Postgraduate Year One (PGY1) Pharmacy Residency Program - Los Angeles

Kaiser Permanente

Kaiser Permanente, the largest private integrated care organization in the United States, has a nationwide enrollment of 8.6 million members throughout the nine states. The Kaiser Permanente Medical Care Program, Southern California Division provides medical care services to over three million members. In 2006, Kaiser Permanente implemented a highly sophisticated national electronic health record system (KP-HealthConnect) that links Kaiser Permanente facilities across the nation and provides authorized health care providers with online access to patient and clinical information 24/7. This provides a unique opportunity for the resident to be involved in many aspects of an organized health care delivery system with an emphasis on preventative care. The goal of this residency program is to help each participant understand how all the components of pharmacy services are integrated in order to provide our members with high quality, affordable health care. The resident will be exposed to various areas of pharmacy practice and will have many opportunities for unique and educational learning experiences.

Kaiser Permanente Medical Care Program - Los Angeles Area

The Los Angeles Service Area with a membership of over 277,000 patients is one of thirteen service areas of Southern California Kaiser Permanente.

Serving as the tertiary referral site for the southern California region, the Los Angeles Medical Center is also a teaching facility for 200 medical residents and fellows. It is the largest of the Kaiser Permanente facilities in southern California with 400 beds. The medical center also includes medical office buildings in Pasadena, Glendale, East Los Angeles, and a mental health facility in downtown Los Angeles.

Geographical Information

The Los Angeles Medical Center is located in Hollywood, west of downtown Los Angeles. All the exciting activities of the Los Angeles area are readily available. Theater, professional sports, recreation, and fine restaurants are easily accessible.

Pharmacy Services

At Kaiser Permanente, pharmacists work in an environment that allows them to do what they do best-practice pharmacy. They work as part of a true integrated health care team of physicians, nurses and other health care providers, and receive professional support from pharmacy management, pharmacists, pharmacy interns, technicians, and assistants. Our outpatient, ambulatory care and inpatient pharmacies offer a variety of clinical and progressive practice settings.

In addition to our clinic and acute care settings, our state-of-the-art centralized Call Center in Los Angeles and automated refill pharmacy at Downey, offer centralized call processing and high-tech automated drug dispensing. These facilities are on the cutting edge of medication dispensing.

The Pharmacy Services in the Los Angeles area offers a wide variety of pharmacist-run primary care programs. Working under a protocol, pharmacists may perform physical assessment, order labs, and initiate and adjust medication based on clinical judgment. We currently offer the largest variety of primary care pharmacy programs in southern California in the areas of asthma, anticoagulation, CVD management, congestive heart failure, diabetes, geriatrics, psychology, adult oncology, pediatrics oncology, renal, HIV, pain management, Medication Therapy Management (MTM), New Member Program, and amiodarone monitoring.

Residency Specific Information

The pharmacy residency at Kaiser Permanente Los Angeles has been in existence since 1977 and is the oldest residency in the Kaiser system.

The resident will become familiar with the various aspects of pharmacy practice in a health maintenance organization. The residency includes experiences in acute and ambulatory care practice, drug information/drug-use policy development, and practice management (outpatient and inpatient). Time is allowed for the resident to pursue an area of particular interest. Residents participate in all P&T committee activities throughout the 12 months, are active members of the pharmacy management team, and serve as preceptors for pharmacy students during their rotations.

The Kaiser Permanente Los Angeles Area Residency Program is accredited by the American Society of Health-System Pharmacists and uses the ASHP Residency Learning System (RLS) model to design and deliver training. The residency will begin in June 2013 and end on June the following year. The residency program consists of the following training experiences for the participants:

Ambulatory Patient Care

The ambulatory care experience will allow the resident to learn a variety of ambulatory services in the managed care setting. Pharmacists in this setting serve as independent health care providers to offer patient care and drug monitoring. Physician-approved protocols allow pharmacists to perform routine drug-related patient assessments, order drug-related laboratory tests, initiate/adjust/discontinue drug therapy regimens, and perform other specifically approved activities. In this setting, residents will learn to assess patients, perform medication therapy management, and provide patients with disease state and drug education. The resident will be able to select several of the ambulatory care experiences and spend several weeks in each area.

