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Residency Manual

2020-2021

Cleveland Clinic Indian River Hospital Department of Pharmacy Services

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TABLEOFCONTENTS 1.0 General

1.1 Definition 1.2 Philosophy and Purpose 1.3 ASHP Accreditation 1.4 Qualifications of Resident 1.5 Residency Faculty Structure 1.6 Acceptance Into the PGY-1 Pharmacy Residency Program 1.7 Resident Statement of Agreement

2.0 General Information

2.1 Residency Overview 2.2 Residency Benefits 2.3 Pharmacist Licensure 2.4 Required Meetings 2.5 Staffing Requirements 2.6 CCIRH Policies and Procedures 2.7 Resident Holidays 2.8 Duty Hours 2.9 Resources

3.0 PGY-1 Pharmacy Residency Required and Elective Experiences

3.1 Syllabus with Learning Experiences and Required Readings 3.2 Required Clinical Rotations 3.3 Elective Rotations 3.4 Longitudinal Experiences 3.5 Teaching Requirements 3.6 Resident Schedule

4.0 PGY-1 Pharmacy Residency Expectations and Residency Requirements

4.1 Professional Practice 4.2 Residency Requirements 4.3 Determination of Graduation

5.0 Presentations

5.1 Continuing Education Presentations 5.2 Pharmacy Presentations

5.2.1 Department Presentations 5.2.2 Topic Discussions 5.2.3 Journal Club

6.0 Residency Project 6.1 Purpose 6.2 Selection of Residency Project

6.2.1 Project Advisor 6.2.2 Project Time Line

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6.2.3 Project Presentation

7.0 Faculty

7.1 Department of Pharmacy Administration 7.2 Residency Advisory Committee (RAC) 7.3 Rotation Preceptors

8.0 Evaluations 9.0 Appendixes

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March 22, 2019 Dear Residents, On behalf of the CCIRH Department of Pharmacy, I would like to welcome you to your post-graduate training program. We are committed to the provision of an outstanding residency training program. As a community hospital, we offer a variety of experiences designed to prepare you for the various roles in pharmacy practice. The goal of this residency program will be the development of practical clinical and operational skills that will prepare you for future employment or a PGY-2 Residency. We will delegate to you both clinical and operational responsibilities under the guidance of our experienced pharmacy staff. You will refine your teaching and leadership skills by working in a multidisciplinary environment with patients, caregivers, nurses, physicians, as well as students from colleges of medicine, pharmacy and nursing. You will participate in multi-disciplinary patient care activities to further develop your problem-solving skills and the ability to work with other healthcare providers. Preceptors will establish minimum expectations as laid out in the syllabi for your performance during rotations. However, you should strive to surpass these minimum expectations. You will be encouraged to work with as much independence as desired and achievable. The year ahead of you will be busy and challenging, but I am confident that benefit from our residency program and achieve great success. I am excited to work with you over the next year. Best Regards, Nicole Brooks, PharmD, BCACP, CACP Residency Program Director

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Ralph Turner, DBA, MSHA, MPA, FACHE

Chief Operating Officer

Paul DiPasquale, PharmDDirector Of Pharmacy

Nicole Brooks, PharmD, BCACP, CACP

Director of PGY1 Pharmacy Residency Program

Medication Management Clinic Coordinator

Medication Management Clinic Pharmacists/LPN

PGY1 Pharmacy Residents

Serenity Ford, PharmDPharmacy Operations

Manager

IT Pharmacist

Clinical Pharmacists

Sterile Products Pharmacist

Senior Technician

Technicians

Pharmacy Buyer

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1.0 General

1.1 Definition

Cleveland Clinic Indian River Hospital (CCIRH) Postgraduate Year One training (PGY-1) Pharmacy Residency Program is a 12-month program developed to meet and exceed all pharmacy practice standards established by the American Society of Health-System Pharmacists. This residency training program is designed to develop the resident’s clinical expertise and education in a variety of pharmacy practice areas.

1.2 Philosophy and Purpose

The growth of pharmacy practice and the utilities of a pharmacist are substantially increasing throughout many institutions. Many more physicians rely on the expertise of a pharmacist for therapeutic and pharmacologic decisions. Therefore, in order to provide the most comprehensive pharmaceutical care in all areas of pharmacy practice, it is essential for pharmacy graduates to have formal training. Pharmacy residencies serve as one of the best modalities for pharmacy graduates to obtain practical pharmacy skills. Under the guidance from preceptors, residents will have the opportunity to apply and integrate pharmaceutical care principles in the care of patients. PGY1 Program Purpose: PGY1 pharmacy residency programs build on Doctor of Pharmacy (Pharm.D.) education and outcomes to contribute to the development of clinical pharmacists responsible for medication-related care of patients with a wide range of conditions, eligible for board certification, and eligible for postgraduate year two (PGY2) pharmacy residency training.

1.3 ASHP Residency Accreditation

In order to provide universal post-graduate training and to ensure complete competency on pharmaceutical practice, ASHP has set standards for residency programs. The residency must pursue compliance with these standards in order to maintain accreditation. CCIRH PGY-1 Pharmacy Practice Residency Program became an accredited program by ASHP in October 2008.

