COURSE TITLE: REQUIRED/ELECTIVE: Hospital APPE PHAR 981 Required Session Description The Hospital Pharmacy APPE is a minimum of six weeks (240 hours) of experiential training required for all entry-level PharmD candidates. The student is supervised and evaluated by practicing hospital pharmacists who hold faculty appointments in the College of Pharmacy. The overall goals of this externship are to provide the student with a general understanding and appreciation of institutional practice. Specific objectives include but are not limited to the following: Session Goals: A. To provide the pharmacy student with experience in hospital pharmacy practice. B. To assist the pharmacy student in understanding and relating hospital pharmacy practice to the total concept of the hospital health care delivery system. C. To provide the pharmacy student with appropriate knowledge and understanding of the hospital and the administrative operation of its pharmacy department. D. To provide the pharmacy student with appropriate knowledge and understanding of all aspects of drug-use control in the hospital and the responsibilities of the pharmacist in providing optimum pharmaceutical services for patients. E. To provide the pharmacy student with appropriate knowledge and understanding of the requirements, procedures and techniques related to aseptic compounding and parenteral admixture services. F. To provide the pharmacy student with appropriate knowledge and understanding of the responsibilities of the pharmacist in providing drug information and clinical pharmacy services to patients and health professionals. G. To provide the pharmacy student with experience in the preparation and organization of special projects relevant to the practice of hospital pharmacy.
2 H. To provide the pharmacy student with appropriate knowledge and understanding of the responsibilities and utilization of supportive personnel. I. To assist the pharmacy student in the development of appropriate communications skills, interpersonal relations and a professional attitude. J. To provide the pharmacy student with appropriate knowledge and understanding of the laws, regulations and standards relevant to hospital pharmacy practice. K. To identify, list, discuss or compare the indications, uses, manufacturers, brand name, generic name, dosage forms dosing regimen, contraindications, interactions, special instructions, storage requirement, and legal classification of all drugs assigned and routinely dispensed in hospital pharmacy practice. Student s Responsibilities: A. The student is required to be a registered pharmacy intern in the State of Idaho and other state licensing requirements where applicable. B. The student should exhibit professional appearance both in manner and dress and should adhere to the standards of dress and behavior specified by the practice site. The student should be well groomed and dress in a professional manner including shirt and tie, laboratory jacket, and an identification badge. C. Hospital pharmacy policies and procedures are specific to each individual institution as contained in the Hospital Pharmacy Policy and Procedure Manual and will be explained to each student during the orientation program at the hospital. The student must abide by these policies and procedures at all times. D. Any information about a hospital and/or a hospital pharmacy's operation must be considered confidential and is not to be discussed with other students or with anyone other than the instructors and the faculty members in charge of the educational program. E. Any information about a patient's illness or medication is confidential and is not to be discussed with anyone other than the instructor, other pharmacists on duty, and when in the patient's best interest, with health professionals providing care to that patient. F. The student is required to perform assignments and functions normally performed by pharmacists, and will actively participate in those activities
3 which represent learning experiences. It may be necessary at times to devote more than scheduled time while participating in these activities. G. The student must commit to an active learning process. Learning, especially in the practice setting, requires initiative, enthusiasm, and active participation on behalf of the student. H. The student should never hesitate to admit lack of knowledge in an area, and should seek assistance from appropriate individuals. I. The student should never question the advice or directions of the instructor in public, in front of other students or members of the staff. Disagreements must be discussed in private. J. Evaluation and criticism of the student by the instructor should be viewed as a means of learning and not as personal embarrassment. K. The student should not perform dispensing functions, make professional decisions, or communicate with patients and/or health professionals without first checking with an instructor. L. Attendance at the hospital during the institutional session is mandatory. The student must notify in advance an instructor at the hospital if tardiness or an absence is anticipated. The instructor will attempt to arrange for the time to be made up. The student having unexcused absences will be subject to appropriate action by the College of Pharmacy. M. The student must not receive financial compensation for participating in the Hospital Pharmacy APPE, serve in a site of previous employment, or with a preceptor with whom he or she is related. Institution s Responsibilities: A. The hospital must be accredited by the Joint Commission on Accreditation of Health Care Organizations and meets standards set forth by all governmental agencies including the State Board of Pharmacy, Drug Enforcement Agency, and the Food and Drug Administration. B. The institution and/or any of its staff must be free of any violations of state and/or federal law. C. The hospital pharmacy should have an adequate professional library. D. The hospital pharmacy should provide comprehensive pharmacy services which include unit dose drug distribution, a parenteral admixture service and the provision of drug information to patients and health professionals.
