Duquesne University Mylan School of Pharmacy

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1 Duquesne University Mylan School of Pharmacy Course Title: Pharmacy in Long Term Care Academic Semester: Fall 2016 Course Number: PHPR 466 Credits: 3 Prerequisites: None Course Hours: Tuesday 6-9 pm Please note that this course is a hybrid course. Sessions listed in bold are live sessions. Those marked on-line will be delivered via GoTo Meeting. Location: Room 102 Bayer Course Faculty: Patricia Keys, Pharm.D. Robert Maher, Pharm.D. Christine O'Neil, Pharm.D. Course/Concentration Coordinator Office Hours: By Appointment Course Description: This course is one of two courses designed to provide the student with a concentration in geriatrics. The focus of this course is to introduce the student to the principles of the practice of geriatric/senior care pharmacy and the drug related problems associated with the elderly. This course also will address the role of the pharmacist as a consultant to residents of nursing home, and other long-term care geriatric residential settings. Major topics areas that will be discussed include introduction to normal aging, drug use in the geriatric population with emphasis on the major geriatric syndromes. In addition this course deals with the medication therapy review process, interventions following a medication therapy review, utilization management, Center of Medicare and Medicaid Services (CMS) requirements, the CMS/State survey process, governmental issues dealing with long term care pharmacy, issues dealing with cost/operational issues dealing with long term care and disease state management. This course covers the certification requirements to become a certified geriatric pharmacist and addresses other clinical settings for a consultant pharmacist such as Medication Therapy Management (MTM)

2 Textbooks: o Chapters on Geriatric Topics at the Merck Website: o - You must register to have access to the free online version Also instructors will assign at times supplemental readings Required Equipment: None Educational Technology Requirements: Blackboard will be used for posting of handouts and readings required for this course unless indicated other by faculty member. Evaluation: Instructional Strategies: Interactive Lecture Assignments: 1. MTM Project: Students will select a senior patient to interview and will conduct a medication therapy review, create a Pharmacist Care Plan, and a provide a medication action plan and personal medication record for the patient 2. Consultation Assignments Students will be required to conduct a drug regimen review o Prepare a pharmacy consultation note on assigned geriatric nursing home cases. o Student will be prepared to give an overview discussion of his or her assigned patients Examinations and Evaluation: MTM Project 20% LTC Consultation Project 20% Case Discussion Questions/Class Participation 10% Exam #1 Midterm Exam 25% Exam #2 Long Term Regs Exam 25% Grading: Final grades will be assigned after review by all of the instructors in the course. A = B- = A-= C+= B+= C = B = F =<69.5

3 Upon successful completion of this course, the student will be able to: Course Objectives 1. Discuss the theories on aging. 2. Distinguish normal aging from pathological aging with regard to various organ systems - body composition, renal, cardiovascular, etc. 3. Describe age-related factors that may affect the pharmacokinetics of drugs. 4. Describe age-related factors that may affect the pharmacodynamics of drugs. 5. Identify barriers to effective communication with elderly and the health care professionals. 6. Given a specific scenario, identify strategies to overcome barriers to effective communication between elderly and health care professionals. 7. Discuss drug use patterns among various subtypes of geriatric patients. 8. Recognize therapeutic categories requiring special monitoring/precautions in the geriatric patient. 9. Discuss principles of geriatric prescribing. 10. Describe the process of Comprehensive Geriatric Assessment and the Role of the Pharmacist 11. Recognize the potential for ethical conflicts when caring for elderly patient especially in situations of terminal illness, dementing or progressive neurological illness, other chronic or progressive illness, need for long term care or other assisted living arrangements, patients and family with unrealistic expectations, conflicts. 12. Recognize and discuss the following major geriatric syndromes, the I's of geriatrics: Iatrogenesis Impaired Senses Inanition (Nutrition in the Elderly) Intellectual Impairment Isolation Insomnia Immobility Impaction and Incontinence Instability Infection 13. Discuss the influence of social structure in the elderly on health. 14. Describe living arrangements available to seniors with defined levels of care. 15. Discuss the epidemiology of adverse drug reactions in the elderly. 16. Explain the organizational structure of long-term care facilities and long term care pharmacies 17. Describe the different levels of care provided by a nursing facility 18. Differentiate long-term care from acute care with respect to all of the following: a. Identity of providers b. Outcomes c. Delivery Systems 19. Distinguish the responsibilities of consultant pharmacists at each level of care provided by a nursing facility.

