EXPERIENCE
Enhanced responsibilities for pharmacy interns at a teaching hospital Christine M. Gillis, Kevin E. Anger, and Michael C. Cotugno
Abstract Objective: To describe the implementation of a pharmacy intern distribution coordinator position and its impact on the intern’s professional development. Setting: Tertiary academic medical center. Practice description: In 2009, our institution implemented a pharmacy intern distribution coordinator position, which was previously staffed by a pharmacist. Interns, who are in their first through fourth professional year, take the lead in the medication distribution process while under the direct supervision of a pharmacist. The intern adjudicates the medication distribution process by ensuring proper processing, filling and timely delivery of the medications, as well as triaging inventory issues and maintaining open communication with the pharmacists about any medication issues. Additionally, the intern can make clinical interventions during the various checkpoints in the final verification process and answer drug information questions for fellow medical professionals. Practice innovation: Pharmacy intern resources and development are maximized via staffing in a medication distribution coordinator position previously staffed by a pharmacist. By adapting to the role of pharmacist early on in one’s career, pharmacy interns are provided with a valuable opportunity to grow professionally. The position can foster the development of pharmacotherapy knowledge, communication skills, leadership experience, time management, and critical thinking by allowing pharmacy interns to practice at the top of their licensure.
Christine M. Gillis, PharmD, PGY1 Pharmacy Resident, Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA Kevin E. Anger, PharmD, BCPS, Clinical Pharmacy Specialist, Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA Michael C. Cotugno, BSPharm, Director of Pharmacy Patient Care Services, Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA Correspondence: Christine M. Gillis, Brigham and Women’s Hospital, Department of Pharmacy, Pharmacy Administration: Lower Level-2, 75 Francis Street, Boston, MA 02115; [email protected] Disclosure: The authors declare no relevant conflicts of interest or financial relationships. Received February 4, 2014. Accepted for publication August 11, 2014. Published online in advance of print February 20, 2015.
Conclusion: Our pharmacy intern distribution coordinator position provides interns with a professional development opportunity by assuming enhanced roles and responsibilities in a hospital pharmacy department. The expansion of the pharmacy intern’s role can increase pharmacy department resources and provide a valuable platform for their development. Institutions should seek to maximize the opportunities for pharmacy interns to work at the peak of their licensure. J Am Pharm Assoc. 2015;55:198–202. doi: 10.1331/JAPhA.2015.14022
198 JAPhA | 5 5:2 | M AR/AP R 2 0 1 5
ja p h a.org
Journal of the American Pharmacists Association
intern distribution coordinator position
W
ith increasing demands on hospital pharmacies, the role of the pharmacy technician has greatly expanded over the past decade. The implementation of “tech-check-tech” [TCT] programs has allowed technicians to assume more responsibilities by providing them with the duty of verifying the accuracy of unit dose medication orders filled by fellow technicians.1–3 The number of states that have adopted this practice has dramatically grown since more data in the literature has highlighted the success of these programs.3 Many of the TCT programs have been studied, and the literature has consistently reported that these programs are beneficial, successful and sustainable, given accuracy rates of 99.8% in regards to filling medication orders correctly.1–3 By shifting this responsibility to the technicians, pharmacists have more time to focus their attention on making clinical interventions and providing patient-centered care with reduced interruptions regarding medication distribution issues.4
Objectives The purpose of this paper is to describe the implementation of a pharmacy intern distribution coordinator position in an academic medical center and its potential impact on the intern’s professional development.
Key Points Background: ❚❚ The role of the pharmacy technician has greatly expanded over the past decade with increasing demands on hospital pharmacies. ❚❚ Through implementation of “tech-check-tech” programs, technicians are able to assume more responsibilities and free up more time for pharmacists to make clinical interventions and provide patient-centered care with reduced interruptions regarding medication distribution issues. Findings: ❚❚ The pharmacy intern represents another resource in many day-to-day workflow situations. ❚❚ Through implementation of the pharmacy intern distribution coordinator position, interns have been able to assume enhanced responsibilities by overseeing the medication preparation process, checking process, and delivery preparation process, while working under the direct supervision of a licensed pharmacist. ❚❚ This position provides interns with a professional development opportunity through fostering leadership, communication, clinical skills, and professional growth by allowing interns to practice at the top of their licensure.
