UNIVERSITY OF HOUSTON COLLEGE OF PHARMACY
PHAR 5692
ADVANCED HOSPITAL PHARMACY PRACTICE EXPERIENCE DESCRIPTION
Upon completion of PHAR 5692, the student shall be able to perform the functions of a pharmacist
in a hospital setting. The functions in a hospital pharmacy practice involve:
I.
Dispensing Function: in-patient area, manufacturing, compounding, repackaging,
controlled substances, and investigational drugs.
II.
Management Function: operations, purchasing, inventory control
III.
Educational Function: drug information, healthcare professional education, patient
education.
IV.
Pharmaceutical Care Function: monitoring, evaluating drug therapy, emergency
pharmacy services, communication.
Required Reading:
Advanced Hospital Pharmacy Practice Experience Readings
Brown TR, (ASHP), Introduction to Hospital and Health-System Pharmacy l Pharmacy Practice
(Chapters 7-16)
DEA Pharmacist’s Manual
Texas Pharmacy Rules Institutional Pharmacy
Texas Controlled Substances Act and Rules
Recommended:
Texas Pharmacy Act
Hansten PD, Drug Interactions, (latest edition)
Trissell Larry, Handbook of Injectable Drugs (latest edition)
Ansel and Stoklosa, 13th ed., Pharmaceutical Calculations
American Journal of Health-System Pharmacy (AJHP)
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PHAR 5692 Advanced
Hospital Pharmacy Practice Experience
Goals and Objectives
Goals
1. To develop a pharmacist who understands the operational aspects of hospital pharmacies and
their role in institutional healthcare delivery.
2. To develop a pharmacist who is familiar with institutional drug distribution systems.
3. To develop a pharmacist with good interpersonal/professional relationships.
4. To develop a pharmacist with good problem-identification and problem-solving skills and
professional judgment.
5. To develop a pharmacist who can select, initiate and monitor drug therapy.
Objectives
Upon completion of this rotation, students should be able to:
1. Provide a tour of departments, patient care areas and pharmacy-related areas of the hospital.
2. Locate the pharmacy’s policy and procedure manual and describe an overview of its contents.
3. Understand and perform functions related to the unit-dose drug distribution system.
4.
Review, interpret and evaluate new prescriptions and medication orders for accuracy and
appropriateness.
5. Communicate with patients in an effective and professional manner.
6. Describe the components of a patient medical record and their locations within the medical record.
Students should know institutional policies concerning documentation in the patient’s medical record,
and be familiar with all areas for documentation, including the Medication Administration Record
(MAR).
6. When presented with patient problems, recommend therapeutic plans to health care providers and
identify monitoring parameters and endpoints that measure desired outcomes.
7. Describe federal and state laws for controlled substances and their consistency with the hospital’s
policies and procedures.
8. Describe good hospital manufacturing and repackaging practices.
9. Perform pharmaceutical calculations, and aseptically compound sterile products.
10.
Under supervision of a pharmacist, check intravenous admixtures and other sterile preparations
prepared by technicians.
11. Describe special requirements for preparing cytotoxic agents and investigational drugs.
12. Describe the hospital’s methods, guidelines and equipment for administering intravenous solutions
including antibiotics, chemotherapy agents and intravenous push medications.
13. Accurately and effectively, communicate (oral, written and nonverbal) concise information to other
healthcare providers.
14. Describe procedures for appropriately receiving and responding to a drug information request at the site.
Demonstrate awareness of available sources of drug information.
15. Describe the role and impact of the following regulatory agencies on hospital pharmacy practice:
(FDA, DPS, DEA, TSBP, Medicare, Joint Commission, OSHA).
16. Define, compare and contrast inventory control and purchasing methods with the hospital’s policies,
procedures, and practices.
17. Describe the hospital’s quality improvement program, including adverse drug reaction reporting,
medication error reporting, and infection control monitoring.
18. Explain basic pharmacy fiscal procedures including the annual budget process.
19. Describe the pharmacy department’s involvement on hospital committees (i.e., Pharmacy and
Therapeutics, Pharmacy-Nursing, Infection Control, Institutional Review Board, etc).
