Preparing for pharmacy residency accreditation surveys

Transcription

1 special feature Preparing for pharmacy residency accreditation surveys Michael A. DeCoske, Pau l W. Bush, and Janet L. Teeters Am J Health-Syst Pharm. 2010; 67: The progress of health-system pharmacy depends on residency training. An increasingly talented pharmacy work force is necessary if the profession is to reach the heights of its collective aspirations. Both the American College of Clinical Pharmacy (ACCP) and the American Society of Health-System Pharmacists (ASHP) have affirmed residency training as the vehicle by which progress in the profession of pharmacy will take place. 1,2 The report by the ACCP Task Force on Residencies recommended requiring residency training by 2020 for all pharmacists engaging in direct patient care and, in addition, asserted the need for residency program accreditation to ensure that programs meet or exceed established residency standards. 1 Currently, ASHP is the only organization that accredits pharmacy residency programs. 3,4 ASHP s Commission on Credentialing (COC) recommends the accreditation standards, evaluates programs against the standards, and develops recommendations for accreditation status. The government requires residency programs in hospitals to be ASHP accredited before they can pursue Medicare pass-through funding. With an expanding number of residency programs and new residency program directors (RPDs) nationally, these programs must maintain a state of continual survey readiness in order to guarantee the quality of residency training. The idea of updating residency programs to meet residency accreditation standards just before a residency survey or merely for the purpose of passing is a disservice to residents and to the profession. The professional assurance that residency-trained practitioners nationwide have a baseline skill set enables physicians and other providers to have the confidence to utilize pharmacy services. Well-run residency programs help provide that assurance. Current process of residency accreditation The residency survey timeline begins several months before the survey and extends long afterward. A presurvey questionnaire (unique for postgraduate year 1 [PGY1] and postgraduate year 2 [PGY2] programs) and supporting attachments are due to ASHP 45 days before a scheduled survey. These documents represent an opportunity for RPDs to assess their residency program against the residency accreditation standard and serve as a study guide, but they also represent one of the most challenging aspects of the survey process. Data collection can be time-consuming, especially if an RPD is not familiar with what is expected. However, the information collected is extremely valuable to the ASHP accreditation survey team and helps facilitate a smoother survey process. Key attachments include a sampling of residency evaluations, residency program structural planning documents, and current residents customized plans. Academic records are completed for each resident and preceptor involved in the program. These forms are a standardized minirésumé and allow the surveyor to efficiently assess the qualifications of residents, preceptors, and Michael A. DeCoske, Pharm.D., BCPS, is Coordinator, Administrative Services, Duke University Hospital, Durham, NC; at the time of writing he was Health System Pharmacy Administration Postgraduate Year 2 Resident, Medical University of South Carolina, Charleston. Pau l W. Bush, Pharm.D., M.B.A., FASHP, is Chief Pharmacy Officer, Duke University Hospital. Janet L. Teeters, M.S., is Director, Accreditation Services Division, American Society of Health-System Pharmacists, Bethesda, MD. Address correspondence to Dr. DeCoske at Duke University Hospital, DUMC 3089, Durham, NC (michael.decoske@ duke.edu). The authors have declared no potential conflicts of interest. Copyright 2010, American Society of Health-System Pharmacists, Inc. All rights reserved /10/ $ DOI /ajhp

2 RPDs. The general organization data collection form and ambulatory and acute care grids provide a baseline scope of services offered at the hospital and by the department of pharmacy. Another set of materials (e.g., copies of acceptance letters, certificates, manuscripts, policies and procedures) is compiled for onsite review. A complete list of current attachments required for submission before the survey or onsite should be reviewed, as this information may change over time. 3,4 In general, the onsite residency survey is conducted as a series of discussions between surveyors and individuals involved in the training program. The details of setting up the residency survey are coordinated electronically or by telephone between an ASHP lead surveyor and the RPD or other program leader. These details include developing a plan for the residency survey and scheduling appropriate meetings