1.4 Qualifications of Resident

As per ASHP requirements for pharmacy residents, the resident must be a graduate of a college or school of pharmacy accredited by the Accreditation Council for Pharmacy Education (ACPE) or otherwise approved to participate in the ASHP match program through PhORCAS.

1.5 Residency Faculty Structure

Residency Program Director (RPD) The purpose of the Residency Program Director is to:

• Act as the direct supervisor to the residents • Organize recruitment of new residents • Oversee continual quality assessment and improvement of the residency • Ensure program goals and specific learning objectives are met • Ensure training schedules are maintained • Ensure appropriate preceptorship is provided for each learning experience • Ensure resident evaluations are routinely conducted • Oversee Residency Advisory Committee (RAC)

Residency Program Coordinator (RPC)

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The purpose of the Residency Program Coordinator is to:

• Assist in recruitment of new residents • Manage updating of syllabi and evaluation materials • Ensure program goals and specific learning objectives are assigned to appropriate learning

experiences • Ensure appropriate preceptor is assigned to each learning experience • Ensure each resident is provided the opportunity to be taught and evaluated on each ASHP

required outcome, goal, and objective • Create and update training schedules • Create and update forms, templates, and files, as needed • Prepare and maintain Preceptor Records Binder • Prepare resident onsite binder prior to start of each residency year • Organize materials for RAC meetings • Assist RPD in various residency-related projects

Residency Advisory Committee (RAC) The RAC is comprised of the Director of Pharmacy, Clinical Pharmacy Manager, Residency Program Director, Resident Advisors, Residency Preceptors and various staff members of the CCIRH Department of Pharmacy. The purpose of the RAC is to:

• Participate in the selection of residency candidates • Facilitate the education of the residency program by contributing to the development of

residency guidelines • Aid in the evaluation process of each resident

The advisory committee will assist the RPD in significant decision-making processes in the residency program. RAC meetings will be called by the RPD a minimum of four times per residency year. Members will be appointed to the RAC annually.

1.6 Acceptance Into the PGY-1 Pharmacy Residency Program

Application Requirements: Interested applicants must be PharmD graduates of accredited college of pharmacy, be eligible for licensure in the State of Florida, and submit the standard application materials through PhORCAS (i.e. Letter of Intent, CV, the 3 standard reference forms in PhORCAS, official college transcripts), along with: 1. We request a minimum of one (two is preferred) of your three references

should come from a preceptor who you have worked with in a clinical setting, related to an APPE in acute or ambulatory care. The clinical preceptor should be able to comment on your scope of responsibility, total patient load, level of autonomy, clinical abilities, and organizational and time management skills. All 3 reference writers should use the standard PhORCAS template to submit their candidate recommendation and comment on a minimum of 7 of the 13 listed candidate characteristics.

2. A response to the following essay statement is required for acceptance. The essay response should be no longer than one page in length. An application will not be reviewed if this statement is missing. Please note that the essay is separate from your letter of intent. Reflecting on your APPE rotations, please provide a piece of critical feedback you have received from one of your preceptors on a direct patient care rotation. Explain how you have incorporated this feedback into your practice and/ or worked to improve in this area.

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NOTE: 1. Residency applicants must currently be authorized to work in the United States. Cleveland Clinic Pharmacy does not sponsor applicants for work Visas. 2. Appointments of applicants to residency positions may be contingent upon the applicants satisfying certain eligibility requirements [e.g., graduating from accredited college of pharmacy, obtaining pharmacist license in Ohio (for Ohio sites) or Florida (for Florida sites) within 90 days of start date, and successful completion of a pre-employment physical and drug screen, including testing for cotinine]. 3. Unfortunately, we cannot accommodate OPT (Optional Practical Training) Visas for the Cleveland Clinic Pharmacy Residency Program as the program extends beyond 12 months. 4. The Cleveland Clinic Pharmacy Residency Program does not meet the qualifications of an OPT STEM employer because Cleveland Clinic is not enrolled in E-Verify. Program will not consider applicants with GPA less than _____3.25_________ Program will not consider applicants from pass/fail schools

Candidate Interview process: Selected Residency applicants will be interviewed as per ASHP standards on a formal, criteria-based process. Candidates will be evaluated and ranked on their academic performance, professional activities, skills, attitudes, ability to obtain outcome goals, references, on-site interview, and case review. Resident candidates should be prepared to participate in a patient case review. The selection of candidates to be ranked will be made based on the consensus of the RAC. The National Matching Service finalizes candidate selection.

1.7 Resident Statement of Agreement

Prior to start of the residency program, the resident will be asked to sign a Resident Statement of Agreement which outlines expectations of the resident during the year as well as benefits the resident will receive. Please refer to Appendix A of this manual for a copy of the Residency Agreement.

2.0 General Information

2.1 Residency Overview

PGY -1Pharmacy Residencies are formal training programs that focus on the development of practice skills in a variety of pharmacy practice areas. All residents are involved in service, education, and research activities. The residency will be tailored to the individual needs of the resident.

