The curriculum of City of Hope’s PGY2 Medication-Use Safety and Policy Residency involves required learning experience rotation blocks and longitudinal experiences that are project-based. Elective rotations (e.g., Investigational Drug Services, Opioid Management, etc.) are also available for the resident to customize the residency to align with specific interests.
Required Learning Experiences
- Adult Hematology
- Inpatient Operations
- Clinic Operations
- Compliance & Regulatory
- Clinical Informatics
- Automation & Technology
- Formulary Management & Drug Use Policy
- Community Clinic Operations
- Medication Event and Adverse Drug Reaction Analysis – Longitudinal
- Research Project – Longitudinal
- Medication Safety Leadership – Longitudinal
The resident will focus on safety considerations in induction and consolidation for AML, autologous hematopoietic stem cell transplant patients, CAR T-Cell therapy, and medications with specific monitoring parameters and administration instructions (e.g., filgrastim, IVIG, TPN). Considerations for evaluating preventability of adverse drug reactions (administration/timing of pre-medications, titration guidelines) will be highlighted.
The resident will gain an understanding of Main Pharmacy operations, including procedures involving unit dose packaging, cassette fill, and Pyxis fill for both controlled and non-controlled medications. Emphasis will be placed on technical aspects of the preparation of hazardous and non-hazardous medications and compliance considerations mandated by USP 800 and USP 797. Precautions taken for medication storage, labeling, and other redundancy processes will be stressed.
The resident will become familiar with safety considerations in the ambulatory clinics, including preparation and double-check processes involving chemotherapy and investigational drugs. Medical oncology chemotherapy regimens and adverse effects will be emphasized.
Compliance and Regulatory
This rotation will provide a broad understanding of hospital accreditation survey readiness and compliance with state regulations. The resident will design and perform audits to address survey findings and the hospital’s Medication Error Reduction Program. There will be opportunities to collaborate with Enterprise Quality and Risk Compliance to address patient safety and regulatory issues and participate on the Survey Readiness Team and Safe Patient Team.
The resident will evaluate Epic ERX medication builds, order sets, and Beacon chemotherapy treatment plans for design improvements to maximize safety. This experience will include a focus on strategies to optimize barcode medication administration and EHR clinical decision support tools. The resident will assess proposed Epic changes presented at the Clinical Content Review Board and Patient Care Services Committees.
Automation and Technology
Safety options employed with various technologies (e.g., infusion pumps with dose error reduction software, medication barcode scanning, automated dispensing cabinets, RFID tray replenishment system) will be covered. The resident will review best practice guidelines for use of these technologies and conduct gap analyses. The resident will coordinate a smart pump drug library update with Nursing and Biomedical Services and lead the Alaris Guardrails Taskforce in a review of CQI data.
Formulary Management and Drug Use Policy
This rotation will expose the resident to supply chain issues, purchasing considerations, and recall management. The resident will formulate strategies for handling drug shortages and implement a plan for managing a medication supply issue, including communication to healthcare professionals.
Community Clinic Operations
This rotation will give the resident an opportunity to understand the unique compliance and safety issues of community infusion practice. Regulatory considerations for sites on and off the hospital license will be addressed. The resident will assess workflows and policies in the community clinic sites to identify opportunities for practice alignment, attend the Community Quality Leadership Meeting, and conduct a patient tracer at a community clinic site.
Medication Event and ADR Analysis
The resident will collaborate with the Medication Safety Officer to investigate medication events, assess severity and stage of the medication use process, and prepare monthly medication event reports for presentation to Safe Medication Committee and P&T Committee. The resident will develop apparent cause analyses (ACA) for selected medication events and conduct a root cause analysis (RCA) and failure mode effects analysis (FMEA). This experience will also give the resident an opportunity to mentor and oversee the interns and PGY1 residents in their monthly analysis of adverse drug reactions.
The resident will complete a research project aimed at improving the medication-use system. The research project will be presented as a poster at the ASHP Summer Meeting, and the resident will create a manuscript suitable for publication.
Medication Safety Leadership
The resident will participate in various multidisciplinary committees throughout the year to gain a comprehensive understanding of the medication-use process. The resident will present lessons learned/good catches or other safety issues at weekly inpatient huddles.
The PGY2 Medication-Use Safety and Policy resident will participate in various departmental and multidisciplinary committees and task forces as assigned by the Residency Program Director. Assignments will be determined based on current department initiatives. At a minimum, this will include monthly participation on Safe Medication Committee, Pharmacy & Therapeutics Committee, Pharmacy Informatics Committee, and patient safety tracer teams.