2013 Self Care Newsletter - AACP

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Self-Care Therapeutics/Nonprescription Medicines ... associate editor for the Handbook of Nonprescription Drugs and has authored the Nausea and. Vomiting  ...
American Association of Colleges of Pharmacy Self-Care Therapeutics/Nonprescription Medicines Special Interest Group Newsletter March 2013 SPRING 2013 ELECTIONS!!! Please review the biographies for Chair-Elect and Secretary-Elect contained in this newsletter. An email containing a hyperlink for voting will be sent during the month of April by AACP. Table of Contents: Chair-Elect 2014-2015 Information

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Secretary-Elect 2014-2015 Information

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Faculty Development: Snapshots from 2012 NMA

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Update on Over-The-Counter Acetaminophen Labeling

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Expanding the Scope of Community Pharmacy Practice by Utilizing a Focused Set of Collaborative Practice Agreements in a Community Pharmacy Setting

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Self-Care Recommendation Follow-Up: A Novel Activity for Students on Rotation

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The Development of Simulated Introductory Pharmacy Practice Experiences at Two Colleges of Pharmacy and the Subsequent Incorporation of Self-Care Topics

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Chair-Elect Candidate: Stefanie Ferreri, PharmD

Dr. Stefanie Ferreri is a Clinical Associate Professor at the UNC Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill. She has served as course coordinator for the required self-care course at UNC since 2001, and has developed a self-care elective course offered since 2011. In addition to her teaching responsibilities Dr. Ferreri serves as director of UNC’s PGY1 community pharmacy residency program and also works in a community pharmacy, providing medication therapy management and diabetes education to patients. Dr. Ferreri has published numerous articles related to self-care. In addition, she serves as an associate editor for the Handbook of Nonprescription Drugs and has authored the Nausea and Vomiting chapter found in the 17th edition. Dr. Ferreri also served as a reviewer for the Constipation chapter found in the 16th and 17th editions. She is also a guest editor for the OTC Supplement found in Pharmacy Today since 2007. In addition to her publications, Dr. Ferreri has spoken about self-care related topics at national and state-association meetings. She serves as an OTC media advisor for APhA and has been on numerous radio and television shows promoting the role of the pharmacist in self-care. Dr. Ferreri is a member of the steering committee for the Nonprescription Medicines Academy, serving from 2010-2013. She is also a member of the steering committee for the APhA Self-Care Institute, serving since 2007. She was appointed to the Self-Care Therapeutics/Nonprescription Drugs SIG Programming Committee for 2012-2014. 2

Chair-Elect Candidate: Meghan Sullivan, PharmD

Dr. Meghan Sullivan is an associate professor at the University of New England (UNE) College of Pharmacy, with a shared faculty position at Martin’s Point Health Care. Dr. Sullivan received her Doctor of Pharmacy degree from Wilkes University’s Nesbitt College of Pharmacy and Nursing and obtained both her PGY-1 Community Pharmacy residency and teaching certificates from The Ohio State University College of Pharmacy, in conjunction with Kroger Patient Care Center. She held a faculty position at the University of Maryland School of Pharmacy, in partnership with Safeway Pharmacy, prior to joining the College of Pharmacy at UNE. Dr. Sullivan currently co-teaches the self-care therapeutics course at UNE. She also co-advises an independent study course dedicated to the enhancement of self-care activities within advanced pharmacy practice experiences, through the development of self-care therapeutics modules accessible to all UNE community preceptors. Dr. Sullivan has been fortunate to present on selfcare topics at the local, state, and national level. Most recently she provided continuing education programming titled “OTC Updates,” across the state of Maine through the “Maine Pharmacy Association on the Road CE Show”. In addition to her self-care endeavors, Dr. Sullivan coordinates the advanced pharmacy practice laboratory that, among many things, includes immunization and medication therapy management certification, as well as interprofessional education experiences within the community. Outside of the classroom Dr. Sullivan has been actively involved in the AACP SCT/NM SIG, serving on the nominations and programming committees, and has also attended multiple APhA Self-Care Institutes. She currently serves as the advisor for the UNE APhA Academy of Student Pharmacists, a board member for the Maine Pharmacists Association, and as an editorial advisory board member for Pharmacy Today. 3

