Community Memorial Hospital - Menomonee Falls, WI

APPE Experience Type
Acute Care

Address
W180 N8085 Town Hall Rd.
Menomonee Falls, WI 53052

Phone
262-257-3070

Link to Site Home Page

Main Contact
Christine Vogt
cvogt@communitymemorial.com
262-257-3179

Teaching Philosophy

• Teaching is done in a practical, hands on style while staffing – students are assigned to a specific pharmacist each day.
• Independence is encouraged - Students are given patients to assess and they verbally report a plan back to the pharmacist. During this process, instruction is provided by the pharmacist and a learning assessment is done on the student.
• Students assist pharmacists with questions from other pharmacists, nurses and physicians.
• Medication specific information is provided via pharmacist teaching during chart evaluations, interactions with physicians and nurses, and formal presentations.
• Exposure to committees and decision making processes is provided.

Detailed Site Information

Institution
Community hospital, 200 beds, average census of 125 patients, orthopedic center of excellence, open heart program

Institutional Mission Statement and Vision
The CMH mission is to enhance and improve quality of life by providing high-quality, safe, cost-effective health services and wellness resources that meet the comprehensive needs of the community. These services are provided in a personal and compassionate manner, reflecting concern for the rights and dignity of persons served.

Pharmacy Services

Leadership and Practice Management

• Provide a written mission statement for the Pharmacy Department that reflects patient care and operational responsibilities.
• Optimize the use of personnel and resources through scheduling.
• Assure that the pharmacy is staffed with an adequate number of competent personnel to provide the defined services of the department.
• Assure state licensure of all staff as required.
• All personnel will sign the departmental and hospital commitment statements.
• All personnel will participate in continuing education activities as appropriate to maintain or enhance competence and licensure.
• Recruit and select personnel on the basis of job related qualifications.
• Identify and implement staff retention strategies including professional development opportunities.
• Promote pharmacy technicians as valuable contributors to health care delivery.
• Orient and evaluate new personnel through established procedures.
• Clearly define areas of responsibility within the pharmacy with written position descriptions and organizational charts.
• Collaborate with physicians, nurses, health systems administrators and others to identify the key pharmacy services that are essential to safe and effective patient care.
• Define policies and procedures of the department in writing. These are available to all employees within the department.
• Monitor workload and financial performance.
• Assure compensation for services provided.
• Maintain an ongoing, systematic program for quality assessment and improvement of the pharmacy and medication use processes. Participate in hospital wide quality improvement activities.
• Provide pharmaceutical services 24 hours a day.
• Participate in facility wide and departmental disaster preparedness.
• Respect and protect patient confidentiality by restriction of access to computer databases, reports and documents containing patient information.
• Assure adherence to Corporate Compliance policies and procedures.
• Foster cultural diversity and recognize its impact on the medication use process.
• Participate in self assessment opportunities to identify areas for improvement in the medication safety and the medication use system.
• Participate in patient and medication safety initiatives undertaken by the hospital.

Drug Information and Education

• Provide patient specific drug information, actively participate in patient education coordinated with nursing, medical, and other clinical staff as needed, ensuring that all patients are given adequate information about the medications they receive.
• Provide accurate and comprehensive information about drugs to other pharmacists, physicians, nurses, other health professionals, and patients as appropriate
• Provide up to date drug information found in current periodicals, recent editions of textbooks, and electronic information to professional staff as appropriate. Resources shall be readily available in patient care areas. No medication should be administered unless medical and nursing personnel have received adequate information about, and are familiar with, its therapeutic use, potential adverse effects, and dosage.
• Attend and provide input as it relates to medication use at multidisciplinary Discharge Planning Rounds.
  Provide discharge medication teaching to increase patient understanding and compliance with the medication regimen upon discharge and to provide continuity of care across different care settings; identify the potentially high risk or non-compliant patient population for early and effective intervention.
• Inform hospital staff about the use of medications on an ongoing basis through appropriate publications, presentations, and programs.
• Participate in orientation of new nursing staff, and student nurse interns.
• Identify and assess core competencies for pharmacy staff.
• Provide an educational site and preceptors for pharmacy and prepharmacy students, pharmacy interns, and pharmacy technicians according to the requirements of their school.