with hospital administration, physicians, nurses, residents, preceptors, pharmacists, and pharmacy technicians. Additional logistic considerations may be discussed to determine where the surveyors will tour to see the residency training facility and services. Physicians and nurses who have a meaningful working relationship with the residents and pharmacy department and are familiar with the residency program should participate in the survey. Appendix A provides examples of the types of questions that might be asked during physician and nursing sessions. Of note, both medical residents and attending physicians may be considered for inclusion in the interviews. Physicians who are involved with the pharmacy and therapeutics committee or other key pharmacy-related committees should be included. Beyond the group discussions, surveyors are interested in ensuring that all elements of the residency practice environment meet or exceed the residency accreditation standard and therefore tour pharmacy operations and nursing units. Residency surveys are usually completed in two days (Appendix B). Surveys of sites with multiple residency programs (PGY1 and several PGY2 programs) seeking accreditation may take three days to complete. At the conclusion of the visit, surveyors verbally provide preliminary findings of how the program meets the standard, based on information obtained from all of the interviews, tours, and documents that have been reviewed up until that point. Although the review focuses on opportunities to improve the program as it relates to areas of partial compliance or noncompliance, positive features of the program are usually noted as well. After the visit, a formal written report is prepared, outlining areas of partial compliance and noncompliance and consultative recommendations. Rather than view these findings as negative, RPDs should regard partial compliance and consultative recommendations as areas of opportunity to better align with national standards. While several findings may share the title partial compliance, the severity of each should be evaluated individually. The correction of partial compliance findings may range from a small adjustment in residency program structure to much larger changes in pharmacy services offered by the pharmacy department. After reviewing the report, the RPD prepares and submits a formal written report to the ASHP Accreditation Services Division outlining its response, action plan, responsible parties, and timeline (if appropriate) for all areas of concern. All noncompliance and partial compliance findings require a response. While not mandatory, responding to consultative recommendations provides insight into changes within the residency program and department of pharmacy that have occurred as a result of the survey. Appendixes often accompany the progress report and provide a tangible demonstration of the improvements made after the residency survey. Appendixes should include actual examples of the documents used (e.g., an actual evaluation with comments, policies created, meeting minutes) or other relevant documentation that can show that implementation has occurred to address a particular concern. The surveyor report and residency program response are presented at the COC meeting, and appropriate accreditation status and duration are recommended. The COC s recommendations are sent to the ASHP Board of Directors for final endorsement, which usually occurs one month after the COC meeting. Currently, residency programs are usually surveyed every six years. If there are serious issues or significant changes to a program, the COC may request earlier survey visits. Based on the findings of the surveyors and the subsequent response, a residency program may not receive accreditation, may be granted conditional accreditation, or may be granted accreditation for one, two, three, or six years. For the programs that receive accreditation for less than six years, a progress report is prepared to determine continued accreditation status. At a minimum, all programs must provide an update to the COC in three years, even if they received six years accreditation. Additional information about the accreditation process can be found on the ASHP website. 5 Survey experience at the Medical University of South Carolina Twelve residency programs at the Medical University of South Carolina (MUSC) and South Carolina college of pharmacy at MUSC residency program were surveyed November 17 19, A survey preparation team was assembled, and a gap analysis was performed to compare cur- 470

