1. No category

Pharmacy 201W
SPE Manual
2013 – 2014
If you have questions regarding the SPE Program, please contact:
Ms. Wanda Spurrell
Room 3442, School of Pharmacy
Memorial University of Newfoundland
Phone: 709-777-6498 Fax: 709-777-7044 e-mail: [email protected]
Table of Contents
Acknowledgments
Introduction .............................................................................................................................. i - xi
Educational Outcomes ........................................................................................................ i
Pharmacy 201W: Learning Objectives ......................................................................... ii - iii
General Performance Guidelines for the Student ........................................................ iv - v
Addressing Student/Preceptor Concerns............................................................................ vi
SPE Checklist............................................................................................................ vii - viii
Activities & Questions and Evaluation ............................................................................. ix
Activity and Question Checklist ................................................................................. x - xii
Section 1: Provide Patient Care .............................................................................................. 1 - 4
Objectives ............................................................................................................................1
Readings and References ....................................................................................................1
Tools and Forms ..................................................................................................................1
Activities ........................................................................................................................ 1 - 4
Section 2: Accept Professional Responsibilities ................................................................... 5 - 22
Objectives ............................................................................................................................5
Readings and References ....................................................................................................5
Activities & Questions ................................................................................................. 5 - 22
Section 3: Use Management Skills in Practice ................................................................... 23 - 30
Objectives ..........................................................................................................................23
Readings and References .......................................................................................... 23 - 24
Activities & Questions ............................................................................................... 24 - 30
Appendix:
Nomenclature - NIDPF Medications
Evaluation Forms - Separate Enclosure
Acknowledgments
The Structured Practice Experience (SPE) program is an integral component of the course of
study leading to the Bachelor of Science in Pharmacy degree at Memorial University of
Newfoundland. The program is coordinated and administered by the School of Pharmacy.
Since time spent in the SPE is eligible and contributes towards meeting the practice experience
requirements for licensing with the Newfoundland & Labrador Pharmacy Board (NLPB), the
program has been planned and developed with input from the NLPB through the Joint
Committee on Structured Practice Experience.
We would also like to acknowledge the following individuals and/or groups for sharing material
for this SPE manual:
The College of Pharmacy, Dalhousie University
We appreciate the support of all the dedicated pharmacists who volunteer their time and share
their knowledge and experiences by serving as preceptors in the program.
The policies, procedures, evaluation tools and other materials in this manual continue to develop
and evolve. We thank both the preceptors and students for their constructive feedback and invite
you to continue to offer your comments and suggestions for improvement.
We hope that participation in the practice experience program is rewarding and enjoyable for all.
Introduction
Educational Outcomes
The Association of Faculties of Pharmacy of Canada (AFPC) has developed educational
outcomes for pharmacy graduates in Canada. These outcomes have been adopted by the School
of Pharmacy and guide the curriculum and experiential learning program. Students are expected
to demonstrate specific knowledge, skills and behaviours from the following key areas with the
goal of becoming Medication Therapy experts:
1. Care Provider: Graduates use their knowledge, skills and professional judgement to provide
pharmaceutical care and to facilitate management of patient’s medication and overall health
needs.
2. Communicator: Graduates communicate with diverse audiences, using strategies that take
into account the situation, intended outcomes of the communication and the target audience.
3. Collaborator: Graduates work collaboratively with teams to provide effective, quality health
care and to fulfill their professional obligations to the community and society.
4. Manager: Graduates use management skills in their daily practice to optimize the care of
patients, to ensure the safe and effective distribution of medications, and to make efficient
use of health resources.
5. Advocate: Graduates use their expertise and influence to advance the health and well-being
of individual patients, communities, and populations, and to support pharmacist’s professional roles.
6. Scholar: Graduates have and can apply the core knowledge and skills required to be a
medication therapy expert, and are able to master, generate, interpret and disseminate
pharmaceutical and pharmacy practice knowledge.
7. Professional: Graduates honour their roles as self-regulated professionals through both
individual patient care and fulfillment of their professional obligations to the profession, the
community and society at large.
These outcomes have been used to develop the various activities in the SPE program and the
evaluation tools used to assess students’ performance.
http://www.afpc.info/downloads/1/AFPC_Education_Outcomes_AGM_June_2010.pdf
i
Pharmacy 201W
Pharmacy 201W is an introductory practice experience after the first year of the pharmacy
program. It consists of a 4-week placement in a community pharmacy under the supervision of a
pharmacist preceptor. For many students, this represents their first working experience in a
pharmacy. It is intended to introduce the student to drug distribution and patient care activities
in the pharmacy including the regulatory framework and professional responsibilities
surrounding these aspects of pharmacy practice. During the SPE students will complete
assignments and take part in activities which will enable them to meet the learning objectives of
the program.
The 201W manual is organized into sections, each containing specific assignments to assist the
preceptor in helping the student develop knowledge and skills in the key competency areas;
and to enable the preceptor to assess the student’s level of proficiency and competency in each
area.
The table on the following page further defines the competency categories by providing a
brief description of the components that make up each one, based on the expected learning
outcomes for a first year student.
Some activities in the manual are linked to just one learning outcome, while other activities may
be associated with several outcomes. For example, a student counseling a patient may
demonstrate elements of the communicator, scholar and professional educational outcomes.
ii
Pharmacy 201W Learning Goals
Competency
Area
Care Provider
Communicator
Collaborator
Manager
Advocate
Scholar
Professional
Competency Elements
• Develops professional, caring relationships with patients and/or caregivers
• Accurately and completely gathers patient information
• Documents information in a timely, professional manner, in accordance with
existing policies
• Recognizes simple drug-related problems
• Effectively communicates non-verbally and verbally with others
• Communicates effectively in writing
• Functions as a member of a team
• Manages his/her time and recognizes the importance of efficiency in the
workplace
• Participates in the safe and efficient distribution of medications
• Incorporates the use of technology, where applicable
• Follows procedures/checks to ensure safety and quality of services provided
• Supports the role of pharmacists in the health care system
• Demonstrates understanding of core knowledge covered thus far and is able
to apply this knowledge in daily practice
• Educates regarding medications and their appropriate use (selected
drugs/devices)
• Demonstrates professionalism throughout patient encounters
• Practices in an ethical manner and assures primary accountability to the
patient
• Seeks/ accepts feedback to identify limitations or strengths in own
performance
• Demonstrates professional accountability (e.g., complies with legal
requirements of practice; fulfills professional standards of practice; fulfills
commitments in a reliable manner; maintains a professional image; maintains
appropriate boundaries)
iii
General Performance Guidelines for the Student
The primary objective of the practice experience program is to learn from experience. Students
are expected to actively participate in pharmacy practice during the rotation.
