Course Outline and Syllabus for Students Name: Medication Therapy Management I Course Number: PHM 105H Course Title: Medication Therapy Management I Course Time and Location: Winter term: Lectures: Tuesdays 11:00 am 12:00 pm, Room PB-B150; Labs: Thursdays (3.0 hours, rotating schedule in 7 th floor Herbert S. Binder Professional Practice Lab) Course Co-coordinators and contact information: Jauher Ahmad: jauher.ahmad@utoronto.ca Andrea Cameron: aj.cameron@utoronto.ca Office hours: Tuesdays & Thursdays; Please contact one of the coordinators by email 48 hours in advance in order to schedule an appointment (please include MTM-1 in subject line). Students are encouraged to contact a coordinator by email for any type of inquiry. Course Description: Medication Therapy Management (MTM) involves a partnership between the patient, pharmacist, and other healthcare providers to promote safe and effective medication use so that desirable patient outcomes are attained. It is founded on the philosophy of Pharmaceutical Care, and may encompass an array of services, whereby the pharmacist employs a systematic patient-centered approach to define and achieve goals related to optimal pharmacotherapy. The MTM series of courses will be delivered longitudinally over three years of the undergraduate program, with MTM1 being the first of the four-part course series. MTM1 will allow students to begin to apply knowledge and develop skills needed to undertake MTM, with content drawn from co-requisite and pre-requisite courses. Lecture and laboratory sessions will be designed to facilitate guided, independent, and collaborative learning. A key element of MTM1 is that students will have the opportunity to undertake the role of a pharmacist in a simulated community practice and will be responsible for various tasks, such as conducting patient interviews, assessing the appropriateness of pharmacotherapy, providing medication-related patient education, actively participating in the medication-dispensing process, responding to drug information queries from patients and health care providers, documenting pharmacotherapeutic recommendations, and interpreting the pharmacist's ethical and legal obligations within provincial and federal regulatory frameworks. Course Goal: This course will introduce and develop fundamental knowledge, skills and attitudes intrinsic to the pharmacy student s professional identity development; these attributes will be transferable to diverse practice settings, and prepare students for their first year early experiential rotation. The design of MTM1 was founded on the Association of Faculties of Pharmacies of Canada Educational Outcomes (refer to Appendix A for the relevant outcomes for this course). Required: Yes Elective: No Page 1 of 12
1. Course Learning Objectives: Upon completion of this course, students will have achieved the following level of learning objectives, at the introductory level: Knowledge (a) Define Medication Therapy Management (MTM) (b) Understand how MTM relates to the patient care process used in Pharmaceutical Care (c) Discuss how the drug distribution process in community practice intersects with MTM (d) Identify and differentiate activities and responsibilities within the scope of practice of pharmacists, pharmacy students, interns, and pharmacy technicians (e) Identify the legal requirements for usual drug distribution activities in community practice, as required by relevant federal and provincial legislation (f) Describe and/or demonstrate the administration of various dosage forms used to achieve therapeutic outcomes (g) Outline core elements of patient counseling (h) Outline key steps in completing a medication review (i) Identify factors that may contribute to medication-related errors in a community practice setting Skills (j) Effectively prioritize and organize workflow as an individual as well as within a simulated team-based community practice (k) Interpret and process prescription orders (verbal and written) commonly presented in community practice (l) Accurately complete pharmaceutical calculations related to medication dispensing (m) Adhere to legal requirements for drug distribution activities in community practice (n) Develop techniques to communicate effectively, both verbally and in writing, to patients and health care providers (o) Classify and respond effectively to routine drug information requests (p) Identify medication processing errors (MPEs) involving written prescriptions (q) Develop patient interviewing skills using a systematic framework during simulated patient encounters (r) Perform and document a medication review (s) Provide accurate and relevant medication-related education using a patient-centered approach Page 2 of 12
