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Clinical Pharmacy Education-Community Pharmacy Internship

Clinical Pharmacy Education-Community Pharmacy Internship. Charles Lee, PhD Professor of Pharmaceutical Sciences Lloyd L. Gregory School of Pharmacy Palm Beach Atlantic University West Palm Beach, FL. Evolution of US Pharmacy Education . 1821 PCP BS program 1950 USC 1st PharmD program

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Clinical Pharmacy Education-Community Pharmacy Internship

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  1. Clinical Pharmacy Education-Community Pharmacy Internship Charles Lee, PhD Professor of Pharmaceutical Sciences Lloyd L. Gregory School of Pharmacy Palm Beach Atlantic University West Palm Beach, FL

  2. Evolution of US Pharmacy Education • 1821 PCP BS program • 1950 USC 1st PharmD program • 1960 UCSF 2nd PharmD program • 1960-2000 BS/PharmD duel track or BS+PharmD add-on for most pharmacy schools • 2000 ACPE accredits PharmD program only • 1975 Curriculum begins to increases focus on clinical • Pharmacy practice transforms from product orientation to patient orientation • Dichotomous practice models still exist

  3. Pharmaceutical Care • 1975 Mikeal et al Pharmaceutical Care is the care that a given patient requires and receives which assures rational drug usage

  4. Pharmaceutical Care • 1992 Strand et al Pharmaceutical Care is that component of pharmacy practice which entails the direct interaction of the pharmacist with the patient for the purpose of caring for that patient’s drug-related needs

  5. Pharmaceutical Care • 1993 ASHP Pharmaceutical Care is the direct, responsible provision of medication related care for the purpose of achieving definite outcomes that improve a patient’s quality of life

  6. Pharmaceutical Care • 1996 APhA Pharmaceutical Care is a patient-centered, outcomes-oriented pharmacy practice that requires the pharmacist to work in concert with patient and the patient’s other healthcare providers to promote health, to prevent disease, and to assess, monitor, initiate and modify medication use to assure that drug therapy regimens are safe and effective

  7. Pharmacist- Formulation Scientist John Stith Pemberton

  8. Coca Cola Formula • Invented in 1886 • 5 cents/glass • 9 drinks/day • 25 gallon/1st yr • Sold in 1888 $2,300 • Sold in 1923 $25 mm • 2009 market value=$125 bb

  9. Pharmacist Provided MTM • Comprehensive or targeted Medication Therapy Reviews • Adherence Reviews-based on number or type of medications • Targeted Medication Intervention Program • High alert or high cost medications • Targeted population (geriatrics or pediatrics) • Disease State Management • Interdisciplinary approach to achieve therapeutic goals • Diabetes, cholesterol, asthma • Health and wellness services • Immunization • Wellness screening • Smoking cessation • Weight management

  10. Payer Perspective on Return on Investment • APhA Survey for MTM program from 10 Respondents (2008) • ROI ranged from 2:1 to 12:1 (median=3:1) • $700,000/yr saving for 200 patients for insurer • 4.5 mm/yr for self-insured employer

  11. ACPE • 1932 ACPE was established for the accreditation of pharmacy education • 1975 Expanded its scope of activity to include accreditation of continuing pharmacy education. • 1999 developed standards for certificate programs in pharmacy. • 2000 Recognized Doctor of Pharmacy as the only accredited pharmacy degree program • 2003 Name changed to the Accreditation Council for Pharmacy Education in 2003. • 2007 Revised standards, 30 standards, 3 Appendices

  12. ACPE Mission and Philosophy • Establish standards and criteria for the accreditation of pharmacy education program, continuing education program and pharmacist certification program • Promote continuous quality improvement and encouraging innovation in pharmacy education • Consult and assist in the development of learning outcomes and assessment of professional competencies

  13. Standards 2007 Areas of Emphasis • STD 13: Curricular core-knowledge, skills, attitude, values • STD 14: Pharmacy practice experiences • STD 15: Assessment and evaluation of student learning and curricular effectiveness • STD 19: Progression of students • STD 24, 25: Faculty and staff-quantitative and qualitative factor • STD 29: Library and educational resources

  14. Pharmacy Curriculum • Basic Biomedical Sciences • Pharmaceutical Sciences • Social, Behavioral and Administrative Sciences • Clinical Sciences • Electives • Pharmacy Practice Experiences

  15. Standards for Pharmacy Practice Experiences • Standard No. 14: Curricular Core-Pharmacy Practice Experiences • The school must provide a continuum of required and elective pharmacy practice experiences throughout the curriculum to support the achievement of professional competencies • The pharmacy practice experiences must integrate, apply, reinforce, and advance the knowledge skills, attitudes and values developed through the other components of the curriculum • The pharmacy practice experience must include direct interaction with diverse patient populations in a variety of practice settings and involve collaboration with other health care professionals • Required: IPPE (>=300 hours), APPE (>=1400 hours) • Electives

