1. finance
2. personal finance
3. lending
4. student loans

INTRODUCTORY PHARMACY PRACTICE EXPERIENCES
(IPPE-II INSTITUTIONAL)
PHAR 4339
5/19/14 – 6/13/14 Session A
or
6/16/14 – 7/18/14 Session B
or
7/21/14 – 8/15/14 Session C
St. John Fisher College of Pharmacy
Introductory Pharmacy Practice Experience - Institutional
PHAR 4339 (3 credit hours)
This Introductory Pharmacy Practice Experience (IPPE) rotation is the second of four
introductory rotations offered at the Wegmans School of Pharmacy. The focus of this
rotation will provide the student with knowledge and experience in the operational aspects
of institutional pharmacy and also introduce them to some clinical aspects of pharmacy
practice. This is a 160 hour rotation. Please review the course manual thoroughly. As a
professional, the student will be responsible for the content contained within.
The Wegmans School of Pharmacy would like to thank the members of the Inpatient
Pharmacy Advisory Committee (IPAC) who volunteer their time to meet regularly with
the Office of Experiential Education. Their input has been invaluable for the creation and
continued improvement of the experiential education program.
Accessory
The student will create a portfolio (MyFolio) in E*Value which will contain site requirement
forms, resume/CV, intern permit, HIPAA training forms, and immunization documentation.
Confidentiality
Patient information is private and we are entrusted with it. The patients trust us because
we are health care professionals. Therefore, confidentiality is the foundation for the
establishment of trust between patients and health care providers. The students are
expected to not discuss any patient information that they have encountered at their
rotation sites outside of their learning environment. Any infraction will result in immediate
dismissal from the site and a failing grade will be given for the rotation. The student will
be reported to the Student Progress Committee.
IPPE-II_Manual
2
Letter to the Preceptor
Thank you for contributing your time and effort in our educational endeavor. We are preparing a
generation of professionals who will lead our profession into the future.
Preceptorship is an
opportunity to shape the future of pharmacy.
PHAR 4339 is a four week rotation in which each student will complete at site a minimum of five, eight
hour days each week (total of 160 hours). The student will spend the majority of time assisting in the
operational aspects of the pharmacy - the process for getting the medication to the patient in an
accurate and timely fashion. The student will also complete homework and tasks which will enhance
the learning experience. The homework and tasks must be approved by the preceptor and if not
acceptable will be repeated until completed to the preceptor’s satisfaction. Finally, the student will
keep a reflection journal that will be reviewed and discussed with their preceptor.
The students will upload all documents to E*Value Coursework (Learning Modules) for review by the
preceptor. Preceptors should review the student’s documents in E*Value and discuss their growth
and educational plans in regards to the pharmacy profession. The preceptors will also verify
completion of homework assignments and tasks and assess student performance in E*Value.
Preceptors will be notified electronically when their student has submitted assignments/tasks and
when formative and final assessments are due.
Expectations of Preceptor:
1. Introduce student to site/staff and review rotation schedule.
2. Explain your expectations to student: start times, procedure for turning in homework, procedure
for completing tasks, assignment of presentation topic, and assessment procedure.
3. On the first or second day set dates when students will complete required activities.
4. Set dates and time for the formative assessments (week 2) and final assessment (week 4).
5. Coach and mentor student to achieve mastery of “activity list” starting with day two.
6. Coach and mentor student regarding homework – give practical examples to reinforce learning.
7. Review student’s written homework and provide feedback to the student.
8. Identify and resolve student difficulties early.
a. For serious issues such as repetitive tardiness or unexcused absences document the
issue and notify the Experiential Education Office as soon as possible.
b. The E*Value Concern Card is a feature available to send our office a message regarding
any student issues you would like us to be aware of. You can complete a Concern Card in
E*Value by clicking on Evaluations/On-The-Fly.
9. Discuss career options with the student (locally at current site and other sites in general).
10. Motivate, motivate, motivate, and motivate the student some more! Share your pharmacy practice
challenges and how you handle these difficult situations.
11. Attend development presentations at school as the preferred method of preceptor training. In lieu
of attending presentations review materials are available on the Pharmacist’s Letter Website at
http://www.pharmacistsletter.com. For groups, an onsite presentation can be scheduled to offer
preceptor development sessions, contact the Experiential Education Office for more details.
Should you have any questions, please contact:
Ms. Andrea DiGiorgio
Experiential Education Coordinator
Wegmans School of Pharmacy
St. John Fisher College
3690 East Avenue
Rochester, NY 14618
Phone: (585) 385-7249
Email: adigiorgio@sjfc.edu IPPE-II_Manual
3
IPPE-II Overview
1. HOMEWORK: All assigned homework should be discussed with the preceptor prior
to the student completing the assignment. Once the homework is completed the
student will upload it to Coursework in E*Value. The document uploaded to
Coursework should be one document encompassing all of the individual topics for
each week. The preceptor may request a printed copy to review with the student. The
preceptor will point out its strengths and weaknesses, and comment on each
assignment. If not acceptable the student must re-do the assignment using the “onthe-fly” feature in Coursework until approved by the preceptor in E*Value Coursework.
Homework can be completed in a sequence that is preferable to the preceptor.
2. ACTIVITIES/TASKS: The student must complete and have their preceptor verify (in
E*Value) as acceptable all required activities/tasks in order for the student to pass the
rotation. For each task the student will upload a brief description of the activity
performed. The activity may be repeated until the student masters the activity.
Activities/tasks can be completed in a sequence that is preferable to the
preceptor.
3. JOURNAL REFLECTION: At the end of each rotation week the student will create and
submit a journal reflection document (see example later in manual) in Coursework
which includes at least two new error prevention strategies in bullet form. The student
will then reflect and write about how they might use these concepts/tasks to benefit
patient care and prevent errors. The reflection piece should not be long; it should be
concise so it will be easy for you to review later. The preceptor will review the
document in Coursework, comment and indicate whether or not the reflection is
acceptable.
4. ERROR PREVENTION ANALYSIS PAPER: Beginning week four, the student and
preceptor will select three practical error prevention techniques identified from the
previous three weeks. The student will then write one paragraph (for each error
prevention technique) describing the pros and cons of implementing these three
strategies. The document must be submitted through Coursework for review and
approval by the preceptor.
5. MEDICATION PASSES: Each student will witness at least one patient medication
pass and create a document containing a brief description of and reflection on the