Secretary-Elect Candidate: Dr. Amanda Howard-Thompson, PharmD, BCPS Dr. Amanda Howard-Thompson is an Associate Professor at the University of Tennessee (UT) Health Science Center in Memphis, TN. She has appointments to both the College of Pharmacy and the College of Medicine, within the Departments of Clinical Pharmacy and Family Medicine respectively. Dr. Howard-Thompson has a wide range of experience focused in self-care through her teaching, leadership, and clinical roles. She has been the Course Director for the Self-Care and Nonprescription Drugs course at UT for five years (2008-present). Dr. Howard-Thompson serves as the UT-OTC Team Faculty Advisor and panel judge for the annual Tennessee Pharmacists Association NASPA/NMA Self-Care Championship for three years running, and also serves as the Faculty Advisor to the American Pharmacists Association Academy of Student Pharmacists (APhA-ASP) Operation Self-Care group. In addition to directing the Self-Care and Nonprescription Drugs Course, Dr. HowardThompson also teaches the majority of topics within the course. She has also served as a reviewer for the 18th edition of the APhA Handbook of Nonprescription Drugs. Dr. Howard-Thompson received both her Bachelor of Science in Biology and Doctor of Pharmacy from the University of Tennessee. She has completed ASHP accredited residencies in Pediatric Pharmacotherapy (PGY-1 at LeBonheur Children’s Medical Center) and Internal Medicine (PGY-2 at Methodist University Hospital in Memphis, TN). In addition to her academic duties she maintains a clinical practice site at the UT Family Practice Center, where she works under a collaborative practice agreement with family medicine health care practitioners in the areas of anticoagulation, diabetes, hypertension, hyperlipidemia, asthma/ COPD, smoking cessation, and medication therapy management. 4

Secretary-Elect Candidate: Catherine Cone, PharmD

Catherine Cone is an Assistant Professor/Clinician Educator within the Pharmacy Practice and Administrative Sciences Department at the University of New Mexico College of Pharmacy. Catherine graduated from the University of Arizona in 1997 with her Doctor of Pharmacy degree and went on to complete a residency (PGY1) with a focus in ambulatory care at the New Mexico VA Health Care System. Dr. Cone’s tenure at the VA continued for ten years, where she served as the Residency Program Director and Ambulatory Care Pharmacy Specialist. In 2007 she made her transition into academia, and currently teaches three courses at the University of New Mexico. She teaches the Pharmaceutical Care Lab for second-year pharmacy students (fall and spring semesters), as well as the Geriatric Medication Management elective and the Teaching a Care Lab elective for third-year pharmacy students. Dr. Cone supervises an employee-centered ambulatory care clinic site, where she provides over-the-counter medication consultation for employees and assists providers by performing medication chart reviews. Clinic staff and patients routinely use her drug, herbal, and vitamin information services. Dr. Cone also provides a comprehensive medication therapy management service for patients.

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Faculty Development: Snapshots from 2012 Nonprescription Medicines Academy (NMA) Annual Meeting Facilitation of Team-Based Discussions and Awareness of Available OTC Products Through Use of Cough and Cold “Drug Cards” Leticia Shea Regis University [email protected] The presentation discussed the creation of “OTC drug cards” that reviewed relevant information found on nonprescription cough and cold product labeling. The cards were developed to increase student knowledge of various OTC products and to foster confidence, in relation to product selection and appropriate patient counseling. The cards also serve as an innovative way to cut departmental spending during a time when budgets are shrinking due to a tough economy, in addition to conserving vital physical space within the classroom. Students are introduced to the drug cards as part of a team-based learning exercise. Cards can be found at each team station and it is the responsibility of every team to familiarize themselves with the products and have a discussion centering on the nuances of each product. Teams must then provide recommendations to successfully treat cough and cold symptoms in a variety of patient populations. One of the highlights of the exercise are the intra- and inter-team debates that ensue when justifying one individual’s/team’s rationale for choosing a specific product. The exercise promotes student engagement and confidence when discussing the vast number of products available to treat cough and cold symptoms.

