EVENT GUIDELINES

Pharmacy Practice

Purpose: To provide the Health Science student with an opportunity to develop and demonstrate knowledge and skills in pharmacy practice.

Description This event will consist of two rounds of competition. Round One will be a written, multiple choiceof Event: test of knowledge and understanding. The top scoring competitors will advance to Round Two for

the performance of selected skill procedure(s) identified in a written scenario. The scenario will require the use of critical thinking skills. The performance will be timed and evaluated according to the event guidelines.

Dress Code: Competitors shall wear proper business attire or official HOSA uniform, or attire appropriate to the occupational area, during the orientation and written test. Competitors will wear attire appropriate to the occupational area during the skill procedure(s). Bonus points will be awarded for proper dress.

Rules and 1. Competitors in this event must be active members of HOSA-Future Health Professionals, Procedures in good standing in the category in which they are registered to compete (Secondary or

Postsecondary/Collegiate). Competitors should compete in skill events at the highest level of their training.

2. Competitors must be familiar with and adhere to the “General Rules and Regulations of the National HOSA Competitive Events Program (GRR)."

3. The test will consist of fifty (50) multiple choice items.

Round One: Written Test Plan History and Profession of Pharmacy ...............................7.5% Pharmacology for Technicians..............................15%

Pharmacy Law and Regulations........................................15% Sterile and Non-Sterile Compounding...............................10% Medication Safety...........................................................12.5%

Pharmacy Quality Assurance..............................................5% Medication Order Entry and Fill Process...........................15% Pharmacy Inventory Management...................................7.5% Pharmacy Billing and Reimbursement.............................7.5% Medication Formulation Usage............................................5%

4. All competitors shall report to the site of the event orientation at the time designated. The

Round One test will immediately follow the orientation. No proxies will be allowed for the orientation.

5. Test Instructions: There will be a maximum of 60 minutes to complete the test. There will be a verbal announcement when there are 15 minutes remaining for the test period.

Pharmacy Practice Guidelines (August 2014) 1

New for 2014-15Pharmacy Practice is a brand new skill event designed just for Colorado HOSA members. The event has been prepared by the University of Colorado Skaggs School of Pharmacy

EVENT GUIDELINES

NOTE: States/regions may use a different process for testing, to include but not limited to pre-conference testing, online testing, and testing at a computer. Check with your Area/Region/State for the process you will be using.

6. All official references are used in the development of the written test. The specific reference selected for each procedure is listed in the Facilities, Equipment and Materials section of these guidelines.

Ballington, Don and Anderson, Robert. Pharmacy Practice for Technicians. Paradigm Education Solutions. Latest edition.

Ballington, Don and Laughlin, Mary. Pharmacology for Technicians. Paradigm Education Solutions. Latest edition.

Dosage Form Use Document – from CU Skaggs School of Pharmacy

www.pocketnurse.com for demo dosage forms and other supplies for procedures

7. The test score from Round One will be used to qualify the competitor for the Round Two skill procedures, and will be used as a part of the final score for the event.

8. For national competition, one, two or three skill procedures will be selected and may be evaluated as stand-alone skills, or in combination. The procedures approved for this event are:

Procedure I: Identify Problems or Missing Items on PrescriptionsProcedure II: Interpret Prescriptions and Dispense CorrectlyProcedure III: Donning Aseptic Gear in Sequential OrderProcedure IV: Aseptic TechniqueProcedure V: Non-sterile Compounding – Suspension/SolutionProcedure VI: Non-sterile Compounding – Two OintmentsProcedure VII: Non-sterile Compounding – Ointment with TabletsProcedure VIII: Patient Education: Proper Dosage Form Usage

* Two of the procedures in red will be piloted at the 2015 Colorado State Leadership Conference.

9. The selected procedure(s) for Round Two, in the form of a written scenario, will be presented to the competitor at the start of the skill to be performed. One or more procedures may be combined in the scenario. The scenario will be the same for each competitor and will include a challenging component that will require the competitor to apply critical thinking skills.

10. The scenario is a secret topic. Professional ethics demand that competitors DO NOT discuss or reveal the secret topic until after the event has concluded. Competitors who violate this ethical standard will be disqualified.