Journal of the American Pharmacists Association
EXPERIENCE
Background The Pharmacy Practice Model developed by the American Society of Health-System Pharmacists seeks to further the role of the pharmacy technician. This model is silent on the role of the pharmacy intern position, which represents another pool of resources in many day-today workflow situations.4 Traditionally, the role of the pharmacy intern in a hospital setting is very similar to the pharmacy technician in that the intern’s main responsibilities include preparing and distributing medications.5 Some institutions have recognized this and have implemented formal internship programs to expand the intern’s exposure to pharmacy beyond that of a technician.5,6 Depending on individual state laws, interns are granted more duties and responsibilities, given their status with the board of pharmacy. Under the Massachusetts Board of Registration in Pharmacy’s regulations, pharmacy interns are able to have expanded roles and responsibilities while acting under the direct supervision of a pharmacist.7,8 At Brigham and Women’s Hospital, a 793-bed teaching hospital located in Boston, the pharmacy department has addressed the issue of increasing workload demands of the pharmacist by increasing the role of the pharmacy intern within allowable limits. By doing so, the department is able to optimize its resources by allowing interns to practice at the top of their licensure. The department provides pharmacy interns with the opportunity to assume enhanced roles in the medication use process, which prepares them for their future careers. By adapting to the role of the pharmacist early in one’s career, pharmacy interns are provided with a valuable opportunity to grow professionally. By enhancing interns’ responsibilities, the position can foster the development of vital clinical, personal and professional skills, such as leadership, effective communication, time management and critical thinking.
Description of intern distribution coordinator position Currently, the state of Massachusetts does not allow TCT programs. A new position, pharmacy intern distribution coordinator, was created in 2009 to replace a position previously held by a licensed pharmacist. This position enables pharmacists on staff to practice at the top of their licensure and frees up additional pharmacy human resources to assume other staffing requirements. To date, 25 pharmacy interns—most of them in their first 3 professional years of pharmacy education—have been employed as the intern distribution coordinator. Pharmacy interns who are eligible to staff the position are either full- or part-time employees of the department. They must have a valid Massachusetts Pharmacy Intern License, must be currently enrolled in their first through fourth professional year, and must be in good academic standing with their respective college or institution. j apha.org
MAR /APR 2015 | 55:2 |
JAPhA 199
EXPERIENCE
intern distribution coordinator position
In addition to meeting these eligibility requirements, intern selection is based upon the candidate’s pharmacy work experience and demonstration of interpersonal communication skills in the workplace. Introductory Pharmacy Practice Experience (IPPE) and Advanced Pharmacy Practice Experience (APPE) students who are completing their rotations at the institution are not eligible to serve as the distribution coordinator. Interns undergo full-time training for 2 weeks (80 hours) with a full-time pharmacist in medication distribution, workflow of the pharmacy, information systems, communication process, and computerized prescriber order entry (CPOE) system. Once the intern has demonstrated competency to the training pharmacist in these areas of training, the intern takes the lead in the medication distribution process in the central pharmacy while remaining under the direct supervision of a pharmacist.
Distribution coordinator responsibilities The intern’s duties as the distribution coordinator include overseeing the medication preparation process, checking process, and delivery preparation process, while working under the direct supervision of a licensed pharmacist, who is always available for consult and reinforcement if needed by the intern. Throughout the entire medication distribution and administration process, bar code technology is used, as it decreases medication dispensing errors and potential adverse effects.9 All of these responsibilities, which mirror those of a licensed pharmacist in this position, require the intern to multitask and prioritize the work to become an effective leader and member of the pharmacy team. Similar to TCT programs, the main responsibility of the intern is to verify the accuracy of medication doses that have been filled by Certified Pharmacy Technicians or other pharmacy interns. Medication doses include new and continuation of existing orders for unit dose medications, bulk bottles, premade injectables, and oral syringes. During the preparation process, the intern must ensure timely filling of the medication doses by technicians and interns after the label has been generated. It is the intern’s responsibility to verify the correct patient name, medical record number, medication, strength, quantity and expiration date, during the checking process of each medication dose by comparing it to the original order in CPOE. In addition to these check points and depending on the specific medication, the intern must also ensure the medication has been placed in an appropriate bag with labels affixed to it. During the final preparation for delivery, the intern has to scan each medication dose to track it in the computer system as being sent from the central pharmacy. On average, the intern checks 300 medication doses for unit dose medications and bulk bottles during an 8-hour shift. Additionally, the intern checks approximately 100 medication doses for premade injectable medications 200 JAPhA | 5 5:2 | M AR/AP R 2 0 1 5
ja p h a.org
during this time. While overseeing the preparation, checking, and delivery preparation processes, the intern also has to ensure the timely delivery of the medications to the floors. Delivery technicians leave the central pharmacy every hour on the half hour during a day and evening shift to bring checked medication doses to the floors. It is the intern’s duty to multitask and prioritize the checking of medication doses to meet the delivery deadline, in addition to handling telephone calls from other health professionals and questions from fellow coworkers. The intern also directly communicates with or pages the technician if the technician is late for a delivery. By managing the delivery technicians and tracking the distribution of medications via the computer system, the intern controls the entire distribution process for medication doses. The intern takes the necessary steps to resolve any delay in patient care and maintain efficient workflow. The intern is aiding in delivering the five functions of the pharmacy, which include delivering the correct drug to the correct patient via the correct route for the correct reason at the correct time.10 The intern must