20. Discuss USP Chapter 797 guidelines.
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Competencies for Advanced Hospital Pharmacy Practice Experience
(PHAR 5692)
Upon completion of Advanced Hospital Pharmacy Practice Experience (PHAR 5692), the student
will be able to:
1. Review medication orders for completeness and potential problems concerning accuracy,
allergies, legality, dose, route, frequency, and duration of use.
2. Demonstrate proficiency in reviewing medication order for drug-drug; drug-food; drug-disease
interactions and drug duplication.
3. When a problem is identified, make appropriate interventions in the patient’s behalf.
4. Perform distributive functions in a unit-dose drug-distribution system including preparation of
first dose selection, cart filing, cart exchange, extemporaneous packaging, and use of dispensing
automation.
5. Develop, implement, and manage a unit-dose drug-distribution system.
6. Describe federal and state laws for controlled substances and how the hospital’s policy and
procedures comply with those laws.
7. Demonstrate knowledge of the different types of formularies in a hospital setting.
8. Select and recommend an appropriate formulary drug when a non-formulary drug is ordered.
9. Calculate correct amounts of additives for intravenous or TPN products.
10. Aseptically prepare intravenous admixtures and TPN solutions.
11. Define risk levels for sterile products and describe the facility’s guidelines and procedures
appropriate for risk level.
12. Perform appropriate calculations needed to fill prescription or medication orders.
13. Demonstrate proficiency in communications skills by performing patient counseling on topics
such as warfarin self-administration and monitoring, inhaler use, and proper use of discharge
medications.
14. Review, interpret, and evaluate medication orders against a pharmacy patient profile and
patient’s medical record.
15. Describe procedures for the preparation, inventory, dispensing, and monitoring of
investigational drugs.
16. Define and describe perpetual and physical inventories and methods of purchasing, ordering,
and receiving merchandise.
17. Effectively communicate with other health care professionals.
18. Recommend appropriate drug therapy and alternative therapeutic solutions.
19. Compound extemporaneous products and describe institutional guidelines for compounding and
packaging of products.
20. Describe the role and impact of regulatory agencies or accrediting organizations including the
FDA, DEA, Texas State Board of Pharmacy, Medicare, OSHA, DPS, Joint Commission, and
ASHP as they affect hospital pharmacy practice.
21. Utilize hospital-based drug information resources to answer therapeutic questions.
22. Describe the role of hospital committees, including Pharmacy and Therapeutics, Infection
Control, Quality Assurance, and Discharge Planning,
23. Complete an adverse drug reaction report.
24. Reconcile pharmacy medication profiles with nursing medication administration records.
25. Describe the impact of the USP Chapter 797 guidelines in pharmacy practice.
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Grading Policy
1.Grading Criteria for Advanced Hospital Pharmacy Practice Experience - PHAR 5692
Grading Criteria is competency based. Minimal passing performance is 70%.
Grading Criteria:
A total of 500 points may be achieved upon completion of the PHAR 5692, Advanced
Hospital Pharmacy Practice Experience. These points are composed of scores from the
written final examination, practical examination, and the course coordinator’s evaluation.
The following maximum point values may be achieved in each of the areas:
Written Final Examination
Practical Examination (Errors & Omissions)
Mid-term Evaluation from preceptor
Final Evaluation from preceptor
Preceptor Experiential Grade
Practice Experiential Director Grade __
TOTAL
150 points
150 points
*P/F
*P/F
100 points**
100 points***
500 points
*In order to receive a passing grade for the rotation the intern:
1. Must NOT receive four (4) or more “2” ratings on the end on rotation evaluation in the
first 18 dimensions.
2. Must NOT receive a “1” rating on the end on rotation evaluation on dimensions 1 – 22.
**Preceptor Experiential Grade is based on the following:
Drug Utilization Review
Meets Stated Goals and Objectives
Professionalism
Communication/Interpersonal Skills
Initiative/Attitude
Total
20
20
20
20
20
100
***Practice Experiential Director Grade – Accountability or Responsibility points
A letter grade is assigned based on the total points earned.**
A = 450 - 500 points
B = 400 - 449 points
C = 350 - 399 points
D = 325 - 349 points
F = <325 points
(90 - 100%)
(80 - 89%)
(70 - 79%)
(65 - 69%) – repeat APPE
(< 65%) – repeat APPE
**To obtain a grade of C or better the student must:
a. Earn a minimum of 105 points (70%) on the Written Final Examination.
b. Earn a minimum of 105 points (70%) from the Practical Examination.
c. Follow guidelines of the Internship and Attendance Policies.
d. Complete all required course evaluations (preceptor, site, intern).
e. Submit all required rotation paperwork by the appropriate deadlines.
