Pharmacy Practice

Event Guidelines

Pharmacy Practice

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Purpose: To provide the Health Science student with an opportunity to develop and demonstrate knowledge and skills in pharmacy practice.

Description This event will consist of two rounds of competition. Round One will be a written, multiple choice

of Event: test of knowledge and understanding. The top scoring competitors will advance to Round Two for the performance of selected skill procedure(s) identified in a written scenario. The scenario will require the use of critical thinking skills. The performance will be timed and evaluated according to the event guidelines.

Dress Code: Competitors shall wear proper business attire or official HOSA uniform, or attire appropriate to the occupational area, during the orientation and written test. Competitors will wear attire appropriate to the occupational area during the skill procedure(s). Bonus points will be awarded for proper dress.

Rules and 1. Competitors in this event must be active members of HOSA-Future Health Professionals,

Procedures in good standing in the category in which they are registered to compete (Secondary or Postsecondary/Collegiate). Competitors should compete in skill events at the highest level of their training.

2. Competitors must be familiar with and adhere to the “General Rules and Regulations of the National HOSA Competitive Events Program (GRR)."

3. The test will consist of fifty (50) multiple choice items.

Round One: Written Test Plan

History and Profession of Pharmacy 7.5%

Pharmacology for Technicians 15%

Pharmacy Law and Regulations 15%

Sterile and Non-Sterile Compounding 10%

Medication Safety 12.5%

Pharmacy Quality Assurance 5%

Medication Order Entry and Fill Process 15%

Pharmacy Inventory Management 7.5%

Pharmacy Billing and Reimbursement 7.5%

Medication Formulation Usage 5%

4. All competitors shall report to the site of the event orientation at the time designated. The Round One test will immediately follow the orientation. No proxies will be allowed for the orientation.

5. Test Instructions: There will be a maximum of 60 minutes to complete the test. There will be a verbal announcement when there are 15 minutes remaining for the test period.

NOTE: States/regions may use a different process for testing, to include but not limited to pre-conference testing, online testing, and testing at a computer. Check with your Area/Region/State for the process you will be using.

6. All official references are used in the development of the written test. The specific reference selected for each procedure is listed in the Facilities, Equipment and Materials section of these guidelines.

· Ballington, Don and Anderson, Robert. Pharmacy Practice for Technicians. Paradigm Education Solutions. Latest edition.

· Ballington, Don and Laughlin, Mary. Pharmacology for Technicians. Paradigm Education Solutions. Latest edition.

· Dosage Form Use Document – from CU Skaggs School of Pharmacy

· www.pocketnurse.com for demo dosage forms and other supplies for procedures

7. The test score from Round One will be used to qualify the competitor for the Round Two skill procedures, and will be used as a part of the final score for the event.

8. For national competition, one, two or three skill procedures will be selected and may be evaluated as stand-alone skills, or in combination. The procedures approved for this event are:

Procedure I: Identify Problems or Missing Items on Prescriptions

Procedure II: Interpret Prescriptions and Dispense Correctly

Procedure III: Donning Aseptic Gear in Sequential Order

Procedure IV: Aseptic Technique

Procedure V: Non-sterile Compounding – Suspension/Solution

Procedure VI: Non-sterile Compounding – Two Ointments

Procedure VII: Non-sterile Compounding – Ointment with Tablets

Procedure VIII: Patient Education: Proper Dosage Form Usage

* Two of the procedures in red will be piloted at the 2015 Colorado State Leadership

Conference.

9. The selected procedure(s) for Round Two, in the form of a written scenario, will be presented to the competitor at the start of the skill to be performed. One or more procedures may be combined in the scenario. The scenario will be the same for each competitor and will include a challenging component that will require the competitor to apply critical thinking skills.

10. The scenario is a secret topic. Professional ethics demand that competitors DO NOT discuss or reveal the secret topic until after the event has concluded. Competitors who violate this ethical standard will be disqualified.

11. In case of a tie, the highest test score will be used to determine the rank.

12. Competitors must complete all steps of the procedure listed in the guidelines even if the steps must be simulated/verbalized. Steps may NOT be simulated/verbalized when the equipment/materials are available.