Creation of the Interactive Board Game “OTCranium” Miranda Wilhelm, Cynthia Wuller, Heidi Harshman Southern Illinois University Edwardsville School of Pharmacy [email protected], [email protected] The use of games in the classroom is an active learning strategy that encourages student involvement, increases motivation, and improves retention of information. “OTCranium”, an interactive game modeled after Cranium®, was created as a review of over-the-counter medication topics to be addressed before the final exam in the selfcare courses. The game board, pawns, and playing cards were constructed for “OTCranium” in a manner similar to the popular game. Two hundred questions reviewing a variety of self-care topics were created utilizing didactic lectures, an OTC textbook, drug information databases, and nonprescription medication manufacturer websites. The questions were then divided equally among four categories (Self-Care Sayings, Imaginative Inventions, AllKnowing Apothecary, and Efficacious Entertainer). Questions tested student knowledge in the areas of symptom assessment, medication selection, and drug information. Plans are to incorporate the game, to a larger extent, into the self-care curriculum. 6

Faculty Development con’t: Self-Care Assignments as Part of a Community Care Advanced Pharmacy Practice Experience (APPE) Nicole Gattas St. Louis College of Pharmacy [email protected] The required self-care course at St. Louis College of Pharmacy is a component of the pre-professional Doctor of Pharmacy curriculum; a minimum of three years prior to the Community Care APPE. Therefore, a need to emphasize self-care as part of this experience exists in order to reinforce nonprescription product knowledge prior to graduation. The presentation described the self-care assignments students performed during their Community Care APPE, in addition to with the ways rotation quality was measured. Tools and technology incorporated to ensure assignment completion were also described. Quality is partly ensured by designating one faculty “course coordinator” for all Community Care experiences. The coordinator schedules a student orientation followed by a second “on-campus” meeting to set learning expectations. During the five-week rotation, students are required to complete three specific self-care activities; 1) Complete a minimum of five topic discussions related to various selfcare topics. 2) Provide a minimum of five self-care recommendations throughout the rotation. 3) Complete a minimum of five self-care quizzes on Moodle (a free source e-learning software) and achieve an 80% minimum score for each. For each activity different tools were used to ensure completion of the project; these tools were further described as part of the presentation.

Schedule II and III Drugs in Ontario: Understanding The Nuances of The Canadian Drug Scheduling System Nardine Nakhla University of Waterloo [email protected] The presentation outlined the various medications assigned a schedule II (“behind-the-counter”) classification as well as those considered schedule III (“over-the-counter”) products. As the United States considers possible additions to their existing “behind-the-counter” category of medications, it is important to consider the possible benefits and drawbacks of having more medications available exclusively to the pharmacy department compared to those directly available to the patient and pharmacist. The National Association of Pharmacy Regulatory Authorities (NAPRA) serves as an umbrella association for Canada’s pharmacy regulatory authorities and works to manage the National Drug Schedules (NDS). The NDS criterion corresponds to the level of professional intervention required and advice necessary for the safe and effective use of products by consumers. Drugs are placed in the appropriate category, considering a series of factors based upon the differing degrees of counselling/ supervision necessary to encourage appropriate use. The categories are as follows:  Schedule 1: Require a prescription as a condition of sale.  Schedule 2: Available only from the pharmacist and without a prescription.  Schedule 3: Available without a prescription and located in the self-selection area of a pharmacy.  Unscheduled: Products not listed in Schedule 1, 2 or 3 that may be sold in any retail outlet. 7

The Creation of Educational Commercials by Students for OTC Dermatological Products Ann Zweber and Roberto Linares Oregon State University [email protected]

Faculty Development con’t:

The presentation described the incorporation of student-developed commercials as an innovative and interactive teaching strategy, allowing students to share their knowledge of dermatological conditions and products in a creative manner. The presentation at NMA outlined the current way this teaching strategy is implemented, and generated discussion for ways to enhance the activity.

The APhA Self-Care Institute June 14-17, 2013 Renaissance Washington, Downtown Hotel Washington D.C. *Faculty nominations made by Deans* _________________________________

Self-Care Programming in 2013!!

AACP Annual Meeting July 13-17, 2013 Hyatt Regency Chicago Chicago, IL _________________________________ The Nonprescription Medicines Academy Annual Conference September 26-29, 2013 Cincinatti, OH