process. The Medication Pass Verification Form (see back of manual) may be used
to document and reflect upon this event. Either the medication nurse or a pharmacist
may sign the document verifying that the medication pass was observed. Each
student will then upload the completed document into Coursework.
6. FORMATIVE AND FINAL ASSESSMENTS: During weeks 2 and 4 of the rotation,
both the student and preceptor will complete an assessment of the student
independently using E*Value. For each evaluation period, the forms should be printed
and the student and preceptor should compare the student’s self-assessment with the
preceptor’s assessment and discuss the differences and similarities. A strategy for
enhancing the students learning for the remainder of the rotation should be discussed
at the end of week 2. For students at risk for failure during a formative
assessment a written plan of action for improvement should be composed by
IPPE-II_Manual
4
the preceptor and student, signed by the student and preceptor and a copy sent
to the Assistant Director of Experiential Education.
7. PRECEPTOR SUMMARY GRADING FORM: During the final week of the rotation the
preceptor will complete the summary grading sheet which includes indicating if the
student passed or failed the rotation.
NOTE: Documents should be verified by preceptor in E*Value when indicated.
Student is responsible to make sure preceptor completes all requirements of the
rotation.
Clerkship/Rotation Policies & Regulations
The student must share the clerkship manual with their preceptor during their first
day of rotation. The student is responsible for reading the content of the clerkship
manual and is expected to follow the policies and regulations as stated. Any
infringements may lead to automatic dismissal from the site and failure of the rotation.
I.
Pre-requisite
The student must successfully complete all other required courses in the first and
second professional years at the Wegmans School of pharmacy, and possess a
valid intern permit.
II.
Health records
Students should have all site required health records up to date (physical
examination, immunization, PPD or CXR) before starting rotation. These
requirements will vary by site. Copies of these records must be in the Wellness
Center and it is highly recommended that they be uploaded to MyFolio for better
access by the student when needed. Failure to adhere to this policy may result in
the delay of completing your rotation.
III.
Professional insurance
St. John Fisher College arranges liability insurance for students each year.
IV.
1.
2.
3.
4.
5.
6.
7.
Site Selection
A site assignment is tentative and does NOT guarantee that a student will
attend that site.
Student is responsible for ALL expenses associated with attending site.
Students may NOT have a first degree relative as a preceptor.
Students may NOT receive academic credit for working at a site where they
are currently employed.
Students will NOT accept any remuneration from the site while on rotation.
For IPPE-I, IPPE-II, APPE Institutional, or APPE Community, students may
NOT select a rotation site at which they are currently employed.
The Assistant Director of Experiential Education or assigned preceptor can
refuse a student assignment if she/he feels there may be a conflict of interest.
IPPE-II_Manual
5
8.
9.
10.
V.
For IPPE I and APPE Community Pharmacy a student may not select a site
where they have been employed in the past.
For IPPE-III, IPPE-IV, APPE Ambulatory Care, APPE Acute General Medicine
or APPE Electives, a student may NOT select a site where their potential
preceptor would have a dual role as a preceptor and a “boss” or ”job reviewer”.
If the assigned preceptor does not have such a role, then the student can
perform a rotation in an institution where they are currently employed.
Students who feel that they may not meet the above guidelines should contact
the Director of Experiential Education and the prospective preceptor before
selecting the site.
E*Value and Coursework Portfolio
The student is responsible for maintaining and uploading all required documents to
E*Value and Coursework. This system will be used for verifying compliance and
assessing student performance.
VI.
Grading
Grading will be Satisfactory (Pass) or Unsatisfactory (Fail). Failure of any portion
of the course will mandate repeating the entire course.
VII.
Evaluations
The preceptor will evaluate the student throughout the rotation, formal and informal
feedback is encouraged. Preceptor evaluation of the student should be used to
encourage student improvement in specific areas where the student is not
performing well. The student must evaluate the preceptor, the course, and the site.
Failure to adhere to this policy may result in an incomplete grade or failure. Failure
may result if required documents are not completed and received by the
Experiential Education Office by their due date.
VIII.
Weather conditions
All students should follow the weather advisory from SJFC regarding cancellation
or delay of classes on campus. However, the students who cannot travel to their
sites due to hazardous weather conditions should immediately notify their
preceptors and the Experiential Education Office at (585) 385-7249. Attendance
policy still applies regarding make up days and missing days.
IX.
Dismissal from sites
All students are representing Wegmans School of Pharmacy and the Pharmacy
profession during their presence at the rotation site. Therefore, professionalism
and the highest standards are expected from students during their training at the
sites. The Department of Pharmacy Practice and the site reserve the right to
dismiss any student who does not uphold a professional attitude during the
clerkship time. Any student caught under the influence of any substance of
abuse/addiction, or caught stealing from the site will be dismissed automatically
and fail the rotation. The student will then be reported to the Student Progress
Committee and if necessary, the WSOP Student Honor Committee.
X.
Academic Honesty & Plagiarism
IPPE-II_Manual
6
St. John Fisher College has a firm policy concerning academic dishonesty that
includes, but is not limited to, cheating, plagiarism, or any other action that
misrepresents academic work as being one’s own. Students are expected to
demonstrate academic honesty in all coursework, whether completed in-class or
not, individually, or as part of a group project. Violations of academic honesty
include, but are not limited to, cheating and plagiarism. All students are expected
to be familiar with the details of the Policy on Academic Honesty, which are found
in the current Student Handbook.
XI.
Professionalism
As consistent with the expectations of a professional and practice environment,
professional behavior and attitudes are expected for all students enrolled in this
course. Examples of professional behavior include, but are not limited to,
appropriate demeanor, grooming, punctuality, and civility.
XII. Personal Appearance
As a representative of the School of Pharmacy, a student’s personal appearance is an
extension of the School and will, to some degree, determine how customers, patients,
and colleagues view the student, the program, and the profession of pharmacy.
Conservatism and discretion are key determinants of professional attire. Business
casual is the minimum requirement for appropriate attire for students during the three
didactic years of the Pharmacy program. The following guidelines for attire are provided
to assist the Pharmacy Doctoral Candidate to what is deemed as acceptable. The
WSoP Dress Code shall be in effect from 8:00 AM until 5:00 PM Monday through Friday
and covers the WSoP building and atrium. Students are also expected to adhere to the