Ambulatory Care - Cardiovascular Track

Outpatient Anticoagulation Service

This pharmacist-run program provides care to over 2,300 physician-referred patients on both oral and injectable anticoagulants. Pharmacists in this service provide individual drug education, monitoring and adjustments for each patient’s diagnosis and laboratory values. The initial consultation with the pharmacist involves orientation to the service and drug/disease state education. Subsequently, pharmacists evaluate the patient's lab results, assess drug dosage and patient compliance, identify any drug interactions, make dosage adjustments, and arrange follow-up appointments utilizing telemedicine. Although this is an outpatient service, this program also follows patients in skilled nursing facilities. The resident will have the opportunity to rotate through this service and build upon skills necessary for patient care, drug monitoring and evaluation.

Heart Failure Management
The heart failure program provides service to high-risk patients with stage 3-4 heart failure. The heart failure pharmacist provides patients with disease state education, medication initiation and titration, symptom assessment training, physical assessment, and disease state monitoring. Heart failure patients are at high risk for hospitalization due to exacerbation. Therefore, the pharmacist monitors each patient closely to prevent decompensation of heart failure. The resident will work closely with both the pharmacist preceptor as well as the cardiologists to help each patient maintain heart function and prevent complications.

 

Ambulatory Care - Primary Care Track

Complete Care CVD Management Program
The resident will have the opportunity to rotate through several Complete Care CVD Management Programs in the Los Angeles Medical Center. We currently have four centralized, primary care programs supporting three family medicine modules and one internal medicine module. These programs aim to improve clinical outcomes of patients with or at high risk for cardiovascular disease. Populations for CVD integration include: diabetes mellitus (DM) type 2, hypertension (HTN), dyslipidemia, atherosclerotic disease, and chronic kidney disease. The resident will have opportunities to interact with patients via individual face to face clinic visits, telephone consultations, email "secure" messaging, as well as group appointment visits. This rotation also provides the resident opportunities to work directly with members of the multidisciplinary care team. The resident will educate patients regarding their disease states and recommend non-pharmacological methods of managing their chronic conditions. Upon disease state assessment, the resident may provide medication initiation and titration, monitoring of necessary laboratory tests, and drug interaction screening. The resident will also recommend routine screenings and immunizations for health maintenance (i.e. retinal exam, foot check, pap-smear, mammogram, colorectal screening, etc.) when appropriate. Overall, the experience will help the resident build his/her skills in primary care.

Medication Therapy Management Program
Medication Therapy Management Program (MTMP) must be offered to eligible Part D Medicare patients to decrease adverse effect, increase patients’ understanding of medication, and to increase adherence to medications as outlined by Centers for Medicare and Medicaid Services. MTMP is an integrated program where pharmacist utilizes approved therapeutic protocols to provide individualized medication therapy management for patients with chronic disease states such as diabetes, hypertension, and hyperlipidemia to positively impact the health of our MTM members. The resident will gain clinical experience through patient interactions with an emphasis on optimizing therapeutic outcomes though improved medication use, identifying/clarifying active medication profile, supporting adherence, reducing/preventing adverse events, optimizing dosing and monitoring, and facilitating cost effective therapy. The goal of our residency program is to facilitate our resident’s development of drug management and clinical decision making skills.

Geriatric Management Program
We are one of the few medical centers in Southern California that has a multidisciplinary geriatrics clinic that includes a pharmacist. You will get the opportunity to work with the neurologists, geriatricians, social medicine workers and nursing to provide dementia and poly-pharmacy interventions.

