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Stamp of Approval: ASHP Residency Accreditation Assures Quality

AS PART OF THEIR QUEST for ASHP accreditation in 2007, pharmacy leaders at Deaconess Health System in Evansville, Indiana, decided they needed to do something bold and innovative. They sent residents to the poverty-stricken community of Annotto Bay, Jamaica, to work with a team of pharmacists, physicians, and others on an international mission that many pharmacists might never experience.

In turn, Society surveyors praised Deaconess for offering residents creative patient-care training that benefited a needy community. ASHP accredited the program in August 2007.

“The surveyors were impressed with the flexibility of our program and the fact that we are able to provide opportunities outside the scope of our hospital,” said Joyce Thomas, Pharm.D., CACP, Deaconess pharmacy director.

The experience in Annotto Bay taught then-resident Andrea Tuma, Pharm.D., the ways in which cultural barriers can affect medication counseling.

“Americans are so used to the idea of seeing a doctor and taking medications, but these patients didn’t have the same access,” Tuma said, recalling her initial struggles. “My experience drove home the point that counseling is a two-way interaction, and that you have to listen as much as you talk.”

Reaching a Milestone

Thomas’s work in enhancing her residency program is an example of how ASHP accreditation helps raise the bar in training pharmacists as they move from pharmacy school to careers in hospitals and health systems.

This year, ASHP will accredit the 1,000th residency program to undergo its rigorous accreditation process since the program’s start in 1963. This important milestone for ASHP—the only organization that accredits pharmacy residency program —reveals how broadly accreditation has spread. It also highlights the far-reaching program improvements that often accompany this process.

ASHP believes so deeply in the value of accredited residencies, in fact, that its House of Delegates passed a resolution on the issue in 2007. The resolution states that by 2020, all new pharmacy graduates who will be providing direct patient care should first complete an ASHP-accredited residency.

“I think ASHP members realize that accreditation has been a huge value for our profession,” said Janet Teeters, M.S., B.S.Pharm., director of ASHP accreditation services, adding that accredited residency programs exist in hospitals, clinics, home health care, community pharmacies, and ?managed care organizations. “Accreditation really pushes the profession forward, making these sites strive to improve their training and clinical pharmacy services.”

ASHP survey reports, for instance, may recommend more diverse pharmacy services to match a diverse patient population, leading health systems to create specialized clinics for anticoagulation, diabetes, heart failure, or asthma.

“We often see reports of people hiring more staff, implementing new clinical services, putting in automation, or redesigning their work areas as a result of our visits,” Teeters said. “The peer review findings or recommendations in the accreditation reports often help pharmacy directors gain the resources they need.”

Those reports start with surveyors like David Warner, Pharm.D., ASHP director of residency program development. Warner travels up to 140 days a year, surveying residency programs and conducting other related work across the U.S. and in Puerto Rico.

ASHP surveyors meet with pharmacy residents, pharmacists, technicians, physicians, nurses, hospital administrators, and many others during the program review. They critique a variety of elements, including the way that residents are trained and evaluated.

ASHP surveyors judge programs using a core set of seven principles, including determining if the program:

• Uses a systems-based approach to train residents,
• Has well-qualified preceptors and program directors,
• Offers comprehensive, safe, and effective pharmacy services, and
• Requires a commitment from its residents to achieve the program’s educational goals and objectives and support the organization’s missions and values.

Warner and other surveyors emphasize the importance of teaching and mentoring residents as well as teamwork within the setting. “We look for the relationship that the pharmacy has with other professions,” he said. “Do physicians and pharmacists collaborate in patient-care decisions?”

In 2008, ASHP conducted more than 230 on-site survey visits. More than 130 of those were new programs. Those figures show the continuous growth in accreditation since the Society bestowed its first accreditation certificate to the program at Jefferson Medical College in Philadelphia in 1963. By 1964, 33 programs had been accredited.

Attracting Future Residents

Thomas sought accreditation after a discussion with a colleague in which she learned that most potential residents are interested in accredited programs.

“When recruiting, I find that residents are looking for accredited programs because they are quality programs backed by ASHP,” she said, adding that the accreditation process led to other inventive learning opportunities. Thomas wanted her residents to teach at a university, so she collaborated with Butler University College of Pharmacy and Health Sciences in Indianapolis to make it happen.