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Update on Over-The-Counter Acetaminophen Labeing Cara M Brock, PharmD Clinical Instructor, Director of Professional Labs Roosevelt University College of Pharmacy [email protected] Over the last few years there have been several changes to the labeling of over-the- counter (OTC) pain relievers and fever reducers, in addition to changes to the amount of active ingredient in single-ingredient pediatric formulations. These changes were the result of recommendations from the U.S. Food and Drug Administration (FDA) to address safety concerns for patients self-treating various conditions with OTC analgesics and other acetaminophen-containing products, in addition to pediatric preparations and the potential for misuse.1 Labeling changes for all OTC acetaminophen-containing products1-7 In April 2009 the FDA issued a final rule amending the labeling requirements for all OTC internal analgesic, antipyretic and antirheumatic (IAAA) drug products. The rules apply not only to single ingredient products, but also to any combination product commercially available that contains acetaminophen. The changes required for acetaminophen products are as follows: • • • • •

Labeling must include a warning with information on the potential for liver injury associated with acetaminophen usage, as well as a recommendation to consumers with liver disease to consult with a doctor before using acetaminophen The name “acetaminophen” must be prominent (highlighted or bold type) on the principal display panel (PDP) of the product. The PDP is defined by the FDA as the area of the packaging most likely to be seen at the time of purchase by the consumer (i.e., the front of the package) Labeling must include a concomitant use warning in both “Do Not Use” section and the severe liver injury warning section Warnings must be revised to include a statement to consult a doctor or pharmacist if the consumer is unsure if a specific product contains acetaminophen, or if the individual is taking warfarin Alcohol warning must be included as an adjunct to the liver injury warning (previously the alcohol warning was required to be separate)

In July 2011, McNeil Consumer Healthcare Division informed the FDA of voluntary amendments to dosing instructions and maximum daily dosage on their Tylenol ® products: • •

Dosage Information o Extra Strength Tylenol® dosing changes - 2 caplets or gelcaps every 6 hours while symptoms last Daily dosages: o Regular Strength Tylenol® – No more than 10 tablets in 24 hours o Extra Strength Tylenol® - No more than 6 caplets or gelcaps in 24 hours

It is expected that manufacturers of generic acetaminophen products will follow suit. The dosing information and maximum daily dosages for Tylenol® Arthritis Pain Extended Release Gelcaps/Caplets and Tylenol®-8 hour Extended Release Caplets remain the same as does the FDA recommended maximum dose of 4 grams in 24 hours. 9

Update on Over-The-Counter Acetaminophen Labeing con’t

Changes in Pediatric OTC Acetaminophen Products 1, 8-10 Based on recommendations by an FDA Advisory Panel for Nonprescription Medications, the Consumer Healthcare Products Association (CHPA) announced plans for all manufacturers of single-ingredient OTC pediatric acetaminophen products to convert to a single concentration oral suspension. Additional changes recommended by the advisory panel include: • • • •

Liquid and chewable dosage forms should be manufactured in only one strength Dosing instructions to reduce fever for children aged 6 months to 12 years should be included Dosing instructions should be based on weight, in addition to age A standard for dosing in milliliters should be implemented for all dosing devices

These are recommendations only and there are currently no formal requirements for manufacturers of pediatric acetaminophen formulations to adopt these changes. Pediatric Formulations Currently Available11-14 Infant • Suspension 160mg/mL o Dosing directions in milliliters - dosed by age and weight o A syringe is included and marked in milliliters Children 2 – 11 years • Suspension 160mg/mL (ages 2-11) o Dosing directions in milliliters and teaspoon(s) - dosed by age and weight o A dosing cup is included • Orally dissolving chewable tablets 80mg (ages 2-6) o Dosing directions by weight and age • Orally dissolving chewable tablets 160mg (ages 6-12) o Dosing directions by weight and age The McNeil Tylenol for Health Professionals website has many helpful patient handouts regarding the safe use of acetaminophen-containing products and the most current dosing recommendations for adults and children. http:// www.tylenolprofessional.com/patient-education-handouts.html

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Update on Over-The-Counter Acetaminophen Labeing con’t References 1.

Questions and Answers on Final Rule for Labeling Changes to Over-the-Counter Pain Relievers. U.S. Food and Drug Administration Website. Available at: http://www.fda.gov/Drugs/NewsEvents/ucm144068.htm Accessed January 29th, 2013.

2.

FDA Requires Additional Labeling for Over-the-Counter Pain Relievers and Fever Reducers to Help Consumers Use Products Safely. U.S. Food and Drug Administration Website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm149573.htm Accessed January 29th, 2013.

3.

Shuren, J. Organ-Specific Warnings; Internal Analgesic, Antipyretic, and Antirheumatic Drug Products for Over-The-Counter Human Use; Final. Monograph Federal Register Vol. 74, No. 81 Wednesday, April 29, 2009 Rules and Regulations. p19385 – 19409.

