluations including: o Entering Interest form o Goal-based evaluations o Summative (by preceptor and self-evaluations) o Preceptor evaluations o Learning experience evaluations o Custom evaluations o Customized training plans

A record of all educational in-services and seminars presented o Outlines and/or lecture slides o Evaluation of in-service or seminar where applicable o Any edits that you received

Residency Project Materials o Proposal o IRB submission o Data collection & analysis o Final manuscript o Any edits that you received

Any formulary reviews, written drug information responses or other completed assignments

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*The contents of the residency notebook serve as documentation of activities completed during the

residency year. The residency yearbook is a permanent record which is the property of Vanderbilt

University Medical Center.*

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Requirement for Receiving a Certificate

Upon successful completion of all program requirements and compliance with all conditions of the

residency program, Vanderbilt University Medical Center will award the resident a certificate indicating

successful completion of the residency program. The purpose of the PGY2 pharmacy informatics

residents is to prepare the pharmacist for practice in a pharmacy informatics position. Residency

training is designed to provide the resident experience in applying informatics and technology to

enhance care of the patient and support healthcare professionals. This is accomplished by staffing

responsibilities, clinical rotations (if desirable) and working with a broad range of medication systems,

health care professionals, and vendors.

This one year specialty residency and training program is designed to prepare and provide pharmacy

informatics experiences so that the resident will have the core skills to pursue pharmacy informatics as a

career. Through a varied list of potential activities including clinical systems, automation, robotics, and

pharmacy workflow management systems, the resident can have a robust learning environment.

All of the following criteria must be satisfied to successfully complete the program:

Completion of a residency research project that is approved by the program director and submission of a formal write-up in manuscript format by June 1 of the academic year.

Completion of the required number of formal presentations (Journal Club, Therapeutic Exchange and Topic Presentation).

Satisfactory completion of all rotations as determined by the primary preceptor for the rotation

Completion of the required number of Competency Based Assessments.

A minimum of 75% of all residency objectives marked as “Achieved for Residency” by preceptors or residency program director.

Completion of the residency notebook.

Residents who fail to complete all program requirements and/or do not comply with all conditions of

the residency program shall not be awarded a certificate of completion.

Submission of a completed notebook to the program director (at the conclusion of the program) that

includes evaluations, self-evaluations, and preceptor and learning experience evaluations for all

concentrated and longitudinal experiences.

Poster presentation of the research project at the ASHP MYM Meeting or other comparable scientific

meeting.

Submission of project abstract for the annual SERC Southeastern Residency Conference or comparable

meeting.

The resident reports to and is supervised by the rotation preceptor and the residency director/

coordinator.

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Responsibilities of the resident include:

Development of personal goals for the residency following an initial evaluation of career interests, prior

experience, and areas of strength and weakness.

Compliance with rotation expectations.

Meeting with the rotation preceptor to define individual goals and objectives for the rotation

completing assignments by the end of the rotation.

Scheduling routine meetings with rotation preceptor.

Informing the residency director of difficulties encountered in meeting goals and objectives or problems

with preceptors assuming responsibility of the rotation preceptor in his/her absence.

Preparing a written self-evaluation, preceptor and learning experience evaluation at the conclusion of

each rotation and quarterly for longitudinal requirements.

Timely communication regarding absences and requested leave; failure to inform the program director

of an absence/ illness will result in disciplinary action.

Completion of quarterly reports to be reviewed by the residency director; the purpose of these reports

will be to assure that the established residency goals and objectives are being achieved.

Provision of pharmacy staffing coverage as indicated on the Pharmacy Staffing Schedule.

Completion of a major residency project

PGY2 projects will be presented at platforms at the Southeastern Residency Conference (SERC) for

Pharmacy Residents and Preceptors.

Submissions of articles to departmental newsletters.

Attendance at the ASHP Midyear Clinical Meeting and Southeastern Residency Conference for Pharmacy

Residents and Preceptors. Residents may attend other professional meetings if the staffing schedule

permits.

Submission of a completed notebook to the program director upon completion of the program. Specific

details regarding “Notebook Requirements” can be found in the program specific residency manual.

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Learning Experience Type Duration Designation

Orientation Rotation 4 weeks Required

Clinical Systems Rotation 4 weeks Required

Clinical Pharmacy Systems Rotation 4 weeks Required

Clinical Rotation Rotation 4 weeks Required

Clinical Decision Support Rotation 4 weeks Required

Data Management Rotation 4 weeks Required

CDS II Rotation 4 weeks Elective

Medication Safety Rotation 4 weeks Required

Technical Concepts Rotation 4 weeks Required

EHR & Vendor Relations Rotation 4 weeks Elective

Ambulatory Rotation 4 weeks Elective

Staffing Longitudinal 12 months Required

Project Management Longitudinal 12 months Required

Automation Project Longitudinal 12 months Required

Research Project Longitudinal 12 months Required

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Appendices

A: Orientation Checklist

B: Evaluation Schedule 2014-2015

C: Requirements Tracking Form

D: Requirement Timeline

E: Learning Experiences

F: Clinical On-Call

G: PTO Request Procedure

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Appendix A: Orientation Checklist Pharmacy Resident

Central Pharmacy

Orientation Items Resident Initials Trainer Initials Date Reviewed

General Daily work flow Unit Dose Area Times and associated tasks

Review Pharmacist Shift slots and associated duties Pharmacist in charge IV/Central UD Float Central UD IV/TPN

Review how to read/interpret staffing schedule

Review daily Technician slots and associated responsibilities

N/A

Procurement Process Storeroom Staff Storeroom Responsibilities Storage locations: walk in fridge, storeroom, Med Carousels, PakPlus room Over fill cart, IV/TPN room

Med Carousel/Connect Rx Process Log In code given Pull on demand pick Review of AcuDose/Cartfill Process Pharmacist Scan process Acceptance of AcuDose zones

AcuDose Fill Process AcuDose Orientation with Frank Ray Checking AcuDose Doses AcuDose Log-in and Filling AcuDose Machines Narcotic Check in Narcotic Room

Medication Error Recording Process in the Central Area Internal Errors External Errors

Narcotic Room Procedures CII Safe Log-in and orientation with Charity Prater Checking process Discrepancy resolution Narcotic orders attachment in HMM (patient specific)

Cart Fill Process Pull process from Med Carousel Check Process Catch-up Doses Delivery of meds to patient specific med drawers

Look alike – Sound alike medications

Extemp Process Set up/Filling Process Checking Process

Non-Sterile Compounding area Orientation to Area What type of products made Who to ask if questions PCCA

Order Processing (Vopping) in Central Areas Central order processes for What to send to the ED

Resident:________________

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How to Clarify an order (resident pager list/operator)

Crash Carts 6 month expiration Red Locks Charges ED Trays

Specific References: Psych book, IV reference manual etc. Blood Factor book, Clozaril, MSDS, etc.

Borrow/Loan policy and procedures

Unit dose packaging TadPoles Bar coding Responsibilities of Pharmacy Unit Dose Packaging Options How to check items in Pak Plus

Tube system policy and procedures Tube System Competency Check List

*Outpatient prescriptions, Stallworth and Psych Hospital Procedures on weekends (cover on first weekend)

IV/TPN/IDS Room


General workflow and distribution of responsibilities amongst pharmacists and technicians

How to find things in the IV room

IV preparation policy and procedures Set up of IV Preparations and Batches Reconstitution of vials Preparation of syringes, PB, LVP and checking these Storage of medications prior to delivery Delivery Schedule

Sterile products preparation check off

Call for medications

Review of how we meet USP 797

Latex allergy policy and procedures

Review of IV resources: how to determine compatibilities, expirations, Vandy IV manual, IV room website , latex website

Narcotic Preparation and wastage Log sheets Wastage record Record of RX number in patient maintenance

Standard Time Schedules

Investigational Drug Area

TPN Area

Outpatient Areas


Review of what and where all outpatient pharmacy services are located, hours, key persons

**Indigent Med Program: policy and procedures – please learn the process of who is eligible, what the policy is, how patients are approved, how much medication can be dispensed.

**Sample pharmacy: policy and procedures, location, products available, how it works, who pays for it, and why we offer this service, how to look up formulary for this

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Process for prior authorization etc. of high cost drugs and our policy/procedure for handling these (identify main agents etc.)

