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St. John's UniversityCollege of Pharmacy and Health SciencesAmbulatory Care 5407 Course OutlinePreceptor:Regina Ginzburg, Pharm.D., CDE, BC-ADMAssociate Clinical Professor, St. John’s UniversitySite:The Institute for Family MedicineMt-Sinai Residency in Urban Family Practice230 West 17th StreetNew York, NY 10011Prerequisites:Completion of the required coursework up to and including the spring semester of the third professional year of the Doctor of Pharmacy program. Successful completion of the competency exam.Rotation Description: The course is a required advanced pharmacy practice experience (APPE) designed to ensure student pharmacist preparedness for entry-level practice in an ambulatory care setting. This experience provides the student the opportunity to practice and enhance skills relative to the application of the utilizing Pharmacist’s Patient Care Process (PPCP) to patients in the ambulatory care setting. Students are expected to become active members of the healthcare team by monitoring patients’ drug therapy, providing therapeutic recommendations, and counseling patients. Emphasis will be placed on pharmacist-patient relationships, team dynamics and collaboration in order to promote and deliver safe medication use, develop value based patient care plans, communication skills and ensure an optimal patient care experience. The goal of this course is to provide adequate experience to enhance knowledge and skills acquired through didactic education and Introductory Pharmacy Practice Experiences (IPPEs) and apply them in direct patient care activities in an ambulatory care setting.Learning Objectives and Competencies:Upon completion of this clerkship, the students should be able to:Collect information to identify a patient’s medication-related problems and health-related needs Analyze information to determine the effects of medication therapy, identify medication-related problems, and prioritize health-related needs Establish patient-centered goals and create a care plan for a patient in collaboration with the patient, caregiver(s), and other health professionals that is evidence-based and cost-effective Implement a care plan in collaboration with the patient, caregivers, and other health professionals Follow-up and monitor a care plan Collaborate as a member of an interprofessional team Identify and screen patients at risk for prevalent diseases in a population Maximize the appropriate use of medications in the population by applying cost-benefit, formulary, and/or epidemiology principles to medication related decisions Recommend and encourage vaccines against preventable diseases Educate patients and professional colleagues regarding the appropriate use of medications Use evidence-based information to advance patient care Fulfill a medication order or assist with related tasks Create a plan for continuous professional development Learning Activities for Ambulatory Care:Patient Care Activities:Create a SOAP note by collecting pertinent information from the electronic medical record, patient, and/or caregiverFormulate a patient-specific care plan Discuss patient-specific care plans including monitoring parameters and goals with preceptorAssist with relevant health screenings (ie. atherosclerotic cardiovascular disease (ASCVD) risk, diabetes, immunizations, Screening, Brief Intervention, and Referral to Treatment (SBIRT))Assist with the provision of pharmacist-delivered care based on New York laws: Collaborative Drug Therapy Management (CDTM) and relevant lab monitoring (point of care tests or other labs for the setting) Counsel patients/caregivers on medications, self-care, and devices Screen patients for health literacy level and adherence with available toolsAssist with patient follow-up careDocument patient encounters and track interventions through MedKeeperMedication Reconciliation:Perform a comprehensive medication review Create a medication list or identify other patient adherence tools (ie. medication synchronization, blister pack, phone app, etc)Communicate with the patients’ preferred pharmacy to obtain adherence history or solve medication access issues Communicate identified medication related issues to applicable persons – prescribers, patient, or caregiversInterprofessional Team Member & Special Projects:Attend team huddles and understand the role of team membersAnswer drug information questions from providersParticipate in medication use evaluations or other site-specific projects Choose recently published manuscript that affects ambulatory pharmacy-based patient care and lead a discussion to educate the interprofessional teamDevelop and deliver a brief educational program regarding medication therapy to health professionals or lay people by?assessing the learning needs of the intended audience, selecting the most effective technique to promote active learning, and presenting in an organized and timely mannerParticipate in site-specific interprofessional activities Engage in case discussions Engage in team based learning Collaboration with other healthcare learners on activities and projects Presentation of medication history to team / team memberDefinition of Academic Service-Learning (AS-L):Academic Service-Learning at St. John’s University is a classroom/experiential site- based program that involves students in some form of required community service activity and uses that activity as a means of understanding course concepts. It is a pedagogical approach whereby students engage in a service activity that benefits the common (public) good. The service activity meets course objectives, and through reflection students examine issues pertaining to justice and identity. Application of Academic Service-Learning:Within CPP 5407, doctor of pharmacy