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1. Exams and Evaluations for Advanced Hospital Pharmacy Practice Experience

Preceptor Midterm and Final Evaluation. These evaluations should be completed following
the “Guidelines for Preceptor Evaluation of Student” described in this manual.

Practical Examination. To prepare for this examination, the student should complete, with
the involvement of an instructor at their hospital site, both the Intravenous Admixture
Compounding Checklist and the Drug Distribution: Unit Dose Checklist. In addition,
completion of normal student/intern responsibilities should adequately prepare the student
for examination. The practical examination may involve the following:
A.
Drug Distribution: Unit Dose Activities
1.
2.
3.
4.
5.
B.
Preparation of patient profiles
Critique of profiles prepared by a technician
Critique of Unit Dose Cassettes prepared by a technician
Critique of medication order filled by a technician
Review of patient profile and/or medication orders for allergies, drug-drug
interactions, drug-diet interactions, drug-disease state interaction.
Intravenous Admixture Activities
1.
Preparation of intravenous admixture or other sterile products.
2.
Critique of intravenous admixture or other sterile products prepared by a
technician.

Interventions. A minimum of ten (10) interventions will be completed by students during
the rotation using the appropriate method. Interventions will be graded on quality and
completeness. Students will lose 10 responsibility points for each intervention not meeting
standards.

Homework assignments. Homework assignments will be provided to the intern prior to the
rotation. They should be studied in preparation for the final written examination.

Final Written Examination. This examination will be based upon the competencies,
required readings, and homework assignments.
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PHAR 5692
Advanced Hospital
Pharmacy
Competencies
Drug Distribution-Unit Dose-Order Entry
Checklist
Intravenous Admixture Compounding
Checklist
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Orientation to the Hospital and Pharmacy Department
Objectives
Completed by Date
1.
Complete a tour of the hospital to become familiar with the
location of various departments, patient care areas, and
pharmacy-related areas.
________________
2.
Complete a tour of the pharmacy, noting location of equipment,
supplies, drug products, and reference materials.
________________
3.
Introduce student to each employee. The student and employee
should be told about each other’s functions and responsibilities.
________________
4.
Review the department’s Policy and Procedure manual.
Topics to be reviewed include:
a.
confidentiality
b.
manner of dress
c.
lines of authority (as related to students)
d.
scheduling of student hours
e.
absence and tardiness (as related to students)
f.
scheduling of student evaluations
g.
telephone etiquette - does student answer phone properly?
h.
safety and emergency procedures
_________________
Discuss the scope of pharmacy services at the site. For example:
a. Distributive
b. Clinical/pharmaceutical care
c. Research/Investigational
6. Describe inter- and intra- departmental services that support
inpatient drug distribution.
5.
________________
__________________
7.
Describe the formulary system used at the site.
__________________
8.
Describe the site’s policy and procedure on generic substitution
__________________
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Performance Dimensions
Provides drug product
Determines appropriateness of order
Evaluates and selects product
Assures product/prescription accuracy
Objectives
I.
Completed by Date
A.
Describes policies and procedures for dispensing
unit dose drugs, including stat, refrigerated,
controlled substances, and automatic stop orders.
________________
B.
Performs functions related to the distribution
aspect of the unit dose system including:
________________
1.
2.
3.
4.
5.
6.
7.
8.
9.
first dose selection
cart filling
cart exchange
extemporaneous packaging
record keeping for pumps/devices (if applicable)
delivery
floor stock replacement (i.e. Pyxis ® machine, manual system)
refrigerated items
automation
C.
Checks for the accuracy of filled medication cassettes/carts and
takes appropriate corrective action, if necessary.
__________________
D.
Reviews medication orders for drug related
problems. For example:
__________________
1.
