The purpose of the Hospital/ Health-Systems Pharmacy Practice rotation is for students to gain experience in various aspects of inpatient pharmacy services. This may include, but is not limited to, provision of products to patients and other hospital/clinic departments, clinical pharmacy services, and pharmacy management.
Hospital/ Health-Systems Rotation Goals and Objectives
The following are guidelines regarding activities in which students should gain experience or at least exposure during the Hospital/ Health-Systems Pharmacy Rotation. These goals and objectives and the suggested time to spend on particular tasks may be adjusted according to the student's previous experience, the preceptor's expertise, and the unique characteristics of the rotation site.
When using the checklist, the student and preceptor may initial and date the appropriate boxes indicating items completed. If particular items, such as Investigational Drugs, are not available at the rotation site, please indicate “N/A."
Overall ratings of the accomplishment of checklist tasks are reflected in items 1 and 2 (Knowledge/Application section) of the final rotation evaluation and grade assignment.
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 a hospital/ health-systems 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 the hospital/ health-systems
- 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 entry 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
- Repackaging bulk to unit dose with appropriate record keeping and labeling
- Bulk dispensing, if applicable, according to established procedures at the hospital/ health-systems
- Unique dose preparation procedure, often called “specials”
- Non-sterile compounding - Student should use appropriate ingredients, make accurate calculations, make accurate measurements, and use correct procedures to make the product.
- Sterile compounding - Student should follow procedures to maintain sterile environment, including cleaning procedures, use of personal equipment, and aseptic technique. Student should make accurate calculations and measurements and learn fundamental concepts of IV compatibility and stability. Products to make include, but are not limited to, 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 - Student should follow procedures to maintain sterile environment, including cleaning procedures and aseptic technique. Student 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 prepare chemotherapeutic agents for patient administration.
- Delivery procedures - Student describes procedures for delivering products to patients/patient care areas and identifies products requiring special handling precautions (ie. fragile, “do not tube”, cytotoxic, costly products, etc…)
- Floor stock systems - Student describes use of floor stock systems used including rationale for providing floor stock instead of dispensing products pursuant to patient orders, locations in which floor stock systems are most appropriate, and procedures for maintaining floor stocks.
3. 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 - Student should describe pharmacist's role in investigational drug program in the hospital/ health-systems as well as storage, distribution, and record keeping requirements for investigational drugs.
5. Code Arrest Procedures - Student should describe the pharmacist's role in code situations and attend a code, if possible within hospital/ health-systems policies regarding code procedures. Student should become familiar with code cart stock, and if possible prepare a code cart for delivery to a 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 hospital/ health-systems regulations regarding pharmacy practice
- Departmental and hospital/ health-systems 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-four 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 a hospital/ health-systems pharmacist.
- Formulary – Student should define formulary and related terminology, process for adding or removing a product from the formulary, hospital/ health-systems 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, in order to solve medication order problems or perform clinical pharmacy consults. Students should also participate in patient counseling. 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 evaluate and resolve drug related problems.
- Evaluating information –Student should evaluate patient information and organize it for presentation to preceptor other health care providers to facilitate patient care decisions
- Documentation – The student should document clinical services and patient care interventions according to hospital/ health-systems procedures.