4.

General Food Labeling Requirements. U.S. Food and Drug Administration Website. Available at: http://www.fda.gov/Food/ GuidanceComplianceRegulatoryInformation/GuidanceDocuments/FoodLabelingNutrition/FoodLabelingGuide/ucm064866.htm#3 Accessed January 29th, 2013

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McNeil Consumer Healthcare Announces Plans For New Dosing Instructions For Tylenol ® Products. McNeil Website for Professionals. Available at: http://www.jnj.com/connect/news/all/mcneil-consumer-healthcare-announces-plans-for-new-dosing-instructions-for-tylenol-products Accessed January 29th, 2013.

6.

Products and Dosage; Tylenol Extra Strength ® McNeil Website for Health Professionals. Available at: http://www.tylenolprofessional.com/productsand-dosages/extra-strength-tylenol.html Accessed January 29th, 2013

7.

Products and Dosage; Tylenol ® Regular Strength. McNeil Website for Health Professionals. Available at: http://www.tylenolprofessional.com/ products-and-dosages/regular-strength-tylenol-tablets.html Accessed January 29th, 2013

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OTC Industry Announces Voluntary Transition to One Concentration of Single Ingredient Pediatric Liquid Acetaminophen Medicines. Consumer Healthcare Products Association website. Available at: http://www.chpa-info.org/05_05_11_PedAceConv.aspx Accessed January 29th, 2013

9.

Reducing Fever in Children: Safe Use of Acetaminophen. U.S. Food and Drug Administration Website. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm263989.htm Accessed January 29th, 2013

10. Nonprescription Drugs Advisory Committee and the Pediatric Advisory Committee.

Minutes of the Joint Meeting of the Nonprescription Drugs Advisory Committee and the Pediatric Advisory Committee. U.S. Food and Drug Administration Website. Available at: http://www.fda.gov/ downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/NonprescriptionDrugsAdvisoryCommittee/UCM264147.pdf Accessed January 29th, 2013.

11. Products and Dosage; Infant’s Tylenol ® Oral Suspension Liquid. McNeil Website for Health Professionals. Available at: http://www.tylenol.com/ product_detail.jhtml?id=tylenol/children/prod_inf.inc&prod=subpinf Accessed January 29th, 2013.

12. Products and Dosage; Children’s Tylenol ® Oral Suspension Liquid. McNeil Website for Health Professionals. Available at: http://www.tylenol.com/ product_detail.jhtml?id=tylenol/children/prod_child.inc&prod=subpchild Accessed January 29th, 2013.

13. Products

and Dosage; Children’s Tylenol ®Meltaways ® Chewable Tablet. McNeil Website for Health Professionals. Available at: http://www.tylenol.com/product_detail.jhtml?id=tylenol/children/prod_child_meltaways.inc&prod=subpchildmeltaways Accessed January 29th, 2013.

14. Products and Dosage; Children’s Jr. Tylenol ® McNeil Website for Health Professionals. Available at: http://www.tylenol.com/product_detail.jhtml? id=tylenol/children/prod_jr.inc&prod=subpjr Accessed January 29th, 2013.

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Expanding the Scope of a Community Pharmacy Practice by Utilizing a Focused Set of Collaborative Practice Agreements in a Community Pharmacy Setting Jennifer Robinson, PharmD Clinical Assistant Professor/Director of Student Services Washington State University College of Pharmacy [email protected]