11. In case of a tie, the highest test score will be used to determine the rank.

12. Competitors must complete all steps of the procedure listed in the guidelines even if the steps must be simulated/verbalized. Steps may NOT be simulated/verbalized when the equipment/materials are available.

13. The competitor must earn a score of 70% or higher on the combined skill procedure(s) of the event (excluding the test) in order to be recognized as an award winner at the NLC.

14. The timing for the skill will begin when the scenario is presented. Competitors will be stopped at the end of the time allowed for a selected procedure(s).

Pharmacy Practice Guidelines (August 2014) 2

EVENT GUIDELINES

Required Personnel1. One Event Manager per event2. One Section Leader per section3. One judge per procedure selected per section (with expertise in the specific skill area)4. Proctors for testing 5. One-two event assistants per section6. One-two patients as required by the scenario (per section)7. Holding room attendants(s) 8. Timekeepers (if necessary)9. One QA to provide quality assurance for the event by ensuring that the guidelines

are followed and all event documents are complete.

Facilities, Equipment and Materials (Per Section)

General Clinical and/or laboratory stations for selected procedures Access to sink for selected procedures Holding rooms or areas for competitors Written scenario (one copy per competitor and judge) Patient and judge scripts as needed Pencils for judges Stopwatch Rating sheets – one per judge per competitor Evaluation Forms – competitor, judge, and personnel #2 lead pencils with eraser to complete evaluations

Round One: Written Test (Reference: All resources) One test copy per competitor Scantron /answer forms

Round Two:

Procedure I Identify Problems or Missing Items on Prescriptions (Reference: Ballington, Chapter 6) Pencil/eraser

Procedure II Interpret Prescriptions and Dispense Correctly (Reference: Ballington, Chapter 6) Pencil/eraser Counting tray/spatula Two medication vials of each size (10 dram, 20, 30, 40, 60) Labels (4 per competitor) Demonstration medications

o Keflex 500 mg, #30o Cephalexin 500 mg, #30o Norco 5/325, #150o Hydrocodone/Acetaminophen 10/325, #150o Polytrim ophthalmic drops, 10 mL bottle

Pharmacy Practice Guidelines (August 2014) 3

Competitor Must Provide: Event guidelines (orientation) Pens and #2 lead pencils with eraser Calculator

EVENT GUIDELINES

o Poly-dex ophthalmic drops, 5 mL bottleo Triamcinolone 0.1% cream, 80 g tubeo Triamcinolone 0.1% ointment, 80 g tube

Procedure III Donning Aseptic Gear in Sequential Order (Reference: Ballington, Chapter 11) Tape to represent different rooms Sink access Soap or hand sanitizer Barrier devices (gloves, gown, shoe covers, mask, hair net)

Procedure IV Aseptic Technique (Reference: Ballington, Chapter 11) Isopropyl alcohol and sterile water in spray bottles Paper towels Horizontal hood (counter space with backdrop) Powdered and liquid medication vials Sterile water vial Safeline Vial Access Cannulas (pocketnurse.com) Alcohol swabs 250 mL NS or D5W bag

Procedure V Non-sterile Compounding – Suspension/Solution (Reference: Ballington, Chapter 8) Pencil/eraser Paper Crushable Tablets (at least 15-20 per competitor) Counter space Mortar and pestle 50 mL and 100 mL graduated cylinders One vial of varying sizes (2 oz., 3 oz., 4oz.) Sink access

Procedure VI Non-sterile Compounding – Two Ointments (Reference: Ballington, Chapter 8) Pencil/eraser Paper Two different ointments, one labeled as 2% and the other 10% Counter space Weighing scale Wax paper or similar item (to be able to weigh product) Either mortar and pestle or compounding slab with spatula Container for final product Sink access

Procedure VII Non-sterile Compounding – Ointment with Tablets (Reference: Ballington, Chapter 8) Pencil/eraser Paper Ointment Crushable tablets (at least 10-15 per competitor) Counter space Weighing scale Wax paper or similar item (to be able to weigh product) Mortar and pestle Compounding slab with spatula Container for final product Sink access

Procedure VIII Proper Ophthalmic Drop Usage (Reference: Safemedication.com, How to Use Eye Drops Properly) Eye drops

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EVENT GUIDELINES

Tissue or cloth Sink access

Icon Key

Competitors must meet a 70% mastery score on skills in this event.

