Adapted from WSU College of Pharmacy Spring 2010 CASE & KEYS Emergencies in the Community Pharmacy Scenarios

PharP 503 Applied Patient Care III: Medication Therapy Management

SAMPLE
EmergenciesintheCommunityPharmacyHumanPatientSimulation

DebriefingKEY/GradingRubric
RationaleandCompetencyBasedOutcomes: Recognitionandappropriatetreatmentofmedicalemergenciesisanimportantpatientcareskillfor pharmacists.Itisessentialthatthepharmacistutilizesappropriateassessmentskillsandclinical knowledgeinordertoprovidethehighestlevelofpatientcare.Throughhumanpatientsimulation scenarios,thislabwillprovideopportunityforstudentpharmaciststorecognizeandimplement appropriatetreatmentforemergenciesinthecommunitypharmacy. FollowingsuccessfulcompletionoftheEmergenciesintheCommunityPharmacyLab,student pharmacistswillbeabletodemonstratesignificantprogressinthefollowingWSUCollegeofPharmacy CompetencyBasedOutcomes:
DrugKnowledge: Applyprinciplesofclinicalpracticeguidelines,anddrugtreatmentalgorithmsforvariousdiseasestates andtheirinterpretationintheclinicalsetting.(1c8) Communication: Demonstrateproficiencyinverbalcommunicationwiththeuseofcommonandappropriatelyselected medicalterminologythatisusedinpatientcare.(2a2) Professionalism: Consistentlymaintainaprofessionaldemeanor;acquirestrategiesanddemonstratetheabilityto effectivelymultitaskandmanagestressfulsituationswhenprovidingprofessionalservicesandwhen communicatingwithpatients,otherhealthcareproviders,andcoworkers.(3a6) MedicationTherapyManagement: Provideappropriaterecommendationstosolveidentifiedproblems,basedonthorough,objective,and soundclinicaljudgments. (5c2) Verifyaccuracyanddispenseoradministermedications,includingimmunizations.(5d6)

LearningObjectives: Correctlyassesspatientbyidentifyingtheemergencyinatimelymanner.

Implementemergencyprocedureforspecificemergencyasoutlinedintherequired reading. CorrectlyutilizethecontentsofthepatientsprescriptionandOTCmedications. Administerappropriateintervention/treatmentforspecificpatient.

Providepatientwithappropriatefollowupinstructions.
Revised for AACP Annual Meeting July 13, 2010 Seattle, WA Original: Brenda Bray/Lisa Bilich/Britanie Poreba/Jennifer Robinson 3-15-10 FINAL

Adapted from WSU College of Pharmacy Spring 2010 CASE & KEYS Emergencies in the Community Pharmacy Scenarios PharP 503 Applied Patient Care III: Medication Therapy Management

DebriefingKeyandGradingScaleAsthma
EssentialElementstoEvaluate Key AllGroups GroupAssessment ResponsibilitiesoftheIndividual andTeam SimManetiquette,preparedness, professionalism,andrespect P/F
Allparticipatedprofessionallyin simulationanddebriefing Groupcommunicationwasadequate tofunctionasateamduringan emergencysituation

Notes/Key Objective(s):
Followedguidelinesduringsimulation (i.e.nodrinks,gum,pens,etc.) Practicedappropriatebloodborne pathogenprecautions Allwererespectfultoclassmatesand facilitators Eachgroupcanbe gradedasawhole Notebelowonlythose studentswhoare deficientinanyarea Eachteammember contributedtodiscussion Differenceofopinion wasexpressedas constructiveand professional

complainofchestpressureor suffocationtopromptstudentsinto asking

PatientAssessment:Correctlyassesspatientbyidentifyingemergencyinatimelymanner PhysicalAssessment Appropriateassessmentquestions Symptoms(question patientaboutsymptoms) asked(OLDCART) PatientSymptoms Symptomsnoted:Pressurein - O=onset P/F chest,wheezes,senseof L=location **Ifstudentsfailtocommunicatewith suffocation,andincreased D=duration patienthaveSimMancontinueto respiratoryeffort. C=characteristics
A=aggravatingfactors R=remittingfactors T=treatment Studentsshouldassess forchangesinhealth status,allergies,home medications,andany medicationsthatthe patienthastakenpriorto arrival.(**Allthese shouldbeassessedprior toanymedicationsbeing given) Patientjustreturned fromthedentist possiblelatexexposure (potentialasthmatrigger)

DocumentationofPatient MedicalHistory **PatientsHistorywillvary dependingonscenario P/F

ChangesinHealthStatusassessed AllergiesAssessed(Penicillinand beestings) Typeofallergicreactionassessed (Penicillincausesarashandthe beestingscauseswelling) Amoxicillininthepastwithno issue Patientnoteslatexexposure sometimestriggersasthma;just camebackfromthedentist HomeMedications reviewed/assessed(albuterol inhaler) Others? Didnotomitrelevantinformation

Revised for AACP Annual Meeting July 13, 2010 Seattle, WA Original: Brenda Bray/Lisa Bilich/Britanie Poreba/Jennifer Robinson 3-15-10 FINAL

Adapted from WSU College of Pharmacy Spring 2010 CASE & KEYS Emergencies in the Community Pharmacy Scenarios PharP 503 Applied Patient Care III: Medication Therapy Management EmergencyCorrectlyIdentified
Scenario1:MI(NKDA) Scenario2:Allergy Scenario3:Stroke

Yes No TimeFrame: __________

Scenario4:Asthma
Scenario5:Hypoglycemia

Patientwillstartexhibitingthe correspondingsign/symptomsrelated tothescenario Scenario4:Asthma:patientwill exhibitpressureinchest,senseof suffocation,nonproductivecough, expiratorywheezes,prolonged expiratoryphase,patientcomplaining ofdifficultybreathing,anincreased respiratoryeffortwithincreasedRR, chestdistension,andbluishlips.

Implementemergencyprocedurecorrectly. Locateandcorrectlyutilizecontentsofcommunitypatientsprescriptionbag. Administerappropriateintervention/treatmentforspecificpatient Studentpharmacistsexpectedto Stopquestioning correctlyimplementcommunity Placepatientincomfortable pharmacysemergencyprotocol. uprightposition Call911(ifappropriate) Vitals:BP130/80,HR
Scenario4:Asthma:patientwill exhibitpressureinchest,senseof suffocation,nonproductivecough, expiratorywheezes,prolonged expiratoryphase,patientcomplaining ofdifficultybreathing,anincreased respiratoryeffortwithincreasedRR, chestdistension,andbluishlips; difficultytalking. Appropriatedosesare: AlbuterolInhaler:acute bronchospasm:48inhalations every20minutesforupto4 hours,then48inhalations every14hoursasneeded Epipen:0.3mgSCorIMevery 20minutesto4hoursfor asthma

Administeralbuterolinhaler AdministerEpipen Ifpatientbecomes unresponsive Monitorvitalsigns o Pulse o RespiratoryRate o BP o Skin o other Reassure/calmpatient

118,RR28;Glucose 140;wheezing, coughing,hardtotalk astimegoeson

Albuterol: bronchdilataor Epinephrine:alpha agonist;bronchodilation;

Providepatientwithappropriatefollowupinstructions. Followupinstructionsandpatient Medicalreferral(ifindicated) education Instructionsformedications Implicationsforfuture P/F treatment

Revised for AACP Annual Meeting July 13, 2010 Seattle, WA Original: Brenda Bray/Lisa Bilich/Britanie Poreba/Jennifer Robinson 3-15-10 FINAL