Education and Training- Residency programs allow time for residents to pursue and achieve defined educational outcomes set by ASHP. In addition, residents will be involved in teaching healthcare students, pharmacy staff, nurses, and medical practitioners.

Pharmacy Operations- Residents will partake in pharmacy services. Residents will be held responsible and accountable for the provision of various clinical services and/or distributive services provided in practice areas of the pharmacy.

2.2 Residency Benefits

Resident Stipend: $ 40,000 Paid-Time-Off (PTO)- Refer to Appendix I. Twelve (12) days may be used by the resident at their discretion for vacation, holidays, interviews, and short term illness. No more than 20% of a given rotation may be taken off unless prior approval is given by the RPD. A maximum six (6) approved conference days are not considered personal days and are in addition to these twelve (12) days.

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Resident is encouraged to maximize their amount of time on their particular rotation. Missing 20% or more of a rotation will require either make-up time at the end of the residency or a repeat of the rotation as an elective. Residents taking leave greater than paid leave allowed (i.e, “time-off” days) cannot be awarded a residency certificate unless additional leave is made up.

i For example, if a resident needs to take a leave of absence and they have 12 days of “time off,” they can use the 12 days and then will need to make up the remaining days taken on the leave of absence [i.e., a resident takes 4 weeks leave or 20 work calendar days leave of absence, they will be required to make-up 8 days for the residency at the end of the year].

If a resident taking a leave of absence exhausts all of their permitted days off (i.e., 12 days “time off”), they will need to take unpaid leave, unless eligible for Short Term Disability pay, per Human Resources Benefits eligibility guidelines. Make-up Time for Absences 1. Leave of absence(s) may extend the training period to reach an acceptable level of performance in order to graduate from the program. The resident must complete 12 months of residency. 2. Any leave greater than or equal to 7 calendar days will require the resident to make-up missed time. a. Leave of absence time must be completed within 6 months of the date the program was scheduled to be completed, or the resident forfeits the privilege of receiving the Certificate of Completion of the program. Upon returning from leave, hours will be paid and must be: worked under the guidance of a preceptor, equal to the hours missed, and used to complete the requirements not yet achieved. All requests for time-off must be submitted in writing to the rotation preceptor, RPD, and Director of Pharmacy 4 weeks prior to and are subject to their approval. The resident is required to arrange coverage of any activities missed as a result of the request. Extended Leave of Absence Refer to Appendix H. In the event that a resident requires an extended leave of absence for personal leave, extended sick leave or medical leave, it is the resident’s responsibility to ensure that all paperwork is completed and turned into Human Resources. The time away from the residency program due to a leave of absence must be completed at the end of the residency. Each case will be reviewed by the Residency Advisory Committee for evaluation. The resident will be able to return and complete the residency off cycle as long as the leave of absence is approved through Human Resources and does not exceed six months.

Health Insurance- The resident will receive health care benefits according to the CCIRH employee policy as entitled for a full-time employee of the Department of Pharmacy.

Professional Meetings- Residents will receive reimbursement pursuant to Human Resources policy (Appendix L) for expenses incurred during attendance at the following conferences:

1.) ASHP Clinical Midyear Meeting 2.) Florida Residency Conference

Procedures for submitting reimbursement for professional meetings: 1.) Prior to Travel (no less than 2 weeks prior) obtain “Request for Travel” form

a. Gather program materials, sample flights, hotel reservations, etc. and attach to form. b. Submit form to RPD for review and further instructions

2.) After travel has occurred: a. Obtain “Travel Expense Form” and complete all necessary information. b. Receipts of events must be organized by day and taped to a 8” X 11” paper. c. Forms are to be submitted to the RPD and Director of Pharmacy. d. Forms must be signed by the Administrator or Vice President over Pharmacy

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Each resident will assist with the recruitment efforts of the department at the residency showcases. Residents are expected to prepare and staff the residency showcase or any other function that involves recruitment, unless given permission otherwise.

Affiliated College of Pharmacy Online References- See Residency Director and/or Preceptor

2.3 Pharmacist Licensure

The resident must obtain Florida pharmacist licensure within 90 days of the start day of the residency program. Failure to obtain licensure within the first 90 days will result in dismissal from the program.

2.4 Required Meetings

The resident will be required to attend a number of meetings throughout the year. Other meetings may be required by specific rotations. These meetings must be coordinated with each preceptor. Exceptions to this are if the resident is staffing or if there is a patient care issue which takes precedence and must be addressed immediately.

1. Pharmacy & Therapeutics Committee 2. Department Meetings 3. Continuous Quality Improvement

2.5 Staffing Requirements

The resident will be required to work a minimum of 40 hours per week for at least 52 weeks. However, it is understood that the resident will likely need to work greater than 40 hours to facilitate all patient care responsibilities. Specific hours will depend upon the individual needs of the rotation and will be determined by each preceptor at the beginning of the rotation. Unless otherwise specified by the preceptor, the resident will be expected to report to the main pharmacy by 0700. Residents are expected to punch in at the beginning of every shift and punch out prior to leaving for the day. While on the Ambulatory Care rotation residents are expected to punch in and report to the clinic by 0745.