(t) Document clinical encounters accurately and appropriately (u) Reflect on performance, respond to feedback, and modify behaviour accordingly (v) Produce pharmaceutically acceptable topical dosage forms during a compounding practice lab Attitudes/Values (w) Demonstrate professionalism through appropriate behaviours and attitudes, as guided by faculty expectations on professionalism 2. Rationale for Inclusion in the Curriculum: The Blueprint for Pharmacy: The Vision for Pharmacy (June 2008) 1 outlined a future of pharmacy practice in Canada focused on improving drug therapy outcomes for Canadians through patient-centred care. MTM is being adopted throughout Canada; it encompasses diverse pharmacist services designed to enhance patient outcomes through empowering patients to optimize their medication use, and promotes collaborative practice with other healthcare providers. In the Pharmaceutical Care Model, a critical underpinning of MTM, pharmacists identify, prevent, and resolve actual and potential drug therapy problems through an iterative process that includes clinical assessment, care plan development and implementation, and follow-up monitoring. MTM1 will allow students to begin to develop cognitive skills and apply knowledge, driven by content previously or concurrently taught within the curriculum, so that they may become effective practitioners in this context. 3. Pre-requisites: PHM 110 Health Systems I PHM 113 Pharmacy Informatics PHM 130 Pharmacy Calculations 4. This course is a pre-requisite for: PHM 151 (EPE-1) 5. Co-requisites: PHM 101 Pharmacotherapy I: Foundations and General Medicine PHM 141 Pharmaceutics PHM 114 Social and Behavioural Health Online Modules: Jurisprudence; Language of Practice; Pharmaceutical Care/Patient Care Process 1 Task Force on a Blueprint for Pharmacy. Blueprint for pharmacy: the vision for pharmacy. Ottawa (ON): Canadian Pharmacists Association; 2008 Page 3 of 12
6. Course Contact Hours and Teaching Methodologies: Didactic (lecture) Laboratory or Simulation Other (please specify)* * Other specific information: see out-of-class section below Total course contact hours 12 hours 27 hours 39 hours 7. Estimate and description of student's weekly out-of-class preparation time excluding exam preparation: Preparation will be required for each of the laboratory sessions (Labs 1 through 8, as well as the Compounding Lab ). A one-hour Orientation session will occur prior to the first lab. Students will receive a list of medications reflecting themes related to dosage forms. They will research specific medications using a combination of product monographs and other tertiary references to prepare a medication-related patient education template. The preparation time for each lab is estimated to be 1.5 to 2 hours x 9 labs = 13-18 hours per term. Students will also be responsible for online co-requisite materials. The Jurisprudence online module (estimated time 4-5 hours); the Language of Practice module (estimated time 4-5 hours); and the online Patient Care Process module (estimated time: 4-5 hours) As well, students will be expected to know the material/content covered in Pharmacotherapy 1: Foundations and General Medicine, as appropriate. The online co-requisite material will be tested as part of the mid-term and final written examinations. 8. Required Resources/Textbooks/Readings: As assigned 9. Recommended Resources/Textbooks/Readings: E-RESOURCES/TEXTBOOKS: Students will be expected to utilize various resources throughout the course, using either e-resources available through the Leslie Dan Faculty of Pharmacy website (http://guides.library.utoronto.ca/pharmacy) or current editions of textbooks available in the Professional Practice Laboratory, including: ODB Formulary/e-Formulary CPS Therapeutic Choices (CTC) Lexi-Comp/Lexi-Interact Micromedex Therapeutic Choices for Minor Ailments (CTMA) Pharmacotherapy (DiPiro and/or Goodman & Gilman) Compendium of Self Care Products (CPMA) Drugs in Pregnancy and Lactation Martindale Page 4 of 12
Medical Dictionary (Oxford Concise and/or Taber s) USP Volume I Health Care Professional; USP Volume II Advice for the Patient 10. Topic Outline/Schedule: See section 1 above for specific objectives and level; lecture topics are listed below, to address these objectives, together with learning that will occur in the associated labs. Each lecture includes a set of slides with relevant material to support the students learning. Lecture Week 1: Course Introduction Overview of MTM Course & Pharmaceutical Care Week 2: Overview of MTM1 Lab Logistics The Prescription Process and Lab Overview Week 3: Lab 1 Prep Oral Solid Dosage Form Communication Skills and the Patient Interview Week 4: Lab 2 Prep Oral Liquid Dosage Form Administering suspensions to children Dangerous abbreviations Week 5: Lab 3 Prep Schedule I, II and III drugs Tips on counseling Topical medications Week 6: Lab 4 Prep Tips on counseling for Ophthalmic, Otic, Vaginal, Rectal Foreign Product Identification Documentation in Pharmacy Practice Week 7: Lab 5 Prep Prescription Transfers Page 5 of 12