code when serving as a representative of the program.
Hair: Hair should be clean and neatly groomed. Hair may not be dyed any unnatural
hair colors. Males shall have short hair (above the shoulders) and it shall be neatly
combed. At times and at the discretion of the course instructor, (lab, etc), it may be
necessary for females with longer hair to have it pulled back. Hair ornaments shall be
moderate and in good taste.
Nails: Nails must be neatly manicured (not chipped) and kept at a length that will not
interfere with the duties of a pharmacist (e.g., dispensing prescription, compounding in
lab, making IVs). If polish is used, it must be conservative in color.
Skin: No body piercings (other than earrings) or tattoos are allowed to be visible.
Permissible Jewelry: Females and males are allowed no more than two earrings per
ear. Earrings should be of a conservative nature (not large, no gauges or stretchers,
etc.).
Shirts: Revealing clothing (e.g., tank tops, spaghetti straps, halter tops, midriffs, tube
tops, swim tops) is not permitted, and proper undergarments shall be worn. For men
sweaters are acceptable. If shirts are worn they should have a collar and should be
tucked in. For women, blouses should not be low cut or tight fitting. Hoodies and
sweatshirts may not be worn in the building during the hours that the dress code is in
effect.
IPPE-II_Manual
7
Skirts/Dresses: Skirt length shall be no shorter than one inch above the knee (when
standing) and may not be tight fitting. Split skirts are permitted, provided they are not
tight fitting and fall within the skirt guidelines.
Pants/Slacks: Pants shall not be tight fitting. Denim of any color, spandex, leggings,
athletic wear, and sweat suits are not permitted. Pants must be worn properly at the
hips. Any pants that contain rivets are not considered business casual. No shorts of any
kind are allowed in the building during the hours that the dress code is in force. No
student shall dress in a way that his/her underwear is partially or totally exposed and
proper undergarments shall be worn.
Shoes: Shoes must be clean and in good condition. Non-dress open toe casual sandals
(flip flops, Birkenstocks, etc) shall not be worn. No athletic shoes or sneakers are
permitted.
Head Gear: Hats, caps, and other head gear may not be worn in the building during the
hours that the Dress Code is in effect. Only headgear worn for bona fide religious
purposes is permissible.
Should the student be cold in class this code shall not
prohibit a student from wearing a jacket during class.
A faculty member who sees a student in violation of the student policy and procedures
will counsel that student. Continued infractions of the student policy and procedures will
result in sanctions appropriate to the policy (such as being sent home for repeated
violations of dress code).
XIII.
Confidentiality & HIPAA
Patient information is private and we are entrusted with it. The patients trust us because
we are health care professionals. Therefore, confidentiality is the foundation for the
establishment of trust between patients and health care providers. The students are
expected to not discuss any patient information that they have encountered at their
rotation sites outside of their learning environment. The student will also complete and
abide by any site specific HIPAA requirements. Any infraction will result in immediate
dismissal from the site and a failing grade will be given for the rotation.
XIV. Sexual Harassment
Sexual harassment is strictly prohibited. Below is the legal definition of sexual
harassment, any allegation of sexual harassment by preceptor or student MUST be
reported immediately to the Director of Experiential Education and the Director of Human
resources. Sexual harassment, by law, is defined as unwelcome sexual advances,
requests for sexual favors, or other verbal or physical conduct of a sexual nature when 1)
submission to such conduct is made an explicit or implicit term or condition of employment,
2) submission to or rejection of such conduct is used as a basis for employment decisions,
or 3) such conduct has the purpose or effect of unreasonably interfering with an
individual’s work performance, or educational experience, or creates an intimidating,
hostile, or abusive work or educational environment. Sexually harassing conduct may
include, but is not limited to, sexually charged or sexually suggestive comments or jokes,
sexual advances, requests for sexual favors, sexually suggestive pictures, drawings or
emails, or similar conduct of a sexual nature.
IPPE-II_Manual
8
XV.
Student Complaint Process
If the student feels they are being asked to perform an activity that is considered
unprofessional conduct, puts patients or the student at risk for harm, or is contrary to the
law, policies and/or regulations of the institution, site or college, the student should
immediately discuss the concern with their preceptor. If the student is not satisfied with
their preceptor’s response the student should immediately contact the Experiential
Education Coordinator (Ms. Andrea DiGiorgio) at (585) 385-7249. The Director of
Experiential Education or the Assistant Director will then talk with the student and
preceptor to discuss possible options.
IPPE-II_Manual
9
Preceptor (P) and Student (S) Rotation Reminders:
Week 1, Day 1, 2014
Student to complete in advance of rotation start date the Pre-Rotation
Self Evaluation. Student and preceptor will review Day 1 of rotation
Preceptor to review manual with student.
Schedule date and time for Formative assessment with student
- Due Week 2
Schedule date and time for Final assessment with student
- Due Week 4
Review student homework and activities.
Complete time form.
Complete Journal Reflection Form.
S
P
P
S
S
P
S
P
P
S
S
Weeks 1 – 4, 2014
Review homework assignment and journal documentation with student.
Review, comment, and sign (if acceptable) completed homework and journaling
with student.
Complete weekly homework and journaling.
Verify tasks/activity completion.
Complete time form.
Complete Formative assessment of student
- Due Week 2
Complete Formative self-assessment
- Due Week 2
Compare Formative assessments and discuss similarities and differences
- Due Week 2
Complete preceptor and site Final assessments on Thursday of week 4
P
P
S
S
P
P
P
S
P
S
S
Week 4, 2014
Select 3 error prevention strategies from the journal writings, the student will then
write a procedure to implement these strategies
Upload all completed assignments into E*Value and notify preceptor to review
Complete 10 minute presentation
Evaluate 10 minute presentation
Complete Final student self-assessment.
Complete Final assessments of student
Compare & discuss preceptor’s Final assessment of student with student’s Final
self-assessment.
Complete time form and sign.
Complete Summary Grade form.
Complete Journal Reflections.
Upload final copies of all completed homework and journal writings to
E*Value
P
S
S
S
S
P
P
S
P
P
S
S
IPPE-II_Manual
10
Time Form
Student’s Name: ____________________________
Rotation Site: ______________________
Date: _______
Preceptor’s Name (Printed): ________________________
Preceptor’s Signature: ______________________________
It is the student’s responsibility to have this form completed by the preceptor. Students
must complete a minimum of 8 hours each day Monday – Friday.
2014
Hours
Preceptor’s
Preceptor’s comments
signature
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Day 11
Day 12
Day 13
Day 14
Day 15
Day 16
Day 17
Day 18
Day 19
Day 20
Total hours
(Should be ≥
160 hours)
This is a form that must be maintained by the student and uploaded to Coursework in E*Value.
IPPE-II_Manual
11
WEEKLY HOMEWORK AND READING ASSIGNMENTS:
The preceptor will review each topic with the student so the student understands the concept thoroughly.
Homework can be completed in a sequence that is preferable to the preceptor. Below is a suggested
sequence to encourage timely completion of homework assignments. The student will submit the
completed homework to his/her preceptor through Coursework. Homework should be completed at home
unless allowed specifically by the preceptor to be done at site. Homework must be completed and accepted
by preceptor.
TOPICS – WEEK 1
Orientation to site and introduction to site team.
- Include ancillary members of the healthcare team that interact with the
pharmacy department
- Give an overview of the profession of pharmacy to the student and describe
current pharmacy issues of importance
State the drug information reference your preceptor prefers and why.
Review a medical record in the institution (electronic or paper).
- Briefly describe the various sections of the medical record and what type of
material is contained in each section.
Briefly describe the function of other healthcare workers, including the following:
Physicians, Nurses, OT/PT, Nutritionists, Respiratory Therapists, and Lab Personnel.
According to your preceptor, define medication reconciliation.
- Describe how your site is performing medication reconciliation.
- How could this process be improved?
Review some medical administration records (MAR’s) and answer the following:
- Describe the purpose of the MAR
- How are the medications organized on a MAR such as routine medications, prn
medications or others?
- What does a “prn” order mean?
- List examples of prn orders
- What are the standard administration times for a Q.I.D. order versus Q6H at
your facility?
- What are the common administration times for the following: Q.I.D., T.I.D.,
B.I.D., Q.D., versus Q6H, Q8H, Q12H, Q24H
- How can you tell a medication is given by looking at the MAR?
- Who can add information to an MAR?
- How can you identify errors reviewing an MAR?
- In general terms, describe how paper, pre-printed and electronic MARs are
utilized.
READ the ASHP Statement on the Pharmacy and Therapeutics Committee:
http://www.ashp.org/DocLibrary/BestPractices/FormStPTCommFormSyst.aspx
- Describe the membership of the P&T committee as recommended by ASHP
- Briefly describe the functions of the P&T committee as recommended by ASHP
- If possible, attend a P&T committee meeting
IPPE-II_Manual
12
TOPICS – WEEK 2
READ the ASHP Guidelines on Medication use Evaluation:
http://www.ashp.org/DocLibrary/BestPractices/FormGdlMedUseEval.aspx
- Describe the purpose/benefits of the MUE process from the perspective of
the physician/provider, patient, and pharmacist.
READ The ASHP Guidelines on Adverse Drug Reaction Monitoring and
Reporting:
http://www.ashp.org/DocLibrary/BestPractices/MedMisGdlADR.aspx
- Describe your site’s process for identifying and reporting ADR’s
- What are the challenges to improving the system currently in place?
- List the criteria that mandate reporting ADR’s to the FDA listed in box B2
located at: http://www.fda.gov/Safety/MedWatch/HowToReport/default.htm
- Review the FDA’s ADR voluntary reporting form (3500) at
http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Forms/U
CM163919.pdf
- Complete the form from a real case or a fictitious example submitted by
your preceptor.
READ The ASHP Statement on the Pharmacist’s Role in Substance Abuse
Prevention, Education and Assistance.
http://www.ashp.org/DocLibrary/BestPractices/SpecificStSubstance.aspx
- Describe the process for tracking/auditing controlled substances in the
institution.
- How are CII’s, CIII’s, CIV’s, and CV’s inventoried and tracked in the
pharmacy and on the nursing units?
IPPE-II_Manual
13
TOPICS – WEEK 3
READ The ASHP Discussion Guide for Compounding Sterile Preparations:
http://www.ashp.org/s_ashp/docs/files/HACC_797guide.pdf
- After discussing with your preceptor, describe in general terms, the process of
how USP 797 is being implemented at your site.
- Describe your sites challenges for implementing USP 797.
- Describe how your site monitors compliance of aseptic technique for the
compounding of sterile preparations.
- Describe the difference between a sterile product and a sterile preparation.
READ The ASHP Guidelines on The Pharmacy and Therapeutics Committee and
the Formulary System.
http://www.ashp.org/DocLibrary/BestPractices/FormGdlPTCommFormSyst.aspx
- Describe the advantage(s) and disadvantage(s) of a formulary system from the
perspective of the institution, patient, and physician/provider.
- Describe how an institutions use of a formulary may affect patients on
discharge. Why is there potential for patients to receive duplicate therapy?
- According to your preceptor, describe what it means to have a drug on
restricted status?
READ the ASHP Statement on Unit Dose Drug Distribution:
http://www.ashp.org/DocLibrary/BestPractices/DistribStUnitDose.aspx
READ the ASHP Bulletin on Single Unit and Unit Dose Packages of Drug:
http://www.ashp.org/DocLibrary/BestPractices/DistribTABUnitDose.aspx
- Briefly describe what a unit dose system is.
- What are the advantages/disadvantages of a unit dose system? (Think in terms
of error prevention.)
- Calculate an expiration date for a medication to be prepared in a unit dose
package.
- Describe the process for determining the shelf quantity of commonly used
medication.
IPPE-II_Manual
14
TOPICS – WEEK 4
READ the ASHP Guidelines on Handling Hazardous Drugs
http://www.ashp.org/s_ashp/docs/files/BP07/Prep_Gdl_HazDrugs.pdf
Chemotherapy:
- At your site, describe how chemotherapeutic agents are handled differently
(ordered, stored, doses calculated, compounded, and transported to patient
care areas) as compared to non-chemotherapeutic agents?
- How is the chemo hood different from the other hoods and why is it different?
MSDS:
- What is a material safety data sheet (MSDS)?
- Where are they stored at your rotation site?
Review the following: http://www.ismp.org/Tools/highalertmedications.pdf from ISMP’s
High Alert Medication List (print and review this form with your preceptor).
Ask your preceptor to select a medication that is on the sites formulary and is also listed
on the High Alert medication list or is in a class on the list.
- Review a drug information resource on the medication. Describe why you think
the medication is on the High Alert Medication List.
- State what special Precautions the institution is taking to prevent a medication
misadventure with this medication.
Review ISMP’s Error Prone Abbreviation List
http://www.ismp.org/Tools/errorproneabbreviations.pdf
- Compare ISMP’s “Error Prone Abbreviation List” to your sites banned
abbreviation list. Do you agree with your sites banned list? Why or why not?
Offer suggestions for improvement.
Review ISMP’s list of Confused Drug Names
http://www.ismp.org/tools/confuseddrugnames.pdf
Review sites sound alike-look alike (SALA) medication list. Describe the error
prevention techniques utilized by the site to prevent errors. Suggest a new technique
and ask you preceptor to evaluate its practicality.
IPPE-II_Manual
15
Rotation Task/Activities:
Please be advised that the tasks below do not need to be completed in the order stated, this is a
template that the preceptor may use for guidance. Once tasks/activities are completed by the student,
the preceptor will verify acceptable completion in E*Value Coursework. If necessary, students will be given
several opportunities to complete each task at an acceptable level.
Complete task 1 by Friday of Week 1
1. Process orders to ensure accurate and timely delivery of medication to
the patient
- enter or verify medication information into computer system
- print label
- select medication (or describe process)
- fill medication order (or robot)
