PhPr 803B - Institutional Pharmacy Practice
The purpose of the Institutional Pharmacy Practice rotation is for students to gain experience in various aspects of inpatient pharmacy services. This includes, but is not limited to, provision of products to patients and other hospital/clinic departments, clinical pharmacy services, and pharmacy management. Students should approach the rotation understanding that the ultimate goal in all instutional pharmacy tasks is improving patient care.
Prior to the rotation, the student should download the Checklist for All rotations and the Institutional Pharmacy Practice Rotation Checklist to be used as guides for student activities during the rotation.
General Requirements
Download Checklist for All Rotations
A description of the checklist and general information applicable to all rotations may be found on the Policies and Expectations page of this website.
Institutional Rotation Goals and Objectives
Download Institutional Rotation Checklist
The following are guidelines regarding activities in which students should gain experience or at least exposure during the Institutional Pharmacy Rotation. These goals and objectives and the suggested time to spend on particular tasks may be adjusted according to previous experience of the student as well as the unique characteristics of an institution.
When using the checklist, the student and preceptor may initial and date the appropriate boxes indicating items completed. However, the item will not be considered completed until the preceptor initials are in place. If particular items, such as Investigational Drugs, are available at the rotation site, please indicate “N/A."
1. Processing Medication orders – Most students should have considerable exposure to these tasks on this rotation, up to two weeks. Whenever possible, this exposure should be varied among areas within the pharmacy department and integrated into other aspects of pharmacy services, as they often are in the daily life of an institutional pharmacist. Students should participate in order screening/entry done in patient care areas and pharmacy satellite locations as well as the central inpatient pharmacy.
- The student should describe requirements for receiving orders including written, electronic, verbal, and any other means allowed in institution
- The student should evaluate orders for completeness, appropriate indication, appropriate dosing and route of administration, allergies, drug-drug interactions, drug-disease interactions, formulary requirements
- The student should perform order including creating a profile or adding information to existing profile, and select products appropriately.
2. Preparation/Distribution of products – Most students should spend considerable amounts of time with these “hands on” activities, possibly up to two weeks of the rotation. The experience should include these types of activities performed in patient care areas and pharmacy satellite locations as well as the central inpatient pharmacy. Students may work with pharmacy technicians performing these tasks, including the following.
- Unit dose – cart fill/delivery (suggest 2-3 days)
- Repackaging bulk to unit dose with appropriate record keeping and labeling (suggest ¼-1/2 day)
- Exceptions to unit dose dispensing/bulk dispensing according to established procedures (Specific time not suggested, may incorporate this objective into other product preparation objectives)
- Unique dose preparation procedure, often called “specials” (Specific time not suggested, would incorporate into non-sterile compounding or other product preparation objective)
- Non-sterile Compounding (Suggest ½ day, activity may be dispersed throughout rotation to ensure student sees various commonly ordered preparations). Student should use appropriate ingredients, make accurate calculations, make accurate measurements, and use correct procedures to make the product.
- Sterile compounding (Suggest 3-5 days, activity may be dispersed throughout rotation to ensure student sees various commonly ordered preparations). Student should follow procedures to maintain sterile environment, including cleaning procedures, use of personal equipment, and aseptic technique. Student should also make accurate calculations and measurements. Products to make include, but are not limited to, the following large volume IV hydration fluids, small volume preparations (i.e. IVPB antibiotics and other medications), medications administered by continuous infusion (i.e. cardiac drips), and total parenteral nutrition.
- Cytotoxic agents (Suggest ½ day, may be incorporated into sterile compounding experience). Students should follow procedures to maintain sterile environment, including cleaning procedures and aseptic technique. Students should use appropriate personal protective equipment and follows procedures for disposal of unused cytotoxic agents and supplies used in handling cytotoxic agents. If possible, student should prepares chemotherapeutic agents for patient administration.
- Describes procedures for delivering products to patients/patient care areas and identify products requiring special precautions (ie. fragile, “do not tube”, cytotoxic, costly products, etc…)
- Floor stock systems - Describes use of floor stock systems used including locations in which they are used, rationale for providing of floor stock instead of dispensing products pursuant to patient orders, and procedures for maintaining floor stocks.
3. Controlled Substances - (Suggest up to ½ day which may be divided between “time in the vault” and other activities that require handling of controlled substances). Student should describe procedures for procurement of controlled substances; their inventory/storage requirements within the pharmacy department and in patient care areas; procedures for distribution / tracking of controlled substances and prevention of theft/diversion; and procedures for disposal/handling of expired or partially used products.
4. Investigational Drugs - (Suggest up to ½ day, depending on extent of institution’s involvement in investigational drugs). Student should describe pharmacists role in investigational drug program in institution as well as storage, distribution, and record keeping requirements for investigational drugs.
5. Code Arrest Procedures - Student should describe the pharmacists’ role in code situations at specific institution and attend a code, if possible within institutional policies regarding code procedures. Student should also stocks a code cart for delivery to patient care area.
6. Pharmacy Management - (Suggest 1-2 days). Students should be exposed to various aspects of pharmacy management including, but not limited to, the following.
- Inventory procedures including procurement/storage, product recalls/returning products to suppliers, disposal of expired materials, including special requirements for hazardous substances, and theft / diversion precautions
- Billing procedures for pharmacy services including provision of products and clinical services
- Procurement and maintenance of equipment in the pharmacy
- Compliance with federal, state, and institutional regulations regarding pharmacy practice
- Departmental and institutional meetings relevant to pharmacy services (ie. Staff meetings, P&T, interdisciplinary, etc….)
- Adverse drug event and medication error reporting including follow-up evaluation
7. Medication Therapy Management Most students should have considerable exposure to these tasks while on this rotation, up to two weeks. Whenever possible, this exposure should be varied among areas within the pharmacy department including activities in patient care areas and pharmacy satellite locations. These activities may be integrated into other aspects of pharmacy services, as they often are in the daily life of an institutional pharmacist.
- Formulary – Student should defines formulary and related terminology, process for adding or removing a product from the formulary, institutional procedures for formulary enforcement, and attend a Pharmacy and Therapeutics Committee meetings if possible.
- Interviewing patients – Student should be able to obtain information needed for appropriate care such as allergy or medication history information to solve medication order problems, perform clinical pharmacy consults as well as counseling patients. Student should also be able to describe resources available for communication with non-English speaking patients and their appropriate use.
- Gathering information – Student should efficiently gather accurate information from charts, medication administration records, patient care flow sheets, laboratory reports, or other sources efficiently to solve drug related problems.
- Evaluating information – Student should evaluate applicability of information and organizes it for presentation to other health care providers.
- Documentation – The student should document clinical services and patient care interventions according to institutional procedures.