PHRM 8131
Advanced Pharmacy Practice Experience
Advanced Institutional
Course Syllabus
Preceptor
Include title & credentials
Practice Site Address
Office Telephone
Other Telephone (optional)
Email
Hours
Description of Advanced Institutional APPE
This advanced pharmacy practice experience (APPE) builds upon the introductory institutional experience,
providing student exposure and involvement in a variety of inpatient pharmacy practice settings.
Emphasis is placed on regulatory, human resource, patient care, and technology issues as well as drug
distribution, inter-department collaboration, and general pharmacy administration.
Course Meeting Times
This course is scheduled to meet for one calendar month, with a minimum of 160 hours spent on
activities directly related to the objectives identified below. The preceptor has the authority to determine
specific meeting time parameters within the aforementioned schedule. See the PCSP Bulletin (p.31) for
the Experiential Policy for Attendance and Absence.
Hours: State hours the student is to be on site, including situations where student may
need to stay after hours. Specify lunch & departure times. Time at lunch does not count
toward hours spent at site.
Provide daily schedule indicating when different
activities or breaks may take place. Include time to meet with the student to discuss the
student’s performance and make recommendations for improvement. Attach a weekly
calendar.
Daily Schedule/Assignment Calendar:
Pre-Arrival Instructions & Logistics for Students
• Describe or outline specific department or site requirements. For example, “HIPPA
•
•
training to be conducted by district office or PIC on Day 1 of rotations.”
List information such as directions to facility, parking instructions, and other site
requirements.
Provide information (links or attached reading material) about any topics that the
student should review prior to the start of the rotation.
PHRM 8131, Advanced Institutional APPE
Syllabus (Revised 03-25-13)
Page 1
Advanced Institutional APPE Objectives/Goals
The following are guidelines regarding activities in which students should gain experience or at least
exposure during the Advanced Institutional 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.
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.
a. The student should describe requirements for receiving orders including written, electronic,
verbal, and any other means allowed in institution
b. The student should evaluate orders for completeness, appropriate indication, appropriate
dosing and route of administration, allergies, drug-drug interactions, drug-disease
interactions, formulary requirements
c. The student should perform order entry including creating a profile or adding information to
existing profile, and select products appropriately.
2. Preparation/Distribution – 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.
a. Unit dose – cart fill/delivery
b. Repackaging bulk to unit dose with appropriate record keeping and labeling
c. Bulk dispensing, if applicable, according to established procedures at the institution
d. Unique dose preparation procedure, often called “specials”
e. Non-sterile compounding - Student should use appropriate ingredients, make accurate
calculations, make accurate measurements, and use correct procedures to make the product.
f. 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.
g. 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.
h. 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…)
i. 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.
PHRM 8131, Advanced Institutional APPE
Syllabus (Revised 03-25-13)
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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 institution as well as storage, distribution, and record keeping requirements for
investigational drugs.
5. Code Procedures - Student should describe the pharmacist's role in code situations and attend a
code, if possible within institutional 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.
a. 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
b. Billing procedures for pharmacy services including provision of products and clinical services
c. Procurement and maintenance of equipment in the pharmacy
d. Compliance with federal, state, and institutional regulations regarding pharmacy practice
e. Departmental and institutional meetings relevant to pharmacy services (ie. Staff meetings,
P&T, interdisciplinary, etc….)
f. Adverse drug event and medication error reporting including follow-up evaluation
Advanced Institutional APPE Competencies:
Experiential activities are matched to the PC 12 Competencies, which are based on the ACPE
competencies. Using the aforementioned objectives as a guide, consider student activities
applicable to your practice setting; then to standardize student achievement for your
experience, use specific metrics when assessing competence.