- label
- complete safety checking
Complete tasks 2, 3 and 4 prior to Friday of Week 2
2. Perform at least 5 interventions while processing orders.
Be sure to document using sites procedures (only need to document
once). Describe to preceptor the patient benefits of the interventions.
3. Provide simple drug information (verbal and written) to healthcare
workers or patients on 5 different medications
- student may use medication safety guides from site or the web at:
http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm
- use drug information sources at the site such as USPDI or Facts and
Comparisons
Complete tasks 5, 6 and 7 by Friday of Week 3
4. Read The ASHP Guidelines on Preventing Medication Errors in
Hospitals:
http://www.ashp.org/s_ashp/docs/files/MedMis_Gdl_Hosp.pdf
5. Review the ISMP Medication Errors Reporting Program (MERP):
https://www.ismp.org/orderforms/reporterrortoISMP.asp
-Use the ISMP website to report an actual error assigned by your
preceptor.
6. Compound simple sterile preparations
- Student will perform calculations required and compound at least 10
sterile products using aseptic technique.
FINAL TASK:
7. On site 10-minute presentation on topic assigned by preceptor.
Preceptor will use the Presentation Evaluation Rubric in E*Value to
assess the student.
IPPE-II_Manual
16
Journal Reflection:
Pharmacy professionals are committed to lifelong learning, often this is called
independent learning. The result is for the student to take accountability and
responsibility for their own learning. This is a skill that should be nurtured in the students
early years of college and will help the student tremendously throughout their career. One
tool to assist the student is keeping a journal.
Immediately at the end of each rotation week the student will create a journal reflection
document and list in bullet form at least two new error prevention strategies. The following
is an example:
Journal Reflection
Date:
Error prevention strategies:
1._________________________________________________________________
2._________________________________________________________________
Reflections:
The student will then reflect and write about how they might use these concepts/tasks to
benefit patient care and prevent errors. The reflection piece does not have to be long; in
fact it should be concise so it will be easy for you to review later. At the beginning of the
next rotation week the student will bring a printed copy to site for discussion with their
preceptor. Once the preceptor approves the reflection the student will upload the
completed reflection paper into E*Value and notify their preceptor that the document is
available for verification.
The course coordinator will review these on a regular basis so please complete and
upload your entries into E*Value in a timely manner.
IPPE-II_Manual
17
10 Minute Presentation
By the end of the rotation the student will compose and present a brief paper
on a topic assigned by the preceptor. Some suggested topics are below
(preceptor may also suggest a topic relevant to the practice site).
Pharmaceutical
Phenytoin vs free Phenytoin
Basics of sterile preparation
Any new technology used in pharmacy
Overview of any herbal medication
New vaccine issues
Brief review of new drug (unfamiliar to staff)
Patient controlled analgesia
Review of teratogenicity scale
Compatibility of nebulized solutions
Treatment of hiccups
Significant side effect of a medication or
drug/lab interaction or nutrient/drug interaction
- CYP 450
- Daptomycin and INR
- Ciprofloxacin and tube feedings
Peds related
Diaper rash care
Lice treatment
Otitis guidelines
Medication administration options in peds
Psych med use in peds (black box warning)
Holliday-Segar Method of calculating fluids
Lead poisoning treatments
APGAR scores
Autism overview
General medical
Disease state focusing on specific area
diagnosis of pneumonia
genetics behind CF
treatment of thrombocytopenia
treatment of heparin induced
thrombocytopenia
causes of hyponatremia or hypernatremia
INR/coagulation labs
Review RBC indices
Urinalysis
CSF fluid
Review procedure in layman’s terms
CABG
Placement of coronary stent
Benefits of PICC line
-Placement of coronary stent
-Benefits of PICC line
Shunts
Different types of IV lines
Overview of BLS, ACLS or PALS
IO lines
Different types of enteral tubes
Glasgow Coma Scale
Medication extravasation care
Chemo medication extravasation care
Altitude sickness
A copy of your presentation must be uploaded into Coursework in E*Value.
IPPE-II_Manual
18
Presentations will be cited following the style adopted by the National Library of Medicine
and used in Index Medicus with the exception that only the first three authors (last name
and two initials, if available) are listed. Examples of this style follow. Note that “Letter,”
“Editorial,” “News,” or “Abstract” is added at the end of references to these types of paper.
References should be listed at the end of the presentation, and at the preceptor’s
discretion may also be listed at the bottom of an individual slide where the information is
presented.
(a) Standard journal article, including electronic journal article (list all
authors when three or fewer; when four or more, list only first three
and add “et al.”*):
1. Driscoll DF, Bhargava N, Li L et al. Physicochemical stability of total nutrient
admixtures. Am J Health-Syst Pharm. 1995; 52: 623-34.
(b) Article from journal paginated by issue:
2. Smith DL. The effect of patient noncompliance on health care costs. Med Interface.
1993; 6(4):74-6,78,84.
(c) Letter, editorial, or abstract:
3. Stiles ML, Allen LV Jr, Prince S et al. Stability of ranitidine hydrochloride during
simulated home care use. Am J Hosp Pharm. 1994; 51: 1706-7. Letter.
(d) Book—personal author(s):
4. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation: a reference
guide to fetal and neonatal risk. 5th ed. Baltimore: Williams & Wilkins; 1998.
(e) Chapter or article in a book:
5. Jackson EK. Diuretics. In: Hardman JG, Limbird LE, Molinoff PB et al., eds.
Goodman and Gilman’s the pharmacological basis of therapeutics. 9th ed. New York:
McGraw-Hill; 1996:685-713.
(f) Editor, compiler, or chair as author of book:
6. Barone MA, ed. The Harriet Lane handbook: a manual for pediatric house officers.
14th ed. St. Louis: Mosby-Year Book; 1996.
(g) Government agency publication:
7. National Institute on Alcohol Abuse and Alcoholism. Eighth special report to the U.S.
Congress on alcohol and health. Washington, DC: U.S. Department of Health and
Human Services, 1993; NIH publication no. 93-3699.
(h) Package insert:
8. Zofran package insert. Research Triangle Park, NC: Glaxo Wellcome; 1996 Oct.
(i) Paper presented at a meeting:
9. Saltiel E, Nishimura LY, Shane R. Pharmacoeconomic analysis of enoxaparin in
orthopedic patients. Paper presented at ASHP Annual Meeting. Reno, NV; 1994 Jun 7.
(Note: Give date paper was presented, not range of dates of meeting.)
IPPE-II_Manual
19
(j) Electronic sources:
10. Martindale: The extra pharmacopeia [CD-ROM]. Reynolds
JEF, ed. Denver: Micromedex; 1988.
11. Food and Drug Administration. Use of investigational products
when subjects enter a second institution. IRB operations
and clinical investigation information sheet. www.fda.gov/oc/
oha/useofinv.html (accessed 1997 Aug 25).
12. Harrison CL, Schmidt PQ, Jones JD. Aspirin compared with
acetaminophen for relief of headache. Online J Ther [serial
online]. 1992 Jan 2; Doc no. 1.
IPPE-II_Manual
20
Presentation Evaluation Form IPPE II
(Preceptor to complete on-line in E*Value)
Student:_______________________________
Site:____________________________Topic:__________________Date:___________
1
Improvement needed;
below expectations
2
Meets
expectations
3
Exceeds
expectations
Organization