4 E. The hospital pharmacy should be clean, organized, and reflect a professional environment. F. The hospital pharmacy should have a written policy and procedure manual. G. The hospital pharmacy should adhere to the ASHP Guideline "Minimum Standard for Pharmacies in Institutions" and the ASHP Statement on "Clinical Pharmacy and Its Relationship to the Institution". H. The hospital and its pharmacy should philosophically support the APPE program and should have the ability to carry out the educational responsibilities in conjunction with the Idaho State University College of Pharmacy. I. Patient data are readily accessible for providing pharmaceutical care to patients. J. Sufficient opportunity and time for interaction with patients and preceptors is provided. K. An environment which fosters and promotes direct interactions with other health care professionals (e.g., physicians, nurses, dentists, dietitians, etc.) must be available. L. The institution demonstrates a strong commitment and support for the provision of pharmaceutical care. Preceptor s Responsibilities: A. At least one instructor at the site should be certified as a preceptor with the Idaho Board of Pharmacy. B. The instructor should be actively engaged in practice and should provide and promote optimal pharmaceutical care services. C. The instructor should be willing to accept the responsibility for the guidance and training of the student and be able to devote adequate time to this activity. D. The instructor should be willing to meet at regular intervals with faculty members responsible for the educational program in order to discuss the current status of the program and ways to improve it.
5 E. The instructor should belong to local, state, and national professional organizations and should participate regularly in continuing education programs. F. The instructor should attempt to instill the principles of professional ethics in the student through actions as well as words. G. The relationship between the instructor and the student should be one of teacher-student, rather than employer-employee. H. The instructor should explain in detail what is expected of the student as it relates to appearance, attitude, hospital/hospital pharmacy policy, the objectives of the practice experience and how they will be accomplished. I. The instructor should meet at regular intervals, usually at least once per week, with the student to discuss any questions the student may have and to provide an on-going evaluation of the student's performance. J. The instructor's evaluations of the student should be in private, whenever possible, and criticism should be constructive and sympathetic. K. The instructor should never hesitate to admit that he or she does not know the answer to a student s question, and should seek assistance when appropriate.
6 A. Session Requirements GENERAL INFORMATION The student is required to successfully complete the following as they relate to the Hospital Practice APPE 1. A minimum of 240 on-site hours in the six week session; 2. Attendance at all scheduled hours and shifts, staff meetings, preceptor-student conferences and other functions pertaining to the session; 3. Adherence to the internship practice rules and regulations of the Idaho Board of Pharmacy Laws and Idaho Code; 4. The understanding and performance of the duties and course objectives with minimal supervision at an acceptable and satisfactory level of competence judged by the preceptor and APPE coordinator to be necessary for professional practice; 5. Completion of the APPE evaluation and the return of it along with the required evaluation from the preceptor to the College of Pharmacy APPE Coordinator; and 6. The student will receive a letter grade for the course. B. Orientation The orientation at the hospital should include the following: General Orientation to Hospital - an overview of the hospital and its services, a tour of the facilities to include such things as a visit to a nursing unit, the hospital library, cafeteria, etc.; General Orientation to Pharmacy Department - tour and overview of pharmacy, an orientation to hospital and hospital pharmacy policies and procedures; Review of Session Objectives and Expectations - discussion of student schedule, how the objectives are to be accomplished, expectations of students, evaluation and grading, project assignments, homework, etc.; Orientation to Actual On-the-Job Experience - specific on-the-job training in order to function effectively in the pharmacy;
7 Special Assistance/Questions - time to be allotted to provide the student with any special assistance required and/or to answer questions the student may have; and Directions and Expectations for the initial few days should be reviewed. C. Institutional Areas of Instruction and Checklist Each student upon completion of the institutional session should have received orientation, instruction and experience in, but not limited to, the following areas of institutional pharmacy practice: 1. Administration and Management of a Hospital Pharmacy 2. Inpatient Drug-Use Control 3. Parenteral Admixture Service 4. Drug Information and Patient-Oriented Services The objectives for each of these areas are outlined in this syllabus. In addition, a checklist has been developed to assist both student and instructor in determining the current status and completion of each objective. Objectives can be accomplished in a number of different ways; by discussion, observation, performance or assignment. The student and preceptor(s) are urged to periodically review the status of each objective and to plan for the completion of all objectives upon completion of the institutional session. Emphasis should be placed on the areas of drug-use control and parenteral admixture services; however, the student's previous experience should be taken into consideration.
