PHAR 530 Community IPPE Guide – Spring 2020 – Page 1

PHAR 530 - COMMUNITY PHARMACY PRACTICE

INTRODUCTORY PHARMACY PRACTICE EXPERIENCE (IPPE)

GUIDE

Class of 2023

© 2020 by Virginia Commonwealth University School of Pharmacy

Office of Experiential Education All Rights Reserved

PHAR 530 Community IPPE Guide – Spring 2020 – Page 2

OFFICE OF EXPERIENTIAL EDUCATION

OEE@VCU.EDU

Rucha S. Bond, PharmD 804-828-3059 Associate Dean, Experiential Education rbond@vcu.edu

Wanda Coffey, MA 804-628-8268 Senior Administrator – External Affairs

wcoffey2@vcu.ecu

Denise L. Emminger 804-628-8267 Senior Administrator – Experiential Student Affairs dlemming@vcu.edu

Betty B. Dobbie 804-628-7546 Experiential Learning Specialist bbdobbie@vcu.edu

Kathy Barret 804-828-3005 Administrative Assistant kwbarret@vcu.edu

Mailing Address

410 North 12th Street P.O. Box 980581

Richmond, VA 23298-0581

Office Location McGuire Hall – Suite 201

1112 East Clay Street

Phone 804-828-3005 800-330-0519

Fax

804-828-7436

Websites VCU School of Pharmacy

www.pharmacy.vcu.edu > Experiential Education

CORE www.corehighered.com

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VCU SCHOOL OF PHARMACY PHAR 530 – COMMUNITY PHARMACY PRACTICE GUIDE

INTRODUCTORY PHARMACY PRACTICE EXPERIENCES (IPPE)

The Introductory Pharmacy Practice Experience (IPPE) Program in the first three years of the doctor of pharmacy degree program, and the Advanced Pharmacy Practice Experience (APPE) Program in the fourth year together augment the students’ classroom education by providing real-life experiences in many aspects of contemporary pharmacy practice. This 4-credit hour Community Pharmacy Practice course consists of four weeks (160 hours) of pharmacy experience in a community pharmacy setting. This course will introduce the P1 student to the fundamentals of pharmacy practice in the community pharmacy environment. The course is graded as honors, high pass, pass, fail. The purpose of this Guide is to help the student and the preceptor monitor the student’s progress in achieving the Community IPPE objectives and developing professional competencies. The Guide is divided into:

Orientation Checklist - Utilize this checklist on the first day of the rotation to assist both student and preceptor with orientation.

Learning Objectives - Identify what each student should be able to do by the end of this Community IPPE rotation, with suggested activities that support the desired outcomes described in the learning objectives.

Drug Information Form – Appendix A National Health Observances – Appendix B

Your preceptor or a preceptor-designee, (i.e. pharmacist, resident, technician, P4 student) may act as the point person for discussions on certain activities. ASSIGNMENTS There is a mandatory Community IPPE meeting during CPD I and required evaluations as posted in the syllabus.

This Guide is provided to the student (and is available on-line for the preceptor) with a list of activities to assist the student and the preceptor in meeting the learning objectives. These documents are posted in CORE along with the required evaluations.

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ORIENTATION CHECKLIST FOR ROTATIONS

On the first day of the rotation, utilize this checklist to assist both student and preceptor with orientation.

Introductions o Preceptor: background and training (resume), professional goals, vision for the profession o Site: description of the pharmacy and the community it serves; programs and services provided;

vision and plans for the future o Student: (share portfolio/resume): strengths/weaknesses/ previous experience; specific interest

areas’ goals and expectation of the rotation’ career goals o Staff: organizational chart

Goals and objectives of the rotation o Syllabus and Guide o Feedback and evaluation o Daily requirements, special activities/projects o Preceptor’s expectations of student

Student’s role in existing pharmacy or patient care service Appropriate to the scope of rotation experience you are offering Challenging to students Communicated to other staff

o Student’s responsibilities during the rotation Professionalism Who will they report to? How will they be held accountable? What are the consequences for not fulfilling their responsibilities? How should they document fulfillment of their responsibility?

o Student’s expectations/goals/requests o Calendar or schedule of activities with deadlines

Scheduling o Amount of time student with spend with preceptors and others o Hours/schedule; time/duration for meals/breaks o School’s absence policy/procedure and holidays – posted in syllabus