13. The competitor must earn a score of 70% or higher on the combined skill procedure(s) of the event (excluding the test) in order to be recognized as an award winner at the NLC.

14. The timing for the skill will begin when the scenario is presented. Competitors will be stopped at the end of the time allowed for a selected procedure(s).

Required Personnel

1. One Event Manager per event

2. One Section Leader per section

3. One judge per procedure selected per section (with expertise in the specific skill area)

4. Proctors for testing

5. One-two event assistants per section

6. One-two patients as required by the scenario (per section)

7. Holding room attendants(s)

8. Timekeepers (if necessary)

9. One QA to provide quality assurance for the event by ensuring that the guidelines are followed and all event documents are complete.

Facilities, Equipment and Materials (Per Section)

General

¨ Clinical and/or laboratory stations for selected procedures

¨ Access to sink for selected procedures

¨ Holding rooms or areas for competitors

¨ Written scenario (one copy per competitor and judge)

¨ Patient and judge scripts as needed

¨ Pencils for judges

¨ Stopwatch

¨ Rating sheets – one per judge per competitor

¨ Evaluation Forms – competitor, judge, and personnel

¨ #2 lead pencils with eraser to complete evaluations

Round One: Written Test (Reference: All resources)

¨ One test copy per competitor

¨ Scantron /answer forms

Round Two:

Procedure I Identify Problems or Missing Items on Prescriptions (Reference: Ballington, Chapter 6)

¨ Pencil/eraser

Procedure II Interpret Prescriptions and Dispense Correctly (Reference: Ballington, Chapter 6)

¨ Pencil/eraser

¨ Counting tray/spatula

¨ Two medication vials of each size (10 dram, 20, 30, 40, 60)

¨ Labels (4 per competitor)

¨ Demonstration medications

o Keflex 500 mg, #30

o Cephalexin 500 mg, #30

o Norco 5/325, #150

o Hydrocodone/Acetaminophen 10/325, #150

o Polytrim ophthalmic drops, 10 mL bottle

o Poly-dex ophthalmic drops, 5 mL bottle

o Triamcinolone 0.1% cream, 80 g tube

o Triamcinolone 0.1% ointment, 80 g tube

Procedure III Donning Aseptic Gear in Sequential Order (Reference: Ballington, Chapter 11)

¨ Tape to represent different rooms

¨ Sink access

¨ Soap or hand sanitizer

¨ Barrier devices (gloves, gown, shoe covers, mask, hair net)

Procedure IV Aseptic Technique (Reference: Ballington, Chapter 11)

¨ Isopropyl alcohol and sterile water in spray bottles

¨ Paper towels

¨ Horizontal hood (counter space with backdrop)

¨ Powdered and liquid medication vials

¨ Sterile water vial

¨ Safeline Vial Access Cannulas (pocketnurse.com)

¨ Alcohol swabs

¨ 250 mL NS or D5W bag

Procedure V Non-sterile Compounding – Suspension/Solution (Reference: Ballington, Chapter 8)

¨ Pencil/eraser

¨ Paper

¨ Crushable Tablets (at least 15-20 per competitor)

¨ Counter space

¨ Mortar and pestle

¨ 50 mL and 100 mL graduated cylinders

¨ One vial of varying sizes (2 oz., 3 oz., 4oz.)

¨ Sink access

Procedure VI Non-sterile Compounding – Two Ointments (Reference: Ballington, Chapter 8)

¨ Pencil/eraser

¨ Paper

¨ Two different ointments, one labeled as 2% and the other 10%

¨ Counter space

¨ Weighing scale

¨ Wax paper or similar item (to be able to weigh product)

¨ Either mortar and pestle or compounding slab with spatula

¨ Container for final product

¨ Sink access

Procedure VII Non-sterile Compounding – Ointment with Tablets (Reference: Ballington, Chapter 8)

¨ Pencil/eraser

¨ Paper

¨ Ointment

¨ Crushable tablets (at least 10-15 per competitor)