2.
3.
4.
5.
E.
completeness
accuracy
legality
potential allergic reaction
valid indication
6.
7.
8.
9.
10.
drug disease interaction
proper dosage form
correct dose and interval
drug-drug, drug-food interaction
drug duplication
Labels and dispenses medication to be delivered accurately and
professionally. Applies appropriate auxiliary labels.
F. Refilling orders:
_________________
_________________
1. Describe the procedure by which medication is re-ordered for the patient.
2. Interpret and refill any authorized refill request
3. Recognize an unauthorized refill request and communicate with the person requester.
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Objectives
Completed by Date
G.
Identify labeling requirements including auxiliary labels for
1. Solids
2. liquids
3. compounded products
4. internal products
5. external products
6. non-human use preparations, i.e. cleaning solutions
7. injections
________________
H.
Student will screen legend Schedule, II, III, IV, V
prescriptions/medication orders for all legally required information.
___________ _____
I.
Student will screen investigational prescription/medication orders
for all legally required information.
___________ ____
J.
Student will screen prescriptions/medication orders to determine
if drug, dose, and dosing and schedule are appropriate.
___________ ____
Student will review, interpret, and evaluate new prescription o r
medication orders and identify those which require priority
attention and/or clarification.
L. Student will perform necessary calculations to fill prescription
or medication order.
___________ ____
K.
___________ ____
Under the supervision of your preceptor:
M.
Complete the Drug Distribution Unit Dose Checklist on the
following pages.
___________ ____
Turn in to the course coordinator before taking practical examination.
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Drug Distribution – Unit Dose-Order Entry Checklist
The University of Houston College of Pharmacy – Advanced Hospital Pharmacy Practice
Experience
Student:_______________________________ Date:______________________________
Preceptor:______________________________
Site:______________________________
Please check the appropriate evaluation category for each skill and review with the student.
SKILL
ASSESSMENT
Needs
Competent Reinforcement
Notes
RECEIPT AND INTERPRETATION
OF MEDICATION ORDER
Review for: Patient’s name, location, time
and number of doses needed to fill required
supply; appropriateness of drug, dose,
route, and frequency
Allergies and hypersensitivities
Review medication order against orders on
patient profile
Record necessary information on patient
profile
Send required medications to patient care
area
ESTABLISHING A PATIENT
PROFILE: UNIT DOSE
Enter patient’s name, age, gender,
identification number, primary diagnosis,
physician, allergies, special diets, and other
items per practice site policy and procedure
For each order received, record:
Pharmacist’s initials
Date received
Drug name, strength, sig, route
Start and stop date
“fill” or “set” level – know definition
Amount initially dispensed
Whenever medication is dispensed, review
the order against the patient profile for:
Potential drug interactions
Therapeutic duplication
Inappropriate therapy
Special religious requirements
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Page 2 – Drug Distribution – Unit Dose-Order Entry Checklist
SKILL
ASSESSMENT
Needs
Competent Reinforcement
Notes
IV ADMIXTURE PATIENT PROFILE
All information included on unit dose
patient profile should be included, along
with:
Base solution and quantity
Additive(s) and quantity(ies)
Bag or bottle number
UNIT DOSE DISTRIBUTION
Review patient profile for drug
interactions, therapeutic duplication and
problems, automatic stop dates
Credit patient with returned medications
on patient profile (if applicable)
Fill patient medication drawer with
appropriate amount of medication
Check expiration dates
Attach ancillary labels
Review procedures for dispensing unit dose
medications via automated devices (ex:
PYXIS)
PATIENT DISCHARGE
Credit patient with returned medications on
patient profile (if applicable)
Profile is discontinued and sent for
charging (if appropriate)
Appropriate medications are returned to
stock
POINTS FOR REVIEW
COMMENTS:
Credit and charging & patient transfers _____________________________________________
Reconciling
_________________________________________________________________
Narcotic dispensing____________________________________________________________
Floor stock medication___________________________________________________________
_____________________________________________________________________________
Preceptor signature
Date
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II.
Communicates with patients about prescription drugs
Interviews and counsels patients on drug usage, dosage, packaging, and
storage
Discuss drug cautions, side effects, and patient conditions
Explains policies on fees and services
Relates to patients in a professional manner
Interacts to confirm patient understanding
Objectives
III.
