Part III: Community Placement; Overview of Learning Activities

Pharmacy Placements April 2021

Part III: Community Placement; Overview of Learning Activities Essential activities. Students and preceptors will work together to ensure all essential learning activities for the ten day community placement are completed. The placement will include active participation and observation in the following aspects of community pharmacy practice. It is expected that the student will have several opportunities to undertake some of the learning activities to develop the pharmacy practice skills. Activity One: Dispensing of Medicines This activity will first include observing, then active involvement, in as many aspects of the dispensing process as possible during the placement, with the aim of self-completion, of accurately dispensed prescription medicines. Activity Two: Extemporaneously compounded product This activity involves preparation of an extemporaneously compounded product under supervision. Activity Three: Patient Education This activity will involve providing patient care when handing out dispensed medicines. Activity Four: Providing Primary Healthcare/OTC This activity will first include observing, then active involvement, in gathering information from the patient, assessing appropriate treatment and providing patient-centred advice on pharmacological and/or non-pharmacological treatments. Activity Five: Pharmacist Only Medicines This will first include observing, then active involvement, gathering information from the patient, assessing appropriate treatment and providing patient-centred advice on Pharmacist Only Medicines. Activity Six: Medicine history taking/Medication Review/Care Plan This activity will involve the student practicing the medicine history taking skill by interviewing an assigned patient, collecting a full medication history, completing a medicine reconciliation to determine the complete, current and accurate prescribed medicines list for the patient then undertaking a medicine review, preparing a care plan and letter to another health professional involved in care for this patient. Activity Seven: Medicines information enquiry This activity will involve the student answering a medicines information request. A set of default enquiries is available on the BPharm portal. Activity Eight: Medication Safety This activity will involve the student becoming familiar with the system for managing reporting of adverse drug reactions and incidents and what processes are in place for error minimisation. Activity Nine: Professional Services and Health Promotion The student will observe how community pharmacy aligns with the NZ Pharmacist Framework by delivering professional services and reinforcing national health initiatives e.g. smoking cessation. Activity Ten: Pharmacy Management This activity will involve the student becoming aware of systems for managing a community pharmacy in terms of staff and financial management. Activity Eleven: Personal reflection journal and learning record This activity will involve the student recording and reflecting upon their learning experiences throughout their placement.


Optional Activities

‘Optional Opportunities’ includes some suggestions for extra activities that may be made available to the student, during the placement. These can be attempted once the student has completed all of the portfolio activities and dependent on time and resources available. Some sites will offer these as essential activities during the placement; however, this will not be possible for all sites. If the student is particularly interested in any of these optional activities, they are encouraged to ask the preceptor who will let the student know if they are possible. These optional activities will not be assessed but will be of great benefit to the student in their understanding of pharmacy practice healthcare in New Zealand. Suggested Optional Activities ♦ Accompany a pharmacist on a visit to a residential care facility, patient home visit, Long

Term Conditions review visit. ♦ Attend a multidisciplinary meeting with a pharmacist at a local medical practice. ♦ Complete documentation of a controlled drug dispensing. ♦ Discuss common prescription interventions. ♦ Observe a Community Pharmacy Anti-Coagulant Monitoring Service consultation. ♦ Check a patient’s hospital discharge notes/lab investigations/previous prescriptions on

shared electronic records e.g.TestSafe. ♦ Observe preparation of aseptic products, blister packaging. ♦ Discuss dispensing practicalities and legal requirements of methadone/suboxone. ♦ Observe a health screen consultation e.g. blood pressure measurement. ♦ Observe the management of section 29 medicines, special authority number searches,

prescription subsidy cards, work and income prescription medicine reports, owed medicines, certified true copies.

♦ Dispense a Medicines Practitioner Supply Order. ♦ Discuss ethical issues staff are commonly faced with in the pharmacy. ♦ Discuss Consumer Guarantees Act and its application to community pharmacy. ♦ Observe the marketing of a community pharmacy and any online presence e.g. e-

commerce, social media. ♦ Discuss the role of professional organisations such as the Pharmacy Guild, the

Pharmaceutical Society and Green Cross in community pharmacy practice. ♦ Discuss medicine safety and how medicine errors are minimised at several points e.g.

computer alerts, Tall Man lettering. ♦ Discuss how out of stock medicines are managed between Pharmac and the community

pharmacy customers. ♦ Observe online submission of a pharmacy claim to sector services and/or a physical batch

collation to be sent to sector services.

There are likely to be area-specific and/or community-specific activities that may be available. Preceptors will advise appropriate alternative activities.


Community Pharmacy Placement Checklist Checkbox Introduction to the community pharmacy with an explanation of working areas and

staff roles. Dispensing prescriptions, as many as possible over the 10 day placement, practicing

the skills of prescription/chart screening for both legal, clinical and funding issues.

Undertake as many medicine reconciliations as possible.

Prepare an extemporaneously compounded product.

Provide patient education on dispensed medicines to as many patients as possible over the 10 day placement.

Provide primary healthcare and over the counter medicine consultations to as many health consumers as possible over the 10 day placement.