The orientation includes an event element. Competitors must bring pencils/pens.

Round One scores are used to advance competitors to Round Two at the NLC.

Includes a secret topic that may not be discussed or revealed to others until the event has concluded.

Event Flow Chart

Sample Round One Test Questions

1. Professionals and consumers can report serious adverse drug reactions toA. the DEA.B. the PTCB.C. MedWatch.D. the NABP.

2. What is a common side effect of narcotics?A. swelling.B. constipation.C. wheals.D. wheezing.

3. Why are many patients with asthma reluctant to use inhaled corticosteroids? Pharmacy Practice Guidelines (August 2014) 5

Scan Tests

Top competitors advance to Round Two

Competitors perform skills

Competitor not recognized at

Awards Session

Add competitors’ test score to his/her skill score for final tally.

Rank top 10 competitors according

to their final score.

Did competitor earn

70% of skill points?

No Yes

Orientation50-item test in 60 minutes

EVENT GUIDELINES

A. They dislike the dosing regimen.B. They fear potential side effects.C. They object to the taste.D. They think corticosteroid inhalers are too difficult to use.

PHARMACY PRACTICE

Competitor #: _______________ Judge's Signature: _______________________________

Procedure I Identify Problems or Missing Items on a Prescription Reference: Ballington, Chapter 6

Time: 8 minutes

Possible Allocated

1. Prescription #1Smith, John5555 W Auraria CtDenver, CO 80219

#1 Healthcare Offices303-555-5656

Rx: Fentanyl 100 mcg patch #90 (No Written date)1 patch Q3 days for 1 month

Refills: 0

Dr. M. Johnson, MD____________ (No DEA Number)

a. Unacceptable quantity 1

b. Missing address of doctor’s office 1

c. No DEA number 1

d. Missing date written 1

2. Prescription #2John5555 W Auraria CtDenver, CO 80219720-546-3255 DOB: 08/15/56

#1 Healthcare Offices1357 E. Bonner StDenver, CO 80219

303-555-5656

Rx: Testosterone depot 100 mg/mL #10 ml 7/27/2014Inject 2 mL (200mg) Q2W

(No Indication)

Refills: 0

Nick Johnson, MD____________ DEA: AJ3462841

a. Missing last name 1

Pharmacy Practice Guidelines (August 2014) 6

a

b

c

d

a

b

c

d

EVENT GUIDELINES

b. Missing route of administration (PO, IM, SQ, IV, etc.) 1

c. Invalid DEA number 1

d. Missing indication for medication use 1

Items Evaluated Possible Allocated

3. Prescription #3Bullock, Seth2415 E. Colfax AveDenver, CO 80219

Colorado Alpine Care4110 Washington St.

Denver, CO 80209303-550-5676

Rx: Adderall XR 30 mg #6 07/11/2015Ṫ daily PRN PA

x Dispense as writtenRefills: 1

Sean Stevenson, MD No DEA

Numbera. Written date cannot be in the future 1

b. No refills allowed 1

c. No DEA number 1

d. Missing route of administration (PO, IM, SQ, IV, etc.) 1

4. Prescription #4Bullock, Seth2415 E. Colfax AveDenver, CO 80219

Colorado Alpine Care4110 Washington St.

Denver, CO 80209303-550-5676

(7/29/2014)Rx: Hydrocodone/APAP 5/325 (Percocet) # 20Ṫ tab by mouth PRN, stop 1 week from today

Refills: 10

Sean Sternson, MDDEA: AS2441753

a. Unacceptable amount of refills 1

b. Signa needs verification as the written date is longer than 1 week ago

1

Pharmacy Practice Guidelines (August 2014) 7

a

b

b

c

a

c

d

d

EVENT GUIDELINES

c. Drug name error (Not Percocet) 1

d. Missing frequency 1

TOTAL POINTS -- PROCEDURE I 16

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EVENT GUIDELINES

PHARMACY PRACTICE

Competitor #: __________________ Judge's Signature: ___________________________

Procedure II Interpret Prescriptions and Dispense Correctly Reference: Ballington, Chapter 6