also maintain open communication with the staffing pharmacists regarding distribution issues. If a medication needed to fill a medication dose is out of stock in the pharmacy, the intern takes the lead in solving the inventory issue. If the medication is not stocked in the hospital, the intern is responsible for communicating with the purchasing office to discover if it can be ordered or borrowed from another institution in the area. With the problem of medication shortages over the past several years, the intern must be aware of the short-supply medications and how the institution has responded. The intern communicates with pharmacists to make them aware of the delay in care or a need for a change in therapy. By identifying and handling inventory and distribution issues, the intern reduces interruptions in the staffing pharmacists’ workflow. Additionally, the intern can further develop his or her own clinical skills by answering drug information questions from various health professionals. Physicians, nurses, radiologists, surgeons, anesthesiologists, and many other health professionals call the pharmacy on a regular basis to ask a wide variety of questions about storage, stability, compatibility, and availability of specific medications. Instead of deferring the question to the pharmacist, the intern can use various online databases, such as Micromedex and Lexicomp, to research questions, verify potential responses with a supervising pharmacist, and provide answers in an accurate, efficient, and professional manner. The pharmacist under whom the intern is working is always available for further guidance in researching a drug information question if the intern is unable to find the correct information from a validated source. By taking on this task, the intern becomes comfortable with answering questions in a Journal of the American Pharmacists Association
intern distribution coordinator position
time-pressured situation as well as communicating with other health professionals.
Impact on professional and leadership development As previously described, the intern has an enhanced role and responsibilities compared to typical interns and technicians. By taking the lead in the preparation, checking, and delivery preparation processes, as well as answering drug information questions and triaging inventory issues, the intern actively participates in patient care by being an integral member of the pharmacy department. Through his or her role as the distribution coordinator, the intern can practice and refine important skills such as critical thinking, leadership, effective communication, time management, and professionalism. Interns are able to enhance their clinical skills by making interventions on a daily basis. There are numerous checkpoints in the checking process during which the intern has the opportunity to make an intervention, such as identifying an incorrect product or package selection by the pharmacist while processing an order. Through repeated repetition of the checking process, the intern can efficiently recognize when a medication dose has been incorrectly prepared and how to properly resolve the issue. The intern can foster a learning environment for himself or herself by identifying and questioning possible medication errors, as well as for the technician who may have inadvertently caused the error by picking the incorrect package during the medication preparation process. Leadership and effective communication skills can also be cultivated while staffing the intern distribution coordinator position. To be an effective leader, one needs to be flexible, organized, able to deal with difficult situations, and able to multitask.11 The intern can acquire these various leadership skills by becoming the manager of the distribution of medications. The position requires the intern to prioritize the checking of medication doses while triaging telephone calls and tracking the delivery of medication doses simultaneously. When the intern identifies or is confronted with an issue, he or she does not simply defer it to the pharmacist. The intern is expected to take the lead and resolve the issue on his or her own. If further collaboration is needed, the intern must communicate with fellow technicians or pharmacists. The intern can learn how to resolve an issue in a stressful situation, such as during a code, which is a daily occurrence in the life of a hospital pharmacist. Lastly, the intern is able to observe professionalism and learn from other staff pharmacists on a firsthand basis. Schools of pharmacy have sought to incorporate professionalism into the pharmacy curriculum; this professionalism cannot be gained from a lecture, a textbook, or a role-play exercise.12–14 Through this distribution coordinator position, professionalism can be acquired Journal of the American Pharmacists Association
EXPERIENCE
through workplace experiences in which interns work in real-life situations that require them to use their clinical skills while interacting with other health professionals. As stated in the American College of Clinical Pharmacy White Paper on Development of Student Professionalism, exposure to various role models is the most effective way to develop professionalism.15 Interns have the opportunity to work with more than 40 staff pharmacists while serving as the distribution coordinator. Through this experience, interns can observe how different pharmacists triage issues and interact with other health professionals on a daily basis. Pharmacists can further influence the interns by providing constructive feedback on the intern’s strengths and weaknesses and how to further improve as a future pharmacist.16 Interns can also learn other important professional qualities such as how to respect one’s peers and the importance of accountability and punctuality.17
Lessons learned and future directions Feedback from pharmacy staff and administrators has reinforced the importance of the distribution coordinator position to the department and to interns’ personal development. Interns in this role have self-reported and been observed to have improved leadership skills, communication skills, and overall professionalism. The majority of interns who have worked in the coordinator position have gone on to successfully complete pharmacy practice residencies or assume leadership roles in their places of employment. When reflecting on their time as the intern distribution coordinator, former interns have attributed much of their early success as a student and a pharmacist to experiences gained from the distribution coordinator position. Keys to success and sustainability of the position include quality training and methods of feedback. Future directions include enhanced electronic training on information systems and drug information resources. Surveying and acquiring feedback from pharmacists, technicians, and interns is needed to further gauge the impact of the position on the pharmacy medication distribution activities. Additionally, accuracy data are needed to further evaluate the impact and success of the program compared to TCT programs and pharmacists staffing the position.