students become integrated members of a healthcare team that is dedicated to optimizing patient care and fulfilling health care needs. This course provides an important experiential learning opportunity for the student in which they practice, perform and observe theories and practical applications of the course content and their discipline. The course is designated as an AS-L course and has been approved as such by the University’s Office of Academic Service-Learning. Due to the direct and indirect patient care responsibilities of CPP 5407, the student will spend a significant amount of time engaged in service activity that benefits the common (public) good. In addition to service activities, students will participate in structured and organized reflection that will be organized by their preceptor. Reflection is an important component of AS-L since it provides the opportunity for students to link what they learn in the course with what transpires in pharmacy practice and their communities. Reflection can be accomplished in a variety of ways such as: discussions, papers and diaries.This rotation dedicates approximately 80 hours of service to the patients of the Institute for Family Health. Students will reflect on their service through reflective discussions throughout the month and one reflection paper. Following the completion of the course, the student should be aware that the Office of Academic Service-Learning will contact them to solicit their feedback on this AS-L experience. Students are urged to complete this feedback honestly and as soon as possible upon receipt. Refection papers: Identify what you observed the first week regarding your patient care experiences and how it affected you personally and/or professionally. Please explain whether this first week’s experience is what you had anticipated it to be prior to this course. Identify any surprises or challenges that you have encountered and how you have dealt with these experiences. Then reflect how this experience evolved throughout the rotation and the impact it has had on you as a person, you as a pharmacist and your perception of the role of the pharmacy profession in serving this population. Explain your thoughts on the larger social and cultural contexts of the indigent community served by the Institute for Family Health and the impact of economic and health care obstacles faced in providing care to this patient population. A final reflection paper will be at the end of the rotation discussing what additional experiences in patient care in the subsequent weeks affected your viewpoints as a student, future pharmacist and the ability to serve this population. Rotation Schedule:Meeting with preceptor will be incorporated into rotation schedule. An individualized schedule will be provided at the start of rotation. Below is an overall example of the rotation schedule.Lunch:usually 12pm – 1pm.Student 1: Week 1 & 3Student 2: week 2 & 4MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYAMAssignments / clinic prepAssignments/ clinic prepClinic with attending OR pharmacy clinicAssignments / clinic prepPharmacy ClinicPMDiabetes groupClinic Core lectures (1st & 3rd Wed of month)Clinic Assignments / clinic prepStudent 1: Week 2 & 4.Student 2: week 1 & 3MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYAMAssignments / clinic prep Assignments/ clinic prepPharmacy ClinicAssignments / clinic prepAssignments/ clinic prepPMDiabetes group ClinicAssignments/ JC or cases (2nd & 4th Wed of month)ClinicClinic Please note: Schedule is subject to change on any given rotation.ASSESSMENT:Professionalism: A student must be “acceptable” for all five professionalism criteria in order to pass the experience. An “unacceptable” rating on any professionalism metric during the experience will result in failure of this course. Comments are required if selecting any “unacceptable” rating.”PROFESSIONALISMACCEPTABLE UNACCEPTABLE AltruismStudent makes an unselfish commitment to serve the best interests of the patient and rotation via prioritizing rotation requirements, demonstrating effective listening skills, interacting with others in a compassionate manner, and developing trusting relationshipsCommentsHonesty and IntegrityStudent displays honesty and integrity via abiding by patient (HIPAA) and student (FERPA) confidentiality requirements, and maintaining academic mentsRespect for OthersStudent treats others as he/she would want to be treated via arriving on time for rotation activities, respecting the feelings, needs, thoughts, and opinions of the preceptor/faculty /colleagues, demonstrating ability to receive constructive feedback, and providing constructive feedback in a respectful and educational mentsProfessional PresenceStudent instills trust via attending and participating in rotation requirements, dressing appropriately for the rotation, and accepting responsibility for one’s own mentsDedication and Commitment to ExcellenceStudent strives for excellence and assume responsibility for his/her learning and professional development via adequately preparing for all rotation sessions, embracing responsibility for one’s own learning, and actively seeking guidance and mentoring as ments:B. Experiences: Using the 3 levels of entrustment described below, determine the extent to which the student can be trusted to perform each required task. The EPA task/objective assessment table below must be completed in CORE by the preceptor twice: at mid-point of the APPE and at the end of the APPE. The student must complete this same table in CORE on the first day of the rotation to self-evaluate his/her skills at the start of the rotation to provide the preceptor with an idea of areas in which the student feels he/she requires more experience. *Brief descriptions/feedback are required if selecting Level 