Concentrated Health Systems

Goals

Through Introductory Pharmacy Practice Experiences (IPPEs), student pharmacists are expected to master foundational competencies in three domains:

1. Communication and Professional Behavior
2. The Practice of Pharmacy
3. Public Health.

Competencies from these three domains address basic skills that prepare students for Advanced Pharmacy Practice Experiences (APPEs).

The purpose of this IPPE is to:

• Develop foundational knowledge, skills, and attitudes for pharmacy practice in the inpatient pharmacy setting
• Instill professionalism
• Expose students to the roles of the pharmacist in the inpatient pharmacy setting
• Prepare students for APPE rotations.

Objectives

• Discuss the process to prepare, dispense, and deliver medication orders, including extemporaneous preparations and sterile products, accurately, completely, and efficiently.
• Demonstrate the ability to interact verbally and in writing with healthcare providers and patients by gathering, organizing, and appropriately recording information and by consulting and counseling competently.
• Describe the steps that must be taken to ensure departmental compliance with accreditation, legal, regulatory and safety requirements.
• Interpret patient information according to task at hand and available setting.
• Research and appropriately utilize resources (e.g., current practice guidelines, literature related to evidence-based medicine and practice, list of available resources for meeting an identified patient or population-based need) to improve an individual patient’s care or the care of patients within the practice setting.
• Discuss the components of obtaining an accurate medication history or conducting a patient interview.
• Correctly perform calculations to dispense and/or compound medications.
• Articulate the pharmacist’s role in medication use oversight (e.g., formulary management, practice guidelines).
• Articulate the pharmacist’s role in medication safety and quality improvement activities (e.g., adverse drug reaction reporting, medication reconciliation).

Due to the duration of this experience (2 weeks) and the variation in sites utilized for the experience, students may not achieve all goals and objectives during this experience. Preceptors may assign readings, shadow experiences, or discussions with various members of the pharmacy team to expose students to the goals and objectives listed above

Note

For professionalism and attendance policies, refer to Policies and Requirements.

What is expected from preceptors?

The preceptor’s main role is to act as a resource and point-person for students throughout their experience.

The preceptor should:

• Set expectations on day one.
• Orient students to the clinical atmosphere, relevant sources of information, and introduce them to staff & colleagues they may interact with at their practice setting.
• Refer to the "Concentrated Health Systems Activities" section below for guidance in determining the types of activities in which to participate. These activities will vary based on your practice site and your previously assessed skill level.
• Discuss your previous pharmacy practice experiences to assess skill level and determine appropriate operations and clinical activities.
• Provide you with enough guidance, support, and on-going real-time performance-based feedback to be successful.
• Meet with you often to check-in on goals, expectations, progress, etc.; to provide an opportunity to reflect upon and debrief experiences; to give and receive feedback.

Students should contribute to the workflow of the community pharmacy, but this is also a learning experience. While constant oversight is certainly not required, regular check-ins and on-the-job mentoring are expected.

IPPE first day

• Orient the student to your site
• Introduce student to staff and colleagues
• Give the student(s) a tour of the site
• Review expectations
• Assess skill level of the student by asking the student about their previous inpatient pharmacy practice experiences

During the IPPE

• Provide activities for the student as well as allowing them to observe your site. Use the “Possible Activities for Hospital IPPE Student Pharmacists” (see page 3) to guide you in determining the types of activities that are appropriate for the student to participate in. These activities will vary based on your practice site and the previously assessed skill level of the student.
• Provide on-going feedback to the student to help the student improve their skills
• Students can participate in various continuous quality improvement projects for the inpatient pharmacy.

After the IPPE

The preceptor will complete an IPPE Student Evaluation for each student s/he precepts. The evaluation focuses on assessing the professionalism demonstrated by the IPPE student pharmacist.

What is expected of students?

The preceptor understands that students are still developing their knowledge and patient interaction skills. If the preceptor asks a student to complete a task beyond their current abilities, students should feel comfortable asking for guidance and/or additional training.

The student is expected to complete all assigned activities with a high level of professionalism and commitment. Professionalism includes dressing appropriately, attendance and punctuality, work ethic, as well as your respect for patient care and the clinical care team. Students may be asked to observe and/or participate in a variety of operational and clinical activities. Students may vary in previous experience within a health system. Thus, a thorough orientation and detailed instructions for specific activities may be required. Examples of potential activities are included in the ”Summer Hospital Operations Activities" section below and include various continuous quality improvement projects.

A final summative evaluation will be completed for each student via E*Value. Students may work with multiple pharmacists/preceptors while on rotation. Preceptors will discuss student performance with any other providers students have worked with during the rotation to capture a comprehensive evaluation of student performance.

Due to the short duration of this experience (2 weeks), students may not have an opportunity to complete each item in the evaluation tool. In this case, preceptors should mark “Not observed.” Students will not be penalized for items marked not observed on the evaluation tool.

The final evaluation should be discussed between the student and preceptor at the practice site towards the end of the experience.

Shift types

• Infusion Center

• Clinical Pediatric Hybrid

• Operations #1 & #2

• ICU

• Orthosurgery

• Neurosurgery

• NeuroSpine

• Infectious Disease

• Oncology/BMT (12L)

• IP Diabetes Rotation

• General Surgery (13L)

• Emergency Department

Observe pharmacy workflow in all areas of the inpatient pharmacy & hospital

• Technician activities: unit dose, bar-coding, IV and chemotherapy preparation, medication stocking, inventory
• Pharmacist activities: order verification/entry, review of medications prepared by technicians, narcotic dispensing, antimicrobial stewardship

Observe and discuss the medication order review process

• Observe pharmacists assessing medication orders for appropriateness of indication, dose, route of administration, frequency/rate of administration, and directions for use
• Identify and adjust the dosage of medications based on estimates of renal and/or hepatic function as necessary
• Observe how pharmacists communicate with other health professionals to clarify, correct, or adjust medication orders and provide supporting evidence/drug information as needed

Observe and participate in the medication distribution system throughout the institution

• Select the correct product from the pharmacy inventory and properly prepare and label the medication
• Perform appropriate calculations for the preparation of sterile products and extemporaneously compounded oral/topical formulations
• Observe aseptic technique for preparation of sterile compounds
• Perform a unit-dose cart fill and check a unit-dose cart filled by a technician
• Perform a load, unload, inventory and refill for an automated drug dispensing unit (e.g. Pyxis)

Participate in direct patient care activities

• Observe and perform medication histories for medication reconciliation
• Monitor and document patient care activities provided under protocol (e.g., TPN, anticoagulation, IV to PO switches, pain management, pharmacokinetic dosing, etc.)
• Observe and perform discharge medication counseling

Participate in quality improvement programs to minimize errors and promote safety in the acute care setting

• Assist in the performance of a medication storage area (e.g., pharmacy, Pyxis unit, nursing unit) inspection to identify and remove outdated or expired medications.
• Assist in completion of incident reports, medication error reports and adverse drug event reports
• Perform audits, analyze data and create reports for quality improvement strategies related to medication use