Time: 13 minutes

Possible Allocated

1. Prescription #1

a. Prescription number 1

b. Patient name 1

c. Date of initial dispensing 1

d. Correct drug strength and formulation 2

e. Correct signa 2

f. Prescriber name 1

g. Name and address of pharmacy 1

h. Correct amount dispensed 1

2. Prescription #2

a. Prescription number 1

b. Patient name 1

c. Date of initial dispensing 1

d. Correct drug and strength 2

e. Correct signa 2

f. Prescriber name 1

g. Name and address of pharmacy 1

h. Correct amount dispensed 1

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EVENT GUIDELINES

Items Evaluated Possible Allocated

3. Prescription #3

a. Prescription number 1

b. Patient name 1

c. Date of initial dispensing 1

d. Correct drug and strength 2

e. Correct signa 2

f. Prescriber name 1

g. Name and address of pharmacy 1

h. Correct amount dispensed 1

4. Prescription #4

a. Prescription number 1

b. Patient name 1

c. Date of initial dispensing 1

d. Correct drug and strength 2

e. Correct signa 2

f. Prescriber name 1

g. Name and address of pharmacy 1

h. Correct amount dispensed #1 tube of 80 grams

1

TOTAL POINTS -- PROCEDURE II 40

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EVENT GUIDELINES

PHARMACY PRACTICECompetitor #: ___________________ Judge's Signature: ___________________________

Procedure III Donning Aseptic Gear in Sequential Order Reference: Ballington, Chapter 11

Time: 8 minutes

Possible Allocated

Note to Judge: Directions are sequential and points should not be given for steps done out of order.

1. Take off earrings, hand jewelry, and cosmetics 2

2. Place gear in the following order:

1: Place shoe cover

2. Place hair cover

3. Place face mast

* One point for every item that is put on in the correct order

3

3. Hand cleansing with soap (up to the elbows) 2

4. Place gown 2

5. Apply sterile, foamed alcohol to hands and allow to dry 2

6. Place sterile powder-free gloves 1

TOTAL POINTS -- PROCEDURE III 12

**If a student jeopardizes the patient's or his/her own safety or fails to perform a critical technique and does not take immediate action to correct the error, the total points for the procedure or specific subpart(s) will be deducted.

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EVENT GUIDELINES

PHARMACY PRACTICE

Competitor #: __________________ Judge's Signature: ___________________________

Procedure IV Aseptic Technique Reference: Ballington, Chapter 11 Time: 12 minutes

Possible Allocated

1. Spray hood first with sterile water, followed by isopropyl alcohol. Alcohol must remain in contact with the surface for 30 seconds prior to compounding any products.

2

2. Wipe hood in an up/down motion from top to bottom (for horizontal hood) 2

3. Wipe the top of the vial(s) and 250mL solution bag port with alcohol swab 1

4. Powder Vial: add appropriate amount of diluent, remove needle, mix until powder is completely reconstituted, wipe vial with alcohol swab before reinserting needed, and then draw out correct amount of medication

Liquid vial: draw up equivalent volume of air into the syringe, once needle is in the vial, depress the syringe to inject air into vial, withdraw appropriate amount of medication

Ampule: Tap ampule to verify medication is at the bottom, wrap an alcohol-soaked swab around the neck of the ampule and snap the neck, use filtered needle to withdrawal correct amount of medication, and switch needle to an unfiltered needle.

3

5. Insert medication into the correct port on the 250mL bag 1

6. Pull syringe back to the correct mL of medication you injected into the 250mL bag

2

7. Put all vials, 250mL bag, syringes, and needles on table outside of hood. 1

8. Spray hood with isopropyl alcohol 1

9. Wipe hood in an up/down motion from top to bottom (for horizontal hood) 2

10. Did the student’s technique block airflow in the hood at any point? (i.e. did hands/fingers/other body parts come between the air filter and the needle inserting into vial/bag)

4

TOTAL POINTS -- PROCEDURE IV 20

**If a student jeopardizes the patient's or his/her own safety or fails to perform a critical technique and does not take immediate action to correct the error, the total points for the procedure or specific subpart(s) will be deducted.