The student, not the preceptor, is responsible for his/her own learning. Preceptors volunteer
their time to teach students. The preceptor’s first duty is to his/her patients and work site.
Students must respect this.
The student is expected to take the initiative and:
•
•
•
•
•
establish with the preceptor, a schedule and time line for completing activities.
complete the required activities in the manual.
seek ways to apply his/her knowledge to practice situations.
seek regular consultation with the preceptor to obtain feedback on performance and
advice concerning areas in need of development.
accept and act upon constructive criticism.
In order to maximize the learning experience, the student should indicate to the preceptor any
areas in which s/he has had previous experience and also areas in which s/he may need particular
help.
A minimum time requirement of 35 hours per calendar week is mandatory during the SPE.
Students are expected to be punctual and present at the site according to the schedule arranged
with the preceptor. Students may not leave the practice site during scheduled hours without
permission from the preceptor.
Absences are permitted only in the case of legitimate illness, bereavement or family emergency.
Any student who must be absent during the SPE is required to notify both the preceptor and
the SPE Coordinator as soon as it is determined that (s)he is not able to attend. A note from a
health professional (as per Memorial University Regulations 2013/14, Sections 5.14.4 and
5.14.6; http://www.mun.ca/regoff/calendar/sectionNo=REGS-0859) or other appropriate
written documentation must be supplied to the SPE Program Coordinator for all absences.
Preceptors are requested to note any absences on the student evaluation forms. Missed time is
expected to be made up.
Students must exhibit a professional appearance, both in manner and dress, and must follow the
standards of the pharmacy to which they are assigned.
Each student must wear a name tag indicating his/her full name and the title “Pharmacy Student.” A laboratory/dispensing jacket is also required, unless otherwise directed by the
preceptor.
Students are expected to adhere to the following guidelines for conduct:
•
Students are expected to behave with mutual respect and courtesy toward all pharmacy
staff, patients and their families, and other health professionals.
iv
•
•
•
•
When interacting with patients, students must clearly identify themselves as
pharmacy students. Professional decisions or judgments should not be made by the
student without the advice or approval of a pharmacist.
Students must respect any and all confidences revealed during the SPE including
patient data/health conditions, pharmacy records, professional policies, financial
information or anything else of a confidential nature.
The advice, direction or criticism of the preceptor, or other pharmacists should not be
questioned in public (especially in the presence of patients or other health professionals)
but is best discussed in private.
Students are expected to be attentive to the laws and regulations which govern pharmacy
practice and seek clarification from their preceptor when necessary.
Students and preceptors are referred to the SPE Program Policy Handbook
http://www.mun.ca/pharmacy/practice/SPE_Policy_Handbook_2013.pdf for complete
information about the SPE Program structure, administration and policies.
v
Addressing Student/ Preceptor Concerns
It is important for students to discuss any concerns they have about their SPE with the preceptor
or the SPE Program Coordinator at the time of the concern. Little or nothing can be done if the
student waits until the end of a rotation to bring up a problem.
The following approach is suggested as the best way to handle troublesome situations that may
arise during the SPE program:
•
•
•
•
•
Address the issue promptly; do not wait too long, hoping that the problem will disappear.
Bring the concern to the attention of the other person directly and attempt to resolve the
issue together.
Be as specific as possible when identifying a problem; always listen carefully and
thoughtfully to the other person.
Focus on the situation, not the person.
Serious or unresolved difficulties should be brought to the attention of the SPE
Coordinator.
Students with concerns should only share these with the individual involved, the preceptor,
or the SPE Program Coordinator, not with any other students, pharmacy staff, other
preceptors, etc.
vi
SPE Checklist
This checklist should be referred to at the beginning and throughout the SPE program by the
student and preceptor in order to ensure that the necessary items are covered. Check (√) as the
task is completed.
Before Starting the SPE
(√)
Student is registered as a Pharmacy Student with the appropriate provincial licensing body
Student has provided preceptor with letter of introduction
First Day
(√)
Student is introduced to pharmacy staff members, with a discussion of their duties and responsibilities
Student is given a tour of the pharmacy which includes location of important areas, including the
following:
• Arrangement of pharmaceuticals in dispensary
• Dispensing equipment and supplies
• Pharmacy library/Reference materials
• Washroom/Lunch room/Coat storage
Preceptor discusses with student policies and procedures for:
• Dress code
• Daily schedule, including breaks, lunch, etc.
• Telephone procedures (e.g., how to answer the phone, pharmacy phone #, fax #)
• Security within the pharmacy
• Confidentiality
• Internet access
• Customer check-out
• Any other pertinent topics
Student and preceptor review goals for the SPE program & establish a schedule for completing activities
During SPE
(√)
Preceptor provides immediate and specific feedback to student, as required
Student completes/discusses with the preceptor activities & questions in the manual
Student and preceptor complete documentation for activities & questions
Preceptor completes Preceptor’s Evaluation of Student (Midpoint) by end of Week 2
Student and preceptor discuss student’s performance at midpoint
vii
End of SPE
(√)
Student completes required documentation and returns to SPE Coordinator
• Activity & Question Checklist (completed and signed by both student and preceptor)
• Patient Counseling Self-Assessment
• Student’s Evaluation of the Preceptor & Site
• Student’s Evaluation of the SPE Program (online, link to be emailed to students)
Preceptor completes required documentation and returns to SPE Coordinator
• Preceptor’s Evaluation of the Student (Final) + Certification of Supervised SPE
• Counseling evaluations
• Preceptor’s Evaluation of the SPE Program
Student and preceptor discuss student’s performance
viii
Activities & Questions
and Evaluation
The manual contains a number of activities and questions which must be completed successfully
by the end of the SPE.
The ‘Activities’ are provided to give the student an opportunity to learn about and gain experience relating to the educational outcomes. They are intended to stimulate discussion
between the student and preceptor. The preceptor and student may also have additional ideas for
useful activities to maximize the student’s practice experience. The ‘Questions’ must be completed by the student, the answers reviewed by the preceptor,
and then discussed with the student. Students’ answers to questions are not to be returned to the
School for grading.
