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Tips for Successful IPPE Rotations Renu Singh, PharmD, BCACP, CDE – Clinical Professor and Chair, SSPPS APPE/IPPE Curriculum Committee (SAICC) Kelly Lee, PharmD, MAS, BCPP – Associate Professor of Clinical Pharmacy, Associate Dean for Assessment and Accreditation June 17, 2015

Outline • Introductory Pharmacy Practice Experience (IPPE)

Structure and Schedule • IPPE Requirements • Community IPPEs • Institutional Health-System IPPEs • Evaluations • Questions/Discussion

IPPE Structure and Schedule

Introductory Pharmacy Practice Experience (IPPE)

P1 Summer

Community P2

Summer Institutional

P3

Service Learning and OSCE

OSCE=Objective Structured Clinical Examination

Schedule for IPPEs

SITE PRECEPTOR 6/29-7/10 7/13-7/24 7/27-8/7 8/10-8/21 8/24-9/4

Pharmacy ABC Dr. Jane Student A Student B Student C Student D Student E

Current P-1 Students: Community (80 hours over 2 weeks)

SITE PRECEPTOR 6/29-7/10 7/13-7/24 7/27-8/7 8/10-8/21 8/24-9/4 9/7-9/18

Hospital ABC Dr. Jane Student A Student B Student C Student D Student E Student F

Current P-2 Students: Institutional Health-System (80 hours over 2 weeks)*

*Exception: 1-week Graveyard Shifts

Introductory Pharmacy Practice Experiences (IPPEs)

IPPE Requirements at SSPPS • Students are expected to engage in introductory pharmacy

practice experiences (IPPEs) in the following areas during the first three years of the pharmacy curriculum:

• Community pharmacy (minimum of 80 hours) • Institutional health-system pharmacy (minimum of 80 hours) • Health-related service learning • Simulated activities (assigned by SSPPS)

• Students must complete all required IPPEs by the end of the Winter Quarter of the P-3 year

• Students must complete a total of 300 hours for IPPEs in order to progress to fourth year APPEs

• IPPEs cannot be paid experiences • All students must have a pharmacy intern license

Community IPPEs – Week 1 (Introduction) • Orientation and expectations for

rotation including IPPE competency checklist

• Pharmacy tour (location of medications, supplies, references, and other areas of importance)

• Introduction to employees • Introduction to pharmacy workflow

• Receiving prescriptions from patients • Screening prescriptions • Hand off to order entry

• Introduction to inventory control • Purchasing & Pricing • Outdated medications • Return to wholesaler • Return to stock/Returns from patients • Recalls

• Legal Standards • Prescription requirements-written/oral • Refills • Controlled substance /security forms • Filing/record keeping requirements • HIPAA regulations • Methamphetamine Act (PSE) • Pharmacist in Charge/Pharmacist

responsibilities • Board of Pharmacy/DEA/DHCS

oversight • Third Party Reimbursement

• Managed care/PBM • MediCal, CMS, CCS • Health plan website/patient eligibility

Community IPPEs – Week 2 (Practice) • Prepare and dispense prescriptions

• Perform pharmaceutical calculations for compounded preparations

• Receive prescriptions • Review prescriptions

• Check allergies • Clinical review/patient profile • Check for correct drug, dose, route • Clinical Pharmacology/Online

references • Prescription transfers • Disease state management (may be

specific to site i.e. HTN, HIV, DM, Asthma, etc)

• OTC product selection and consultation • Medication Therapy Management (MTM) • Preventive health (immunizations,

tobacco cessation, etc) • Patient Counseling • Regulatory/Performance Improvement

• Board of Pharmacy standards • Do not use abbreviations • Mandatory patient counseling

requirements • Medication errors

Community Pharmacy Preceptor Pearls 1 – Orient and walk through the store 2 – Tailor the learning experience for individual students 3 – Ask students questions and assess knowledge 4 – Explain the "whys” 5 – Be a model for the students 6 – Provide continuous feedback Learning Activities Examples: • What's wrong with this prescription? • Checking in DEA 222 • OTC selection in special population • Time management tip – What to do first?

Student Comments – Community Practice IPPEs • “My preceptor treated me as part of the team” • “Would like experience to “provide more opportunities to practice

counseling”. • “It would have been nice if we learned more of the business side of

community pharmacy because the filling and answering phone is already familiar from our own job”

• “I love how they let you make phone calls to Dr's offices and to patients.:

• “The experience was very informative and it is a great opportunity to get a chance to do many things like fill prescriptions, transfer RX's, administer flu shots.”

