Rotation 3: Pharmacy Administration: Transitioning to a New Perspective

Posted by Emily VanWieren at Sunday, November 20, 2016

First Impressions and a Day in the Life
What does a pharmacist in administration do?? Before this rotation, I had no idea what pharmacists do on a daily basis in this non-traditional role. I quickly learned that a job in administration felt similar to being in leadership for a student organization, something I was familiar with after being president of our chapter of APhA-ASP. My preceptor was in charge of the outpatient pharmacy as well as transitions of care initiatives at the hospital. We attended many meetings with various interdisciplinary professionals working at the hospital to brainstorm new ideas, create action plans, implement new projects, and track progress. Interpersonal and written communication was key in getting a message across and producing the best outcome. I helped interview technicians and pharmacists for positions that were open. I was also assigned various projects analyzing data and creating proposals for funding and restructuring of positions.


Transitions of Care
I became passionate about transitions of care over the course of this rotation. After two inpatient clinical rotations, I understood what happened while patients were in the hospital, but I had no idea what happened when they were discharged to go home. There are many medication errors that happen upon admission and discharge (transitions of care), and pharmacists can play a huge role in reducing these errors and creating a safer experience for patients throughout the whole health care continuum. I was heavily involved in counseling patients on their new medications during my organ transplant rotation, and there was some counseling on new anticoagulants during my internal medicine rotation, but a large majority of patients receive their discharge instructions via paperwork, and sometimes nurse education. One of my major projects was to create a proposal that would encourage more use of student resources to counsel patients being discharged on their medication changes so that patients and their caregivers understand exactly how, why, and when to take their medications. Pharmacists and student pharmacists can and should take ownership in transitions of care due to our vast knowledge of medications and our primary focus on medication use.


Reflections
I thoroughly enjoyed my administration rotation because I felt my skills of interpersonal communication, teamwork, and organization were in line with the day to day activities of a pharmacy administrator. I enjoyed hearing other's perspectives and brainstorming new ideas that would affect a large number of patients. Although I didn't have one-on-one interaction with patients on this rotation, I was surprised by how much I used my clinical knowledge and understanding of pharmacist workflow in order to problem solve and create ideas for large-scale solutions.

What is an Administration – Technology Systems rotation?

Posted by Anna at Thursday, December 20, 2012

This was a common question I received after informing people the title of my nontraditional rotation. After completing this rotation, I finally have a good answer!

The rotation was an administrative rotation within the context of the technology systems used in a hospital. These different systems include automated medication packaging, automated dispensing cabinets, and automated inventory management, to name a few. I worked under a pharmacist responsible for understanding the various systems, and who uses their capabilities and the data they collect to improve efficiency and safety within the health system.

My rotation followed a similar format to the other administrative rotations discussed by my colleagues already. However, I also spent the first week or so working with pharmacy technicians and actually using the technology. This included receiving medications from the order, picking medications for delivery, and going on runs to stock automated dispensing cabinets. This was not my favorite part of the rotation; however, it was important I understood how the systems worked in order to interpret the data they generated.

My day can easily be summarized into two main tasks: meetings and projects. I attended meetings that covered the administrative side of things (management/operations, policy review, and Joint Commission preparation) and those more specific to supporting the technology systems (purchasing/contracting, drug shortages, and quality improvement). Projects I completed include:

-          Review of pharmacy technician medication kit filling records to determine utilization of extra technician hours

-          Assessment of stock out data from Omnicells and recommendations for how to meet goals

-          Creation of a new database to store controlled substance research prescriber information

-          Collection of data and development of a timeline for implementation of consolidating purchasing of a product for the health system

-          Review of medication usage and current par levels in Omnicells and recommended changes

-          Evaluation of usage of bulk compounded products by outpatient areas

All of these projects involved ridiculous amounts of data which I had to sift through and make sense of. As a result, I became intimately acquainted with pivot tables.

I am very happy with my selection for a nontraditional rotation. I learned a lot about the administrative side of hospital pharmacy, and I better understand the challenges faced in this environment. This rotation taught me that how we get the drug to the patient is just as important as choosing the right drug. After this experience, I would be very open to an administrative position in the future.