Topic was relevant to practice
Logical information sequence
Appropriate continuity of presentation
Appropriate balance of emphasis
Appropriate utilization of time allotted
123
123
123
123
123
Comments and Suggestions for Improvement
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Visual Aids/Handouts




Well organized handouts presented to audience
Clear and legible
Complemented the presentation; not used to read directly
References in correct format and complete
123
123
123
123
Comments and Suggestions for Improvement
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Verbal Presentation Delivery






Clear, audible speech (rate was easy to understand)
No distracting mannerisms
Eye contact with audience
Ability to handle questions
Clear expectation/articulation of concepts
Minimum use of space fillers (e.g., umm, yea)
123
123
123
123
123
123
Comments and Suggestions for Improvement
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Total Score___________
Note: student must attain a passing score of ≥30 points to pass the presentation. If student fails
the presentation the student will repeat until acceptable by the preceptor.
Signature of evaluator___________________________________________________
IPPE-II_Manual
21
Formative and Final Assessments
Complete using E*Value
Week 2 (Formative)
Week 4 (Final)
The formative and final assessments of professionalism and learning outcomes will help the student to
recognize their strengths and also their weaknesses which require changes and improvements. An honest
assessment will help the student in their learning endeavor. The formative assessment must be completed
at least once at mid-rotation. The student must also complete a self-assessment at this time. The preceptor
and student should then discuss and compare the student’s self-assessment and the preceptor’s
assessment of the student.
Please answer statements in E*Value using the following scale:
Verbal
Language
PROFESSIONALISM AND COMMUNICATION ASSESSMENT
-1Needs Attention
Negative attributes
Include these
examples
-2Meets Standards
Positive attributes include
most of these examples
-3Exemplary
Positive attributes
include all these
examples plus “meets
standards”

Inappropriate
vocabulary used
for audience
Grammar
impedes
understanding
 Vocabulary is
appropriate for audience
(peer, faculty, patient,
doctor)
 Makes significant
contributions to the
conversation
 Vocabulary always
appropriate for the
audience (peer,
faculty, patient,
doctor, etc…)
May be inaudible,
demanding tone,
disrespectful tone,
inappropriate
volume for
situation
(example: too
loud for
confidentiality)
Verbal
presentations (if
any) suggests
lack of
preparation
 Demonstrates confident
tone without arrogance
 Respectful
 Verbal presentations (if
any) flow fairly smoothly
– suggesting good
preparation
 Demonstrates empathy
 Adjusts style and
tone for specific
situation and/or
audience
 Verbal presentations
(if any) are smooth
and rehearsed
Appears
distracted
Inappropriate use
of technology
(uses phone at
inappropriate
times)
Closed posture,
staring
Inappropriate
distance
 Usually shows active
engagement (examples:
nodding, leaning in,
appropriate eye contact,
posture)
 Demonstrates empathy
 Always demonstrates
active engagement in
conversation
(examples: nodding,
leaning in,
appropriate eye
contact, posture,
etc…)

Delivery & Tone
Verbal


Body Language
Non-Verbal




IPPE-II_Manual
22

Listening



Instructions need
to be repeated
Interrupts
inappropriately
Does not ask
appropriate
questions
Struggles
comprehending
verbal instructions
Written
Email

Errors in spelling,
grammar, etc…
 Inappropriate for
audience- ex:
demanding

Lack appropriate
level of formality
ex: excessive
abbreviations.
 Text-style writing
Charting/
Recording/
Documentation

Not addressing
legal
requirements
 Lacks clarity or is
not concise
 Plagiarism and/or
inaccuracy
 Documentation
does not suggest
content knowledge
 Writing is illegible
Appearance




Punctuality/
Attendance/
Accountability
Professionalism




 Responds to verbal
instructions
 Demonstrates
understanding of
information heard
 Demonstrates
engagement by asking
appropriate questions.




