(PGY1 Elective Rotation)
Sara Bamford, PharmD
Description of Practice Site:
University of Utah Hospitals & Clinics (UUHC) is comprised of 4 hospitals, 18 clinics, 15 retail pharmacies, 3 infusion centers, ambulatory clinic services, and a comprehensive drug information service. University Hospital is a 436 bed, level 1 trauma center with strong critical care, emergency medicine, surgical services, obstetrics and gynecology, neonatal, internal medicine and subspecialties, neurosciences, and rehabilitation. University Neuropsychiatric Institute is an 80 bed inpatient psychiatric facility. The Huntsman Cancer Center consists of a 50 bed inpatient service, an ambulatory infusion suite, and extensive ambulatory cancer clinics, including bone marrow transplant. The University Orthopaedic Hospital provides mostly ambulatory care surgery services plus orthopaedic specific clinics. At UUHC, the ambulatory care network includes the Community Clinics, located throughout the Salt Lake Valley, and the specialty clinics and infusion room at University Hospital. While on rotation, the resident will primarily be at University Hospital but will have the opportunity to visit numerous UUHC sites.
UUHC purchases nearly 80 million dollars a year in drugs. As a system, UUHC is eligible to acquire drugs at Public Health Service pricing, or 340B pricing for use in the outpatient setting. The main intent for the resident is to develop an understanding of UUHC’s drug procurement process and associated policies, including regulations that pertain to 340B pricing. While on rotation, the resident will develop an understanding of UUHC’s drug costs, contracting process, negotiations, vendor relations as well interacting with UUHC’s group purchasing organization and wholesalers. The resident will learn inventory management strategies and methods of implementing formulary additions, changes and deletions. In addition, the resident will become actively involved in managing medication shortages, backorders and recalls. The resident will be introduced to the department’s compliance, supply chain, revenue integrity, regulatory and financial issues. Residents will complete several projects to apply key concepts and understand how to justify pharmacy services via supply chain management.
R1.1 Identify opportunities for improvement of the organization’s medication-use system.
- Explain the organization’s medication-use system and its vulnerabilities to adverse drug events (ADEs).
- Analyze the structure and process and measure outcomes of the medication-use system.
- Identify opportunities for improvement in the organization’s medication-use system by comparing the medication-use system to relevant best practices.
- Explain the process for developing, implementing, and maintaining a formulary system.
- Make a medication-use policy recommendation based on a comparative review (e.g., drug class review, drug monograph).
- Participate in the identification of need for, development of, implementation of, and evaluation of an evidence-based treatment guideline/protocol related to individual and population-based patient care.
- Design and implement pilot interventions to change problematic or potentially problematic aspects of the medication-use system with the objective of improving quality.
- Devise an effective plan for minimizing stress while attending to personal needs, maintaining relationships, and meeting professional obligations.
|Rotation Activity||RLS Goal||Teaching Method|
|Attend meetings with department leaders. Understand the relationship pharmacy has with other departments. Discuss change management and leadership styles and philosophies, specifically during weekly topic discussion sessions between the resident and preceptor.||All||I, C, M, F|
|Understand UUHC drug procurement policies and processes. Work with the pharmacy purchasing staff to procure regular drug supply from the wholesaler, in addition to placing orders for drop shipment items, direct orders and emergent drug orders.||R1.1||I, M|
|Review supply chain management issues. Describe the implications of 340b pricing for the organization. Review 340b splitting software with pharmacy buyer.||R1.1||I, M|
|Attend meetings with vendors, medical service representatives, Supply Chain Management Team, Products Evaluation Committee, Technology Assessment, and Pharmacy & Therapeutics Committee and apply lessons learned to enhancing medication-use system and associated policies.||R1.2||I, M|
|Conduct a project related to a change in supply chain at UUHC. Examples of projects include: formulary change, managing drug shortages, backorders and recalls.||All||I, C, M, F|
|Effectively communicate departmental and organizational changes surrounding a drug shortage, backorder or recall. Be able to identify key stakeholders and communicate with them in a timely and concise manner. Specifically, present shortage, recall and supply issues at University Hospital Inpatient Pharmacist and Technician Staff Meetings, draft bi-weekly email to all pharmacy staff regarding supply chain issues and submit a supply chain related article to the department newsletter.||E7.3||I, C, M, F|
Readings and Preparatory Work:
- Readings on H:\Rx Pharmacists\Resident Supply Chain Rotation
- 340b Tutorial: https://www.340bpvp.com/public/gps/gps.html
The resident will have the opportunity to work on a wide range of relevant supply chain management projects during the rotation. Projects will be concentrated on topics and initiatives that will enable to resident to work with different areas within the department of pharmacy as well as departments throughout the entire organization. Projects opportunities will be driven by current organizational initiatives and may require the resident to facilitate meetings and make presentations.
Typical Daily/Weekly/Monthly Activities:
Usual time for rotation is 8:00 am to 5:00 pm, but it is necessary for the resident to be flexible in their schedule due to variable meeting times. The rotation schedule will be reviewed at the beginning of the week and will likely be updated throughout the week. An additional meeting at the end of the week will be scheduled to review what was learned over the course of that particular week.
The resident will receive feedback on a regular basis regarding their progress on projects, readings, and participation/communication. They will sit with the preceptor at midpoint for a formal summative evaluation and again at the end of the rotation. The summative evaluations will be recorded in ResiTrak.