Ambulatory Care - Oncology Track

Adult and Gynecologic Oncology Program
The resident will have the opportunity to learn the most common oncology disease states and the associated first line, second line, and applicable third line treatment regimens. The resident will also process prescriptions for chemotherapy regimens. The resident will learn how chemotherapy agents are prepared and administered and learn how to prevent & manage associated side effects. The oncology pharmacist participates in the dispensing and management of research medications in numerous clinical trials. Furthermore, the clinical pharmacist works closely with oncology physicians to monitor and manage patients with anemia under Erythropoietin Management Protocol. Other clinical protocol work may include antiemetic, anticoagulation, GCSF, and pain management for oncology patients.

Pediatric Hematology/Oncology Program
The clinical pharmacist is part of the multidisciplinary team in charge of managing medications, monitoring side effect, and drugs interactions, and providing patient (caregiver) education to improve patient compliance. The pediatric oncology pharmacist is a member of the Children’s Oncology Group (COG) and is responsible for interpreting COG protocol treatment plans in order to verify inpatient and outpatient chemotherapy orders. Furthermore, pediatric oncology pharmacist is responsible for assessing patient’s emetogenic risk prior to undergoing chemotherapy as part of the Antiemetic Medication Therapy Management program. In addition, the clinical pharmacist in collaboration with pediatric oncologists will ensure that patient receives adequate stem cell support and pain management. As part of the experience, the resident will also be exposed to patients with hematologic disorders such as hemophilia, sickle cell, and aplastic anemia. The resident will attend regional pediatric tumor boards as part of their rotation and weekly multidisciplinary rounds.

 

Acute Patient Care
 

During this experience, the resident will participate in pharmaceutical involvement in acute patient care in the biggest tertiary hospital in Southern California. Los Angeles offers unique rotations in PICU, ICU, Med surgery, Cardiac Surgery, and Infectious Disease. The resident will learn to assume responsibility for the management and outcome of inpatient drug therapies. The resident will perform many clinical and distributive functions pertaining to but not limited to: aminoglycoside and vancomycin protocols; anticoagulation protocols; antibiotic surveillance program; total parenteral nutrition monitoring; drug/medication utilization evaluation; adverse drug reaction reporting; medical emergency, pediatric and critical care code blue participation; management of the drug distribution system; IV admixture preparation; and quality improvement programs. The experience will include exposure to Pharmacy & Therapeutics Committee, MedExec, and attendance of regional inpatient pharmacy management meetings.

Acute Care - Medicine Track
 

The resident will gain clinical and distributive experience in the inpatient setting. Clinical Inpatient Pharmacy services at LAMC include pharmacokinetic dosing, anticoagulation dosing, code blue participation, code stroke participation, TPN rounds, and antibiotic dosing.

 

Acute Care - Critical Care Track
 

In examining the role of the pharmacist practicing in a tertiary care CCU/ICU, the resident will perform many clinical functions, from participating in rounds to verifying transcription of drug orders on the medication administration record. Antibiotic dosing, anticoagulation management, parenteral nutrition monitoring and drug therapy of critically ill patients will be of major focus. Half of the track will focus on Infectious Disease, during which the resident will participate in antimicrobial stewardship rounds and evaluate targeted antimicrobial regimens.

 

Drug Education/Medication Use

Evaluation/Continuous Quality Improvement
 

The drug education program is a cooperative effort between the Kaiser Permanente Pharmacies in the California Division and the Permanente Medical Group to promote the appropriate and cost effective use of medications. The resident will become familiar with the development of educational programs used to influence physicians’ prescribing practices, as well as the methods used to promote rational and cost-effective therapies. Active participation also includes the development of indicators used to measure the quality of medication usage, as well as the quality of pharmaceutical care. Major factors affecting drug use, adverse drug reaction monitoring and reporting, and methods used to assess continuous quality improvement will be emphasized.