Participate in as many Pharmacist Only Medicine consultations (under supervision) as possible over the 10 day placement.

Medicine History taking, Mediation reconciliation, Medication Review, Care Plan.

o Obtain a medication history from a patient under supervision, o Undertake a medicine reconciliation, o Complete a medication review o Prepare a care plan. o Prepare a summary letter to the patient’s prescriber

Understand how to complete a CARM report for an adverse drug reaction.

Answer a medicines information question.

Pharmacy Placements Revised April 2021

Suggested programme for Community Pharmacy Placement 2

Day 1 in Community Phcy

•Preceptor expectations.•professional behaviour, patient confidentiality, amount of self-directed learning

•dress code, exchange contact details for unanticipated situations

•health and safety

•Orientation to site.•working areas, wards, dispensary

•introduction to staff•software/technology•explanation of staff roles and departmental activities

Day 2, 3 & 4 in Community Phcy

•Identify a patient to interview and undertake medication history for medicien reconcilation, mediation review and care plan activity.

•Step-wise interacting with patients/customers.

•Step-wise dispensing of prescriptions, MPSOs, controlled drugs etc.

•Observation of Pharmacist Only Medicine consultation.

Day 5 & 6 in Community Phcy

•Step-wise Pharmacist Only Medicine consultation.

• Familiarisation with Over the Counter medicines from dermatology, gastrointestinal, infections, respiratory & cardiovascular modules.

•Medicine history taking by interviewing patient that student will then be undertaing a medicine reconcilation, medication review & developing a care plan for.

•Completion of mid point assessment.


•Full dispensing and patient/customer interactions.

•ADR and near miss reporting

•Medicine information queries.

•Medication review and identifcation of any potential and actual medicine related problems to be addressed in a care plan.

•Areas from mid-point assessment addressed.


•Care plan -completion of care plan.

•Prepare an Extemporaneously Compounded Product.

•Patient consultation with a focus on adherence.

•Pharmacy Management - staff & financial.

•Optional activities.

Post Placement

•Preceptor complete final assessment and send to Auckland School of Pharmacy.

•Student complete learning activities in ePortfolio AFTER completion of placement days


CPP Pharmacist’s Assessment of Part III Student Performance Student: Dates of Placement:

Pharmacy:

Pharmacist preceptors are to complete this assessment for each student at the end of the visit.

A. Professional Behaviour Assessment. Please tick the appropriate boxes for each of the 12 Indicators.

Indicators Not at all or

rarely*

Some of the time*

Most of the time

All of the

time

1. Student’s appearance and dress conforms to professional and pharmacy standards.

2. Student is punctual and shows good time management i.e. arrives on time, meets deadlines for completion of tasks.

3. Student behaves in an ethical manner and acts in accordance with the profession’s Code of Ethics.

4. Student treats confidentiality and privacy issues appropriately.

5. Student is respectful i.e. demonstrates regard for others, acts in a manner that shows recognition that he/she is a guest at the practice site as a professional student.

6. Student shows empathy and interest i.e. demonstrates appreciation of others’ positions and demonstrates consideration towards others.

7. Student exhibits a positive attitude, a willingness to learn, and participates actively.

8. Student accepts and applies constructive feedback.

9. Student communicates accurately, concisely and confidently.

10. Student shows integrity interacting with patients, staff and other health professionals in socially and culturally diverse settings.

11. Student shows initiative and is self-directed in undertaking tasks i.e. after initial instructions initiates activities to complete them.

12. Student demonstrates accountability i.e. holds oneself liable for tasks/responsibilities, does not blame others for mistakes or mishaps and accepts responsibility for actions.

* Extra evidence is required if this box checked


B. Specific Task Performance Please assess the student on their performance of the specific tasks using the criteria below, in the following table.

Not Achieved Achieved Merit The student displayed a poor interest

or understanding of the tasks/activities and/or required significant help and supervision.

The student consistently displayed appropriate interest and

understanding of the tasks/activities and achieved them with expected levels of help and/or supervision.

The student displayed outstanding interest and

understanding and performed all tasks/activities to the highest standard and displayed a level of ability

beyond that expected.

Specific task Circle appropriate achievement level Comments

(Please elaborate on your choice)

Dispensing • Was a logical, safe and systematic

approach used when dispensing? • Did labelling instructions address

patient needs? • Was the student proficient in

dispensing at least 40 prescription forms under supervision?

Not Achieved* Achieved Merit

Providing advice when handing out dispensed medicines

• Was the patient/care-giver interaction patient-centered?

• Was the information appropriate to ensure safe and proper use of medicines(s)?


Primary health care (OTC) patient consultations

• Was sufficient information gathered to make a differential diagnosis?

• Was an appropriate treatment/referral recommendation provided?

• Was the interaction patient-centered?


C. Global Placement Module Assessment Criteria Please circle which criteria best reflects the student’s overall performance during their placement.


The student displayed a poor interest or understanding of the tasks/activities and/or required significant help and supervision.

The student consistently displayed appropriate interest

and understanding of the tasks/activities and achieved them with expected levels of

help and/or supervision.

The student displayed outstanding interest and understanding and performed all tasks/activities to the highest standard and displayed a level of ability beyond that expected.