As our healthcare system’s focus shifts to the prevention and more effective treatment of chronic conditions, due to the Affordable Care Act, the practice of pharmacy will certainly evolve to meet the challenges that arise. It is anticipated there will be a shortage of primary care services available to patients within the United States when the Affordable Care Act is fully implemented. Currently ninety- three percent of the United States population lives within five miles of a pharmacy, with individuals tending to see their community pharmacist more frequently than their primary care physician. In addition to this high level of accessibility, the education a pharmacist earns prepares them to be the medication expert within the healthcare team. Pharmacists can be utilized as physician extenders, providing care to patients suffering from acute and/or chronic medical issues as well as providing preventative care through use of Collaborative Practice Agreements (CPAs). In Washington State, a group of community pharmacists collaborating with the Washington State Pharmacy Association (WSPA) is working on a CPA project aimed at expanding the clinical services provided within a community pharmacy setting. The CPA project group has identified twenty-one independent protocol topics that involve treatment of acute issues commonly seen within the community pharmacy setting (Table 1, Page 13). Educational training modules are being developed; with the expectation these practice agreements can be appropriately executed by pharmacists through utilization of basic assessment tools and widely accepted treatment guidelines. The training modules will be similar to the certification seminars that have been successfully utilized to train pharmacists as immunizers in Washington State. As you probably know pharmacists in the community setting are not recognized as providers and subsequently, are not reimbursed by insurance carriers for patient consultation services (beyond medication therapy management). The project team is strongly encouraging community pharmacists to charge a fee for the patient consultation services provided as part of the CPA protocol, even if a legend drug is not dispensed. Data will be gathered to evaluate the effectiveness of the CPA project based on patient satisfaction, pharmacist satisfaction, and economic outcomes for both patient and pharmacy. If you would like additional information about the CPA’s utilized in this project feel free to contact me. [email protected].                          

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Expanding the Scope of a Community Pharmacy Practice by Utilizing a Focused Set of Collaborative Practice Agreements in a Community Pharmacy Setting con’t

TABLE  1 CPA  Protocol  Topics • Bronchospasm • Eye  Allergy • Nasal  Allergy  (anti-­‐histamine  nasal  spray) • Allergic  Rhinitis  (steroid  nasal  spray) • Herpes  Virus • Bee  Sting  (non-­‐anaphylactic) • Epi-­‐Pen  Replacement  (patient  with  expired  Epi-­‐Pen) • Middle  Ear  Infection • Outer  Ear  Infection • Animal  Bite • Minor  Wound  (anti-­‐infective  treatment) • Burns • Acute  Nausea  and  Vomiting • Motion  Sickness • Traveler’s  Diarrhea • Pink  Eye • Migraine  (reNill  of  previously  prescribed  sumatriptan) • Moderate  Pain  (2  day  supply  of  tramadol) • Birth  Control  (one-­‐month  supply  of  brand  previously  prescribed) • Uncomplicated  Urinary  Tract  Infection • Vaginal  Yeast  Infection

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Self-Care Recommendation Follow-Up: A Novel Activity for Students on Rotation Jamie Shelly, PharmD Academic Postdoctoral Fellow in Pharmaceutical Care Labs Division of Practice Advancement and Clinical Education University of North Carolina Eshelman School of Pharmacy [email protected] Brian Decker, PharmD Candidate University of North Carolina Eshelman School of Pharmacy [email protected]

A new opportunity is on the horizon for students at the University of North Carolina Eshelman School of Pharmacy (UNC ESoP) who are completing their Introductory Pharmacy Practice Experience (IPPE) in the community setting. This one-month summer rotation occurs immediately following the PY2 year, where students are required to take a course discussing self-care and nonprescription medications. During this course students are taught the QuEST/SCHOLAR-MAC method to assess a patient’s candidacy for self-care. As an IPPE requirement, students must document the use of the QuEST/SCHOLAR-MAC process, in addition to any recommendations made for at least two patients on a standardized form developed at UNC. While this is reflective of a pharmacist’s role in terms of assessment and providing recommendations, one important piece is missing: follow-up. Despite our best efforts as pharmacists to provide optimal patient care, follow-up on self-care recommendations is often difficult. Having students become involved in the self-care recommendation follow-up process offers numerous benefits not only to patients, but also to students, the practice site, and our profession. Conceptually, patients receive higher-level care when their conditions are reassessed periodically. Students greatly benefit from a process granting them further patient interaction, as well as the opportunity to build upon their assessment, critical thinking, and documentation skills. Practice sites benefit from the rapport established with patients through follow-up, and could potentially see an increase in business gains. Lastly, having students document selfcare follow-up provides data that can be used to gather insight into what recommendations are followed, which are effective, and other outcomes parameters. To evaluate student self-care follow-up and assess the impact of student pharmacists’ recommendations, a pilot program was developed by group consisting of a UNC student, faculty member, and preceptor at a local chain pharmacy. The program, entitled “Self-Care: Active Recommendation and Follow-up (SCARF)”, was conducted at a single pharmacy for nine weeks beginning in February 2012. A documentation form was created that included “recommendation” and “follow-up” sections. After a student made a self-care recommendation, patients were asked for permission for telephone follow-up in one week regarding the recommendation(s) made. If the patient agreed, his or her follow-up information regarding the recommendation was recorded on the form (e.g. agent recommended, directions for use, reason for recommendation, non-pharmacologic measures discussed, etc.). Follow-up was only offered to those patients asking for a recommendation based on symptoms; patients who asked to be directed to a particular product or were seeking confirmation of the appropriateness of a 14