8 HOSPITAL PHARMACY APPE OBJECTIVES The student and preceptor should periodically review progress of the session through use of the following checklist. Since each institution may vary in its operations, not all activities may be applicable. I. Administration The pharmacy student should receive orientation, instruction and experience in, but not limited to, the following specific areas and activities: Objectives: 1. Organization of hospital including: Organizational structure, types of patients, relationship of pharmacy director to hospital administration, and relationship of pharmacy to other hospital departments. 2. Organization of pharmacy department including: General organization and staffing, services provided to inpatients, outpatients, employees, responsibilities of administrative/supervisory personnel, pharmacists, technicians, etc. 3. Administration and professional policies including: Confidentiality of patient information, tardiness/absenteeism policies, evaluation, promotion, and termination policies, training and evaluation of technicians, staff scheduling, medical sales representative/sampling polices. 4. Policy and procedure manual including: Purpose, organization, content, development, revisions, and distribution. 5. Pharmacy membership on hospital committees including: P&T Committee, Quality Assurance/Utilization Review, Infection Control, and other patient care committee representation. 6. Interdepartmental communications and activities 7. Intradepartmental communications including: Staff meetings, inservice, and other mechanisms. 8. Local, state, and federal laws, regulations, and standards of practice including: Purchase, storage, dispensing, and administrative records for controlled substances; purchase, storage, and records for tax-free alcohol use; packaging/re-packaging of unit-of-use medications, etc; investigational drug use procedures and policies; legal aspects of technicians; JCAHO standards of practice. 9. Drug procurement and inventory control including: Purchasing, formulary system, drug pricing policies, drug recalls, inventory control and reordering policies, storage of hazardous pharmaceuticals. 10. Hospital library and pharmacy drug information resources including: Location, policies regarding use, and drug information resources. 11. Safety practices including: Handling of toxic, caustic or flammable chemicals; operation of special equipment, glass and needle disposal, cleaning and housekeeping. 12. Quality assurance including: Philosophy and goals, description of programs, evaluation, development, and resources available.
9 II. Inpatient Drug-Use Control The pharmacy student should receive orientation, instruction and experience in, but not limited to, the following specific areas and activities: Objectives: 1. Inpatient pharmacy policies and procedures including: Dress code, breaks/lunch, pharmacist & technician responsibilities, double check dispensing procedures, automatic stop orders, short-list, etc. 2. Twenty-four hour service/after hour coverage including: Staffing, coverage, on-call responsibilities, etc. 3. Formulary system or equivalent including: Description, use, non-formulary policies, special order drugs, and revisions. 4. Patient care unit including: Nursing station organization, medication storage, controlled substances, patient charts, physician orders, medication administration records, pharmacy inspection procedures. 5. Medication order cycle: Initiation of medication order, nursing and ward clerk responsibilities, technician and pharmacist responsibilities. 6. Drug distribution and control including: Unit dose, floor stock orders, stat orders, PRN orders, new orders, first dose orders, controlled substances, code and emergency medication responsibilities, medication cart filling, checking, delivery, dispensing records, computerized order entry and record keeping systems. 7. Review and interpretation of medication order including: Drug identification, generic and/or trade name, correct dose, frequency, administration, and precautions. 8. Preparation and verification of medication label including: Trade and/or generic name, dosage form, strength, expiration date, auxiliary labels, control number, patient name/location, etc. 9. Preparation of medication for dispensing including: Oral solids and liquids, topicals, injectables, extemporaneous compounding, calculations, weighing, measurements, etc. 10. Understanding of medication dispensed and medication profile review including: Pharmacologic action and use, major adverse effects, contraindications, drug interactions, and monitoring parameters. 11. Medication administration including: Individual responsible for administration, method of recording doses, doses not administered, medication error reports, medication brought to hospital, selfadministration policies, etc. 12. Patient charges including: Medication charges, credits, returns to stock, floor stock items, etc. 13. Packaging including: Extent and type, equipment, control records, labeling, expiration dating, etc. 14. Utilization of technicians including: Training, evaluation, supervision, and legal aspects. 15. Discharge medication including: Policies and procedures, labeling, and patient education.