Completed by Date
A.
Interviews and counsels patients on drug usage, dosage,
packaging, and storage.
_______________
B.
Discuss drug cautions, side effects, and patient conditions.
_______________
C.
Explains policies on fees and services.
_______________
D.
Relates to patients in a professional manner.
_______________
E.
Interacts to confirm patient understanding
_______________
Monitors and evaluates drug therapy; initial and ongoing
A. Establishes and interprets data bases
Database includes active problems, PMH, pertinent PE, and lab data, hospital course
Medication history performed and complete
Medication profile complete and up to date
Pharmacokinetic parameters determined
Objectives
A.
Completed by Date
Locate the following in a patient’s chart:
1.
2.
3.
4.
5.
6.
7.
8.
________________
patient diagnosis
physician’s orders
medication administration record
nursing notes
laboratory reports
patient allergies/drug sensitivities
history and physical
progress notes
B.
Review, interpret, and evaluate new medication orders against
the pharmacy patient profile. Identify those which require priority
attention and/or clarification.
_________________
C.
Record all appropriate information on the pharmacy patient
medication profile.
_________________
D.
Perform and complete medication history
_________________
E.
Identify appropriate pharmacokinetic monitoring parameters for each patient. ___________
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Monitors and evaluates drug therapy; initial and ongoing
B. Identifies drug related problem(s)
Determines if any drug related problems exist
Supports through documentation of the drug related problems
Objectives
A.
Completed by Date
Review patient medication profiles for drug related problems.
For example:
1.
2.
3.
4.
5.
________________
completeness
6. drug disease interaction
accuracy
7. proper dosage form
legality
8. correct dose and interval
potential allergic reaction
9. drug-drug, drug-food
valid indication
interaction
10. drug duplication
B.
The student is able to screen for allergic reactions.
________________
C.
Reconcile pharmacy medication profiles with nursing medication
administration records.
________________
III.
Monitors and evaluates drug therapy; initial and ongoing
C. Recommends appropriate therapeutic plan(s)
Determines appropriate therapeutic endpoints and plan
Recommends appropriate drug therapy (dose, duration, route, etc.)
Selects appropriate parameters to monitor efficacy and toxicity
Objectives
Completed by Date
A.
The student is able to suggest appropriate alternatives to manage
therapeutic duplication.
________________
B.
The student is able to suggest appropriate alternative to manage
therapeutic problems.
________________
III.
Monitors and evaluates drug therapy; initial and ongoing
D. Devises follow-up plan(s)
Determines appropriate time(s) to re-evaluate patient and assess efficacy and toxicity
Conducts the follow-up plan in a timely manner
Objectives
Completed by Date
A.
Determine appropriate time to re-evaluate the patient and assess
efficacy and toxicity.
________________
B.
Conducts the follow-up plan in a timely manner.
________________
C.
Identify the outcome(s) that occurred as a result of an intervention
in a drug-related problem.
________________
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IV.
Maintains Professional - Ethical Standards
Complies with laws and regulations
Applies good professional judgment in legal interpretations
Exhibits reliability and credibility in dealing with others
Deals professionally and ethically with colleagues and patients
Maintains confidentiality
Objectives
Completed by Date
A.
Describe Federal and State laws for controlled substances.
________________
B.
Describe the hospital’s policies and procedures to comply with
laws and regulations for controlled substances records, including:
1. filling
2. discrepancy
3. waste
4. nursing records
5. shift counts
6. storage and access to narcotic cabinet
7. quality assurance audits
________________
C.
Participate in a daily or weekly inventory audit of controlled
substances.
_________________
D.
Participate in a monthly nursing unit audit of controlled
substances.
_________________
Describe how controlled substances are ordered through the DEA
order form and who has the authority to sign the form.
________________
F.
Describe laws regarding the requirements for ordering, storage,
transfer, dispensing, and use in compounding of ethyl alcohol.
_________________
G.
Review local fire ordinances concerning the storage of volatile
liquids including ethyl alcohol.
_________________
H.
Describe good manufacturing practices.