An Activity and Question Checklist follows on the next page. It is to be used as a guide and
monitor to ensure that all required activities and questions are completed. It should be consulted
regularly and items checked off as they are done. The filled-out Activity & Question Checklist
is required to be returned to the School at the end of the 4-week SPE.
SPE rotations are academic courses and must be successfully completed in order to enter
the next year of pharmacy study and to graduate from the School of Pharmacy.
Overall evaluation of the SPE will result in the assignment of one of the following letter grades:
PWD (pass with distinction), PAS (Pass) or FAL (Fail).
A passing grade is contingent upon:
• performance at the Expected Level (or beyond) in the required competency areas as per
the Preceptor’s Evaluation of Student form
• satisfactory attendance
• proper completion of activities and questions, as determined by preceptor’s evaluation and submission of materials to the School, as required.
ix
Activity and Question Checklist
Activity
or
Question
Timeline
for Completion
Description
(e.g., Week 1, 2, 3 or 4)
Completed Date
& Student’s Initials
Section 1: Provide Patient Care
A1.1
Review telephone answering procedures;
answer telephone
A1.2
Observe staff greeting patients, receiving Rx’s & gathering patient information; review
patient information requirements for new
patients/patients on file; note documentation
of allergies and conditions
A1.3
Greet patients, receive Rx’s & gather patient
information
A1.4
Practice assessing drug orders
A1.5
Review PMP during Rx filling process
A1.6
Discuss compliance aids
A1.7
Counsel patients; conduct self-assessment &
seek feedback
A1.8
Discuss scenarios: interpersonal
communication
Section 2: Accept Professional Responsibilities
A2.1
Discuss privacy & confidentiality
A2.2
Discuss process for delivery of Rx’s
A2.3
Respond to ethical/legal scenarios
A2.4
Complete professional organizations activity
x
Reviewed with Preceptor
Preceptor’s Initials
Activity
or
Question
Timeline
for Completion
Description
(e.g., Week 1, 2, 3 or 4)
Completed Date
& Student’s Initials
Section 2: Accept Professional Responsibilities
Q2.1:
A, B, C
Complete prescription regulations exercises
Section 3: Use Management Skills in Daily Practice
A3.1
Participate in medication distribution
A3.2
Discuss use of child-resistant containers
A3.3
Discuss efficiency in workplace; use of
technology; interdependency of roles of
dispensary staff, particularly role of technician
A3.4
Discuss use of auxiliary labels
A3.5
Review Standards of Practice for Medication
Management
A3.6
Become familiar w/ 3rd party billing issues
A3.7
Review and answer questions about
extemporaneous preps; participate in
compounding activities
A3.8
Discuss dealing w/ Rx forgery/TRPP Program
A3.9
Discuss purchasing/inventory including
security and accountability procedures for
narcotics and controlled drugs; participate in
ordering & receiving activities
Q3.1
Complete nomenclature exercise
Q3.2
Complete drug scheduling exercise
xi
Reviewed with Preceptor
Preceptor’s Initials
Activity
or
Question
Description
Q3.3
Answer questions about dispensing exempted
codeine compounds
Q3.4
Answer question re: emergency supply
Timeline
for Completion
(e.g., Week 1, 2, 3 or 4)
Completed Date
& Student’s Initials
Reviewed with Preceptor
Preceptor’s Initials
The preceding activities have been completed by the student and discussed with the preceptor as indicated.
We certify that the information provided in the checklist is complete and is in no way false or misleading.
Student’s Signature: Date:
Preceptor’s Signature:
Date:
xii
Section 1: Provide Patient Care
Objectives
After completing this section, the student is expected to be able to:
•
•
•
•
•
establish a rapport with the patient by using effective dialogue; demonstrate professional,
caring behaviour toward the patient and/or the patient’s care provider
gather and document patient information (i.e. for the patient medication profile)
begin assessing patient and drug use information in order to identify simple drug-related
problems
counsel a patient about his/her medication (for selected drugs) under direction of the
preceptor
seek and accept feedback to identify weaknesses or strengths in own performance
Readings and References
•
•
•
•
“Communications” lectures/tutorials from PHM 2101/2 and 2650/1
Communication Skills in Pharmacy Practice, 6th ed. by WN Tindall et al.
Pharmacists Talking with Patients: A Guide to Patient Counseling, 2nd ed. by MJ Rantucci
e-CPS (in e-Therapeutics), available online through the Health Sciences Library
Tools and Forms
•
Patient Counseling Evaluation Forms (Evaluation Forms, separate enclosure)
- Student Self-Assessment
- Assessment of Student Performance by Preceptor
Activities
The student is expected to:
A1.1
Review with the preceptor telephone answering procedures and answer the telephone.
A1.2
a. Observe the preceptor and other staff greeting patients, receiving prescriptions, and
gathering patient information.
b. Review with the preceptor the patient information that is required to be obtained
when receiving a prescription from a new patient. What information should be
verified with a patient already on file?
c. Note where medical conditions and allergies are documented in the patient
medication profile. What other types of notes and messages are noted in a
patient’s profile? A1.3
Under supervision of the preceptor, greet patients, receive prescriptions, and gather
necessary patient information.
1
A1.4
Discuss with the preceptor how s/he assesses the appropriateness of a given drug order
for a particular patient. The student should develop a list of questions that s/he would
ask him/herself while assessing a drug order.
A1.5
Review every patient’s profile prior to dispensing a prescription, to identify drug-related
problems such as:
i. Contraindications to drug use. For example: amoxicillin for a patient with a
documented penicillin allergy;
ii. Nonadherence. For example: too frequent refills;
iii. Drug misuse. For example: inappropriate drug use patterns, particularly of drugs
with abuse potential
A1.6
Discuss with the preceptor compliance aids to assist patients in adhering to drug therapy.
Patient Counseling
In order for patients to use their medications properly, they must be provided with sufficient
information about the medication. Ensuring the patient receives this information is the joint
responsibility of the prescriber, the pharmacist and the patient.
Many pharmacists find counseling one of the most rewarding aspects of their work. By taking
just a few minutes with patients to educate them about their prescribed medications, pharmacists
have a unique opportunity for enhancing the quality of patient care and improving health
outcomes.
In School, students are taught the ‘Three Prime Questions’ approach to patient counseling.