Optimizing Medication Therapy

• Clinical actions and recommendations are made to ensure safe and effective use of medications that have a potential effect on patient outcome.
• Review medication history for each patient. Accurately determine patient's current drug therapy upon admission and assure reconciliation of the patients’ medication list.
• Provide safe administration of patient medications by requiring a review of drug therapy by the physician as part of medication reconciliation.
• Review all prescribers’ medication orders (except in emergency situations or in those instances where a medication is administered under the direct supervision of the physician) for appropriateness before the first dose is dispensed.
• Questions regarding the order must be resolved with the prescriber prior to processing the order.
• Provide clearly written medication orders free of disallowed abbreviations for patient care.
• Medication use shall be monitored, including assessment of therapeutic appropriateness; therapeutic duplication; appropriate route and method of administration; patient compliance; drug-drug, drug-food, drug-lab, drug-disease interactions; laboratory data shall be monitored to evaluate the efficacy of medication therapy and to anticipate toxicity and adverse effects, including signs and symptoms relevant to the patient’s medication therapy.
• Provide consultations to other health professional regarding medication therapy selection and management.
• Provide physicians with a mathematical prediction of loading dose, maintenance dose, serum concentrations, and times to draw serum drug levels for drugs with a narrow therapeutic index.
• Initiate, monitor, and modify medication therapy for individual patients, consistent with laws, regulations and hospital policy.
• Conduct ongoing medication use evaluation to ensure that medications are used appropriately, safely, and effectively.
• Represent the Pharmacy Department on committees, task forces, workgroups and unit based councils that make decisions concerning medication use or redesign initiative such as patient-focused care.
• Supply documentation to medication staff, administrators and others of pharmaceutical care and patient outcomes from medication therapy, outpatient clinics and other pharmacy actions.
• Provide input in clinical care plans, guidelines, Interdisciplinary Standards of Care or protocols involving medication therapy.
• Review laboratory reports of microbial sensitivities and other pertinent laboratory results and advise prescribers if microbial resistance or if deficiency or toxicity is noted.
• Participate in the development of the annual CMH Antibiogram.
• Participate in development of policies and procedures concerning preventive and postexposure immunization programs for patients and hospital employees.
• Participate in the development, review and revision of all preprinted or standing order forms for completeness and adherence to the patient safety recommendations from the Institute for Safe Medication Practices.
• Develop standards for the use of high risk medications and administration of medications to decrease the risk of medication errors.
• Develop a list of sound alike/look alike medications and implement processes to decrease the risk of interchange of these pairs.
• Respond to Code Blue situations; maintain BLS certification.
• Verify the validity of off label medication use with primary, secondary or tertiary medication references.

Medication Distribution and Control

• Procure, distribute, and control all drug products used in the hospital for inpatient and ambulatory patients following processes to avoid sound alike/look alike pair interchange.
• All medication orders shall be reviewed by a pharmacist and assessed in relation to a medication profile before administration (excluding emergency situations or when given under the direct supervision of a LIP).
• Provide patients with appropriate safeguards in the prescribing, administration and documentation of medication.
• Participate in the maintenance of a formulary. Eliminate multiple brands of the same drugs and also multiple therapeutically equivalent products. Provide a mechanism for adding or deleting medications to or from the hospital formulary.
• Identify prescribers who have been granted appropriate clinical privileges in the hospital and are legally permitted to order medications.
• Identify personnel who are authorized by the hospital and appropriately trained to administer medications.
• Prepare or supervise preparation of drug formulations, dosage forms, strengths, and packaging not commercially available in accordance with applicable practice standards and regulations. Adequate quality assurance procedures and competencies shall exist for these operations.
• Prepare or supervise preparation and labeling of sterile medications in a suitable environment.
• Define responsibility for the compounding and dispensing of medications in a distribution system which provides for patient safety.
• Provide for patient safety by the appropriate labeling on all medications dispensed and medication containers from which drugs are administered.
• Provide pharmacy services, which protect the patient from nosocomial infections.
• Supply medications in unit dose packaging whenever possible. Manipulation of medications before administration by final users should be minimized.
• Assure the storage and preparation of medications under the proper conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security to ensure medication integrity and personnel safety.
• Monitor, report and prevent medication errors. Review of errors with appropriate actions will be conducted.
• Monitor, report and prevent adverse drug reactions. Establish an ongoing and concurrent surveillance system based on the reporting of suspected ADRs by pharmacists, nurses, physicians or patients. Broaden the knowledge of serious ADRs among the health professionals in the hospital and forward reports of unique reactions to the FDA so that they may identify all important drug reactions not well defined in current drug literature. Alert the patient to all significant ADRs and provide appropriate counseling.
• Prevent injury and promote a safe and secure environment.
• Provide for patient safety by removing recalled drug products from the hospital.
• Control the activity of drug vendor representatives within the hospital.
• Prohibit the use of medication samples within the hospital.
• Provide adequate inventory of drugs and pharmaceuticals to meet patient needs and procure quality products at the lowest price.
• Establish mechanisms to provide adequate inventory of drugs and pharmaceuticals to meet patient needs in the event of a disaster or drug shortage.
• Establish a consistent and fair pricing policy as well as provide for a return on CMH investment.
• Control availability and consumption of alcoholic beverages by patients while in the hospital.
• Provide for personnel safety when storing, handling and disposing of cytotoxic and other hazardous drug products.
• Ensure control and accountability for the distribution and use of controlled substances and other medications with a potential for abuse.
• Supply cost information necessary to adjust the book value of inventory for the pharmacy.
• Supply statistical information, which serves as an indicator of departmental activity in the dispensing of pharmaceuticals to inpatients, outpatients, employees and hospital departments.
• Prevent pharmaceutical stock from becoming obsolete, outdated, subject to deterioration, or unsafe for use. Detect and correct any storage arrangements that might contribute to medication errors.
• Limit floor stock medications as appropriate. The potential for medication errors and adverse effects will be considered for every medication allowed as floor stock.
• Provide necessary pharmaceutical antidotes for the management of toxicological emergencies. Provide pharmaceutical services in case of disaster.
• Participate in decisions about crash cart medication contents and the role of pharmacists in medical emergencies.
• Identify and monitor processes to decrease drug diversion.
• Provide leadership and advice regarding drug delivery systems, compounding devices, administration devices, and automated dispensing machines. Evaluate and monitor the use of these devices and the potential for medication errors associated with their use.
• Provide leadership and advice regarding the use of future technology in the medication use process (bar coding, CPOE).
• Provide expertise in the selection of drug manufacturers and suppliers to prevent the use of counterfeit or tainted medications.
• Identify processes for safe handling and disposal of hazardous/toxic pharmaceuticals.