_________________
Describe policies and procedures regarding repackaging of drug
products.
_________________
J.
Describe policies and procedures for repackaging and
compounding controlled substances.
_________________
K.
Define maximum and minimum volumes for intramuscular
and subcutaneous injections.
_________________
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V. Communicates with patients about nonprescription products, devices, and diagnostics
Questions patients on conditions and intended drug use
Assists in and recommends drug selection
Communicates OTC drug dosage, usage and storage, side-effects, packaging
Refers patients to other health professionals
Provides information on medical/surgical and home health care devices and diagnostic
products
Provides poison control treatment, information, and referral
Objectives
Completed by Date
A.
Communicates with patients about nonprescription products,
devices, and diagnostics.
________________
B.
Questions patients on conditions and intended drug use.
________________
C.
Assists in and recommends drug selection.
________________
D.
Communicates OTC drug dosage, usage and storage,
side-effects, and packaging.
________________
F.
Refers patients to other health professionals, when appropriate.
________________
G.
Provides information on medical/surgical and home health care
________________
devices and diagnostic products.
G.
Provides poison control treatment, information, and referral.
VI.
Compounds
Utilizes acceptable professional procedures
Selects appropriate equipment and containers
Prepares special dosage forms
Documents calculations and procedures
________________
Objectives
Completed by Date
Intravenous Admixtures
A. Aseptically prepare I.V. admixtures including necessary
pharmaceutical calculations.
________________
1.
2.
3.
4.
B.
Select appropriate bulk solution.
Select appropriate diluent.
Apply appropriate product labeling, to include auxiliary information.
Determine stability, incompatibilities and storage requirements.
Describe the special precautions observed when preparing or
administering hazardous or cytotoxic agents.
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_________________
C.
Under the supervision of a pharmacist, check intravenous solutions
and other sterile products prepared by technicians for accuracy
and completeness.
_________________
D.
Describe procedures for compounding sterile preparations
according to standards of USP Chapter 797.
_________________
E.
Describe the procedure for the preparation of investigational
drug IV admixtures.
_________________
F.
Describe the site’s procedures and guidelines for:
1. antibiotic standardization of base solutions
2. chemotherapy standardization of base solutions
3. minimal volume
4. I.V. push guidelines
_________________
G.
Describe the methods, equipment, and supplies
used to administer intravenous solutions including
the types of administration sets, needles, catheters,
pumps, and devices used at the site.
________________
H.
Describe I.V. medication errors and procedures
used to prevent errors.
_________________
Under the supervision of a preceptor:
I.
Complete the Intravenous Admixture Compounding
Checklist on the following page.
_________________
Turn in to the course coordinator before taking practical examination.
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Intravenous Admixture Compounding Checklist
University of Houston College of Pharmacy Advanced Hospital Pharmacy Practice Experience
Student: ____________________________ Date: ____________________________________
Preceptor: ___________________________Site: _____________________________________
Please check the appropriate evaluation category for each skill and review with the student.
SKILL
ASSESSMENT
Needs
Competent Reinforcement Notes
ASEPTIC TECHNIQUE
Remove jewelry from hands and wrists.
Roll sleeves above elbow.
Scrub nails, hands, arms (to elbow) with water and
disinfecting agent for at least 30 seconds. Turn faucet off
with paper towel.
Follow proper personnel garbing procedure.
LAMINAR FLOW HOOD
Turn hood on 30 minutes before use
Clean sides and work surface using proper technique and
appropriate solution.
Allow work surface to dry.
INTERPRET MEDICATION ORDER
Read order and determine if appropriate dose, route,
frequency of administration
Check for potential incompatibilities.
Determine the admixture materials needed.
Calculate amount of each admixture needed (show work on
order)
Determine the volume of each additive
LABEL PREPARATION
Type label for IV admixture
Label should include the following items:
Patient name
Unique identifying number
Patient room number
Additive strength and amount
Base solution
Preparation date
Expiration date and time
Prescription or bottle number
Administration directions
Ancillary precaution labels
Initials of pharmacist and technician
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page 2 – IV Checklist
SKILL
Student: _______________________________
ASSESSMENT
Needs
Competent Reinforcement
Notes
COMPOUNDING: ASEPTIC TECHNIQUE
Place the needed ingredients in the hood workspace. Do not
place paper, pencils, labels, orders, etc. in hood. Do not put
head inside the hood.
