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DSM Experience

Non-Prescription Experience

Purpose

The purpose of the community clinical clerkship is to integrate pharmaceutical care² into community pharmacy settings and to embrace the concept that the pharmacist must be responsible and accountable for optimal drug therapy.  During the course of this rotation, the pharmacy student will be given an opportunity to provide direct patient care in the community pharmacy practice environment, to refine their skills in communication, patient care, health and wellness promotion, and practice management and to gain the experience and abilities needed to prosper professionally in a competitive health care system.  Emphasis will also be placed on utilizing primary literature and evidence-based medicine to determine therapeutic plans.

Goals and Objectives

 Note: ACP goals are numbered; Specific objectives are in italics and bulleted.

 Practice Foundation Skills

 1.      Take personal responsibility for attaining excellence in the ability to provide patient care in the community practice setting.

·         Display initiative in preventing, identifying and resolving patient care problems. 

·         Choose daily activities so that they reflect a priority on the delivery of patient care.

2.      Demonstrate ethical conduct in all practice-related activities.

·         Act ethically in the conduct of all practice-related activities.

 3.      Demonstrate the characteristics of a professional.

·         Choose daily activities so that they reflect the pursuit of expertise in the development of problem solving skills.

·         Dress in attire that conveys a professional image (including a short, white laboratory coat)

·         Consistently maintain personal self-control and professional decorum.

·         Present pharmacy concerns, solutions and interests in an assertive manner.

4.      Appreciate the need to adapt patient care for diversity.

·         Explain the need to adapt patient care plans for diversity (e.g., cultural, religious, racial, age, gender, sexual orientation, disability).

5.      Display a caring attitude toward patients in all aspects of job responsibilities.

·         Integrate compassionate and empathic behaviors with the delivery of patient care.

6.      Maintain confidentiality of patient and proprietary business information.

·         Observe legal and ethical guidelines for safeguarding the confidentiality of patient information.

·         Observe the community pharmacy’s policy for the safeguarding of proprietary business information.

7.      Manage time effectively to fulfill practice responsibilities.

 8.      Communicate clearly when speaking or writing.

·         Organize all written and oral communication in a clear, concise and logical manner.

·         Address all communication at the level appropriate for the audience.

·         Use correct grammar, punctuation, spelling, style, reference system, and formatting conventions in preparing all written communications.

·         Speak clearly and distinctly

·         Use listening skills effectively in performing job functions.

·         Use persuasive communication techniques effectively.

·         Prepare all communications so that they reflect the positive image of a pharmacy professional

Direct Patient Care 

1.      Design, recommend, monitor, and evaluate patient-specific therapy commensurate with the health care needs of the patient and the scope of responsibilities of the community pharmacist, to include the following: 

a.      Establish a collaborative professional relationship between the pharmacist and the patient and/or caregiver.   

b.      Build the patient-specific information base needed to design and implement a comprehensive patient care plan:

·         Collect and organize all patient-specific information to prevent, detect and resolve medication-related problems, to meet the patient’s health care needs, and to make appropriate therapeutic recommendations.

·         Determine the presence of any of the following medication or disease related problems in a patient’s current therapy:

1.      Medication used with no medical indication

2.      Medical conditions for which there is no medication prescribed

3.      Medication prescribed inappropriately for a particular medical condition

4.      Incomplete immunization regimen

5.      Anything inappropriate in the current medication therapy regimen (dose, dosage form, duration, schedule, route of administration, method of administration)

6.      Presence of therapeutic duplication

7.      Prescription of medication to the which the patient is allergic

8.      Presence of or potential for adverse drug or device-related events

9.      Presence of or potential for clinically significant drug-drug, drug-disease state, drug-nutrient or drug-laboratory test interactions.

10.  Interference with medical therapy by social, recreational, nonprescription, or nontraditional drug use.

11.  Problems arising from financial impact of medication therapy on the patient

12.  Patient lack of understanding of medication therapy

13.  Patient not adhering to medication regimen

14.  Patient at risk for complications associated with an existing disease state

15.  Patient at risk because of patient-specific characteristics (e.g., age, living/working environment)

16.  Therapy is adversely affecting patient’s quality of life 

3. Design patient care plans

·         Using an organized collection of patient-specific information, summarize the patient’s health care needs.