• “It was already a great experience. Providing more exposure to medication therapy management would be helpful as well.”

• “The pharmacists and techs were really great and their enthusiasm and passion definitely fostered a great learning environment.”

What makes a strong Community Pharmacy IPPE experience for the students?

• An orientation which includes • Explanation of workflow: How to answer phones, expectations when handling rx orders • Overview of insurance processes • Training/introduction to the computer system (as appropriate)

• A structured activity plan for students • Create a site specific checklist to promote discussion with preceptor(s) • Explain the role of IPPE learners to staff • Provide mini-projects

• Variety of opportunities • Assess student background and community experience

• Students appreciate learning new processes; not only dispensing • Maximize student time with the preceptor to learn:

• Customer service, ethics, professionalism, compounding, MTM, other areas of clinical expertise • Explore OTC aisles and help patients with product choices

• Aim for each student to meet all/most eleven IPPE competency domains during the two week block

Institutional Health-System IPPEs – Week 1 (Intro) • Orientation and expectations for

rotation including IPPE competency checklist

• Pharmacy tour • Storage of oral and IV

meds/supplies • Locate references, resources

• Introduction to pharmacy workflow • Receiving orders from physicians,

nurses, pharmacy staff • Completing order entry • Filling orders via unit dose,

intravenous/admixture processes • Introduction to commonly used

reference materials (Clinical Pharmacology Online, Micromedex, Intranet, etc.).

• Hospital policies and procedures • Medication distribution system (unit

dose, cart fill, automated dispensing system [PYXIS, Omni-Cell, Sure-Med] etc.).

• Medication control systems (e.g. Controlled Substances), storage and security functions related to medication distribution process

• Inventory control • Purchasing • Pricing • Outdated medications • Return to wholesaler • Return to stock/Returns from

patients • Recalls

Institutional Health-System IPPEs – Week 2 (Practice)* • Discuss the utilization of the hospital drug formulary program and its impact on

cost effective patient-centered care • Shadow clinical pharmacists for an introduction to the role of the Clinical

Pharmacist (Team-based, Operations-based) • Discuss the current Quality Improvement programs the institution employs and

their impact on error control • Shadow pharmacists and technicians and discuss the importance of aseptic

technique; observe preparation of IV admixtures and IV room maintenance activities

• Discuss legal and regulatory standards • Order processing • Introduction to controlled substance dispensing • Filing/record keeping • HIPAA regulations • Pharmacist and technician responsibilities • The Joint Commission, DHCS, Board of Pharmacy, DEA and other regulatory

agency oversight

*may vary depending on setting

Institutional Health-System Preceptor Pearls • An orientation on the first day

• Review expectations • Introductions to key staff members, layout of the pharmacy and

hospital • A structured activity plan for the students

• Written and provided to the student • Variety of opportunities

• Shadowing different pharmacists in different settings • Students appreciate learning the thought process of a practicing

pharmacist • Aiming for each student to meet all/most eleven IPPE

competency domains during the two week block

Student Comments – Institutional IPPEs • “This was one of the greatest experiences that I have had for

my IPPE rotations”. • “This rotation was very comprehensive. I was able to rotate

around different settings. The preceptor did a good job in setting up the rotation”.

• “I thoroughly enjoyed learning how an in-patient pharmacy operates by learning from different techs”

• “I was given a tour and shown around the NICU. It was great being able to watch the pharmacist approve orders, go through her process of thinking, and help her fill orders for the NICU”.

• “I had fun doing IPPEs at this site. It brought more real world experiences into my education”.

Course Objectives – IPPE Competency Domains • By the end of the community or institutional pharmacy IPPE experience, the

student will be able to: 1. Accurately prepare, label, dispense and distribute medications to ensure patient safety 2. Collect, record, and assess patient data to identify medical and medication-related

problems 3. Demonstrate knowledge of commonly used medications, formulations and drug products 4. Identify and assess for potential drug-related problems 5. Perform accurate pharmaceutical calculations involved in the preparation of compounded

preparations, dose calculations, and applications of pharmacokinetic calculations 6. Demonstrate caring, ethical and professional behavior when interacting with patients,

caregivers, health care professionals, and in all practice activities 7. Demonstrate effective and appropriate verbal, non-verbal and written communication

abilities when interacting with patients and their caregivers, and other health care professionals

8. Provide effective health and medication counseling to patients and their caregivers 9. Demonstrate appropriate use of drug information resources to assist in patient care 10. Promote to patients the importance of health, wellness and disease prevention 11. Assist patients with questions/problems related to prescription medication coverage,

health insurance or economic barriers to healthcare.