1 and Level 2. Please indicate why you feel the student is at a Level 1 or 2 and provide some feedback as to what you feel the student should work on to achieve a Level 3.Level of entrustmentDescriptionLevel 1The student has some knowledge but is unable to operationalize that knowledge. The student can be trusted to thoughtfully observe. This is acceptable for students in the Introductory Pharmacy Practice Experience (IPPE). Level of entrustment is low.I trust the student, with specific direction and direct supervision, to initiate a preliminary assessment of common conditions seen within the practice setting. The student requires significant correction for performance improvement. Level 2The student has a broad knowledge but needs to be told what to do to correct performance (significant proactive correction). The student can perform the tasks in a rudimentary fashion, free of challenges or problems. Appropriate level for an IPPE student at the end of their experience or an Advanced Pharmacy Practice learner at the beginning of the APPE year. This student is at the level of “APPE-ready”. Level of entrustment is moderate.I trust the student, with direct supervision and frequent correction, to assess common chronic conditions seen within the practice setting. The student accepts feedback for performance improvement.Level 3The student demonstrates sufficient knowledge and skills necessary to perform tasks in a manner consistent with an entry-level pharmacist. The student requires minimal corrections and guidance. This is the minimum goal for a student at the completion of an APPE rotation. Level of entrustment is high. I trust the student, with limited correction, to assess common chronic conditions seen within the practice setting. The student is self-directed and seeks guidance as necessary.Opportunity Not Available (ONA):??The opportunity to experience and complete this task, while normally available,?was not available during this students’ rotation period. ?LevelLearning ActivitiesExample ONA123Patient Provider DomainCollect a medication and related medical history of a patient including medication history and adherenceSOAP note, patient encounter, informal patient discussion, drug info questionsUse health records to determine a patient’s health related needsAssess a patient’s signs and symptoms to determine whether the patient can be treated within the scope of practiceMeasure an adult’s patient’s vital signs and interpret the results and/or interpret laboratory results Evaluate an existing drug therapy regimen including a prioritized health-related problem list for a patient and identification of drug interactionsAssess a patient’s health literacy Follow an evidence-based disease management guidelineWork with a patient to develop a patient-specific treatment plan and education care planSelect monitoring parameters and determine the appropriate time interval to collect monitoring data Write a note that documents the findings, recommendations, and plan from a patient encounterEducate a patient regarding the appropriate use of a new medication, device to administer a medication, or self-monitoring testAssist a patient with behavior change (shared decision making and MI)Collect and evaluate the selected monitoring parameters to determine the therapeutic and adverse effects related to the treatment planRecommend modifications or adjustments to an existing medication therapy regimen based on patient responsePresent a case to a colleague during a handoff or transition of careInterprofessional Team Member Domain Engage other professionals when developing strategies to meet the health care needs of patients and populations while respecting the dignity and privacy of the patientPatient care activitiesSOAP note, patient counseling, daily huddles, quality improvement projects Provide a thorough medication history including all medication related problems to other health professionalsUtilize appropriate screening tools to identify patients at risk for prevalent and preventable diseases in a population and provide recommendations to the healthcare team. Effectively utilize cost-benefit, formulary, and/or epidemiology principles to medication related decisions when developing the shared plan. Use setting appropriate communication skills to facilitate discussions and interaction that enhance team function and rmation Master DomainLead a discussion regarding a recently published manuscript and its application to patient careJournal club, case presentation, inservice, or drug information questionDevelop and deliver a brief educational program regarding medication therapy to health professionals or lay peopleRetrieve and analyze scientific literature to make a patient-specific recommendationRetrieve and analyze scientific literature to answer a drug information questionPractice Manager DomainEnsure that the formulary preferred medications are used when clinically appropriate and assist a patient to acquire medications through support programs Care planningSelf-Developer Domain Perform a self-evaluation to identify personal strengths and weaknessesReflection paper, CV updateRECOMMENDED RESOURCES: Main library, St. John’s University (stjohns.edu/academics/libraries)Dr. Andrew J. Bartilucci Heath Education Resource Center (HERC), St. John’s University()Pharmacist Patient Care Process: Pharmacy Law: New York State Office of the Professions – State Education Department : New York State Department of Health. Pharmacists as Immunizers:? b. New York State Department of Education. Office of Professions. Administration of Immunizations c. Non-Patient Specific Standing Orders and Protocol ( example) . Center for Disease Control and Prevention: Immunization Schedules: Letter () ................
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