This concludes my very last rotation at the University of Michigan hospitals—sad!!! Starting in January I test my winter driving skills (if we ever get a winter) as I venture out to Detroit’s Sinai-Grace Hospital for an Infectious Disease rotation!

A little bit of Everything

Posted by David Plumley at Tuesday, September 11, 2012

Sorry for my absence and delay in posting, but the last 6 weeks have been very busy for me. I recently finished my non-traditional rotation with Dr. Lindsey Kelley, as well as my PharmD. seminar presentation with Dr. Randy Regal.

I most definitely felt a ton of pressure to perform during my seminar, especially with Dr. Regal as my preceptor.  While I didn't steal all his jokes or puns I borrowed a fair share from him. I felt like my presentation went well overall and, hopefully, the people in my room managed both to stay awake and learn something about the use of protease inhibitors in treating HCV.

As far as my administration rotation with Dr. Kelley, I very much enjoyed working with her and would recommend her rotation to anyone interested in administration or anything to do with transitions of care.  My 5 weeks with her flew by, both because we were very busy with many projects but also because I was having so much fun.  It was possibly my favorite rotation thus far.

Dr. Kelley is involved in UMHS's specialty pharmacy program, transitions of care, 340B contracting, and ACP.  I will talk a little bit about each area and do my best to explain what took me the better part of 5 weeks to understand.

Specialty pharmacy(SP) is something new to Michigan and an area that is rapidly evolving.  Basically SP involves the dispensing special drugs to specific populations — transplant and cancer patients to name a few.  These drugs are special because they are limited in distribution from drug companies, require special monitoring, are very expensive, and often times insurance companies restrict where a person can get these drugs.  As a healthcare institution UMHS's goal is to provide these drugs to their patients and employees on their own or by partnering with other parties. My part in this effort was to compare different SP companies to see what they offer, what UMHS currently offers, and what we should offer.

Transitions of care (TOC) is something that Dr. Kelley is very interested in and an activity we spent a lot time working on.  This is because it is a important initiative for health systems and crosses over into other areas we were working on.  TOC from a pharmacy standpoint involves medication management/reconciliation at every transition (change in location) a patient goes through.

I was involved in projects relating to better ways to get patients discharge meds (there were some very interesting ideas for this), how we help patients get access to their meds as an outpatient, and the inner workings of our own ACP.  This  was specially fun because it involved a lot of creativity and I was able to work with many different groups all over the hospital.

Finally 340B, in my own simplistic view, is a special drug pricing strategy that UMHS has access to due to out patient population.  Again, UMHS is very cutting edge with these programs in order to better serve our patients and make our health system more sustainable.  This activity involved many meetings with many different groups, and took me weeks to understand.  I will not go into too much detail on this latter topic, but if you want to know more I have a sweet diagram I can share with you.

Being involved in all of these different activities required many 10+ hour days filled with meetings and special projects.  But it did not feel like work all the time, Dr. Kelley allowed me tons of autonomy to work on my own and to select projects that I was interested in.  This really helped me succeed. I hope to take the skills I learned from this rotation and bring them to bear on all of my other experiences this year.

If you have any questions about this rotation feel free to find me and ask.

Thanks for reading.

Pharmacy Administration

Posted by Anonymous at Wednesday, August 22, 2012

This first quarter of P4 year is going by quickly! Between finishing my seminar, doing PharmD investigation data collection, and preparing for each day of rotation, this summer has been a busy one!

My second rotation was Pharmacy Administration with Dr. Stevenson and Dr. Clark at the University Hospital. Going into P4 year, I ranked this rotation because I wanted to learn more about the roles that administrators have in the department, and what advances in pharmacy practice they are advocating. Both Dr. Stevenson and Dr. Clark are very involved in numerous projects, within the health system and on a national basis, and I was able to see what dedication it takes to be an effective leader in their positions! 