3 rent ASHP residency accreditation standards with MUSC residency program practice. The team coordinated the completion of all requisite materials for submission and organized the surveyor visit and onsite exhibits. The team was also responsible for working with each RPD to facilitate the residency response. Overall, the residency survey preparation process was found to be quite challenging, particularly because the number of programs to be surveyed was large, there were new RPDs, residency program leadership had turned over, and the residency accreditation standard had been revised and updated. Also, since onsite reviews are so infrequent, individuals were not accustomed to preparing for the process, nor were they completely familiar with what to expect during the survey visit itself. Some individuals may not fully grasp how to implement new or revised residency accreditation standards. Based on the challenges experienced at MUSC, we surveyed residency programs around the United States to assess their level of preparedness for a residency survey. Survey of residency programs. In March 2009, an online survey tool (SelectSurveyASP Advanced ) to assess RPD readiness for an accreditation survey visit was prepared in coordination with MUSC and ASHP s Accreditation Services Division. The final survey tool consisted of 39 questions (closed- and openended). Demographic information was collected, as were subjective data regarding past participation in ASHP residency surveys. Questions analyzed RPD activities related to recent changes in ASHP residency accreditation standards 3 and frequent areas of partial compliance noted from past ASHP surveys conducted under the 2007 standard. 4 Questions were pilot tested by several RPDs to assess their validity and ease of use. s containing a link to the survey were sent to all RPDs in the United States contained in an ASHP database. The online survey tool was reviewed and deemed exempt by the institutional review board at MUSC. Survey results. A total of 1041 surveys were sent, 41 of which were undeliverable, yielding 1000 usable surveys. A total of 524 surveys were completed, for an adjusted response rate of 52.4%. The majority of the respondents directed PGY1 residency programs (71%), with 29% directing PGY2 programs. Thirty-eight RPDs (7%) served as director for multiple programs. The majority of RPDs surveyed (53%) served as RPDs for three years or less, while 24% served for six years or longer. Most RPDs had one or two residents (64%), while 9% of RPDs had six or more residents simultaneously. Seventy percent of respondents reported that they were informed about updates to residency standards. ASHP s Communiqué newsletter and the ASHP Accreditation website were cited as the preferred means to receive updates from ASHP. Other methods used to obtain updates included workshops and the residency townhall meeting at the ASHP Midyear Clinical Meeting and the biannual National Residency Preceptors Conference. In terms of continual program improvement, 63% of program directors reviewed residency accreditation standards at least annually to assess for necessary program changes, while 24% of RPDs chose to do so every two or three years or less frequently. Overall, when asked about current program preparedness, 153 RPDs (29%) felt either unprepared or very unprepared if an unannounced survey (similar to one conducted by the Joint Commission) were to be conducted. Of the subset of RPDs who had not previously experienced a residency survey, 91 (44%) felt unprepared or very unprepared. Of the 316 RPDs (60%) who had previously participated in a residency survey, 254 RPDs (80%) classified themselves as prepared or very prepared for an unannounced survey. Residency programs were assessed for preparedness by evaluating the following elements of the residency accreditation standard: the residentcustomized plan, the learning experience (rotation) orientation, learning experience descriptions, resident and preceptor evaluations, preceptor development, and Accreditation Council for Graduate Medical Education (ACGME) duty-hour compliance. These elements were selected, as they were either new to the 2007 PGY1 and PGY2 standards or had been frequently cited on surveys compared with the 2007 residency accreditation standards. RPDs responded to statements about a sample customized plan process. Ninety percent of the respondents indicated that they had a mechanism in place to assess entering residents abilities and interests. From this assessment, 83% had a written customized plan for each resident, with 75% having an initial program plan drafted by the completion of the formal hospital and residency program orientation period; 78% had the plan officially signed by both the resident and the program director. Subsequently, 46% of the respondents had the customized plans communicated to all learning experience preceptors, and 67% had updates to the plan made throughout the year and documented in writing on the original plan. Six percent of respondents reviewed and updated the customized plans monthly, 85% reviewed and updated the plan quarterly, 36% reviewed the plan as needed, 5% reviewed the plan at the end of the residency year, and 7% had some other frequency of plan review. Learning experience orientation included a description of the practice setting (e.g., type of patients) for 90% of the respondents, 58% included expectations of rotation hour requirements, 96% included a review of educational goals and objectives that 471