Conclusion The distribution coordinator position provides pharmacy interns with professional development opportunities by assuming an enhanced role and responsibilities in a hospital setting. The experience can foster leadership, communication, clinical skills, and professional growth, which are valuable to young professionals in the pharmacy field as they progress through their education and become the future of the pharmacy profession. j apha.org
MAR /APR 2015 | 55:2 |
JAPhA 201
EXPERIENCE
intern distribution coordinator position
References 1. Reed M, Thomley S, Ludwig B, et al. Experience with a “techcheck-tech” program in an academic medical center. Am J Health Syst Pharm. 2011;68(19):1820–1823. 2. Ambrose PJ, Saya FG, Lovett LT, et al. Evaluating the accuracy of technicians and pharmacists in checking unit dose medication cassettes. Am J Health Syst Pharm. 2002;59(12):1183–1188. 3. Adams AJ, Martin SJ, Stolpe SF. “Tech-check-tech”: a review of the evidence on its safety and benefits. Am J Health Syst Pharm. 2011;68(19):1824–1833. 4. The consensus of the Pharmacy Practice Model Summit. Am J Health Syst Pharm. 2011;68(12):1148–1152. 5. Skledar SJ, Martinelli B, Wasicek K, et al. Training and recruiting future pharmacists through a hospital-based student internship program. Am J Health Syst Pharm. 2009;66(17):1560–1564. 6. Clark JS. Developing the future of pharmacy through healthsystem pharmacy internship programs. Am J Health Syst Pharm. 2007;64(9):952–954. 7. Massachusetts Department of Health and Human Services. Massachusetts Board of Pharmacy Rules and Regulations. 247 CMR 8 Pharmacy Interns and Technicians http://www. mass.gov/eohhs/docs/dph/quality/boards/pharmacy/alerts/ pha‐247‐cmr‐8.pdf Accessed February 3, 2015. 8. Massachusetts Department of Health and Human Services. Massachusetts Board of Pharmacy Rules and Regulations. 247
202 JAPhA | 5 5:2 | M AR/AP R 2 0 1 5
ja p h a.org
CMR 2 Definitions http://www.mass.gov/courts/docs/lawlib/230‐ 249cmr/247cmr2.pdf.pdf.AccessedFebruary3,2015. 9. Nanji KC, Cina J, Patel N, et al. Overcoming barriers to the implementation of a pharmacy bar code scanning system for medication dispensing: a case study. J Am Med Inform Assoc. 2009;16(5):645–650. 10. Keresztes JM.Role of pharmacy technicians in the development of clinicalpharmacy.AnnPharmacother.2006;40(11):2015–2019. 11. Zilz DA, Woodward BW, Thielke TS, et al. Leadership skills for a high-performance pharmacy practice. Am J Health Syst Pharm. 2004;61(23):2562–2574. 12. Jungnickel PW, Kelley KW, Hammer DP, et al. Addressing competencies for the future in the professional curriculum. Am J Pharm Educ. 2009;73(8):156. 13. Brehm B, Breen P, Brown B, et al. An interdisciplinary approach to introducing professionalism. Am J Pharm Educ. 2006;70(4):81. 14. Poirier TI, Gupchup GV. Assessment of pharmacy student professionalism across a curriculum. Am J Pharm Educ. 2010;74(4):62. 15. Roth MT, Zlatic TD. Development of student professionalism. Pharmacotherapy. 2009;29(6):749–756. 16. Hammer D. Improving student professionalism during experiential learning. Am J Pharm Educ. 2006;70(3):59. 17. Holt SL, Lau MS, Wong FL, et al. Tenets of professionalism for pharmacy students. Pharmacotherapy. 2009;29(6):757–759.