This approach focuses on actively involving the patient in the consultation rather than simply
providing information to the patient. In this model, the pharmacist verifies the patient’s understanding of the medication by asking three prime questions: What were you told the
medication is for?; How were you told to take the medication?; What were you told to expect?
Each of these questions may be expanded upon according to individual circumstances. The
pharmacist then fills in any gaps in the patient’s knowledge, if necessary.
Further information about this counseling technique is available at
http://www.accesspharmacy.com/content.aspx?aID=55609181
Ref: Herrier Richard N, "Chapter 3. Case Studies in Patient Communication" (Chapter). Terry L. Schwinghammer, Julia M.
Koehler: Pharmacotherapy Casebook: A Patient-Focused Approach, 8e.
A1.7
Select, with the help of the preceptor, at least two medications or devices that are likely
to arise as new prescriptions at the SPE site to provide patient education or counseling
about. With the approval of the preceptor, and under the direction of the preceptor,
the student should counsel patients for each given medication.
Patient Counseling Instructions for the Student
For the medications/devices selected above, the student is required to verify patient
understanding about their prescribed (new) medication using the Three Prime Questions
2
approach. The student should prepare for these sessions by (re)familiarizing him/herself with the
product. Role playing with the preceptor is recommended before consulting with patient(s).
The student should practice counseling on these medications whenever the opportunity arises
during the SPE (i.e. not limit him/herself to counseling once only on each medication). At the
end of the counseling session, the student should thank the patient for allowing him/her the
opportunity to do this.
Note: Drugs and devices students would have practiced providing patient education
about during the first year ‘Skills’ course include: inhalation devices (metered dose
inhaler, turbuhaler, Advair diskus, Spiriva ), aerochamber, eye drops/ointment,
ear drops, nasal spray, vaginal suppositories/cream, rectal suppositories, Epipen ,
transdermal patches, amoxicillin suspension, oral syringe.
Role of the Preceptor
For each counseling session, the preceptor is asked to select an appropriate patient for the student
to counsel. The preceptor should provide an explanation of the assignment to the patient (i.e. for
student training purposes) and request the patient’s participation. If it is difficult to “find the right patient” who is also receiving one of the selected medications for the first time, an option which may be considered is to counsel a patient who has previously received the medication but “act as
if ” it is an initial counseling session.
The preceptor is responsible for supervising the student and ensuring that information and advice
provided by the student is accurate. This may be accomplished in a couple of ways:
•
•
the preceptor may sit in on the session, i.e. three people will be present at all times
the preceptor may position him/herself within earshot of the conversation and join the
student and patient at the end of the session for comments
It may, therefore, be desirable to avoid peak traffic hours in the pharmacy.
In the case where the preceptor may have to correct the student, or provide clarification or
additional information, it should be done as diplomatically as possible. While it is recognized
that the patient’s well-being is of primary importance, it is important that the student not be
belittled in front of the patient and that all parties involved appreciate that this is a learning
experience!
The student is required to self-assess his/her performance for at least two (2) counseling sessions
and document using a self-assessment form. This is a good chance to allow the student to
reflect on his/her performance by sharing the results of the self-assessment with the preceptor
and seeking his/her feedback. Preceptor feedback is essential in guiding future performance
by identifying strengths that can be encouraged and weaknesses that can be addressed.
The preceptor is required to evaluate the student using the enclosed evaluation form.
Documentation/evaluation is required for two counseling sessions by the student, i.e. one for
each medication. The student, however, should not be limited to counseling once only on
each medication. The evaluation forms are required to be submitted to the SPE
3
Coordinator along with the Preceptor’s Evaluation of Student form at the end of the SPE.
Interpersonal Communication
Interpersonal communication can be described as one-to-one interaction between two
individuals. The communication between the patient and the pharmacist serves to form the basis
of building trust between them. Developing effective relationships with patients is essential in
the provision of pharmaceutical care.
In most communication encounters, we normally do not have time to stop and analyze the
interaction (i.e. what was said, how it was said). However, as pharmacists, it is important to
consider and reflect on our communication behaviour and pursue ways of improving our
dealings with patients, their families and other health professionals.
A1.8
Discuss with the preceptor the following situations. What communication issues are
involved? Analyze the situation and consider specific communication techniques or
strategies (e.g., empathic responding, assertiveness, etc.) that might be used in responding
to each patient to result in the most positive interaction.
a. A 45-year-old female patient enters the pharmacy and tosses a new prescription on
the counter. When she is told it’s going to take about 20 minutes to prepare, she responds angrily and loudly, “Twenty minutes! You’ve got to be kidding. I had a 2 p.m. appointment with the doctor and he didn’t see me until 3:15. You people must think we have nothing better to do than wait on you! Besides, all you have to do is put
a few pills in a bottle. What could take so long?”
b. Mrs. Jones enters the pharmacy to have her antihypertensive medication refilled.
According to your records, the refill is about 2 weeks late. You say to Mrs. Jones, “I noticed your blood pressure medication should have run out several weeks ago. Can
you tell me how you’re taking it?” She replies, “I’m tired of taking this medication. Sometimes I don’t take it like I should.”
Linkages of Activities with Educational Outcomes
Activity Care
Communicator Collaborator Manager Advocate Scholar
or
Provider
Question
A1.1
A 1.2
A 1.3
A 1.4
A 1.5
A 1.6
A 1.7
A 1.8
4
Professional
Section 2: Accept Professional Responsibilities
Objectives
By the end of the SPE, the student will be expected to:
•
•
•
•
•
•
maintain a professional image (appearance, language, demeanor)
practice in an ethical manner (e.g., ensure patient confidentiality)
demonstrate reliability in fulfilling commitments;; recognize patients’ needs as priority
comply with the legal and regulatory requirements of practice
respect and fulfill professional standards of practice
demonstrate an understanding of the roles of various provincial and federal professional and
regulatory organizations, particularly in relation to their efforts in advancing the role of
pharmacists
Readings and References
•
•
•
•
•
•
Pharmacy Legislation http://www.nlpb.ca/pharmacy-practice/
• Provincial Legislation: Pharmacy Act and Regulations
• Federal Legislation: Food & Drugs Act and Regulations (particularly Parts C and G);
Narcotic Control Regulations; Benzodiazepines and Other Targeted Substances
Regulations
Tamper-Resistant Prescription Drug Pad Program
Code of Ethics of the Newfoundland and Labrador Pharmacy Board
http://www.nlpb.ca/media/NLPB-Code-of-Ethics-2001.pdf
NLPB Standards, Policies & Guidelines http://www.nlpb.ca/pharmacy-practice/standardsguidelines-policies/
• Delivery of Prescriptions by Newfoundland & Labrador Pharmacies
Links to national pharmacy associations, pharmacy regulatory bodies, professional
associations http://www.nlpb.ca/pharmacy-practice/links/
e-CPS (in e-Therapeutics), available online through the Health Sciences Library
Activities
The student is required to:
A2.1
Discuss the issue of patient confidentiality with the preceptor in relation to the NLPB
Standards of Pharmacy Practice: Privacy and Confidentiality of Personal Health
Information.