Drug Interactions Intro to Professional Services and Expanded Scope of Practice Week 8: Lab 6 Prep MedsCheck Process in Detail Week 9: Lab 7 Prep Drug Safety in Pregnancy Tips on inhaled medications Narcotic Safety and Awareness Act Week 10: Lab 8 Prep Narcotic, Controlled Drugs and Targeted Substances Week 11: Prescription Processing Errors Ontario Drug Benefit Program and Third Party Insurance Milestone Prep Week 12: Compounding Lab Prep (Lab 9) Final Written Exam prep/review The majority of the weekly labs are developed around a dosage form theme (see weekly Lab Schedule below for details regarding themes). All labs (except orientation) are mandatory. Students will also complete a compounding lab at which time they will prepare a topical prescription dosage form. Lab ORIENTATION LAB One hour - not assessed, attendance is optional but highly recommended PRACTICE LAB Full lab - not assessed. Attendance is mandatory LAB 1 Dosage Form: Oral Solid Drug Information: Formulations/Non-medicinal ingredients LAB 2 Page 6 of 12
Dosage Form: Oral Liquid Drug Information: Pediatric dosing LAB 3 Dosage Form: Topical Drug Information: NAPRA Drug Schedules LAB 4 Dosage Form: Ophthalmic/Otic & Vaginal/Rectal Drug Information: Foreign Drug Identification LAB 5 Dosage Form: Intranasal and Transdermal Drug Information: Drug Interactions LAB 6 MedsCheck Lab LAB 7 Dosage Form: Inhaled Drug Information: Drug Safety in Pregnancy and Lactation LAB 8 Dosage Form: Various/Culminating Drug Information: ODB/Limited Use Codes LAB 9 Compounding Lab Make Up Lab (for students with valid petitions) Final MILESTONE Lab Exam Page 7 of 12
11. Assessment Methodologies Used: Learning Objectives Addressed Assessment 1: See appendix B: Outline of Sample Lab Session Assessment 2: Material from online modules and lab/lecture content up until 1 week prior to midterm Assessment 3: Material from all prior labs and lectures Assessment 4: Material from any lab/lecture, with focus on content since midterm Assessment Method Used Assessment 1: Performance-based lab activities Assessment 2: Midterm Written MCQ/Short Answer Assessment 3: Milestone (OSCE) Assessment 4: Final Written MCQ/Short Answer When Administered Assessment 1: Weekly during 9 labs Assessment 2: Midterm Assessment 3: End of Term Assessment 4: Final Exam Period Percentage of Course Grade Assessment 1: (7 x 5%) + (2 x 2.5%) = 40 Assessment 2: 20 Assessment 3: 20 Assessment 4: 20 For Group Work (maximum 10% of course grade) indicate how marks within groups are allocated: Individualized or Same for all Group Members Assessment 1: Assessment 2: Assessment 3: Assessment 4: Remediation Opportunities? Assessment 1: Assessment 2: Assessment 3: Assessment 4: Expectation for pass grades for all Pharmacy courses is 60%. 12. Policy and procedure regarding make-up assignments/examinations/laboratories: MISSED EXAM POLICY: This course will conform to the procedures and requirement identified under the Missed Examination or Assignment policy outlined in the Faculty of Pharmacy calendar Students who miss the midterm or final test and who have a valid petition filed with the Registrar s office will be eligible to complete a make-up test. The format of this test will be at the discretion of the course coordinator, and Page 8 of 12
may include, for example, an oral examination. In the absence of a valid petition, a grade of zero will be assigned for the missed mid-term or final test. Students who miss the final milestone will be allowed an opportunity to make up the milestone examination if a petition (with appropriate supporting documentation) is submitted and deemed valid by the Faculty. In the absence of a valid petition, a grade of zero will be assigned for the final milestone. A student who is given permission to attend a make-up midterm test or milestone examination must pay a Special Examination fee of $70 per midterm or examination. Failure to make arrangements for paying this fee by the deadline provided will result in the loss of privilege to attend the make-up test or examination, and a grade of 0 will be assigned for the missed test or examination. PROFESSIONAL CONDUCT: Students are expected to become familiar with and adhere to the following University policies which can be found in the Faculty Calendar: - Standards of Profession Practice Behaviour for All Health Professional Students - Code of Behaviour on Academic Matters - Code of Student Conduct. Should a Clinical Instructor or Course Coordinator feel that an intervention is required due to issues of professionalism, a Feedback Form will be completed, shared with the student, and kept in the student s file. Students who arrive late for the weekly lab will have 10% deducted from their overall mark for that lab. 13. Policy and procedure regarding supplemental assignments/examinations/laboratories: Laboratories are mandatory. Students who miss a scheduled laboratory session and who have a valid petition filed with the Registrar s office will be eligible to complete a make-up lab. In the absence of a valid petition, a grade of 'zero' will be assigned to the missed laboratory component or session. Missed Assignment Policy: Students who fail to submit an assignment by the specified due date, and who have a valid petition filed with the Registrar s office will be eligible to submit the completed assignment, or an alternative assignment based on course requirements, with no academic penalty. Late Assignment Policy: Students who fail to submit an assignment by the specified due date will receive a deduction of 15% for each day beyond the due date (including weekends/holidays), to a maximum of 45%. Assignments will not be accepted for grading after 3 late days. Page 9 of 12
