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Community Introductory Pharmacy Practice Experience (IPPE) Journal Student Name IPPE dates IPPE site name, city, state INTRODUCTION: Before I begin discussing my Community Introductory Pharmacy Practice Experience (IPPE), I would like to mention a bit of background information relating to my past experiences in the community pharmacy setting. From November of 2XXX through May of 2XXX I was employed at a (Retail Giant) Pharmacy in Scottsbluff, NE as a Pharmacy Technician. Upon moving to Omaha in June 2XXX, I began working as a Pharmacy Technician at (Student employer) Pharmacy in Bellevue. I received my Pharmacist Intern license early on during the fall 2XXX semester at the UNMC College of Pharmacy, and have worked as a Pharmacist Intern there ever since. Although my role at (Student employer) Pharmacy extends beyond that of a typical Pharmacist Intern in a community pharmacy due to the clinical responsibilities that the pharmacists at (Student employer) hold, I continue to gain experience there doing many of the same types of things a Pharmacist Intern working at a chain pharmacy would do since (Student employer) Pharmacy is a retail pharmacy as well. All told then, before I began my Community IPPE at (IPPE Pharmacy), I had two and one-half years of experience within the community pharmacy setting.

My point in bringing up my past experiences in community pharmacy as both a Pharmacy Technician and a Pharmacist Intern is to give an idea of why most of what I experienced and was shown at (IPPE Pharmacy) was not new to me. I am not saying that the Community IPPE at (IPPE Pharmacy) was not worthwhile, but I do want any peruser of this journal to understand that I did not experience any sort of epiphany regarding what it means to practice as a community pharmacist. I feel that I had a solid understanding and respect for what it means to practice as a community pharmacist before the Community IPPE, and I continue to see this as a setting that I could enjoy practicing in after I graduate from the College of Pharmacy in 2XXX. The journal entries that follow highlight some of the things that I feel were the most important learning experiences of each week; they by no means detail everything that I did while on this practice experience.

WEEK ONE: The first week at (IPPE Pharmacy) Pharmacy gave me an opportunity to utilize a different computer operating system, called PDX, from what I had used in the past. I felt this was very useful, as it gave me an opportunity to see how another operating system would look like and how it would compare to what I had used before. My preceptor and Pharmacy Manager at the store, (IPPE preceptor), told me that (IPPE Pharmacy) was going to be going to a new computer system very soon (within a few months or so), but I was happy to at least try PDX for a point of comparison with FSI (which the Nebraska Medical Center Outpatient pharmacies use) and Connexus (which is the name of the system (Retail Giant) uses). Since this particular (IPPE Pharmacy) Pharmacy was fairly low volume, I was able to learn the system at least well enough to be able to do the most routine tasks that a pharmacist would have to do on a daily basis by the end of the first week. One of the main differences between (IPPE Pharmacy) Pharmacy and (Student employer) Pharmacy (again, where I currently work) is the vast amount of over-the-counter products that (IPPE

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Pharmacy) has to offer compared to (student employer). I enjoyed this, as it allowed for an area of patient contact/counseling that I do not get very much of at (student employer), as our OTC selection at (student employer) is quite limited due to space constraints. One particular experience that stood out for me this week relates to OTC products. A mother asked my preceptor and I about suppositories she could use to help her constipated 2 year old child have a bowel movement. She had just been to the doctor’s office with her child and the doctor recommended that she purchase some infant suppositories for use to help relieve her daughter’s constipation. The mother was quite distraught about the idea of using a suppository on her child, and was also unclear on the dosing regimen. (IPPE preceptor) took care of the vast majority of the interaction with the mother on this one, but it was still a good experience for me to listen in on the conversation. I also chipped in to the consultation by recommending some ways to help prevent any future cases of constipation, such as increasing her daughter’s fluid and fiber intake. By the end of the consultation, I could tell that the mother’s anxiety had been greatly relieved, and (IPPE preceptor) gave the mother her card to call back if she had any other questions or concerns. It felt good to see a very worried mother leave the pharmacy area with her questions answered. For this journal, I am supposed to assess how I have progressed during the practice experience at the end of each week. As mentioned in my introduction, nothing that I have done here so far has been entirely new to me, and I have felt very capable of handling each task I have been given so far. Learning a new computer system has been a bit challenging and frustrating at times, but I feel like I am doing very well with PDX for only being one week into the experience on the whole. I am staying positive and trying to learn as much as I can during this experience. WEEK TWO: During week two at (IPPE Pharmacy), I began to recognize some interesting differences on the business side of the pharmacy’s operation between (IPPE Pharmacy) and the (Retail Giant) where I had previously worked. Although the (Retail Giant) Pharmacy that I had worked at in Scottsbluff was considerably busier than this particular (IPPE Pharmacy) Pharmacy, (we filled at least 3 to 4 times as many prescriptions per day at the (Retail Giant) than they do at this (IPPE Pharmacy)), the (IPPE Pharmacy) Pharmacy kept many interesting drug products on hand that I had never even heard of before. My preceptor, spoke to me about (IPPE Pharmacy)’s stance on inventory. She explained that (IPPE Pharmacy) goes out of its way to try to keep a wide variety of medications on hand for their patients, both potential and current, in an effort to better serve them. At (Retail Giant), the focus was definitely on only keeping drugs in stock that you knew were going to get used; although I know that both (IPPE Pharmacy) and (Retail Giant) are profit oriented, it seemed like (IPPE Pharmacy)’s corporate stance on this particular issue was a lot more patient-oriented. The inventory issue was also an interesting contrast with what I am used to now that I work for a Nebraska Medical Center pharmacy, as the NMC has a formulary of its own and we are only allowed to carry products that are on the formulary.