How we manage the purchase, distribution and charging of medications used in the clinics Medicare/Tenncare issues What are the toughest problems in clinic medication reimbursement

Coumadin Clinic **Who is serviced/eligible **How to enroll a patient (Starpanel) – please walk the resident through the Starpanel process How information is communicated/documented Policy and Procedures/Protocol CC follows Staff involved in clinic Standards of care in regards to anticoagulation History of the service at Vanderbilt Credentials involved and structure of providing this service Quality assurance/improvement in this area

N/A

Order Processing: Orientation Checklist


Orient to satellites Locations Areas serviced by each Hours

Order clarifications

Work flow

Pharmacist and technician responsibilities

Adverse Drug Reaction reporting , Medication Error reporting

Customer Service Focus

Intervention Documentation

Telephone Courtesy/Etiquette

IV medication administration policy and chart

Meds/Devices brought from home

PCA Pump Policy

DI Resources: Micromedex, Lexi-Comp, Kings, Facts & Comp, Up to Date, Trissell’s, Pubmed

Alaris GuardRails for IV pumps

How to use phone and beeper system

Dashboards (Will do with Blair, Pratish, and Erin )


Warfarin

Aminoglycoside

Heparin

Consults

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Appendix B: Evaluation Schedule 2014-2015

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Appendix C: Tracking Form SUMMATIVE EVALUATIONS

Rotation Rotation 1

Rotation 2 Rotation 3 Rotation 4 Rotation 5

Preceptor’s Evaluation

Resident Self-Assessment

Learning Experience

Rotation Rotation 6

Rotation 7 Rotation 8 Rotation 9 Rotation 10 Rotation 11



Learning Experience

LONGITUDINAL EVALUATIONS

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Hospital Practice (Staffing)



Learning Experience

Residency Project



Learning Experience

Automation Project



Learning Experience

Training Plan Progress

Residency Council Report

Resident Training Plan Self-Assess

TOPIC PRESENTATIONS

#1 #2



Learning Experience

JOURNAL CLUB

#1 #2



Learning Experience

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THERAPEUTIC EXCHANGE



Learning Experience

OTHER REQUIREMENTS (WITHOUT FORMAL EVAUALTIONS)

SERC Presentation

Manuscript

Project Requirements

Proposal IRB Data Collection Presentation

Report/ Manuscript

Research Project

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Appendix D: Requirement Timeline (For Guidance Purposes Only; Dates are subject to change based on individual resident goals/assigned tasks) **This may not be all inclusive – watch your residency requirements tracking form!**

July Baseline self-assessment (Entering resident interest and preference information) Select and develop 60 minute CE Presentation Dates for Journal Club, Case Presentation Selected, CE Presentation August Project topic/preceptor confirmed

Project literature review and bibliography completed and submitted. MUE topic selected and timeline for completion established.

Register for ASHP Midyear Meeting September Project design/Methods write-up complete Project Proposal Presentation –IRB submissions If taking a poster to MYCM, investigate deadlines for abstract submission

How many Criteria Based Assessments have you completed? Pace yourself! Evaluate where you stand with longitudinal assignments (P&T Monograph, MUE) October Project Proposal completion and submitting to IRB, establish timeline for project data collection

and analysis etc. Recruitment Showcases

Case Presentations and Journal Clubs November If taking a poster to MYCM need to complete slide by mid November.

Recruitment Showcases How many Criteria Based Assessments have you completed? Pace yourself! Résumé preparation and interview skills

December ASHP Midyear – UHC Posters, showcase January Register for SERC and Prepare SERC abstract February Complete and submit SERC abstract Wind up data collection for project Case presentations and journal clubs

How many Criteria Based Assessments have you completed? Pace yourself! March Project: begin organizing data – analyze data - results April Pre-SERC project presentation I, II, III, IV, SERC

How many Criteria Based Assessments have you completed? Pace yourself! May Project manuscript – first draft completed May 15th June Final Project manuscript due June 15 All Criteria Based Assessment Requirements completed by Jun 15

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Appendix E: Learning Experiences

Case Conference

Topic Presentation

Research Project

Staffing Experience


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Residency Project Description Worksheet

2014-15

_________________________________________________________________

Resident: Project Advisor:

Date of Initiation: Date of Completion:

Responsible Investigators:

Department(s) Involved:

Key Personnel to Obtain Approval From:

Question to be answered:

Expected Outcomes of the Study:

Rationale for the Study:

Defining Measurements:

Data that will be collected:

Databases to Study or Create:

Data Analysis:

Description of Results:

Benefit to the Resident:

Benefit to the Department:

Likelihood of Publication:

Commitments: ______________ _________________ __________

Resident Preceptor Other

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Past Residency Projects

2006 – 2014

Year Resident Title Comment

2006 - 2007 Alan Chung

Evaluation of an Integrated Computerized Pharmacist Intervention Database

*

2007 - 2008

Alan Chung Minimizing Alert Fatigue in a Pharmacy Computer System

2008 - 2009

Matt Marshall

Traffic Jams in the Medication-Use Superhighway * ◊

2011 - 2012 Wing Liu Reconciliation of Drug-Drug Interaction Alerts Between Customized and Commercial Database Compendia

◊

2012 - 2013 Vanitra Richards Evaluation of Contraindicated Drug-Drug Interaction in a CPOE System, a Pharmacy Information System,

and an Electronic Prescribing System

*

2013 - 2014 Anuj Thirwani Implementation of Clinical Decision Support to enhance Antimicrobial Stewardship-guided novel

Laboratory Test Ordering

*

2014 - 2015 Seth Strawbridge

* Presented at the Southeastern Residents Conference (SERC) in Athens, GA ◊ Presented at the ASHP Residency Poster Presentation

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Staffing Learning Experience Contact person: Molly Knostman, PharmD, MHA Preceptor: TBD- Staffing Mentor Phone: 343-0221 Pager: 835-7162

General Description The Pharmacy Practice longitudinal rotation is an opportunity for the resident to develop foundational practice skills in hospital pharmacy practice. The residency will work in the VUH Inpatient Operation Central and Satellite pharmacies. The resident will develop proficiency in automated central distribution, narcotic distribution and management, extemporaneous oral preparations, medication order processing, drug information, intravenous admixture and TPN admixture. The resident will also develop an understanding of workflow processes in a department setting, as well as medication safety monitoring.

The resident is required to staff every fourth weekend 7a-3:30p and one evening during the week 3:30-7p. Resident will train and staff in the Central pharmacy during the first semester of the PGY1 year. Around the first of January, the residents will receive cross training in the 6th floor pharmacy satellite to augment their view of patient care in a hospital setting. They will staff the first two hours of their weekday shift on the 6th floor satellite once training is complete. Goals and Objectives The goals selected to be taught and evaluated during this learning experience include:

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

Goal R1.4: Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system.

Goal E7.2: Communicate effectively

Goal E7.4: Manage time effectively to fulfill practice responsibilities Activities The activities assigned to this learning experience reflect the activities a pharmacist working in this environment is expected to be able perform. These activities were also selected to help you work toward achieving specific objectives which in turn will help you achieve the goals assigned to the learning experience.

Activity Objectives Covered

Demonstrate proficiency in the VUH Inpatient Pharmacy Demonstrate proficiency with systems and processes and manage the established levels of efficiency Demonstrate a broad view of the work place and rotate among the various stations maintaining effective work flow and efficiency

OBJ R1.3.1 OBJ R1.3.2 OBJ R1.3.3 OBJ R1.3.4

Display initiative in preventing, identifying, and resolving pharmacy-related patient-care problems

OBJ R1.4.1

Use an understanding of effectiveness, efficiency, customary practice and the recipient's preferences to determine the appropriate type of, and medium and organization for, communication Use listening skills effectively in performing job functions.

OBJ E7.2.1 OBJ E7.2.3

Use time management skills effectively to fulfill practice responsibilities OBJ E7.4.1

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Preceptor Interaction There will be assigned staffing mentor. This person will work with the resident on their designated weekend help the resident understand all operational aspects of the pharmacy. The staffing mentor is to assist the resident in any operations questions and to evaluate the resident’s progress in operational activities throughout the year.

Evaluation Strategy Evaluation of residents will be based on the RLS Learning Goals. Resident will complete the weekend review form to help foster discussion with their longitudinal mentor, RPC and staffing evaluator. Evaluation will consist of a summative evaluation at the end of each quarter (September, December, March, June). The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning of the rotation. Residents will be requested to complete a self-evaluation for all evaluations. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in Resitrak. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

Timeline for the Experience This is a longitudinal experience that will last the duration of the residency year.

Staffing Guidance and Expectations

First Quarter

Orient to the Central Pharmacy and learn the procedures of both the unit dose area and the sterile products preparation areas.

Adjust to the scheduling assignments and focus on being present and ready to work in the assigned area at the assigned time. Stay in the work area during your entire shift and be available to focus on the work at hand. Observe appropriate break time such as 30 minutes for lunch breaks. Learn to indicate any scheduling adjustments on the posted pharmacist schedule such as swaps in assignments

Develop an understanding of the systems and processes and develop skills such as with CPOE order processing (“VOP”).

Develop relationships with the Central Area team.

Follow the established dress code and other workplace policies. Be sensitive to the needs of the other staff in the area and do not routinely ask to leave early. Make sure that work is caught up prior to leaving your assignment.

Begin to develop a broader view of the work place and rotate among the various stations (AcuDose check or cart check, extemp prep, packaging machine, phones, tube station, IV Room, etc.) in order to maintain and effective work flow and efficiency level.

Learn to collaborate with other staff members shift regarding work flow issues or whenever time may become available to work on projects but remain available to return your focus to the work at hand whenever workload increases.

Remain flexible and ask questions.

Resident will check in with the pharmacist and technician mentors at the end of each weekend shift to see if there are suggestions for improvement are areas that they would like more exposure and complete The Weekend Staffing Report. This report will include activities learned, accomplishments, problems solved etc. as well as areas in need of clarification or focus for the next weekend.

Second Quarter

Demonstrate proficiency in all areas of the Central Pharmacy.

Demonstrate proficiency with systems and processes and manage the established levels of efficiency.

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Demonstrate a broad view of the work place and rotate among the various stations maintaining effective work flow and efficiency.

Primary assignment will be to float between the IV Room and Unit Dose areas

Resident will check in with the pharmacist and technician mentors at the end of each weekend shift to see if there are suggestions for improvement are areas that they would like more exposure and complete The Weekend Staffing Report.

Third Quarter

As above with more autonomy

Begin floating to 6th Floor Satellite to obtain broader vision of pharmacy services Fourth Quarter

Begin to practice some skills related to the (PIC) role such as having an increased responsibility and awareness of the workflow and employees during the shift. The resident should assure all work has been completed for the shift prior to approving anyone to leave early (then check with the lead tech and check who is working in an overtime slot to help with these decisions).

