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Course Approval

Disease state/formulary management clerkship pharmacy XXXX


Course Syllabus


Course Title: Disease State/Formulary Management Clerkship

Course Number: PHR XXXX

Team Leader:

Ranee Lenz, Pharm.D.,
1300 Coulter, Suite 309, Room 315
Phone: (806) 356-4000, ext. 251
Fax: (806) 356-5379
Email: ranee.lenz@ttuhsc.edu

Team Members:

Amarillo

Butch Habeger, R.Ph., MBA, FASHP
(806) 356-4000, ext. 249
Fax: (806) 356-5379
Email: butch.habeger@ttuhsc.edu

Stephanie Anderson, Pharm.D.
(806) 356-4000 ext. 270
Fax: (806) 356-5379
Email: stephanie.anderson@ttuhsc.edu

Sherida Nelson, R.Ph.
(806) 356-4000 ext. 250
Fax: (806) 356-5379
Email: sherida.nelson@ttuhsc.edu

Clerkship Coordinator:

Loree Allen
School of Pharmacy
1300 Coulter, Rm. 206
Amarillo, TX 79106
Phone: 806/356-4000 Ext 306
Fax: 806/356-4018
Email: loree@cortex.ama.ttuhsc.edu

Daily Schedule: Students should participate in clerkship activities for a minimum of 40 hours per week. Schedule depends on clerkship rotation and site needs.

Textbooks: Disease State/Formulary Management Clerkship Manual (Please note: the standard policies and procedures in this manual have been altered to meet the needs of this clerkship site). No other formal textbook is required. A drug info handbook is highly recommended.

Prerequisites: P-4 standing as per Student Credentialling Committee.

Catalog Description: Course will incorporate policy development, formulary management, and disease state management utilizing TDCJ healthcare facilities.

Course Mission: Pharmaceutical care experiences with Managed Healthcare patients (clinical and management tracts available). Pharmacists can have various patient role settings within the managed care setting. Services provided to the patient include counseling or education and disease state management. Disease state management opportunities in which a pharmacist participates include anticoagulation, asthma/COPD, hypertension, hyperlipidemia, and diabetes management. Additional administrative roles a pharmacist may participate in include determining the pharmacoeconomic impact of drug selection, tracking prescription benefit management trends, and development of disease guidelines or policies. Texas Tech Managed Health Care faculty and preceptors will offer rotations in which at least 1 model of a disease state management service as well as well as one financial aspect this department engages in.

Tech's Top Ten and Course Objectives:

  1. COMMUNICATION


    1.1 - General Communication

    Competency Definition: Pharmacists effect patient care and the delivery of health care using timely, efficient, and appropriately targeted communication skills. Communication skills provide the foundation for patient - pharmacist relationships as well as relationships with other health care providers and payers.

    The P4 clerkship student shall be able to:

    1. present (both orally and in written format) a therapeutic issue or concept with confidence and independent proficiency to patients, fellow health care providers, and the lay public.
    2. develop presentation skills by delivering inservices to other health care professionals and the health care team by adapting content to the level of the audience.
    3. demonstrate good human relation skills.
    4. consistently, accurately, and succinctly relay drug information to patients and colleagues
    5. recognize their knowledge and experience limitations ("I don't know, however, I will investigate and give you a call.")

    1.2 - Communication in the Patient or Caregiver Interview

    Competency Definition: Conducting and recording a thorough patient interview (medical history and medication history) enables creation and implementation of a drug therapy related problem list and pharmacist's care plan.

    The P4 clerkship student shall be able to:

    1. conduct and document a thorough patient interview that includes the following components: chief complaint, history of present illness, past medical history, social history, family history, and medication history (e.g. prescription medications, drug therapy related devices, nonprescription medications, alternative therapies including herbals, vaccination history, drug and food allergies.
    2. create a patient work up of drug therapy related problems.
    3. create a drug therapy related problem list.
    4. effectively interact with patients who are cognitively or physically impaired ( e.g. interviewing proxies and caregivers).
    5. communicate an educational message to a patient appropriate to a selected clinical situation.
    6. communicate with a patient or patient's agent at an appropriate level.

    1.3 - Patient Education

    Competency Definition: Enhancement of a patient's knowledge and understanding of medical care and related drug therapy related plans will improve patient compliance and translate into improved patient economic, clinical, and health outcomes.

