PROVIDE PHARMACEUTICAL CARE
PHRD 4300 Experiential Practice III
Below expectations
I rated myself “meets expectations” for provide pharmaceutical care when a mother
approached me and asked for a cold product for her son. His symptoms included chest
congestion, aches and pains, and nasal congestion. I referred her to my preceptor and she
recommended Tylenol Cold for children. The mother asked her how much she should
give her child and my preceptor looked up each ingredient in the pediatric dosing
handbook and made recommendations based on the child’s weight. This helped me to
learn how to go about dosing OTC medications for children.
Comment: this statement is below expectations for PHRD 4300 because it reflects
the preceptor’s rather than the student’s competency. The student learned about
dosing OTC medications in children which is important but not enough to justify
the competency claim. The issue is not what knowledge the student possesses but
what he/she can do with that knowledge. The student should be encouraged to
review the pharmacotherapy of cough and cold products and find an adult patient
with cold symptoms to counsel. The student should be encouraged to choose an
appropriate product to recommend to that patient and to bring his/her
recommendation to the preceptor for approval. The student should be reminded to
include reflective “how to improve” thoughts in his/her writing.
PHRD 4300 Experiential Practice III
Meets expectations
I met expectations for provide pharmaceutical care when I counseled a patient on an OTC
medication. I approached a lady in the cough and cold aisle and introduced myself as a
pharmacy student. I asked if I could help her and she seemed grateful for my offer. I
asked her to describe her symptoms and she told me nasal congestion was her chief
complaint. She also said she was very tired, yet couldn’t sleep because of the congestion.
In order to be complete, I asked her about aches, fever, and cough, but she said no to all
of them. I verified that she had no other health conditions and she was taking no other
medications. I recommended pseudoephedrine and diphenhydramine. I told her that
pseudoephedrine would relieve the congestion, but might keep her up at night, and
recommended that she take it during the day. I recommended diphenhydramine at night
to help dry her passages and help her sleep. I verified my recommendation with my
preceptor and she agreed. The patient seemed very pleased with the help and I told her to
call if she had any questions.
Upon reflection, there was quite a bit that I left out. I should have indicated the
directions on the packages and made sure she knew how to take both medications. I
should have recommended some non-pharmacological ideas, such as increased water
intake. I will use this experience to be better prepared for my next patient.
Comment: this statement meets expectations for PHRD 4300. The student has
shown an understanding of the pharmaceutical care process in an encounter with an
adult patient without any other medical problems beyond her cold. For example,
he/she has established the nature and extent of the patient’s symptoms and
established a medical and medication history. The student has recognized that
he/she can improve on their performance but, nonetheless, he/she has performed
well for a student in the third semester of the program.
Feedback to the student should reward his/her performance. He/she should be
reminded about the AACP Background Paper II statement that experience is
necessary to build competency and that the whole concept of the experiential
program is for students to learn from their encounters with patients (i.e., to be in a
better position to do more for subsequent patients). The feedback should also
encourage the student to incorporate a greater level of detail in subsequent
statements. For example, he/she should demonstrate competency recommending
doses of medications and competency in advising patient’s about likely side effects of
medications (the latter done to some degree in this statement). The feedback should
point out the student has not completed all the required elements of a competency
statement. There is no reflection to relate the narrative description of events to the
competency. (i.e. “This shows Provide Pharmaceutical Care because….). The
writing preceptor has the option to return the statement for revision to address this
point but also, as a way to encourage the student, can accept the statement but
stipulate that all future statements must address the required elements.