During the rotation, I was able to shadow my preceptors during meetings, and also interact with several assistant directors. Since Dr. Clark and Dr. Stevenson have different priorities within the Department and College, I was able to split my time between shadowing them. Both preceptors have excellent insight into the current trends in pharmacy practice- it was helpful to get their perspectives as I think more about life after graduation! I was also impressed by all the progressive initiatives the Department of Pharmacy was moving forward with to improve patient safety streamline the medication use process.

I completed several written projects- the ones that I enjoyed the most were deriving the total cost estimate of outsourced compounded products per fiscal year 2012, and analyzing the monetary value of recruiting a pharmacy technician compared with the financial modeling of base pay increases. Another component of the rotation was hold a journal club discussion with all of the assistant directors during a management meeting. I feel these activities helped me gain confidence in my presentation skills, both verbal and written, while becoming familiar with the tasks administrators tackle within this organization.

I would recommend this rotation to anyone who would like some "hands-on" experience in the world of pharmacy administration, and the opportunity to work with two of the nation's top pharmacy leaders! 

Good-bye Children, Hello B2!

Posted by ayumi :) at Saturday, July 28, 2012

Hello, hello, again! Long time no see?  I wasn't sure if I'll make it out of my first rotation, and I'm sure you were worried for me, too.  However, here I am again, living to talk about completing my first rotation AND since I’m so behind on this blogging business, completing my second rotation as well!  Time flies when you're having fun (or struggling like woah in my case), that's for sure!

I’m going to give you a little summary about how my Peds ID rotation ended up.  I was talking about how scared I was for rotations to begin, and how nervous I was about ID because it was never my forte, and unfortunately it still isn’t.  That said, my learning curve during this rotation was exponential! Really.  I read more articles about pediatric diseases and treatments than I had ever in my life.  I now know what it means to “choose the right drugs for the right bug coverage,” and that “narrow therapy” is always better than “broad therapy.”  These concepts, I kid you not, where some of the basic things we learned in therapeutics, but it was a difficult for me to fully understand why.  Once you can put a patient’s face to an infection, though, things start to make more sense.  I guess it just adds the urgency and seriousness of what we’re dealing with.  It’s like any other concept.  You just have to go through the hands-on process to actually “get” what’s going on. 

I still am not ready to be an ID pharmacist tomorrow; however, I have tons more respect for the ID team that I worked with and my preceptor.  Dr. Klein knows so much!  Everyone who was involved in this rotation are really good at including the student in all the patient discussions and makes you feel like you’re part of the group, well, because you are.  I do wish I had this rotation a little bit later in my rotation series, just so I would be more prepared and know what to expect, but what’s done is done, and I’m never looking back.  Good-bye Mott Hospital, it’s been real!  Oh, and THANK YOU to my fantastic ID team!  If you’re interested in Pediatrics and ID, this would be a good rotation to rank.  Everyone is so knowledgeable and willing to help you learn!

And two days later…  Hello B2!  I’ve graduated from pediatrics and moved on to the bigger and busier hospital, UH.  I spent most of my days in the basement pharmacy, which was good because Michigan summers are crazy thunderstorm-y, and I am not a fan of storms.  If you’re in the basement, there are NO windows, so you can see what ruckus Mother Nature is causing outside.

My second rotation was Nontraditional – Administration with Dr. Kelley.  She’s new, so not a lot of people have had the fantastic opportunity of meeting her just yet.  Of course, I am one of the lucky ones who got to spend five whole weeks with her!  I know, this is a moment where jealousy would be an appropriate emotion.  I’m telling you right now, P3s and below, when it comes to ranking time, even if you don’t think you’re interested in admin, rank Dr. Kelley high!  I really, truly enjoyed working with her!

I’m sure you’re now super curious as to why it was so great, right?  What does a pharmacist in administration do anyways?  Well, since I just finished my 5 weeks, I can answer that!  Dr. Kelley and I were problem solvers, brainstormers, new idea investigators, policy analyzers, ghost busters!  You name, we did it.  We went to a lot of meetings involving different departments and different minds, all focusing on how to make patient care at UMHS better.  I had the pleasure of meeting and working with so many BIG DEAL people! 