4 would be evaluated during the learning experiences, and 92% included activities that would be performed to meet the goals and objectives for the rotation (e.g., rounds, inservice education, discharge counseling). Seventy-six percent of programs reported having specific rotation descriptions for each rotation or learning experience. Many sites provided rotations in a specific area for both PGY1 and PGY2 residents. To differentiate PGY1 and PGY2 rotations, 55% had unique learning experience descriptions, with accompanying activities for PGY1 and PGY2 residents who were completing a rotation in the same area. Eighty-nine percent of RPDs reported currently reviewing resident and preceptor evaluations to ensure that qualitative and quantitative assessments occur. Twenty-one percent of RPDs frequently used past preceptor evaluations to improve future preceptor effectiveness in providing useful qualitative feedback to residents, while 31% reported rarely or never doing so. Thirty percent of RPDs provided feedback and areas for improvement to preceptors immediately after they reviewed preceptor and resident evaluations, 17% provided feedback to preceptors on a quarterly basis, and 35% provided feedback to preceptors annually. Eighteen percent of respondents reported rarely or never providing feedback to preceptors. Other programs provided feedback on an as-needed basis or when a trend was noticed in several resident evaluations. The most commonly selected activities for preceptor development included preceptor attendance at conferences with preceptor training sessions (53%), one-on-one feedback to individual preceptors (44%), and preceptor participation in a collegerun preceptor development program (44%). Many sites reported having homegrown preceptor development programs, seminars, journal clubs, and instructional guides used internally to train preceptors. Many residency programs (84%) allowed residents to moonlight in addition to their residency responsibilities. This occurred internally only (32%), externally only (22%), both internally and externally to the organization (27%), or in emergency staffing situations (3%). Forty percent of RPDs reported reviewing ACGME duty-hour compliance once at the outset of the program, 9% reviewed duty hours several times a year, and 38% reviewed duty-hour requirements only when a situation arose where a violation was expected. Finally, only 13% of the programs surveyed formally tracked residents duty hours. Recommendations for residency programs preparing for an accreditation survey The large proportion of RPDs who reported being unprepared or very unprepared for an unannounced survey is concerning, given the importance of having standards to help ensure a well-run residency program. However, these findings are not too surprising, given the number of RPDs with less than four years experience or no previous experience in an ASHP accreditation survey. Further, it became apparent that some respondents may not fully comprehend the requirements of the standard, based on their responses to the survey of targeted areas of the standard. Thus, they may be even more unprepared than previously thought. The following recommendations have been developed based on the residency program standards, the results of the preparedness survey, and the MUSC experience. The recommendations are intended to provide guidance for RPDs before a residency survey and for continual preparedness between residency surveys. Recommendation 1: Continually monitor the ASHP website for updates to residency accreditation standards. RPDs and other residency program leaders should routinely review residency accreditation standards for updates or changes. This can be done by accessing the ASHP Accreditation webpage. 5 Standard review should occur annually at a minimum. RPDs should review the Communiqué (ASHP Accreditation newsletter found on the Accreditation webpage) at least twice a year for alerts to standards changes, for interpretations of the standards, and to identify problematic areas. RPDs should review their own residency accreditation survey report from the last ASHP accreditation visit (annually) to ensure compliance with the findings and to promote continuous quality improvement. In addition, pharmacy services can be compared with ASHP Best Practices and the ASHP 2015 Initiative. 