  16. IPPE Standards Guideline 14.4 • Minimum 300 hours over 3 years (P1-P3) • Involve actual practice experiences in community and institutional settings • Assume direct patient care responsibilities under appropriate supervision • Early sequencing in the curriculum • Interface with didactic course work • Provide introduction to the profession, leading to entry into APPE

  17. IPPE Program- Content Example 1 • Community pharmacy • Institutional pharmacy • Community service and medical missions • Clinical pharmacy • Community patient-centered care • Geriatrics

  18. IPPE Program- Content Example 2 • First year: service learning experience • Second year: practice skills experience • Third year: Patient care experience

  19. IPPE Program- Content Example 3 • Early pharmacy education with community teachers • Mentoring program • Community practice • Institutional practice • Pharmaceutical care clinic

  20. IPPE Program- Content Example 4Rite Aid Internship Year 1: • Defining the Rite Aid Internship • Rite Aid pharmacy computer system (NEXGEN), HIPAA, CIA and Rite Aid policies and procedures. • Pharmacy professionalism Year 2: • Inventory management • Dispensing practices • Automation • Third party training

  21. IPPE Program- Content Example 4 Rite Aid Internship Year 3: • Pharmacy workflow • Clinical Services • Third Year Intern Project • Mentor 1st or 2nd year Rite Aid Intern • Business of Pharmacy Year 4: • Learning the profit & loss system • Mentoring a 3rd year Rite Aid Intern • Fourth Year Special project • Learning Pharmacy Manager responsibilities

  22. IPPE Program- Content Example 5Walgreens Pharmacy • Prescription Medications • OTC products • Herbal products • Patient counseling guidelines • Disease state information • Pharmacy Law and Ethics • Management of Pharmacy

  23. Commonality and Differences • Pharmacy program- 6yr vs 2+4 • College setting-medical center affiliated vs independent • Site setting-community vs institutional • Site availability-region dependent • Site specialty • State law dictates time to start internship • Structured vs episodic learning? • Partially fulfilled by simulation program?

  24. Course Designation and Contents • Sch 1 PHAR 530, 532, 538 • Sch 2 IPPE 101, 103, 201, 301, 303 • Sch 3 PHR1242, 2112, 3232 • Community • Institution • Patient care

  25. Course Syllabus • Course description • Course pre-requisites • Textbook and other learning materials • Learning objectives/outcomes • Measure of outcomes • Course outline and agenda • Evaluation • Course policies and procedures • Standards of dress and personal appearance

  26. PHAR 530, 532, 558 Objectives/Outcomes • Affirm the role of the pharmacist in the health care team • Provide ethical patient care • Promote the safe use of medications • Perform calculations required to compound, dispense and administer medications • Identify the most frequently prescribed drugs by category • Demonstrate effective communications skills • Evaluate information from resources of the health care system and integrate it into pharmacy practice • Promote health improvement, wellness and disease prevention • Demonstrate critical thinking skills to facilitate decision making • Examine legal/ethical aspects of patient care • Describe the process of third-party claims adjudication • Incorporate technology/informatics into pharmacy practice • Participate in service learning opportunities* PHAR 532, 558 with additional objectives 9.

  27. PHAR 530 Objectives/Outcomes 8.Promote health improvement, wellness and disease prevention • Read information found in a patient medication profile • Assess selected therapeutic outcomes, including pulse rate and blood pressure 9. Demonstrate critical thinking skills to facilitate decision making • Discuss OTC pharmacotherapy decisions on product selection with preceptor

  28. PHAR 530 Course Schedule DATEACTIVITY Aug 26 IPPE Orientation, A workbook is provided to the student with a list of questions and activities to help guide the site visit Sep 02 Criminal background check and HIPAA and OSHA training Site Visit #1 Sep 09 Foundations lab Sep 16 Site Visit #2 Sep 23 Service learning opportunity or alternate site visit date Sep 30 Site Visit #3 Oct 07 Reflection #1 due in LiveText “What is professionalism, and why is it important?” Site Visit #4 Midpoint IPPE evaluations should be completed in EMS Oct 14 Fall Break Day/School holiday Oct 21 Site Visit #5 Oct 28 IPPE Conference …… …… Dec 9 *extended over the semester

  29. PHAR 530 Assessment Criteria • Professionalism and Behavior evaluated by preceptor Minimum score 3.0 to pass, but does not count toward grade • Competency assessment by community practice preceptor (70%) and faculty (30%) Minimum score 3.0 to pass • Orientation/Conference #1 15% • Conference #2 15% • Medical Terminology 15% • LiveText Reflection #1 10% • LiveText Reflection #2 10% • Workbook Questions/Activities 35% • Total 100% *Preceptor training critical

  30. PHAR 530 Grading Criteria • A workbook is provided to the preceptor with a list of questions and activities to help guide the site visit • Assessment of professionalism and performance will be completed in the EMS web-based system by the Preceptor at the site using a grading rubric that describes performance requirements • Grading Scale • Honors 4.75 - 5.00 • High Pass 4.50 - 4.749 • Pass 3.0 - 4.49 • Failure <3.0

  31. PHAR 532 Course Schedule • WK -1: Course Orientation, Campus Conferences • WK 1: Mon-Fri , 36 hr (4.5 days) 1. Orientation to department and site 2. Role of pharmacist in health care team 3. Interdisciplinary communication 4. Provide ethical patient care 5. Distribution order processing 6. Define and discuss systems management 7. Purchasing, Inventory Control 8. Discuss Performance Improvement Initiatives • WK 1: Fri 1-4 pm Conference, Webex conference if necessary • WK 2 Mon-Fri, 36hr 9. Legal: Controlled Substances 10. Medication Reconciliation 11-15 • WK 2 Fri 1-4 pm Conference, Webex conference if necessary *Intense schedule in 2 weeks (80 hr)

  32. PHAR 532 Assessment Criteria • Professionalism and Behavior evaluated by preceptor Minimum score 3.0 to pass, but does not count toward grade • Competency Assessment by institutional practice preceptor (80%) and faculty (20%) Minimum score 3.0 to pass • ConferencesAttendance 20% • Calculations Worksheet 25% • Service Learning Reflection 10% • IPPE Hospital Workbook Content Exam 25% • LiveText Reflections 20% • Total 100% *Preceptor training critical

  33. PHAR 538 Course Outline • WK 1-18 • 7 site visits • 3 on-campus conferences • Workbook/Assignment activities • Community service activity at site • Health care project at site • Journal site visit, Reflection in LiveText

  34. PHAR 538 Course Schedule Week 1: on campus conference • Orientation • LiveText, EMS review, Terminology Week 2: Foundations lab Week 3: Site Visit 1 Prior to site visit • Complete OTC CASE • Top Rx Drugs • Drug Information Question SITE activities 1. Ear Care OTC Products Case 2. Begin planning a health promotion activity, Participate in educational offerings designed to benefit the health of the general public • Self Care: Diabetes • Blood Pressure: Hypertension • Cholesterol: Hyperlipidemia 3. Discuss with Preceptor the patient interview using edited Script and Form created in Communications Class. 4. Ask for a patient to interview or use a relative or family friend.

  35. PHAR 538 Assessment Criteria • Professionalism Behavior Minimum score 3.0 to pass • Competency Assessment Minimum score 3.0 to pass • Participation/Attendance Conference #1 Develop Conflict Management Script, hand in scenario 20% • Participation/Attendance Conference #2 Management, hand in organization chart 10% • REFLECTIONS 20% • Patient Interview 10% • Service Learning Reflection 10% • Management Overview Reflection 10% • Workbook Activities Completion 10% • Terminology Quizzes 10% • Total 100% *Use LiveText or Blackboard for documentation

  36. IPPE 101/IPPE 103 Course Outcomes Same eight (8) performance outcomes Different settings 101 (community), 103 (institution) • Outcome 2: Given a patient, caregiver, or health care professional, conduct an interview to collect subjective information required for professional functions at the practice site. • Activities to achieve outcome • Elicit patient-specific information necessary for processing prescriptions/medication orders. • Ask appropriate questions to clarify subjective information. • Accurately document subjective information.

  37. IPPE 101- Community Practice Site based activity Points • Community Experience (1 wk, 40 hr) 70 (Preceptor Evaluation) • School based activity 30 • Orientation • Web based tutorial • Assignment/Project Total points 100

  38. IPPE 103- Institutional Practice Site based activity Points • Institutional Experience (1 wk, 40 hr) 70 (Preceptor Evaluation) School based activity 30 • Orientation • Web based tutorial • Assignment/Project Total points 100

  39. Assessment Criteria • Categorical/Numerical (MC/10, NI/8, SD/0) • Meets Competency (MC-10 points) Sometimes needs assistance to complete criterion elements. • Needs Improvement (NI-8 points) Usually needs assistance to complete criterion elements. • Significant Deficiency (SD-0 points) Always or nearly always needs assistance to complete criterion elements • Grade • 90 – 100 A • 80 – 89 B • 70 – 79 C • < 70 F

