Building a Hospital
Internship Program
Approved by
The Minnesota Society of Health System Pharmacists
Last Updated 2/23/09
Table of Contents
Introduction……………………………………………….…page 2
Intern Capabilities………………………………………...…page 3
Preceptor Requirements………………………………..……page 6
Creating a Budget……………………………………………page 7
Recruitment……………………………………………….…page 8
Progression & Evaluation……..……………………………..page 9
Appendix: Sample Position Description...………………....page 10
References…………………..……………….…………..…page 13
Introduction
Why is it important to develop an internship program?
Hospital pharmacy internship programs have the potential to benefit the student and the institution. From the student’s perspective, many are interested in participating in hospital internships that allow them to utilize and expand upon the knowledge they have learned in the classroom.1 Students also look to learn new clinical and practical skills that are not covered in the classroom.2 Finally, students have opportunities to meet and network with others practicing in health-system pharmacy.
Developing a challenging and practical hospital internship program also benefits an institution. First, it allows an institution to help develop future practitioners1. Guiding students through an internship program helps them grasp concepts early on and better prepares them to work as pharmacists. Second, interns can help advance pharmacy services. 1 This may be particularly advantageous when trying to meet the American Society of Health-System Pharmacist’s (ASHP) 2015 Initiatives or Best Practices and The Joint Commission’s National Patient Safety Goals. Interns can either directly develop new services or interns can help indirectly by filling some of the pharmacists’ roles while the pharmacists work on developing new services. Third, although students are traditionally thought to learn from pharmacists, students can also share new information they have learned in the classroom with pharmacists.1 This mutual learning may benefit the institution. Lastly, strong internship programs allow institutions to develop students’ interest in hospital pharmacy, leading to improved recruitment and retention.1
How can I develop a strong hospital internship program?
MSHP recognizes the need for information that outlines an appropriate internship program. Rather than providing a research paper, our intent is to provide practical tools to assist you in developing an internship program. While no two programs are exactly alike, certain elements should be in place to suit the needs of the institution and intern. This document is designed to highlight key areas to address. In addition to this document, it may be beneficial to contact other program directors to answer any additional questions you may have.
Intern Capabilities
As the Minnesota Board of Pharmacy (MN BOP) dictates, pharmacy students become interns after completion of the first academic year. However, students can be hired before they officially become interns. Students currently in their first year of pharmacy school can be trained in all aspects of technician duties or basic hospital operations. Table 1 describes learning objectives in these areas.
Table 1: Basic Pharmacy Operations3,4,5
o Understand processes and elements of medication dispensing systems (including automation)o Understand use of medical records
o Fill medication orders in scheduled batches and first fill area
o Pre-package and label medications
o Dispose of waste in compliance with applicable regulations
o Compound extemporaneous products
o Demonstrate proper aseptic technique
o Compound intravenous sterile products (including TPNs)
o Restock medication trays and kits
o Triage phone calls
o Understand proper handling of controlled substances
o Understand assignment of expiration dating
o Check work performed by technicians (Tech-Check-Tech)
o Attend regular intern meetings
Upon becoming interns, students can perform any duties performed by a pharmacist under the supervision of their preceptor. Supervision, as defined by the MN BOP Rule 6800.5100 Subp. 8, “means that in the pharmacy where the intern is being trained, a registered pharmacist designated as preceptor or another registered pharmacist shall be in continuous personal contact with and actually giving instructions to the intern during all professional activities of the entire period of the intern's internship.” Although technicians also require pharmacist supervision, MN BOP Rules allow interns to perform activities that go above and beyond that of a technician (to see a complete list of MN BOP Rules surrounding internships, please see their website at: http://www.phcybrd.state.mn.us/). Table 2 provides examples of some advanced activities that interns have performed at various institutions across the country.
Table 2: Advanced Intern Activities3,4,5
o Perform medication reconciliation/inpatient medication admission historieso Enter and review medication orders
o Retrieve and interpret lab values
o Engage in multidisciplinary actions (such as patient care rounds)
o Provide discharge counseling/reconciliation and prepare medication discharge lists
o Answer drug information requests made by other health care professionals
o Perform TPN order entry and verification
o Identify candidates for possible IV to PO conversion
o Review patient charts for possible adverse drug reactions
o Monitor patient therapy according to the scope of practice within the institution (electrolytes, TPNs, anticoagulation, renal dose adjustments, etc)
o Screen patients for eligibility for influenza and pneumococcal immunizations
o Assist pharmacist in codes after taking the ACLS competencies
o Shadow pharmacists in areas of interest
o Present patient cases
The anticoagulation service at St. Mary’s Medical Center in Duluth, Minnesota is one example of an advanced service to which pharmacy interns can contribute. On weekends, the intern first meets with the clinical pharmacist. Based on the intern’s experience level and the projected workload for the day, the duties are divided between the intern and the pharmacist. Anticoagulation activities performed by the intern may include: assuring the last dose was given, interpreting labs (including INR, platelets, hemoglobin), evaluating for signs/symptoms of bleeding or clotting, monitoring for changes in diet, and checking for drug interactions. For new patients, the intern may be responsible for the entire preliminary workup of the patient including reviewing the patient’s chart and history and interpreting anticoagulation goals and indications. Interns will present their findings to the pharmacist and work with him/her to determine an appropriate anticoagulation dose. Upon discharge, interns provide anticoagulation counseling and help determine where the patient will receive INR monitoring.
Although it may not seem intuitive, many institutions already partake in a variety of activities in which intern participation can be extended. Table 3 lists some of these activities.