PC 12 COMPETENCIES:
1. Communication
2. Evidence-based Decisions in the Practice of Pharmacy
3. Problem Prevention and Solving
4. Dispensing of Pharmaceuticals
5. Providing Pharmaceutical Care to Individual Patients
6. Providing Pharmaceutical Care to Patient Populations
7. Inter-professional Interaction and Teamwork
8. Ethical and Legal Judgment
9. Personal and Professional Growth
10. Management Skills
11. Advancement of Pharmacy and Health Care
12. Promotion of Health and Public Welfare
Examples:
1. Educational presentation
 Prepare and present a medication or disease state-related topic to the preceptor and an audience
of other healthcare professionals (e.g., physicians, nurses, physician assistants, other healthcare
staff) [minimum of 1]
PHRM 8131, Advanced Institutional APPE
Syllabus (Revised 03-25-13)
Page 3
2. Drug information and literature review
 Prepare a written summary of clinical trial(s) evaluating medical therapy that applies to a
patient case [minimum of 1]
 Address drug information requests from healthcare providers and/or patients [minimum of 2]
Assessment Methods
The student pharmacists on an Advanced Institutional APPE will be assessed for achieving the APPE
objectives and competencies subjectively and objectively by the preceptor. Preceptors are to evaluate
the student based on objective materials and subjective assessment and are required to complete a
formative mid-point evaluation and a summative final evaluation using E-Value.
(OPTIONAL) Objective evaluations may include, but are not limited to:
1. Communication Evaluation Form
2. Presentation Evaluation Form
3. Drug Information Request Form
The optional objective evaluation forms identified above are available to preceptors who
choose to utilize them. The subjective assessment shall include the competencies as
determined by the Office of Experiential Education at Presbyterian College School of
Pharmacy.
Students will receive a letter grade as determined in the final evaluation. To satisfactorily complete the
Advanced Institutional APPE, students must receive a grade of C or higher, complete the competency
checklist, and upload the requested materials in their online portfolio (My Folio).
Grading Scale:
93 - 100%
90- 92%
87 - 89%
83 - 86%
80 - 82%
77- 79%
70- 76%
60- 69%
<60% F
A
AB+
B
BC+
C
D
(Grading scale approved by PCSP faculty)
Level of Student Responsibility
The student on an Advanced Institutional APPE is expected to have face-to-face interaction with patients
under the supervision of a pharmacist preceptor or a healthcare provider. The student is expected to
interact in a professional manner with other healthcare professionals and patients.
Type of Setting for the APPE
An Advanced Institutional APPE should occur in an inpatient healthcare setting, a hospital-based clinic,
outpatient home infusion clinic, or a similar setting in which patients are evaluated by other healthcare
professionals.
Student Professionalism & Code of Conduct
A student pharmacist on an Advanced Institutional APPE is expected to follow the rules, policies and
procedures pertaining to the honor code and professional standard at Presbyterian College School of
PHRM 8131, Advanced Institutional APPE
Syllabus (Revised 03-25-13)
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Pharmacy. Any violation of the Honor Code (e.g., cheating, plagiarism, falsification, withholding
information, tampering with records, etc.) or the professional standards (e.g., unprofessional behavior,
including tardiness, absences, behavior, appearance, etc.) will be reported immediately upon discovery
and will be dealt with per Presbyterian College School of Pharmacy policy and procedure. See Student
Bulletin for full details of this policy.
Special Accommodations
Any student pharmacist on an Advanced Institutional APPE who has a disability that may prevent him/her
from fully demonstrating his/her abilities should inform the preceptor personally as soon as possible to
discuss accommodations necessary to ensure full participation and facilitate his/her educational
opportunities.
Student Responsibilities During the Experience
Please see the activity checklist at the end of this syllabus to use as a source reference to
detail specific competency-based student activities as needed. Apply, edit, delete, and/or
replace those examples listed below as you deem appropriate.
1. Formal Patient Case (with drug literature review)
a. Student pharmacists need to learn how to appropriately evaluate and apply clinical guidelines
and evidence-based medicine in devising treatment plans for patient care. In addition,
student pharmacists need to understand how to tailor and design a treatment plan for an
individual patient based on the patient’s medical/surgical, family and social history; drug
allergies; subjectively obtained information; objectively obtained information, including
physical assessment findings, laboratory tests and other medical procedures; and incorporate
the long-term goals for the patient based on his/her disease states.
b. The student pharmacist will document and formally present at least one (1) patient case with
a review of a clinical trial to the preceptor over the course of the Advanced Institutional
experience. The preceptor will approve the patient and journal article for the student
pharmacist to present to assure the patient difficulty and journal article is appropriate for the
student.
c. The student pharmacist will prepare a handout of the patient case that includes the following
components: history of present illness, past medical and surgical history, social and family
history, drug allergies, physical assessment findings, laboratory tests and other medical
procedures, a problem list, goals of therapy for each disease state, a detailed assessment of
medical problems incorporating evidence-based medication and nationally recognized clinical
guidelines, and an appropriate plan of care including monitoring and follow-up.
d. The student pharmacist will critically review and describe at least one (1) clinical trial
evaluating a medical therapy that applies to the patient case. The clinical trial should be a
clinical evaluation of medical therapy and not a review article of a treatment or disease state.