Journal of the American Pharmacists Association
Enhanced responsibilities for pharmacy interns at a teaching hospital Christine M. Gillis, Kevin E. Anger, and Michael C. Cotugno
Abstract Objective: To describe the implementation of a pharmacy intern distribution coordinator position and its impact on the intern’s professional development. Setting: Tertiary academic medical center. Practice description: In 2009, our institution implemented a pharmacy intern distribution coordinator position, which was previously staffed by a pharmacist. Interns, who are in their first through fourth professional year, take the lead in the medication distribution process while under the direct supervision of a pharmacist. The intern adjudicates the medication distribution process by ensuring proper processing, filling and timely delivery of the medications, as well as triaging inventory issues and maintaining open communication with the pharmacists about any medication issues. Additionally, the intern can make clinical interventions during the various checkpoints in the final verification process and answer drug information questions for fellow medical professionals. Practice innovation: Pharmacy intern resources and development are maximized via staffing in a medication distribution coordinator position previously staffed by a pharmacist. By adapting to the role of pharmacist early on in one’s career, pharmacy interns are provided with a valuable opportunity to grow professionally. The position can foster the development of pharmacotherapy knowledge, communication skills, leadership experience, time management, and critical thinking by allowing pharmacy interns to practice at the top of their licensure.
Christine M. Gillis, PharmD, PGY1 Pharmacy Resident, Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA Kevin E. Anger, PharmD, BCPS, Clinical Pharmacy Specialist, Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA Michael C. Cotugno, BSPharm, Director of Pharmacy Patient Care Services, Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA Correspondence: Christine M. Gillis, Brigham and Women’s Hospital, Department of Pharmacy, Pharmacy Administration: Lower Level-2, 75 Francis Street, Boston, MA 02115; [email protected] Disclosure: The authors declare no relevant conflicts of interest or financial relationships. Received February 4, 2014. Accepted for publication August 11, 2014. Published online in advance of print February 20, 2015.
Conclusion: Our pharmacy intern distribution coordinator position provides interns with a professional development opportunity by assuming enhanced roles and responsibilities in a hospital pharmacy department. The expansion of the pharmacy intern’s role can increase pharmacy department resources and provide a valuable platform for their development. Institutions should seek to maximize the opportunities for pharmacy interns to work at the peak of their licensure. J Am Pharm Assoc. 2015;55:198–202. doi: 10.1331/JAPhA.2015.14022
198 JAPhA | 5 5:2 | M AR/AP R 2 0 1 5
ja p h a.org
Journal of the American Pharmacists Association
intern distribution coordinator position
W
ith increasing demands on hospital pharmacies, the role of the pharmacy technician has greatly expanded over the past decade. The implementation of “tech-check-tech” [TCT] programs has allowed technicians to assume more responsibilities by providing them with the duty of verifying the accuracy of unit dose medication orders filled by fellow technicians.1–3 The number of states that have adopted this practice has dramatically grown since more data in the literature has highlighted the success of these programs.3 Many of the TCT programs have been studied, and the literature has consistently reported that these programs are beneficial, successful and sustainable, given accuracy rates of 99.8% in regards to filling medication orders correctly.1–3 By shifting this responsibility to the technicians, pharmacists have more time to focus their attention on making clinical interventions and providing patient-centered care with reduced interruptions regarding medication distribution issues.4
Objectives The purpose of this paper is to describe the implementation of a pharmacy intern distribution coordinator position in an academic medical center and its potential impact on the intern’s professional development.
Key Points Background: ❚❚ The role of the pharmacy technician has greatly expanded over the past decade with increasing demands on hospital pharmacies. ❚❚ Through implementation of “tech-check-tech” programs, technicians are able to assume more responsibilities and free up more time for pharmacists to make clinical interventions and provide patient-centered care with reduced interruptions regarding medication distribution issues. Findings: ❚❚ The pharmacy intern represents another resource in many day-to-day workflow situations. ❚❚ Through implementation of the pharmacy intern distribution coordinator position, interns have been able to assume enhanced responsibilities by overseeing the medication preparation process, checking process, and delivery preparation process, while working under the direct supervision of a licensed pharmacist. ❚❚ This position provides interns with a professional development opportunity through fostering leadership, communication, clinical skills, and professional growth by allowing interns to practice at the top of their licensure.