6,7 Recommendation 2: Establish a survey preparation team. Before a residency survey, it is advisable to assemble a survey preparation team consisting of residency program leaders, department of pharmacy leaders, and residents. The group should systematically perform a gap analysis of its program versus the ASHP accreditation standard to identify areas of noncompliance or partial compliance using the presurvey questionnaire. These areas should be quickly updated, and appropriate education should occur for all involved in the residency program. Ideally, this process should begin six months before the scheduled residency survey. The survey preparation team should be responsible for overseeing the completion and submission of the presurvey documents as well as preparing the exhibits for onsite review. Further, the team can work with the lead ASHP surveyor to oversee an efficient survey itinerary and arrange for the necessary meetings during the visit itself. Finally, the residency survey is an excellent opportunity to showcase the residency 472

5 program and its valuable contribution to the health system to hospital administrators and leadership. The team should include key leaders in the itinerary, when possible. The survey preparation team should also refer to the accreditation standard for interpretation of the presurvey selfassessment document, as additional information is listed in the accreditation standard. Recommendation 3: Prepare preceptors and residents for the survey. Preceptors should be aware of some key areas that surveyors routinely evaluate, including clinical teaching roles (instructing, modeling, coaching, and facilitating), timeliness for overall completion of evaluations, quality of the evaluation narrative commentary, and the process utilized for communication among preceptors. Residents should understand the appropriate materials to include in their residency portfolio and should review the residency accreditation standard and the Residency Learning System Goals and Objectives for their program. Being conversational in these areas will help the surveyor get the most out of the individual sessions with the residents and preceptors. Separate preceptor and resident preparation meetings before the residency survey can help to allay any fears or concerns associated with the process and ensure that all involved are presenting a consistent message to surveyors. Recommendation 4: Develop resident-customized plans. Residentcustomized plans should follow the sequence described in the results section. A formal mechanism should assess the entering resident s abilities and interests. The resident s interests, as well as weaknesses and strengths, should help direct the plan. From this assessment, a customized plan is developed and signed by the RPD and resident, generally by the completion of the formal hospital and residency program orientation period. At a minimum, customized plans should be reviewed and updated quarterly by the RPD and shared with each preceptor. While it is clear that not all programs are currently following this pattern, doing so represents compliance with the residency accreditation standard and is the optimal way to ensure that residents are meeting their individualized objectives, activities, and plan. Recommendation 5: Provide learning experience orientations. A formal orientation should be conducted at the beginning of each discrete learning experience (i.e., rotation). This includes but is not limited to monthly rotations, longitudinal experiences, on-call programs, medication-use evaluations, and staffing experiences. Orientations should contain an overview of the learning experience and should be initiated by the preceptor. A description of the learning experience should be used to outline rotation expectations (e.g., activities to be performed, such as rounds, patient interviews, and presentations), and how each meets the required goals and objectives for that learning experience should be reviewed. The list of goals and objectives to be evaluated, as well as how the evaluation process will occur, should be reviewed with the resident. Resident-customized plan review and compliance with ACGME duty-hour requirements should also be included during the orientation by the preceptor. Rotation orientation often provides the most comprehensive means by which a resident and preceptor can coordinate prior to the learning experience. Careful consideration to the resident s customized plan should be made, and adaptations to the experience to meet the resident s goals, as appropriate, may be implemented. Recommendation 6: Develop learning experience descriptions. Each learning experience should have a learning experience description. This includes but is not limited to all clinical rotations, medicationuse evaluations, on-call programs, and staffing assignments. Also, for each learning experience, when applicable, there should be separate descriptions for PGY1 and PGY2 residents to show the difference in activities and expectations. As