Communicate end of shift issues to the unit dose area evening pharmacist prior to leaving.

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Staffing Form

Pharmacist Resident

Staffing Report

Name:

Date:

Location for staffing:

Pharmacist in charge:

What did I do this weekend? (check all that apply)

Answered at least 5 phone calls

Dose Edge

Checked/Filled Extempts

Identified and resolved a medication error and

documented in Veritas

Prepared indigent meds

Clozapine registry

IDS dispense

Sent missing dose

Helped resolve an AcuDose issue

Documented my interventions/DI Questions in

Quantifi

Checked Pak Plus

Psych Orders

Regenerated or rescheduled an order

Vopped at least 20 orders in HMM

Helped resolve staffing issue (ie sick call)

Checked crash cart, ED, FEL trays

Prepared and checked out event box

Borrow and Loan

Checked or prepared compounding item

Verified and dispensed Factor order

Checked TPN

Checked or dispensed narcotic with CDR

Connect RX (stock outs, inventory, event report)

Med Carousel

Other_____________________________

What did I learn this weekend?

__________________________________________________________________________________________________

______________________________________________________________________

Next weekend, I want to learn or try to:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

________________________________________________________

Comments from pharmacist in charge: Initials__________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

________________________________________________________

***[This document will serve as the basis for your quarterly staffing evaluation completed by your mentor.

Please retain in your residency binder.]***

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Orientation – Rotation Description PGY2 Pharmacy Informatics Phillip W. Stewart, DPh Informatics Pharmacist & RPD, Pharmacy Product Group HealthIT @VUMC Office: 615.936.2930 Cell: 615.829.13147 [email protected] Learning Experience Description This is the initial orientation to VUMC and core systems where the resident learns the daily operational aspects of the pharmacy including dispensing, administration, policies and procedures, and skills needed for staffing. 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. The Resident will attend core computer systems training primarily comprised of CPOE, Pharmacy system, BCMA, EHR (StarPanel). The resident will also rotate through the various work areas of the pharmacy; preparing extempts, cartfill, automated dispensing machines, prepackaging process area, AcuDose replenishment, IV room processing including IV preparation, checking, validation, limited exposure to TPN process, order processing and general workflow that prepares the resident for staffing duties. The rotation will include office setup, any orientation and learning On-Call duties for the coming year. Learning Experience Goals and Expectations

R4.1 Demonstrate a working knowledge of available technology and automation systems for prescribing medications.




Daily Schedule Required Hours The hours of this month long rotation is typically Monday through Friday, 8-4:30 pm. This can vary depending on the time of year and department requirements, thus the resident should remain flexible as much as possible. The Resident will report to 3401 West End Avenue & Central Pharmacy as needed. Required Meetings, as applicable to Pharmacy Informatics: Meeting will be limited due to staffing orientation. The resident will be encouraged when possible to attend the weekly Pharmacy Informatics meeting when possible.

mailto:[email protected]

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Learning Experience Requirement/Responsibilities Activity: Objectives Covered: Observe, participate and comprehend critical and basic steps for order entry such as order evaluation and appropriateness.

Obj. R 4.1

Observe, participate and comprehend basic steps for order dispensing including order evaluation, preparation, and appropriateness.

Obj. R 4.2

Observe and comprehend the role of pharmacist processing including dosage form selection, dose range, allergy interactions, timing of medications and dispense choices.

Obj R 4.2

Observe and comprehend underlying principles and decision process for actual dispensing whether via automation devices or manual product dispense.

Obj R 4.3

Participate and shadow individual members of the Pharmacy Informatics group to learn how each member contributes to the larger group, identify duties, while learning and documenting activities and skill sets required for ongoing support of systems and users.

Obj R 4.1 Obj R 4.2 Obj R 4.3

Observe and comprehend medication management of controlled substances, automated dispensing devices activities, vendor packaging activities, carousel technology, inventory receiving, barcode scan for inventory verification and other miscellaneous preparations for RapidFill, TPN, etc.

Obj R 4.7

Resources for Review and Discussion ASHP Goals – Pharmacy Informatics & Technology section related to principles of Informatics Competencies in Pharmacy Informatics – Fox, Thrower, Felkey Pharmacy Informatics Primer - Dumitru Local archive (Evernote) of informatics related articles, papers, references. Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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Clinical Pharmacy Systems – Rotation Description PGY2 Pharmacy Informatics Phillip W. Stewart, DPh Informatics Pharmacist, Pharmacy Product Group HealthIT @VUMC Office: 615.936.2930 Cell: 615.829.1347 [email protected] Learning Experience Description The clinical pharmacy systems rotation is a 4 week block rotation in which the resident becomes familiar with primary medication use information systems of the pharmacy and medical center. The Resident will develop a basic understanding of Computerized Prescriber Order Entry (CPOE) systems, pharmacy order entry systems, barcode medication administration systems (BCMA), automated dispensing systems, automation, and electronic health records. Additionally, the resident may be exposed to system databases, interfaces, clinical drug databases, introductory clinical decision support, DoseEdge, IV robot, outpatient dispensing systems, group tasks assignments (SharePoint), pharmacy charges, and some specific pediatric tasks native to their work. Depending on department initiatives during the rotation, the resident may be involved with the planning and implementation of new systems or system upgrades. Throughout the rotation, the resident will develop an understanding of the advantages of electronic systems that support pharmacy functions and enhance pharmacy medication safety. In the event an informatics student or PGY1 resident rotation, the PGY2 informatics resident will be expected to participate in the interactions with all as defined by the RPD. Learning Experience Goals and Expectations

R1.1 Demonstrate understanding of basic pharmacy informatics principles, standards, and best practices.

R2.2 Assure that all patient-specific, medication-specific, and evidence-based pharmacotherapy information required to support effective medication-related decisions is readily available in a useful format to members of interdisciplinary, patient-centered teams.



R 4.4 Demonstrate a working knowledge of currently available technology or automation of the safe and efficient administration of medications.

R 4.5 Demonstrate a working knowledge of currently available automated technology for documenting medication administration.


R4.9 Contribute to resolution of identified operational problems. R6.1 Demonstrate the personal skills and abilities of a pharmacy informatics leader.


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R6.2 Represent the pharmacy informatics perspective in interactions with the information technology staff, other health care staff, and /or technology and automation vendors.

Daily Schedule Required Hours The hours of this month long rotation is typically Monday through Friday, 8-4:30 pm. This can vary depending on the time of year and department requirements, thus the resident should remain flexible as much as possible. The Resident will report to 3401 West End Avenue. Required Meetings, as applicable to Pharmacy Informatics: Clinical Systems Pharmacy Informatics Group – weekly every Tuesday DBMI seminars/meetings – every Wed 12N during academic year Horizon Informatics Clinical Systems meeting – monthly every third Monday at 3P Medication Use & Safety Information Committee (MUSIC) - monthly Pharmacy Informatics Practice Subcommittee – weekly every Wed at 8A Pharmacy and Therapeutics Committee - monthly Pharmacy Informatics Steering Committee – monthly every third Thursday at 11A Evidenced Based Medicine meeting – first Thursday of each month 9a Others as determined based on need/experience Learning Experience Requirement/Responsibilities Activity: Objectives Covered: Comprehend and explain the basic principles and standards of pharmacy informatics, from the selected reading materials and how these are applied to the routine work day. This can include testing on an applied change with orders sets (EBM team) or a pharmacy request solution (via Sharepoint requests).

Obj R 1.1.1-5

Meet with selected resources (D. DiPersio) who can speak to the work being done with third party vendors that provide dosing, allergy, warnings that populate various systems in the medication use system. The resident will discuss with preceptor the Best Practices of Informatics, Informatics Training in Pharmacy, and demonstrate a general understanding of how pharmacy informatics interrelate with clinical pharmacy and medication safety. Understand how and why a structured process for testing is needed. Participate in testing scenario such as FDB update or upgrade testing (Judy Doan).

Obj. R 2.1.1-2, Obj. R 2.2.1-2

Demonstrate and have general understanding of the impact of the various medication use systems of VUMC and Pharmacy, including CPOE, BCMA, databases and decision support. Workflows analysis for various members of the Informatics Team.

Obj R 4.2.1-2, Obj R 4.3.1-2, Obj R 4.4.1-2, Obj R 4.5.1-2

Explain with a general understanding of the process and implications of the medication procurement, inventory, and integrity of products between the pharmacy and automation systems (L Lowman, A Bryant).

Obj R 4.7.1-2

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After understanding the general structure of the medication use systems, identify an opportunity for quality improvement within a medication system. Design and implement the improvement opportunity identified above. This will likely be designing the logic of the change rather than implementing the coding process in the system. This may include training of staff in order to implement the intervention. Demonstrate the beginning knowledge during problem resolution times such as On Call.

Obj R 4.9.1

Understand and demonstrate the core principles related to Order Processing and work toward participating and eventually leading a training class for staff. This also can apply to other informatics projects such as VOIS (Vanderbilt Oncology Information Systems).