Here are some projects I got to work on during my 5 weeks… 1.  Looking at the feasibility of offering the service to flavor medications at our outpatient pharmacy.  2.  Conducting a gap analysis on the hospital’s 340B policy and procedures.  3.  Creating surveys for a new software being implemented at Mott.  4.  Observing and writing a report on the current discharge process.  5.  Creating a flow chart.  6.  Preparing handouts for various meetings.  In addition, we had lots of discussions on leadership, transitions of care, residencies, interviews, etc.  It might sound overwhelming.  I was overwhelmed for the first week or so, just because we never had a standard day.  Everyday was different.  Depending on what kind of person you are, this can be good or bad.  If you like structure and a set schedule, this rotation might be tough, but if you like not knowing what your day’s going to be like and living in the unknown, this rotation is pretty great and exciting.  I was in between the two.  I like knowing the future to a certain extent, so not knowing what kind of projects were going to pop up after each meeting made me a little anxious.  That said, I get bored really easily, but during this rotation I was seldom bored. 

Some tips for those of you who have this rotation in your future…  Don’t worry!  If I can make it through this, anyone can!  The earliest I went into rotation was 7am, usually 8am, so not super early.  Some days are long depending on how many meetings you have, but some days you just get to work on your projects.  I did have it easy because my rotation was in July, and according to Dr. Kelley, a lot of people like having fun in the summer and taking vacations, which means lots of canceled meetings!  I was spoiled.  So all I can say is, GOOD LUCK!  Hope your schedules aren’t too busy…  I tried keeping a to-do list of just rotation projects, and giving myself vague deadlines so if I run into problems, I can ask her whenever she seemed to have time.  She’s pretty hands off, and let’s you figure out a lot of things, so it’s a great opportunity to figure out how you work independently.  Oh, and I loved the fact that I met so many great people!  All my projects involved different groups of people (ACP, 12W Mott, Business director, financial director, Oncology…) so you have a myriad of chances to interact and network with pharmacists and nurses and other staff and hear their stories!  How cool.

Yes, yes, I liked this rotation a lot.  I don’t think I have the personality to be an admin pharmacist, but I’m really glad I had this rotation!  Thank you Dr. Kelley and everyone else in B2!  I’ll come back and visit J

I’m writing all this in transition to my third rotation on the Megabus – Community Rotation – Specialty Pharmacy (HIV/AIDS) in Chicago!  I hear this rotation is intense!  I’m nervous.  On the other hand, I am super excited to be in Chicago in the summer!  I get to live with my best friends for 5 weeks!  Should be a blast and a half! 

Mkk, until next time!  Hopefully you’ll hear from me sooner next time.

Hope your summer is fun-filled!

yours truly,

ayumi 

Putting healthcare on a diet: Toyota Production System

Posted by mariarx at Tuesday, June 12, 2012

Looking at the title you might be asking yourself "what in the hell do cars have to do with hospitals?" Our answer to you is - let's get lean.

Lean thinking is a concept derived from Toyota and how they work. The company has successfully integrated ideas such as worker responsibility, problem solving, just in time production, and inventory management to maximize quality and profits. The process of taking these concepts from car manufacturing to health systems was fairly simple - applying these will be the real battle. UMHS has committed to getting all of its health care providers thinking and acting lean. Assistant Directors Phil Brummond, Lindsey Kelley, fellow admin blogger Tom and I, attended the LEAN workshop in hopes of solving the pharmacy departments most perplexing problems. During the workshop we realized that every department has problems, and the lean problem solving process could really help give everyone a place to start and map out WHY problems are present.

The first 2 days of the lean workshop involved a highly technological simulation of emergency department workflow... we got to spend 4 rounds playing with lego patients, running around a conference room, and rolling dice. Each round, interspersed with lectures and discussion, added an extra layer of lean. We started with sheer chaos, with teams only finishing 3-4 patients in a 10 minute round. By the last round, our teams had finished 15 patients with time to spare. All of this was accomplished by implementing lean processes one round at a time.

