Students attended the Clinical Pharmacy Course (CPC) at The U.S. Army Medical Department Center and School, Fort San Houston, Texas the third week of March 2018. CPC is the only short course dedicated to Clinical Pharmacy Practice. This course is agenda-driven based upon current DoD and Army Clinical Pharmacy practice as established by the U.S. Army Pharmacy Consultant. This course focuses on closing competency gaps by developing critical skills and attributes required to perform as a Clinical Pharmacists or Clinical Pharmacy Technicians. Additionally, this course encourages pharmacy personnel to occupy greater roles in patient's healthcare, which has been shown to decrease overall medication cost to the organization.
The CPC focuses on the Pharmacist-Patient role in the Medical Home, Warrior Transition, Pain Management, Deployment Medicine, and other Specialty Clinics. Students will gain understanding of appointment coding, RVU's, schedule management, AHLTA Pharmacy Note; Interventions, Specialty Pharmacy, e-Profiles, IT Clinical Systems, MODS, Clinical Reports, conversions to formulary medication, and Opioid Reduction Strategies.
Pharmacists and technicians attending the CPC develop confidence, acquire knowledge and obtain a skillset to practice at the edge of their licensure. More than five years ago, most of these practices were not even discussed in the pharmacy communities, but are now being practiced widely throughout the Army. CPC is the initial thrust that some Clinical Pharmacist and Clinical Pharmacy Technicians require to step out of their comfort zone and explore new possibilities to improve patient's wellbeing.
This course is an initiative by the Pharmacy Consultant to The Surgeon General and was originally organized in February of 2016 by Dr. Jennifer Evans with the help from LTC Leslie Walthall. It is now a semi-annual course that trained 147 civilian, and military members from Army, Navy, Air Force and VA. Due to the increasing interest in this course, another iteration was added this year and was conducted this past March. The objective of this course is to standardize and improve the practice of Ambulatory Clinical Pharmacy by both Clinical Pharmacists and Clinical Pharmacy Technicians. Over the last six iterations, this course has undertaken dramatic changes incorporating topics such as Battlefield Acupuncture, Physical Exam and computer training on various software such as AsUType while also peaking the interests of our sister services who have now become regular attendees.
The newest, and by far the most interesting topic in CPC, is the Battlefield Acupuncture. This technique was developed in 2001 by Dr. Richard Niemtzow and is managed by the US Air Force Acupuncture Center. This class focuses on a protocol-based acupuncture of five points on each ear to relieve or reduce minor to significant pain. Open label studies shown a response rate of over 80%, but while in clinic physicians report seeing a response rate of greater than 95%. If a patient responds appropriately, this practice can help reduce the use of opioids and/or NSAIDs improving overall wellbeing of the patient. Although due to limited evidence this may still be a placebo effect, it is extremely safe for all non-pregnant immunocompetent adults and as long as the patient is whiling to try, it serves as a great tool for our Clinical Pharmacists.
Clinical Pharmacists are often consulted regarding patients that suffer from variety of medical conditions that are treated by multiple medications. Hypertension, hyperlipidemia and diabetes are very common medical conditions that are closely interrelated and should be evaluated at every visit. One exam that is often overlooked when seeing diabetic patients is the foot exam. In diabetes, patient's feet may lose sensation and therefore become damaged and/or infected without their awareness. A diabetic foot exam is not routinely conducted by primary care providers but serves as a key determining factor for a patient's wellbeing and future mobility. Clinical Pharmacists that are routinely conducting these exams developed and taught a class during the CPC regarding these issues.
The physical exam that is performed by Clinical Pharmacists is not the typical exam where someone slaps a blood pressure cuff on your arm, a thermometer in your mouth while asking you a series of questions about smoking and drinking as the blood pressure machine is conducting its assessment. In this course, pharmacists are taught proper methods for taking blood pressure in standard and non-standard patients such as obese, amputees, and others; conduct a diabetic foot exam using a monofilament, tuning fork and a reflex hammer; and a series of questions to ask patients that help avoid missing pertinent health information. Pharmacists that step into these rolls are able to recognize if the diabetic patient's feet have signs of undiagnosed damage and refer them to a specialist before their condition becomes worse and/or irreversible.
Although AsUType software has been available in most DoD hospitals, it is not utilized by majority of users to its maximum potential. This software allows the user to type short user-defined codes in any word processor such as MS Word, AHLTA notes, or Notepad that are then auto translated into user friendly text. Additionally, this program allows users to program decision trees that with further input help build their clinical note. During the CPC, users receive a robust class on AsUType which assists both technicians and pharmacists in quickly documenting patient encounters allowing for greater time spent with the patient.
A newer and a less recognizable position in the practice of Clinical Pharmacy is the Clinical Pharmacy Technician. People holding these positions are often overlooked and undertrained, but are always expected to perform at the highest standards for Pharmacy Technicians. CPC is the only Army course that recognizes the Clinical Pharmacy Technician's role in the success of Clinical Pharmacy and attempts to grow this field by incorporating technician instructors and building separate tracks relevant to the Clinical Pharmacy Technician practice. For majority of the course Clinical Pharmacy Technicians are incorporated with the Clinical Pharmacists but a few classes are separated into tracks that allow instructors to discuss more pertinent topics to their field. For technicians these topics include methods for gathering data that help identify at-risk patients, communicating with patients, scheduling appointments, and performing in-depth medication reconciliation prior to patient's visit with the Clinical Pharmacist. CPC recognizes efforts by our Clinical Pharmacy Technicians as a force multiplier that allows the Clinical Pharmacist to increase number of patients seen while spending more time with each patient.
The CPC is taught on a military installation utilizing DoD Instructors without a registration cost. Additionally, each student may receive up to 34 hours of Accreditation Council of Pharmacy Education (ACPE) Continuing Pharmacy Education (CPE) credits required to maintain licensure.
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