Meredith Petty, Pharm.D., clinical supervisor and residency program director at Deaconess, agrees that accreditation makes all the difference in recruiting and retaining residents.

“If I were a resident and taking an extra year to learn and develop myself, I’d want to be in a program that’s accredited,” she said, pointing to the fact that accredited programs are held to a higher standard.

The accreditation process can be done in a year or it can take place across multiple years. This all depends on how fast organizations develop their programs. ASHP will only conduct accreditation site surveys for those programs that have been operating with a resident for at least nine months.

Chris Taylor, Pharm.D., BCPS, clinical pharmacist at the Phoenix VA Healthcare System, believes accreditation can be a boost for program visibility. His accredited post-graduate year two (PGY2) residency program in internal medicine benefits from being listed on the ASHP’s popular online Residency Directory.

“Only accredited programs are included in the directory, so recruitment can be much more difficult if you’re unaccredited,” Taylor said.

Like the program at Deaconess, new training opportunities came with Taylor’s pursuit of accreditation. Taking the advice of surveyors, Taylor now conducts workshops for resident preceptors, including one that is designed to teach preceptors how to complete quality resident evaluations.

ASHP provides preceptors with many resources, including its National Residency Preceptors Con?ference. Held every other year, the conference brings together preceptors, residency program directors, and residents who network and participate in educational sessions.

Searching for Accredited Residencies

After she graduated from The James L. Winkle College of Pharmacy at the University of Cincinnati in 2006, Danielle Patrick, Pharm.D., was only interested in residency programs that had successfully made it through ASHP’s rigorous accreditation process. Patrick graduated from her PGY2 residency in critical care at University Hospital in Cincinnati in 2008.

“The paperwork, reports and evaluations are all part of a continual process in which the program is trying to improve,” Patrick said. “The value of accreditation to me is that I know I’m getting a great education and that I’ll be well-qualified based on the fact that I finished an accredited program.”

Midway through her PGY2 residency in pharmacy administration at Aurora Health Care in Wisconsin, Ashley Feldt, Pharm.D., said she takes real comfort in knowing that her residency program is ASHP-accredited.

“It makes me feel real positive that surveyors are reviewing a program to make sure there are enough preceptors to train residents and that they are committed to the program,” she said. The surveyors also indicated that Aurora’s operations are cutting edge, a plus for Feldt.

“We are in the process of implementing computer prescription order entry and bar-coding, the best practice for patient safety,” she said.

In her exploration of 2010 PGY1 residency programs, Angela Bingham, a student at the South Carolina College of Pharmacy at the Medical University of South Carolina campus in Charleston, is mindful that health systems are on the lookout for future employees who complete accredited residencies.

“When entering the job market, employers want to be confident that new employees can provide direct patient care that comes from accredited residency training,” she said.

No accreditation? No funding, says VA

?If you want to start a pharmacy residency program at any U.S. Department of Veterans Affairs (VA) medical center, you better ensure that it is accredited by ASHP. That’s because the VA requires its residency programs to be accredited in order to receive federal funding.

“There has to be a guarantee that the funding is used correctly and within professional standards, and accreditation is key to ensuring that that will occur,” said Lori Golterman, Pharm.D, clinical specialist in pharmacy benefits management services at the VA Central Office in Washington, D.C. “ASHP has supported our programs a great deal and helped us grow the quality programs that we have.”

The VA has an estimated 120 accredited programs, and trains about 22 percent of all pharmacy residents in the U.S., she said. More than 430 residents were enrolled in VA residencies in 2008.

The VA is assessing its medical centers without pharmacy residency programs to determine how they can implement the programs at those centers, Golterman said. Pharmacy residencies are offered at 89 of the VA’s 155 centers.

All new VA pharmacy residency programs must submit their ASHP accreditation survey reports to Golterman’s office. Report results are shared with all program directors to ensure a continual improvement process.

Golterman’s office has requested VA funding for an additional 80 residency positions over the next five years. She attributes the need for more positions to a rise in both the number of pharmacy schools and actual graduates.