http://www.nlpb.ca/media/SOPP-Privacy__Confidentiality_Personal_Health_InfoSeptember2002.pdf
Suggested items for discussion include:
i. What constitutes ‘personal identifiable health information’?
ii. What are the individual pharmacist’s responsibilities for compliance with the standards? The Pharmacist-in-Charge’s responsibilities?
5
iii. To whom and under what circumstances may a pharmacist disclose health
information that s/he has collected about a patient? List situations where a
pharmacist may be required by law to disclose personal identifiable information.
iv. Consider how you might respond to a request by the following to disclose personal
health information:
–
police or other law enforcement official
–
another pharmacist, or other health care professional
–
third party payor
–
family member (e.g. a spouse requesting duplicate receipts for income tax
purposes or concerning a deceased patient)
–
the parent of a minor
A2.2
Discuss with the preceptor the process that is followed when a prescription is delivered.
How is the delivery package labeled to ensure patient privacy? How is patient counseling
managed when a prescription is delivered?
A2.3
Determine how you would respond to the following ethical/legal scenarios. Discuss with
the preceptor.
a. You discover while gathering information for a patient profile that the doctor has
prescribed medication in the name of another family member who is the only person
covered on the NLPDP card that he is presenting. The patient explains that he cannot
afford the prescription.
b. A patient brings back a broken 100 ml bottle of Novahistex® DH syrup that she
dropped while she was getting into her car. She requests another one. What would
you do?
A2.4
Identify for each of the following professional organizations:
i. Its major responsibilities
ii. Membership composition
iii. Current initiatives or political/advocacy activities
a.
b.
c.
d.
e.
NAPRA
NLPB (or provincial regulatory body)
PANL (or provincial professional association)
CPhA
CSHP
6
Questions
Q2.1 Complete the “Prescription Regulations” exercises, Parts A, B and C.
Prescription Regulations
Part A
In practice, pharmacists often encounter prescriptions which are incomplete or not entirely
legally correct. In some circumstances the problem may be resolved simply by asking the patient
for the necessary information, but sometimes a law or regulation precludes the pharmacist from
dispensing a prescription until appropriate steps are taken.
Directions
For the following sample prescriptions,
i) identify the problem if one exists.
ii) give the proper procedure to follow if a problem exists.
7
1.
Memorial University
School of Pharmacy
St. John’s, NL
709 777-7211
Name Kent McCarthy
Address ________________________
Date
Rx
Cipro 500 mg
i BID x 10 days
20
Refill
Doctor _________________________________
8
May 1/14
2.
(Tamper Resistant Prescription Pad)
Dr.
Address
Telephone #
123456
Name Gerald Palmer
Date __________
Address
____________________________________
MCP #
_______________________________
_______________________________
Rx
Tylenol # 4
i (one) q 4 -6 h prn pain
30 (thirty)
Doctor
License #
Valid for Controlled Substances
9
3.
Memorial University
School of Pharmacy
St. John’s, NL
709 777-7211
Name Jim Saunders
Address ________________________
Date May 1/14
Rx
Garamycin Ophth. Drops
ii gtt o.s. QID
5 mL
Refill prn
Doctor
J Jones
Doctor _________________________________
_________________________________
10
4.
(Tamper Resistant Prescription Pad)
Dr.
Address
Telephone #
123457
Name Todd Hillier
Date 01/05/14
Address
58 Pine Street
St. John’s, NL
MCP #
012 345 678 910
Rx
Atasol 30
i (one) q 6 h prn pain
40 (forty)
Refill x 2
Doctor Doctor
License # F01234
Valid for Controlled Substances
11
5.
(Tamper Resistant Prescription Pad)
Dr.
Address
Telephone #
123458
Name Jill Bailey
Date 01/05/14
Address
21 Cook Street
St. John’s, NL
MCP #
012 345 678 911
Rx
Dexedrine Spansule 10 mg
i q am
30 (thirty)
Refill x 3
Doctor Doctor
License # F01234
Valid for Controlled Substances
12
6.
Memorial University
School of Pharmacy
St. John’s, NL
709 777-7211
Name Jim Saunders
Address ________________________
Rx
HC 1% / Nystatin
Apply TID
30 g
Refill 1
Doctor
T Mills
13
Date May 1/14
Part B
Assume the prescriptions on the following pages are on file at your pharmacy. In each case, a
pharmacist from another pharmacy has requested a transfer of the prescription to him/her.
Directions
i) Determine if it is OK to transfer the prescription away and how you would handle each
request.
ii) If it is not OK to transfer the prescription, explain why.
14
7.
Memorial University
School of Pharmacy
St. John’s, NL
709 777-7211
Name Matthew Lewis
Address ________________________
Date May 1/14
Rx
Ventolin Inhaler
i puff QID prn
Mitte: 1 puffer
Refill 3
Doctor
J Smith
This prescription was filled once in your pharmacy, on May 2, 2014 (1 puffer was
dispensed). Can it be transferred to another pharmacy?
15
8.
Memorial University
School of Pharmacy
St. John’s, NL
709 777-7211
Name Darlene Smith
Address ________________________
Date Apr 2 /14
Rx
Tri-Cyclen Lo 21
ud
21
Refill 3
Doctor
M Taite
This prescription was transferred to your pharmacy from Jones’ Pharmacy.
Rx information obtained from Mr. Jones (PhC) at time of transfer on April 2/14:
Original Rx date, January 10/14 (Rx # 602141)
Last refill, March 5/14
Number of refills remaining, 4
You have filled this Rx once (21 tablets were dispensed on April 2). Can it now be
transferred to another pharmacy?
16
9.