Now you could be asking, "guys... how the heck do you take a lego and dice game and make it work in the real world?" I wish I had the answers. The lean workshop didn't give us a map to find the answers to all of our problems. But, it did give us the boyscout tools needed to navigate through the swamps, deserts, and forests of UMHS. By bringing these tools back to the pharmacy department and teaching others how to use them for themselves, we can (slowly) get to the root of a lot of the problems plaguing the department. Making people really examine every step of their routine and workflow - to look for how things should be done, and not how they've been done in the past - is the real goal of this workshop. One of the most profound things I learned was that you cannot MAKE people change, you need them to WANT to change. Given the power and opportunity, health care personnel will makes the changes needed to get more out of their job while also making it more fun, easier, and less stressful.

We learned a lot at the lean workshop and came back to the hospital with a lot to think about and consider. For now, we take it one step at a time and try and lay some groundwork in the last 2 weeks of rotation for the future. I want to be the person who writes their name in the wet cement of the future, even though I may not be around for it to dry.

Maria & -TV-

“No plan, no progress!”

Posted by Michelle at Friday, June 08, 2012

Salvete omnes! (That would be Latin for “Hello all!”)  My first rotation is an administrative one at UM’s home infusion service, HomeMed.

First, I will engage in a short digression. After arriving early for my first day of rotation, I waited in the lobby before meeting my preceptor(s) and discovered the delightful coffee table tome The Art of JAMA II. This book is a collection of some the fine art pieces published on the cover of JAMA over the years, and as a small-time art enthusiast, I was intrigued. Why am I telling you this? In one of the author’s accompanying essays, she noted something to the effect of, “Learning to look at your patient is like learning to look at a painting.” I thought this was a lovely simile. I encourage you to think about it. :)

Back to the topic at hand. For those not familiar with home infusion, it is a branch of pharmacy that furnishes intravenous drug therapy to patients for administration in their own home. Some examples of the treatments HomeMed provides include antibiotics, total parenteral nutrition, hydration, IVIG, clotting factors, chemotherapy, and pain management. Generally speaking, HomeMed receives referrals from the hospital, compounds the medications in the clean room, and then sends them out via driver to the patient.  On administrative rotation, I spend the lion’s share of my time in meetings with my preceptor, Dr. Chris Maksym, or other leadership staff members. These meetings cover a vast array of topics: vendor RFP presentations, software transition & development, patient care quality, accounts receivable, fiscal year goals, workflow optimization, payor audits, personnel management and process improvement. Suddenly, I am glad that I took accounting as an elective P1 year.

One of the most significant things I’ve learned about home infusion so far is that REIMBURSEMENT IS KEY! I’ve met a hospital staff pharmacist or two who left retail to escape the insurance burden; if that is so, then home infusion is not your cup of tea. Because home infusion is a (relatively) new kind of service when compared with traditional settings like inpatient hospital or retail pharmacy, avenues for reimbursement are convoluted. Some products are covered under Medicare Part B, but they must meet highly specific requirements. If not, the drug may be covered under Part D, but a patient’s supplies and nursing likely won’t be reimbursed. Medicaid has yet different stipulations. Myriad documentation will be required should either of these entities or other insurers like BCBS appear for an audit. The pharmacists at HomeMed must maintain acute awareness of the current billing rules in addition to their clinical knowledge so as to prevent major problems in the remuneration arena.

It has been extremely interesting to work with Dr. Maksym; you can tell his brain is always calculating and problem-solving. As an administrator, he is exquisitely concerned with A) metrics and B) vision. You yearn for another full-time employee in your department because business has increased and it will improve patient care? Excellent, now back it up with data. How can HomeMed increase efficiency so that the hospital receives its first-dose chemo on time and patient satisfaction is enhanced? If we’re changing that assessment form, why don’t we make it electronic now so it doesn’t need conversion in two years? As he is wont to say, “No plan, no progress!”

Meetings, meetings everyday...

Posted by mariarx at Saturday, May 26, 2012

Week one of rotation one is done. Woo!