Table 3: Activities Extended to Interns3,4,5
o Perform a DUE/DURo Give a presentation (to pharmacists for CE credit, to pharmacy staff as general education)
o Perform quality assurance initiatives
o Create drug information charts/cards
o Participate in journal club and case reviews
o Develop and implement guidelines, protocols, policies, or procedures
o Participate in formulary or P & T committee meetings
The application of the activities listed in the tables above will vary across institutions. The Appendix provides a sample intern position description from the University of Minnesota Medical Center, Fairview.
Preceptor Requirements
The MN BOP has several rules surrounding the requirement for obtaining and maintaining a preceptor certificate (Rule 6800.5350). Table 4 highlights the requirements that pharmacists must fulfill.
Table 4: Preceptor Requirements
o Obtain and renew certification every two yearso Participate in an instructional program specifically for preceptors, provided by or approved by the MN BOP, within the previous 24 months
o Participate in the college-based externship program of the University of Minnesota, College of Pharmacy as an approved preceptor or complete at least 4,000 hours of pharmacy practice after licensure, with at least 2,000 hours of that pharmacy practice after licensure as a pharmacist in Minnesota
o Practice at least 20 hours per week as a pharmacist
o Have a history of exemplary practice with respect to compliance with state and federal laws
o Assist the intern in fulfilling the competencies of the internship requirement
ASHP provides additional information on how to be an effective teacher and preceptor, training students to become competent pharmacists. To read more about this topic, please visit ASHP’s Preceptor Information Web site at http://www.ashp.org/Import/MEMBERCENTER/NewPractitionersForum/DevelopmentalResources/PreceptorInfo.aspx.
Creating a Budget
With increasing healthcare-related costs and target margins, it can be difficult to create new positions or expand current ones. The following are two possible ways to approach creating a budget for interns. First, one can split technician or pharmacist shifts in order to create intern positions. For example, a pharmacist wants change from a 0.8 FTE to a 0.6 FTE. It can be difficult to find a casual pharmacist to fill the remaining 0.2 FTE. In order to alleviate this problem, one can hire an intern as a 0.2 FTE to supplement the role of the pharmacist.
Another solution would be to lobby with upper management for intern positions. One can present a case for labor cost savings, recruitment savings, and retention upon graduation.
An unpublished time study was conducted at Abbott Northwestern Hospital in Minneapolis, Minnesota in 2008. During the study, pharmacy interns recorded the types of activities they performed and the amount of time they spent doing each activity. The amount of time interns spent on particular activities was compared to the cost associated with pharmacists or technicians performing the same activities. This study showed that interns are cost-effective, flexible additions to the pharmacy and healthcare team.
Recruitment
Recruiting interns to your program can be tricky and time consuming. The key is to use more than one communication method and to use communication lines that students utilize. Table 5 lists several options for drawing attention to open intern positions.
Table 5: Recruitment Techniques3
o Send a letter to the students utilizing a pharmacy school’s student serviceso Post open positions online
o Advertise at an MSHP meeting
o Participate in mentor programs
o Post or email announcements at a pharmacy school (with permission from student services)
o Attend student organization meetings
o Utilize student organization websites
(eg., http://www5.pharmacy.umn.edu/mpsa/index_files/internresid.htm)
Progression & Evaluation
Transitioning interns as they progress through pharmacy school can be a difficult task. It is important to recognize that as interns progress through school, their skill level progresses along with their knowledge base. Interns look to utilize work experience to gain clinical experience and refine their skills. Institutions are also constantly looking for ways to improve care and minimize costs. The combination of student eagerness and a need to improve care can be beneficial for an intern and an institution.
Intern expectations can be increased gradually as they progress through school. For example, interns can start out performing basic technical operations and progress to clinical activities. The clinical activities can be tailored to an institution’s needs.
One may evaluate an intern’s performance as you would an Advanced Pharmacy Practice Experience (APPE) student. A list of objectives an APPE student must complete at the University of Minnesota, College of Pharmacy can be found at: http://www.pharmacy.umn.edu/pharmd/prod/groups/cop/@pub/@cop/@pharmd/documents/asset/cop_61323.pdf.
Appendix:
Sample Position Description
Pharmacist Development Program Summary
University of Minnesota Medical Center, Fairview
What is Fairview?
Fairview is one of the largest not-for-profit health care systems in Minnesota, consisting of seven hospitals and multiple clinics. The University of Minnesota Medical Center, Fairview and University of Minnesota Children’s Hospital, Fairview are part of the Fairview health-system and includes both the Riverside and University campuses which are separated by the Mississippi River. The University of Minnesota Medical Center, Fairview and University of Minnesota Children’s Hospital, Fairview is a multidisciplinary teaching hospital with expertise in several areas including organ transplant, blood and bone marrow transplant, behavioral sciences, cardiology, neurosciences, oncology, and pediatrics.
What is the Pharmacist Development Program’s objective and design?
The objective of the program is to provide pharmacy students the opportunity to work at a large academic medical center, learning the operations of a hospital pharmacy and building clinical knowledge.
Each year of the program correlates with the year of pharmacy school that the student is enrolled. The first year will be dedicated to learning the operations of the hospital pharmacy working as a pharmacy technician. As the student progresses through school, they will become more involved with patient care by directly assisting pharmacists with clinical responsibilities on the patient care units. An assigned mentor and the inpatient supervisor will be responsible for evaluating the students’ progress.
What are the Student/Intern Requirements?
1. Be currently enrolled in a four-year Doctor of Pharmacy Program and in good academic standing
2. Maintain updated pharmacy internship status with the Minnesota Board of Pharmacy after completion of the first year of pharmacy school coursework
3. Be able to work every other weekend
4. Attend monthly workshops to enhance clinical pharmacist skills
5. