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ARNOLD & MARIE SCHWARTZ COLLEGE OF PHARMACYAND HEALTH SCIENCES

Long Island University

Division of Pharmacy Practice

PH 600 –Advanced Pharmacy Practice Experience - Community

Course Faculty:Pharmacy Practice Faculty and Volunteer/Adjunct Community Pharmacy Preceptors

Revised May 2014

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I. Course Name:Advanced Pharmacy Practice Experience - Community

II. Course Number:PH 600

III. Course Credits:Five (5)

IV. Course Coordinators and Faculty:Course Coordinators:Stanley Feifer, MS:

Office room number: Pharmacy Building LB12Telephone: (718) 488-1243Email: [email protected]

Edgar Schwartz, RPh:Office room number: HS 114 Telephone: (718) 488-1244Email: [email protected]

V. Course Rationale: The community pharmacist is the most accessible health care provider and is, therefore, at the forefront of patient care. The community pharmacy practice setting allows pharmacists to provide a broad spectrum of patient-centered services including disease state management, medication therapy management (MTM), health screenings, patient triage to self-care or referral to medical care, prescription and nonprescription medication counseling monitoring and follow-up of therapy.

The overall goal of this advanced pharmacy practice experience (APPE) is to develop the skills necessary for student pharmacists to become health care providers in the community setting. As community pharmacies undergo significant changes to provide patient-centered care, students will be instrumental in developing such programs and services on an as-needed basis.

VI. Course Overview:This is a 5-week required APPE in community pharmacy. This experience will prepare students to practice patient-centered care in the community setting. Students will have the opportunity to develop and participate in various patient care activities such as disease state management, medication therapy management, and health screenings/wellness programs. Students will provide comprehensive patient counseling in a variety of areas including nonprescription, herbal, prescription medications, and home health devices. Additionally, students will gain experience in medication therapy management, and communicating recommendations to other health care providers including pharmacists, physicians, and nurses. The students will also participate in dispensing activities, specialty compounding, and other patient services for the advancement of patient care in the community pharmacy.

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VII. Course Time Commitments:A. Experiential Hours: Five days per week (full time; 8-hours per day) for

one 5-week block of time. A one-hour lunch break is included in the 8-hour day. Students should expect to accommodate their time at the site to participate in scheduled patient programs (e.g., brown bags, disease state management, and patient education seminars).

B. Homework/self-study: 10 hours/week

VIII. Prerequisite and Co-requisite Courses: A. Prerequisite Courses: Pharmacotherapeutics, Pharmacology/Medicinal

Chemistry, Pharmacy Law and Ethics, Pharmaceutics, Community IPPE B. Co-requisite Courses: 6th year standing

IX. Prerequisite Knowledge:Basic pharmacy computer skills and knowledge of third party billing.A working knowledge of legal and ethical issues affecting the profession of pharmacy.Basic pharmacy compounding skills.General knowledge of disease states and their treatment including diabetes, hypertension, hyperlipidemia, asthma, and osteoporosis. General knowledge of self-care products and their appropriate use.General knowledge of home diagnostic and monitoring devices sold in pharmacies.

X. Attendance Policy:Attendance at the practice site is required except for prearranged College functions. All missed hours have to be made up at the discretion of the preceptor. Students must notify the preceptor (before 8:00 am or as soon as the pharmacy opens) and Professor Edgar Schwartz at (718) 488-1244 (before 8:00 am) of any unexpected absence and provide written documentation afterwards (e.g., a physician’s note), in most cases no later than 72 hours following the absence. Failure to do so could result in receiving an incomplete in the course or disciplinary action. Attendance at professional meetings is allowed with permission from the preceptor, although time may need to be made up. Absence due to other circumstances must be preapproved by the preceptor and course coordinator, and missed hours must be made up at the discretion of the preceptor.

XI. Policy Concerning Students with Special Needs:If there is any student who feels that he or she may need an accommodation for any type of disability, the student should make an appointment to see the course coordinator as soon as possible.

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XII. Required Clerkship References/Other Materials:

A. References

Texts from previous pharmacotherapeutic courses Drug Information Handbook and/or electronic drug information resources

B. Additional Required Materials:Materials supplied/announced by individual preceptorsShort (i.e., blazer length), white, clean laboratory coatIdentification badge (i.e., name tag) as required by the College and/or the experiential site

Students are required to bring copies of their complete health form and their original New York State Pharmacy Intern Permit to each experiential site.

Student must complete HIPAA training mandated by the College and may be required to complete HIPAA training at the experiential sites.

XIII. This Course will Assist the Student in Meeting the Following Curricular Endpoints:

Gather and organize accurate and comprehensive patient information to identify ongoing or potential drug therapy problems. (A1a)

Interpret and evaluate patient and drug-related data needed to identify actual or potential drug therapy problems. (A1b)

Design, implement, and defend a course of treatment based on evidence that best addresses the patients’ health needs. (A1c)

Prepare, dispense, and/or administer a pharmaceutical product for patient use based on professional practice guidelines. (A1d)

Counsel patients to ensure appropriate pharmaceutical care outcomes, and institute programs to maximize compliance to drug regimens. (A1e)

Educate patients about behaviors that promote health (including drug adherence), maintain wellness, prevent, and control disease. (A1f)

Monitor patients to optimize therapeutic efficacy and minimize side effects. Develop strategies to manage and minimize potential adverse events. (A1g)

Design evidence-based disease management programs that incorporate outcome indicators, drug treatment protocols, risk reduction strategies, and education programs for health care providers and patients. (A2b)

Apply the principles of business planning to develop a business plan that supports the implementation and provision of pharmaceutical care services, identifies and acquires necessary resources, and assures financial success of the practice. (B1b)

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Evaluate the quality, effectiveness (including cost-effectiveness), and outcomes from institutional and community based interventions designed to improve health. (B1d)

Identify and report medication errors and adverse drug reactions to appropriate individuals and organizations. (B2a)

Evaluate information obtained from adverse drug reaction and medication error reporting systems to identify probable causes. (B2b)

Provide clinical preventive services (based on pharmacists practice activity domains) to improve outcomes and quality of life. (C1b)

Identify the needs for patient follow-up and referral to other health and disease prevention programs and be able to provide the follow-up and referral when necessary. (C1c)

Assess and monitor at-risk populations to identify and report health problems, and to prioritize interventions in collaboration with patients, other health professionals, members of the community, and policy makers. (C1d)

Communicate and collaborate with patients, care givers, physicians, nurses, other health care providers, policy makers, members of the community and administrative and support personnel to engender a team approach to patient care. (D1)

Retrieve, analyze, and interpret the professional, lay, and scientific literature to provide drug information and counseling to patients, their families or care givers, as well as other health care providers. (D2)

Demonstrate expertise in informatics. (D3) Carry out duties in accordance with legal, ethical, social, economic, and

professional guidelines. (D4) Evaluate and resolve ethical dilemmas that arise in practice and find a

solution that is acceptable to all parties involved. (D4a) Maintain professional competence by identifying and analyzing emerging

issues, products, and services. (D5)

XIV: This Course will Assist the Student in Meeting the Following Course-specific Endpoints:

Obtain necessary information from the patient, caregiver, and/or other members of the healthcare team. (A1a)

Identify relevant information in the patient profile or medical record. (A1a)

Interview the patient and caregiver employing effective communication strategies. (A1a)

Identify the patient’s primary complaint(s) and reason(s) for seeking medical care. (A1a)

Perform selected aspects of physical assessment, as appropriate. (A1a) Protect the confidentiality of patient information. (D4) Evaluate information obtained from the patient’s history and physical

assessment. (A1b) Assess any patient history of allergies and intolerances. (A1b) Review and interpret prescription orders for patients. (A1d)

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Evaluate the acceptability of prescription order transmission and legitimacy of source. (A1d)

Determine the validity of the patient-prescriber relationship. (A1d) Clarify, add, and/or correct prescription order information when

necessary. (A1d) Accurately prepare and dispense medications. (A1d)

Correctly count, measure, mix, reconstitute, and calculate the quantity of medications to dispense.Correctly prepare the label for the finished prescription.Select an appropriate container based on the chemical and physical properties of the drug that meets the patient’s characteristics or needs.

Accurately compound individual or bulk medications. (A1d)Locate accurate information on extemporaneous formulations.Evaluate the suitability of an extemporaneously compounded formulation.Calculate the correct quantity of ingredients.Use correct gravimetric and volumetric measuring procedures to obtain the desired quantity of the formulation component.Use good compounding practices in the extemporaneous production of a patient-specific drug delivery system.Identify physical and chemical incompatibilities among components of a given formulation and recommend appropriate alternatives to avoid incompatibilities.

Perform any additional patient calculations needed (e.g. creatinine clearance, ideal body weight, body surface area, body mass index). (A1b)

Identify the cause and significance of adverse drug effects. (A1b) Evaluate the significance of actual or potential drug interactions. (A1b) Assure that there is not excessive medication use or unnecessary drug

duplication. (A1b) Determine the extent to which medical conditions or diseases are treated

and controlled. (A1b) Identify signs or potential indicators of drug misuse or abuse. (A1b) Develop a complete medical and drug therapy problem list. (A1a, A1b)

- Use relative priority to direct the pharmacotherapeutic plan- Differentiate active from inactive problems.- Rank patient problems based on urgency and severity.- Identify any preventative and health maintenance issues

Understand and use principles of evidence-based medicine to assess information needs, formulate focused queries, acquire the best available evidence, evaluate the evidence and apply clinical expertise in using the evidence in providing patient-centered care. (D2, D3)

Maintain awareness of evidence-based information resources. Identify and locate the best evidence on clinical questions, including systematic reviews, meta-analysis, practice guidelines and randomized controlled trials. (D2, D3)

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Identify and regularly use information resources that enhance the pharmacist’s understanding from patient viewpoints, beliefs, and attitudes. (A1h, D2, D3)

Effectively communicate research findings at appropriate levels for patients and healthcare professionals. (A1e, A1f, D1)

Identify, evaluate and regularly use a variety of information resources, including those intended for lay people and those written for healthcare professionals and including reference books, fulltext databases, websites, and primary literature. (D2, D3)

Demonstrate proficiency in searching the biomedical literature using a variety of resources and interfaces, including Med line, via PubMed or other interfaces: Build search strategies using Boolean operators, controlled vocabularies where available (e.g. National Library of Medicine Medical Subject Headings (MeSH)), database limiting capabilities and field searching. Refine and implement effective search strategies for different purposes. (D3)

Use available services of librarians and other information professionals to supplement information retrieval and to learn about new resources and enhancements to existing resources. (D3, D5)

Determine the accuracy of information by investigating authority of resources, effectiveness of search strategy, and potential biases or conflicts of interest in the information retrieved. (D3, D5)

Determine applicability of the information to specific clinical questions and draw conclusions from new information to build on previous knowledge base. (D5)

Understand issues of privacy, copyright, plagiarism and other issues involved in the legal and ethical uses of information. (D4)

Practice life-long learning by maintaining records of information retrieval processes and by updating and refining information search and retrieval skills to maintain awareness of current issues, products and services. (D5)

Use current awareness tools such as journal and database alerting services. (D3)

Identify, use and share available resources for continuing education in the effective uses of current information resources and technologies. (D3, D5)

Construct a well-built question based on the patient’s drug therapy problem(s) or needed information. (D2, D3)

Integrate evidence from the literature with clinical expertise and patient preferences to draw a conclusion. (A1h, D2, D3)

Identify pharmacotherapeutic goals and endpoints of therapy. (A1c) Apply principles of biochemistry, medicinal chemistry, pharmacology,

and pathophysiology to select the appropriate drug(s). (A1c) Consider social, economic, and cultural factors that influence a patient’s

perspective on health, illness, and medication use. (A1h) Apply pharmacokinetic and pharmacodynamic principles to select the

appropriate dose, dosage schedule, and drug delivery system. A1c) Determine the appropriate therapy duration. (A1c) Apply pharmacoeconomic principles in drug selection. (A1h, B1d)

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Identify and minimize or avoid drug interactions, adverse effects, and contraindications associated with the recommended drug therapy. (A1g)

Recommend complementary therapies as appropriate to enhance therapeutic outcomes. (A1c)

Apply principles of nutrition to improve health, augment drug therapy, and reduce disease risk. (A1c, A2b, C1b, C2b)

Recommend appropriate medical goods and devices that could benefit the patient. (A1c)

Monitor patient-specific subjective and objective parameters for drug efficacy and toxicity. (A1g)

Assess appropriate parameters in a timely manner and at appropriate intervals/frequencies. (A1g)

Anticipate, monitor for, and report adverse effects and drug interactions. (A1g)

Refer patients to other health care professionals when indicated. (C1c) Comply with federal, state, and local statutes and regulations that affect

pharmacy practice. (D4) Resolve ethical and moral decisions faced by pharmacists. (D4a) Assess the health needs of a specific patient population by analyzing

epidemiologic data and identifying risk factors that would adversely affect patient health. (C1a, C1d)

Develop appropriate criteria and outcome indicators and conduct medication reviews in specific populations. (B1d, B1c, B2e, C2b)

Evaluate pharmacoeconomic data relevant to appropriate disease-specific treatment plans. (A2c, A2d, A2e, B1d)

Design evidence-based disease management programs that incorporate outcome indicators, drug treatment protocols, risk reduction strategies, and education programs for health care providers and patients. (A2a, A2b, A2c, B2b, C1b)

Communicate clearly, accurately, compassionately, confidently, and persuasively with patients, caregivers, other health care professionals, and the public using appropriate listening, verbal, nonverbal, and written communication skills. (D1)

Exhibit a caring and respectful attitude and demonstrate empathy while establishing rapport and communicating with the patient and/or caregiver. (A1h)

Establish a collaborative relationship with other healthcare professionals that foster a team approach to patient care. (B2e)

Demonstrate professionalism and leadership within professional and civic organizations. (C2a, C2c)

Effectively communicate drug and health information at appropriate levels for patients and healthcare professionals. (A1e, A1f, D1)

Demonstrate sensitivity and tolerance within multicultural interactions and settings. (A1h)

Educate patients and/or caregivers about drug therapy. (A1e, A1f)- Explain to patients or caregivers the drug, dosage, indication, and

storage requirements for a given drug.

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- Educate patients or caregivers on the symptomatology, significance, frequency, and treatment of adverse drug reactions.

- Explain any action that should be taken in the event of a missed dose.- Demonstrate proper administration technique for a given drug

delivery system.- Facilitate patients assuming an active role in their self-care and

overall health.- Choose communication methods that are sensitive to the social and

cultural background of the target audience.- Confirm patient understanding of counseling provided and clarify if

needed. Educate patients or caregivers about the proper use of medical goods and

devices. (A1c, A1f)- Identify print, audiovisual, and/or computerized sources of patient

education information on medical devices and goods that meet the patient’s needs.

- Demonstrate and verify the proper use of medical goods and devices to ensure effective use.

- Communicate storage, calibration, and maintenance information for medical goods and devices.

Document pharmaceutical care activity in a patient profile or medical record to facilitate communication and collaboration among healthcare providers. (A1c, B1c)

Identify and analyze emerging issues, products, and services that may impact patient-specific and population-based pharmaceutical care. (D5)

Assess one’s own knowledge and abilities independently. (D5) Set personal knowledge and ability goals and take responsibility for

attaining them. (D5) Recognize self-limitations and seek appropriate assistance/clarification.

(D5) Review topics relevant to patient care activities to enhance knowledge

base and preparedness. (D5) Accept feedback and implement suggestions for improvement. (D5) Manage time appropriately and efficiently. (D5) Exhibit intellectual curiosity to ensure ongoing professional competency.

(D5)

XV. Course-specific Learning/Behavioral Objectives/Goals: The overall goal of this course is to ensure that the student pharmacist is developing the knowledge, skills, attitudes, and behaviors required to practice community pharmacy. Equally important, the student pharmacist will begin to hone his/her skills in providing direct patient care and taking responsibility for such actions. The student will participate in disease state management, medication therapy management, and wellness and health screenings. Specific objectives are as follows:

Effectively communicate, verbally and in writing, with patients and/or caregivers

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Effectively communicate accurate and appropriate drug information and consultation to health care professionals

Identify, interpret, and/or evaluate sources of information for clarifying or answering questions related to prescriptions, nonprescription medications, alternative and complementary therapies, surgical/medical devices, and overall healthcare

Assess the appropriateness of a patient’s drug therapy and identify, resolve, and prevent drug-related problems

Utilize the P.R.I.M.E. (Pharmaceutical related, Risks to the patient, Interactions, Mismatch between medication and indication, Efficacy issues) method to identify pharmaceutical care interventions.

Perform and document interventions (such as communicating with prescribers and their agents) to correct potential prescription errors or otherwise improve patient outcomes.

Demonstrate the skills of inquiry, logic and critical analysis Interview patients to gather needed information prior to recommending

a prescription or nonprescription therapy Perform physical assessment, if applicable and evaluate laboratory

tests, if available, to assess drug therapy outcomes and to monitor patients in the community pharmacy

Counsel patients requiring prescription, nonprescription therapies, and medical devices

Monitor patients receiving medications for efficacy, toxicity, adherence and appropriate therapeutic outcomes

Participate and contribute to programs related to disease prevention, vaccination and wellness in the pharmacy and community

Participate in medication therapy management Demonstrate a basic understanding of pharmacy business management

(i.e., inventory management, workflow, human resource management, etc.)

Demonstrates competency all aspects of filling and dispensing of prescriptions.

Perform pharmacy related calculations Demonstrates skills needed to compound extemporaneous products, if

applicable Reflect on the experiences encountered in order to gain insight as to

their importance for a career as a pharmacist Demonstrates legal/ethical behavior including protecting the

confidentiality of patient information

XVI. Course Map:TBD

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XVII. Grading Policy: This course will be graded on a Pass/Fail basis.The grade is made up of the following components: 1. Evaluation by on-site preceptor. Student must achieve a 2 or higher on each of

the competencies for the rotation, as assessed by the preceptor at the site.2. Assessment of assignments by faculty preceptor at the College. Student must

achieve a 2 or higher for all assignments.3. Professionalism (see Section XX)4. Course pre and post exam. Students will be assessed on their knowledge of

various concepts and areas within community pharmacy practice. At the student orientation at the College an exam will be administered to evaluate the student’s knowledge in 4 content areas including nonprescription medications, Top 200, prescription errors and omissions and patient profiles. Please utilize Appendix F to review the most common nonprescription ingredients. On the final day of PH 600 students will be given a similar exam to assess their knowledge at the completion of the experience. Students must score 70% or higher on the final exam. At the discretion of the site and/or faculty preceptor, additional requirements (assignments/time/examinations) may be necessary for any student who does not pass the final exam. The additional requirements will need to be completed within the designated time frame in order to pass the APPE.

XVIII. Course Requirements and Assignments

The student is required to provide patient-centered care through drug therapy assessment, MTM, and patient counseling. Additionally, students will participate in health screenings and wellness programs, disease state management, and other patient care programs at the pharmacy. At developing sites, students will help to implement and develop such programs or may pilot a new service.

The student is required to place all written coursework in a one-inch binder with the following tabbed sections: MTM’s, Interventions (separate prescription and OTC interventions), Patient Counseling, Major Project, Evaluation Forms, and Miscellaneous. At the end of the APPE, the student will submit this binder to the course coordinators at the College for grading, EXCEPT for full-time faculty precepted sites, where the student will submit the binder to the faculty preceptor for grading.

The student needs to use the forms included in this manual. The manual and forms will be available on E-value for electronic use.

A. Medication Therapy Management (Appendix A)

Throughout the experience the student will be involved in various aspects of medication therapy management. A comprehensive MTM includes all aspects described in MTM Core Elements 2.0. Before you begin the MTM assignment you are required to read the Core Elements, which can be found at:

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www.pharmacist.com (MTM Central tab) and the following article, which should be discussed with your preceptor.

McGivney MS, Meyer SM, Duncan-Hewitt W, et al. Medication therapy management: Its relationship to patient counseling, disease management, and pharmaceutical care. J Am Pharm Assoc; 2007;47:620-628.

a. With the help of your preceptor, identify at least two (2) patients who: are taking at least five (5) medications

AND have at lest 3 chronic disease states

b. Review the disease states and their therapeutic management.c. Students may identify patients through different formats. If the site has

an existing MTM program, the preceptor may assign a patient to you and provide a patient medication profile, in which the patient will need to be contacted via phone. If the site does not have a formal MTM program, an MTM like session can be accomplished by identifying a patient at the pharmacy that qualifies (requirements above) through other activities, such as interventions, counseling, blood pressure screening etc. In this scenario, a medication history and other parts of the MTM will be done in person.

d. Students should fill out the Medication Therapy Management Form (Appendix A) to document all aspects of the MTM. Using the patients profile or through interview, fill out the medication therapy review (MTR) portion of the medication therapy management form (MTM).

e. Prepare for the Initial Patient contact via phone by reviewing guidelines and textbooks for disease specific information/questions that you may have for the patient based on the profile.

f. Once in contact with the patient fill out the Patient History portion and set up an appointment with the patient or caregiver to conduct a comprehensive MTM.

g. Based on the patient interview, identify any issues using the PRIME process and, make an assessment and plan that includes patient medication knowledge and compliance, appropriateness of therapy received by patient, as well as goals for each disease state.

h. During the appointment help the patient fill out a Medication Action Plan (MAP) utilizing the information you documented during the assessment. Fill out the “My Medication Record” form and Personal Medication Record (PMR) and make copies of those two forms for the patient.

i. For 1 of the MTM patients, prepare a doctor letter/FARM note for the health care provider with a summary of your visit and all interventions. The doctor letter/FARM note should only be sent to the health

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http://www.pharmacist.com/

care provider if instructed by the preceptor. If needed, schedule a follow up appointment with the patient and/or refer to health care provider.

B. Prescription Department Activities: Dispensing, Patient Counseling, and Interventions: The student is expected to spend the majority of (if not the entire) experience engaged in department activities. During this time, students will identify prescription-related interventions and will provide prescription counseling. Additionally, students should participate in any specialty compounding that is performed at the site. The dispensing time should be incorporated into the student’s schedule and should be flexible based on other activities performed at the pharmacy.

a. Interventions: The student is required to identify and document at

least ten (10) different interventions for prescription medications. Students should fill out the Prescription Intervention Form (Appendix B). The preceptor should sign the intervention form and it should be included in the student’s binder at the completion of the experience.

b. Prescription counseling: The student is required to counsel patients as part of the daily activities in the pharmacy. At least ten (10) patient counseling sessions on different categories of prescription products (see Appendix D – Patient Counseling Competency Checklist) must be documented on a counseling log. At least two of the medications that the student documents should be medications that require a medication guide. A complete list of medications that require a med-guide and the guide itself can be found on the Pharmacist Letter website under pharmacist resources. The student should fill out the Patient Counseling Record Log (Appendix C) and have the preceptor sign it to verify that the counseling was completed. Additionally, the preceptor should check off prescription product categories that were completed by the student on the Patient Counseling Competency Checklist (Appendix D).

C. Self-care/OTC Interventions and Consultations: The student is required to engage in nonprescription product interventions/consultations/recommendations. At least ten (10) such interventions/consultations/recommendation must be documented (Appendix E). Students should counsel patients on different areas of self-care including OTCs, herbals, vitamins, nutritionals, and home testing/diagnostic products (see Appendix G – Patient Counseling Competency Checklist). The preceptor should sign the checked off self-care categories on the Patient Counseling Competency Checklist that were completed by the student. Additionally, the student should fill out the Patient Counseling Record Log (Appendix F) and have the preceptor sign to verify that the counseling was performed.

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D. Home Diagnostics Assignment: Students should become familiar with home diagnostic kits available in the community pharmacy. For a list of commonly available kits please see Appendix H (Home Diagnostics Assignment). Students should be responsible for all information indicated in Appendix H for each of the kits but will need to document this information for only one selected kit. The student is required to answer all questions in Appendix H pertaining to the selected kit and include references where applicable and submit the assignment in the binder.

E. Alternative Medicine Assignment: Students should be familiar with commonly used herbal products. Students are required to fill out the grid in Appendix I (Herbs and Supplement Assignment). It is suggested that students use an electronic version of the grid so that space can be increased, if needed, to include all pertinent information. Appropriate references must be included. The completed assignment must be submitted in the binder. Students are responsible for knowing the information documented in the assignment.

F. Drug Interaction Alert assignment: The student should refer to Appendix J. The student will need to become familiar with the software used by the pharmacy to aid in the dispensing process. One feature of most software used, is an alert identifying potential Drug Interactions.

To complete this assignment, the students will identify (3) clinically significant drug interaction alerts prompted by the software and evaluate their validity. The students must describe the mechanism for the interaction, and the management/recommendation for how to resolve the potential problem (e.g. Call a physician, space the drug from other medications, etc.)

G. Business Management: The student is required write a reflective essay on either 1) Participation in and evaluation of the pharmacy’s inventory procedure or 2) Involvement in writing up or evaluating the pharmacy schedule. The student should describe the experience and the influence that the experience had on the student. See Appendix K for assignment guidelines.

H. Major Project: Students should choose 1 option from a, b or c listed below. The project must be preapproved by the onsite preceptor at the beginning of the rotation After completion of the project/service, students should write a reflective essay on their experience of participating in the project/service.

a. Hypertension Screening Program: The student is required to measure and evaluate the blood pressure of a minimum of 10 patients. A table should be created including the patient’s blood pressure, current prescription and nonprescription medications, other pertinent medical history information and comments regarding their current antihypertensive medications. Any interventions should be discussed with the preceptor.

.

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b. Patient Compliance Program: The student is required to consult with a minimum of 5 patients who present with compliance issues. If a compliance project is already implemented at the pharmacy the student may use those patients. If there is no such program in the pharmacy, patients can be identified during daily patient encounters or through a review of patient profiles. The student should document basic patient information (all patient identifiers should be removed), what the compliance issue is (based on interaction with the patient) and what interventions can be made to improve medication compliance. A table can be created to document information. Any interventions should be discussed with the preceptor.

c. New Drug Update: The student is required to prepare and present a thorough review on a new drug (prescription or OTC approved within the last 12 months) to the pharmacy staff. A handout should be prepared for and distributed to the audience. Guidelines for the New Drug Update are available in Appendix L. Presentation materials should be included and submitted to the preceptor on or before the designated deadline, which will be provided.

Written Assignment ChecklistAPPE Requirements Minimum

Requirements Deadline Completed

Medication Therapy Management (MTM #1)

1 Midpoint

Medication Therapy Management (MTM #2) with Doctor letter

1 Endpoint

Prescription drug-related interventions

10 5 Midpoint5 Endpoint

Prescription medication/product counseling

10 Endpoint

OTC-related interventions

OTC-medication/product counseling

10

10

10 Midpoint

10 Endpoint

Drug Interaction Alert (clinically significant)

3 Midpoint

Alternative Medicine 10 Midpoint

Home Diagnostic 1 Midpoint

Business management 1 MidpointMajor Project 1 Endpoint

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XIX. Miscellaneous Facts/AnnouncementsStudents must be officially enrolled in the course to be assigned to an experiential site. Due to insurance regulations, there will be no exceptions to this rule.

Students must complete the appropriate health forms before beginning the program and submit same to the course coordinator or designee. Portions of the form need to be completed by a licensed physician, and must indicate that the student has received certain inoculations, has not been exposed to and/or does not have tuberculosis, and is in good general health. Forms will be provided to students by the Office of Experiential Education. Each student needs to provide the course coordinator with a copy of his/her New York State Pharmacy Intern Permit to participate in the program.

Each student also needs to complete HIPAA training mandated by the College before being assigned to an experiential site. At the site, the student may be asked to complete site-specific HIPAA training. If required, students must complete said training or will be dropped from the course.

As described in the accompanying documents, students must be professionally and conservatively dressed when visiting an experiential site. For example, a short white laboratory coat and an identifying badge must be worn at all times; shorts, jeans, sneakers, T-shirts, open-toe shoes, work boots, and similar clothing are not deemed appropriate. Men should wear dress (or neatly pressed khaki) slacks/ shirt/tie and women should wear dress slacks/blouse, skirt/blouse or a dress.

Any and all questions related to this syllabus should be directed to the course coordinator.

XX. Professional Behavior Expectations:As described in the accompanying documents, students must exercise the utmost professional behavior throughout the program. Special care must be taken not to discuss any patient by name, not to discuss information with a patient that can be heard by others, not to speak to anyone in a disrespectful manner or tone, and not to provide information to a patient or health care professional without first checking this information with the preceptor. Note that medical records and patient profiles are private legal documents that must be handled in a confidential manner. These documents should not be moved, written on, copied by hand, scanned into a computer, or photocopied without the expressed permission of the preceptor or his/her designee.

Presented/submitted materials must be developed by the student and not by others. Plagiarism will not be tolerated. Unacceptable behavior or plagiarism will subject the student to a failing grade in the course and appropriate disciplinary action by the Dean of Students and/or the College's Disciplinary Committee. Students are expected to treat patients, each other, faculty members/preceptors, and all health care professionals with respect and courtesy.

Policy:

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Points will be deducted for unprofessional behavior. The maximum allowable deduction during the course is 10 points. A deduction of 10 points or more will result in failure of the experience. Professionalism points are determined as follows:

← - 15 minutes or more late for a shift -1 point

← - Not notifying on-site preceptor of absence the morning of occurrence (no later than 8 am) -1 point

← - Not notifying college of absence the morning of occurrence (no later than 8 am) -1 point

← - No professional attire/lab coat/name badge worn during assigned shift -1 point

← - Not having completed assignments at the site when faculty preceptor comes to visit -1 point

← - Designated deadlines for assignments missed (Midpoint deadline -1 point per day; Endpoint deadline -1 point per day; Any outstanding resubmissions after the block officially ended -1 point per day)

XXI. Advanced Pharmacy Practice Experience Activities:Due to the “real-life” nature of this course, it is not possible to predict exactly which activities will be available for individual students. Nevertheless, it is anticipated that most of the learning objectives outlined earlier will be met and all assignments will be developed. Questions concerning site-specific issues should be discussed with the preceptor and with the course coordinator if needed.

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Community Pharmacy Advanced Pharmacy Practice ExperienceSample Calendar for Completing Course Activities

Week 1: Orientation at the College of Pharmacy on first dayOrientation to pharmacy and personnel Become familiar with pharmacy layout

Prescription area – such as are products arranged alphabetically by generic or trade names; is there a “fast mover” section

Nonprescription products, including OTCs, home testing devices, nutritional products, and surgical supplies and their placement in the pharmacy (behind the pharmacy counter, on the pharmacy shelves, in a locked showcase, etc.)

Learn how to use the pharmacy computer system and how to view patient history, to create a new patient profile, fill new prescriptions, refill prescriptionsBegin to assist the pharmacist in all aspects of filling and dispensing prescriptions including pharmacy compounding Learn the procedure to take telephone prescriptions Counsel patients on prescription medicationsPerform self-care consultations/interventions patients on self-care/OTC productsDiscuss and approve topic for major projectDiscuss options for business management assignmentReview topics in self-care including OTC warnings/precautions, contraindications and other pertinent counseling pointsWeek 2:Continue filling, dispensing, and counseling on prescription productsContinue self-care consultations/interventionsPerform prescription interventionsDocument /drug interactions /herbal treatment/home diagnostic assignmentIdentify MTM patientsWork on major projectWeek 3:Continue filling, dispensing, and counseling on prescription productsContinue self-care consultations/interventionsPerform prescription interventionsContinue to document /drug interactions /herbal treatment/home diagnostic assignmentInterview MTM patients and document: MTR, PMR, MAPWork on major projectMidpoint assessment (All assignments due by the midpoint deadline should be submitted)Week 4:Continue filling, dispensing, and counseling on prescription productsContinue self-care consultations/interventionsPerform prescription interventionsContinue to work on major projectWeek 5:Continue filling, dispensing, and counseling on prescription productsContinue self-care consultations/interventionsPerform prescription interventionsMajor project/presentationFinal Assessment (All assignments due by the final deadline should be submitted)

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ASSESSMENTS

Appendices Table of Contents

Appendix A: Medication Therapy Management (MTM) Form

Appendix B: Prescription Intervention Category Reference and Documentation Form

Appendix C: Patient Counseling Documentation Form: Prescription Products

Appendix D: Self-Care Intervention Documentation Form

Appendix E: Patient Counseling Record Log: Self-care/Nonprescription Products

Appendix F: Nonprescription Ingredient Chart

Appendix G: Home-Diagnostic Test Documentation

Appendix H: Alternative Medicine Assignment

Appendix I: Drug Interaction Alert Assignment

Appendix J: Business Management Guideline

Appendix K: New Drug Update Guideline

Appendix L: Reflective Essay Sample

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Arnold & Marie Schwartz College of Pharmacy and Health SciencesLong Island University

Medication Therapy Management (MTM)Appendix A

Patient History Form

Patient Information:Name: ______________________ Phone (H): ______________ (W): ________________Address:______________________________ City: _____________ State: ________

(For in-pharmacy use only. Please cut off patient information before including in student binder.)

Medication Therapy Review (MTR) based on profilePrescription Medications Utilized

Name of medication

(Specify Brand or Generic)

Dosage and route

Indication(based on dose and other medications)

Duration of therapy

Comments/Medication issues:-compliance-side effects- different indication(document when reconciling)

Non-prescription (OTC) Medications UtilizedName of

medicationDosage and route

Reason for use Duration of therapy

CComments

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Alternative Therapies Utilized (e.g., herbal agents) Name of agent Dosage

and routeReason for use Duration of

therapy

CommentsComments

Condition List (compile a list of possible conditions based on the medication list):

1.2.3.4.5.

Medication Related Concerns (Using PRIME): Compile a list of medication-related problems

Problem TypesPharmaceutical Related (Assess for inappropriate dosage, dosage form, route, timing, duration and frequency).Risks to patient (Assess for contraindication, allergy, ADR or side effects, misused, medication errors)Interactions (Assess for drug-drug, drug-food, drug-lab, drug-disease interactions).Mismatch between medications/indications (assess for medication used without indication, untreated indications)Efficacy issues (Assess for suboptimal selection of pharmacotherapy for indications, minimal or no evidence of therapeutic effectiveness, inappropriate administration, patient preference issues, medication availability consideration, compliance/administration considerations, pharmacoeconomics consideration)

Consider Disease Related Concerns (Separate all concerns by disease state): need to read about disease state in Dipiro and/or guidelines

i.e. Diabetes-Patient is indicated for an ACE-I

Compile a list of patient-specific questions to be asked and answered on initial contact (Separate questions based on disease state (Make sure all questions are open-ended)

i.e. Hypertension-How often do you check your BP?

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Initial Patient Contact

Follow MTM Patient Call Script:

Student: Hi, may I speak to [patient’s name]?Verify you are speaking to the patient

I’m [your name], a pharmacy intern, calling from __________ Pharmacy. The reason for my call is to provide a service to you where we can look for ways to improve your medication regimen. For example we can help you save money on your medications, resolve any medication-related problems you may be having, and answer any questions you might have about your medications. This service is free-of-charge to you. I’m going to ask you some questions about your medications and your health and then call you back to make an appointment for you to come into the pharmacy and discuss information about your medications at a later date. Is this something you’d be interested in?

If patient says they live too far away. . .It may be possible to provide this information to you over the phone. Would you be interested in that?

If patient says no. . .Student: That’s fine. You can always give us a call if you change your mind. However, would you still be willing to answer some questions about your medications?

If patient says yes. . .Great!Begin the interview at the next bullet

If patient does not answer. . .Call the patient on two separate occasions. Leave a message on the third call. DO NOT leave any disease specific information on a voice mail. Hello, this is [your name]. I’m calling from ___________ Pharmacy. Please give me a call back at ……

Tips

Recommend patient calls be completed over a two week time span, varying the day and time of day for the calls.

Stress to the patient the medication review is a FREE service available through their benefit plan(if applicable) and that they would like to see patients take advantage of this service. If the patient receives the review from you they may continue filling their prescriptions at their current pharmacy.

If you encounter a language barrier:

Try to determine if there is someone that can serve as a translator in the patient’s home, perhaps a staff member speaks their native language.

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Patient History FormStudent Date:Site: Preceptor:

Patient Database:

Pt Initials: _________ Date of visit: ___________

Date of Birth (Age): ________

Gender: ______ Ethnicity: _______________

ABW: __________ Height: ______

Marital Status: ___________________

Pregnancy Status: __________________

Medical Alerts: (examples: hearing aids, prosthesis, heart valves, eyeglasses)

_____________________________________________________________

Allergies (medication, food – please include reactions:)

____________________________________________________________

Smoking History: Caffeine History

____Never smoked ____ Never Consumed

____Packs Per Day for ____ Years ____ Drinks Per Day

____ Stopped _____ Years Ago ____ Stopped ___ Years Ago

Alcohol History: Dietary History:

____ Never Consumed ____ Number of Meals Per Day

____ Drinks Per Day ____ Food Restrictions (explain)

____ Stopped ____ Years Ago Other: _____________________

Recreational Drugs:

____ Never Used

____ Types of Drugs __________________

____ Stopped ____ Years Ago

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Medical History: Have you or any blood relatives had any of the following? (mark all that apply)

Disease State Self Diagnosis Date RelativeHigh Blood Pressure

Heart Disease

Stroke

Diabetes

Hyperlipidemia

Kidney Disease

Asthma

Osteoporosis

Pain related condition

Lung Disease

Cancer

Depression

Mental Illness

Substance Abuse

Other

Medical Problem List: Have you experienced or do you have any of the following?

# Disease Yes No # Disease Yes No1 Known Kidney Problems Sores on Legs or Feet2 Frequent Urinary Infections Known Blood Clot Problems3 Frequent Urination at Night Leg Pain or Swelling4 Known Liver Problems/Hepatitis Unusual Bleeding or Bruising5 Trouble Eating Certain Foods Anemia6 Nausea/Vomiting Thyroid Problem7 Constipation/Diarrhea Known Hormone Problem8 Bloody/Black Bowel Movements Arthritis or Joint Problem9 Abdominal Pain/Cramps Muscle Cramps or Weakness10 Frequent Heartburn/Indigestion Memory Problems11 Stomach Ulcers in the Past Dizziness12 Shortness of Breath Frequent Headaches13 Coughing up Phlegm/Blood Rash or Hives14 Chest Pain/Tightness Change in Appetite/Taste15 Fainting Spells or Passing Out Walking or Balance Problems16 Thumping or Racing Heart Other

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Immunization History: (include dates if available): Influenza _____________

Pneumococcal __________

Tetanus _______________

Other: ____________________

Laboratory findings: (if not explain importance of keeping records):

Blood Pressure:Glucose:A1c:Total Cholesterol: LDL: HDL: Triglycerides

Take Medication History (refer above to record Rx’s OTC/Alternative medications) Do not lead patients to answer which Rx medications they are taking unless there is a discrepancy or medication in the profile not mentioned. Reconcile patient’s answers with profile and document in the comments column.

Pharmacist's/pharmacy intern’s impression on patient medication knowledge and compliance, as well as appropriateness of therapy received by patient:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations and Plans:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Follow up: (to be done face to face, over the phone)

My Medication Plan (MAP) should be provided to patient and the following discussed: Medication Counseling OTC /Alternative medication Counseling Disease state-related counseling: goals and monitoring

Personal Medication Record (PMR) – given to patient and reviewed. A list of a medications and strengths, the directions, indications, drug allergies and manifestation, medications the patient has had adverse reactions to in the past, all medical conditions, vaccination history, surgical history. The PMR should be updated every time their medication regimen is changed or there is a new development in their medical history.

Doctor Letter/FARM note should be completed for the physician.

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MY MEDICATION RECORD

Name:____________________________ Birth Date: ___________ Phone: _____________Always carry your medication record with you and show it to all of your doctors, pharmacists and other healthcare providers.Emergency Contact InformationName:RelationshipPhone NumberPrimary Care PhysicianPhone NumberAllergiesWhat allergies do I have? (medicines, food, other)

What happened when I had the allergy or reaction?

Other Medicine ProblemsName of medicine that caused problem What was the problem I had with the

medicine?

When you are prescribed a new drug, ask your doctor or pharmacist:What am I taking?What is it for?When do I take it?Are there any side effects?Are there any special instructions?What if I miss a dose?Notes:

Patient’s SignatureHealthcare Provider’s Signature

Date last updatedDate last reviewed by healthcare provider

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PERSONAL MEDICATION RECORD (PMR)

Name:_________________________ Birth Date: _________________________Be sure to include ALL prescription medications, nonprescription medications (over-the-counter medications), vitamins, and herbal supplements.

Drug Take For

When do I take it? Start Date

Stop Date

Doctor Special InstructionsName Dose Morning Noon Evening BedtimeGlyburide 5 mg Diabetes 1 1 1/15/08 Johnson(000-

0000)Take with food

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MY MEDICATION ACTION PLANPatient:Doctor (Phone):Pharmacy/Pharmacist (Phone):Date Prepared:

The list below has important Action Steps to help you get the most from your medications. Follow the checklist to help you work with your pharmacist and doctor to manage your medications AND make notes of your actions next to each item on your list.Action Steps -> What I need to do… Notes -> What I did and when I did it…

My next appointment with my Pharmacist is on: ____________(date) at __________ AM PM

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[Pharmacy Name or Logo]Dear [Prescriber Name]:

[Pharmacy Name] is pleased to offer Medication Therapy Management (MTM), a program to assist patients with all of their medication needs this service is designed to allow pharmacists to work collaboratively with local prescribers to enhance our patients’ quality of care.

As part of this program, pharmacists may conduct a comprehensive medication review of a patient’s prescription and nonprescription medications, as well as vitamins, minerals, herbal products, and other dietary supplements. We will also provide patient counseling on new prescription orders and over-the-counter therapies. In addition, we will contact patients for follow-up monitoring visits, as needed, to check their progress with new medications, and to ensure drug therapy problems have been adequately resolved.

One of your patients, Mrs. X is a 76 year old African American female, qualified for an MTM. She is currently taking the following medications:

1. Calan (verapamil) 240 mg once daily 2. Glucophage XR (metformin ER) 500 mg twice daily3. Coreg CR (carvedilol CR) 20 mg orally once daily 4. Benicar HCT (olmesartan/hydrochlorothiazide) 40/25 mg orally once daily5. Centrum Silver (multivitamins) one tablet daily

The issues that we identified with Mrs X are as follows:

1. We spent a significant time reviewing Mrs. X’s diabetes. We found that the patient’s glucose levels (pre and post prandial levels), were elevated (136-237-please see attached sheet). The patient is on metformin therapy with a recent switch to the ER formulation. The patient may benefit from an increase in dose or the addition of a medication which targets her postprandial glucose levels (i.e. Janumet 5/500 mg) **see attached blood sugar levels**

2. In addition, the patient noted 5-10 pounds weight gain within the time Coreg CR was started. We acknowledge that Coreg CR is indicated in arrhythmia, heart failure and other conditions; however, Mrs. X denies having such conditions. If Coreg is being used for the treatment of hypertension in Mrs. X, switching to a vasodilator such as hydralazine to minimize this side effect may benefit.

3. During the visit, Mrs. X also mentioned diarrhea. We counseled the patient on a proper diet of sugar-free foods which do not contain sorbitol or similar ingredients

4. She complained of a headache and wanted her blood pressure checked. Her pressure was well controlled with a reading118/78 mmHg (normal is 120/80 mmHg).

5. We reviewed the patient’s current medical conditions and risk factors for heart disease and suggest the addition of aspirin to the patient’s medication regimen.

6. Since the patient is post-menopausal, we counseled the patient on the importance of calcium and vitamin D intake. She was counseled on taking 1200-1500 mg of calcium per day and 400 IU of vitamin D.

7. In addition, since we are in the flu season, we informed Mrs. Marshal of the importance of getting the influenza vaccine. We also talked to Mrs. Marshal about the importance of getting the pneumococcal vaccine as well. However Mrs. Marshal could not recall when was the last time she was administered the shot.

Thank You very much for your time and consideration and If you have any questions or concerns please contact us at [PharmacyNumber]

Sincerely, __________________________________ Rx Student, PharmD 2010

I agree with the above assessment and recommendations. _________________________ _______

Pharmacist Signature Date

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Appendix B

Prescription Intervention Category Reference

Category (circle or if other please specify) Must complete 10 intervention in different categories

1. Indication2. Length of therapy3. Drug/drug, drug / food, or drug / lab interaction4. Adverse effects5. Therapeutic duplication6. Teratogenicity /breast feeding7. Medication identification8. Compatibility /stability9. Clarification of quantity to be dispensed10. Clarification of frequency11. Clarification of dose12. Clarification of administration route13. Recommendation of alternative agent14. Recommendation of alternative route15. Formulary/ non-formulary issue16. Drug Information17. Other (specify)_______________________________________________________

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PH 600Appendix B

Prescription Intervention Documentation Form

Student:____________________________________ Student ID #:_________________________

Site:___________________________Preceptor:___________________Date:_________________

Intervention 1 Intervention 2 Intervention 3 Intervention 4 Intervention 5Date of intervention

Intervention category

Question/Problem

Response

Reference

Preceptor’s Initials

I have reviewed and approved all the interventions listed above.

Preceptor’s Signature and Date _______________________________________________________

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PH 600

Appendix BPrescription Intervention Documentation Form

Student:____________________________________ Student ID #:_________________________

Site:___________________________Preceptor:___________________Date:_________________

Intervention 6 Intervention 7 Intervention 8 Intervention 9 Intervention 10

Date of intervention

Intervention category

Question/Problem

Response

Reference

Preceptor’s Initials

I have reviewed and approved all the interventions listed above.

Preceptor’s Signature and Date _______________________________________________________

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Patient Counseling GuidelinesPrescription Medication and Products

Patient counseling has been shown to be most effective when the pharmacist uses open-ended questioning to ask the patient about his/her medications. The Indian Health Service developed a checklist of open-ended questions to facilitate patient counseling on new and refill prescriptions. Please refer to the checklist below when counseling patients in the community pharmacy.

New PrescriptionsIndian Health Service Counseling Model checklist for new prescriptions:1) What did the doctor tell you the medication is for?

What problem or symptom is it supposed to help?What is it supposed to do?

2) How did your doctor tell you to take the medication?How should you take your medication (special instructions for eye drops, asthma inhalers/devices, injectables, etc.)How much? How long? How often? What did the doctor say to do if you missed a dose? How should you store your medication?

3) What did the doctor tell you to expect?What good effects, bad effects, precautions to take?What should you do if a bad reaction occurs?

4) Just to make sure that I didn’t leave anything out, please tell me how you are going to take your medication?

Prescription RefillsIndian Health Service “show and tell” counseling method for prescription refills:1) What do you take this medication for?2) How do you take it?3) What kinds of problems are you having?

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Appendix CPatient Counseling Record Log

Prescription Medication/Products

The student should record all prescription-related patient counseling in the log below. The preceptor should initial and date the log to verify that the counseling was performed. After the APPE is completed, the student should place the log in his/her binder.

Patientage & sex

Medication name & dose Condition Preceptor initials and

date

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Self-Care/OTC Intervention and Consultation

QuEST and SCHOLAR Process for Counseling Self-Care Patients (OTC Counseling)*

Quickly and accurately assess the patient Ask about current complaint (SCHOLAR) Ask about other medications and other products Ask about coexisting conditions and allergies

Establish that the patient is an appropriate self-care candidate No severe symptoms No symptoms that persist or return repeatedly without an identifiable

cause No self-treating to avoid medical care

Suggest appropriate self-care strategies Medication General care measures

Talk with the patient About medication action About administration About adverse effects and how to manage them About what to expect from treatment About appropriate follow-up

Symptoms : What are the main and associated symptoms?Characteristics: What are the symptoms like?History: What has been done so far?

Has this happened in the past?Onset: When did it start?Location: Where is the problem?Aggravating factors: What makes it worse?Remitting factors: What makes it better?

*Buring SM, Kirby J, Conrad WF. A structured approach for teaching students to counsel self-care patients. Am J Pharm Educ. 2007 February 15; 71(1): 08.

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PH 600Appendix D

Self-Care Counseling/Intervention Form

Student:____________________________________ Date: ______________________

Site:___________________ Preceptor’s Signature:______________________________

Who is the product for? Self Child Other: _______________Circle: M F Pregnancy/Lactating: Y NAge of patient (if pediatric patient, need exact age and/or weight):______________

1) Describe the patient’s symptom(s) using the SCHOLAR mnemonic:a. Symptoms:

__________________________________________________________b. Characteristics:

__________________________________________________________c. History:

__________________________________________________________d. Onset: __________________________________________________________e. Location: __________________________________________________________f. Aggravating factors:

__________________________________________________________g. Remitting factors:

__________________________________________________________

2) List other coexisting disease states, conditions, allergies, or medications, that may have influenced your recommendation:________________________________________________________________________________________________________________________________

3) What was the outcome of your self-care consultation? Referral to primary care provider: Why? _____________________________________________________________________________________________________ No recommendation necessary, the condition is self-limiting. Recommended an OTC product (please include name of product, dose, instructions for use, adverse effects, warnings and time limit for safe use, any other pertinent information):____________________________________________________________________________________________________________________________________________________________________________________________________________

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Appendix ECounseling/Intervention Record Log Self-Care/Nonprescription Products

The student should record all nonprescription-related patient counseling in the log below. The preceptor should initial and date the log to verify that the counseling was performed. After the APPE is completed, the student should place the log in his/her binder.

Patientage & sex

Non-prescription product (OTC, herbal, home testing

device)

Condition Preceptor initials and

date

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Appendix FNonprescription Ingredient Chart

* Please focus on single ingredient products to obtain your informationIngredient Common brand

nameIndication Warnings Contraindications Common side

effectsCommon DailyDosages

Antihistamines

Diphenhydramine

Loratidine

Certirizine

Fexofenadine

Cough expectorant

Guaifenesin,

Cough suppressant

Dextromethorphan

DecongestantsPhenylephrine

Pseudoephedrine

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Analgesics

Ibuprofen

Naproxen

Acetaminophen

PPIOmeprazole OTC

Lansoprazole

Omeprazole plus sodium bicarbonate

H2 AntagonistsRanitidine

Cimetidine

Famotidine

Nizatidine

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AntacidsCalcium carbonate

Sodium bicarbonate

Magnesium hydroxide

Aluminum hydroxide

AntidiarrhealBismuth subsalicylate,

Loperamide

Laxatives

Fiber (psyllium, polycarophil, methylcellulose)Docusate

Bisacodyl

PEG

Hemorrhoids41

Phenylephrine

Hydrocortisone

AntigasSimethicone

Antifungals (Athlete’s foot, jock itch, ringworm)Miconazole

Clotrimazole

Tolnaftate

Terbinafine

Butenafine

Yeast InfectionsMiconazole

Clotrimazole

Tioconazole,

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Butoconazole

Ocular productsPheniramine plusNaphazoline

Ketotifen

Naphazoline or tetrahydrazoline

Nasal decongestantsOxymetazoline

InsomniaDoxylamine

Diphenhydramine

PMSPamabrom/Pyrilamine

Motion SicknessDimenhydrinate

Meclizine

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Arnold & Marie Schwartz College of Pharmacy and Health Sciences Long Island UniversityHome-Diagnostic Tests

Appendix G

1. Find the following test kits in the pharmacy. (If some of these are not available in your pharmacy, research and learn about the tests).

HIV Cholesterol Drug UTI Menopause monitor Male fertility Ovulation kit Yeast infection screening kit Pregnancy test Fecal occult test (colorectal cancer screening test A1C

2. Review these kits.3. Answer the following questions for one of the testing kits. (Type and reference your

responses.)

Home diagnostic kits Name of Device:

What is the objective of using this test?

What questions would you ask a patient before recommending this product?

What are some important features and limitations of this device?

What are some factors that can affect the test results?

How would you counsel a patient on how to use this home diagnostic test?

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Arnold & Marie Schwartz College of Pharmacy and Health Sciences Long Island University

Alternative Medicine AssignmentAppendix H

Herb or Supplement Primary Use/Benefit Disease/Drug Interaction Common DailyDosages

Black Cohosh

Chondroitin

Coenzyme Q-10

Ginger

Gingko Biloba

Ginseng

Gluosamine

Melatonin

Saw Palmetto

St. John’s Wort

* Include references

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Arnold & Marie Schwartz College of Pharmacyand Health Sciences

Long Island UniversityAppendix I

Drug Interaction Alert Assignment

Student:____________________________________ Student ID #:________________

Site:___________________________Preceptor:___________________Date:________

I. Describe, in detail, the prescription that was being filled when an alert for apotential Drug Interaction was prompted. The student should include any relevant information about the patient such as concurrent medical conditions, medications, and age, as well as all of the information on the prescription with the exception of patient identifying information.

II. Document the alert verbatim as it appears on your screen

III. Describe the mechanism for the Drug Interaction (must be clinically significant) being presented. The student is to research, in a reputable source for this information.