Compound at least 6 inches inside hood.
Arrange items properly without interrupting HEPA
airflow.
Wipe Vials, ampules, and IV bag or bottle port with 70%
alcohol and allow to dry.
Select the appropriate size syringes for each additive and
set next to each item.
Attach needle to syringe aseptically.
For vials requiring reconstitution:
Determine the amount of diluent: follow the manufacturer’s
directions or determine powder volume.
Vent vial.
Add diluent.
Remove venting needle.
Rotate vial gently back and forth until in solution.
For ampules:
Tap down to remove solution.
Swab neck with alcohol.
Use thumb and index finger at neck of ampule to open.
Quickly snap top of ampule off.
Withdraw desired quantity.
Attach filter needle to syringe containing additive.
Draw up appropriate volume of additive aseptically.
Remove air bubbles from syringe.
Inject additive into IV bag or bottle.
Mix primary solution between each addition
Check solution for particulate matter, damaged container,
etc. by “swirling” and holding to light or using a light box.
LABELING
Attach label in appropriate location
Have preparation checked and initialed
Preparation is “bagged” or “foiled” if light sensitive.
Preceptor’s Signature/Date
_______________________________________
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Manufacturing, Compounding, and Repackaging
Objectives
Completed by Date
A.
Describe packaging equipment and operation.
_______________
B.
Describe overfill volumes for liquid dosage forms.
_______________
C.
Describe the guidelines for the cutting of tablets and suppositories
_______________
D.
Determine expiration date for compounded and
repackaged products.
_______________
E.
Describe the procedure for standard compounded products:
_______________
1.
2.
3.
4.
5.
F.
product formulation sheets
calculation/measurements
checking
filling
revision process
Compound extemporaneous product formulas:
1. when a “recipe” is available
2. when a “recipe” is not available
3. Describe good manufacturing practices
_______________
_______________
VII. Communicates
with health professionals
Obtains or provides accurate and concise information in a professional manner
Uses appropriate oral, written, and nonverbal language
Objectives
Completed by Date
A.
For those orders requiring clarification, communicate with the
physician or nurse to resolve problems to obtain clarifying or
additional information in a timely and professional manner.
________________
B.
Describe the policy and procedures at the site for recording
clarified medication orders in the patient’s medical record.
________________
VIII. Retrieves
and evaluates drug information
Selects best available resource for answering a drug related request in a timely fashion
Interprets the information obtained and judges relevance
Objectives
Completed by Date
A.
Review the procedures for receiving a drug information request :
________________
 obtain pertinent information from the caller
 select appropriate drug information sources for any given question
 answer question or find someone who can
 documentation of question and answer
 evaluation of call (quality assurance)
B.
Describe the practice site’s procedure for handling a poison
ingestion call. List the number for the regional poison center.
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________________
Objectives
Completed by Date
C.
Review the hours of operation, region of service and the
population the drug information center serves.
________________
D.
Describe the function of a drug information service:
 maintenance of adequate resources and drug literature
 extemporaneous questions
 Pharmacy and Therapeutics committee support
 distribution of drug literature and pharmacy bulletins
 in-service education support
 reviewing activities of drug vendors
 legal liability of supplying drug information
________________
E.
Describe information sources that are available:
 primary
 secondary
 tertiary
 computerized
________________
F.
Communicate effectively, in person or by telephone, with
pharmacists, nurses, physicians, and patients in solving drug
information problems.
_________________
G.
Describe intravenous compatibility data:
when compatibility data is available
 when compatibility data is not available
________________
H.
Describe the references to use to identify foreign drugs and be able
to provide U.S. equivalents.
________________
I.
Identify a tablet/capsule using an imprint.
________________
J.
Describe the site’s treatment of extravasations and how this can
differ at various institutions.
_______________
K.
Respond to other health care professionals’ questions regarding
questions regarding:
 product availability
 manufacturer
 storage requirements
 dosage
 appearance
 potential interactions
 side effects
 usage
 bioavailability information
________________
L.