Obj R 6.1.1-7, Obj R 6.2.1-2, Obj R 6.4.1

Resources to meet: Wing Liu, PharmD, Principal Domain Specialist, HEO Nancy Rudge, MSN, Manager, Portfolio & Product Management Matt Marshall, Informatics Pharmacist, Pharmacy, EDW, Data Management Mark Bailey, MBA, RN, Information Systems Analyst Craig Bailey, EHR Portfolio Support, Portfolio & Product Management Laura Lowman, CPhT, Pharmacy Systems Support, Informatics Andrea Bryant, DPh, Program Director of Inventory and Product Integrity Julia Cartwright, DPh, VOIS Manager, Portfolio & Product Management David DiPersio, PharmD, Informatics Clinical Pharmacist Others as appropriate during the rotation Resources for Review and Discussion The Pharmacy Informatics Primer - Doina Dumitru Building Core Competencies in Pharmacy Informatics – Fox, Thrower, Felkey ASHP Goals – Pharmacy Informatics & Technology section related to principles of Informatics Various informatics articles to be determined based on need/experience Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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Clinical Systems – Rotation Description PGY2 Pharmacy Informatics Leslie Mackowiak, RPh, MS Director, EHR Portfolio HealthIT @VUMC Cell: 615.755.4681 [email protected] Learning Experience Description The clinical systems rotation is a four-week block rotation in which the resident becomes familiar with medication use information systems of the medical center. The Resident will develop a basic understanding of Computerized Prescriber Order Entry (CPOE) systems, pharmacy order entry systems, barcoded medication administration systems (BCMA), automated dispensing systems, automation/robotics, outpatient order management, meaningful use, electronic health records along with other current informatics topics. Additionally, the resident may be exposed to system databases, systems interfaces, clinical drug databases, and clinical decision support at a high level. Depending on department initiatives during the rotation, the resident may be involved with the planning and implementation of new systems or upgrades of existing systems. This rotation will also begin the initial conversations regarding the Resident longitudinal project. Throughout the rotation, the resident will develop an understanding of the advantages of electronic systems that enhance clinical medication safety. Learning Experience Goals and Expectations

R1.1 Demonstrate understanding of basic pharmacy informatics principles, standards, and best practices.

R2.1 Evaluate the validity of information and knowledge in the organization’s technology and automation systems.


R3.4 Assure the implementation of documented, formal testing procedures for data and transactional verification and /or validation.

R 4.1 Demonstrate a working knowledge of available technology and automation systems for prescribing medications.


R4.9 Contribute to resolution of identified operational problems. R6.3 Demonstrate the technical skills essential to the role of a pharmacy informatics.

Daily Schedule Required Hours The hours of this month long rotation is typically Monday through Friday, 8-4:30 pm. This can vary depending on the time of year and department requirements, thus the resident should remain flexible as much as possible. The Resident will report to 3401 West End Avenue.


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Required Meetings, as applicable to Pharmacy Informatics: Perioperative Steering Committee Weekly Pharmacy Informatics Group – meets every Tuesday Core Data Management Meeting – every Wed 4P Monthly Informatics Clinical Systems group meeting – third Monday at 3P Monthly Medication Use & Safety Information Committee (MUSIC) Monthly Pharmacy and Therapeutics Committee – monthly Monthly Pharmacy Informatics Steering Committee – monthly Others as determined based on need/experience Learning Experience Requirement/Responsibilities Activity: Objectives Covered: Explain and have general understanding of the various medication use systems of VUMC and Pharmacy, including databases and decision support.

Obj R 1.1 Obj 2.2 Obj 4.1

After understanding the general structure of the medication use systems, identify an opportunity for quality improvement within a medication system.

Obj R 1.1 Obj R 2.1 Obj 4.9

The resident will discuss with preceptor the Best Practices of Informatics and demonstrate a general understanding of how informatics interrelates with clinical pharmacy and medication safety.

Obj R 1.1 Obj 4.6 Obj 6.1

Testing procedures involvement Obj R 3.4 Resources for Review and Discussion ASHP Goals – Pharmacy Informatics & Technology section related to principles of Informatics Best Practices for Health-System Pharmacy (ASHP) Various informatics articles to be determined based on need/experience Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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Clinical Informatics Rotation – Rotation Description PGY2 Pharmacy Informatics Appropriate Clinical Preceptor (May change yearly depending on availability and resident specific interest) Learning Experience Description The clinical rotation is a 4 week block rotation in which the resident becomes familiar with the unique clinical pharmacy practice principles, standards, and best practices that can potentially intersect with pharmacy informatics. The rotation involves provision of in-house pharmaceutical care for an interdisciplinary team. The resident will serve as the drug expert for one team, attending rounds daily and managing the drug therapy for all patients on the team from admission to discharge. Exposure to this component of patient care will broaden the resident’s knowledge base, give understanding of the utility of informatics in patient care, and spark ideas of improvement of the medication sure system. Additionally, the resident will develop a knowledge base of the types of questions to ask the customer in order to most appropriately develop informatics tools to help facilitate the unique and complex medication use process. The rotation may also have an ongoing longitudinal component as projects come out of the rotation that may need further involvement for completion. The resident will be come an integral resource in clinical pharmacy initiatives. Learning Experience Goals and Expectations

R1.2 Evaluate opportunities for improving patient outcomes by improving the safety and quality of the medication-use system through the application of informatics principles, standards, and best practices.



R 4.2 Demonstrate a working knowledge of currently available automated technology for order processing.



R4.5. Demonstrate a working knowledge of currently available automated technology for documenting medication administration.

R6.2 Represent the pharmacy informatics perspective in interaction with the information technology staff, other health care s staff, and/or technology and automation vendors.

Daily Schedule Required Hours The hours of this month long rotation is typically Monday through Friday, 7-3:30 pm. This can vary depending on the time of year and department requirements, or clinical rotation thus the resident should

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remain flexible as much as possible. The Resident will report to Vanderbilt University Medical Center and/or 3401 West End Avenue. Required Meetings, as applicable to Pharmacy Informatics: P & T Committee (VUH or VCH) – monthly Medication Use & Safety Improvement Committee (MUSIC) - monthly Pharmacy Informatics Steering Committee – monthly Evidence Based Medicine meetings - monthly Others as determined based on need/experience Learning Experience Requirement/Responsibilities Core components of the rotation include:

Identification of potential drug therapy problems Design and modification of drug regimens Therapeutic drug monitoring Provision of drug information Patient Counseling Proficiency in relevant primary literature

Activity: Objectives Covered: Effectively use the institution’s technology and automation systems to assist in patient care (StarPanel, HEO, HMM, AdminRx).

Obj R4.1.1-2 Obj R4.2.1-2 Obj R4.3.1-2 Obj R4.4.1-2 Obj R4.5.1-2

Actively participate in multi-disciplinary rounds. Obj R6.2.1-2 Assess pharmacotherapy needs of each patient by developing problem lists, reviewing labs, reviewing vital signs, and assessing appropriateness of medications.

Obj R1.2

Document patient care in Quantifi. Obj R1.2 Document pharmacotherapy consultations in Starpanel for patients with formal pharmacotherapy consults.

Obj R1.2

Provide concise, applicable, comprehensive, and timely responses for drug information requests from patients and healthcare providers.

Obj R6.2

Review primary literature as appropriate for conditions and therapies on daily team patient census.

Obj R2.2

Demonstrate an inquisitive mind by looking up unfamiliar information (lab tests, disease states, procedures etc.).

Obj R 2.2

The resident will work with appropriate staff and committees during this rotation and will represent pharmacy informatics with the highest standards. The resident will be evaluated on the interaction and organization with these groups as well as knowing the underlying principles for creating solutions for unique clinical or medication issues. Manage time to effectively fulfill practice responsibilities.

Obj R6.2.1-2

The resident will be able to explain and have general understanding of the medication use process and understand the need for customization

Obj R 4.1.1-2 Obj R 6.2.1-2

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for specific patient clinical groups. The resident will be involved with designing, testing, education, and implementing unique solutions for a clinical patient population. The resident will understand the Department’s current initiatives, status, and development of these goals related to medication use process. The resident will be actively involved in assisting with prioritization of initiatives and communicating the status of projects to the customers.

Obj R 4.1.1-2 Obj R 6.2.1-2

Resources for Review and Discussion Best Practices for Health-System Pharmacy (most recent edition) ASHP Informatics Goals & Objectives Evidence Based Guidelines for specific disease states (i.e. CHEST, AASLD, AHA, ADA, etc.) Health Care Informatics: A Skills Based Resource ASHP 2006 Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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Clinical Decision Support – Rotation Description PGY2 Pharmacy Informatics Fred Hargrove, DPh Informatics Pharmacist, Manager, Pharmacy Product Group HealthIT @VUMC Office: 615.343.5145 [email protected] Learning Experience Description The clinical decision support rotation is a 4 week block rotation in which the resident becomes familiar with potential types of decision support utilized at this institution, whether general or advanced. Additionally, the resident will develop a knowledge base of the types of questions to ask the customer in order to most appropriately develop the decision support tool. If not already exposed, the resident will be introduced to HL7 coding. The resident does not have to be proficient with HL7 but rather develop a general understanding of the coding of advance decision support. The ultimate purpose is to allow the resident to develop the necessary skills to differentiate which decision support method to utilize as well as the ideal way to create and implement the chosen method of support. It is understood that learning all the details of all decision support methods in one month is impossible, however, this experience is for the resident to obtain a comfort level with the available tools for clinical decision support. This rotation may be repeated in the course of the year in order to be exposed to more in-depth knowledge of decision support tools from a pharmacy informatics perspective. The resident will become an integral resources in the department initiatives for decision support. Learning Experience Goals and Expectations


R1.3 Evaluate opportunities for improving operational efficiencies in order to better serve patient and health professional needs through the application of informatics principles, standards, and best practices.




R4.9 Contribute to resolution of identified operational problems. R6.4 Represent pharmacy informatics concerns in strategic planning for the implementation, use, and

maintenance of technology and automation systems.


