2. Marlene Gukert mgukert@ualberta.ca mgukert@ualberta.ca Experiential Education Program Faculty of Pharmacy and Pharmaceutical Sciences; UofA MARCH 2014

3.  Involves 7 learning outcomes  Following slides highlight these  Professional*  Communicator*  Care Provider*  Collaborator*  Advocate  Scholar*  Manager* * Assessments are on these 6 2

4.  Overarching across all activities  Professionalism  ethical behaviours  appropriate appearance  patient accountabilities  demonstrates initiative  Communicator  w ith patients, staff, other health care professionals  written; computer notes, assignments 3

5.  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

6.  Primary focus: assess students ability to gather information. Students should:  determine adherence, administration, patient goals, medical conditions  address effectiveness and safety: Do you think this medication is working for you?  develop a care plan, including DRPs and documentation 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

7.  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

8. 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

9. MEDICAL CONDITION AND/OR DRPs GOALS OF THERAPYALTERNATIVESRECOMMENDATIONS/ PLAN MONITORING PARAMETERS FOLLOW-UP 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.Non- adherence 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. 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)?  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 ACTIONS TAKEN  Appropriate/acceptable action has been taken (first year students will likely require assistance)  Monitoring plan present Includes:  safety  efficacy  frequency  duration (if appropriate)  which healthcare provider will follow-up (first year students will likely require assistance)  Follow-up plan present Includes:  who  how  when  includes outcome (if possible) 8

10.  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

11.  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

12.  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

13.  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

14.  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

15.  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

16.  ACTIVITY: complete the Quality Processes and Risk Management Section of the ISMP (Institute for Safe Medication Practices) Medication Safety Self- Assessment for Community/Ambulatory Pharmacy.  DISCUSSION ACTIVITY: Discuss entire self- assessment (characteristics 166-198 with preceptor. - Following the discussion choose 5 characteristics from the assessment to include in Medication Assignment (portfolio) 15