Pharmacy Residency Program Overview

The Advancing Practice learning experience is a required longitudinal experience at Tallahassee Memorial HealthCare. This learning experience will focus on building the resident’s competency in improving pharmacy services through formulary management, evaluating the medication use system and designing and implementing a quality or research project to improve practice.

Based on the results of the quality/research project, the resident will build and refine the skills necessary to conduct and manage a major project over the course of one year. In addition, it allows the resident to prepare and present a major project at the regional level and improve communication skills.

During the course of the year, the resident will focus on the key steps to performing a quality/research project to include, idea generation, literature search, study design, writing a protocol, ascertaining stakeholders support, receiving the appropriate committee approval(s), data analysis, presenting project and preparing in publishable form.

This learning experience will also build the resident’s skill sets in promoting optimal pharmacotherapy through formulary management. The resident will work closely with the medical team on analyzing a drug or class of drugs for formulary addition or deletion. In addition, the resident will work with the clinical staff on improving a medication use system via completing a medication use evaluation (MUE) pertinent to the organization. The MUE may focus on either a specific medication (drug utilization review) or medication use process, e.g., prescribing, preparing, dispensing or administering.

The Residency Program Director (RPD) serves as the primary preceptor for this learning experience ensuring all steps in the process and deadlines are performed and met. While the RPD is the preceptor for the learning experience, any of the preceptors for the residency program may serve as mentors and/or co-investigators for the project, formulary review and/or medication use evaluation.

Ambulatory Care is a required, six-week learning experience at Tallahassee Memorial HealthCare Transitional Center (TC). On average, there are approximately 100 patient visits at TMH’s TC monthly. Patients with greater than a one-week time frame following up visit with their primary care physician and meet one of the following criteria may be enrolled into the TC: 1) insured with primary care visit greater than 5 days out, 2) insured with no primary care physician assigned or 3) uninsured. At the patient’s consent enrollment into the TC occurs prior to discharge.

The purpose of this rotation is to expose the resident to the utilization of drugs in an ambulatory care practice setting at one of the most critical points in disease state management. This rotation will emphasize appropriate clinical decision making such as changing therapy to meet patient compliance issues, accessibility to healthcare care, monitoring of critical labs, and providing education to patients and staff. The Clinical pharmacist on the team rounds with the physician or nurse practitioner, performs medication reviews to include appropriate therapy changes as indicated by labs, compliance cost, etc, and provide education to patients, caregivers and healthcare professionals.

Cardiology is a required learning experience at Tallahassee Memorial Hospital on the Cardiac Progressive and Cardiac Intensive Care Units. There are 50 beds between the two units and one multidisciplinary team. The multidisciplinary team consists physicians, case managers, nurses, dieticians and the clinical pharmacist. The purpose of the Cardiology rotation is to increase the resident’s knowledge and experience in the provision of clinical pharmacy services to patients on the cardiac unit. The rotation will facilitate the resident’s development into a competent and confident pharmacy practitioner. The resident will gain an appreciation for managing these patients within the complexities of the institutional pharmacy matrix. The pathophysiology and drug therapies for acute coronary syndromes, congestive heart failure, arrhythmias and other cardiac disease states will be reviewed with the resident. In addition, the Cardiology rotation will help the resident develop a lifelong learning approach that includes evaluation of current literature.

The clinical pharmacist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team and includes participating in the multidisciplinary rounds, follow-up on clinical initiatives and distributive functions. The pharmacist also provides education to patients and their family members, physicians, nurses, and pharmacy colleagues.

Internal Medicine is a required 12-week learning experience with Tallahassee Memorial HealthCare Family Medicine Residency. The 12 weeks is divided into two separate learning experiences hence Internal Medicine I & II. There are two internal medicine teams. Each of the teaching teams includes the medical students and residents, pharmacy clinical pharmacologist, pharmacy students, and attending physician. The clinical pharmacologist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team, including active participation in work and attending rounds daily, collaboration with decentralized pharmacists, education of patients and their family members, as well as education of physicians and nurses.

The Internal Medicine experience is an intensive inpatient and outpatient experience which allows for both closely supervised and more autonomous pharmacy practice by the resident. The primary goal is for the resident to learn clinical and communication skills necessary to deliver pharmacotherapy services to patients in inpatient and outpatient settings. This is achieved through both didactic and practical experiences. The pharmacy resident is also responsible for identifying and resolving medication therapy issues for patients and assuming care of all patients under the care of the Family Medicine team.

Oncology is a required, four- to six-week learning experience at the TMH Cancer Center . On an annual basis, service is provided to approximately 5,000 patients in our outpatient facility. The team consists of pharmacists, hematologists/oncologists, gynecologic-oncologists, navigators, clinical dieticians, and nurses.

The clinical pharmacist team leader is responsible for ensuing safe and effective medication use for all patients in the infusion center, which may also include attending rounds, education of patients and their family members, education of physicians and nurses, and education of pharmacy staff. The pharmacist is also responsible for the distributive functions of this unit.

The oncology rotation will provide the resident with the opportunity to further develop and refine advanced pharmacotherapeutic management skills required for provision of care of patients with hematology/oncology disorders. The resident will assist in the overall monitoring and management of the complex treatment and supportive care issues throughout the continuum of care.

