IPPEs and APPEs
The UCSF School of Pharmacy provides students with an interprofessional, experiential foundation spanning the realm of healthcare delivery systems that prepares them to achieve professional excellence, advance the field of pharmacy practice and bridge gaps in care, especially for the underserved.
Introductory Pharmacy Practice Experiences (IPPEs)
In the 1st, 2nd, and 3rd years, students participate in Introductory Pharmacy Practice Experiences (IPPEs) to gain actual practice experiences in community and institutional settings and as appropriate, assume direct patient care responsibilities. Through IPPEs, students practice and strengthen their patient care skills through a wide array of pharmacy practice experiences. The IPPEs complement the didactic curriculum and involve a variety of experiences including shadowing pharmacists, interviewing and counseling patients, developing and utilizing specialized skills such as immunization delivery, and participating in community health screenings and fairs. These introductory experiences prepare students for the final stages of the curriculum.
Advanced Pharmacy Practice Experiences (APPEs)
Beginning in spring of the 3rd year, students complete Advanced Pharmacy Practice Experiences (APPEs). APPEs are offered in hospitals, outpatient facilities and community clinics. Through APPEs, students apply formal classroom training to the pharmacy practice, developing the clinical skills to function effectively in a variety of practice environments. Students spend approximately 40 hours a week at their practice sites as part of the clinical curriculum. Since patient care is continuous, some practice experiences fall outside of the traditional 8:00 AM to 5:00 PM workday. For example, some practice experiences require students to attend ward rounds in the hospital which frequently begin as early as 6:00 AM and at times students are involved with patient care situations as late as 11:00 PM; some responsibilities to patients may occur on weekends.
In all of the APPEs, students are under the supervision of pharmacists who are members of the faculty and who also provide patient-oriented pharmaceutical services. Since the locations of APPEs vary, a car may be a necessary resource during this portion of the program.
Approximately 60% of the students in the Pharmaceutical Care pathway complete their APPEs in Greater Sacramento, Fresno, Los Angeles / Orange County, and the North Bay. Entering students should understand that they may be required to complete their APPEs at a location other than the San Francisco Bay Area.
APPE region map and overview
Through Introductory Pharmacy Practice Experiences (IPPEs), student pharmacists will be introduced to the fundamentals of pharmacy practice, in both community and health systems. Students will participate in a variety of pharmacy and patient care-related activities.
The purpose of IPPEs is to:
- Develop the foundational knowledge, skills, and attitudes for pharmacy practice
- Instill professionalism
- Expose students to the roles of the pharmacist and pharmacy practice settings
- Prepare students for Advanced Pharmacy Practice Rotations (APPEs)
The student will be able to:
- Demonstrate professional attitudes and behaviors.
- Demonstrate the ability to interact verbally and in writing with healthcare providers and patients by appropriately gathering, organizing, and recording information.
- Provide effective health and medication counseling to patients and their caregivers.
- Demonstrate the ability to work as a member of the interprofessional team.
- Accurately prepare, label, dispense and distribute medications to ensure patient centered care.
- Demonstrate appropriate use of drug information resources to assist in patient care.
- Educate patients about the importance of health, wellness, and disease prevention.
- Articulate the pharmacist’s role in medication safety and quality improvement activities (e.g., adverse drug reaction reporting, medication reconciliation).
- Describe the steps required to ensure compliance with accreditation, legal, regulatory, and safety requirements.
Goals for all required APPE rotations
- Become an effective professional in the assigned practice setting
- Take initiative and be responsible for learning and actively participate in a variety of activities related to patient care and/or operations of the practice site
- Apply knowledge and skills gained from previous courses to promote safe, effective, and rational therapeutics
- Enhance their skills in communication, problem solving, and critical analysis
Goals for all elective APPE rotations
- Become an effective member within the practice setting
- Take initiative and be responsible for learning and actively participate in a variety of activities within the practice setting
- Apply knowledge and skills gained from previous courses to the practice setting
- Enhance their skills in communication, problem solving, and critical analysis
Patient care process model
Recognizing the need for a consistent process in the delivery of patient care across the profession, the Joint Commission of Pharmacy Practitioners (JCPP) released the Pharmacists’ Patient Care Process. The process is applicable to any practice setting where pharmacists provide patient care and for any patient care service provided by pharmacists.
Using principles of evidence-based practice, pharmacists:
The pharmacist assures the collection of necessary subjective and objective information about the patient in order to understand the relevant medical/medication history and clinical status of the patient. Information may be gathered and verified from multiple sources, including existing patient records, the patient, and other health care professionals. This process includes collecting:
- A current medication list and medication use history for prescription and nonprescription medications, herbal products, and other dietary supplements.
- Relevant health data that may include medical history, health and wellness information, biometric test results, and physical assessment findings.
- Patient lifestyle habits, preferences and beliefs, health and functional goals, and socioeconomic factors that affect access to medications and other aspects of care.
The pharmacist assesses the information collected and analyzes the clinical effects of the patient’s therapy in the context of the patient’s overall health goals in order to identify and prioritize problems and achieve optimal care. This process includes assessing:
- Each medication for appropriateness, effectiveness, safety, and patient adherence.
- Health and functional status, risk factors, health data, cultural factors, health literacy, and access to medications or other aspects of care.
- Immunization status and the need for preventive care and other health care services, where appropriate.
The pharmacist develops an individualized patient-centered care plan in collaboration with other health care professionals and the patient or caregiver that is evidence-based and cost effective. This process includes establishing a care plan that:
- Addresses medication-related problems and optimizes medication therapy.
- Sets goals of therapy for achieving clinical outcomes in the context of the patient’s overall health care goals and access to care.
- Engages the patient through education, empowerment, and self-management.
- Supports care continuity, including follow-up and transitions of care as appropriate.
The pharmacist implements the care plan in collaboration with other health care professionals and the patient or caregiver. During the process of implementing the care plan, the pharmacist:
- Addresses medication- and health-related problems and engages in preventive care strategies, including vaccine administration.
- Initiates, modifies, discontinues, or administers medication therapy as authorized.
- Provides education and self-management training to the patient or caregiver.
- Contributes to coordination of care, including the referral or transition of the patient to another health care professional.
- Schedules follow-up care as needed to achieve goals of therapy.
Follow-up: monitor and evaluate
The pharmacist monitors and evaluates the effectiveness of the care plan and modifies the plan in collaboration with other health care professionals and the patient or caregiver as needed. This process includes the continuous monitoring and evaluation of:
- Medication appropriateness, effectiveness, and safety and patient adherence through available health data, biometric test results, and patient feedback.
- Clinical endpoints that contribute to the patient’s overall health.
- Outcomes of care including progress toward or the achievement of goals of therapy.