Self-Care Recommendation Follow-Up: A Novel Activity for Students on Rotation con’t self-selected product were not included. Forms were divided into two types: forms requiring follow-up and forms requiring pharmacist review. After one week, a student pharmacist followed up with the patient via phone call. Three attempts were made on at least two different days to reach the patient. Individuals who were contacted were asked to provide information such as the ailment that required a recommendation, what the student pharmacist recommended, whether or not the recommendation was followed, what was done as an alternative if the recommendation was not followed, as well as additional information. These items were listed in the follow-up section of the documentation form. If additional pharmacist review was needed, forms were marked as such and referred to the pharmacist on duty. Recipients who were not reached after the required number of attempts were marked accordingly and filed as completed. A total of eight patients were enrolled in the pilot program. Three sought recommendations for cough/cold symptoms, one for headache, one for musculoskeletal pain, one for allergies, one for insomnia, and one for ear congestion. Follow-up for one individual was excluded, as the recommendation was not made directly to the patient. Of the seven patients reached by phone for follow-up, all seven reported following the suggestion of the student pharmacist. Two patients ultimately required antibiotics but reported the student pharmacist’s recommendation as helping for the interim. Overall, 57% of patients achieved resolution, 29% saw improvement, and 14% were “to be determined” as a second recommendation was required upon follow-up. This pilot program has exposed some of the potential benefits to self-care recommendation follow-up. As a result, beginning in summer 2013, all UNC students on their community IPPE rotation will be required to follow up on a minimum of two self-care recommendations. Students will document the recommendation(s) made and followup with their patient accordingly. They will then submit the documentation to their preceptor and the school for review.

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The Development of Simulated Introductory Practice Experiences at Two Colleges of Pharmacy and the Subsequent Incorporation of Self-Care Topics William Maidhof, PharmD Assistant Professor/Industry Professional St. John’s University College of Pharmacy and Health Sciences [email protected] Heidi N. Eukel, PharmD Assistant Professor North Dakota State University College of Pharmacy, Nursing, and Allied Sciences [email protected] Background: In June 2010, the Accreditation Council for Pharmacy Education (ACPE) Board of Directors drafted a policy regarding the incorporation of simulated experiences as a portion of the Introductory Pharmacy Practice Experiences (IPPEs).1 According to the policy, simulated experiences may account for a maximum of twenty percent of total IPPE hours. Simulation activities must have defined learning objectives, should involve learning experiences that are difficult to achieve in actual practice, and should be supervised by individuals (faculty, preceptors, etc.) who can verify the students achieved the stated learning objectives. In addition, activities that incorporate interprofessional simulations are encouraged by ACPE. Development of an IPPE at North Dakota State University: Faculty utilized the ACPE policy to guide the development of simulated experiences for which IPPE credit is earned. Students in their third professional year (P3) participate in thirty hours of simulated IPPE experiences emphasizing pharmaceutical care, disease state management, physical assessment, medication therapy management, immunization administration, and point-of-care testing. The experience hours are embedded within a pharmaceutical care lab that is taught in a licensed pharmacy, by four licensed pharmacist faculty and two pharmacy practice residents. Eighty-five P3 students meet once weekly in groups of twelve for two hours. As the course was developed, activities were deemed appropriate if they involved provision of care to a specific patient and: • Included objectives that were difficult to achieve in practice • Provided hands-on opportunities to enhance student learning • Included structured feedback with detailed assessment of student learning • Were supervised by a licensed pharmacist faculty member Development of an IPPE at St. John’s University: The committee charged with developing a Simulated IPPE was formed during the summer of 2011. The group worked through the remainder of 2011 developing the content for each experience, a workbook containing exercises to complement the active learning component of each experience, and a website containing the syllabus, policies and procedures, pertinent forms, and student resources. 16