10 III. Parenteral Admixture Service The pharmacy student should receive orientation, instruction and experience in, but not limited to, the following specific areas and activities: Objectives: 1. Laminar flow hood including: Function and operation, proper working technique, cleaning, and inspection 2. Methods to minimize microbial and particulate contamination including: Proper skin washing, clothing/hair policies, proper aseptic technique, particulate matter inspection, and filtration devices or practices (i.e. ampules). 3. Parenteral admixture service policies and procedures including: Initiation of IV orders, functions of responsible personnel, stat orders, delivery, charges, returns, etc. 4. Review and interpretation of intravenous admixture order including: Primary solution; total volume; name, strength, and quantity of additives; method and rate of administration. 5. Preparation and verification of label including: Correct bottle number, accurate identification of all ingredients, preparation date, expiration date, accurate infusion rate and administration time, and auxiliary labels. 6. Preparation of intravenous admixtures including: Preparation of primary solution with additives, intermittent solutions (ie IVPB), and parenteral admixtures. 7. Aseptic technique including: Proper technique for withdrawing and transferring contents of ampules and vials using appropriate sterile techniques. 8. Calculations including: Ability to calculate milliequivalents, millimoles, osmolarity, ratio and proportions, percentages, and administration rates. 9. Understanding of intravenous admixture compounding including: Therapeutic use of all ingredients, method of administration, physical/chemical incompatibilities, and stability of extemporaneous admixtures. 10. Administration including: Personnel responsible for administering IVs, administration record keeping, use of filters, infusion pumps and controllers, keep open policies, etc. 11. Parenteral nutrition including: Indications for use, central vs peripheral administration issues, nutrients, additives, trace elements, fat emulsion, preparation, storage, complications, and monitoring parameters. 12. Quality control including: Philosophy and goals, description of bacterial surveillance measures, and particulate matter procedures.
11 IV. Drug Information and Pharmaceutical Care Services The pharmacy student should receive orientation, instruction and experience in, but not limited to, the following specific areas and activities: Objectives: 1. Organization and philosophy of providing patient-oriented services including: Organization and philosophy of patient-oriented services, departmental goals and description of pharmaceutical care services. 2. Departmental capabilities and limitations including: Qualifications and training of pharmacists, barriers to clinical services, types of services provided, and financial justification of services provided. 3. Procedures for answering drug information requests including: Types of questions, documentation procedures, and pharmacist responsibilities. 4. Poison and drug information sources including: Available resources both internal and external to the institution. 5. Newsletter including: Content, responsibility for preparation, frequency, circulation, and benefits. 6. Adverse drug reaction reporting including: Responsibility and system for reporting. 7. Patient education services including: Pharmacist responsibilities, specific programs provided, and 8. Drug use evaluation programs including: Philosophy, departmental goals, pharmacist responsibilities, development, implementation, JCAHO requirements, P&T Committee and medical staff reports. 9. Staff development programs including: Departmental goals, program description, and objectives. V. Project (optional) Depending upon available time, student interest, and institutional needs, each student may be assigned a project during the first part of the institutional session. The project should be relevant to hospital pharmacy practice and must be completed prior to the end of the institutional externship session. Time spent in preparation should be in addition to the regularly scheduled hours. The individual format and requirements for the project should be clearly defined and communicated to the student.