Transcript Pharm 305 Preceptor Course Review April 2013

Marlene Gukert [email protected]
Experiential Education Program
Faculty of Pharmacy and
Pharmaceutical Sciences; UofA
MARCH 2014
 Involves
7 learning outcomes
 Following slides highlight these







Professional*
Communicator*
Care Provider*
Collaborator*
Advocate
Scholar*
Manager*
* Assessments are on these 6
2
 Overarching across all activities
 Professionalism




ethical behaviours
appropriate appearance
patient accountabilities
demonstrates initiative
 Communicator
 with patients, staff, other health care professionals

written; computer notes, assignments
3

Patient Medication History: primary placement activity
 Minimum of 3; one prior to midpoint - for feedback & assessment
 Assist with patient recruitment – at least first
 Preceptor should directly observe first session at beginning of
placement & provide feedback.
 Dermatology; only therapeutic module completed
 Following the session; student should develop patient
assessment & review with preceptor (prior to giving patient
advice unless it is very obvious (ie change to snap caps from
safety caps)
 Resources in manual
 Medication Review Tool, Blank care plan worksheets
 Student completes Medication Record in a MedRec pamphlet;
consider as a BPMH. Vaccination/other medical information can
also be added to the record.
 Document finding on patient profile – brief and for continuity
4

Primary focus: assess students ability to gather
information. Students should:


determine adherence, administration, patient goals, medical
conditions
address effectiveness and safety:


develop a care plan, including DRPs and documentation




Do you think this medication is working for you?
likely need preceptor support beyond assessment
Focus is on determination of DRPSs related to above , medical conditions and
patient goals
Other columns are beyond their abilities…but they can try!
write up as many care plan worksheets as needed for
practice


preceptor review helpful
document care onto computer profile - note form i.e. DAP
5
Rx Counseling of Topical Prescriptions
 all types of topicals: role play if needed
 OTC Counseling of OTC Dermatological
Preparations – role play if needed


Pharmacy Care Plan worksheet
 use for all 3 care provider activities
 to develop systematic process skills
6
Part One : Post 1 care plan (not marked by Faculty)
Part Two:
1. Include ONE DRP statement
a. state why you chose this DRP.
2. Include ONE patient goal
a. was this a realistic goal?
b. were you able to achieve this goal?
c. What was the patient’s stage of change for this goal?
3. What aspect of the patient care process do you think you
need to focus on next year as a result of your patient
interactions & why?
4. What area of care plan development did you find the most
challenging & why. i.e determination of DRPs, alternatives,
follow- up etc
Posted on eClass at end of placement; portfolio component
7
MEDICAL CONDITION AND/OR
DRPs
GOALS OF THERAPY
For each medical condition and/or DRP
identified, create an integrated pharmacy
care plan. List and prioritize each
medical condition first, followed by any
DRPs identified for a given condition.
Although some medical conditions may
not have a DRP, a care plan is still
necessary for ongoing patient
monitoring.
DRP Categories: Indication: 1.
Unnecessary drug therapy, 2. additional
drug required, Effectiveness: 3.
ineffective drug, 4. Dose too low, Safety:
5. adverse drug reaction/interactions, 6.
dose too high, Compliance: 7.Nonadherence
For each medical condition and/or
DRP state desired goals of therapy.
Goals: cure, prevent, slow/stop
progression, reduce/eliminate
symptoms, normalize a lab value.
(Consider realistic goals determined
through patient discussion. Goals of
therapy are measurable or
observable parameters that are used
to evaluate the efficacy and safety of
therapy).
Compare relevant drug and non-drug
therapies that will produce desired
goals. List the pros and cons of each
therapy.
(Consider indication, efficacy, safety,
adherence and cost/coverage).
In collaboration with the patient and
other providers, select the best
alternative and implement the plan.
Provide a rationale for the chosen plan.
Consider:
Drugs: consider drug, formulation,
route, dose, frequency, schedule,
duration, medication management.
Non-drug: non-drug measures,
education, patient referral.
Determine the parameters
for monitoring efficacy and
safety for each therapy.
(Consider clinical and
laboratory parameters, the
degree of change and the
time frame).
Determine who, how and
when follow-up will occur.
 Therapeutic goal/outcome(s)
stated?
 Patient goal incorporated (if
appropriate)
 Is an assessment of each DRP
provided (factors considered to
influence/determine a plan)?
 Are alternatives (with rationale for
each) provided that would be
considered acceptable for a first year
students? (first year students will likely
require assistance)
 Plan/recommendations are outlined
Includes:
 dosing considerations
 patient preferences
 Monitoring plan present
 Follow-up plan present
Includes:
 safety
 efficacy
 frequency
 duration (if appropriate)
 which healthcare
provider will follow-up
(first year students will likely
require assistance)
Includes:
 who
 how
 when
ASSESSMENT CHECKLIST
 Are all DRPs identified (based on 4
prime areas of indication, efficacy,
safety, medication
organization/adherence)? If no,
discuss with student and probe to see if
those missing can be determined.
 Is there an attempt to prioritize DRPs
in an acceptable manner for a first year
student?
 Is rationale provided or discussed for
DRPs (based on either patient or
provider data)?
ALTERNATIVES
RECOMMENDATIONS/
PLAN
MONITORING
PARAMETERS
ACTIONS TAKEN
 Appropriate/acceptable action has
been taken
(first year students will likely require
assistance)
8
FOLLOW-UP
 includes outcome (if
possible)