Revenue Cycle Management

• Identify process to solidify the Pharmacy Department’s Revenue Cycle Management.
• Develop processes to ensure payer compliance, accurate coding, accurate reimbursement and maximum revenue.
• Develop processes to provide DRG Cost Control and DRG Cost Avoidance to strengthen hospital’s revenue cycle.

Facilities, Equipment, and Information Resources

• Provide facilities to enable the storage and preparation of medications under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security to ensure medication integrity and personnel safety throughout the hospital.
• Provide space and equipment for packaging and compounding drug products and preparing sterile products. The work environment will promote orderliness and efficiency and minimize potential for contamination.
• Provide training and assess competence to use equipment for the safe storage, handling, and disposal of cytotoxic and other hazardous drug products to ensure the safety of personnel, patients and visitors.
• Provide appropriate space, resources, and technology to facilitate the provision of drug information.
• Provide a private area for pharmacist-patient consultations to enhance patients’ knowledge and compliance with prescribed medication regimens.
• Provide meeting space for administrative, educational and training activities.
• Supervise the use and restocking of automated dispensing systems and software to promote the accurate and efficient ordering, preparation, distribution, and clinical monitoring of medications.
• Provide space for storage of records to ensure compliance with laws, regulations, accreditation requirements, and sound management techniques; practitioner licenses; permits; and tax stamps. Equipment shall be maintained in accordance with applicable standards, laws, and regulations.
• Provide computer resources to support secretarial functions, maintain patient medication profiles, perform billing processes, manage drug inventory, and interface with other computerized systems to obtain patient specific clinical information for therapy monitoring and other clinical functions to facilitate the continuity of care.
• Maintain pharmacy computer system files to meet patient safety standards; formulary and billing requirements. 

Research

• Provide for patient safety when an investigational drug offers a therapeutic or diagnostic advantage over approved drug products.
• Oversee the storage, distribution, and use of investigational drugs according to an approved protocol.
• Provide information about the safe and proper use of investigational drugs, including possible adverse effects and adverse drug reactions to nurses, pharmacists, physicians, and other health care professionals who will administer, dispense, and prescribe these medications. 
   

Professionalism and Assessment
Forms from the school are used for assessment criterion. The preceptor and the pharmacists that the student works with are involved in the grading process. The frequency of the assessment is based on the school’s requirements.

Resources
Computer access is provided on the first day, this includes the pharmacy information system, internet and Microsoft Office. Parking information is sent to the student before the rotation begins A drawer is provided for the student to store their materials The pharmacy has a break room with a refrigerator for lunches, and the hospital has an on-site cafeteria

   
Acute Care (Our only deficiency is the use of interpreters is very limited and may not be offered during the rotation.)

Primary Preceptor
Christine Vogt
Pharmacy Operations Supervisor

APPE Structure
80% of the time will be equally divided between our medical, surgical, step-down ICU and ICU floors. 20% of the time will be divided between our central pharmacy, hospital-based outpatient pharmacy and our outpatient Anticoagulation Service

Student Roles and Responsibilities
The student is expected to:

Be punctual.
To wear business casual dress with a white coat.
To understand the school’s requirements of the rotation.
To display a professional attitude.

Educational Opportunities
Pharmacist staff meetings and a monthly physician education luncheon.