¨ Counter space

¨ Weighing scale

¨ Wax paper or similar item (to be able to weigh product)

¨ Mortar and pestle

¨ Compounding slab with spatula

¨ Container for final product

¨ Sink access

Procedure VIII Proper Ophthalmic Drop Usage (Reference: Safemedication.com, How to Use Eye Drops Properly)

¨ Eye drops

¨ Tissue or cloth

¨ Sink access

Icon Key

h / Competitors must meet a 70% mastery score on skills in this event.
! / The orientation includes an event element. Competitors must bring pencils/pens.
" / Round One scores are used to advance competitors to Round Two at the NLC.
? / Includes a secret topic that may not be discussed or revealed to others until the event has concluded.

Event Flow Chart

Sample Round One Test Questions

1. Professionals and consumers can report serious adverse drug reactions to

A. the DEA.

B. the PTCB.

C. MedWatch.

D. the NABP.

2. What is a common side effect of narcotics?

A. swelling.

B. constipation.

C. wheals.

D. wheezing.

3. Why are many patients with asthma reluctant to use inhaled corticosteroids?

A. They dislike the dosing regimen.

B. They fear potential side effects.

C. They object to the taste.

D. They think corticosteroid inhalers are too difficult to use.

PHARMACY PRACTICE

Competitor #: ______Judge's Signature: ______

Procedure I Identify Problems or Missing Items on
a Prescription
Reference: Ballington, Chapter 6
Time: 8 minutes / Possible / Allocated
1. Prescription #1
Smith, John
5555 W Auraria Ct
Denver, CO 80219 / #1 Healthcare Offices
303-555-5656
Rx: Fentanyl 100 mcg patch #90 (No Written date)
1 patch Q3 days for 1 month

Refills: 0
Dr. M. Johnson, MD______
(No DEA Number)
a. Unacceptable quantity / 1
b. Missing address of doctor’s office / 1
c. No DEA number / 1
d. Missing date written / 1
2. Prescription #2
John
5555 W Auraria Ct
Denver, CO 80219
720-546-3255 DOB: 08/15/56 / #1 Healthcare Offices
1357 E. Bonner St
Denver, CO 80219
303-555-5656
Rx: Testosterone depot 100 mg/mL #10 ml 7/27/2014
Inject 2 mL (200mg) Q2W

(No Indication)

Refills: 0
Nick Johnson, MD______
DEA: AJ3462841
a. Missing last name / 1
b. Missing route of administration (PO, IM, SQ, IV, etc.) / 1
c. Invalid DEA number / 1
d. Missing indication for medication use / 1
Items Evaluated / Possible / Allocated
3. Prescription #3
Bullock, Seth
2415 E. Colfax Ave
Denver, CO 80219 / Colorado Alpine Care
4110 Washington St.
Denver, CO 80209
303-550-5676
Rx: Adderall XR 30 mg #6 07/11/2015
Ṫ daily PRN PA

x Dispense as written
Refills: 1
Sean Stevenson, MD
No DEA Number
a. Written date cannot be in the future / 1
b. No refills allowed / 1
c. No DEA number / 1
d. Missing route of administration (PO, IM, SQ, IV, etc.) / 1
4. Prescription #4
Bullock, Seth
2415 E. Colfax Ave
Denver, CO 80219 / Colorado Alpine Care
4110 Washington St.
Denver, CO 80209
303-550-5676
(7/29/2014)
Rx: Hydrocodone/APAP 5/325 (Percocet) # 20
Ṫ tab by mouth PRN, stop 1 week from today

Refills: 10
Sean Sternson, MD
DEA: AS2441753
a. Unacceptable amount of refills / 1
b. Signa needs verification as the written date is longer than 1 week ago / 1
c. Drug name error (Not Percocet) / 1
d. Missing frequency / 1
TOTAL POINTS -- PROCEDURE I / 16