Legal and regulatory issues: patient confidentiality, HIPAA, OSHA, daily log

Tour of site: o Parking o Entry codes o Layout: restroom/break area location, records/charts locations, printer/fax machine,

conference/meeting rooms, doctor’s offices o Student’s personal items storage area

Introduction to work area: o Assigned work area o Computer system/codes o Internet use/codes

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LEARNING OBJECTIVE 1: Discuss the properties and formulations of drugs and drug products. Activities that support the desired outcomes of this learning objective may include, but are not limited to:

___ Discuss the medications being dispensed, including:

State the brand and generic name for medications dispensed Give the strengths and dosage forms for medications dispensed Identify the disease state(s) for which the medication is indicated List other medications used to treat the patient’s disease Accurately interpret sig translations

___ Pursue a firm understanding of the top drugs used in the community pharmacy and the student’s Top 200 list.

Gain familiarity with:

Brand and generic name Dosing Routes of administration and/or dosage form Contraindications/precautions Adverse drug reactions Interactions

___ Select a product that is frequently dispensed at the site, but with which the student is less familiar and complete

a Medication Review Documentations, at least one per week (form on page 7)

___ Discuss what medications are Behind-the-Counter (BTC) but do not require a prescription and why

___ Spend time in the pharmacy’s OTC/self-care area, including medical devises and durable medical equipment (if

available) to become more aware of and familiar with these items. Handle the packages; read the labeling. Use

references to expand knowledge and understanding.

___ Spend time observing and assisting the preceptor and/or other pharmacists make OTC recommendations to

patients. Retrieve the products for the patients. As pharmacists gather information from the patients,

observe these three things:

1. Gather information from the patient. At a minimum, this information should include:

• A description of the symptoms and the time course of those symptoms. If the symptoms can be

visualized (e.g. a rash) and are located in a place on the body that is not difficult or inappropriate to

examine in a public setting, then the student should physically examine the patient.

• What has the patient already tried, the time course of that trial, and the results.

• A list of all concomitant disease states, conditions, or medications (prescription, OTC, or health

supplement) which might affect either the patient’s complaint or the product recommendation

2. Decide to either refer the patient to a prescriber or to recommend OTC therapy. If the patient needs

referral, the student should explain to the patient clearly and in lay language why expert diagnostic help and

not self-therapy would be in the patient’s best interest.

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3. If OTC therapy is warranted, design a plan with the patient, including:

• What product would probably fit the patient’s needs most closely

• What time frame the patient could reasonably expect to pass before they see evidence of the OTC

product working or not

• What to do if the OTC product does not work or if it produces unacceptable side effects

**All of these tasks should be performed under the guidance of the preceptor or other pharmacist.**

___ Complete a Patient OTC Counseling Documentations, at least once per week (form on page 8)

___ Other activity as assigned by the preceptor

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Medication Review Documentation

Generic name:

Brand name:

Therapeutic class:

Dosage forms, color, shape, size, any special characteristics of the dosage form:

Top 200? ___ yes ___no

Cost:

Principal indication (labeled and unlabeled):

Dose and instructions for each indication:

Is a dose alternation required in; if yes, explain how: o Renal impairment o Hepatic impairment

o Geriatric patients

o Pediatric patients

Significant drug interactions (Rx, OTC, or herbals) and/or drug-nutrient

Interactions; describe the mechanism:

Adverse drug reactions (include common and serious side effects):

Contraindications/warnings/precautions:

Monitoring Parameters:

Auxiliary Labels Required:

Key counseling points:

Therapeutic alternates:

Student signature/date: _______________________________________________________________

Preceptor signature/date: _____________________________________________________________

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Patient OTC Counseling Documentation

Patient Scenario:

Describe the chief complaint, symptoms, and timeframe that led this patient to seek OTC therapy.

What other diseases, conditions, or medications the patient was taking influenced your recommendation?

Intervention:

Was the patient referred to a primary care provider? ___ YES NO

List the reasons for this decision:

If you recommended an OTC product, please detail your recommendation, the method by which the patient

should monitor for efficacy or adverse effects, and any additional advice you gave the patient.