If I've learned one thing in my first week on the UMHHC Administration rotation, it is how to eat on the go. Running around the hospital from 0800 - 1700 with no break on day 1 was pretty overwhelming. Nothing like learning to swim by being thrown right in the pool. Besides the long day, I got the opportunity to see a full range of administrative task meetings - RFP presentations, team meetings, pharmacy practice rollout and planning.  My second trial by fire happened on days 2-4 since my preceptor, Dr. Brummond, was in the land of Badgers and I was braving meetings on my own. Most meetings have consisted of taking notes (about medication safety, pharmacy operations, IT, drug shortages, Joint Commission) and then looking up all the terms that I'm not familiar with.

Besides meetings with my preceptor, other administrators, and various pharmacy teams; this rotation includes a 5-week (or more) long project. Thanks to fellow blogger, Andre Harvin, the admin team has a database of over 6.5 million points about medication dispensing in the hospital. My job will be to compile a workload analysis; one of many projects that will be done with the data. The past day has been spent fiddling around with Microsoft Access and googling tutorials. Thank the internet for "Access for Dummies." Also, it stinks that Access isn't available on macs. Boo!

I hope to also use the next 4 weeks to work on my leadership skills, hone in what I need to get done for residency applications, and maybe even create a hospital glossary. I think that's all I have for now.... I'm sure the next 4 weeks will be a great roller coaster, and I'll keep everyone posted!

aDmIn RoTaTiOn

Posted by Melanie at Friday, October 21, 2011

Today marks the last day of my administration rotation at UMHHC with Dr. Jim Stevenson and Dr. John Clark. I have to say this month has really flown by. My days were filled with meetings and project work. I definitely learned a lot and had great mentors to learn from.

I was able to attend the Pharmaceutical Benefits Advisory Committee (PBAC) meeting where I learned how drugs are put into different tiers for the employee drug plan. I also saw a Pharmacy and Therapeutics (P&T) Committee meeting where drugs are selected for the formulary in the hospital. I was even in attendance for a meeting with the Provost where Dr. Stevenson gave a presentation on 340b, a program the hospital qualifies for to receive medications at a discounted rate.

I completed several projects during this past month. These projects ranged from quality improvement to medication safety. I also learned how to analyze numbers based upon drug cost to the hospital and insurance reimbursement to justify an additional full-time equivalent (FTE). I learned about Medicare Part D and how a patient would move in and out of the doughnut hole and into catastrophic coverage.

Did you know that in 2011 a patient will only pay 50% of the drug cost for eligible brand-name drugs while in the doughnut hole and the manufacturer will pick up the other 50%? As part of the federal health care reform, discounts for patients will continue to increase through 2020. The following figure illustrates a Medicare Part D plan taken from Novartis Oncology:

http://www.novartisoncology.us/reimbursement/pp/part_d_gap_closure/index.jsp

Administration definitely gives a different perspective on pharmacy. I encourage every pharmacy student to spend at least one day shadowing a pharmacist in administration so that this viewpoint can be observed. It gives you an appreciation for the work that goes into operating and maintaining a pharmacy service. I am very glad I had this experience.

Like Father, Like Son

Posted by Jim Stevenson at Thursday, August 19, 2010

I may have gone to “Take your son/daughter to work day” once during elementary school, but I don’t recall it too well. I’d like to think that my understanding of and appreciation for my father’s job has progressed a bit since second grade. Really though, entering P4 year, I still didn’t have a good idea of what my father, or the rest of the large pharmacy administrative staff, did on a day-to-day basis. Are their roles something I could see myself doing? Are administrative skills genetically heritable? These are the questions I set out to answer during my first rotation.

Aside from honing my clinical skills and preparing myself for a potential residency, one of my main objectives of my P4 year was to get a better idea of how I might best apply myself in the field of pharmacy. I also considered administration to be one of the practice areas that you experience “now or never”. After speaking to the administrators at the hospital, I’ve learned that I was wrong about this “now or never” mentality, as many of them started out in other areas and didn’t even initially consider management. But that’s the spirit of P4 year – being wrong and then learning the truth.