Evaluate the importance of pharmaceutical companies as an
information source.
________________
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IX.
Manages general pharmacy operations
Participates in planning and policy making
Controls drug inventory
Provides drug security, storage, and control procedures
Maintain quality assurance
Participate in basic fiscal procedures
Attends meetings involving pharmacy representation
Facilitates professional growth of others
A.
Participates in planning and policy making
Objectives
Completed by Date
1.
Review the site’s policies and procedures for general pharmacy
operations and discuss their development with the preceptor.
________________
2.
Describe the organizational chart of the pharmacy and how it
reflects the strategic planning of pharmacy services.
________________
3.
Describe the role and impact of the following regulatory agencies
on hospital pharmacy practice:
 FDA
 DEA
 Texas State Board of Pharmacy
 Joint Commission on Accreditation of Healthcare Organizations
 DPS
 Omnibus Budget Reconciliation Act (OBRA)
 Medicare
 Occupational Safety and Health Administration (OSHA)
 Texas Department of Health
________________
4.
Describe the site’s adverse drug reaction monitoring and
reporting system.
________________
5.
Describe the site’s medication error reporting system
________________
B.
Controls drug inventory.
Objectives
Completed by Date
1. Define inventory control and the methods used at the site to
control drug inventory.
________________
2. Describe the different methods of purchasing used at the site
________________
3. Describe how purchasing may vary between institutions and
in hospital versus community settings.
4. Describe methods for acquisition of non-drug and ancillary
products.
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________________
Objectives
Completed by Date
5. Describe the process for ordering and receiving merchandise
________________
including:
 order processing
 validation of receipt
 documenting and tracking of backorders and selection of alternate product sources
 pricing
5.
Define perpetual and physical inventories and benefits of each
________________
6.
Describe the importance of inventory turnover, turnover rate,
method of calculation, how the number of “turns” is influenced by
a prime vendor, and how method(s) of payment to a prime vendor
affect(s) the number of turns.
________________
7.
Describe the policy for the return of goods to the manufacturer or
wholesaler, including outdated, damaged, or recalled products.
________________
8.
Describe the role of Medical Services Representatives and why
they are important, including:
 file directory management of representatives
 resources for drug information and educational resources
 product availability, pricing structures, and changes
________________
9.
Describe methods for the loan and borrowing of drug products
between institutions.
________________
10.
Describe open vs. closed formulary as applied to inventory control.
________________
C.
Provides drug security, storage, and control procedures.
Objectives
Completed by Date
1.
Inspect the security, storage, and control procedures for floor
stock medication issued to areas outside the pharmacy, such as
radiology, emergency room, operating room, recovery room, etc.
________________
2.
Review the site’s inspection procedure including forms and
frequency of these inspections.
________________
3.
Participate in a nursing unit inspection
________________
4.
Describe the site’s drug use evaluation program, including
structure, process and outcome.
________________
5.
Assist with data collection of a drug use evaluation at the site.
evaluation at the site.
________________
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D.
Maintain quality assurance.
Objectives
Completed by Date
1.
Describe the site’s quality assurance program, including
structure, process, and outcome.
________________
2.
Assist with the quality assurance process at the site.
________________
3.
Describe the pharmacist’s role in infection control
________________
4.
Describe the quality assurance program for IV admixtures
used at the site.
________________
5.
Describe quality assurance monitors for manufacturing,
compounding, and repackaging.
________________
E.
Participate in basic fiscal procedures.
Objectives
Completed by Date
1.
Describe the pharmacy budget
________________
2.
Describe the site’s policy and procedure fee
a. charging medication
b. crediting medication
________________
F.
Attends meetings involving pharmacy representation
Objectives
Completed by Date
1.
Describe pharmacy committee activities including pharmacy and
nursing committees and attend committee meeting, if possible.
________________
2.
Describe the purpose, organization, and scope of function of the
Pharmacy and Therapeutics Committee.
________________
3.
Attend a P&T Committee Meeting if possible.
________________
4.
Attend a Gulf Coast Society of Health-System Pharmacist Meeting.
________________
5.
Attend educational programs offered by the hospital not limited
to pharmacy.
_______________
6.
Attend a state or national health system pharmacy meeting.
________________
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