Emails are timely
Respectful tone
Few if any spelling or
grammatical errors
Appropriate formality










Addresses all legal
requirements
Usually clear, concise
Includes proper citations
Good content knowledge
shown
Accurate





Inconsistency in
following dress
code
Sloppy, unkempt
appearance
Lack of CLEAN lab
coat
Often late for
class, meetings,
rotations,
appointments
Often late with
assignments
Acts irresponsible
or immature at
events/meetings/ro
tation sites
Does not carry fair
share of group
work
Makes excuses
 Verifies
understanding of
information heard.
 Makes significant
contributions to
conversation
 Demonstrates
engagement by
asking in-depth
questions







Consistently on time for
class, meetings, rotation,
etc…
Assignments consistently
on time
Diligent
Consistently acts
responsible with groups,
a meetings and/or at site
Always prepared for
group work
Accepts group’s
decisions





Timely & proactive
emails
Respectful tone
No spelling errors
No grammatical
errors
Adjust level of
formality for audience
Addresses ALL legal
requirements
Always clear, concise
Includes proper
citations
Documentation
suggests high level
of content knowledge
Dress is consistent
with Student Dress
Code
Dress is always
situation appropriate
(ex: CLEAN lab coat)
Always punctual
and often early for
appointments and/or
assignments.
Always acts
responsible and
appropriate with all
groups
/events/meetings
Ability to work
independently
Can lead group
work
Works toward
common goals
IPPE-II_Manual
23
Attitude

Character





Exhibiting any of
these behaviors:
negative attitude,
cocky, defensive,
aggressive,
arrogant,
indifferent, blaming
of others
Lacking good work
ethic
Dishonest
Culturally
insensitive
Illegal or immoral
actions
Does not accept
responsibility







Generally positive and
appropriately confident
attitude
Accepts feedback openly
Good work ethic
Willing to help others if
asked
Trustworthy
Appreciates diversity
Exhibits empathy &
compassion