The residents are responsible for their assigned staffing service, and are responsible for assuring that these service commitments are met in the event of an unforeseen absence. Paid time off cannot be used in place of staffing requirements. If a resident requests PTO on a scheduled staffing weekend, it is his/her responsibility to make arrangements with the other resident(s). In order to ensure competence in this role, residents will work under the supervision of another pharmacist during the orientation/training period. Residents are responsible for reviewing every pharmacotherapy consult with the assigned clinical pharmacist at completion of the initial consult and before any notes are placed in the chart or any verbal recommendations are made. All notes must be co-signed by a clinical staff pharmacist during the training period. After the training period, as the resident displays the necessary clinical skills and provided that licensure was obtained, the resident will transition to practice as an independent pharmacist. Residents will participate in every other weekend staffing during the required operational pharmacy practice I & II experiences for a total of at least 20 weekends worked over the program year. Residents are expected to arrive no later than 0700 and work until at least 1530. The resident may have a project day on the Monday after staffing the weekend. In order to minimize time away from the residency rotation, this day will not be offered in lieu of another residency obligation which will take the resident away from their rotation during the pay period week. The resident may choose to work at home on these project days provided there is not another event scheduled that week which will take the resident away from their assigned rotation. The resident will coordinate with the rotation preceptor and RPD prior to each staffing weekend to ensure there are no conflicts which would preclude the resident from working from home.

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2.6 CCIRH Policies and Procedures

The CCIRH Employee Policies and Procedures will be reviewed by the resident during the orientation period. Residents are subject to all of CCIRH Policies and Procedures. Electronic documentation of Policies and Procedures are available on the CCIRH intranet. Important policies to be reviewed prior to starting the residency are included in the appendixes.

2.7 Resident Holidays

One resident will be assigned to work on each designated holiday. Resident will provide pharmacy service coverage on holidays similar to weekend coverage.

a. New Year's Day b. Memorial Day c. Labor Day d. Thanksgiving Day e. December 25th (Christmas Day)

2.8 Duty Hours

Duty hours must be limited to 80 hours per week averaged over a four-week period as to comply with ASHP Accreditation Standards for Pharmacy Residents. Residents will be instructed in and required to electronically log all hours worked at the facility.

The RPD and/or the Director of Pharmacy must approve all outside employment. External employment or “Moonlighting” should be carefully chosen as to not interfere with the ability of the resident to achieve the educational goals and objectives of the residency program. The residency program schedule will not be modified to accommodate moonlighting. Any hours worked moonlighting will be reported to the RPD on a weekly basis. Duty hours including external employment must be limited to 80 hours per week.

2.9 Resources

1. Lexi-comp® Available on the intranet under applications

2. UpToDate®

Available on the intranet dropdown box

3. University of Florida Health Science Center Library Access available through preceptors

3.0 PGY-1 Pharmacy Residency Program Design

3.1 Syllabus with Learning Experiences and Required Readings Prior to beginning each rotation or learning experience residents are to obtain a copy of the syllabus. It is the responsibility of the resident to coordinate and fulfill the objectives set forth by the syllabus. Residents are required to make arrangements to meet and discuss an upcoming rotation with the preceptor at least 1 week prior to starting any new rotation. The purpose is for resident and preceptor to discuss expectations, syllabus, readings, schedule, etc. The resident is also required to make

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arrangements with preceptor within 7 days of end of the previous month to discuss evaluations for that particular experience. The resident and preceptor should complete a pre-rotation checklist prior to the start of each rotation. The resident will discuss their personal goals for the rotation as well as any feedback received from the previous rotation. The resident and preceptor will customize the rotation plan and activities for the new rotation to account for the resident’s interests, strengths, and weaknesses. At the end of the rotation, an end-rotation checklist will be completed where the resident and preceptor will exchange feedback regarding the rotation and identify strengths and areas for improvement to be carried over to the next rotation.

3.2 Required Clinical Rotations

ASHP Residency Accreditation Standards (Appendix F) require PGY-1 residents to achieve satisfactory remarks in four (4) competency areas and all associated educational goals and objectives. (Standard 3.2 of the ASHP Accreditation Standard for Postgraduate Year One Pharmacy Residency Programs):

1. Patient care 2. Advancing practice and improving patient care 3. Leadership and management 4. Teaching, education, and dissemination of knowledge

See Appendix G for the PGY-1 Pharmacy Residency Competency Areas, Goals, and Objectives

The following experiences are designated by CCIRH as required for successful completion of this residency:

Core Rotational 1.) Orientation 2.) Cardiology 3.) Internal Medicine

4.) Advanced Internal Medicine 5.) Critical Care 6.) Ambulatory Care

7) Advanced Ambulatory Care 8.) Infectious Disease 9.) Sterile Preparations 10.) Emergency Medicine

A list of pre-requisites for each experience is included in Appendix U: Program Structure.

3.3 Elective Rotations

The residency program will be tailored to the individual resident. It is one of the goals of the residency program to work with the interests of the resident and to promote other areas of interest for the resident. Residents are to select two electives and one concentrated (2 week) elective. Any elective experience may be modified to a concentrated elective. Other elective options may be available with RPD discussion.