Student signature/date: ___________________________________________________________ Preceptor signature/date: _________________________________________________________

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LEARNING OBJECTIVE 2: Interpret and process medication orders accurately, completely, and efficiently. Activities that support the desired outcomes of this learning objective may include, but are not limited to:

___ Become familiar with the pharmacy computer system: creating, maintaining, and documenting in a patient

profile

___ Ensure familiarity with the medical terminology pertinent to the practice site

___ Be certain to introduce yourself by name and role of student pharmacist when talking with patients

___ Obtain patient information to perform the steps necessary to process and dispense new and refill medication

order:

Interview patients to obtain patient information and create patient profile Interpret and evaluate patient information Identify patient-specific factors that affect health, pharmacotherapy, and/or disease state

management, including health literacy and compliance Receive and interpret prescriptions (order entry) Assess a prescription for necessary components, i.e. drug, dose, route, and frequency (order

verification) Accurately calculate doses for any given drug Compare medications against labels for accuracy (checking) Follow an order through all phases of the medication use process (delivery)

___ Use triple-check match process for prescription verification

___ Use vocabulary appropriate for the patient

___ Use the teach-back method when talking to patients about how to take their medicines

___ Discuss how insurance company formularies affect product selection, prescription processing, and patient care

___ Participate in third party billing, insurance, formularies, and limitations

___ Learn proper procedures for taking/giving a prescription transfer by phone

___ Review the types of medication coverage resources that may be available to patients in the community practice

setting

___ Gain an understanding of pharmacy automation

___ Participate in medication storage, pre-packing, and distribution

___ Review the laws governing pharmacy practice in the Commonwealth of Virginia

https://www.dhp.virginia.gov/pharmacy/pharmacy_laws_regs.htm

___ Other activity assigned by the preceptor

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LEARNING OBJECTIVE 3: Correctly perform calculations to dispense and compound medications. Activities that support the desired outcomes of this learning objective may include, but are not limited to:

___ Perform calculations required to dispense and compound medications: dosage calculations, ratio and percent strength, dilution, concentration, pharmaceutical measurement, and aliquots ___ Perform calculations most frequently necessary at the practice site

__ Calculate the pediatric and geriatric doses for medications that are dispensed

___ Other activity as assigned by the preceptor

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LEARNING OBJECTIVE 4: Identify and use appropriate drug reference sources (electronic and printed) to retrieve drug-related information and apply that information to respond to drug information questions.

Activities that support the desired outcomes of this learning objective may include, but are not limited to:

___ Learn the most commonly used drug/medical references at your site and different circumstances when each

source would be used.

___ Answer at least four drug information questions using the form provided in Appendix A. The questions can be

from patients, physicians, your preceptor, or questions you identify. Students should discuss the answers and

resources used with preceptor. (These forms do not need to be turned into OEE)

___ When drug interaction, allergy, or other potential drug-related problem alerts are generated, the student should

consult appropriate references, discuss the findings with the preceptor, and together determine whether to

interview the patient and/or prescriber to correctly interpret the message and develop a response plan, including

potential alternative therapies.

___ Upon detection of a medication-related problem, design a new or modify an existing drug medication regimen

(drug, dose, route, frequency, and/or duration) to prevent or minimize the risk of the problem adversely

affecting the patient. Document the problem and response as a SOAP note or use a method advocated by the

preceptor.

___ During slow periods, look up the drugs with which you are not familiar and expand your knowledge of drugs with

which you are familiar.

___ Other activity as assigned by the preceptor

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LEARNING OBJECTIVE 5: Educate patients on wellness and health promotion services to advance direct patient

care.

Activities that support the desired outcomes of this learning objective may include, but are not limited to:

___ Provide accurate medication lists to patients on chronic medications and encourage them to always present

an accurate updated list at each doctor appointment, hospitalization, and emergency room visit, to ensure

that all health care professionals have ready access to the patient’s accurate, updated medication list.

___ Assist patients with medication dispensers to help them adhere to their medication regimens.

___ Participate in or observe your preceptor providing advanced patient care services, including:

Screenings (lipid, blood pressure, etc.) and immunization clinics Medication therapy management programs Other health initiatives, i.e. brown bag seminars

___ Participate in the practice’s wellness and disease prevention activities

Create new wellness and disease prevention activities for the practice Create tools and educational materials Write a newsletter about wellness and disease prevention Assist in marketing wellness and disease prevention services

___ Choose a health observance that interests you and that will occur during the rotation (see 2013 National

Health Observances calendar – Appendix B). Develop an activity that can be accomplished during the rotation and be incorporated into the practice site.

