Activity Examples: Acute Care (In-Patient) and Ambulatory Care Pharmacy Practice

Activity Examples: Acute Care (In-Patient) and Ambulatory Care Pharmacy Practice

1.  Evaluate assigned patients as instructed and discuss patient cases with the preceptor. Assess patient information to identify active problems, past medical history, pertinent physical examination findings, nutritional status, and laboratory/special procedure results and monitor drug regimens to manage pharmacotherapy.

2.  Document patient care notes daily in a format determined by the preceptor (e.g. SOAP).

3.  Perform and document patient care interventions by identifying medication-related issues.

a.  Examples of medication-related issues (adapted from ASHP ResiTrak Obj 2.4.2):

i.  Medication with no medical indication

ii. Medical condition with no medication prescribed

iii.  Medication prescribed inappropriately

iv.  Inappropriate dose, dosage form, duration, schedule, route of administration, method of administration

v. Patient allergy

vi.  Adverse drug reaction

vii.  Therapeutic duplication

viii.  Clinically significant drug-drug, drug-disease, drug-nutrient, or drug-laboratory test interactions

ix.  Immunization record is not complete

x. Issues related to use of nonprescription, recreational, or herbal medications and supplements

xi.  Patient non-adherence

xii.  Financial issues

xiii.  Patient requires additional education/counseling

b.  Identify and report medication errors and adverse drug reactions according to hospital policy.

c.  Discuss unusual presentation of signs and symptoms of medical and drug-related problems commonly seen in special populations, including older adults.

4.  Monitor laboratory data, perform and document pharmacokinetic dosing, including but not limited to an aminoglycoside and vancomycin. (This can also be simulated if necessary.)

5.  Perform and document consultations such as TPN, ADR, anticoagulation, drug interaction, drug information, renal dosing, or hepatic dosing consults.

6.  Obtain patient medication histories

7.  Discuss unusual presentation of signs and symptoms of medical and drug-related problems commonly seen in special populations, including older adults.

8.  Recommend medications and/or laboratory tests in accordance with collaborative practice agreement protocols.

9.  Perform medication reconciliation for individual patients at transitions in care settings (home, hospital, nursing home, assisted living, etc.), identifying and resolving medication-related problems and ensuring patient awareness and understanding as appropriate.

10.  Perform economic and clinical outcomes analyses to support formulary recommendations and therapeutic guideline development.

11.  Discuss and provide examples of the accreditation process and professional standards (e.g., Joint Commission, ASHP Residency requirements, Board of Pharmacy, etc.).

12.  Attend pharmacy-related meetings (e.g., Pharmacy & Therapeutics Committee, Infectious Disease Control Committee, Medication Safety Committee, etc).