Appendix A: Association of Faculties of Pharmacies of Canada Educational Outcomes for Medication Therapy Management I As Care Providers, pharmacy graduates: 1.1.2 demonstrate that the patient's goals are the priority; 1.1.4 acknowledge and respect the roles and responsibilities of the pharmacist, the patient and/or caregivers, and the patient's other health care professionals; 1.2.1 elicit the reason(s) for the patient's visit to the pharmacy or encounter with the pharmacist; 1.2.2 obtain and evaluate relevant history from the patient, his/her chart, caregivers and other health care professionals; 1.2.5 complete an assessment of the patient's ability to take / use / administer his/her medications; 1.3.2 determine whether a patient is appropriately managing his/her therapy, including appropriate administration and adherence in particular for chronic disease management; 1.6.6 decide specific actions to be taken by the pharmacist as necessary for management of medication-related needs; 1.7.2 educate the patient regarding the care plan to facilitate understanding and adherence ; 1.10.1 document in a timely, retrievable, usable manner; 1.10.2 fulfill professional responsibilities for documentation. As Communicators, pharmacy graduates: 2.1.1. use active listening skills and respond appropriately, 2.1.2.exhibit empathy, tact and respect in their dealings with others 2.1.3 demonstrate sensitivity, respect and empathy in intercultural and inter-professional situations 2.1.4.when speaking, use organized processes and appropriate, precise expressions and vocabulary 2.1.5.tailor the content of their communication to specific contexts and audiences 2.1.6 adapt their communication techniques to facilitate efficient and effective clinical encounters 2.2.1. write clearly, using organized processes and appropriate vocabulary 2.2.2.correctly apply the rules of syntax, grammar and punctuation As Collaborators, pharmacy graduates: 3.1.5 make their points of view known, listen to and respect the opinions of others, defend points of view if necessary 3.1.6 contribute to planning, organizing and performing of work to be done 3.1.7 respect the rules established by the group 3.1.8 help maintain a healthy work environment and assist with conflict management As Managers, pharmacy graduates: 4.1.1 set priorities and manage their time to balance patient care, workflow and practice requirements 4,2,4 anticipate, recognize and manage human, environmental and medication distribution situations that put patients at risk 4.4.3 manage workload to prioritize provision of professional services As Scholars, pharmacy graduates: 6.1.4 undertake and apply learning required to manage new problems 6.2.1 identify needs for information, recommendations and decisions on medications 6.2.4 determine plausible solutions and select the most appropriate recommendation 6.2.5 communicate information / recommendations 6.2.6 evaluate the usefulness of the information provided 6.2.7 document the information provided 6.3 Educate regarding medications and appropriate medication use, including the pharmacist s role As Professionals, pharmacy graduates: 7.1.1 show respect for patients by acknowledging the patient as a person, listening actively and considering their needs and expectations 7.1.2 accept responsibility for recognizing and meeting patients medication therapy needs 7.1.3 maintain patient confidentiality 7.4.1 comply with the legal and regulatory requirements of practice, 7.4.2 respect and fulfill professional standards of practice 7.4.4 fulfill their professional tasks and commitments to patients in a diligent, timely, reliable, respectful manner 7.4.5 accept responsibility for their decisions and recommendations with patients and colleagues 7.4.7 maintain a professional image, using appropriate language and demeanour, 7.4.8 maintain their professional composure even in difficult situations Page 10 of 12
Appendix B: Outline of a sample lab session in the laboratory component of MTM 1 Format and Structure: Each laboratory session is comprised of the Cognitive Skills (CS) section (in area with computers and accompanying work space), the Patient Care (PC) Skills section (in the adjoining seminar room, or in room as assigned), and a post-lab Documentation phase (which may occur at any location in PB). Five groups of 12-13 students will be assigned to work within the laboratories simulated pharmacies for the CS portion, and then break into groups of 6-7 students for PC skills. Students must check the master schedule carefully to ensure they are present in the lab at the scheduled time. Note: for the MedsCheck lab, a different format will occur; students will be provided details at least one week prior to the lab. Each student must complete a variety of