Course Objectives – IPPE Competency Domains • By the end of the community or institutional pharmacy IPPE experience, the

student will be able to: 1. Accurately prepare, label, dispense and distribute medications to ensure patient safety 2. Collect, record, and assess patient data to identify medical and medication-related

problems 3. Demonstrate knowledge of commonly used medications, formulations and drug

products 4. Identify and assess for potential drug-related problems 5. Perform accurate pharmaceutical calculations involved in the preparation of compounded

preparations, dose calculations, and applications of pharmacokinetic calculations 6. Demonstrate caring, ethical and professional behavior when interacting with patients,

caregivers, health care professionals, and in all practice activities 7. Demonstrate effective and appropriate verbal, non-verbal and written communication

abilities when interacting with patients and their caregivers, and other health care professionals

8. Provide effective health and medication counseling to patients and their caregivers 9. Demonstrate appropriate use of drug information resources to assist in patient care 10. Promote to patients the importance of health, wellness and disease prevention 11. Assist patients with questions/problems related to prescription medication

coverage, health insurance or economic barriers to healthcare.

IPPE Evaluation (Completed by Preceptors)

IPPE Competency Domains

Ability Statement Preceptor Confirmation Demonstrate knowledge of and accept responsibility for that knowledge of commonly used medications, formulations and drug products.

Printed Name: _______________ Signature ___________________ Date: ______________________

Example Performance Competencies

■ The student is able to summarize key information related to the use of common (Top 200) medications

■ The student is able to identify brand and generic names, dosage forms and usual dosing ranges for common (e.g. Top 200) medications and other drugs routinely used in specific patient populations

■ The student is able to describe the mechanism of action of common medications (e.g. Top 200 medications) and other drugs routinely used in specific patient populations at the molecular, cellular, systems, and whole organism levels

■ The student is able to list and describe the mechanism(s) of common drug interactions.

■ The student is able to list and describe the mechanism(s) of common drug interactions.

■ The student is able to cite the spectrum and common indications for commonly used antibiotics

■ The student is able to identify target drug concentrations for Narrow Therapeutic Index drugs.

■ The student is able to determine the appropriate storage of compounded medications before and after dispensing

■ The student is able to identify appropriate medication information sources for professional and patient use

Domain 3. Medication Information

IPPE Competency Domains

Ability Statement Preceptor Confirmation Correlate drug related variables and patient related variables to identify and assess drug related problems. Evaluate how the unique characteristics of patients and patient populations impact on manifestations of drug‐related problems

Printed Name: _______________ Signature ___________________ Date: ______________________

Example Performance Competencies

■

The student is able to evaluate medication orders to identify drug related problems

■ The student is able to assess the urgency and risk associated with identified drug-related problems

■ The student is able to evaluate patient information and medication information that places a patient at risk for developing drug‐related problems

Domain 4. Identification, Assessment , and Resolution of Drug-Related Problems

IPPE Competency Domains

Ability Statement Preceptor Confirmation Provide effective health and medication information to patients and/or care givers and confirm patient and/or care giver understanding of the information being provided.

Printed Name: _______________ Signature ___________________ Date: ______________________

Example Performance Competencies

■ The student is able to use effective written, visual, verbal, and nonverbal communication skills to provide patient/caregiver self‐management education

■ The student is able to appropriately and accurately provide basic medication counseling to a patient or caregiver receiving a medication.

■ The student is able to assess and validate the ability of patients and their agents to obtain, process, understand and use health‐ and medication‐related information

■ The student is able to counsel patients on proper self‐care and preventative care ■ The student is able to use appropriate methods of patient education to review indications, adverse effects,

dosage, storage, and administration techniques

The student is able to use effective written, visual, verbal, and nonverbal communication skills to provide education to the patient/caregiver on drug, drug use, self‐ or preventative care, or other health‐related education to healthcare providers.

■ The student is able to communicate alternative therapeutic strategies to the prescriber to correct or prevent drug‐related problems.

■ The student is able to assist a patient in correctly selecting an OTC preparation. ■ The student is able to develop and provide drug, drug use, or other health‐related education to consumers or

health providers

■ The student is able to provide accurate an response to drug information requests written and verbally. ■ The student is able to use effective written, visual, verbal, and nonverbal communication skills to counsel and

educate a patient or caregiver regarding appropriate medication use, whether prescription and self‐care.