Introducing concept of inter-professional practice early

Discussions with techs, etc about role & scope of practice

Complete a self assessment that builds on the IP self
assessments they were doing in Pharm 300

ACTIVITY: Identify healthcare practices in the community that
are available to patients i.e. dialysis clinics, physiotherapists,
chiropractors, acupuncturists, well baby clinics, diabetic
educators, dieticians, etc.
 either visit or phone the practice to see if they would be
able to have a 10-15 min visit/phone call regarding
healthcare professional collaboration.
9
 Use the Guide to Inter-professional Shadowing card
(green card) for planning & activity
 card is perforated to give to HCP
 provides goals of the interaction and suggested discussion
points. Such as:
 what is the professional’s role and scope of practice?
 What are their professional concerns?
 How does that professional communicate with other
health care professionals?
 Do they collaborate with other healthcare professionals?
 Do they experience any challenges or barriers to
collaboration?
 Discuss their findings with you and complete IP
Reflective Assignment (Portfolio)
10
 ACTIVITY
Prepare or participate in a health promotion
initiative at the pharmacy OR in the community
 Examples include:




creating a display about sun safety or first aid
having a diabetes or blood pressure screening day at
the pharmacy
giving a presentation to a seniors group or a school
11

Students should be completing all drug information
questions

Drug Information form in manual

ACTIVITY:

Provide preceptors with an overview of the library
resources and a minimum of one example of a search
strategy for the selected UofA Library Database(s) now
accessible to preceptors.
12
 Dispensing

activities
completeness of prescriptions and profiles
 Not
formally assessed on dispensing proficiency
and compounding

feedback helpful
 Expected
to understand medication safety
processes

discussions with pharmacy team
13
 ACTIVITY:

Complete the Patient Information section of the Institute for
Safe Medication Practices (ISMP) Self-Assessment for
Community/Ambulatory Pharmacy
 DISCUSSION ACTIVITY:

Discuss findings from the Patient Information Self-
Assessment with preceptor.


purpose is to have a positive discussion regarding the
requirements of practice as well as some of the challenges in
getting and maintaining patient information
not to determine aspects of practice that need to be “fixed.”
14
 ACTIVITY:
complete the Quality Processes and
Risk Management Section of the ISMP (Institute for
Safe Medication Practices) Medication Safety SelfAssessment for Community/Ambulatory Pharmacy.
 DISCUSSION ACTIVITY:
Discuss entire selfassessment (characteristics 166-198 with
preceptor.
- Following the discussion choose 5 characteristics
from the assessment to include in Medication
Assignment (portfolio)
15