PhPr 803E - Adult Acute Care Pharmacy Practice
Download Suggested Tasklist 803E
General Goals
- To develop the skills necessary to actively participate on a patient care team
- To prioritize the provision of pharmaceutical care when given limited time and multiple patients
- To develop a healthy skepticism of opinions of health professionals
- To understand the general types of medication-related problems
- To understand the essential steps in providing pharmaceutical care
- To take personal accountability for the outcome of patients, particularly as such outcomes are the result of medication-related problems
- To communicates clearly both orally and in writing
- To display professionalism in both appearance and actions
Preparation
- Students should familiarize themselves with all of the reference sources at the site with the assistance of the preceptor.
- Attendance is mandatory. If for some good reason a student is going to be absent, they should notify the pharmacy preceptor in advance of the absence.
- Privileged Information. In collecting data concerning patients, remember that this is private information. Do not discuss patients in the hallway or elevators as relatives and friends may be listening.
Student Presentation
The student must give at least one formal presentation during this rotation. The student and preceptor should choose the audience and topic early in the rotation.
General Guidelines
The student will participate in six weeks of clinical rotation, conferences, and patient interaction for a minimum of 40 hours per week. Except for the first day orientation session, the student should report directly to his assigned rounding area at the appropriate time each day. The time before rounds should be spent reading charts of assigned patients, updating patient profiles, and applying the monitoring parameters stated below. At specified times, you will attend rounds with the medical team to which you are assigned along with your preceptor. You may also partake in small group conferences to learn about patients followed by fellow students.
- The first day should include a tour of the pharmacy facility and a discussion of its distribution system, and other pertinent information.
- On the first or second day, the preceptor should present a case history and review the SOAP approach to patient monitoring. Also, each student should receive instruction from the preceptor about conducting medication history interviews and patient discharge counseling sessions.
- Each student should keep track of questions they want to ask the preceptor and not let them go unanswered.
- Students may be asked to follow all patients on their assigned team in depth each week. By the end of the first week students should have patient profiles on a minimum of five patients.
- Profiles may be kept on a blank 3 X 5 card or special profiles adapted to your site. Students will be instructed how to develop their patient profiles on day one. As a minimum, each profile should cntain patient name, date of admission, identification number, age, weight, problem list, pertinent laboratory values, allergies, home medications (from chart or interview) and a medication list. All drugs on the medication list should include date ordered and date discontinued.
- Periodically, the preceptor will review the histories obtained by the student and determine their ability to read the chart including abbreviations, physical examination, etc.
- For each patient, the student should gather the pharmacy data from a patient interview or from their medical chart.
- The preceptor should review content of the discharge counseling before it is done. Usually the patient should be given written or printed material with the name of each medicine, intended use of the medication and pertinent warnings at the time of the interview (USPDI or other patient information materials may be used.)
- Be prepared to discuss all assigned patients with the preceptor. Make formal case presentations. (Refer to Guidelines for Case Presentations on page14 of the introductory section.)
- The student should be prepared to present formal cases to other students and/or preceptor/faculty. The presentation should include the medical, laboratory, and pharmacy data base as well as the therapeutic plan and outcome. (Refer to Guidelines for Case Presentations on page14 of the introductory section.)
Questions To Ask Yourself
- Do all drugs fit a problem?
- Were any home medications stopped on admission? If you cannot find a reason, ask. Remember these drugs at the time of discharge counseling.
- Were any new drugs begun in the hospital? Why? Remember to counsel the patient on these drugs at discharge.
- Is the drug on the formulary? If not, suggest an alternative or justify use of a non-formulary drug.
- Could other less expensive or more efficacious drugs have been chosen?
- Are the doses, routes, schedules, or dosage forms appropriate for this patient?
- Is the optimal dosing regimen prescribed? Consider compliance.
- Are there abnormal laboratory values (especially electrolytes and renal function)? Are the laboratory abnormalities drug-induced? Is a modification of drug dosage required?
- What are the goals of therapy? What are the subjective and objective parameters to monitor this goal?
- What are the toxicities of the drugs? What are the subjective and objective monitoring parameters to detect these toxicities?
- Are there drug interactions? What change in therapy is required, if any?
- Are there any additive effects?
- Are there any problems that need a drug where none is now prescribed?
- What is the projected length of therapy for each medication (especially antibiotics and Schedule II drugs)?
- Is the therapy rational?
- If a drug is to be stopped, does it need to be tapered or can it be stopped abruptly?
- Are duplications in drug therapy present?
- Is there any history of adverse drug reactions?