■ The student is able to demonstrate and/or describe proper administration technique for various drug delivery systems (e.g., inhalers, eye drops)

Domain 8. Patient Education

IPPE Competency Domains

Ability Statement Preceptor Confirmation Assess information needs of patients and health providers and apply knowledge of study design and literature analysis and retrieval to provide accurate, evidence‐based drug information.

Printed Name: _______________ Signature ___________________ Date: ______________________

Example Performance Competencies

■ The student is able to collect accurate and comprehensive drug information from appropriate sources to make informed, evidence‐based, patient‐specific or population‐based decisions.

■ The student is able to recognize the type of content that is available in general (tertiary), secondary, and primary information sources

■ The student is able to collect, summarize, analyze and apply information from the biomedical literature to patient‐specific or population‐based heath needs

■ The student is able to demonstrate utilization of drug information resources ■ The student is able to describe the type of content in commonly used drug and

medical information resources

■ The student is able to collect and interpret accurate drug information from appropriate sources to make informed, evidence based decisions

■ The student is able to use effective written, visual, verbal, and nonverbal communication skills to accurately respond to drug information questions

Domain 9. Drug Information Analysis and Literature Research

IPPE Competency Domains

Ability Statement Preceptor Confirmation

Know and apply principles of health and wellness when providing individual and population‐based health and wellness information. Integrate unique characteristics of individuals and populations in design of health and wellness information.

Printed Name: _______________ Signature ___________________ Date: ______________________

Example Performance Competencies

■ The student is able to participate in activities that promote health and wellness and the use of preventive care measures

■ The student is able to promote to patients the importance of health, wellness, disease prevention (e.g., immunizations, tobacco cessation counseling), and management of their diseases and medication therapies to optimize outcomes.

■ The student is able to provide preventative health services (e.g., immunizations, tobacco cessation counseling)

■ The student is able to promote to patients the importance of health, wellness, disease prevention, and management of their diseases and medication therapies to optimize outcomes.

Domain 10. Health and Wellness – Public Health

IPPE Competency Domains

Ability Statement Preceptor Confirmation

Utilizing knowledge of a wide array of private and public health insurance options, assist patients and care givers to obtain their medications and related para‐pharmaceuticals in an affordable manner that meets their health care needs.

Printed Name: _______________ Signature ___________________ Date: ______________________

Example Performance Competencies

■ The student is able to assist a patient or caregiver in problems related to prescription medication coverage, health insurance, or government health care programs.

Domain 11. Insurance /Prescription Drug Coverage

Evaluations

2015-2016 ONLY E*Value 101 – Accessing Evaluations

2015-2016 ONLY Sample Evaluation

2015-2016 ONLY E*Value 101 - Accessing Student Schedule

2015-2016 ONLY E*Value 101 – Schedule

2015-2016 ONLY E*Value 101 – Accessing Schedule

2016-2017 OASIS Platform for All Evaluations

http://pharmacy.ucsd.edu/ faculty/experiential.shtml

Upcoming Preceptor Development Opportunity

Preceptor Skills Workshop Date: Saturday, August 1, 2015 Time: 7:45am - 12:00pm Location: Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA RSVP to Amber: aberean@ucsd.edu

Contact Information • Experiential Education

• James Colbert, PharmD, jcolbert@ucsd.edu, 858-822-6699

• Lisa Avery: lavery@ucsd.edu, 858-822-2216 (APPE) • Amber Berean: aberean@ucsd.edu, 858-822-7803 (IPPE)

• Assessment and Accreditation • Kelly Lee, PharmD, MAS, BCPP; kellylee@ucsd.edu; 858-822-3462 • Laurie Cartlidge, MEd; lcartlidge@ucsd.edu; 858-822-0445

• Acute Care/Hospital/Health-System • Farivar Jahansouz, PharmD: fjahansouz@ucsd.edu, 858-822-5531

• Ambulatory Care/Community Practice • Sarah Lorentz, PharmD: slorentz@ucsd.edu, 858-822-5574

SSPPS APPE/IPPE Curriculum Committee (SAICC) • David Adler, PharmD • Rabia Atayee, PharmD, BCPS • James Colbert, PharmD • Doug Humber, PharmD • Jennifer Le, PharmD, MAS, BCPS-ID • Kelly Lee, PharmD, MAS, BCPP • Sarah Lorentz, PharmD • Joseph Ma, PharmD • Renu Singh, PharmD, BCACP, CDE (Chair) • Lisa Avery

Questions • Successes and Challenges • How can SSPPS better prepare our students before start

of IPPEs? • Idea of IPPE workbook?