    The P4 clerkship student shall be able to:

    1. interview the patient or caregiver obtaining information necessary to assess the need for additional information, education, and counseling.
    2. provide written patient information in a form that the patient can understand.
    3. identify, analyze and use commercially available patient information monographs.
    4. create patient information monographs.
    5. provide oral consultation concerning the patient's medical care in a manner the patient perceives as empathetic, tactful, and appropriate.
    6. prepare written patient information that is appropriate to the needs and educational level of the patient within a specific healthcare institution or community.

    1.4 - Written Communication [Documentation]

    Competency Definition: Documentation of pharmacy services is an essential activity. Documentation in pharmacy practice includes activities such as: writing a SOAP note in the medical record, providing written pharmacotherapeutic consultations, maintaining required prescription and patient profiles, and submitting proof of pharmaceutical services to third party payers. All documentation is written. Pharmacy services, which are not documented, are considered as never occurring.

    The P4 clerkship student shall be able to demonstrate:

    1. proficiency in providing succinct and accurate patient-specific information related to drug therapy management.
    2. the proper procedures for generating pharmacist's notes to be placed in the patient's legal medical record.
    3. the ability to document patient care in a manner which supports reimbursement for pharmacists' activities beyond dispensing pharmaceuticals.
    4. confidence regarding the information / knowledge provided by providing such notes in the patient's pharmacy/ medical record.

  2. USE OF BASIC SCIENCE

  3. PROBLEM PREVENTION AND SOLVING

  4. DISPENSING OF PHARMACEUTICALS


    Competency definition: Pharmacists perform a unique "safeguard" role in health care by consistently assessing the appropriateness of doses so as to avoid both supertherapeutic and subtherapeutic doses. A pharmacist's mathematical abilities are combined with knowledge of pharmaceutical products and their delivery to create systems approaches to ensuring safe and appropriate doses. The calculation, preparation and assessment of parenteral and nonparenteral doses are central to the pharmaceutical care process in all practice settings.

    The P4 clerkship student shall be able to:

    1. define the normal dose and number of dosage units for any drug product (prescription and nonprescription) used in any of their patient's regimens.
    2. calculate the appropriate dose for any drug product using mathematical skills and mathematical reasoning.
    3. provide the reasoning behind commercial and noncommercial dosing charts and confirm the accuracy of dosing charts.
    4. recognize both supertherapeutic and subtherapeutics doses.
    5. adjust doses based on patient specific parameters such as renal or hepatic dysfunction.
    6. convert doses based upon different dosage forms of a pharmaceutical product.

  5. PROVIDING PHARMACEUTICAL CARE TO INDIVIDUAL PATIENTS


    5.1 - Providing Individual Patient Care

    Competency Definition: Pharmacists base their clinical decision making on an understanding of the most common disease entities. Therefore, students must learn the most common disease states encountered in each clerkship course (e.g. pathophysiology, diagnosis and diagnostic studies, clinical laboratory medicine, treatment regimens, and monitoring parameters) and apply this knowledge to direct patient care.

    The P4 clerkship student shall be able to:

    1. demonstrate an understanding of the pathophysiology, clinical presentation, diagnostic studies, treatment and monitoring of those disease states specified in individual clerkship course manuals.
    2. apply knowledge gained from previous coursework to individual patient care.
    3. demonstrate the ability to create and assess an appropriate pharmacotherapeutic regimen using knowledge gained from coursework in pharmacology, pharmaceutical care, pharmacokinetics, dynamics, pharmacotherapy, and practice management.
    4. integrate knowledge of the basic sciences to differentiate among pharmacologic agents within the same class.

    5.2 - Patient ­Care Plans

    Competency Definition: Central to provision of patient care is creation of a pharmacist's care plan. The major steps in care plan creation, implementation, and modification include: data gathering, patient assessment, care plan formulation/implementation, modification of care plan and implementation of a follow-up plan. Communication of the care plan to the patient and other health care professionals is fundamental to improving patient health care outcomes.

    The P4 clerkship student shall be able to:

    1. accurately and efficiently locate information in the medical chart or other records and apply this information to patient care.
    2. demonstrate effective data gathering skills and be able to report this data in an organized and concise format.
    3. identify both active and potential drug-related problems.
    4. integrate both objective and subjective patient information in the development of the patient care plan.
    5. assess, evaluate, and apply drug information/clinical data to promote optimal health care for an individual patient and for patient populations.
    6. develop a pharmacotherapy plan complete with alternative solutions to treat, improve, and solve drug related problems.
    7. implement a rational pharmacotherapy plan and follow-up for an individual patient.