The clinical trial review will be included in the handout and presentation and applied to the
patient case. The student pharmacist will use proper referencing and list all textbooks or
electronic databases used.
e. The preceptor and audience will evaluate the student using the Presentation Evaluation
Form. The preceptor will discuss the results of the assessment with the student and discuss
his/her performance with constructive comments to improve his/her skills.
2. Drug Information Questions
a. Student pharmacists need to learn how to respond to drug information requests and to tailor
the response depending on the requestor (e.g., patient, pharmacist or healthcare provider).
Student pharmacists also need to understand that not all drug information requests can be
PHRM 8131, Advanced Institutional APPE
Syllabus (Revised 03-25-13)
Page 5
found using tertiary sources, such as drug information texts and databases, and require
reviewing and evaluating primary scientific literature.
b. The preceptor will require the student pharmacist to document at least two (2) drug
information requests that require reviewing and evaluating the primary scientific literature
over the course of the Advanced Institutional experience. If possible, at least one (1) request
will originate from a healthcare provider (e.g., physician, nurse practitioner, physician
assistant).
c. The drug information request and response will be documented on the Drug Information
Request Form. The responses will be reviewed by and discussed with the preceptor. The
form should be filled out completely and include proper referencing.
i. The student pharmacist will record all pertinent information from the requesting
individual on the DI question form and proceed with researching the appropriate
information for answering the DI question.
ii. All references will be recorded on the provided DI question form. Any printed sheets of
reference material will be attached to the DI question form.
iii. The student pharmacist will review the planned response with the preceptor prior to
reporting backing to the requesting staff member.
3. Pharmacy Presentation
a. The student pharmacist will present at least one in-service presentation on a medication- or
disease state-related topic, approved by the preceptor, over the course of the Advanced
Institutional experience and to an audience chosen by the preceptor.
b. The preceptor determines the presentation date/time.
c. The presentation will be a minimum of 10 minutes in length and should not exceed 30
minutes. The student pharmacist will prepare a handout that is at least 2-pages in length and
that includes all sources used with appropriate referencing. A presentation using PowerPoint
slides may be required depending on the preceptor and capabilities of the site.
d. Example audiences include the preceptor and peer students, healthcare administrators
and/or providers, and other healthcare personnel.
e. The presentation will be reviewed and evaluated using the Presentation Evaluation Form. The
preceptor will review the presentation with the student pharmacist and provide constructive
comments in order for the student to improve upon their skills.
f.
PHRM 8131, Advanced Institutional APPE
Syllabus (Revised 03-25-13)
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PHRM 8131 – Institutional Pharmacy Practice Rotation Task Check List
Student
initials
Preceptor
initials
Description of Task
Date
1. Processing Medication Orders: Whenever possible, this exposure should be varied among areas within the pharmacy department and integrated into
other aspects of pharmacy services. Students should participate in order screening/entry done in patient care areas and pharmacy satellite locations as
well as the central inpatient pharmacy.
a. Describes requirements for receiving orders including written, electronic, verbal, and any other means allowed in
institution
b. Evaluates orders for
Completeness
Appropriate indication
Appropriate dosing and route of administration
Allergies
Drug-drug interactions
Drug-disease interactions
c.
Formulary requirements
Order entry
Creates profile or adds information to existing profile
Appropriate product selection
2. Preparation/Distribution of Products: When possible, 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.
PHRM 8131, Advanced Institutional APPE
Syllabus (Revised 03-25-13)
a.
b.
c.
Unit dose – cart fill/delivery
Repackaging bulk to unit dose with appropriate record keeping, labeling (suggest ¼-1/2 day)
Accepted exceptions to unit dose dispensing/bulk dispensing according to established procedures (Specific time
not suggested, may incorporate this objective into other product preparation objectives)
d.
Unique dose preparation procedure, often called “specials” (Specific time not suggested, would incorporate into
non-sterile compounding or other product preparation objective)
e.