Memorial University
School of Pharmacy
St. John’s, NL
709 777-7211
Name Elizabeth Burke
Address ________________________
Date Apr 6 /14
Rx
Temazepam 15 mg
i hs
30
Refill 1
Doctor
B Winsor
This prescription was transferred to your pharmacy from Smith’s Pharmacy.
Rx information obtained from Mr. Smith (PhC) at time of transfer on April 6/14:
Original Rx date, March 7/14 (Rx # 613519)
Last refill, March 7/14
Number of refills remaining, 2
You have filled this Rx once (30 tablets were dispensed on April 6). Can the remaining refill
be transferred to another pharmacy?
17
10.
Memorial University
School of Pharmacy
St. John’s, NL
709 777-7211
Name Eric Pike
Address Elizabeth Ave
Date May 1 /14
Rx
Andriol
i BID
60
Refill 3 (at monthly intervals)
Doctor
C Mason
This prescription has been filled once at your pharmacy. Can the remaining refills be
transferred to another pharmacy?
18
Part C
For the following chart, fill in the required information using the numbers or letters provided to denote
your answer.
Classification
N--------Narcotic Drug
VPN----Verbal Prescription Narcotic (Narc. Prep.)
E---------Exempted Codeine Compound
CD1-----Controlled Drug (Part 1)
CD2-----Controlled Drug (Part 2)
CD3-----Controlled Drug (Part 3)
TS--------Targeted Substance
PD--------Regular Prescription Drug
NPR------No Prescription Required
CD1P-----Controlled Drug (Part 1) Preparation
CD2P-----Controlled Drug (Part 2) Preparation
Prescription Requirements (as per Federal regulations)
1. Written prescription, signed and dated
2. Written or verbal prescription
3. Prescription not required
Additional Prescription Requirements (Newfoundland & Labrador)
4. Drug is listed in Schedule of Drugs, Tamper Resistant Prescription Drug Pad (TRPDP) Program;
prescriptions must be written on the approved Rx pad and may not be accepted verbally.
5. Prescription may be faxed, as per NLPB Standards of Pharmacy Practice; a Rx received by fax in
accordance with these standards may be considered to be equivalent to a written Rx.
Refill Requirements
A. No refills allowed.
B. No refills allowed if original prescription is verbal. If written, the original Rx may be repeated if the
prescriber has indicated in writing the number of refills and dates for, or intervals between, refills.
C. Refills permitted for written or verbal prescriptions if the prescriber authorizes on the original Rx the
number of refills & dates for, or intervals between, refills.
D. Original written or verbal prescription may be repeated if the prescriber has indicated refill authority,
including the number of times it may be refilled.
Record of Receipt (Purchases)
A. Upon receipt, record in a book, register or similar record maintained for that purpose.
B. Record receipt in a manner that permits an audit, though not necessarily in the same form as that
specified above.
C. Record of purchases not required.
Sales Recording Requirements
A. Record all sales in a book, register or similar record (e.g., computer-generated daily sales report)
maintained for such purchases.
B. Prescription sales need not be recorded in a “register.”
19
Description
Ingredients
Class
Rx
Reqmt.
(FED)
1. Ativan® 1 mg
tablets
2. Demerol®
tablets
3. DepoTestosterone®
injection
4. Engerix®-B
10 g (0.5 mL
vial, pediatric)
5. Fiorinal®
capsules
6. Fiorinal®-C ½
capsules
7. Novahistex®
DH liquid
20
Rx
Reqmt.
(NL)
Repeat
Reqmt.
Purchase
Record
Sales
Record
General Use
Description
Ingredients
Class
Rx
Reqmt.
(FED)
8. Novolin®ge
Insulin
preparations
9. Ritalin® 10 mg
tablets
10. Tylenol® No. 1
tablets
11. Tylenol® with
Codeine No. 2
tablets
12. Tylenol® with
Codeine No. 4
tablets
13. Tylenol® with
Codeine Elixir
14. Viagra® 50 mg
tablets
21
Rx
Reqmt.
(NL)
Repeat
Reqmt.
Purchase
Record
Sales
Record
General Use
Linkages of Activities with Educational Outcomes
Activity Care
Communicator Collaborator Manager Advocate Scholar
or
Provider
Question
A2.1
A2.2
A2.3
A2.4
Q2.1
22
Professional
Section 3: Use Management Skills in Daily Practice
Objectives
By the end of the SPE, through participation in the distribution of medications, the student is expected to
be able to:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
upon receiving a written medication order, correctly interpret the order and determine if all legal
requirements of a prescription are met
process prescriptions completely, accurately, and with increased efficiency as the SPE progresses
(entry into computer, selection of product, packaging and labeling, appropriate checks)
follow relevant policies for generic substitution (in accordance with applicable formularies)
demonstrate familiarity with brand and generic drug names (for assigned drug lists)
accurately perform calculations used in pharmacy practice
demonstrate compounding abilities as relevant to the practice site
demonstrate organizational and time management skills (i.e. prioritizing tasks) in the practice setting
explain and apply legislation, regulations and standards governing pharmacy practice, drug
distribution and record keeping, in particular that relating to: Facsimile Transmission of
Prescriptions; Tamper-Resistant Prescription Drug Pad Program; Supply of Exempted Codeine
Products; Security and Accountability Procedures for Narcotics and Controlled Drugs in
Community Pharmacies; Medication Management by Community Pharmacists; Filling Prescriptions
from Out-of-Province Prescribers; and Provincial Drug Schedules
detect and bring to preceptor’s attention concerns with specific prescriptions or situations involving potential inappropriate drug use (e.g., excess prescription quantities, overly frequent refills, altered
prescriptions)
differentiate the duties that must be performed by pharmacists from those that may be delegated to a
technician
demonstrate an understanding of the role of technology (e.g., equipment, computer systems, drug
plan insurance/adjudication systems) in the workplace
interpret and explain basic concepts relating to third party drug insurance plans
demonstrate a basic understanding of inventory management
function as a member of a team by demonstrating effective interpersonal/intergroup behaviours
in the practice setting
Readings and References
•
•
NLPB Provincial Pharmacy Legislation, http://www.nlpb.ca/legislation.html
• Pharmacy Act: Out-of-Province Prescriptions
• Pharmacy Regulations: Part III, (13) Standards of Pharmaceutical Service; Part VII, Drug
Schedules
Tamper-Resistant Prescription Drug Pad Program
23
Readings and References (cont’d.)