·        Identify those patients for whom meeting their health care needs is beyond the scope of practice of the community pharmacist.

·         Formulate effective communication strategies to assure that the patients pursue recommended referrals.

·         Specify pharmacotherapeutic and related health care goals for a patient that integrate patient-specific, disease-specific and medication-specific information, and ethical and quality-of-life considerations.

·         Design a therapeutic regimen that meets the pharmacotherapeutic and related health care goals established with a patient

·         Design monitoring plans for therapeutic regimens that effectively evaluate achievement of pharmacotherapeutic and related health care goals. 

4. Communicate patient care plans to patient.

5. Implement patient care plans.

·         Formulate an effective written or verbal referral to other health care professionals required for meeting the goals of the patient care plan. 

·         Exercise skill in performance of laboratory tests that are conducted in the community pharmacy. 

6. Redesign patient care pans based on evaluation of monitoring data and therapeutic outcomes.

·         Accurately interpret the meaning of monitoring data and therapeutic outcomes.

·         Redesign a patient care plan as necessary based on the evaluation of monitoring data and therapeutic outcomes.

2.      Provide patient-specific and caregiver-specific information.

·         Design medication-use education for patients and caregivers that effectively meets their needs

·         Use effective patient education techniques to provide counseling to patients and caregivers, including information on drug therapy, adverse effects, adherence, appropriate use, handling, drug administration and behavior modification. 

3.      Appropriately document patient care activities.

·         Appropriately select patient care activities for documentation

·         Use effective communication practices when documenting a patient care activity 

4.      Prepare and dispense medications using appropriate techniques.

·         Determine the appropriateness of a prescription before preparing or permitting it to be dispensed.

·         Follow the community pharmacy’s process to maintain the accuracy of the patient’s medication record.

·         Prepare medication using appropriate techniques.

·         Dispense prescriptions following the community pharmacy’s accepted process.

·         Administer medications using appropriate techniques

·         Appropriately fill prescriptions for durable medical equipment (if applicable at the site)

Drug Information  

1.      Provide concise, applicable and timely responses to requests for drug information from health care providers and patients. 

·         Accurately identify the requester’s drug information need

·         Formulate a systematic, efficient, and thorough procedure for retrieving drug information

·         Determine from all retrieved biomedical literature the appropriate information to evaluate.

·         Evaluate the usefulness of the biomedical literature gathered.

·         Provide appropriate responses to drug information questions that require the pharmacist to draw upon his or her knowledge base

·         Assess the effectiveness of drug information responses. 

2.      Participate in identification of need, development, implementation, and assessment of treatment guidelines and/or protocols related to patient care.

3.      Identify information resources appropriate for a community pharmacy practice setting.

·         Describe a variety of print and electronic resources that would be appropriate as a core set of information resources for a community pharmacy.

 

Practice Management 

1.      Understand approaches to individual time management that allow for the delivery of patient care. 

2.      Contribute to the pharmacy’s approach to customer service.

·         Formulate accurate response to patient inquiries

·         Provide accurate descriptions of the community pharmacy’s services

·         Apply appropriate organizational policies and procedures when responding to grievances

·         Understand the pharmacy’s philosophy for assuring patient satisfaction 

3.      Participate in activities that contribute to the pharmacy’s compliance with legal and regulatory requirements and performance standards (e.g., professional standards, statements and guidelines; state and federal laws regulating pharmacy practice; Occupational and Safety Health Administration [OSHA] Guidelines; CLIA guidelines)

·         Explain the legal and regulatory issues that face the community pharmacy practice.

·         Explain the steps required to ensure compliance with legal and regulatory requirements (federal and state laws) regulating community pharmacy practice.

·         Explain the effect of statues, rules, regulations, and professional standards on community pharmacy practice 

4.      Participate in site specific activities related to the day-to-day operations of the site (e.g., inventory, payroll, ordering, business planning, profit centers, etc.) 

References

1.       APhA & ASHP.  Accreditation standards and learning objectives for residency training in pharmacy practice (with emphasis in community care).  Washington; 1996.

2.        Hepler CD, Strand LM.  Opportunities and responsibilities in pharmaceuticalcare.  Am J Hosp Pharm 1990;47:533-543.

Last changed: 12/30/08