My preceptor is Dr. Paul Walker, the Assistant Director of Pharmacy Clinical Services at UMHS. To my surprise, his meetings and projects to not overlap very much with my father’s (my father has his own P4 student this month, Doug Ritchie). I spend about half of my time each day attending meetings with Dr. Walker and about half of my time working on independent projects that I later relay to Dr. Walker.

One of the expectations for students on the administrative rotations is to meet with each of the Assistant Directors. We then find out what they do, how they got there, and how their role interplays with the other administrators. That’s been an interesting aspect of this rotation, as I now know who is in charge of what and the career paths they took to get there.

Another aspect of the rotation I have enjoyed is information on quality improvement in our hospital pharmacy. I’ve always enjoyed research and interpreting numbers, and administrative quality improvement takes those concepts and uses them to improve patient care and the financial efficiency of our services. In the Information Age, we have a lot of numbers at our fingertips, and this will only grow as our health system continues to advance Computerized Physician Order Entry and our software systems.

One Jim Stevenson has already chosen the administrative path. Will there be another? That remains to be seen – I’m barely half way through my first rotation!

The Joint Commision

Posted by Sarah Thiel at Thursday, August 05, 2010

My first rotation is at Providence Hospital in Southfield, Michigan for hospital pharmacy administration (nontraditional).

I was full of pre-rotation jitters Sunday night before my first day. I even picked out my outfit and made my lunch the night before - a habit I had left behind in high school! I got a good nights sleep and left Ann Arbor at 6:30am since I had never driven to Southfield before and wanted ample time to arrive.

I successfully maneuvered through morning rush hour traffic and even found a parking spot that was free of charge - which is a novel idea when one gets used to paying everywhere in Ann Arbor for parking.

My preceptor's administrative assistant met me at the employee entrance and showed me the way to the pharmacy department. She showed me around the department and introduced me to many people. My preceptor (the director of pharmacy) wasn't going to be in until Tuesday, so his manager took me under his wing for the day. When he arrived at 8am he had very interesting news for me - The Joint Commission (TJC) had arrived to survey our hospital system.

My tour of the nursing units was on the fly as the manager took me to every department to check all the medication room refrigerators for multi dose vial dating compliance before the surveyors began looking around. TJC now requires all multi dose vials be dated with a "beyond use date" of 28 days after it was opened or punctured (http://www.jointcommission.org/NR/rdonlyres/7DDACC46-9522-4DA6-B7A4-A41F52745A7E/0/jconlineJune910.pdf).

From there we went to "The Command Center" to get the latest scoop on what the surveyors' schedule would be. Here I was introduced to the two nursing directors as well as the Chief Medical Officer (CMO). One really great aspect of this institution is the level of support the Department of Pharmacy receives from nursing, the CMO, and other higher-up executives- and what a difference this support makes to developing and implementing pharmacy services!

I was then introduced to the Team Leader Surveyor and was able to tag along with the entourage of people accompanying her. What you will quickly find out about TJC surveyors is that they know how to get the information they need and that they are very good at their jobs - if there are any discrepancies in policies or procedures they will find it. They ask hundreds of questions and follow up on any issue of possible concern they find. All the employees at the hospital are basically told the same thing for how to interact with the surveyors: 1) Be polite but don't speak unless spoken to, 2) Be clear and concise when answering questions, and most importantly 3) Don't divulge or offer up any information that wasn't explicitly requested.

Having the Joint Commission here for an entire week has been a great way to kick-off my hospital pharmacy administration rotation. I have already attended several debriefing meetings, participated in conference calls regarding pharmacy technologies, presented information to physician and nursing surveyors, gave two summary overviews of the medication management tracer to the pharmacy staff, discussed the ongoing drug shortage issues, and even discussed initiatives to reduce departmental costs while improving patient care!

Now that week one is already close to an end, I am already very comfortable with this hospital and all the staff- everyone here is so friendly!

Who knows whats in store for next week!