4 20. Explain the scope of pharmacy services provided in acute care and long-term care facilities. 21. Explain the methods of providing pharmacy services (clinical and administrative) needed by patients and facilities that provide long-term care. 22. Describe the economic factors, which must be considered to establish and maintain pharmaceutical services for long-term care facilities. 23. Explain the economics associated with providing pharmacy services for long-term care including: a. Associated costs b. Benefits 24. Explain the origins of the field of consultant pharmacy 25. Explain the legal responsibilities of the consultant pharmacist in each of the following contexts: a. Developing policies and procedures b. Supervising services c. Control of drugs d. Labeling of drugs e. Participation on pharmaceutical service committees 26. List the sections, which should be included in a policy and procedures manual for a nursing home that is related to the provision of pharmaceutical services. 27. Describe the consultant pharmacists responsibilities in each of the following areas: a. Patient drug regimen reviews b. Control of drug use c. Automatic orders d. Disposal of drugs and supplies 28. Describe the types of outcomes, which would indicate that the services provided by a consultant pharmacist are cost-effective. 29. Define and describe the different kinds of drug distribution systems used in a nursing home, from drug procurement by the pharmacy to the administration of drugs to the patients. 30. Explain the medication order cycle from physician order sheets, medication administration record, and medication label 31. Explain federal and state laws and regulations, which govern pharmacy service in long term care.

5 32. Name and describe the various regulatory government agencies relative to the operation of nursing homes. 33. Describe the consultant pharmacist s responsibility when discrepancies in compliance with regulations are identified. 34. Describe the process for conducting a drug regimen review. 35. List and define the five indicators for surveyor assessment of DRR performance. 36. Identify the CMS requirements in regards to the consultant pharmacist s DRR. 37. Discuss how pharmaceutical care of the elderly relates to drug regimen review. 38. Recognize the various communication styles in drug regimen review.

6 Course Outline: (Topics and Dates are Subject to Change) Date Topics Faculty August 30 September 6 September 13 September 20 Introduction to the Geriatrics and Aging Comprehensive Geriatric Assessment/ Clinical Monitoring and incorporating the MTM Model Living Arrangements in the Elderly (Continuum of Care) Communicating with Patients, Caregivers and Inter- Professional Team Assign MTM Cases Socioeconomics of Aging Drug Use in the Elderly Changes in Drug Disposition and Response Adverse Drug Reactions Geriatric Syndromes I Falls/Gait Disorders Drug Disease Interaction Delirium/Behavioral Disorders Geriatric Syndromes II Nutrition Constipation Insomnia Drs.Maher/O Neil Dr. Keys Dr. Keys Dr. O Neil Week of September 27 th Midterm Exam No Class October 4 th Introduction to Long Term Care and Consulting Pharmacy Review of F-Tag 428 Consultation Services October 11 th Review of the F-tag 329 Unnecessary Drugs Uses of Psychotropic Medications in Nursing Facility October 18 th - F-tag 425 Pharmaceutical Services - F-tag 431 Storage, Labeling, Controlled Meds Regulations - Review of the pharmacy and consultant pharmacy in cost control containment Technology and Consultant Pharmacist Utilization Management and Reporting Dr. Maher Drs. Maher/O Neil Dr. Maher October 25 th Survey Process and Tools: The MDS (Minimum Data Set) and other documentation tools of the Nursing Facility Overview of the Quality Assessment and Assurance Committees Review of Consultant Pharmacist Role in Assisted Living/Personal Care homes and Hospice- Case Examples The Geriatric Pharmacist Role in Assisted Living/Personal Dr. Maher November 8 rd Dr Maher Care and Hospice Case Examples November 15 th MTM Presentations Week 1 Faculty November 29 th MTM Presentations Week 2 Faculty December 6 st In Class Group Long Term Case Review Presentations Faculty Week of December 12 th Exam 2 on Long Term Care Regulations

7 Professional Classroom Behavior (particularly student responsibilities and accountability) Policy for Missed or Late Assignments Classroom participation: Students will be allowed to drop one participation score from their final grade. If a student has more than one absence from the class and it is excused (personal illness or death of an immediate family member), he/she will have the opportunity to do a brief written assignment as a make-up for participation. If a student has more than one absence from class and it is unexcused (work, job interview, or any other reason than stated above), he/she will receive a zero for participation for that class. The instructor should be contacted by the student (via telephone, , or in person) before the class meets in order to discuss the absence. Assignments/Projects: Written portions of the activities are due to be posted in Blackboard by 4:00pm on the day of class when they are to be discussed. Anything submitted after 4:00pm that day will be considered late. For each 24 hour block of time that passes after 4:00pm on the due date, 2 points will be deducted from the written assignment score. If the assignment has not been posted within 1 week of the due date, the student will receive a zero for that written assignment. Presentations must be delivered in class on the scheduled date or the student will receive a zero for that portion of the activity. If a student misses the exercise due to an excused absence, he/she can make up the assignment by completing an additional written exercise individually and submitting it to the course coordinator with an oral presentation within 1 week of the missed class. If the student does not turn in the assignment within 1 week of the missed class, he/she will receive a zero for that assignment Administrative Policies Governing All Courses Students are required to review these policies in their entirety. Complete copies of or links to the policies may be found on the Student Services Blackboard site, Policy and Procedures. Exam Tardiness Policy Missed Exams Policy Grade Appeal Policy Academic Integrity Policy Services for Students with Disabilities Audio/Visual Taping Policy

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