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Daily Schedule Required Hours The hours of this month long rotation is typically Monday through Friday, 8-4:30 pm. This can vary depending on the time of year and department requirements, thus the resident should remain flexible as much as possible. The Resident will report to 3401 West End Avenue. Required Meetings, as applicable to Pharmacy Informatics: Weekly Pharmacy Informatics Group – meets every Tuesday Monthly Informatics Clinical Systems group meeting – third Monday at 3P Monthly Medication Use & Safety Information Committee (MUSIC) Weekly Pharmacy Informatics Practice Subcommittee – Weekly on Wed at 8A Monthly Pharmacy Informatics Steering Committee – monthly Evidence Based Medicine meetings - monthly Others as determined based on need/experience Learning Experience Requirement/Responsibilities Activity: Objectives Covered: The resident will be able to explain and have general understanding of the types of clinical decision support available for customization at this institution as well as commercially available support. The resident will be involved with designing, testing, education, and implementing ideal decision support for priority requests during the rotation time period.

Obj R1.2.1-6

The resident will work with appropriate staff and committees during this rotation and will represent pharmacy informatics with the highest standards. The resident will be evaluated on the interaction and organization with these groups.

Obj R2.2; R 1.3

The resident will understand the Department’s current initiatives, status, and development of these goals related to decision support projects. The resident will be actively involved in assisting with prioritization of initiatives and communicating the status of projects to the customers.

Obj R2.1.1-2

Meet with Evidence Based Medicine (Tina French) to be introduced to EBM procedures and resources used to create and review disease/condition related order sets

Obj R2.2

Meet with Pharmacy Clinical Staff (Bob Lobo/Blair Miller) who maintain rules and utilize reports from the surveillance program. Compare commercial surveillance software to locally developed dashboards. The resident should be able to identify advantages and disadvantages of commercial and local surveillance programs.

Obj R4.6.1-2

Participate in the evaluation of pharmacy informatics requests and make recommendations on the best method for addressing the issue/request.

Obj R 4.9

During a clinical pharmacy rotation experience, the resident will observe how informatics resources are used within the clinician workflow and identify a clinical issue that may be resolved or improved with an informatics solution. The resident will make recommendations and develop requirements with a clinical sponsor and present the proposal to the

Obj R2.2.1-2; R1.3

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pharmacy informatics team. Resources for Review and Discussion Best Practices for Health-System Pharmacy (most recent edition) ASHP Goals Health Care Informatics: A Skills Based Resource ASHP 2006 Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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Data Management & Smart Pumps – Rotation Description PGY2 Pharmacy Informatics Fred Hargrove, DPh Informatics Pharmacist, Manager, Pharmacy Product Group HealthIT @VUMC Office: 615.343.5145 [email protected] Learning Experience Description The data management rotation is a four-week block rotation in which the resident becomes familiar with the benefits and limitations of systematically processing data, information, and knowledge in health care. The resident will understand and comprehend the impact of data quality on health outcomes as well as some legal and ethical issues pertaining to health information. The Resident will develop a basic understanding of pumps such as infusion, PCA, micro-infusion, and software reporting and monitoring tools available with certain pump vendors. Depending on department initiatives during the rotation, the resident may be involved with the analysis of how new technology can integrate with existing hardware devices, or possible analysis of upgrades of existing systems. Throughout the rotation, the resident will develop an understanding of the advantages of electronic systems that enhance medication safety. Learning Experience Goals and Expectations



R 3.2 Support efforts to assure the interoperability of technology and automation systems that interface with those of outside organizations.


R 4.8 Demonstrate a working knowledge of emerging technology and automations system that assist with the medication-use system.

R4.9 Contribute to resolution of identified operational problems. Daily Schedule Required Hours The hours of this month long rotation is typically Monday through Friday, 8-4:30 pm. This can vary depending on the time of year and department requirements, thus the resident should remain flexible as much as possible. The Resident will report to 3401 West End Avenue. Required Meetings, as applicable to Pharmacy Informatics: Technical Problem Meeting – daily at 1PM Core Data Availability Meeting – every Wed 4P Weekly Pharmacy Informatics Group – meets every Tuesday


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Monthly Informatics Clinical Systems group meeting – third Monday at 3P Others as determined based on need/experience. Learning Experience Requirement/Responsibilities Activities: Objectives covered: Describe the importance of data management and information in pharmacy

and healthcare systems. Explain how data is stored allowing roll backs, data redundancy, updates, etc. Explain the role of a DBA (database administrator). Understand how a DBA maintains and ensures systems function at all times

(e.g. storage capability, increasing table space, etc.). Explain what stresses a database and how performance/usage is, should and

can be monitored. Discuss the benefits and limitations of systematically processing data,

information, and knowledge in health care. Explain the design of a commercial dB and why separate schemas/views were

created to accommodate specific functions. (e.g. to support HMM labels, reports, displays).

Explain and have general understanding of the various hardware components that comprise the clinical applications used at VUMC and Pharmacy, including applications, databases and interfaces, and also including items such as ADMs.

R Obj 2.1

Describe the core components of database management systems. The resident will discuss with preceptor the Best Practices of Informatics and

demonstrate a general understanding of how hardware is interrelated with system operability.

R Obj 1.3

Participate in an upgrade event that requires analysis, planning, testing, and a contingency plan.

R Obj 4.9

Explain necessary dynamics of FDB (First Data Bank) database. How does HMM data get to the EDW (Enterprise Data Warehouse). Explain how information is used to support Senti7 database and rules that

support clinical monitoring.

R Obj 4.6

Describe and understand tips on efficient queries and what to avoid. Explain how databases are queried and the tools used to execute the queries. Explain data export and how queries can be used in the applications. Demonstrate ability to write simple select queries. Analyze an existing HMM query for refinement; ex. Drug-drug interactions vs.

FDB user defined info. Query the CPOE db for a specific med and frequency of use in response from a

pharmacy data request. Work with HMM rules to understand how tables and databases are structured

and understand process to troubleshoot if/when data is corrupt. Understand patient specific decision support (Shiitake) dosing and Portobello

(orderable items for CPOE) databases.

R Obj 1.3 R Obj 2.1 R Obj 4.9

Resident will learn the inner workings of how smart pump technology is used for safe administration of medications.

R Obj 4.8.1

The resident will interact and have basic understanding of how the various libraries have been configured to avoid adverse outcomes.

R Obj 3.2.1 R Obj 4.4.1-2

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Describe the basic functionality of how a library is set up, maintained and the library update process.

R Obj 4.8.1

The resident will learn how to access and interpret the CQI data received from pumps and how that data can translate in a safer medication use process.

Identify opportunities to refine the library to minimize and target effective alerts for nursing staff.

R Obj 4.5.1-2 R Obj 4.8.1 R Obj 4.9.1

Activities Meet key members of IT team to discuss; IT Role, Team, Accomplishments, Issues, ‘what keeps them awake at night’, projects. Topic Names Other Data Mining, EDW, Enterprise Rx, Matt Marshall, PharmD Therapeutic Monitoring, Pharmacy OneSource Pratish Patel, PharmD HCI Ops database, Crystal Reports, monitoring reports, other

Johniene Doran Chip MacDonald

Oracle database Victoria Zhislin HIPAA, Privacy Linda Campbell AcuDose, Pandora, DoseEdge and other robotics Brian Daugherty, Andrea

Bryant, Liesl Smith, Judy Doan

Pump CQI, CareFusion infusion, Hospira PCA Phillip Stewart Potential projects: Data from Med Admin time changes – HMM rule evaluations; now and stat priorities

AdminRx/HED team, Nancy Rudge

Meaningful Use – tracking dispenses and admins and report that out in eMar fashion if actual admin occurred.

EDW team, Matt Marshall

HEO data validation Wing Liu, Mike Caudil FDB data management David DiPersio Resources for Review and Discussion Introduction to Hospital & Health-System Pharmacy Practice- Holford, Brown Health Care Informatics: A Skills=Based Resource - Felkey, Fox, Thrower The Pharmacy Informatics Primer - Dumitru ASHP Goals – Pharmacy Informatics & Technology section related to principles of Informatics Various informatics articles to be determined based on need/experience Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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Clinical Decision Support II – Rotation Description PGY2 Pharmacy Informatics Wing Liu, PharmD Informatics Pharmacist, Clinical Analyst, Order Product Group HealthIT @VUMC O: 615.875.8930 C: 615.812.0366 [email protected] Learning Experience Description The clinical decision support rotation is a 4 week block rotation in which the resident becomes familiar with potential types of decision support utilized at this institution, whether general or advanced. Additionally, the resident will develop a knowledge base of the types of questions to ask the customer in order to most appropriately develop the decision support tool. If not already exposed, the resident will be introduced to understanding HL7 syntax. The resident does not have to be proficient with HL7 but rather develop a general understanding of the coding of advance decision support. The ultimate purpose is to allow the resident to develop the necessary skills to differentiate which decision support method to utilize as well as the ideal way to create and implement the chosen method of support. It is understood that learning all the details of all decision support methods in one month is impossible, however, this experience is for the resident to obtain a comfort level with the available tools for clinical decision support. This rotation may be repeated in the course of the year in order to be exposed to more in-depth knowledge of decision support tools from a pharmacy informatics perspective. The resident will be come an integral resources in the department initiatives for decision support. Learning Experience Goals and Expectations





R4.9 Contribute to resolution of identified operational problems. R 6.1 Demonstrate the personal skills and abilities of a pharmacy informatics leader. R 6.2 Represent the pharmacy informatics perspective in interactions with the information

technology staff, other health care staff, and /or technology and automation vendors. R6.4 Represent pharmacy informatics concerns in strategic planning for the implementation, use, and

maintenance of technology and automation systems.