an example, if a training site offers a medical intensive care unit (MICU) rotation to both PGY1 and PGY2 residents, there should be two separate learning experience descriptions to differentiate the broad, entry-level skills obtained by the PGY1 resident from the advanced-level training achieved by a PGY2 resident. Further, each learning experience description should link specific rotation activities to the goals and objectives to be evaluated during that rotation. For instance, if a PGY2 critical care pharmacy resident and a PGY2 pharmacotherapy resident complete the same MICU rotation, the activities completed by the residents should correlate to the goals assigned to them for that rotation. Preceptors should document these residencyspecific goals and objectives linked to activities on the learning experience description. Additional facets of a quality description include a learning experience purpose statement, a general description of the learning environment, specific rotation requirements (e.g., readings, presentations, meetings), and a method of evaluation. The learning experience descriptions provided on the MUSC pharmacy residency webpage offer one approach to implementing this recommendation. 8 Written learning experience descriptions should serve as the document for the preceptor to use when orienting the resident to the learning experience. Recommendation 7: Emphasize qualitative assessment in evaluations. Preceptor evaluation of a resident s performance represents an opportunity to continually refine a resident s skills and assess for areas of improvement. Resident and preceptor evaluations should focus 473

6 on the qualitative aspect of resident performance (i.e., documentation of how skills were developed and improved or of which skills still require continued improvement). Evaluations that simply recount tasks or assignments completed by the resident fall short of their intent and are thus time-consuming and ineffective. While most RPDs reportedly reviewed evaluations to emphasize the qualitative aspect, there are likely improvements that can be made. RPDs can demonstrate appropriate quantitative and qualitative evaluations during annual resident orientation and preceptor development sessions. Figure 1 provides a sample quantitative and qualitative evaluation. Preceptor evaluations of residents can also be shared with upcoming preceptors to facilitate opportunities for residents to progress. Recommendation 8: Seek opportunities for preceptor development. The need for quality preceptors will only increase as we strive to expand residency training over the next decade. Residency programs should seek opportunities for preceptor development. Well-trained preceptors have a significant effect on the training and development of pharmacy students, residents, new employees, and, ultimately, patient care. In addition to the formal techniques referenced in the survey, preceptors should receive regular feedback from RPDs regarding their skill in completing resident evaluations. These sessions should include both positive aspects of resident evaluations and suggestions for improvement. Development tools should take into consideration the level of training and years of experience of individual preceptors and should be customizable to preceptor strengths and weaknesses. In addition, programs should explore the development of preceptor mentoring programs where seasoned preceptors can coach their colleagues to success. Figure 1. Sample quantitative and qualitative evaluations for residents and preceptors. PGY1 = postgraduate year 1. PGY1 Outcome 2 Goal 10 Objective 1. Accurately assess the patient s progress toward the therapeutic goal(s). Resident response (quantitative only) I assessed all diabetic patients blood pressure and optimized pharmacotherapy to achieve a blood pressure of 130/80 mm Hg. Resident response (quantitative and qualitative) I assessed all diabetic patients blood pressure and optimized pharmacotherapy to achieve a blood pressure of 130/80 mm Hg. Despite my best efforts, several patients were not able to reach their target blood pressure. This may be due to the selection of a less-than-optimal drug, dose, or frequency or patient nonadherence to the prescribed regimen. Through this rotation, I learned the importance of following up with patients after discharge to ensure they are adherent with their medication regimen. Preceptor response (quantitative only) Resident familiar with guidelines for hypertension, hypercholesterolemia, and osteoporosis. Preceptor response (quantitative and qualitative) Resident was able to identify patients who were not optimally reaching their pharmacotherapeutic goals. Resident learned the challenges of balancing appropriate drug therapy with the adverse-effect profile. I was impressed by the resident s determination in following up with patients after discharge. In future months, the resident could improve patient-interviewing and data collection skills. Recommendation 9: Understand and implement procedures to ensure ACGME duty-hour compliance. It is important that ACGME guidelines are appropriately understood and that systematic procedures are implemented to ensure compliance. 