Patient Safety is a required, longitudinal learning experience at Tallahassee Memorial Healthcare. The resident will work closely with the Medication Safety Officer throughout the year to identify and resolve safety issues within the facility’s medication-use system. The resident will gain an understanding of and experience in the management of the health system’s medication safety program. This exposure and experience shall include developing relationships between the pharmacy department and other areas in the hospital and providing leadership for implementation of safe medication practices within the Tallahassee Memorial HealthCare system.

The pharmacy resident is responsible for actively participating and facilitating the Medication Safety Subcommittee meeting, as well as presenting pertinent medication safety data at the following meetings: Patient Safety, Pharmacy and Therapeutics, and Continuous Quality Improvement. The Medication Safety Officer will review all medication safety events for opportunities for medication-use system improvements and thereby discuss with residents on a weekly basis. The Medication Safety Officer will also discuss various topics with the residents centered on the causes and prevention of medication errors. The resident is ultimately responsible for staff education, development of strategies to evaluate the safety of the medication use process, and development of strategies to implement new medication safety practices within the system.

By the end of the longitudinal learning experience, the resident should be able to effectively facilitate the Medication Safety Subcommittee meeting, identify process changes needed in the facility’s medication-use system, and implement the steps needed to improve the safety of the medication-use process.

Patient Safety and Pharmacy Leadership is a required, longitudinal learning experience at Tallahassee Memorial HealthCare for the PGY1 Pharmacy Resident focusing on administrative responsibilities of Pharmacy leadership and the health system’s medication safety program. The Resident and Director of Pharmacy will meet every other week. During the meetings, the resident will discuss and answer questions to improve their understanding of the medication use system, human resource management, fiscal management, quality assurance, medication safety, and effective interpersonal communication and leadership skills.

The Pharmacy resident is responsible for actively participating in pharmacy discussions with the Director of Pharmacy Services. The Director of Pharmacy will provide reading materials or reference information prior to the meetings. The Director will also assign process improvement projects that enable the resident to evaluate and implement patient safety improvements. The resulting system improvements will ensure a medication utilization system that complies with Joint Commission medication management standards and federal laws.

By the end of the rotation, the pharmacy resident should be able to explain the effect of accreditation, legal and regulatory requirements on patient safety. The resident should be able to identify the proper steps needed to accurately evaluate the Pharmacy’s medication safety system. The resident should also be able to identify leadership qualities necessary to conduct ethical business practices. The resident should also be able to explain the principles of financial and personnel resources of a pharmacy department.

Practice Management is a required, four to six-week learning experience at Tallahassee Memorial Healthcare with the primary purpose of building a strong, effective leader in the profession of pharmacy. The resident will work closely with the Assistant Director of Pharmacy Services to become introduced to the functions and concepts of pharmacy administration within the hospital setting. The learning experience will afford the resident opportunities in developing problem-solving skills related to operational management, enabling strong administrative judgments, and assuming overall responsibilities of leading and managing a pharmacy department.

The pharmacy resident is responsible for updating pharmacy financials daily and actively participating in clinic inspections. The Assistant Director will provide necessary guidance and instruction on how to complete a schedule via OptiLink Plus software and give pertinent financial data so that the resident can formulate predictions to better manage overtime hours. The preceptor will also provide instruction and afford the opportunity of learning the process of ordering, reconciling, and resolving discrepancies associated with controlled substances. The pharmacy resident will also be responsible for attending monthly pharmacy administration and pharmacy staff meetings.

Staffing is a required learning experience designed to train the resident in balancing the various distributive and patient care based functions normally encountered by a hospital staff pharmacist. The residency coordinator and preceptor will coordinate initial training in basic elements of staff pharmacist activities. This will include use of Medication Manager Order processing system in Cerner, documentation methods including ad-hoc charting of interventions and clinical notes, Pyxis automated dispensing machine procedures, CII Safe narcotic procedures, intravenous admixture preparation and checking, and outpatient prescription processing. Specialists in the designated functions will provide the training whenever possible.

Following the initial training, the resident will spend 1 week with a pharmacist in a decentralized pharmacy area focusing on sharpening order entry skills. The resident will also provide other clinical intervention activities during this time, under the supervision of the training pharmacist. The preceptor will be a training pharmacist. If there are two residents, another pharmacist may train the other resident at the discretion of the residency coordinator.

During the remaining course of the residency, the resident will work one weekend per month (two 8 hour shifts) in a staffing role. The resident will also work one 3.5-hour staffing shift each week and at least one 8-hour shift on one major holiday (Thanksgiving, Christmas, or New Year’s Day). The preceptor will work along with the resident on the weekend shift. The preceptor will provide instruction, answer questions, supervise activities, and provide any other guidance as needed to assist resident in the development of necessary skills. Pharmacists generally work one weekend a month. Therefore, if there is a second resident, another pharmacist other than the preceptor may also provide the weekend training role at the discretion of the residency coordinator. In addition, other pharmacists will supervise the residents’ activities during the 3.5 hour and holiday shifts.