  6. PROVIDING PHARMACEUTICAL CARE TO LARGE POPULATIONS

  7. MORAL REASONING, ETHICAL AND LEGAL JUDGEMENT


    Competency Definition: Pharmacists should conduct their professional and personal lives in accordance with a set of moral principles and values. These principles govern pharmacists' individual and collective group activities. Professionalism entails adherence to moral, ethical and technical codes of conduct as well as supporting the entire body of persons committed to the pharmacy profession.

    The P4 clerkship student shall be able to:

    1. Establish and maintain professionalism within all practice settings.
    2. Demonstrate the ability to develop and maintain ethical standards in pharmacy practice.

  8. MANAGEMENT SKILLS


    Competency Definition: All pharmacists require practice management skills regardless of their specific practice setting or orientation. Frontline practicing pharmacists must participate in planning, organizing, leading and controlling organizational resources in the pharmacy environment. They may be responsible for demonstrating the outcomes of their practice to supervisors, other health care providers and payers. Other pharmacists may assume a more direct management role of technicians, other pharmacists, and operations.

    The P4 clerkship student shall:

    1. demonstrate time management skills.
    2. identify the appropriate costs and benefits for any set of alternatives to a given action or program initiative.
    3. identify the cultural differences among patients and the impact these differences have on the delivery of pharmaceutical care.
    4. describe the patient outcomes of a pharmaceutical intervention and develop a methodology to measure those outcomes
    5. describe the operation aspects of pharmacy practice setting: staffing model deployed, systems of drug distribution, reimbursement strategies, methods of financial control, methods of quality management.

  9. ADVANCING THE PROFESSION AND PROMOTING HEALTH

  10. PERSONAL GROWTH


    Students will demonstrate characteristics of personal growth through 1) independence, 2) initiative, and 3) life-long learning

    Independence. One of the primary aspects of independence will be the demonstration of independent learning skills, as shown in preparation for patient care and clerkship assignments. An important aspect of independence is demonstration of appropriate flexibility in delivery of pharmaceutical care.

    Initiative. The student shall demonstrate self-motivation. Some of the qualities seen in the individuals will be the ability to work to their personal and professional limits while taking responsibility for patient care, outcomes, and other clerkship assignments. The student shall be able to understand when to question the statements of others and appropriately gather information related to these statements (e.g., not accepting the statements of others as gospel, but rather independently verify these statements by consulting appropriate references). The student will demonstrate independent initiative by delivering pharmaceutical care to their personal and professional limits and consulting with others when the situation is beyond those limits.

    Lifelong learning. Students shall demonstrate the desire, even the thirst for knowledge, a commitment to continuous, lifelong learning. They should be able to learn in a self-directed manner, investigating new situations presented to them in the delivery of pharmaceutical care. The student must acknowledge personal responsibility for continuous, lifelong learning.

    Composite Competency Definition: Pharmacists should demonstrate comfort, effectiveness, and efficiency in the independent initiation of clinical decision-making and appropriate consequent action in dispatching the functions associated with the delivery of pharmaceutical care, in accordance with valid therapeutic judgment, ethical practice, and sound management principles.

    The P-4 clerkship student shall demonstrate the ability and initiative to:

    1. be a self-starter.
    2. function as an independent, in-depth learner.
    3. make independent judgments.
    4. carry-out the functions of the contemporary pharmacist independently.
    5. evaluate the judgments of other health care providers independently.
    6. initiate self-assessment.
    7. initiate an ongoing process of self-education.
    8. self-educate independently.
    9. initiate interdisciplinary cross-talk.
    10. initiate a comprehensive planning process.
    11. initiate appropriate change.
    12. initiate appropriate intervention.

Additional Competencies

ACCOUNTABILITY


Competency Definition: Pharmacists fulfill multiple responsibilities simultaneously. Central to all pharmacists' responsibilities is self- accountability to ensure that responsibilities are fulfilled to the fullest extent, within the expected time frames, and appropriate follow-up mechanisms are created, implemented, and monitored.

The P4 clerkship student shall be able to:

  1. place the care of patients above all other responsibilities.
  2. perform patient care functions in a punctual and professional manner.
  3. ensure that all patient care functions are performed prior to leaving for the day.
  4. provide optimal care for patients so that practice accountability will be applied to patient care post graduation.
  5. understand a pharmacist's role in patient care and be accountable for the provision of pharmaceutical care to patients.
  6. learn to prioritize and complete the multiple responsibilities of a health care provider.

TEAMWORK


Competency Definition: Teamwork is work done by several associates with each doing a part, but, all subordinating personal prominence to the efficiency of the whole. Pharmacists function as an integral component of a team whose ultimate goal is to provide the best patient care possible.