With respect to drug inventory, (IPPE Pharmacy) also had a manual method of keeping track of their on-hand medication and at the end of the day the technician or pharmacist had to ‘walk the shelves’ to see what needed to be reordered. This is in contrast to both (Retail Giant)’s and (Student employer) Pharmacy’s method of keeping track of inventory; the computer system kept track of the approximate numbers of capsules, tablets, etc. and products are automatically reordered at the end of the day (after a quick double check by one of the technicians or pharmacists, of course.) While at

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(IPPE Pharmacy), I have had the opportunity to actually make the order and transmit it to McKesson, (IPPE Pharmacy)’s medication supplier, on numerous evenings. (IPPE preceptor) also talked to me about (IPPE Pharmacy)’s staffing model. At (IPPE Pharmacy) Pharmacies across the U.S., the Pharmacy Manager is supposed to set the schedule according to an algorithm that tells the manager how many hours he or she has to divvy up between technicians and interns for any given week. Although she did not know the exact nature of the algorithm, she explained that it was based at least in part on number of prescriptions filled, sales numbers, and customer survey results. During this second week of my Community IPPE, I fielded numerous phone calls from doctor’s offices and took many prescriptions over the phone. This phone experience was beneficial for me. Although I also have taken phoned-in prescriptions at (Student employer) Pharmacy, we generally do not have very many scripts called in there as a result of our Pharmacy being inside of a clinic; most of the scripts we fill are either refills or come directly from people bringing us a new script right after their appointment. This experience helped me become more comfortable taking prescriptions over the phone and off the voicemail line. I overcame feeling uncomfortable about asking nurses and doctors to repeat their order if I could not keep up with their rate of speaking, and I became comfortable with reading back the whole prescription to the nurse or doctor, even if I could tell they were frustrated with me because they felt I was taking up too much of their time. As always, the most important thing is patient safety and getting the order right, but taking prescriptions over the phone still takes some practice and thankfully I got plenty of it during my experience at (IPPE Pharmacy)! I also was able to call a doctor to get an order changed that was written incorrectly. Although I had done that before, it was still good practice for me. Early on during my second week at (IPPE Pharmacy), (IPPE preceptor) assigned a project to me. She wanted me to write a paper discussing the different classes of antihypertensives, when they are used, and their side effect profiles. She also wanted me to summarize the treatment protocol discussed by “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure”, which was published in 2003 and details the guidelines that doctors follow in their diagnosis and management of hypertensive patients. The classes of antihypertensive medications she assigned to me are as follows: 1) thiazide diuretics, 2) ACE inhibitors, 3) angiotensin receptor blockers, 4) beta blockers, and 5) calcium channel blockers. Upon my completion of this paper by the end of my second week at (IPPE Pharmacy), (IPPE preceptor) took it home over the weekend and read over it in order for us to discuss it in further detail next week. This was to be my presentation, and we would talk about it next week. At the end of week two, I feel like I am very comfortable in this new environment. I am starting to recognize some of the differences between (IPPE Pharmacy) and the way it handles its’ pharmacy business compared to the way (Retail Giant) did back when I was a technician for them. I am glad that I am getting this information and experiencing the (IPPE Pharmacy) environment firsthand; it will help me decide what type of environment I will want to work in once I graduate and look for an employer. WEEK THREE: (IPPE preceptor) read my paper about antihypertensive medications over the weekend and discussed it with me on Monday. She asked me many different questions about some of the different antihypertensive classes as a sort of ‘quiz’, and offered some additional information. Writing the paper

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was a good opportunity for me to learn more detailed information about some of the medications that I dispense on an everyday basis, specifically with regards to these antihypertensives’ mechanism of action. It was a very useful assignment and I’m glad (IPPE preceptor) had me do this project. Throughout the three weeks here at (IPPE Pharmacy) I have had opportunities to counsel patients with oversight from (IPPE preceptor) and another staff pharmacist. So far in my relatively brief career as a Pharmacist Intern both at (Student employer) and now at (IPPE Pharmacy), I have found the number of patients who do not want to take a minute or two to ask questions about their new medications to be very surprising. Still, there are many people who seem like they understand the significance of understanding their medications, from potential side effects to how the medication will benefit them, and it is always a pleasure to talk to them about their prescriptions. Counseling is one of the most enjoyable aspects of the job and I’m glad my preceptor has given me a chance to do quite a bit of counseling, although I generally do more counseling when I am working (Student employer) than I have done during my IPPE at (IPPE Pharmacy). I have heard from some other classmates currently doing their Community IPPE’s that they have not been given much of an opportunity to do any counseling, so I feel lucky to be in a good position for my practice experience. This week I also talked to (IPPE preceptor) about continuing education once you become a practicing pharmacist and what that entails, as well as how you go about obtaining your license and keeping it current. It was very useful to ask (IPPE preceptor) about the whole process as she had just graduated from UNMC last spring, and it was interesting to talk to a recent graduate about her job search. (IPPE preceptor) also had some good insight to share with me about some of the classes that I will have coming up, and was very personable and helpful throughout the Community IPPE. SUMMARY: Now that I am at the end of my Community IPPE, I feel like I got out of it exactly what I wanted to. I did not learn anything ‘earth-shaking' as I know that I was already competent in the ways of community pharmacy before I began this practice experience as a result of my past work experience. However, I did learn some useful information and at the very least got to spend some time in a retail pharmacy environment in which I may try to get hired someday. I got acquainted with a new computer system, got to practice taking a lot of prescriptions over the phone, and learned a bit about how (IPPE Pharmacy) Pharmacy runs as a business. All in all it was a pretty good experience, although I think it could stand to be a bit shorter, as everything that I did in the three weeks could have probably easily been compressed into two weeks or less. I feel like I gave the Community IPPE my full effort, and that it was for the most part rewarding in return.