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Daily Schedule Required Hours The hours of this month long rotation is typically Monday through Friday, 8-4:30 pm. This can vary depending on the time of year and department requirements, thus the resident should remain flexible as much as possible. The Resident will report to 3401 West End Avenue. Required Meetings, as applicable to Pharmacy Informatics: Weekly Pharmacy Informatics Group – meets every Tuesday Monthly Informatics Clinical Systems group meeting – third Monday at 3P Monthly Medication Use & Safety Information Committee (MUSIC) Weekly Pharmacy Informatics Practice Subcommittee – Weekly on Wed at 8A Monthly Pharmacy Informatics Steering Committee – monthly Evidence Based Medicine meetings - monthly Others as determined based on need/experience Learning Experience Requirement/Responsibilities Activity: Objectives Covered: The resident will be able to explain and have general understanding of the types of clinical decision support available for customization at this institution as well as commercially available support. The resident will be involved with designing, testing, education, and implementing ideal decision support for priority requests during the rotation time period.

Obj R1.2.1-6

The resident will work with appropriate staff and committees during this rotation and will represent pharmacy informatics with the highest standards. The resident will be evaluated on the interaction and organization with these groups.

Obj R2.2; R 1.3

The resident will understand the Department’s current initiatives, status, and development of these goals related to decision support projects. The resident will be actively involved in assisting with prioritization of initiatives and communicating the status of projects to the customers.

Obj R2.1.1-2

Meet with Evidence Based Medicine (Tina French) to be introduced to EBM procedures and resources used to create and review disease/condition related order sets

Obj R2.2

Meet with Pharmacy Clinical Staff (Bob Lobo/Blair Miller) who maintain rules and utilize reports from the surveillance program. Compare commercial surveillance software to locally developed dashboards. The resident should be able to identify advantages and disadvantages of commercial and local surveillance programs.

Obj R4.6.1-2

Participate in the evaluation of pharmacy informatics requests and make recommendations on the best method for addressing the issue/request.

Obj R 4.9

During a clinical pharmacy rotation experience, the resident will observe how informatics resources are used within the clinician workflow and identify a clinical issue that may be resolved or improved with an informatics solution. The resident will make recommendations and develop requirements with a clinical sponsor and present the proposal to the pharmacy informatics team.

Obj R2.2.1-2; R1.3

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Resources for Review and Discussion Best Practices for Health-System Pharmacy (most recent edition) ASHP Goals Health Care Informatics: A Skills Based Resource ASHP 2006 Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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Medication Safety – Rotation Description PGY2 Pharmacy Informatics Terry Bosen, PharmD Medication Safety Officer Office: 615.343.0832 Cell: 615.714.4689 [email protected] Learning Experience Description The Medication Safety Rotation is a four-week block rotation in which the resident is involved in reading, discussion, committee meetings, and projects related to medication safety, process improvements, and mitigation of risk. The resident will have opportunities to develop their understanding of medication safety issues in hospitals and clinics. This rotation will help the resident to have a more clear understanding of the role and responsibilities of a Medication-Safety Officer in a health-system setting. Through this unique rotation, residents gain experience in various methodologies used to measure medication-use safety, participate in the application of technologies that improve the medication-use process, learn and apply methods to promote a culture of safety, analyze complex systems to identify opportunities for improvement, develop effective communication techniques and understand the many human-factors that impact the safety of patient care. The underlying focus of the rotation with the PGY2 informatics resident will be geared toward medication safety as it relates to pharmacy informatics and associated clinical systems.

Learning Experience Goals and Expectations

R1.1 Demonstrate understanding of basic pharmacy informatics principles, standards and best practices.




R4.5 Demonstrate a working knowledge of currently available technology for documenting medication administration.

R4.8 Demonstrate a working knowledge of emerging technology and automation systems that assist with the medication–use system.

R5.4. Report the findings of a technology or automation system project. R6.3 Demonstrate the technical skills essential to the role of a pharmacy informatics. R6.4 Represent pharmacy informatics concerns in strategic planning for the implementation, use,

and maintenance of technology and automation systems. E1.1 Design, executes, and report results of investigation of pharmacy informatics-related issues.


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Daily Schedule Required Hours The hours for this 4 week rotation are typically Monday through Friday, 8 am - 4:30 pm. This can vary depending on the time of year and department requirements, thus the resident should remain flexible as much as possible. Required Medication Safety Meetings, as applicable to Pharmacy Informatics See meetings listed in chart below under activities. A specific meeting schedule will be developed at the beginning of the rotation for each resident based on current institutional safety priorities. Learning Experience Requirement/Responsibilities/Activities Meet key members of medication safety & quality leaders and pharmacy administration to discuss the role of medication safety in the organization, process improvements and accomplishments, system gaps and opportunities for improvement, ‘what keeps them awake at night’, current projects. Topic Leader Goals

Evaluated General medication safety introduction: -Medication Use Process -Gap Analysis -Self Assessments -High Alert Medications -Hazardous Medications -Look-Alike, Sound-Alike Medications -Tallman Lettering Activities Explain the organization’s medication use system and its vulnerabilities to ADEs. Analyze the structure, process, and measure outcomes of Med Use system. Identify opportunities for improvement in the med use system comparing to best practice.

Readings Mark Sullivan Sheree Foster

R1.1 R1.2 R4.2 R4.4 R4.5 R4.8 R6.3 R6.4 E1.1

Occurrence reporting and review process: -internal events (near misses and adverse events) -proactive external event review (ISMP, others) Activities Review weekly report for Pharmacy Directors meeting/discussion – Mon 1P, attend meeting for an overview of problems that have been reported since last meeting.

Terry Bosen

R1.2 R6.4 E1.1

Event Analysis—EA (Root Cause Analysis) -Resident will be involved with an EA if timing is appropriate; otherwise will be topic discussion. Activities Meet to discuss and have the ability to explain the process and philosophy of monitoring and understanding event analysis of a

Quality, Safety and Risk Prevention Kim Domaradzki Pam Bruce

R1.2 R6.4 E1.1

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ADE event. Document a SBAR for that process. General policy structure and medication-specific policies: -Medication Management standards -National Patient Safety Goals (NPSG) -Regulatory compliance; accreditation and standards -TJC preparation and process Activities Meet to discuss and understand the Pharmacy policy structure and how that supports Medication safety.

Sheree Foster R1.1 R1.2

Medication Safety Meetings: (Included but not limited to the meetings listed. Other pertinent meetings will be required based on priorities) -Adult Medication Use and Safety Improvement Committee (MUSIC) -Children’s Medication Use and Safety Improvement Committee (MUSIC) -ADE peer review committee - adult -Event analysis group - VCH -Pharmacy & Therapeutics Committee (VUMC P&T) -Pharmacy Safety Committee -Pharmacy Policy Committee -Pharmacy Directors / Management meetings -Pain Collaborative Oversight Committee (PCOC) -Pharmacy Informatics Steering Committee* - Vanderbilt Diagnostic Imaging & Pharmacy (VDIP) – formerly Radiology Pharmacy Committee Activities Attend relevant meetings to hear, understand and distinguish how pharmacy safety is promoted based on a specific event or a desire to enhance compliance for the enterprise.

Others TBD Cathy Oleis/ Jay Morrison Amy Potts/ Autumne Bailey Terry Bosen Autumne Bailey Jim Koestner Mark Sullivan Sheree Foster Jim Hayman Mark Huntoon/ Autumne Bailey Fred Hargrove Sheree Foster

R1.2 R4.2 R4.4 R4.5 R4.8 E1.1

Med Safety Rotation Project(s): At least one significant project will be required involving a medication safety process improvement requiring pharmacy informatics knowledge. This project will be presented to informatics peers and others if time permits. -Other smaller tasks/projects will be assigned based on institutional safety priorities. Activities Work with a relevant Informatics resource to address a med safety concern that can be further understood and related back to practicing pharmacists for enhanced safety practice.

Terry Bosen R4.8 R5.4 R6.3 E1.1

Medication Safety-Related Organizations/Best Practices: -Institute for Safe Medication Practices (ISMP) -The Leapfrog Group for Patient Safety - Agency for Healthcare Research and Quality (AHRQ)

Readings Leslie Mackowiak Mark Sullivan

R1.1 R1.2

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-Institute for Healthcare Improvement (IHI) -National Patient Safety Foundation (NPSF) -American Society of Health-System Pharmacists (ASHP) -U.S. Food & Drug Administration (FDA), safety alerts, MedWatch, RASMAS -Institute of Medicine (IOM) -The Joint Commission (TJC) – medication management standards, national patient safety goals Activities Attend relevant meetings to hear, understand and distinguish how pharmacy safety is promoted based on a specific event or a desire to enhance compliance for the enterprise.

Bob Lobo Michael O’Neal Sheree Foster

Smart Pumps: -CQI data analysis -Guardrails - Medication Safety Project Activities Participate and become knowledgeable of the smart pump library dynamics and library push process.

Phillip Stewart R1.1 R4.4 R4.8

Pharmacist Interventions (Sentri7), Clinical Alerts Metrics / Benchmarking / Dashboards related to medication safety or medication management Activities Become familiar and demonstrate understanding of the process that clinical pharmacists use to monitor therapeutics using available monitoring systems.

Bob Lobo Terry Bosen

R1.1 R4.2 R6.3 R6.4

Human Factors Safety Science (CRISS team) Activities Set up and attend a 1 hour case review to have basic understanding and ability to demonstrate how human factors influence intersect with Pharmacy Informatics.