IV. Describe the management/recommendation for this Drug Interaction. The student is to describe how this interaction should be managed and/or what the outcome was. If the management required physician’s approval please document the conversation and outcome.

V. Site the reference used to complete this assignment. The source may be in print or electronic form, but should be current and a respected source.

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PH 600Appendix J

Business Management Guidelines

The following is a guideline for the business management assignment. Below is a list of sample questions (not all inclusive) for the students to ask themselves when discussing either the pharmacy inventory or schedule with the preceptor.

A. Evaluating the pharmacy inventory How/who decides how many bottles of medication should be in stock? How often is inventory review conducted and by whom? What happens if they run out of a medication if the pharmacy gets deliveries on set days of the week? What if something is needed for next day?

B. Evaluating the pharmacy schedule Who makes the decision about how many pharmacists/technicians should work at a given time? How or does the workflow throughout the day influence how the schedule is managed? Are resources used appropriately and if not, what is the suggestion? How are vacations/days off managed?

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PH 600Appendix K

New Drug Update Guidelines

This should be an oral presentation on a new prescription or OTC medication that is currently or will be available in a community pharmacy. A typed handout should be distributed to the audience. The presentation can be in either PowerPoint or Word format, unless otherwise specified by the preceptor.

The following information should be included in the presentation:

1. Generic Name2. Brand Name3. Manufacturer4. Category: Rx, Controlled Substance: II, III, IV, V, or OTC5. Therapeutic Class6. Mechanism of Action 7. Dosage Forms Available (appearance of the medication, any unique characteristics of the dosage form)8. Cost9. Indication(s) (FDA-approved and non-approved if applicable)10. Dose for each indication11. Special Dosing Considerations

a. Hepatic impairmentb. Renal impairmentc. Geriatric patientsd. Pediatric patients

12. Clinically significant drug interactions and their mechanism of interaction (including Drug-drug, Drug-OTC, Drug-herbal, Drug-food/nutrients)

13. Adverse Drug Reactions (common and serious ADRs)14. Contraindications, warnings, precautions15. Monitoring parameters16. Auxiliary labels17. Key counseling points18. Similar therapies available/therapeutic alternatives19. Students assessment of place in treatment compared to existing treatment

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Arnold & Marie Schwartz College of Pharmacyand Health Sciences

Long Island UniversityAppendix L

Reflective Writing

This semester, you will be preparing “reflective essays” as part of your experiential education program. You might ask the following: “Why reflect in writing”? The answer is to find and think about connections between your education and what you experience in practice. Reflective writing requires you to “re-live” an experience by reviewing the “facts” of what happened as well as your actions and feelings at the moment, and then ponder the consequences of the experiences for you as a student pharmacist and as a future pharmacist. By thinking about and then writing about these items, it is hoped that each experience will be more meaningful to you and will impact your future education (including self-education) in a positive manner.

There is no single way to prepare a reflective essay. The following approach, however, might help you get started.

To prepare a reflective essay, think about three major categories or three guiding questions: What? So what? Now what? Other authors have termed the three parts as follows: Introduction; body; closure; while others have called it background; relevance; and impact. Let us take the first approach.

What?The first part of your essay is the factual information. Just as if you were writing for a newspaper, you should include the following: What happened, who was involved, when did this happen, what were you doing, what surprised you, what was most difficult, and what were others doing at the time. You could say that this is the “who, what, when, where, and why” of your essay. You should include sufficient information so that the reader of the essay can feel as if he/she were there observing the scene. It is imperative that you include evidence of the activity.

So what?This section should place the “what” into a broader thought or a concept as to what you are learning at the off-campus site or in a class, perhaps a theory that you studied, and, very importantly, the reason that this activity being written about is important. You could state that this section describes the “relevance” of the activity. You should clearly indicate what you expected or anticipated about the experience and what you actually experienced or “felt” about the experience. In this section, you should be discussing “I” statements – such as I believed this or I felt that. In other words, this must be personal not theoretical or global.

Now what?The final section (or “closure”) describes what you will do next based upon what you learned from this experience. You might write what about a new plan for the future; or, you might state that I now believe such and such; or if I could turn the clock back to the beginning of the activity I would do X rather than Y. You also need to connect the activity to the future – meaning, describe the way in which you will take this experience to your next stage of being a student pharmacist or the ultimate stage of being a pharmacist. Once again, you should be writing “I” statements, as this is personal to you.

To reiterateA reflective piece needs to have the three sections outlined above – what, so what, now what; or an introduction, a body, and a closure. The first part needs to indicate the evidence, the middle part needs

49

to discuss the principle on which the experience is based, and the third part needs to take a glimpse into the future.

Sample (abbreviated) essayDuring this past fall semester, I was taking my community pharmacy APPE. After filling a prescription for a patient, I asked a patient if I could speak with him about the medication – ABC inhaler. The patient said that it wasn’t necessary and began to walk away. The pharmacist heard this, and called the patient back to say that it was very important for him to spend a moment with us as this was a new medication and we needed to be sure that everything would be okay. I then counseled the patient about the new inhaler, and realized that the patient could not have used the medication effectively if I did not show him how to use it. I even demonstrated proper use of the product using a dummy inhaler.

This experience taught me several things. First, I need to be somewhat more assertive yet caring when I speak with patients. I need to tell them that I really just need a few minutes and it is because I want to help them to get the best out of their therapy. I also learned that as pharmacists we need to counsel all patients receiving new prescriptions, and just filling the prescription is not enough. Finally, it reminded me about the way we were taught in our communications class to speak with patients, and that the correct style of communication is as important as the content.

In the future, I realize that I probably won’t be able to counsel every patient – although I probably should try. But, it is important that I counsel very young and very old patients, as well as patients receiving new therapies especially if they are difficult to use dosage forms or have major toxicities associated with them. I plan to practice my counseling skills at work and during my next rotation. My goal as a pharmacist practicing in the community is to counsel as many patients as possible to impact direct patient care.

Written by Harold L. Kirschenbaum, MS, PharmD, Associate Dean for Professional Affairs

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PH 600Preceptor Evaluation of Student Competency

Midpoint Assessment

This form is to be completed by the preceptor at the midpoint (by the end of the 3 rd week) of the 5-week rotation. Please check the appropriate box that best represents the student’s performance of each competency. The student must achieve a 2 or higher in each competency to pass the rotation. If the student is not achieving minimum competency (a 2 or higher) please notify the office of Experiential Education. If the statement does not apply, please indicate N/A. The midpoint evaluation should be kept by the student for inclusion in the student binder. This instrument is designed to help the preceptor provide feedback to the student and should be referred to and discussed at the final assessment of the APPE.

Student Name _______________________ Pharmacy _______________________________Date ________________________________ Preceptor __________________________

Unacceptable0

Poor1

Average2

Above Average3

Excellent4

e.g., does not participate and/or complete assigned activities; provides inaccurate information; actions are unprofessional; habitually late to the site; work is unacceptable

e. g., performs a minimum of the assigned activities; presents incomplete data; work indicates a lack of effort and/or very poor knowledge base; requires extensive intervention from preceptor or staff

e. g., performs assigned activities; provides accurate but minimal information; requires moderateintervention from preceptor or staff

e. g., performs all assigned activities; provides complete and accurate information; organized thought process; requires some interventions from preceptor or staff

e.g., exceeds expectations; completes all assigned activities; provides accurate and precise information; manages time efficiently; requires few interventions from preceptor or staff

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Competency ScoreThe student is competent in all aspects of filling and dispensing prescriptionsThe student is able to assess the appropriateness of patient’s drug therapy, and identify, resolve, and prevent drug-related problems, and document interventionsThe student is able to identify, interpret, and/or evaluate sources of information for clarifying or answering questions related to prescriptions, nonprescription medications, alternative and complementary therapies, surgical/medical devices, and overall healthcareThe student is able to monitor patients receiving medications for efficacy, toxicity, adherence and appropriate therapeutic outcomesThe student is able to conduct patient interviews to gather needed patient information to assess appropriateness of prescription and nonprescription therapyThe student is able to perform physical assessment, if applicable and evaluate laboratory tests, if available, to assess drug therapy outcomes and monitor patients in the community pharmacy (e.g., blood pressure screening/monitoring)The student is able to recommend appropriate nonprescription (OTCs, herbals, home monitoring devices) and to refer patients to a health care provider when self-care is inappropriateThe student is able to provide patient counseling for prescription and nonprescription productsParticipate and contribute to programs related to disease prevention, vaccination and wellness in the pharmacy and community

The student is able to demonstrate the skills of inquiry, logic and critical analysisDemonstrate a basic understanding of pharmacy business management (i.e., inventory management, workflow, human resource management, etc)The student is able to perform pharmacy related calculations Demonstrates skills needed to compound extemporaneous products, if applicableThe student demonstrates legal/ethical behavior including protecting the confidentiality of patient information

Indicate areas of particular student strength:

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Indicate areas in which the student needs to improve:

Additional Comments:

Preceptor signature: _________________________ Date: ___________

Student signature: __________________________ Date: ____________


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PH 600Preceptor Evaluation of Student Competency

Final Assessment

This form is to be completed by the preceptor at the completion of the 5-week rotation. Please check the appropriate box that best represents the student’s performance of each competency. The student must achieve a 2 or higher in all competencies to pass the rotation. If the statement does not apply, please indicate N/A. Please fax a copy of this form to the course coordinators at (718) 780-4056.

