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OBJECTIVES

    Objectives: Upon completion of the chapter and exercises, the student pharmacist will be able to
  1. Compare and contrast various types of community pharmacy and ambulatory care practice settings.

  2. Outline the basic management issues (eg, workflow, staff, and business aspects) of community pharmacy practice.

  3. List key steps in the medication order fulfillment process.

  4. Define the term medication therapy management services (MTM) and list core elements of MTM.

  5. Discuss opportunities for provision of MTM and advanced patient care services in the community and ambulatory care setting.

  6. Discuss the impact of technology on present and future community practice issues.

Patient Encounter

A 54-year-old female presents to the pharmacy counter with a new prescription. You recognize her from pictures in the newspaper as the mother of the Olympic cyclist who was severely injured. She hands you the following prescription:

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JOHN TAYLOR, M.D.
1234 MIDWAY AVENUE
ANYTOWN, USA 34567
Name: Nelly Nervous Date: 9/15/14
Lorazepam 0.5 mg #60
One tab bid prn anxiety
Refill: X 2 J Taylor MD

When entering the prescription data, you note her current Rx profile as follows:

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Medication Directions Qty Last Refill Refills Remaining
Glyburide 5-mg tab One po bid AC 60 9/01/14 3
Levothyroxine 112-mcg tab One tab po daily 30 8/25/14 2
Lisinopril 10-mg tab One tab po daily 30 9/01/14 3
Metformin 500-mg tab One po bid with food 60 8/25/14 2
Simvastatin 10-mg tab One tab po qhs 30 6/26/14 5

For the purpose of this exercise, assume today's date is 9/15/14.

Discussion questions for introductory pharmacy practice:

  • What information should be verified with the patient or caregiver before filling the prescription for lorazepam?

  • Is the prescription missing any necessary information?

  • Are you familiar with all of the abbreviations used on the prescription and in the prescription profile?

  • Describe the steps you would take in completing the medication order fulfillment process.

  • What auxiliary labels would most likely be placed on the bottle of lorazepam?

  • What open-ended questions should be asked when counseling the patient on the new prescription?

  • List at least four counseling points that should be provided to the patient when she picks up her new prescription for lorazepam.

Discussion questions for advanced pharmacy practice:

  • Are you able to answer all of the questions directed at the IPPE (introductory pharmacy practice experience) student?

  • Are you concerned about any potential drug interactions with the lorazepam and her current prescription profile? If so, how would you address these issues?

  • Based on the current prescription profile, what adherence issues may need to be addressed? How would you address these issues with the patient?

    When picking up the prescription, the patient asks you for a recommendation for an over-the-counter (OTC) product that will help her get some sleep.

  • What questions should be asked of the patient when performing an OTC consult?

  • What concerns do you have ...

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