Readings Matt Weinger, MD

R1.1

Just Culture / High Reliability Organizations – keeping staff accountable without punitive actions Activities Meet to discuss and have the ability to explain the process and philosophy of monitoring and supporting affected staff when ADE or related events occur.

Readings

R1.1

Resources for Review and Discussion

Failure Modes and Effects Analysis (FMEA) - Resident will be involved with an FMEA if timing is appropriate; otherwise will be topic discussion.

Institute of Medicine (IOM) report: To Err is Human: Building a Safer Health System, 2000. Preventing Medication Errors: Quality Chasm Series, Institute of Medicine, 2007. Best Practices for Health-System Pharmacy (most recent edition) ISMP Guidelines on the Use of Smart Infusion Pumps (safe implementation and use) ISMP as applicable via Medication Management meetings TJC Sentinel Event Alerts related to Medication Management

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Hospital Policy and Procedure Manual Pharmacy Policy and Procedure Manual Manual of Regulatory and Safety Bodies (prepared by VUMC pharmacy) TJC Comprehensive Accreditation Manual for Hospitals Rotation binder of topic discussions and reading materials related to medication safety and

rotation schedule will be provided by preceptor during first week of rotation. Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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Technical Concepts – Rotation Description PGY2 Pharmacy Informatics David Mulherin, PharmD, BCPS Informatics Pharmacist, Pharmacy Product Group HealthIT @VUMC Office: 615.875.9803 Cell: 731.695.9575 [email protected] Learning Experience Description The technical concepts rotation is a four-week block rotation in which the resident becomes familiar with automated dispensing machines, pharmacy distribution automation and their supported servers, interface logic and workflow, hardware configuration and necessary support and maintenance, ITSM (Information Technological Service Management) and ITIL (IT Infrastructure Library) and the integration of the enterprise related systems. Systems evaluated may include automated dispensing machines, and pharmacy dispensing automation. Learning Experience Goals and Expectations


R3.1 Assure the accurate and efficient flow of data between the organization’s technology and automation systems.

R3.3 Guard the confidentiality and security of health data stored in the health care organization’s database.

R4.9 Contribute to resolution of identified operational problems. R6.3 Demonstrate the technical skills essential to the role of a pharmacy informatics. R6.4 Represent pharmacy informatics concerns in strategic planning for the implementation, use, and

maintenance of technology and automation systems. Daily Schedule Required Hours The hours of this month long rotation is typically Monday through Friday, 8-4:30 pm. This can vary depending on the time of year and department requirements, thus the resident should remain flexible as much as possible. The Resident will report to 3401 West End Avenue. Required Meetings, as applicable to Pharmacy Informatics: Problem Meeting – daily Core Data Availability Meeting – every Wed Weekly Pharmacy Informatics Group – meets every Tuesday Monthly Informatics Clinical Systems group meeting – third Monday Monthly Pharmacy Informatics Steering Committee – monthly Monthly EHR – meets 2nd Tuesday Others as determined based on need/experience


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Learning Experience Requirement/Responsibilities Explain and have general understanding of the various hardware components that comprise the clinical applications used at VUMC and Pharmacy, including applications, databases and interfaces, and also including items such as ADMs . Participate in an upgrade event that requires analysis, planning, testing, and a contingency plan. The resident will discuss with preceptor the Best Practices of Informatics and demonstrate a general understanding of how hardware is interrelated with system operability. Activities Meet key members of IT team to discuss; IT Role, Team, Accomplishments, Issues, ‘what keeps them awake at night’, Projects. Topic Names Other Network Security, Firewalls, Virtual Machines Discuss and comprehend data security, encryption, HIPAA, privacy issues

Lane Reams R Obj 3.1 R Obj 3.3

Security Discuss and comprehend confidentiality and security regarding information stored in databases.

Position in transition R Obj 3.1 R Obj 3.3

Servers & Storage Discuss accurate and efficient flow of data between systems with IT leaders.

Darryl Boone, Ted Anders, Lee Knight

R Obj 2.1 R Obj 3.1 R Obj 3.3 R Obj 6.4

Integration & GIE Obtain an understanding of how interfaces are used, constructed, maintained, and customized to facilitate communications among key applications or systems.

Randy Bates, C L McKinney

R Obj 6.3

Computer Operations Data Center

Jon Strong

HC Operations Discuss and comprehend the commons functions, workings and considerations of hardware, servers, and configs.

Craig Bailey R Obj 2.1 R Obj 3.1 R Obj 3.3 R Obj 6.4

Development, Architecture Discuss and comprehend the flow of allergy data between key systems such as StarPanel, HMM, HEO, ex PSS integration

Jeff Byrd R Obj 2.1 R Obj 3.1 R Obj 3.3

Data Warehouse Observe and comprehend how data is

Eric Griffin, Scott McConnell

R Obj 6.3

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collected, aggregated, mined and depersonalized. Who uses this data? ITIL, Service Change Discuss and develop an understanding of change management and considerations for these processes.

Alan Cantrell R Obj 3.3 R Obj 6.4

Problem Management, CMBD, CI (configuration item) Discuss and develop an understanding of problem management and consideration of these processes.

Andrew Hutchison R Obj 3.1 R Obj 3.3

CWS Desktop, Client Integrative Systems Meet to discuss and comprehend an understanding of CWS and the need for a standardized work stations. How does remote computing relate to this?

Dave Hardy

Disaster Recovery Discuss and develop an understanding of the need for DR, what is involved in the planning contingencies, and how the DR team helps manage events during DT events.

Kevin Chenoweth R Obj 2.1

Health Language Discuss and understand what the term Health Language means and is used for in this context.

Steven Clark & Trent Rosenbloom

R Obj 6.4

Development Teams Develop an understanding of how the development team works, plans work, and determines priorities.

Mark Arrietta, Wing Liu, Dario Guise, Dan Albert, VOIS team

R Obj 6.4

Regulatory requirements, Regulatory issues such as Meaningful Use and certification efforts. Discuss and have an understanding of regulatory issues, meaningful use and certification efforts.

Eric Boehme R Obj 3.3

Resources for Review and Discussion ASHP Goals – Pharmacy Informatics & Technology section related to principles of Informatics Various informatics articles to be determined based on need/experience Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be

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provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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EHR and Vendor Relations – Rotation Description PGY2 Pharmacy Informatics Phillip W. Stewart, DPh Pharmacy Informatics, Pharmacy Product Group HealthIT @VUMC Office: 615.936.2930 Cell: 615.829.1347 [email protected] Learning Experience Description The EHR & vendor relations rotation is a four-week block rotation in which the resident becomes familiar with bar coded medication administration and vendor relations that are a dynamic part of the informatics and the medical center. The Resident will become familiar with strategic testing, planning, and implementation of major initiatives. Depending on department initiatives, the resident may be involved with analysis of how new vendor technology can integrate existing systems and devices, upgrades of existing systems and a general understanding of the uniqueness of having direct vendor involvement between the customer client and the vendor business perspective. The Resident will develop a basic understanding of the electronic nursing flowsheet, eMAR and other related aspects of the electronic patient record. Throughout the rotation, the resident will develop an understanding of the advantages of electronic systems that enhance medication safety. Learning Experience Goals and Expectations

R 3.2 Support efforts to assure the interoperability of technology and automation systems that interface with those of outside organizations.

R 4.4 Demonstrate a working knowledge of currently available technology or automation for the safe and efficient administration of medications.

R 4.5 Demonstrate a working knowledge of currently available automated technology for documenting medication administration.

R 4.8 Demonstrate a working knowledge of emerging technology and automation systems that assists with the medication-use system.

R 4.9 Contribute to resolution of identified operational problems. R 5.1 Contribute to planning for acquisition and implementation of significant technology or

automation initiatives involving the pharmacy department. R 5.2 Participate in the implementation of a technology or automation system. R 5.3 Participate in contingency planning. R 6.4 Represent pharmacy informatics concerns in strategic planning for the implementation use, and

maintenance of technology and automation systems. E 1.1 Design executes, and report results of investigations of pharmacy informatics-related issues.

Daily Schedule Required Hours The hours of this month long rotation is typically Monday through Friday, 8-4:30 pm. This can vary depending on the time of year and department requirements, thus the resident should remain flexible as much as possible. The Resident will report to 3401 West End Avenue.



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Required Meetings, as applicable to Pharmacy Informatics: Weekly Pharmacy Informatics Group – meets every Tuesday Monthly Medication Use & Safety Information Committee (MUSIC) Monthly Pharmacy Informatics Steering Committee – monthly Others as determined based on need/experience Learning Experience Requirement/Responsibilities Activity: Objective covered: The resident will be able to explain and demonstrate general understanding of the structure and operations of the vendor role as it relates to the VUMC enterprise. This might include goals, projects and development initiatives.

R Obj 3.2.1 R Obj 4.8.1 R Obj 4.9.1

The resident will be involved with the project life cycle of a significant or relevant initiative for a vendor system at the discretion of the preceptor.

R Obj 3.2 R Obj 5.1.1-6 R Obj 5.2.1-4

The resident will understand the involvement with downtime planning and recovery for internal and external systems. Meet with a member of the Disaster Recover Team to comprehend and understand best practices for downtime (DT) planning for scheduled and unscheduled events for core patient care systems.

R Obj 5.3.1-3

The resident will be expected to participate in the QA process for new systems, upgrades or change requests. Document the process for discussion and application.

R Obj 4.9.1 R Obj 5.1.1-6 R Obj 5.2.1-4

The resident will learn how BCMA, EHR, and nursing documentation is working to enhance medication use process.