Journal of the American Pharmacists Association
EXPERIENCE
Background The Pharmacy Practice Model developed by the American Society of Health-System Pharmacists seeks to further the role of the pharmacy technician. This model is silent on the role of the pharmacy intern position, which represents another pool of resources in many day-today workflow situations.4 Traditionally, the role of the pharmacy intern in a hospital setting is very similar to the pharmacy technician in that the intern’s main responsibilities include preparing and distributing medications.5 Some institutions have recognized this and have implemented formal internship programs to expand the intern’s exposure to pharmacy beyond that of a technician.5,6 Depending on individual state laws, interns are granted more duties and responsibilities, given their status with the board of pharmacy. Under the Massachusetts Board of Registration in Pharmacy’s regulations, pharmacy interns are able to have expanded roles and responsibilities while acting under the direct supervision of a pharmacist.7,8 At Brigham and Women’s Hospital, a 793-bed teaching hospital located in Boston, the pharmacy department has addressed the issue of increasing workload demands of the pharmacist by increasing the role of the pharmacy intern within allowable limits. By doing so, the department is able to optimize its resources by allowing interns to practice at the top of their licensure. The department provides pharmacy interns with the opportunity to assume enhanced roles in the medication use process, which prepares them for their future careers. By adapting to the role of the pharmacist early in one’s career, pharmacy interns are provided with a valuable opportunity to grow professionally. By enhancing interns’ responsibilities, the position can foster the development of vital clinical, personal and professional skills, such as leadership, effective communication, time management and critical thinking.
Description of intern distribution coordinator position Currently, the state of Massachusetts does not allow TCT programs. A new position, pharmacy intern distribution coordinator, was created in 2009 to replace a position previously held by a licensed pharmacist. This position enables pharmacists on staff to practice at the top of their licensure and frees up additional pharmacy human resources to assume other staffing requirements. To date, 25 pharmacy interns—most of them in their first 3 professional years of pharmacy education—have been employed as the intern distribution coordinator. Pharmacy interns who are eligible to staff the position are either full- or part-time employees of the department. They must have a valid Massachusetts Pharmacy Intern License, must be currently enrolled in their first through fourth professional year, and must be in good academic standing with their respective college or institution. j apha.org
MAR /APR 2015 | 55:2 |
JAPhA 199
EXPERIENCE
intern distribution coordinator position
In addition to meeting these eligibility requirements, intern selection is based upon the candidate’s pharmacy work experience and demonstration of interpersonal communication skills in the workplace. Introductory Pharmacy Practice Experience (IPPE) and Advanced Pharmacy Practice Experience (APPE) students who are completing their rotations at the institution are not eligible to serve as the distribution coordinator. Interns undergo full-time training for 2 weeks (80 hours) with a full-time pharmacist in medication distribution, workflow of the pharmacy, information systems, communication process, and computerized prescriber order entry (CPOE) system. Once the intern has demonstrated competency to the training pharmacist in these areas of training, the intern takes the lead in the medication distribution process in the central pharmacy while remaining under the direct supervision of a pharmacist.
Distribution coordinator responsibilities The intern’s duties as the distribution coordinator include overseeing the medication preparation process, checking process, and delivery preparation process, while working under the direct supervision of a licensed pharmacist, who is always available for consult and reinforcement if needed by the intern. Throughout the entire medication distribution and administration process, bar code technology is used, as it decreases medication dispensing errors and potential adverse effects.9 All of these responsibilities, which mirror those of a licensed pharmacist in this position, require the intern to multitask and prioritize the work to become an effective leader and member of the pharmacy team. Similar to TCT programs, the main responsibility of the intern is to verify the accuracy of medication doses that have been filled by Certified Pharmacy Technicians or other pharmacy interns. Medication doses include new and continuation of existing orders for unit dose medications, bulk bottles, premade injectables, and oral syringes. During the preparation process, the intern must ensure timely filling of the medication doses by technicians and interns after the label has been generated. It is the intern’s responsibility to verify the correct patient name, medical record number, medication, strength, quantity and expiration date, during the checking process of each medication dose by comparing it to the original order in CPOE. In addition to these check points and depending on the specific medication, the intern must also ensure the medication has been placed in an appropriate bag with labels affixed to it. During the final preparation for delivery, the intern has to scan each medication dose to track it in the computer system as being sent from the central pharmacy. On average, the intern checks 300 medication doses for unit dose medications and bulk bottles during an 8-hour shift. Additionally, the intern checks approximately 100 medication doses for premade injectable medications 200 JAPhA | 5 5:2 | M AR/AP R 2 0 1 5
ja p h a.org
during this time. While overseeing the preparation, checking, and delivery preparation processes, the intern also has to ensure the timely delivery of the medications to the floors. Delivery technicians leave the central pharmacy every hour on the half hour during a day and evening shift to bring checked medication doses to the floors. It is the intern’s duty to multitask and prioritize the checking of medication doses to meet the delivery deadline, in addition to handling telephone calls from other health professionals and questions from fellow coworkers. The intern also directly communicates with or pages the technician if the technician is late for a delivery. By managing the delivery technicians and tracking the distribution of medications via the computer system, the intern controls the entire distribution process for medication doses. The intern takes the necessary steps to resolve any delay in patient care and maintain efficient workflow. The intern is aiding in delivering the five functions of the pharmacy, which include delivering the correct drug to the correct patient via the correct route for the correct reason at the correct time.10 The intern must