PHRD 4300 Experiential Practice III
Exceeds expectations
A statement that meets or exceeds expectations for PHRD 4350 or 5300 (Experiential
Practice IV or V)
PHRD 4350 Experiential Practice IV
Below expectations
A statement below or meets expectations for PHRD 4300 (Experiential Practice III)
PHRD 4350 Experiential Practice IV
Meets expectations
I felt that I met expectations for this competency when I approached a father in the OTC
aisle looking for a product for his 7 year old son. The customer was looking at the cough
and cold products with much confusion, so I approached him and asked if he needed any
help. He said that he was looking for Children’s Mucinex®. I told him that I was not
aware that they had such a product on the market, so I asked him about the child’s
symptoms as to recommend another product, since this is not available. The father told
me that his son just had a really bad headache and a fever. He also stated that his muscles
felt achy. I asked if his son was suffering from a stuffy nose, cough or congestion. He
denied any of these other symptoms. I was a little taken aback at first because I was
wondering why this man was looking for a product that was used to treat cough and
congestion, when all his son had was a headache and a fever. However, I realized that
this was why I was there, to help people make the best choices. I recommended to him
that the best option would be Children’s Tylenol® or Children’s Motrin® to help relieve
the headache, fever and achy muscles. I said that Mucinex® is a product used to loosenup chest congestion and make coughs more productive. I told him this would not be an
appropriate choice. He agreed and said the Children’s Tylenol® was fine. I showed him
the box and explained the correct dosing for a 7 year old which was 2 teaspoonfuls, by
mouth, every 6 to 8 hours. I also told him not to give it more than 4 times a day. The
father then proceeded to tell me that 50 children had been sent home from school today
because they were all sick. I told him that it was very unfortunate that his son was sick,
but I found this to be a great opportunity to discuss immunizations. I asked the father if
his son was up-to-date on his immunizations. He said that he was not sure. I showed him
the handout from the immunization class that shows the recommended immunizations for
children in the USA. I explained to him at his son’s age, he may need to get some
booster immunizations, such as hepatitis B, measles, mumps, rubella (MMR), diphtheria,
tetanus and pertussis (DTaP) and he may possible need to start on hepatitis A. I also
explained that at his son’s age, it was OK to have him get a flu shot every year. The
father stated that his wife normally kept track of all these things, but he would make sure
and ask once he got home. I said it was very important, especially for a child his age to
make sure that he was current on all his immunizations. I also reassured him that if his
son was not up-to-date, that there were “catch-up” schedules, so there was no need to
worry. The father was very grateful for this information. I also recommended making
sure that his son was getting enough fluids, such as water and Pedialyte® and he said that
was his next stop to grab some Gatorade®. I told him to make sure to dilute the
Gatorade® because it contained a lot of sugar, which can actually be make his son more
dehydrated. He thanked me and left.
I feel that I met this competency because I was able to prevent a father from making a
wrong choice to treat his son’s symptoms. Many times patients aren’t always aware of
what a product is used for and the usually base their knowledge on what was seen on TV
or by word of mouth. Patients don’t realize that they are getting something for cough,
when in actuality their only symptom is a headache. Also, I feel that I met this
competency because I was able to give this father information on immunizations for his
son. School-aged children need to be immunized because there is such a huge risk of
contamination and out-breaks in school. In this case, the illness was probably due to a
virus, but it is important to prevent any serious out-breaks by making sure children are
immunized.
This is an improvement from last semester because I was able to go more in depth and
discuss the patient on a higher level of complexity. Last semester, I probably would have
just recommended a product and some non-pharmacological treatment and would have
sent the patient on his way. However, since the father told me about all the children
leaving school, I found this to be a great opportunity to discuss immunizations with him.
Patients don’t always realize the role that pharmacist play in regards to immunizations, so
I felt this was a good opportunity to teach this patient about it.
An aspect I may have done differently was to have made a copy of the immunization
sheet that had the requirements for children on it. This probably would have guaranteed
that the patient went home and discussed immunizations with his spouse. I plan to be
more prepared in the future and have several copies on hand.
Comment: the statement meets expectations for PHRD 4350. As described, the
student has gone beyond the father’s initial request for a specific product (Mucinex)
to explore the child’s symptoms and recommend an appropriate product. In
addition, providing recommendations to more fragile patients (e.g. children) is a
reasonable way to differentiate expectations for students in PHRD 4350 from 4300.
Also, the student has extended the interaction to include a discussion of the child’s
immunization status. All those points should be addressed in the positive feedback
given to the student. Providing dosing recommendations for very young children
(i.e. not covered by the product label) is a reasonable way to differentiate
expectations for students in PHRD 5300 from 4350.
PHRD 4350 Experiential Practice IV
Exceeds expectations
A statement that meets or exceeds expectations for PHRD 5300 (Experiential Practice V)
PHRD 5300 Experiential Practice V
Below expectations
A statement below or meets expectations for PHRD 4350 (Experiential Practice IV)
PHRD 5300 Experiential Practice V
Meets expectations
I rated myself “meets expectations” in provide pharmaceutical care because a man
approached me looking for suppositories for his wife. She was a new mother who had
been constipated for two days. I asked him “Is your wife taking any medications”? He
said, “No, except prenatal vitamins and mineral supplements.” I explained to him that
prenatal vitamins and mineral supplements that contain iron and calcium tend to cause
constipation. I asked him “Has your wife tried increasing fluid and fiber intake?” He
said, “Yes?” I was making sure that a non-pharmacotherapy approach was being
implemented. “Does she have any other symptoms like fever, nausea/vomiting, severe
abdominal pain and severe cramping?” He said, “No”. This question was asked to rule
out any complications and to evaluate if self-treatment was appropriate. Because this
patient was a nursing mother, I was not comfortable in recommending any OTC product.