Supervising pharmacist’s comments * Extra evidence is required if this box checked Supervisor’s name:

Signature: Date:


Patient Background Information for Care Plan Date prepared __________ Patient Details

Patient Initials: Gender: Patient’s age (y): Ethnicity: Occupation:

Date of Admission Allergies/Hypersensitivities:

Weight (kg): Height: BMI (kg/m2) Cr Cl: Smoking status: Alcohol intake:

Social History:

Medical Details Current medical history: (Use names of disease states e.g. type 2 diabetes, heart failure) Past medical history (PMH)/Past surgical history (PSH): (e.g. Hip replacement, surgery for bowel cancer)

Relevant family Medical History: (e.g. father died of heart attack at 50yrs of age)

Range of health professionals involved in their care: (e.g. GP, diabetes nurse specialist, out-patient clinic, rheumatologist specialist)


Lab results, Observations, Investigations

Lab Results

Test Normal Range Date Date Date Test Normal

Range Date Date Date

Observations Investigations M

Other Background Information Use of OTC medicines including complementary/nutritional supplements:

Known adverse reactions (ADR) or adverse events (ADE) experienced by the patient form taking/using medicines: Other comments and information gathered from patient: (e.g. sleep habits, caffeine intake, disabilities, pregnancy, breast feeding etc) Information from other sources that differs from information gained from the patient:

Test Normal Range

Date Date Date Test Normal Range

Date Date Date

Blood Pressure

Heart Rate

Temperature

Fluid Balance


Assessment of Current Medicine Regime (prescribed, OTC, social and previously prescribed medicines) Start date

Medication Strength Dose & Frequency

Route Indication Stop Date

Source of Information

Mode of Action Medicine Related Problems (MRPs), Clinical Problem Identified (must apply to the patient e.g.

inappropriate dose, form, frequency, interactions, contraindications, ADE,

adherence issues) □ Patient

□ Community Phcy

□ Hospital Discharge summary □ GP

□ Patient

□ Community Phcy


□ Patient

□ Community Phcy



Care Plan (include all identified clinical problems and medicine related problems identified in your Assessment of Current Medicine Regime.)

Medicine Related / Clinical Problem 1

Medicine Related / Clinical Problem 2

Priority Once all issues are identified, prioritise them in order of importance / severity, where 1 = the most urgent / important

Medicine Related Problem/Clinical Problem Identified for this patient

• Address one identified medicine related problem or clinical problem per row.

• MRP identified may be actual or potential problems.

• Include brief facts to support why you have identified this problem.

Desired goals of treatment

Pertinent considerations of the clinical problem for this patient

Pharmacological and non-pharmacological treatment options

Recommendations for this patient, and why

Specific monitoring and follow-up points required for this patient Who will do this and in what timeframe?

Education points for this patient What does the patient need to know?


Medicine Related / Clinical Problem

3 Medicine Related / Clinical Problem 4



• One identified medicine related problem or clinical problem per row.










Medicine Related / Clinical Problem

5 Medicine Related / Clinical Problem 6



• One identified medicine related problem or clinical problem per row.










Recording Interactions/Conversations with Patients about their Prescribed Medicines Form

This template is used for recording interactions/conversations with health consumers and/or their carers with regard to prescribed/dispensed medicines.

Record brief details of the patient (age, gender and other relevant details, no name) or record if the consultation occurred with the patient's agent.

List the name, dose, frequency and clinical indication for each of the medicines you are discussing with the patient/carer.

Using the Three steps to Better Health Literacy guide, briefly describe

a) Has had these medications before and if so for how long.

b) What the patient already knows about their medicines

c) What were the agreed 2-3 areas to cover during this interaction/conversation?

Briefly describe what education/advice you provided the patient/carer.

Briefly outline any patient concerns they had with regard to their medicines and how you addressed them.

Briefly outline any actual of potential adherence problems you discussed with the patient/carer and how you addressed them.

Briefly outline your summarised key pieces of information you ensured the patient/carer needed to know.

Any other relevant information?


Primary Health Care: Pharmacy/General Medicines OTC Form

This template is used for recording interactions/conversations with health consumers with regard to OTC supply of Pharmacy/General Medicines.


Briefly describe the main clinical signs and symptoms.

Briefly describe the patient's relevant medical and medication history.

What was your provisional diagnosis? What were the other possible diagnoses?

Outline the treatment you recommended, which may have included a referral to another healthcare provider.

Outline any patient counselling/advice you gave.

What was the outcome of this patient interaction/consultation?



Primary Health Care: Pharmacist Only Medicines OTC Form

This template is used for recording interactions/conversations with health consumers with regard to OTC supply of Pharmacist Only Medicines.


Briefly describe the main clinical signs and symptoms.

Briefly describe the patient's relevant medical and medication history.

What was your provisional diagnosis? What were the other possible diagnoses?

Outline the treatment you recommended, which may have included a referral to another healthcare provider.

Outline any patient counselling/advice you gave.

What was the outcome of this patient interaction/consultation?


Part III: Community Placement; Overview of Learning Activities

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