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EVENT GUIDELINES

PHARMACY PRACTICE

Competitor #: __________________ Judge's Signature: ___________________________

Procedure V Non-sterile Compounding – Suspension/Solution Reference: Ballington, Chapter 8 Time: 10 minutes

Possible Allocated

1. Correct written instructions 2

2. Wash hands 2

3. Appropriate amount of tablets 2

4. Grind down tablets with mortar and pestle 1

5. Mix powder with liquid and pour into graduated cylinder 1

6. Add liquid to achieve desired amount 2

7. Transfer final product into correct dispensing container 2

8. Wash tools when done 1

9. Wash hands 2

TOTAL POINTS -- PROCEDURE V 15

**If a student jeopardizes the patient's or his/her own safety or fails to perform a critical technique and does not take immediate action to correct the error, the total points for the procedure or specific subpart(s) will be deducted.

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EVENT GUIDELINES

PHARMACY PRACTICE

Competitor #: __________________ Judge's Signature: ____________________________

Procedure VI Non-sterile Compounding – Compounding Two Ointments Reference: Ballington, Chapter 11 Time: 8 minutes

Possible Allocated

1. Correct written instructions 2

2. Wash hands 2

3. Correct amount of Medication Ointment A 2

4. Correct amount of Medication Ointment B 2

5. Mix on compounding slab with spatula or with mortar and pestle 1

6. Ointment is mixed mostly uniform 2

7. Transfer final product into dispensing container 1

8. Wash tools when done 1

9. Wash hands 2

TOTAL POINTS - PROCEDURE VI 15

**If a student jeopardizes the patient's or his/her own safety or fails to perform a critical technique and does not take immediate action to correct the error, the total points for the procedure or specific subpart(s) will be deducted.

Pharmacy Practice Guidelines (August 2014) 14

EVENT GUIDELINES

PHARMACY PRACTICE

Competitor #: __________________ Judge's Signature: ___________________________

Procedure VII Non-sterile Compounding – Compounding Ointment with Tablets Reference: Ballington, Chapter 8

Time: 10 minutes

Possible Allocated

1. Correct written instructions 2

2. Wash hands 2

3. Use appropriate amount of tablets 2

4. Grind down tablets with mortar and pestle 1

5. Mix powder and partial amount of lotion base with spatula on compounding slab

2

6. Add lotion base until desired amount

7. Mixture is reasonably smooth, particles not too rough 1

8. Transfer final product into dispensing container 1

9. Wash tools when done 1

10. Wash hands 2

TOTAL POINTS -- PROCEDURE VII 16**If a student jeopardizes the patient's or his/her own safety or fails to perform a critical technique and does not take immediate action to rectify the error, the total points for the procedure or specific subpart(s) will be deducted.

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EVENT GUIDELINES

PHARMACY PRACTICE

Competitor #: __________________ Judge's Signature: ____________________________

Procedure VIII Proper Ophthalmic Drop Usage Reference: Safemedication.com, How to Use Eye Drops Properly Time: 5 minutes

Possible Allocated

1. Wash hands with soap and water. 2

2. Check dropper tip to ensure dropper integrity. 1

3. Avoid touching tip of dropper. 2

4. Tilt head back, pull down lower eye lid with finger to form a pocket. 2

5. Hold dropper with tip down with other hand as close to eye without touching it.

1

6. Brace remaining fingers of that hand against your face 1

7. While looking up, gently squeeze dropper to have a single drop fall into the pocket made by the lower eyelid. Remove finger form the lower eyelid.

2

8. Close eye for 2 to 3 minutes and tip head down towards the floor. 2

9. Do not blink or squeeze eyelid. 2

10. Place a finger on the tear duct and gently apply pressure. 2

11. Wipe excess liquid off of face with a tissue or cloth. 1

12. Verbally acknowledge to the judge that a wait of at least 5 minutes is necessary between drops into the same eye.

2

13. Replace and tighten cap on dropper bottle. Do not wipe or rinse the dropper tip.

2

14. Wash hands with soap and water. 2

TOTAL POINTS - PROCEDURE VIII 24

**If a student jeopardizes the patient's or his/her own safety or fails to perform a critical technique and does not take immediate action to correct the error, the total points for the procedure or specific subpart(s) will be deducted.

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