Student Name _______________________ Pharmacy ______________________________Date ________________________________ Preceptor _________________________

Unacceptable0

Poor1

Average2

Above Average3

Excellent4

e.g., does not participate and/or complete assigned activities; provides inaccurate information; actions are unprofessional; habitually late to the site; work is unacceptable





Competency ScoreThe student is competent in all aspects of filling and dispensing prescriptions

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The student is able to assess the appropriateness of patient’s drug therapy, and identify, resolve, and prevent drug-related problems, and document interventionsThe student is able to identify, interpret, and/or evaluate sources of information for clarifying or answering questions related to prescriptions, nonprescription medications, alternative and complementary therapies, surgical/medical devices, and overall healthcareThe student is able to monitor patients receiving medications for efficacy, toxicity, adherence and appropriate therapeutic outcomesThe student is able to conduct patient interviews to gather needed patient information to assess appropriateness of prescription and nonprescription therapyThe student is able to perform physical assessment, if applicable and evaluate laboratory tests, if available, to assess drug therapy outcomes and monitor patients in the community pharmacy (e.g., blood pressure screening/monitoring)The student is able to recommend appropriate nonprescription (OTCs, herbals, home monitoring devices) and to refer patients to a health care provider when self-care is inappropriateThe student is able to provide patient counseling for prescription and nonprescription productsParticipate and contribute to programs related to disease prevention, vaccination and wellness in the pharmacy and community

The student is able to demonstrate the skills of inquiry, logic and critical analysisThe student is able to monitor patients receiving medications for efficacy, toxicity, adherence and appropriate therapeutic outcomes

Demonstrate a basic understanding of pharmacy business management (i.e., inventory management, workflow, human resource management, etc)The student is able to perform pharmacy related calculations Demonstrates skills needed to compound extemporaneous products, if applicableThe student consistently arrives on timeThe student demonstrates legal/ethical behavior including protecting the confidentiality of patient information

II. Preceptor: Please provide additional comments if desired:

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PH 600Faculty Preceptor Evaluation of Student Competency

Midpoint Assessment

This form is to be completed by the preceptor at the midpoint (by the end of the 3 rd week) of the 5-week rotation. Please check the appropriate box that best represents the student’s performance of each competency. The student must achieve a 2 or higher in each competency to pass the rotation. If the student is not achieving minimum competency (a 2 or higher) please notify the office of Experiential Education. If the statement does not apply, please indicate N/A. The midpoint evaluation should be kept by the student for inclusion in the student binder. This instrument is designed to help the preceptor provide feedback to the student and should be referred to and discussed at the final assessment of the APPE.

Student Name _______________________ Pharmacy ______________________________Date ________________________________ Preceptor _________________________

Unacceptable0

Poor1

Average2

Above Average3

Excellent4

e.g., does not hand in assignments; provides inaccurate information; actions are unprofessional; habitually late to the site; work is unacceptable





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Assignment Score Missed deadline professionalism points

Medication Therapy Management (2)Prescription drug-related interventions (10)Prescription medication counseling (10)Nonprescription product counseling (10) Drug Interaction Alerts (3) Herbal and Supplements (10)Home Diagnostic Test (1)Business Management (Inventory or scheduling) (1)Major Project (HTN screening, Patient Compliance, New Drug Update) (1)

II. Preceptor


Indicate areas in which the student needs to improve


Student signature: __________________________ Date: ___________

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PH 600Faculty Preceptor Evaluation of Student Competency

Final Assessment

This form is to be completed by the preceptor at the completion of the 5-week rotation. Please check the appropriate box that best represents the student’s performance of each competency. The student must achieve a 2 or higher in all competencies to pass the rotation. If the statement does not apply, please indicate N/A. Please fax a copy of this form to the course coordinators at (718) 780-4056.

Student Name _______________________ Pharmacy _______________________________Date ________________________________ Preceptor __________________________

Unacceptable0

Poor1

Average2

Above Average3

Excellent4

e.g., does not hand in assignments; provides inaccurate information; actions are unprofessional; habitually late to the site; work is unacceptable





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Assignment Score Missed Deadline Professionalism Points

Medication Therapy Management (2)Prescription drug-related interventions (10)Prescription medication counseling (10)Nonprescription product counseling (10) Drug Interaction Alerts (3) Herbal and Supplements (10)Home Diagnostic Test (1)Business Management (Inventory or scheduling) (1)Major Project (HTN screening, Patient Compliance, New Drug Update) (1)


Indicate areas in which the student needs to improve:

The student meets the overall requirements of this APPE: _______

The student does meet the overall requirements of this APPE: ______ Please Explain:

Additional comments:

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Preceptor’s signature: Date:

------------------------------------------------------------------------------------------------------------For Office Use Only:

Pass _____

Fail _____ Please provide explanation:

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PH 600 – Professionalism Assessment (On-site Preceptor)

Student:___________________________________ Student ID #:___________________

Site:_______________________ Preceptor:________________________Date:________

Preceptor: Please document the dates of each occurrence where applicable. If the student did not exhibit any of the behaviors listed below please write “Not Applicable” across the page.

Date of occurrence

On-site preceptor

Student arrived 15 or more minutes late (-1 point per occurrence)

Student did not notify on-site preceptor of absence the morning of occurrence (no later than 8 am)(-1 point per occurrence)

No professional attire/lab coat/name badge worn during assigned shift(-1 point per occurrence)

Preceptor signature: _____________________________ Date: ________________

**Please FAX this form to the Office of Experiential Education 718-780-4056. Thank you.**

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PH 600 – Professionalism Assessment (Faculty Preceptor)

Student:___________________________________ Student ID #:___________________

Site:_______________________ Preceptor:________________________Date:________

Preceptor: Please document the dates of each occurrence where applicable. If the student did not exhibit any of the behaviors listed below please write “Not Applicable” across the page.

Date of occurrence

Faculty preceptor

Student did not notify college of absence the morning of occurrence (no later than 8 am) (-1 point per occurrence)

Student did not have completed assignments at the site when faculty preceptor come to visit (-1 point per occurrence)

Designated deadlines for assignments were missed (-1 point per day late per assignment)

Outstanding resubmissions after block ended (-1point per day late after block has ended)

Preceptor signature: _____________________________ Date: ________________

**Please FAX this form to the Office of Experiential Education 718-780-4056. Thank you.*

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PH 600Preceptor and Site Evaluation Form for Volunteer Faculty Sites (completed by the Student)

This form is to be completed by the student at the completion of the 5-week rotation. Please submit this form to the course coordinators along with the course binder at the end of your rotation.

Student Name _______________________________ Preceptor _______________________________________Pharmacy (include name and address) ___________________________________________________________________

Key: 5 = Strongly Agree, 4=Agree, 3=Neutral, 2=Disagree, 1=Strongly Disagree, NA= 0

ROTATION ORGANIZATION AND MANAGEMENT SA A N D SD N/A

Orientation to the site was adequate

Expectations were clearly explained

The preceptor was prepared for the APPE

The APPE was well organized

Appropriate time was provided for completion of projects and assignments

SITE RESOURCES SA A N D SD N/A

Access to reference materials was adequate

Opportunities for interactions with other healthcare professionals were provided

The site offered a variety of learning experiences

The pharmacy personnel were receptive and willing to interact with students

Site accommodations were appropriate for student learning (adequate space for personal belongings, meeting area, resources, etc.)

The setting provided opportunity to accomplish the APPE assignments, projects, and learning objectives

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PRECEPTOR SA A N D SD N/A

The preceptor followed the syllabus

The preceptor demonstrated an interest in teaching

The preceptor explained and clarified information

The preceptor was accessible and willing to help students

The preceptor spent adequate time with students

The preceptor encouraged students to make comments and ask questions

The preceptor was enthusiastic and interested in the practice of pharmacy

The preceptor was a good role model and demonstrated professional and ethical behaviors

The preceptor provided ongoing constructive criticism when appropriate

The preceptor provided adequate supervision

The preceptor encouraged students to solve problems and make professional decisions with supervision

STUDENT OPINIONS SA A N D SD N/A

The college curriculum prepared me for this APPE experience

I was judged fairly regarding my level of knowledge and skills

This APPE experience prepared me for practicing pharmacy after graduation

I would recommend this site to others

Additional Comments: What was the most significant strength of this clerkship?

_______________________________________________________________________________________

___________________________________________________________________________________________________________What was the most significant strength of your preceptor?

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_______________________________________________________________________________________

___________________________________________________________________________________________________________

What was the most significant weakness of this clerkship?

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

What was the most significant weakness of your preceptor?

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Student’s signature _________________________________________ Date ________________

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