I referred to the Handbook of Nonprescription Drugs under constipation and it said
nothing about nursing mothers. However, it said in pregnancy that, if faster relief was
desired, then consultation with a primary care provider was advised. I consulted with my
preceptor who further questioned him, “What type of delivery did your wife have.”
“Have you reported the constipation to her OBGYN?” He said “She had vaginal delivery
and that her physician wanted her to use a suppository but he does not know what to
choose.” My preceptor and I recommended glycerin suppositories because there is no
systemic absorption, and the onset of action is 25 minutes to one hour compared to 12 –
72 hours for docusate sodium.
I met expectations for provide pharmaceutical care by demonstrating comprehensive and
systematic counseling skills. I acquired and synthesized information to form appropriate
conclusions, considered appropriate pharmacological and non-pharmacological
alternatives, and chose appropriate options for a breast-feeding mother. This is an
improvement over last semester because I was able to acquire a greater amount of
information about the patient and personalize a recommendation for her. Given a similar
situation in future, I will inform the patient’s husband about local (anal) irritant effects
that may occur with the medication. I also should have informed the patient’s husband to
contact her physician if the constipation persisted for more than 2 weeks.
Comment: This statement meets expectations for PHRD 5300. The student has
demonstrated comprehensive care by following the individual steps of the
pharmaceutical care process to a greater degree than expected for PHRD 4350. The
student has identified a possible cause for the patient’s problem, ruled-out issues
that might require referral to a physician, addressed non-pharmacological solutions,
and made (with the preceptor’s assistance) an appropriate recommendation specific
to the patient (breast-feeding mother). In terms of further improvement, the student
should be reminded to provide written instructions to the customer for the use
(insertion) of suppositories and encouraged to incorporate that information in the
competency statement to demonstrate that he/she has that knowledge. The student
should be encouraged to present his/her own opinions about the treatment of special
population groups to the preceptor rather than deferring to the preceptor. The only
way to become comfortable in recommending treatments to any population group
(e.g. breast feeding mother) is to make a recommendation and confirm its
appropriateness with the preceptor).
PHRD 5300 Experiential Practice V
Exceeds expectations
I feel that I met expectations for provide pharmaceutical care because of an interaction I
had with a pharmacist last week at work. A patient came into the pharmacy and wanted
acetaminophen for her 11-month-old infant. She noticed that the box did not include a
dose for children less than 2 years old. She asked the pharmacist how much to give her
daughter and the pharmacist replied, “You have to contact your pediatrician.” The
patient was upset and went back to the OTC aisle. I approached the pharmacist and
asked why he/she did not give the mother a dose for acetaminophen, in which he/she
replied, “I don’t know, because it says on the box to talk to their physician.” I looked in
my Drug Information Handbook and found the dosing for acetaminophen asked the
pharmacist to help me in working through the calculation so that I could give the mother
a dose before she left the store. The pharmacist agreed and we worked through the
calculation.
I found the mother and apologized and gave her the dosing for her daughter. I told her to
use the Tylenol Concentrated Infant’s Drops (80 mg/0.8 ml) and give her daughter 1
dropper full (0.8 ml) q 4 to 6 hours as needed for the fever. I also informed the mother
not to exceed 5 doses in 24 hours. I also told the mother that if the fever got worse or did
not subside in 3 days to call her physician. The mother was very grateful for the
information and said that she had to give her daughter the Tylenol and was just going to
“guess” a dose since the pharmacist wouldn’t help her.
I think this demonstrates improved competency over PHRD 4350 because I would have
accepted the pharmacist’s decision not to recommend an acetaminophen dose for the
baby last semester. I think it’s very important for pharmacists to recommend doses of
OTC medications to parents with children less that 2 years old. Otherwise they are likely
to give an incorrect dose to their children. I am glad that I spoke up to the pharmacist and
let her know how I feel on this matter and that I would like to see her come to me if this
situation arises again.
Comment: this statement demonstrates exceeds expectations for PHRD 5300
because 3rd year students are not expected to challenge decisions made by their
preceptors. The student has demonstrated critical-thinking, decision-making,
problem-solving, communication, and ethical skills beyond expectations for a
student at this stage of his/her career. The student has not included a “how to
further improve” reflection but the writing preceptor has the option to occasionally
approve statements which don’t meet technical requirements.