Elective Experiences: 1.) Administration 2.) Hematology/Oncology 3.) Nutrition Support 4.) Primary Care Medication Management 5.) Advanced Critical Care

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6.) Advanced Infectious Disease 7.) Advanced Emergency Medicine

If a specific area of interest of the resident is not listed as an elective rotation and the hospital has the opportunity in providing that experience, the RPD will attempt to facilitate the learning experience. Each residency elective must be decided by the resident and confirmed by the preceptor and RPD at least 8 weeks prior to the assigned elective month.

3.4 Longitudinal Experiences

In conjunction with core learning experiences, residents are required to complete experiences in a longitudinal format. These experiences will occur throughout the program. See program structure grid for details. Longitudinal Experiences:

1.) Leadership in Pharmacy 2.) Education in Pharmacy 3.) Longitudinal Research Project 4.) Operational Pharmacy Practice 5.) Advanced Operational Pharmacy Practice

Operational Pharmacy Practice and Advanced Operational Pharmacy Practice

In order to provide continuity of clinical pharmacy services, residents are each required to cover clinical services for their assigned rotation and all clinical services on weekends and holidays. Examples of current pharmacy services include order entry, anticoagulation dosing and monitoring, pharmacokinetic consults, antibiotic dosing and monitoring, and parenteral nutrition consults. Each weekend will have one resident covering. The resident will be responsible for assisting with order entry and other distributive processes, operations and management of the pharmacy, supervising pharmacy technicians, and maintaining clinical services.

3.5 Teaching Requirements

CCIRH has affiliations with several Colleges of Pharmacy, including Nova Southeastern University, Ohio Northern University, Palm Beach Atlantic University, Creighton University, and the University of Florida. These affiliations include accepting Advanced Pharmacy Practice Experience students from these schools. The resident will be actively involved in teaching/precepting students throughout the year. Towards the end of the residency, the resident will be the primary preceptor for at least one student and will be responsible for orientation, evaluation, and grading of that student. The resident will work with their preceptor in facilitating experiences for the student.

3.6 Resident Schedule

The RPD and Residency Program Coordinator are responsible for scheduling the required experiences and dates. They will develop resident schedules at the beginning of the residency year, except for elective rotations. The schedule will be posted online via PharmAcademicTM.

4.0 PGY-1 Pharmacy Residency Expectations and Residency Requirements

4.1 Professional Practice

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Professional Conduct - It is the responsibility of all residents to uphold the highest degree of professional conduct. The resident will display an attitude of professionalism in all aspects of daily practice. Professional conduct is expected to be maintained at off campus functions that are representing CCIRH, including meetings (i.e. ASHP Midyear and the FRC). Professional Dress - Residents are expected to dress in an appropriate professional manner whenever they are in the institution or attending any function as a representative of CCIRH. Clean, pressed white lab coats of full length will be worn at all times in patient-care areas and when presenting on hospital grounds. If problems exist with the dress code, the RPD or preceptor will address these issues. Patient Confidentiality - Residents are responsible for maintaining strict patient confidentiality. Any consultations concerning patients will be held in privacy with the utmost concern for the patients’ and families’ emotional and physical well-being. Issues will not be discussed unless medically pertinent. Further information regarding patient confidentiality can be found in the CCIRH Employee handbook. Laptops assigned to residents must be stored in the pharmacy at the end of the day. Residents should not bring laptops home. Attendance - Residents are expected to attend all functions as required by the Residency Advisory Committee, RPD, and rotation preceptors. Residents are responsible for weekend/weekday coverage of clinical pharmacy services. The resident must make up days that are missed if not approved by the RPD. All leave requests should be discussed in advance with the involved preceptor to assure that service responsibilities can be fulfilled. Residents must attend required meetings unless on an approved leave of absence. This also includes punctuality. It is important to be on time to all scheduled rotations, residency program, and other professional activities.

Corrective Action- The RPD and Director of Pharmacy will follow the Human Resources Corrective Action policy to address issues with work performance. (Appendix J)

4.2 Residency Requirements

Residents will be required to perform or participate in a number of activities throughout the year. These requirements must be completed within one year of the beginning of the residency program (unless a leave of absence has been approved) in order to obtain a CCIRH PGY-1 Pharmacy Residency Certificate. The certificate acknowledges a resident’s successful completion of all requirements in accordance with the residency guidelines and recognizes a minimum level of competency in the area of pharmacy practice. See section 4.3 Determination of Graduation for details. PharmAcademicTM Performance Indicator Definitions: See Appendix V: Residency Program 3-Part Assessment Strategy

1. Needs Improvement (NI) a. The resident is deficient in skills/knowledge in this area and requires assistance to

successfully complete the learning activities associated with the objective in more than 30% of instances.

b. Resident is unable to ask appropriate questions to supplement limitations and/or has a general deficit in this area.

c. The resident’s level of skill on the objective does not meet the preceptor’s standards of either “Achieved” or “Satisfactory Progress,” whichever applies.