Non-sterile Compounding (Suggest ½ day, activity may be dispersed throughout rotation to ensure student
sees various commonly ordered preparations)
Uses appropriate ingredients
Makes accurate calculations
Makes accurate measurements
Uses correct procedures to make the product
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PHRM 8131 – Institutional Pharmacy Practice Rotation Task Check List
f.
3. Controlled Substances:
Sterile compounding
Follows procedures to maintain sterile environment, including cleaning procedures, use of personal equipment, &
aseptic
technique.
Makes
accurate calculations and measurements
Compounds sterile preparations including
Large volume IV hydration fluids
Small volume preparations, ie. IVPB antibiotics and other medications
Medications administered by continuous infusion i.e. cardiac drips
Total Parenteral Nutrition
g. Cytotoxic agents (Suggest ½ day, may be incorporated into sterile compounding experience)
Follows procedures to maintain sterile environment, including cleaning procedures and aseptic technique
Uses appropriate personal protective equipment
Follows procedures for disposal of unused cytotoxic agents and supplies used in handling cytotoxic agents
Makes accurate calculations and measurements
Prepares chemotherapeutic agents for patient administration
h. Describe procedures for delivering products to patients/patient care areas including products requiring special
precautions (ie. fragile, “do not tube”, cytotoxic, costly products, etc…)
i. 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 to
maintain floor stocks.
a. Describes procedure for procurement of controlled substances
b. Describes inventory/storage requirements of controlled substances within the pharmacy department and in patient
care areas.
c. Describes procedures for distribution / tracking of controlled substances and prevention of theft/diversion
d. Describes procedures for disposal/handling of expired, partially used products
4. Investigational Drugs:
a. Describes pharmacists role in investigational drug program in institution
b. Describes storage, distribution, and record keeping requirement
5. Code Arrest Procedures:
a. Describes pharmacists role in code situations at specific institution
b. Attends a code, if possible (Institutional policies regarding individuals allowed to attend codes must be adhered to.)
c.
PHRM 8131, Advanced Institutional APPE
Syllabus (Revised 03-25-13)
Stocks a code cart for delivery to patient care area
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PHRM 8131 – Institutional Pharmacy Practice Rotation Task Check List
6. Pharmacy Management:
a. Describes procedures regarding inventory
Procurement and storage
Handling of product recalls and returning products to suppliers
Disposal of expired materials, including special requirements for hazardous substances
Theft/diversion precautions
b. Describes procedures for billing for pharmacy services including provision of products and clinical services
c. Describes for procurement and maintenance of equipment in the pharmacy
d. Describes procedures for assuring compliance with federal, state, and institutional regulations regarding pharmacy
practice
e. Attends departmental and institutional meetings relevant to pharmacy services (ie. Staff meetings, P&T,
interdisciplinary, etc.)
f. Describes procedures for adverse drug event and medication error reporting including follow-up evaluation
7. Medication Therapy Management: Students should have considerable exposure to these tasks while on this rotation. 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.
a. Formulary
Defines formulary
Describes process for adding or removing a product from the formulary
Describes institutional procedures for formulary enforcement
Attends Pharmacy and Therapeutics Committee meetings when possible
b. Interviews patients to obtain information needed for appropriate care
Gathering allergy or medication history information to solve medication order problems
Gathering information pursuant to clinical pharmacy consults
Patient Counseling
Describes resources available for communication with non-English speaking patients, and uses them appropriately
c. Gathers pertinent information from charts, medication administration records, patient care flow sheets, laboratory
reports, or other sources efficiently to solve drug related issues
d. Evaluates applicability of information and organizes information for presentation to other health care providers
e. When possible, participates in patient care rounds, case discussions, or other clinical pharmacy activities available
at the rotation site, under the supervision of the preceptor.
f. Documents clinical services and patient care interventions according to institutional procedures
PHRM 8131, Advanced Institutional APPE
Syllabus (Revised 03-25-13)
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PHRM 8131 – Institutional Pharmacy Practice Rotation Task Check List
The above are guidelines regarding the activities in which students should gain experience or at least exposure during the institutional rotation. These may be
modified according to the expertise of the preceptors and unique characteristics of a practice site. If particular items, such as Investigational Drugs, are not
available at the rotation site, please indicate “N/A.”
PHRM 8131, Advanced Institutional APPE
Syllabus (Revised 03-25-13)
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