Drug Information

Kaiser Permanente has one of the nation’s largest drug information programs located at the Drug Information Service (DIS) in Downey. This training helps develop the necessary skills to provide accurate drug information as well as furthering drug researching skills. Pharmacists trained in this field locate information from a large variety of sources such as textbooks, articles, pharmaceutical industry services, internet programs, etc. The resident will be trained in utilizing the many drug information tools available, evaluating clinical literature, and how to disseminate drug information. Activities will also include the development of a drug monograph by reviewing relevant literature research and studies. Consideration of drug cost, place in therapy, comparisons with other therapy options, and formulary recommendations will be made by the resident. Drug information is a very resourceful tool in clinical practice since health care providers must be able to prescribe and monitor medications in a safe manner.

Pharmacy Practice Management

The resident will be exposed to pharmacy practice management by taking part in the leadership team. The resident will attend leadership team meetings, offsite conferences, Pharmacy & Therapeutics Committee meetings, medical symposiums and any other management event conducted within their residency year. In addition, the resident will meet one on one with pharmacy services leaders and clinical operations managers in order to obtain an overview of pharmacy administration. They will be given the opportunity to participate in a Management Excellent Training Program for a few days over several weeks. The resident will continue to develop problem-solving skills, communication skills, gain an understanding of drug use policies, and learn to make judgments, set priorities, and assume responsibility.

New Program Member

Each medical center has a New Member Program (NMP), whose services are offered to all new Kaiser Permanente members who are currently taking prescription medications. The NMP program facilitates the process of new members obtaining their prescription medications or equivalent Kaiser formulary medications quickly and efficiently. Ultimately, the NMP program results in increased patient satisfaction, and reduced costs due to monetary savings from both prescription drug costs as well as monetary savings resulting from decreased provider time during initial new member office visits. The resident will gain experience in clarifying medication profiles, converting medications to alternatives if necessary. The goal of our residency program is to facilitate our resident’s development of drug management and clinical decision making skills in order to facilitate cost effective therapy, as well as, provide our residents opportunities to impact both patient and physician satisfaction with pharmacy services.

ELECTIVE EXPERIENCES

Although the residents will be required to spend a certain amount of time in the major areas of pharmacy practice, the resident is encouraged to tailor the residency experience to his or her individual interests.

Outpatient Pharmacy

During the outpatient pharmacy experience, the resident will learn the routine duties and responsibilities of the outpatient staff pharmacist. These pharmacists are responsible to train and directly supervise pharmacy technicians, interns, and pharmacy assistants; provide professional consultation on all new prescriptions and handle complaints appropriately; order pharmacy inventory and supplies; complete pharmacy reports and maintain files for legally required documents, etc. In addition, the resident will be exposed to outpatient pharmacy management responsibilities and the critical aspects of achieving financial responsibility in the outpatient setting while maintaining excellent service to our patients. The resident will have the unique opportunity to expose themselves to technological advances occurring within Kaiser Permanente such as the large-scale Central Refill Pharmacy located in Downey. The resident will leave the outpatient pharmacy rotation with a much broader understanding of the pharmacy manager’s role in not only the daily activities of running a pharmacy, but also in terms of his/her impact on pharmacy as a whole.

Integrated Pain Management Program
 
As part of the Pain Management Program, the clinical pharmacist assists the interdisciplinary pain team to manage medications (both pain-related and neuropsychiatric), monitor side effects and drug interactions, and to provide patient education which improves medication compliance. The pharmacist provides routine monitoring of high risk chronic pain patients with psychosocial co-morbidities. The pharmacist is responsible to authorize refills of all scheduled II controlled substances to prevent medication overuse and abuse behavior. The resident will work together with the clinical pharmacist in his/her various responsibilities.