tasks within their 3.0 hr. lab session that will mirror activities in pharmacy practice. Students will need to develop their ability to manage their time and competing priorities. One Pharmacist Facilitator (PF) (also termed: Clinical Instructors ) will be present in the CS component of the lab. One Pharmacist Facilitator will be present with a designated group for the PC skills component of the lab. As stated above, there are three core components of each simulated lab: the Cognitive Skills component (1.25 hrs) and the Patient Care Skills component (1.25 hrs.), followed by a 0.5 hour post-lab documentation stage. Following each 2.5 hours within the simulated pharmacy, students will complete the Patient Encounter Documentation Form within the remaining 0.5 hours, to be submitted before the end of the 3-hour session at a designated area. Part 1: Cognitive Skills (1.25 hrs): This component of the simulated lab is designed to mirror community pharmacy practice in Ontario, with its ebb and flow of patient and prescriber needs, and competing demands for one s time. Each student will have a number of tasks to complete within this time-frame. Students will not be expressly guided to engage in certain stations at specific times; it is the student's responsibility to manage their time so that the tasks are completed by the end of the component. Upon arriving in the lab, each student will be presented with an individualized folder of work. The specific tasks in CS are described below. a) Prescription Checking Each student will be required to discern the accuracy of 2 prescriptions that have previously been processed. Students will be required to indicate whether any medication- processing errors (MPEs) exist that would be problematic for the patient, or are legally/procedurally incorrect (e.g. wrong translation of Latin abbreviations, wrong physician name on the prescription, etc.), and determine and document a correction, if appropriate. b) Verbal Task During the CS component, a PF will phone each student with a verbal task. Verbal tasks for the labs can include calling a prescriber for a refill prescription, requesting a prescription transfer, and receiving verbal prescriptions for Schedule 1 medications (including verbal prescription narcotics). If receiving a verbal prescription or transfer, students will also process the verbal prescription or transfer. The PF, when calling in, will use Latin abbreviations and common conventions with prescriptions; students will be expected to translate these verbally when verifying the order. Page 11 of 12
c) Drug Information Task A written drug information question will be assigned to each student in their folder at the beginning of each lab. Students will answer and document their response using a systematic process on the form provided, as well as describe their search process, noting references utilized. Each question may be from a patient or healthcare provider, and is designed to have students practice researching, classifying, answering, and documenting routine questions using tertiary resources. Students may use electronic or print resources. The Drug Information Task must be completed during the lab, and handed in to the PF by the end of the CS component. d) Prescription Processing Each week, a student will process two prescriptions. The student is required to review the appropriateness of the prescription (i.e. verify that dosing is appropriate for the indication) and accurately process the prescriptions for that patient using the Kroll computer system. Part 2: Patient Care Skills (PC) (1.25 hrs): Once the CS component of the lab session is completed in the pharmacy dispensary, groups of 6-7 students will relocate to rooms for the PC component. Students are expected to prepare in advance of each lab, using a list of twelve medications posted on Blackboard, and the Medication Related Education Template. Students may bring their prepared templates with them to lab, but will be expected to refer to them only when necessary, rather than reading directly from them. Students should be prepared to counsel on any of the twelve medications each week; when they receive their folder in Part 1 (CS), they will then know their assigned medication for PC. The student will play the role of a registered pharmacy student and gather patient information (e.g. allergies, medication use, medical conditions, relevant family and social history) before they provide medication-related patientcentered education. Each role-play is expected to conclude within an eight minute time-frame. Students will be required to use a Patient Care Skills Documentation Form, and submit this during the post-lab documentation stage. Part 3: Documentation (0.5 hours self-directed): As pharmacists in training, students will engage in reflective practice and documentation by completing the Patient Care Skills Documentation Form. Using the course template, students will complete this post-encounter, according to professional documentation expectations by the end of the 0.5 post-lab documentation phase. Page 12 of 12