9 Providing residents with a sound academic and clinical education must be balanced with concerns for patient safety and resident wellbeing. The intent of this requirement should be kept in mind when an RPD knows a resident is working hours beyond the residency requirements (i.e., moonlighting) to ensure that the quality of his or her residency experience and the provision of safe patient care are not affected. Annual resident schedules should be built around the key components of duty-hour requirements. Specifically, programs should comply with the 10-hour suggested rest time between shifts, maximum of 80 hours worked per week (averaged over one month), and one day off per seven days worked (averaged over one month). Routinely review the ACGME website and its duty-hour language for more insight and clarification. 10 Conclusion The residency survey preparation process can be lengthy and timeconsuming; however, being well informed and prepared should make the survey process less stressful. References 1. Murphy JE, Nappi JM, Bosso JA et al. American College of Clinical Pharmacy s vision of the future: postgraduate pharmacy residency training as a prerequisite for direct patient care practice. Pharmacotherapy. 2006; 26: American Society of Health-System Pharmacists. ASHP policy position: education and training. doc1c.asp?cid=512&did=7319#0701 (accessed 2009 May 20). 3. Teeters JL. New ASHP pharmacy residency accreditation standards. Am J Health- Syst Pharm. 2006; 63: American Society of Health-System Pharmacists. Communiqué. Import/ACCREDITATION/Residency Accreditation/Communique.aspx (accessed 2009 Nov 30). 474

7 5. American Society of Health-System Pharmacists. Accreditation homepage. (accessed 2009 May 20). 6. Hawkins BH, ed. Best practices for hospital and health-system pharmacy: positions and guidance documents of ASHP. Bethesda, MD: American Society of Health-System Pharmacists; American Society of Health-System Pharmacists. ASHP goals and objectives for the 2015 Initiative. Import/PRACTICEANDPOLICY/ 2015Initiative/Goals.aspx (accessed 2009 May 10). 8. Medical University of South Carolina and SC College of Pharmacy at MUSC residency program homepage. pharmacy/residency_programs/ rotationdescriptions2008.shtml (accessed 2009 May 25). 9. Smith KM, Trapskin PJ, Armitstead JA. Adoption of duty-hour standards in a pharmacy residency program. Am J Health-Syst Pharm. 2005; 62: Accreditation Council for Graduate Medical Education. Resident duty hours language. dutyhours/dh_lang703.pdf (accessed 2009 Nov 30). Appendix A Sample session for nurse and physician interviews during pharmacy residency accreditation survey Order of events 1. Surveyor gives professional background 2. Surveyor explains purpose of residency survey 3. Nurse and physician participant introductions 4. Nurse and physician interviews Sample questions posed 1. Can you describe your interactions with pharmacy residents and the pharmacy residency program? 2. Do you find the residents to be helpful and integrated into activities? 3. How well are you supported in your job by the department of pharmacy services? 4. Do you have suggestions for improvement of the pharmacy residency program? 5. (For nurses) Can you describe how nursing and pharmacy work together to ensure patient safety? 6. (For physicians) Can you discuss the resident s and pharmacist s roles in helping to select appropriate drug therapy? Appendix B Sample two-day residency accreditation survey itinerary Day 1 8:00 a.m. 8:30 a.m. Kickoff meeting with hospital administrators 8:30 a.m. 10:00 a.m. Presentation: overview of residency 10:00 a.m. 11:30 a.m. Presentation: overview of department of pharmacy 11:30 a.m. 12:00 p.m. Question-and-answer session 12:00 p.m. 1:00 p.m. Lunch 1:00 p.m. 2:00 p.m. Tour of department of pharmacy and hospital 2:00 p.m. 3:00 p.m. Meet with preceptors 3:00 p.m. 3:30 p.m. Meet with residency program director 3:30 p.m. 4:00 p.m. Review resident portfolio 4:00 p.m. 5:00 p.m. Meet with residents Day 2 8:00 a.m. 8:30 a.m. Surveyors onsite document review 8:30 a.m. 9:00 a.m. Meet with pharmacists 9:00 a.m. 9:30 a.m. Meet with technicians 9:30 a.m. 10:00 a.m. Meet with physicians 10:00 a.m. 10:30 a.m. Meet with nurses 10:30 a.m. 11:00 a.m. Meet with department of pharmacy management 11:00 a.m. 11:30 a.m. Final question-and-answer session 11:30 a.m. 12:30 p.m. Private surveyor conference 12:30 p.m. 2:00 p.m. Presentation of accreditation report to pharmacy staff 2:00 p.m. 2:30 p.m. Final meeting with hospital administrators 475