•
•
•
•
•
NLPB Standards of Pharmacy Practice, http://www.nlpb.ca/pharmacy-practice/standardsguidelines-policies/
• Facsimile Transmission of Prescriptions for Community Pharmacies
• The Sale of Exempted Codeine Products in Community Pharmacies
• Security and Accountability Procedures for Narcotics and Controlled Drugs in Community
Pharmacies
• Medication Management by Community Pharmacists
• Standards of Practice for Pharmacy Compounding
• The Role of the Pharmacy Technician in Community Pharmacies
• Delegation of Duties in Community Pharmacies
A Guide to Understanding the NL Provincial Drug Schedules http://www.nlpb.ca/media/Schedulesguide-2013.pdf
“Third Party Issues”, Tech Talk CE by S. Hutty, in Pharmacy Practice, Sept. 2003, Vol. 19, No. 9
http://www.canadianhealthcarenetwork.ca/files/2009/10/TT_Sep_CE.pdf
Newfoundland & Labrador Interchangeable Drug Products Formulary (available online at
http://www.health.gov.nl.ca/health/prescription/idf.html
e-CPS (in e-Therapeutics), available online through the Health Sciences Library
Activities
The student is required to:
A3.1
Participate in the preparation and distribution of pharmaceuticals in response to prescriptions for
individual patients. This includes the compounding of common dosage forms such as powders,
creams, ointments and oral solutions, where applicable. Performance of dispensing activities
should include the following steps:
i. Using the computerized dispensing software program, check the patient profile for
completeness, or enter a new profile, if necessary (Review NLPB Pharmacy Regulations,
13(7-14)).
ii. Examine the prescription for completeness, authenticity.
iii. Locate the appropriate drug, check the expiry date, ensure the correct strength and dosage
form, provide the prescribed quantity of drug, and place the drug in the appropriate container.
[What are the practices in the pharmacy for filling narcotic and controlled drug prescriptions
(i.e. are they double-counted?).]
iv. Generate a proper label and affix it to the container.
v. Check that you have filled the prescription properly and accurately.
vi. Notify the preceptor that the prescription is ready to be checked by him/her and dispensed.
A3.2
Discuss with the preceptor the requirements in your province for child-resistant
containers. What procedure is followed if a patient, or their agent, requests that a childresistant container not be used?
24
A3.3
a. Discuss with the preceptor how the use of computer technology, automation and support staff
at your site contributes toward the efficiency of the workplace.
b. Distinguish between the key responsibilities of the pharmacy manager, pharmacist-incharge, staff pharmacists and technicians and discuss how these jobs are highly
interdependent. Differentiate between the duties that must be performed by pharmacists from
those that can be delegated to a technician.
c. Discuss how the workflow of the dispensary is managed in order to maximize efficiency
(e.g., task assignment; priority setting/ranking order of completion of tasks by level of
importance or urgency; initiation and completion of required daily activities).
Auxiliary Labels
Auxiliary labels are used to emphasize important points about dispensed medications, including proper
use, storage, and any necessary precautions. For example, a Shake Well label is indicated for
prescriptions containing ingredients that may physically separate on standing (e.g., suspensions,
lotions).
A3.4
Discuss the use of auxiliary labels with your preceptor. Take notice of the use of auxiliary labels
by the pharmacist (i.e. how and when these labels are used and the types of medications they are
used on).
Medication Management
Changes to the NL Pharmacy Regulations as well as standards of practice adopted by the Newfoundland
& Labrador Pharmacy Board give pharmacists in NL a broadened ability to provide prescription
medications to better serve patients. The Standards of Pharmacy Practice for Medication Management
give pharmacists independent authority and accountability for the extension or adaptation of a
prescription and provide the framework to guide pharmacists in safe and effective practice.
A3.5
Review the NLPB Standards of Pharmacy Practice for Medication Management. Are
there special requirements needed in order to participate in Medication Management?
Check with your preceptor to see if s/he or other pharmacists at the site participate in
Medication Management. Where applicable, discuss with the preceptor how this new
authority has been integrated into their practice. In what types of instances is Medication
Management provided? Are there limitations on Medication Management? When a
pharmacist performs activities under Medication Management, who else is required to be
notified and within what time frame? How is Medication Management documented?
Where applicable, review completed Medication Management forms.
Students completing SPEs in other provinces should perform this activity looking at
areas of advanced scopes of practice pertinent to their sites. This may include practices
similar to those above or others, including pharmacist prescribing, provision of injections,
ordering of lab tests, etc.
25
Prescription Drug Coverage/Third Party Billing
All Canadians have access to the insured health services defined by the Canada Health Act including
medically necessary hospital services, medicines used during hospitalization, and required physician
services. Prescription medicines used by non-hospitalized patients are not paid for by this system.
However, most Canadians have access to reimbursement for prescription medications through private
insurance plans, provincial drug benefit programs or even federal programs for certain groups.
Many Canadians have private insurance/third-party insurance for prescription drugs as part of the group
health benefits provided by their employers, which may also cover the employee's family. Employers
purchase these plans from insurance companies and determine the terms of the plans.
How much the prescription costs the patient depends on the type of coverage provided by the drug plan.
Plans can be ‘open access’ and cover all prescription medications approved by Health Canada and
prescribed by a licensed physician. Other plans cover drugs on a specific formulary that the employer
has agreed to. Some plans have fixed co-pays (e.g., $7.50 per prescription); others may have percentage
co-pays (e.g., 20% of the total cost of the prescription); while others may have yearly deductibles that
need to be met (e.g., patient pays the first $50 before the plan covers anything). There are hundreds of
plans with many variations among them.
This section is intended to serve as a basis for discussion between the student and preceptor in order to
develop the student’s basic knowledge of third party billing procedures. Students are encouraged to discuss with their preceptors issues that arise with third party billing during their SPE rotations.
Preceptors are encouraged to use situations as teaching examples.
A3.6
a. Review “Third Party Issues”. Discussion with the preceptor should include the following
terms associated with third party billing. For example:
– deductible
– co-payment
– benefit list
– adjudication
– special authorization
– coordination of benefits
b. To review the policies and billing procedures involved in most insurance companies
is beyond the scope of this exercise. Rather, students are asked to familiarize
themselves with a few of the more commonly encountered third party plans. In NL,
these include: Medavie Blue Cross, Desjardins, Government of Newfoundland and
Labrador Prescription Drug Program. For students not practicing in NL, plans applicable for
your province should be reviewed.