  40. Professionalism and Behavior Criteria • Items • Patient and provider communication • Appearance, attire • Timeliness, commitment • Initiative • Pass/Fail, does not count toward grade • Meets Competency • Significant Deficiency • SD may contribute to failing course

  41. IPPE 201-Patient Care I • Min 50 hr during the 2nd year • 2-3 students/group • 6 assignments • Course Outcomes • Develop pharmacist-patient relationship • Collect pharmaceutical care database • Develop problem list • Make appropriate health care recommendations (under guidance of preceptor)

  42. IPPE 201 Assessment Preceptor evaluation 80% of course grade Assignment # Assessment Activity Points 1 Database Collection 10 2 Medication History and Personal Medication Record 15 3 Vital Signs/ ROS/Problem List 15 4 SOAP note 15 5 15-minute Patient Case Presentation 15 6 Supervised Interview 10 Course master evaluation 20% of the course grade Workshop Participation: Medication history, documentation (e.g., SOAP note) 14 Course Closure Activities: Reflection Paper 6 Total Points for the Course 100

  43. IPPE 301-Patient Care II • Min 50 hr during the 3rd year • 5 assignments • Course Outcomes • Engage in the process of providing Medication Therapy Management (MTM) services • Learn to identify and assess medical and medication‐related problems. • Develop, implement, and follow‐up on recommendations for identified problems in collaboration with their preceptor and other healthcare providers. • Develop communication skills with other members of the healthcare team.

  44. IPPE 301 Assessment Criteria Preceptor evaluation 60% of course grade Assignment #Assessment ActivityPoints 1 Supervised Interview 12 2 Medication Therapy Review with problem list 16 3 SOAP Note with Cover Letter Medication Action Plan Personal medical record (PMR) 16 4 F/U SOAP Note & Updated PMR 16 Course Master evaluation 40% of the course grade 5 Health Fair Poster Session 10 Workshop Activities & Participation 20 Complete Student Portfolio (midpoint & final) 10 Total Points for the Course 100

  45. IPPE 303 Community Pharmacy Practice • Min 160 hr in 4 wk during the 3rd yr • Six (6) terminal performance objectives • 5. Identify five potential elements of medication error prevention at the practice site, using ISMP recommendations. • Access at least weekly the ISMP FDA Safety Alerts. • Describe issues related to dangerous abbreviations, high alert medications, and look alike/sound alike medications. • Discuss with the preceptor each of the five safety issues identified and possible solutions. • Post in Blackboard two safety intervention assignments. • The interventions can be for an individual or the practice. List the issue and the corrective action taken.

  46. IPPE 303 Assessment Criteria • O = Outstanding (10 points): The student is able to perform all of the skill’s elements with minimal assistance from the preceptor. • A = Acceptable (8 points): The student is able to perform the skill but requires assistance from the preceptor for some of the skill’s elements. • N = Not acceptable (0 points): The student is unable to perform the skill without assistance from the preceptor for all or most of the skill’s elements. • Grade (solely assessed by preceptor) • 90 – 100% of 60 points A • 80 – 89% of 60 points B • 70 – 79% of 60 points C • < 70% of 60 points F

  47. Professionalism and Behavior Criteria • ITEM 4: Initiative • Acceptable/Unacceptable, does not count toward grade • Acceptable The student consistently (greater than 90%): (1) Accepts responsibility and demonstrates accountability without repeated reminders; (2) Demonstrates a sense of duty; (3) Demonstrates an earnest desire to learn; (4) Demonstrates the willingness and flexibility to contribute to the well-being of others; (5) Applies knowledge, experience, and skills to the best of his/her ability. • Unacceptable Does not meet criteria for acceptable as stated above.

  48. PHR 1242 Community Professional Development I • Visit 1: Introduction to learning • Visit 2: Concept of Pharmaceutical care • HW #2: Component of Rx • Practice skills • OTC moment • Visit 3: Pharmacy workflow • HW#3: Rx label • Practice skills • OTC moment • Visit 4-13 • Visit 7 Midterm Preceptor Evaluation of student performance • Visit 14: Final Evaluation and Review

  49. PHR 1242 Community Professional Development I HW #3 • Self-study assignment • Rx label • Formulations and substitutions • Pharmacy skills focus • Information on Rx label • List 7 drugs in negative formulary • OTC moment • Active ingredients in Robitussin, Delsym • Journal reflection • How efficient is the workflow at your site?

  50. PHR 1242 Assessment Criteria • Assessment of workplace performance (preceptor) 15% • Assessment of professional competency (preceptor) 15% • Site based assignment 15% • ETR journal and IDK cards 15% • Quizzes 10% • Attendance/dress code*(count toward grade) 10% • Case scenarios, class group assignments 20% • Total 100% • Grading scale A>=90 B=80-89 C=75-79 F<75

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