2. Satisfactory Progress (SP)

a. The resident has adequate skills/knowledge in this area and requires assistance to successfully complete the learning activities associated with the objective in 10-30% of instances. The resident performs associated tasks at an acceptable level, and in a consistent manner.

b. This applies to an objective whose achievement requires skill development during more than one learning experience. In the current learning experience, the resident has progressed at the

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required rate to attain full and independent ability to perform the objective by the end of the program.

c. Resident is able to ask questions to acknowledge limitations and/or judgment is not refined. 3. Achieved (ACH)

a. The resident has the skill/abilities in this area and requires assistance to successfully complete the learning activities associated with the objective in less than 10% of the instances. The resident requires no further developmental work in this area and requires minimal supervision, or

b. The resident has fully accomplished the ability to independently perform the learning activities associated with the objective in a consistent manner.

4. Achieved (ACH-R) for Residency:

a. An objective may be “Achieved for Residency” (ACH-R) when the resident: i. Has “Achieved” the objective at least once during the residency (or at the discretion

of the RPD/Advisor). b. A goal may be “Achieved for the Residency” (ACH-R) when the resident:

i. Has “Achieved for Residency” all the objectives for the specific goal (done automatically by Pharmacademic when all the objectives have been achieved).

Please see Attachment G for the ASHP Outcomes, Goals, and Objectives.

The following activities are designed to achieve the ASHP Residency Outcomes and Standards: 1.) Rotational and Longitudinal Experiences 2.) Complete a residency project (Major) of either a service or research project designed to improve

the services of the department or achieve a specific research objective. 3.) Prepare and present one topic for each learning experience. These presentations are to include at

least 4.) four journal clubs and 5.) at least four formal presentations 6.) Fulfill all clinical pharmacy services 7.) Complete all pharmacy staffing obligations 8.) Attend required residency meetings (detailed in section 2.4) 9.) Actively participate in didactic teaching sessions including journal club, topic discussions, and

case presentations. 10.) Complete as least one Medication Use Evaluation (MUE) 11.) Present longitudinal project to society meeting or conference 12.) Participate in pharmacy resident recruitment 13.) Prepare written manuscript of publishable quality. Publication is recommended but not a

requirement. 14.) Present 1 hour of continuing education credit 15.) Prepare and present at least one Drug Monograph to Pharmacy and Therapeutics Committee 16.) Precept at least one APPE pharmacy student 17.) Take personal responsibility and accountability for providing ethical and quality pharmaceutical

care to enhance patient outcomes 18.) Participate in community involvement events 19.) Lead a formal or informal meeting 20.) Attend and take minutes at P&T meetings 21.) Complete at least one SOAPE note for each direct patient care rotation 22.) Other assigned duties, projects, and activities

4.3 Determination of Graduation

A resident must meet the following in order to successfully complete the residency and be awarded a residency certificate. A resident:

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1. Must obtain pharmacist licensure in the State of Florida within 90 days of residency program start date.

2. Must complete all required residency rotations as outlined by the specific residency program (as outlined in Acceptance Letter).

3. Must have all resident evaluations (in PharmAcademic) completed.

4. Must meet the following:

a. PGY1 Pharmacy: A resident must achieve all goals in R1, R2, R3, R4. By the end of the residency, there can be no objectives that are rated as Needs Improvement.

5. Must complete research or project(s) and present at Florida Residency Conference. Manuscript must be turned in by end of program.

6. Must complete all presentation requirements (e.g., case presentations, seminar, continuing education topics, and research project/DUE proposal and findings).

Each Resident’s Quarterly Evaluations will be reviewed by the Residency Advisory Committee to determine if the resident is on schedule to successfully complete the residency.

5.0 Presentations

5.1 Continuing Education Presentations The residents are required to provide 1 hour of continuing education credit to either pharmacists, pharmacy technicians, or to members of the medical or nursing staff. ACPE certification of continuing education may be obtained through the Treasure Coast Society of Health-System Pharmacists (TCSHP). Certification of CME or CEU credits may be obtained through affiliations provided by CCIRH. The presentation should include an effective delivery method using PowerPoint, handouts, or other material. The formal presentation should last 45 minutes. An outline should be completed at least 4 weeks prior to the presentation and reviewed by the RPD.

5.2 Pharmacy Presentations

5.2.1 Department Presentations

The resident will present a monthly to department staff focused on a clinical issue related to the month’s learning experience. Residents shall ensure no fewer than four of the twelve presentations are in journal club format and at least four in disease state/therapeutic agent presentation format. The remaining four presentations may be in whichever format (journal club or disease state/therapeutic agent) selected by either resident or preceptor. Disease State/Therapeutic Agent Presentations The resident will work with their preceptor to identify a topic based on their interest and will prepare a 30-40 minute presentation and handout. The topic of the presentation and 3 learning objectives should be determined and discussed with the preceptor 7 days prior to the presentation. The resident will include at least 3 learning objectives at the beginning of each presentation. The presentation may include the following: Disease State Presentation

A. Anatomy/pathophysiology B. Epidemiology C. Risk Factors D. Presentation/Clinical Manifestation

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E. Screening/Diagnosis Criteria F. Treatment (emphasis of presentation)

a. Non-pharmacologic b. Organizational guidelines c. Primary literature review d. New/investigational agents e. Surgery