also maintain open communication with the staffing pharmacists regarding distribution issues. If a medication needed to fill a medication dose is out of stock in the pharmacy, the intern takes the lead in solving the inventory issue. If the medication is not stocked in the hospital, the intern is responsible for communicating with the purchasing office to discover if it can be ordered or borrowed from another institution in the area. With the problem of medication shortages over the past several years, the intern must be aware of the short-supply medications and how the institution has responded. The intern communicates with pharmacists to make them aware of the delay in care or a need for a change in therapy. By identifying and handling inventory and distribution issues, the intern reduces interruptions in the staffing pharmacists’ workflow. Additionally, the intern can further develop his or her own clinical skills by answering drug information questions from various health professionals. Physicians, nurses, radiologists, surgeons, anesthesiologists, and many other health professionals call the pharmacy on a regular basis to ask a wide variety of questions about storage, stability, compatibility, and availability of specific medications. Instead of deferring the question to the pharmacist, the intern can use various online databases, such as Micromedex and Lexicomp, to research questions, verify potential responses with a supervising pharmacist, and provide answers in an accurate, efficient, and professional manner. The pharmacist under whom the intern is working is always available for further guidance in researching a drug information question if the intern is unable to find the correct information from a validated source. By taking on this task, the intern becomes comfortable with answering questions in a Journal of the American Pharmacists Association
intern distribution coordinator position
time-pressured situation as well as communicating with other health professionals.
Impact on professional and leadership development As previously described, the intern has an enhanced role and responsibilities compared to typical interns and technicians. By taking the lead in the preparation, checking, and delivery preparation processes, as well as answering drug information questions and triaging inventory issues, the intern actively participates in patient care by being an integral member of the pharmacy department. Through his or her role as the distribution coordinator, the intern can practice and refine important skills such as critical thinking, leadership, effective communication, time management, and professionalism. Interns are able to enhance their clinical skills by making interventions on a daily basis. There are numerous checkpoints in the checking process during which the intern has the opportunity to make an intervention, such as identifying an incorrect product or package selection by the pharmacist while processing an order. Through repeated repetition of the checking process, the intern can efficiently recognize when a medication dose has been incorrectly prepared and how to properly resolve the issue. The intern can foster a learning environment for himself or herself by identifying and questioning possible medication errors, as well as for the technician who may have inadvertently caused the error by picking the incorrect package during the medication preparation process. Leadership and effective communication skills can also be cultivated while staffing the intern distribution coordinator position. To be an effective leader, one needs to be flexible, organized, able to deal with difficult situations, and able to multitask.11 The intern can acquire these various leadership skills by becoming the manager of the distribution of medications. The position requires the intern to prioritize the checking of medication doses while triaging telephone calls and tracking the delivery of medication doses simultaneously. When the intern identifies or is confronted with an issue, he or she does not simply defer it to the pharmacist. The intern is expected to take the lead and resolve the issue on his or her own. If further collaboration is needed, the intern must communicate with fellow technicians or pharmacists. The intern can learn how to resolve an issue in a stressful situation, such as during a code, which is a daily occurrence in the life of a hospital pharmacist. Lastly, the intern is able to observe professionalism and learn from other staff pharmacists on a firsthand basis. Schools of pharmacy have sought to incorporate professionalism into the pharmacy curriculum; this professionalism cannot be gained from a lecture, a textbook, or a role-play exercise.12–14 Through this distribution coordinator position, professionalism can be acquired Journal of the American Pharmacists Association
EXPERIENCE
through workplace experiences in which interns work in real-life situations that require them to use their clinical skills while interacting with other health professionals. As stated in the American College of Clinical Pharmacy White Paper on Development of Student Professionalism, exposure to various role models is the most effective way to develop professionalism.15 Interns have the opportunity to work with more than 40 staff pharmacists while serving as the distribution coordinator. Through this experience, interns can observe how different pharmacists triage issues and interact with other health professionals on a daily basis. Pharmacists can further influence the interns by providing constructive feedback on the intern’s strengths and weaknesses and how to further improve as a future pharmacist.16 Interns can also learn other important professional qualities such as how to respect one’s peers and the importance of accountability and punctuality.17
Lessons learned and future directions Feedback from pharmacy staff and administrators has reinforced the importance of the distribution coordinator position to the department and to interns’ personal development. Interns in this role have self-reported and been observed to have improved leadership skills, communication skills, and overall professionalism. The majority of interns who have worked in the coordinator position have gone on to successfully complete pharmacy practice residencies or assume leadership roles in their places of employment. When reflecting on their time as the intern distribution coordinator, former interns have attributed much of their early success as a student and a pharmacist to experiences gained from the distribution coordinator position. Keys to success and sustainability of the position include quality training and methods of feedback. Future directions include enhanced electronic training on information systems and drug information resources. Surveying and acquiring feedback from pharmacists, technicians, and interns is needed to further gauge the impact of the position on the pharmacy medication distribution activities. Additionally, accuracy data are needed to further evaluate the impact and success of the program compared to TCT programs and pharmacists staffing the position.