PHARMACY PRACTICE

Competitor #: ______Judge's Signature: ______

Procedure II Interpret Prescriptions and Dispense
Correctly
Reference: Ballington, Chapter 6
Time: 13 minutes / Possible / Allocated
1. Prescription #1
a. Prescription number / 1
b. Patient name / 1
c. Date of initial dispensing / 1
d. Correct drug strength and formulation / 2
e. Correct signa / 2
f. Prescriber name / 1
g. Name and address of pharmacy / 1
h. Correct amount dispensed / 1
2. Prescription #2
a. Prescription number / 1
b. Patient name / 1
c. Date of initial dispensing / 1
d. Correct drug and strength / 2
e. Correct signa / 2
f. Prescriber name / 1
g. Name and address of pharmacy / 1
h. Correct amount dispensed / 1
Items Evaluated / Possible / Allocated
3. Prescription #3
a. Prescription number / 1
b. Patient name / 1
c. Date of initial dispensing / 1
d. Correct drug and strength / 2
e. Correct signa / 2
f. Prescriber name / 1
g. Name and address of pharmacy / 1
h. Correct amount dispensed / 1
4. Prescription #4
a. Prescription number / 1
b. Patient name / 1
c. Date of initial dispensing / 1
d. Correct drug and strength / 2
e. Correct signa / 2
f. Prescriber name / 1
g. Name and address of pharmacy / 1
h. Correct amount dispensed
· #1 tube of 80 grams / 1
TOTAL POINTS -- PROCEDURE II / 40

PHARMACY PRACTICE

Competitor #: ______Judge's Signature: ______

Procedure III Donning Aseptic Gear in Sequential
Order
Reference: Ballington, Chapter 11
Time: 8 minutes / Possible / Allocated
Note to Judge: Directions are sequential and points should not be given for steps done out of order.
1. Take off earrings, hand jewelry, and cosmetics / 2
2. Place gear in the following order:
1: Place shoe cover
2. Place hair cover
3. Place face mast
* One point for every item that is put on in the correct order / 3
3. Hand cleansing with soap (up to the elbows) / 2
4. Place gown / 2
5. Apply sterile, foamed alcohol to hands and allow to dry / 2
6. Place sterile powder-free gloves / 1
TOTAL POINTS -- PROCEDURE III / 12

**If a student jeopardizes the patient's or his/her own safety or fails to perform a critical technique and does not take immediate action to correct the error, the total points for the procedure or specific subpart(s) will be deducted.

PHARMACY PRACTICE

Competitor #: ______Judge's Signature: ______

Procedure IV Aseptic Technique
Reference: Ballington, Chapter 11
Time: 12 minutes / Possible / Allocated
1. Spray hood first with sterile water, followed by isopropyl alcohol. Alcohol must remain in contact with the surface for 30 seconds prior to compounding any products. / 2
2. Wipe hood in an up/down motion from top to bottom (for horizontal hood) / 2
3. Wipe the top of the vial(s) and 250mL solution bag port with alcohol swab / 1
4. Powder Vial: add appropriate amount of diluent, remove needle, mix until powder is completely reconstituted, wipe vial with alcohol swab before reinserting needed, and then draw out correct amount of medication
Liquid vial: draw up equivalent volume of air into the syringe, once needle is in the vial, depress the syringe to inject air into vial, withdraw appropriate amount of medication
Ampule: Tap ampule to verify medication is at the bottom, wrap an alcohol-soaked swab around the neck of the ampule and snap the neck, use filtered needle to withdrawal correct amount of medication, and switch needle to an unfiltered needle.
/ 3
5. Insert medication into the correct port on the 250mL bag / 1
6. Pull syringe back to the correct mL of medication you injected into the 250mL bag / 2
7. Put all vials, 250mL bag, syringes, and needles on table outside of hood. / 1
8. Spray hood with isopropyl alcohol / 1
9. Wipe hood in an up/down motion from top to bottom (for horizontal hood) / 2
10. Did the student’s technique block airflow in the hood at any point? (i.e. did hands/fingers/other body parts come between the air filter and the needle inserting into vial/bag) / 4
TOTAL POINTS -- PROCEDURE IV / 20