Renal Care Management

The pharmacist works in a multidisciplinary team to take care of end stage renal disease (ESRD), Peritoneal dialysis (PD) and transplant patients in ordering necessary labs and monitoring drug therapy. The renal pharmacist within the program is responsible for evaluation of each new patient’s medications and other disease or medication related issues and makes appropriate recommendations to the nephrologists. The pharmacist is also involved with teaching the “Kidney class” and “Choices class.” These classes educate patients about using caution with certain medications in early kidney disease and explaining differences among dialysis options. Patients are seen on clinic days for medication adjustments and follow-up with their care. In addition, the pharmacist identifies pre-ESRD patients to make sure they are on appropriate therapies to prevent disease progression and takes care of medication problems for kidney transplant patients.

Asthma Management Program

Asthma management is offered for both the adult and pediatrics clinics here at the Los Angeles Medical Center and our outlying Medical Buildings. The resident will get the opportunity to work with each patient one on one to educate them about their inhalers and how to better manage their asthma symptoms.

HIV Management Program

LAMC has the largest HIV population in Southern California. The ambulatory care services for HIV/AIDS patients are provided in a setting that resembles a medical home. Infectious diseases physicians, pharmacist, nurses, social worker, and care coordinator work together as a team to provide comprehensive care for these patients. In addition to managing HIV-related issues, the pharmacist also addresses other conditions commonly found in HIV/AIDS patients.

Psychiatric Clinical Services

The resident will practice in an inpatient and ambulatory mental health center where clinical pharmacists routinely prescribe under protocol and monitor the therapeutic and adverse effects of psychotropic drugs. This is only offered at the Los Angeles Medical Center. The resident will participate in patient treatment planning rounds, provide in-service drug information to staff, interview patients regarding drug therapy, and provide therapeutic consultations to physicians. The resident’s experience will also include how to monitor and track all of the Southern California clozapine patients.

Home Health

The home health pharmacist is responsible for arranging home health pharmacy services for patients who are being discharged from the hospital with intravenous medications. The pharmacist manages each patient’s intravenous regimen under protocols for such therapies as: hyperalimentation, antiviral therapies, pain management, and antibiotic monitoring. In addition, the pharmacist educates patients on any discharge medication that they will be receiving at home. The home health program serves as a means to ensure proper care throughout each patient’s transition from the inpatient to the outpatient setting.

Pediatric Intensive Care

As a member of the pediatric medical team, the resident will participate in work rounds, monitor drug therapy, and provide drug information to physicians and nurses. Infectious disease of the pediatric patient and antibiotic therapy are emphasized.

 

Other Responsibilities:

Professional Meetings & Seminars

The resident will attend the annual California Society of Health-Systems Pharmacists Seminar and the Western States Conference for Residents, Fellows, and Preceptors. In addition, the resident will have the opportunity to attend the ASHP midyear meeting and other pertinent educational courses and seminars.

Teaching Responsibilities

In conjunction with the clerkship program, the resident has the opportunity for precepting clinical clerkship pharmacy students. They meet with the students bi-monthly for case presentation and journal clubs.

Residency Project

The resident will be able to select a project at the beginning of his/her residency year that they will be involved with throughout his/her program. The resident will receive guidance on his/her project from both the residency coordinator as well as the residency preceptors. This project will be presented at the Western States Conference for Pharmacy Residents, Fellows and Preceptors. The resident will complete a poster presentation and a manuscript of his/her work. The resident will also participate in any projects during the rotations assigned by his/her preceptors.

Community Service

The Los Angeles Medical Center Residency Program works with several free clinics in the surrounding area to give back to our community. The resident will have the opportunity to work with community physicians, nurses, and other pharmacists to assist patient in managing their chronic and acute condition in a very economically challenged population.

Compensation and Benefits
•$23.38/hr
•6 paid holidays
•21 days per year earned time off which includes both vacation and sick leave
•9 days per year extended sick leave
•Health benefits including optical and dental for self and dependents (additional information available in the benefits tab above)
•Mileage allowance and other expenses
•Office space with a lap top computer, phone, and pager