Conclusion The distribution coordinator position provides pharmacy interns with professional development opportunities by assuming an enhanced role and responsibilities in a hospital setting. The experience can foster leadership, communication, clinical skills, and professional growth, which are valuable to young professionals in the pharmacy field as they progress through their education and become the future of the pharmacy profession. j apha.org
MAR /APR 2015 | 55:2 |
JAPhA 201
EXPERIENCE
intern distribution coordinator position
References 1. Reed M, Thomley S, Ludwig B, et al. Experience with a “techcheck-tech” program in an academic medical center. Am J Health Syst Pharm. 2011;68(19):1820–1823. 2. Ambrose PJ, Saya FG, Lovett LT, et al. Evaluating the accuracy of technicians and pharmacists in checking unit dose medication cassettes. Am J Health Syst Pharm. 2002;59(12):1183–1188. 3. Adams AJ, Martin SJ, Stolpe SF. “Tech-check-tech”: a review of the evidence on its safety and benefits. Am J Health Syst Pharm. 2011;68(19):1824–1833. 4. The consensus of the Pharmacy Practice Model Summit. Am J Health Syst Pharm. 2011;68(12):1148–1152. 5. Skledar SJ, Martinelli B, Wasicek K, et al. Training and recruiting future pharmacists through a hospital-based student internship program. Am J Health Syst Pharm. 2009;66(17):1560–1564. 6. Clark JS. Developing the future of pharmacy through healthsystem pharmacy internship programs. Am J Health Syst Pharm. 2007;64(9):952–954. 7. Massachusetts Department of Health and Human Services. Massachusetts Board of Pharmacy Rules and Regulations. 247 CMR 8 Pharmacy Interns and Technicians http://www. mass.gov/eohhs/docs/dph/quality/boards/pharmacy/alerts/ pha‐247‐cmr‐8.pdf Accessed February 3, 2015. 8. Massachusetts Department of Health and Human Services. Massachusetts Board of Pharmacy Rules and Regulations. 247
202 JAPhA | 5 5:2 | M AR/AP R 2 0 1 5
ja p h a.org
CMR 2 Definitions http://www.mass.gov/courts/docs/lawlib/230‐ 249cmr/247cmr2.pdf.pdf.AccessedFebruary3,2015. 9. Nanji KC, Cina J, Patel N, et al. Overcoming barriers to the implementation of a pharmacy bar code scanning system for medication dispensing: a case study. J Am Med Inform Assoc. 2009;16(5):645–650. 10. Keresztes JM.Role of pharmacy technicians in the development of clinicalpharmacy.AnnPharmacother.2006;40(11):2015–2019. 11. Zilz DA, Woodward BW, Thielke TS, et al. Leadership skills for a high-performance pharmacy practice. Am J Health Syst Pharm. 2004;61(23):2562–2574. 12. Jungnickel PW, Kelley KW, Hammer DP, et al. Addressing competencies for the future in the professional curriculum. Am J Pharm Educ. 2009;73(8):156. 13. Brehm B, Breen P, Brown B, et al. An interdisciplinary approach to introducing professionalism. Am J Pharm Educ. 2006;70(4):81. 14. Poirier TI, Gupchup GV. Assessment of pharmacy student professionalism across a curriculum. Am J Pharm Educ. 2010;74(4):62. 15. Roth MT, Zlatic TD. Development of student professionalism. Pharmacotherapy. 2009;29(6):749–756. 16. Hammer D. Improving student professionalism during experiential learning. Am J Pharm Educ. 2006;70(3):59. 17. Holt SL, Lau MS, Wong FL, et al. Tenets of professionalism for pharmacy students. Pharmacotherapy. 2009;29(6):757–759.
Journal of the American Pharmacists Association