For the above third party payers, the student should be able to:
•
•
Interpret information on the identification cards
– What is the policy number? Identification number? What is the expiry date?
– Who is the cardholder? Is there family/dependent coverage?
Enter third party information into a computerized patient profile
26
•
Provide examples of groups they cover (e.g., teachers, provincial government employees)
– State general policies which apply to each plan.
– Is it a direct payment or reimbursement plan?
– What is the applicable co-payment or deductible, if any?
– Is generic substitution mandatory?
c. When a third party drug claim is submitted, it is normally done via an online adjudication
system and the pharmacy is advised immediately whether the claim will be paid and the
amount it will receive. The student is encouraged to read and learn to interpret the online
adjudication screen for a third party claim. Discuss with the preceptor the various
adjudication messages that may be received during the claims process, in particular error or
claim rejection messages (e.g., DIN not a Benefit, Exceeds Days Supply, Deduct not
Satisfied, Future Refills Require Special Authorization) and how these issues are generally
dealt with.
Extemporaneous Preparations
The number of prescriptions which require compounding by the pharmacist has decreased, however
pharmacists are occasionally faced with prescriptions that cannot be filled by selecting a product off the
shelf. For example, the dosage form prescribed may not be available or the dosage of the commercial
product may not be suitable (often the case for pediatric patients).
When presented with a prescription that requires extemporaneous preparation, reference sources should
be consulted to obtain formulations with proven stability.
A3.7
a. Discuss with the preceptor some of the drug products that are typically compounded
at the SPE site. Review the formulas for these compounds.
b. Preceptors are encouraged to let students participate in compounding activities as part
of their drug distribution activities. It is suggested the following points be reviewed
with the student:
–
–
–
–
–
–
–
–
Calculations
Compounding procedure/technique and equipment needed
Precautions to follow when handling the ingredients and finished product
Storage requirements and expiry date
Labeling information
Checking the compounding process, including calculations, and the end product
Documentation (e.g., compounding log or worksheet)
Clean-up
c. For the following prescription, locate a formula to make the product as prescribed.
Review with the preceptor. Would the preceptor have used the same resource as you
to obtain the formula? Source the ingredients for the suspension. Work through the
27
calculations to prepare the compound. Have your work double-checked by the
preceptor.
Rx
A3.8
Aldactazide Oral Suspension
6 mg po bid x 30 days
a. Discuss with the preceptor how the Tamper Resistant Prescription Drug Pad Program is
contributing towards reducing drug abuse and drug diversion in our province.
(For students not completing SPEs in NL, discuss similar types of programs in your
province.)
b. Discuss with the preceptor the appropriate action to be taken if a prescription forgery
is discovered.
A3.9
a. Discuss with the preceptor the basic principles of purchasing and inventory control.
For example:
i. How are the maximum and minimum levels of stock and ordering quantities
determined?
ii. What is the difference between direct and wholesale suppliers?
iii. Who are the preferred suppliers at your site? Discuss in relation to minimum order
quantities, delivery time, etc.
iv. Why is inventory counted and how often?
v. Is the dispensary computer system used to keep track of inventory?
vi. What is the procedure at your SPE site for finding, removing and handling expired stock
(including narcotics and controlled drugs)?
vii. What additional procedures are in place to ensure the security and accountability of
narcotics and controlled drugs in the pharmacy? Examine narcotic and controlled drug
records, including receipt logs, prescription files, sales records and destruction
authorizations.
b. Participate in ordering and receiving activities in the pharmacy
28
Questions
Q3.1 Complete the assignment “Product Recognition/Nomenclature”
Product Recognition/Nomenclature - Formulary Products
Becoming familiar with brand names of drugs and nonproprietary drug names is important in the
practice of pharmacy. Familiarization with available products enables the pharmacist to become more
efficient in preparing prescriptions. As well, basic knowledge about drug products is essential for
interacting with patients and physicians.
For the drug categories in the NL Interchangeable Drug Products Formulary (NIDPF), current volume,
which have been assigned (See Appendix), the student is expected to become familiar with:
•
•
•
nonproprietary name
brand name(s)
general indications/therapeutic class, e.g., analgesic, antibiotic, antidepressant
It is important that the student become familiar with this formulary as it is NL provincial law that a
pharmacist, when presented with a prescription for a drug listed in the Formulary, must dispense either
the lowest priced brand of that drug listed in the Formulary or another approved substitute brand of that
drug at the lowest price listed.
Q3.2 Review the Provincial Drug Schedules I, II , III and Unscheduled and the corresponding
legal and professional requirements. Determine the scheduling classification and
placement in the pharmacy of the following products, based on the Newfoundland and
Labrador Provincial Drug Schedules.
Advil® Extra Strength caplets (45’s)
Nicotine patches/gum
ASA 80 mg chewable tablets
Gravol® 50 mg tablets
Polysporin® eye/ear drops
Epipen® /Epipen® Jr
Advil® Jr. Strength chewable tablets (24’s)
Aleve® tablets (pkg sizes > 30)
ASA enteric coated 81 mg
Benadryl® 50 mg capsules
Tylenol® No.1 caplets
Sudafed® Cold & Cough Extra Str caplets
Q3.3 A patient requests “a bottle of Atasol®-8 tablets”. Answer the following questions concerning this request using NLPB Standards of Practice regarding the Sale of Exempted Codeine
Products in Community Pharmacies as a guide.
i. What is the maximum size bottle that he may be supplied with?
ii. Can he purchase more than one unit of the maximum pack size? What if he indicates he is
purchasing for different people (i.e. himself and a family member)?
iii. How must this purchase be documented in the pharmacy?
iv. What are the labeling requirements?
v. How often can a patient purchase an exempted codeine compound?
vi. What if abuse is suspected?
vii. How do you know if the patient has purchased other codeine-containing products elsewhere?
29
Q3.4 A neighboring pharmacy calls your pharmacy to purchase 12 Tylenol® No. 4 tablets, to
fill the balance of a prescription for 36 tablets. Explain the procedure, including
documentation requirements, to be followed by your pharmacy and the other pharmacy.
Linkages of Activities with Educational Outcomes
Activity Care
Communicator Collaborator Manager Advocate Scholar
or
Provider
Question
A3.1
A3.2
A3.3
A3.4
A3.5
A3.6
A3.7
A3.8
A3.9
Q3.1
Q3.2
Q3.3
Q3.4
30
Professional