G. Conclusion H. References

Therapeutic Agent/Class Presentation

A. Introduction/History B. Chemical Structure C. Mechanism(s) of Action D. Pharmacokinetics E. Dosage and Administration F. Preparation G. Adverse Effects H. Special Populations I. Clinical Applications J. Areas of Research K. Conclusions L. References

Competency Evaluation: the resident will present a minimum 3 question quiz during each presentation. The quiz may be presented either verbally during the presentation or in writing. Residents will be evaluated on their presentations using the form Appendix D. Areas to be evaluated include material presented, appropriateness of handouts, presentation style, and the ability to answer questions regarding the topic. The preceptor and RPD will collect evaluation forms and give feedback to the resident after the presentation. Evaluation forms are to be included in the resident binder.

5.2.2 Topic Discussions

The purpose of the topic discussion is to provide the residents with a forum focused on various disease states, evidence based medicine, and treatment related issues pertaining to pharmaceutical care of CCIRH patients. These discussions will supplement the practical and clinical education the residents will receive during their rotations. Topic discussions are to be held at the discretion of the rotation preceptor and will be discussed and scheduled at the pre-rotation meeting in advance of the rotation. Either the resident or preceptor may lead the topic discussion. Pharmacy students can participate. If the topic discussion is led by the resident, the resident should include documentation in the form of meeting minutes in their residency binder.

5.2.3 Journal Club

Competence in medical literature review is an important skill for clinical pharmacists to have in order to provide appropriate interpretations of the data.

Pharmacy residents are required to present an article to the pharmacy at least four times per residency year. General dates will be placed on the residency calendar. Journal club provides the resident with opportunity to present a current article that addresses drug or

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disease related problems. The presentation should be no longer than 30 minutes including discussion. The format should include the following:

a. Study or article objective b. Study Design c. Methods d. Biostatical appropriateness e. Results f. Application to practice

Resident is encouraged to explain the biostatistics The presentation should be informal. The article chosen by the resident must be given to the RPD at least one week prior to the presentation.

6.0 Residency Project

6.1 Purpose

One of the required outcomes of the ASHP Residency Standards is that the resident demonstrates project management skills. A residency project helps the resident develop and justify new services or build upon existing ones. The resident is afforded the opportunity to develop research, project management, and writing skills. The residency project may vary depending on the needs of the hospital and the interest(s) of the individual resident.

6.2 Selection of Residency Project

During the month of orientation & training, the resident must select their project from a list generated by the RPD, Director of Pharmacy, and/or preceptors. The RPD will make every effort to provide opportunity for research projects that align with each resident’s individual interests and that will be sustainable, feasible, and beneficial to the facility. Towards the end of the residency and prior to the Florida Residency Conference (FRC), residents are required to give formal presentations to the pharmacy staff on their residency project.

6.2.1 Project Advisor

The RPD and resident will select a member of the staff to act as a Project Advisor. The Project Advisor will act as a resource and help to facilitate the project.

6.2.2 Project Time Line After a project has been selected and approved, the resident, Project Advisor, and RPD will develop a time line outlining key deadlines. The time line will include the following:

a. Title b. Purpose c. Date to complete writing the proposal or outline of project d. Date of submission to IRB, if applicable e. Date of implementation or start f. Target date of completion g. Target dates for presentation h. Target date for submission for publication (not required, but encouraged)

6.2.3 Project Presentation

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It is expected that residents will present their project in a poster format at the ASHP Midyear Clinical Meeting. Resident must identify appropriate deadlines for submission. A formal PowerPoint presentation is generally made at the Florida Residency Conference. If the resident is unable to attend either of these meetings, then the resident will discuss alternative forums for presentation with the RPD.

7.0 Faculty 7.1 Department of Pharmacy Administration

Director of Pharmacy Paul Dipasquale, Pharm.D. Clinical Manager Serenity Ford, Pharm.D., C.Ph.

7.2 Residency Advisory Committee

Residency Program Director Nicole Brooks, PharmD, BCACP, CACP Residency Program Coordinator Jessica LaFosse, PharmD, CPh, Residency Advisory Committee Members (RAC): Jinal Andrade, PharmD, BCGP

Ravi Bacchus, PharmD, BCCCP Cleon-Paul Blake, PharmD Nicole Brooks, PharmD, BCACP, CACP Daniel Carp, PharmD.,BCNSP

John Comunale, B.S., RPh Paul Dipasquale, PharmD Cecile Kelly, PharmD, BCPS Milena Kelly, PharmD Jessica LaFosse, PharmD, CPh Julian Mattes, PharmD Jeni McGuire, RPh, BCPS, BCCCP Mary Mullinary, RPh Alex Siragusa, PharmD Karen Speed, Pharm.D, BCPS Andrew Stoessel, Pharm.D., BCIDP

Preceptor in Training:

Julian Mattes, PharmD Paul Dipasquale, PharmD Karen Speed, Pharm.D, BCPS Cleon-Paul Blake, PharmD