For example, May is National Blood Pressure education month. Develop activities to educate

patients on high blood pressure. Develop handouts and patient education materials to be available at the site. (Keep in mind your

site’s patient population, i.e. primary language, age group) If space is available, develop a bulletin board or display with educational messages and handouts

regarding the national health observance. Develop a shelf-talker or poster to convey a message about a national health observance. Give a presentation about the national health observance at the pharmacy, a community center,

church, civic building, or library for various groups or associations. If the site has a newsletter or community publication, develop an article about the national health

observance.

___ Develop an activity to focus on seasonal health-related issues, i.e. sunscreen, allergies, bug bites, etc. ___ Other activity as assigned by the preceptor

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LEARNING OBJECTIVE 6: Summarize the process of adverse drug reactions and medication errors detection

and reporting at the site.

Activities that support the desired outcomes of this learning objective may include:

___ Discuss the importance of and process for detecting, reporting, and tracking adverse drug reactions (ADRs)

___ Learn and discuss the ADR reporting system at your site

___ Learn and discuss the most common types of medication errors at your site, at which stage in the medication use

process the errors occur (i.e., prescribing, dispensing, administration) and systems in place to minimize the errors

___ Identify and describe best practices at your site that reduce the potential for medication errors

___ Identify how technology at your site can be used to reduce the potential for medication errors

___ Discuss how your site responds when a medication error is detected

___ Review your site’s list of look-alike/sound-alike drugs and potential errors and consequences. Describe specific

safety strategies that are in place to prevent errors related to the look-alike/sound-alike drugs

___ Discuss the internal and external medication error reporting requirements at your site

___ Refer to the Institute of Safe Medication Practices for guidance to prevent medication errors and achieve safe

medication use

____ Learn and discuss quality controls and quality assurance procedures

___ Other activity as assigned by the preceptor

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LEARNING OBJECTIVE 7: Communicate relevant, concise, and timely information in a clear manner using

terminology and vocabulary appropriate for the intended audiences, e.g.,

pharmacists, technicians, healthcare providers, patients, and caregivers.

Activities that support the desired outcomes of this learning objective may include:

___ Obtain the necessary information when receiving a prescription from a new patient

___ Provide counseling/education to patients when dispensing their prescriptions

___ Interaction with patients and/or caregivers

Participate in refill reminders – call patients to remind them to refill a chronic medication Participate in antibiotic call-back program

___ Provide accurate medication lists to patients on chronic medications and encourage them to always present

an accurate updated list at each doctor appointment, hospitalization, and emergency room visit, to ensure

that all health care professionals have ready access to the patient’s accurate, updated medication list.

___ Assist patients with medication dispensers to help them adhere to their medication regimens

___ Concisely communicate responses to drug information requests

___ Utilize open-ended counseling techniques whenever possible while counseling patients on medications

___ Interaction with other health care providers (if applicable)

Participate in contacting prescribers for medication changes, i.e. formulary changes, errors on

prescriptions, prescription clarifications, adverse drug reactions, etc.

___ Upon identification of a drug-related problem, confer with the preceptor before appropriately communicating

the problem to the prescriber

___ Interact with and learn from the experiences of pharmacy technicians who have an essential role in community

pharmacy operations

___ Other activity as assigned by the preceptor

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LEARNING OBJECTIVE 8: Describe and participate in the various aspects of managing a community

pharmacy, e.g., policies and procedures, inventory, reports, personnel, marketing,

career options, etc.

Activities that support the desired outcomes of this learning objective may include:

___ Describe:

department organizational chart

staffing hours and patterns

responsibilities of various staff to the department, patients, and other departments

____ Through interview and observation, determine all activities where pharmacists interact directly with patients,

caregivers, or other health care professionals

____ Discuss the responsibilities of the pharmacy manager/director and/or review the job description

____ Learn and discuss the pharmacist’s role in specialized patient care services, i.e., health screenings,

immunizations, adverse drug reaction monitoring and intervention, anticoagulation monitoring, etc.

____ Discuss the opportunities for pharmacists to participate in professional and educational activities, i.e. continuing

education, staff development, professional organizations, etc.