The Development of Simulated Introductory Practice Experiences at Two Colleges of Pharmacy and the Subsequent Incorporation of Self-Care Topics con’t The first Simulated IPPE at St. John’s University was run during the spring semester of 2012, and has since been incorporated into first professional year (P1) coursework. The typical P1 class size at St. John’s University is 250-300 students. Participating students meet once weekly for four hours, for the length of the semester (thirteen weeks). The overall experience totals fifty-two hours. To properly operationalize the experience, two full-time faculty were hired to moderate the Simulated IPPE’s. Advanced Pharmacy Practice Experience (APPE) students are assigned to each section, to assist the faculty member in charge. A typical section of a Simulated IPPE contains approximately forty students. Multiple classrooms and student areas have been identified to properly run the experience. Challenges Encountered at NDSU: The challenges that arose during the incorporation of simulated IPPE into the curriculum included faculty time and case development. Because each activity is directly linked to the provision of care to a specific patient and must be supervised by a pharmacist faculty member, coordination of case development and student observation was extensive. Challenges Encountered at St. John’s University: The time required to develop, as well as update, a Simulated IPPE is quite significant. The initial development was a seven-month process and current faculty teaching in the Simulated IPPE consistently update experience content. Additionally, assessing and grading student/group assignments can be time intensive given the section and overall class size. Class size and instructor-student ratio continue to be significant challenges. Accommodating forty to fifty individuals in a room that is not a lecture hall is a challenge at St. John’s University. As a result, the majority of activities are executed using multiple rooms with the faculty member floating from room to room. Another major challenge identified at St. John’s was establishing a budget for the Simulated IPPE. With an average of forty students per section, many items were purchased in bulk quantity (i.e.: twenty-five manual blood pressure cuffs and stethoscopes). A simulated inpatient record software was also purchased for use within the IPPE that requires a yearly fee to upkeep. Highlighted Simulated IPPE Self-Care Activity at NDSU: A two-hour laboratory activity focused on over-the-counter home testing and monitoring devices was incorporated into the Simulated IPPE curriculum. The objective of the activity was to teach students how to critically evaluate home testing and monitoring devices, how to evaluate test results, and how to educate patients on possible results. Interactive stations were designed around various home testing and monitoring devices including an HIV home screening kit, stool blood test, pregnancy and fertility devices, home INR screening, a home cholesterol monitoring kit, a home drug screening kit, urinary ketone-measuring strips, urine strips that test for possible urinary tract infection, home A1C monitor, and a hepatitis C home diagnostic test. At each station, students were presented with a patient case utilizing audio clips, video vignettes, and interactive PowerPoint question and answer cases, in addition to commercially available devices. Students were guided using specific patient case questions, along with a combination of active learning vignettes, patient consultations, and guided worksheets.

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The Development of Simulated Introductory Practice Experiences at Two Colleges of Pharmacy and the Subsequent Incorporation of Self-Care Topics con’t Highlighted Simulated IPPE Self-Care Activity at St. John’s University: During one of the three weeks devoted to self-care topics, students participate in an activity titled “Self-Care Oral Debates.” During this exercise students are divided into groups and are given a product to discuss and defend in reference to one of three topics: system versus topical nasal decongestants, psyllium versus bisacodyl for constipation, and acetaminophen versus ibuprofen for pain. Each group is provided ninety minutes to research their product, as well as the opposing team’s product, and formulate an argument. As research tools, students utilize the Drug Facts label, the 17th edition of the Handbook of Nonprescription Drugs, and approved drug information resources (LexiComp®, Micromedex®, Drug Facts and Comparisons®). Students follow a standard debate format: five minutes for each group to introduce their product, five minutes for each group’s defense (to reaffirm benefit and discuss weakness of the opposing product), and two minutes for each group’s rebuttal (address opposing team’s comments). At the conclusion of the debate, the remainder of the class votes as to the winner. Acknowledgement: The primary authors would like to acknowledge the contributions of all faculty teaching within the Simulated Introductory Practice Experiences at St. John’s University and North Dakota State University. North Dakota State University: Alicia Fitz, Jeanne Frenzel, Kayla Revering, and Elizabeth Skoy. St. John’s University: Maria Leibfried and Michelle Pisano. References: 1) Accreditation Council for Pharmacy Education. Policies and Procedures for ACPE Accreditation of Professional Degree Programs. December 2011 – pages 30-CS – 33-CS https://www.acpe-accredit.org/pdf/CS_PoliciesandProcedures2011.pdf

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