7.3 Rotation Preceptors

Administration: Paul Dispasquale, PharmD

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Ambulatory Care: Milena Kelly, Pharm.D., Advanced Ambulatory Care: Nicole Brooks, Pharm.D., BCACP, CACP Hematology/Oncology Donald Weiss, B.S., RPh Julian Mattes, PharmD Critical Care & Ravi Bacchus, PharmD, BCCCP Advanced Critical Care: Education in Pharmacy: Nicole Brooks, PharmD, BCACP, CACP Emergency Medicine & John Comunale, B.S., RPh & Advanced Emergency Medicine: Jeni McGuire, RPh, BCPS, BCCCP Infectious Disease & Andrew Stoessel, Pharm.D., BCIDP Advanced Infectious Disease: Internal Medicine: Cecile Kelly, PharmD, BCPS Advanced Internal Medicine: Cecile Kelly, PharmD, BCPS Cardiology: Karen Speed, Pharm.D., BCPS

Leadership in Pharmacy: Nicole Brooks, PharmD, BCACP, CACP Longitudinal Research Project: Nicole Brooks, PharmD, BCACP, CACP Orientation & Training: Nicole Brooks, PharmD, BCACP, CACP Operational Pharmacy Practice & Mary Mullinary, RPh & Advanced Operational Pharmacy Practice Alex Siragusa, PharmD Sterile Preparation: Daniel Carp, Pharm.D., BCNSP Nutrition Support: Daniel Carp, Pharm.D., BCNSP Primary Care Medication Management: Jinal Andrade, PharmD, BCGP

8.0 Evaluations

The evaluation process is an important component to residency programs. The feedback the resident receives during these evaluations is meant to assist and develop the resident in achieving the goals of the residency program but also it aids in completing the resident’s personal goals. Prior to completing any online evaluation, the preceptor and resident will meet to discuss the end rotation checklist which will include verbal feedback reflected in the evaluation. Also, it is important that the resident complete an evaluation on the preceptor and rotation in order for the residency program to grow. Evaluations will be made based on the Outcomes/Goals/Objectives set forth in each of the rotational or longitudinal experiences. In addition, the resident will be evaluated on all presentations and small projects. Residents will be required to use PharmAcademic™ for the evaluation process.

Resident Evaluation- The resident will be evaluated by the preceptor(s) for a particular learning experience based on the learning goals and objectives set forth prior to the learning experience.

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Resident Self-Evaluation: The Rresident will evaluate him/herself for a particular learning experience based on the learning goals and objectives set forth prior to the learning experience. Learning Experience Evaluation- This is an opportunity for the resident to evaluate and to provide feedback to the preceptor(s) and the residency director on the learning experience provided. Information that is given will be used for upcoming rotations or other residency classes. Preceptor Evaluation- The resident is to provide a written evaluation for the assigned preceptor. This will aid in the preceptor to identify strengths and weaknesses in order for them to improve later in the residency year or other residency classes.

. It is the resident’s Responsibility to ensure ALL evaluations are completed within 7 days of the end of the learning experience. It is the resident’s responsibility to set up a meeting with preceptor to discuss evaluations. Evaluations should not be submitted until resident and Preceptor have meeting one on one to discuss all evaluations. Evaluation Responsibilities and Deadlines Resident Evaluations Due Date:

Pre-Residency Self Evaluation Prior to start - PharmAcademic™ Pre-Residency Assessment & goals During Orientation - PharmAcademic™ Pre-rotation checklist Seven days prior to new rotation End rotation checklist Last day of rotation Rotation Evaluation Within 7 days of completing rotation Preceptor Evaluation Within 7 days of completing rotation

Training Plans Quarterly Evaluations must be forwarded to residency advisor and RPD.

Residency Director Evaluations Due Date: Training Plans Quarterly Longitudinal Rotations Quarterly Formal Presentations Within 24 hours of presentation Preceptor Evaluations Due Date: Rotation Evaluation Within 7 days of completing rotation Topic Discussion Evaluations Within 24 hours of presentation

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9.0 Appendixes Appendix A Resident Statement of Agreement Appendix B Pre-rotation Checklist Appendix C End Rotation Checklist Appendix D Presentation Evaluation Form Appendix E Topic Discussion Evaluation Form Appendix F ASHP Accreditation Standard for Postgraduate Year One (PGY-1) Pharmacy

Residency Programs Appendix G ASHP Guidance Document for Required Competency Areas, Goals, and

Objectives for Postgraduate Year One (PGY-1) Pharmacy Residency Programs Appendix H Pharmacy Residency Procedure: Leave of Absence Appendix J Paid Time Off (PTO) Policy Appendix K Corrective Action Policy Appendix L Pharmacy Residency Dismissal Policy Appendix M Tobacco Free Campus Policy Appendix N Employee Travel/Professional Development Policy Appendix O Mandatory Influenza Vaccination Policy Appendix P Pharmacy Residency SOP – Resident Duty Hours Appendix Q Pharmacy Residency Policy – Licensure Appendix R Journal Club Evaluation Form Appendix S Successful Completion of Residency Policy Appendix T Preceptor Manual Appendix U Program Structure Table Appendix V Residency Program 3-Part Assessment Strategy Appendix W Preceptor Appointment and Reappointment