Always positive and
projecting
appropriate
confidence
Accepts and acts on
feedback
Good work ethic
Proactively helps
others
Fair & just with
customers,
preceptors,
colleagues
Models cultural
sensitivity, empathy,
compassion
IPPE-II_Manual
24
Formative and Final Assessments
Complete using E*Value
Week 2 (Formative)
Week 4 (Final)
Please answer statements in E*Value using the following scale:
1
2
3
Needs Attention
Meets Standards
Exemplary
The student requires
significant guidance and
reminders to meet basic
criteria, may need
additional training outside
this rotation.
The student requires moderate
prompting to meet MOST complex
criteria and minimal guidance to meet
basic criteria. The student meets all
basic criteria.
The student requires limited
prompting to meet MOST
complex criteria. The student
meets ALL basic criteria.
Learning Outcomes
TAKES THE INITIATIVE to learn what they have identified they don’t know versus misleading others
with incorrect information.
PROMOTES error prevention by identifying critical points in the dispensing process where errors may
occur.
FORMULATES complete, accurate, and evidence-based responses (oral or written) to drug
information questions from patients or other healthcare providers.
EFFECTIVELY utilizes pharmacy reference materials to find needed information.
DEMONSTRATES ability to work in compliance of HIPAA regulations.
CAN STATE the functions of the Pharmacy and Therapeutics committee including procedures for
formulary and therapeutic substitution.
DISTINGUISHES between record keeping requirements of CII’s, C III-V’s and non-controls.
CAN STATE procedures for processing written and verbal orders.
CAN APPLY the pharmacy law and regulations to the operations of a pharmacy.
CAN DESCRIBE the various sections of a medical record.
CAN COMPOUND sterile products in a hood.
CAN DESCRIBE how chemotherapeutic/biologic agents are handled differently from nonchemotherapeutic/biologic agents.
ENSURES that the information on and the preparation of the medication order is accurate and
complete for centralized or decentralized systems.
CAN DESCRIBE the function and state the safety advantages of a unit dose system.
UNDERSTANDS common sig abbreviations; accurately interprets written orders.
IPPE-II_Manual
25
IPPE II Optional Challenge Assignments
The following are suggested optional assignments designed to further challenge the advanced
student. All required tasks must be completed before the preceptor assigns their student
an optional challenge. It is up to the preceptor’s discretion to decide if the student has enough
experience and has demonstrated mastery of the assigned tasks. Upon completion and preceptor
approval of any challenge assignments, the student will complete an “on-the-fly” optional
challenge assignment form in E*Value.
The number of challenge assignments the student may complete while on this rotation is
determined between the student and preceptor. The following is a list of potential assignments;
however, the preceptor may decide to assign the student an assignment of their own design that
is not included on the list below.
1. Complete a reference sheet for the pharmacist identifying critical counseling points for the
drugs and/or devices used to treat any of the disease states listed below. The reference sheet
could include items such as mechanism of action, dosing, timing of administration, side
effects, drug interactions, warnings, and precautions.
a. Hypertension
b. Diabetes
c. Asthma
d. Coronary artery disease
e. Congestive heart failure
f. Head Lice
g. Athlete’s foot
h. Hypercholesterolemia
i. Osteoporosis
j. Hypothyroidism
k. Peptic ulcer disease
l. Acne
m. Influenza
2. Assign the student a drug information question commensurate with their level of education
with a focus on the selection and use of resources to answer the question.
3.
4.
5.
6.
Complete a complex compounding assignment.
Outline the process at your site for a drug product shortage.
Outline a plan for inventory management at your rotation site.
Outline the process for ordering pharmacy inventory at your site (from wholesaler or
other supplier).
7. Create staffing schedule for your pharmacy (include man hours for pharmacists,
technicians, etc.) for a 2-week period during rotation. Include assessment of
workload to justify staffing.
8. Outline process for proper disposal of expired stock medications (legend vs. control)
including hazardous substances.
9. Describe the process of reporting a medication error at your rotation site.
10. Identify five (5) medications used at your rotation site that are not stored at room
temperature and five (5) systemic medications administered by a non-oral route of
administration (identify route and common indication).
IPPE-II_Manual
26
11. Outline and discuss the differences in responsibilities/liabilities between pharmacists
and technicians in the processing of a prescription. What attitudes/behaviors may
contribute to unsafe dispensing practices?
12. Identify 5 patients at your site who are on more than twelve (12) medications.
Identify any potential duplication in therapy or potential drug-drug interactions.
13. Select a recent news article concerning a health care issue related to your site.
Outline and discuss the impact this issue may have on the profession of pharmacy
or how this article may affect the provision healthcare of your patients.
14. Discuss with your preceptor an ethical dilemma (observed or theoretical) and what
procedure or resources your site would utilize to resolve it.
15. Practice dialogue with your preceptor regarding how to handle an angry patient or
provider.
16. Participate in the preparation for or reporting to a credentialing body (i.e. The Joint
Commission)
17. Participate in the assessment of or utilization of Computerized Physician Order Entry
(CPOE).
18. Observe another healthcare practitioners during their daily activities (i.e. NP,
Anesthesiologist, RT, OT, Nutritionist).
IPPE-II_Manual
27
Student Pre-Rotation Self Evaluation
Purpose: The purpose of this form is to give the preceptor an idea of how much
experience and knowledge the student has pertaining to the assigned rotation. This will
help the preceptor in her/his teaching methods especially in the beginning of the
rotation. Please note this form does NOT exempt students from any of the basic
requirements of the manual.
Requirement: This form is to be completed by the student prior to the start of the rotation
approximately 1 month prior to the start of the rotation.
Student Self Evaluation Criteria
1.
I have worked or volunteered in a community/institutional/neither/both (select one)
_____________ pharmacy.
2.
I have worked or volunteered in a community or institutional pharmacy performing functions
as a pharmacy technician for ________ hours.
3.
I have read the homework assignments in the manual and feel confident I could complete
______% of them today.
a. Please list the homework assignments you feel you could complete prior to the start of
the rotation:
4.
I have read the tasks required of me and have already completed________% of them
independently.
a. Please list tasks you have successfully completed independently:
Student signature_________________________
Date________________
IPPE-II_Manual
28
PRECEPTOR SUMMARY GRADING SHEET
(Complete in E*Value Week 4)
1. Student completed a minimum of 160 rotation hours with no unexcused absences:
Satisfactory = Student Completed
Unsatisfactory = Student did NOT complete
2. Student completed assigned homework to preceptor’s satisfaction:
Satisfactory = Student Completed
Unsatisfactory = Student did NOT complete
3. Student completed ALL task activities at an acceptable level:
Satisfactory = Student Completed
Unsatisfactory = Student did NOT complete
4. Student completed Journaling requirements of course:
Satisfactory = Student Completed
Unsatisfactory = Student did NOT complete
5. Student completed the error prevention analysis paper that is acceptable to the preceptor:
Satisfactory = Student Completed
Unsatisfactory = Student did NOT complete
6. Student compared their Formative self-assessments with preceptor’s Formative assessment
of the student midway through the rotation. Student compared their Final self-assessment
with the preceptor’s Final assessment of the student at the end of the rotation.
Satisfactory = Student Completed
Unsatisfactory = Student did NOT complete
7. Student received a score of ≥ 30 on presentation evaluation:
Satisfactory= Score ≥ 30
Unsatisfactory = Score < 30
8. Student’s average on the preceptor’s final assessment of professionalism and learning
outcomes was:
Satisfactory = ≥ 2.0
Unsatisfactory = < 2.0
9. Student reviewed course manual with preceptor during the first week of the rotation:
Satisfactory = Yes
Unsatisfactory = No
To pass PHAR 4339 the student MUST receive a Satisfactory from their
preceptor for ALL the criteria listed above.
IPPE-II_Manual
29
Final Student Evaluation of Preceptor
(Complete in E*Value Week 4)
Please answer the following statements:
Criteria
The evaluation methods and criteria were clarified with me early in the rotation
My preceptor exemplifies the characteristics of a professional
My preceptor gave me adequate feedback on a regular basis
My preceptor’s feedback helped me improve
My preceptor (or designee) was readily available
My preceptor asked questions that caused me to explore issues and answer questions
My preceptor answered my questions clearly
My preceptor prompted me to work independently as needed
My preceptor displayed dedication to teaching/education
Overall my preceptor is an effective educator, coach or mentor
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
What did the preceptor do that was most effective in supporting your learning needs?
______________________________________________________________________
______________________________________________________________________
________________
What would you suggest for changes?
______________________________________________________________________
______________________________________________________________________
________________
Additional Comments: (not mandatory)
______________________________________________________________________
______________________________________________________________________
________________
IPPE-II_Manual
30
Final Student Evaluation of Experiential Site
(Complete in E*Value Week 4)
Please answer the following statements:
Criteria
Exposure to the practice of pharmacy at the site meet your expectations
The site provides an environment conducive to your learning
Y/N
Y/N
Strengths of the site:
______________________________________________________________________
______________________________________________________________________
________________
Weaknesses of the site:
______________________________________________________________________
______________________________________________________________________
________________
Suggestions for improvement:
______________________________________________________________________
______________________________________________________________________
________________
IPPE-II_Manual
31
EXPERIENTIAL EDUCATION ABSENCE REQUEST FORM
St. John Fisher College
3690 East Avenue
Rochester, NY 14618
Phone: 585-385-7249
Fax: 585-385-5295
Except for emergency, this form MUST be submitted to the Experiential Education Office
10 days prior to your requested days.
Student name _____________________________________________ Date _______________
Rotation type and dates ________________________________________________________
Site name and address _________________________________________________________
Preceptor name and phone number _______________________________________________
Dates requested off for current rotation___________ Total days requested off to date________
(include all IPPE and APPE rotations)
Reason for requested days off - be specific (e.g., illness, funeral, etc – days to be made up in the
future). Any excused/unexcused non-emergency absence NOT documented on this form may
result in failure of the rotation:
_________________________________________________________________________
_________________________________________________________________________
C:\Documents and Settings\robrocta\My Documents\Manuals\2006\SJFC\IPPE-EE\EE com.
__________________________________________________________
(continue on back)
and inst..doc
Preceptor approved makeup dates and times: NOTE: Make up time must be in a minimum of
4 hour blocks
Date
Start Time
End Time
Total Hours
_____________________________________________________________________________
Date
Start Time
End Time
Total Hours
.
Preceptor’s signature________________________________ Date ________________
Assistant Director of Experiential Education________________________________Date___
IPPE-II_Manual
32
Sample Action Plan
IPPE-II Action Plan for: STUDENT NAME
Date:
Student X received an overall average of 2.5 for the formative
preceptor assessment of student at week 5. Student X and I discussed
the problem of repetitively showing up late for rotation (6:30AM instead
of 6AM as expected). The student stated that child care was the issue
but now realizes the importance of showing up on time and will make
alternate child care arrangements. The student has agreed to be on
time for the remainder of the rotation. I reminded the student that any
future violations of rotation policies and regulations will result in failure
of the rotation.
Student Signature
Preceptor Signature
cc: Assistant Director of Experiential Education
IPPE-II_Manual
33
MEDICATION PASS VERIFICATION FORM
PHARMACY STUDENT:____________ __________________________________________
WITNESS:___________________________________________________________________
MEDICATIONS OBSERVED:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
REFLECTION (Note any unique challenges or observations regarding the observed medication
administration. Include your thoughts on what could be altered, if any, to benefit the patient):
IPPE-II_Manual
34