R Obj 4.4.1-2 R Obj 4.5.1-2 R Obj 4.8.1

The resident will learn how modifications of EHR can enhance alerts and identify opportunities for quality improvement for nursing during medication administration.

R Obj 4.8.1 R Obj 4.9.1

Resident will discuss Best Practices of Informatics and demonstrate a general understanding of how informatics can enhance various components of the EHR and how this drives initiatives.

R Obj 1.2.1-6

Suggested Activities (but not limited to): Interactions with OB Fetal Monitoring – DAS to StarPanel IVs – LVP to IT pathway Order Tracker info/workflow Pneumovax to Prevnar Med Rec work StarPanel projects Meds Editor BCMA in Peds ED VOIS

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Contacts: Deborah Arriosto, RN HED Team McKesson Team Resources for Review and Discussion ASHP Goals – Pharmacy Informatics & Technology section related to principles of Informatics Health Care Informatics: a Skills-Based Resource, Chapter 7 Point of Care Technology The Pharmacy Informatics Primer, Chapter 6 (BCMA) & 7 (Smart Pump Technology) Introduction to Hospital & Health-System Pharmacy Practice Various informatics articles to be determined based on need/experience Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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Ambulatory – Rotation Description PGY2 Pharmacy Informatics David Mulherin, PharmD, BCPS Informatics Pharmacist, Pharmacy Product Group HealthIT @VUMC Office: 615.875.9803 Cell: 731.695.9575 [email protected] Learning Experience Description The ambulatory rotation is a four-week block rotation in which the resident learns about the basics of systems at VUMC which support the use of medications in the ambulatory setting. Comparisons and contrasts of will be done of issues within clinical decision support between inpatient and ambulatory systems. The resident will become familiar with all of the Vanderbilt ambulatory systems and understand the unique issues encountered in supporting those systems. The resident will familiarize with the informatics issues encountered in transition of care between ambulatory and inpatient settings and strategies to manage them as well as HIE and its role in patient care. Learning Experience Goals and Expectations

R1.2 Evaluate opportunities for improving the safety and quality of the medication-use system through the application of informatics principles, standards, and best practices.

R3.2 Support efforts to assure the interoperability of technology and automation systems that interface with those of outside organizations.

R4.1 Demonstrate a working knowledge of available technology and automation systems for prescribing medications.



R4.4 Demonstrate a working knowledge of currently available technology or automations for the safe and efficient administration of medications.


R4.9 Contribute to resolution of identified operational problems. R5.2 Participate in the implementation of a technology or automations system. R 6.4 Represent pharmacy informatics concerns in strategic planning for the implementation, use and

maintenance of technology and automation systems. E1.1 Design, execute, and report results of investigations of pharmacy informatics related problems.

Daily Schedule Required Hours The hours of this month long rotation is typically Monday through Friday, 8-4:30 pm. This can vary depending on the time of year and department requirements, thus the resident should remain flexible as much as possible.


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Required Meetings, as applicable to Pharmacy Informatics: Problem Meeting – daily at 1PM Core Data Availability Meeting – every Wed 4P Weekly Pharmacy Informatics Group – meets every Tuesday Monthly Informatics Clinical Systems group meeting – third Monday at 3P Monthly Pharmacy Informatics Steering Committee – monthly Others as determined based on need/experience Learning Experience Requirement/Responsibilities Activities Objectives Covered: Explain and have general understanding of the various components that comprise the clinical outpatient driven applications used at VUMC and Pharmacy, including applications, databases and selected interfaces.

R Obj 3.2.1 R Obj 4.1.1-2 R Obj 4.2.1-2

Understand the basics of systems which support the use of medications in the ambulatory setting.

R Obj 3.2.1 R Obj 4.1.1-2 R Obj 4.2.1-2

Compare and contrast the issues within clinical decision support between inpatient and ambulatory systems.

R Obj 1.2.1-6 R Obj 4.1.1-2 R Obj 4.2.1-2

Understand all of the Vanderbilt ambulatory systems and understand the unique issues encountered in supporting ambulatory systems.

R Obj 3.2.1 R Obj 4.1.1-2 R Obj 4.2.1-2 R Obj 4.3.1-2 R Obj 4.4.1-2 R Obj 6.4.1

Understand the informatics issues encountered in transition of care between ambulatory and inpatient settings and strategies to manage them.

R Obj 4.9.1 E Obj 1.1

Understand what is HIE and its role in patient care. R Obj 1.2.1-6 Meet key members of any IT team that relate to any ambulatory or outpatient systems that influence interoperability for these related systems. (see additional IT Individuals table)

R Obj 3.2.1 R Obj 4.1.1-2 R Obj 4.2.1-2 R Obj 4.3.1-2 R Obj 4.4.1-2 R Obj 4.7.1-2 R Obj 5.2.1-4 R Obj 6.4.1

IT Individuals Topic Names Other Rx Star/ePrescribing Shane Stenner, MD

Rachel Lassiter

SureScripts Part of RxStar and review of website

Outpatient Pharmacy System Rusty Catlin Leslie Mackowiak

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Will Walker Phillip Stewart

Ambulatory Systems Wendy Kiepek Discharge Wizards? Leslie Mackowiak VOIS Julia Cartwright Specialty Pharmacy Jerry Buller VMG Pharmacy Hayley Rector

Scott Thompson

Med Reconciliation Leslie Mackowiak HIE Dr. Mark Frisse Transitions of Care Leslie Mackowiak Resources for Review and Discussion ASHP Goals – Pharmacy Informatics & Technology section related to principles of Informatics Various informatics articles to be determined based on need/experience Method of Evaluation Evaluation of residents will be based on the Resident Learning System (RLS). Evaluation will consist of a summative evaluation upon rotation completion, in addition to any criteria-based checklists submitted by the resident. The specific goals and objectives, on which the resident will be evaluated, will be provided at the beginning or the rotation. Residents will be requested to complete a self-evaluation for all evaluation. Residents will also be required to complete a learning experience evaluation and a preceptor evaluation. Evaluations are completed in the evaluation database. All work to be evaluated on rotation must be turned in for review no later than the last day of the rotation.

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Therapeutic Exchange Learning Experience Contact person: Phillip Stewart, DPh Preceptor: To be determined by resident depending on topic Office: 615-936-2930

General Description The purpose of Therapeutic Exchange is for the resident to prepare and present a 60 minute continuing education presentation. The presentation should be on a pharmacotherapy topic that includes some controversy and/or is a hot topic in pharmacotherapy. Primary literature is to be used as a guiding force to put this presentation together.

This will be an ACPE accredited CE program. The CE presentation will be presented to clinical and operational pharmacists in 2 separate sessions. The presentation series is scheduled for Thursdays at 12:00p and 2:00p. Goals and Objectives The goals selected to be taught and evaluated during this learning experience include:

Goal R5.1: Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.

Goal E7.2: Communicate effectively Activities The activities assigned to this learning experience reflect the activities a pharmacist working in this environment is expected to be able perform. These activities were also selected to help you work toward achieving specific objectives which in turn will help you achieve the goals assigned to the learning experience.

Activity Objectives Covered

Design and organize 60 minute continuing education program to be presented to the Department of Pharmaceutical Services at their weekly CE Seminar Design active learning techniques to keep the audience intrigued and engaged

OBJ R5.1.1 OBJ R5.1.4 OBJ R5.1.5 OBJ R5.1.6

Present a 60 minute presentation engaging the audience and communicating clearly Accurately determine the depth of communication appropriate to one's audience.

OBJ E7.2.1 OBJ E7.2.2

Preceptor Interaction The resident will be assigned an evaluator based on the topic selected for presentation. This person is responsible for meeting with the resident prior to the presentation to instruct and assist in the presentation design, evaluate the resident during their presentation, meeting with the resident after the presentation to review other evaluations, and completing a ResiTrak evaluation.

Evaluation Strategy There will be a formal evaluation through ResiTrak for this Learning Experience. The preceptor will meet with the resident after the presentation to review others’ evaluations and to formally discuss the presentation.

Timeline for the Experience The resident will pick their topic in early July. It is the responsibility of the resident to contact their preceptor and set up meeting and evaluation times before the assigned presentation date. All presentations will be in assigned in the Fall.

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Appendix G: PTO Request Procedures

Purpose: To ensure that pharmacy services are provided 365 days per year by Clinical Pharmacists or

Residents in order to prevent service disruptions that could impact patient safety.

1. PTO Request Process

a. Email RPD by the 10th of the month to request time off for the following month. Earlier

notification is preferred. The RPD will check with the assigned preceptor regarding any time off

requests.

b. RPD will communicate PTO to the appropriate staff if approved.

2. Holidays

a. Vanderbilt recognizes 7 holidays: New Year’s Day, Memorial Day, July 4th, Labor Day,

Thanksgiving Day, Christmas Eve and Christmas day. It is assumed that PTO will be used on

these holidays. If you wish to or are assigned to work one of these holidays, advance

notification is required

b. Holiday work is scheduled in advance by Molly Knostman

c. When a holiday is worked on a regular work day (M-F), no Off Day is taken and no PTO is

deducted. If you work a holiday on a weekend, an Off Day will be taken, and no PTO deducted.

d. Holidays may be traded with other residents, but must be approved by Molly and the RPD.

e. Off Days during the week of Christmas and Thanksgiving are not scheduled without approval in

order to ensure appropriate coverage.

3. Sick Call Process

a. Email or call Fred Hargrove, and Phillip Stewart.

b. Email your current preceptor.

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