The P4 clerkship student shall be able to:

  1. function effectively within the team to optimize patient outcomes.
  2. communicate effectively within the team.
  3. handle an appropriate level of responsibility within the team.
  4. interact appropriately with different members of the team (e.g. pharmacists, patients, caregivers, physicians, medical students, nurses, therapists);
  5. sacrifice personal gain for the good of the team and its patient.

LITERATURE EVALUATION AND APPLICATION


Competency Definition: Pharmacists should consistently exhibit leadership in providing drug information using multiple state-of-the-art resources for both patient-specific drug therapy and system-wide drug therapy issues (e.g. creation of clinical practice guidelines or formulary backgrounds).

The P4 clerkship student shall be able to:

  1. demonstrate the ability to make rational, patient-specific therapeutic decisions, based upon critical evaluation of the literature and clinical experience.
  2. locate and analyze literature to solve a therapeutic dilemma in a timely fashion.
  3. make a recommendation to health care colleagues or a team.
  4. display the ability to find and accurately disseminate medical information through formal and informal presentations, discussions, and written communications.
  5. develop a personal method of staying current with the medical and pharmacy literature, including development of a filing system and/or a "peripheral brain."

INTERPRETATION AND APPLICATION OF PHYSICAL ASSESSMENT DATA


-- This competency may not apply to all advanced community sites and will be considered a site specific competency.

Competency Definition: Interpretation of physical assessment data and its application to creating and modifying drug therapy regimens is fundamental to pharmacy practice. Students shall incorporate physical assessment data into the provision of patient care and initiation, modification, and monitoring of drug therapy regimens.

The P4 clerkship student shall be able to:

  1. demonstrate skill in identifying and interpreting results of general and targeted physical exams (performed by any health care practitioner).
  2. apply physical exam data to the initiation and modification, and monitoring of drug therapy regimens.

Ethical standards: The ethics standards for the School of Pharmacy and the School of Pharmacy Code of Ethics is in effect for all components of this course. Candidates found in violation of ethical standards will result in removal from clerkship with a grade of 0% being assigned and will be reported to the Credentialling and Student Affairs committees of the School of Pharmacy.

Course Objectives:

Teaching methods: This experiential course will be delivered in practice settings where students will provide clinical services under the supervision of pharmacy practice faculty/preceptors.

Assessment Methods: If clinical tract is selected, candidate's grades will be based on SOAP notes, professional performance, Texas State Board of Pharmacy Intern-Clerkship Form, and a project. If management tract is selected, candidate will be graded on Texas State Board of Pharmacy Intern-Clerkship Form, professional performance and assigned projects.

Overview of schedule and assessment methods: Candidates will provide care daily under supervision of a preceptor. Grading will be based on overall performance, professional performance and SOAP notes.

Course Safety Requirement: Clerkship Students will always be accompanied by a TTUHSC Preceptor or TTUHSC Employee. For specific policies regarding Safety and Site Specific Activities, an orientation manual is available in the TTUHSC School of Pharmacy Managed Health Care office (Suite 309).

Grading:

This course is graded on a 0 - 100 point scale, with a minimum score of 70 out of 100 points required to pass.

The grading criteria is as follows:

Clinical Tract Grade Summary:

Management Tract Grade Summary:

· Professional Performance

30%

· Professional Performance

10%

· Texas State Board of Pharmacy Intern-Clerkship Evaluation form

30%

· Texas State Board of Pharmacy Intern-Clerkship Evaluation Form

30%

· SOAP Notes - 2 at 10% each

1st SOAP Note due 3rd week

2nd SOAP Note due 6th week

20%

· 4 Assigned Projects (15% each)

60%

· In-Service Presentation due 5th week

20%

Total

100%

Total

100%

INTELLECTUAL INTEGRITY: standard

ATTENDANCE: standard

DRESS: standard

48 Hour Turnaround Policy: standard

SECOND CHANCE POLICY: There is NO second chance policy. If a student fails this course, they must retake it at the next opportunity when they can be rescheduled.

Etiquette: standard

Clerkship Confidentiality: standard

Candidate Disability: standard

Ethical Standards: standard

Facilities: standard

Candidate Inquiries: standard

Communication: standard

Autobiographical Data Form: standard

Immunizations and CPR Certification: standard

REMOVAL FROM THE PRACTICE SITE: standard

MATERNITY NOTIFICATION: standard

EXPOSURE REPORTING: standard

CANDIDATE PROFESSIONAL LEAVE POLICY: standard

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