___ Discuss staffing plans that maximize the provision of pharmacy services

____ Learn and discuss the policies and procedures for pharmacy

____ Discuss drug purchasing system and cost analysis

____ Discuss ordering, perpetual inventory and labeling of scheduled medications

____ Discuss how insurance company formularies affect inventory

___ Participate in drug ordering, check-in, returns, and charging/crediting (including differences between CII’s and other medications)

___ Discuss the paperwork that is kept on file for controlled and non-controlled prescriptions

____ Discuss with pharmacists any changes in practice they have observed since they graduated

___ Review controlled substances policies

___ Discuss the types of audits that occur in a hospital

___ Discuss career path options

___ Discuss advocacy of the profession by state and national pharmacists associations

___ Other activity as assigned by the preceptor

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LEARNING OBJECTIVE 9: Demonstrate communications, attitude, behaviors, and appearance as articulated in

the Attributes of Professionalism policy.

Activities that support the desired outcomes of this learning objective may include, but are not limited to the following policy:

VCU School of Pharmacy Attributes of Professionalism

The following describes the attributes of professionalism expected from students, faculty, and staff in the School

of Pharmacy.

Scholarship & Commitment to Excellence: Actively engaged; demonstrates strong work ethic; strives to exceed

minimum requirements; punctual; prepared; conscientious; seeks additional knowledge and skills

Accountability & Initiative: Accepts personal responsibility; demonstrates reliability and follow‐through with

commitments in a timely manner; accountable for his/her performance; recognizes limitations and seeks help when

necessary; addresses individuals who demonstrate unacceptable behavior

Self‐Growth & Self‐Care: Commits to life‐long learning; seeks & applies feedback for improvement; sets & achieves

realistic goals; maintains personal health and well‐being; avoids harmful behaviors

Responsibility & Sense of Duty: Contributes to the profession; provides service to the community; follows

established policies

Compassion & Respect for Others: Displays empathy; considerate; cooperative; sensitive; respectful of different

socioeconomic backgrounds & cultural traditions; avoids promoting gossip & rumor; respects authority

Integrity & Trustworthiness: Demonstrates high degree of integrity, truthfulness, and fairness; adheres to ethical

standards; maintains confidentiality

Teamwork & Professional Demeanor: Interacts effectively with others; listens & communicates effectively; willing to

assist others; flexible; nonjudgmental; controls emotions appropriately; inspires trust; carries oneself with

professional presence

Concern for the Welfare of Patients: Treats patients & families with dignity; respects patient privacy, values and

belief systems; advocates for patients; places patients’ needs above their own; promotes a culture of safety.

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APPENDIX A

DRUG INFORMATION FORM

Question:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

List the search strategy used:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Answer:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Resources used:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

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APPENDIX B

MAY NATIONAL HEALTH OBSERVANCES JUNE NATIONAL HEALTH OBSERVANCES

Arthritis Awareness Month Better Hearing and Speech Month Global Employee Health and Fitness Month Healthy Vision Month Hepatitis Awareness Month Melanoma/Skin Cancer Detection and Prevention Month® Mental Health Month National Asthma and Allergy Awareness Month National Celiac Disease Awareness Month National High Blood Pressure Education Month National Mediterranean Diet Month National Osteoporosis Awareness and Prevention Month National Physical Fitness and Sports Month National Teen Pregnancy Prevention Month National Toxic Encephalopathy and Chemical Injury Awareness Month National Youth Traffic Safety Month Preeclampsia Awareness Month Ultraviolet Awareness Month UV Safety Month Children's Mental Health Awareness Week North American Occupational Safety and Health Week Hand Hygiene Day Bike to School Day Recreational Water Illness & Injury Prevention Week Cornelia de Lange Syndrome Awareness Day Food Allergy Awareness Week National Women’s Health Week National Alcohol- and Other Drug-Related Birth Defects Awareness Week National Stuttering Awareness Week National Neuropathy Awareness Week HIV Vaccine Awareness Day National Asian and Pacific Islander HIV/AIDS Awareness Day World Autoimmune Arthritis Day Heat Safety Awareness Day National Hurricane Preparedness Week National Senior Health & Fitness Day® World No Tobacco Day

Fireworks Safety Month Cataract Awareness Month Men's Health Month Myasthenia Gravis Awareness Month National Aphasia Awareness Month National Congenital Cytomegalovirus Awareness Month National Safety Month National Scleroderma Awareness Month National Rip Current Awareness Week National Cancer Survivors Day Men's Health Week World Sickle Cell Day National Lightening Safety Awareness Week

National Health Information Center, Office of Disease

Prevention and Health Promotion, US Department of

Health and Human Services, Washington, DC. Available

at:

https://health.gov/news/category/national-health-

observances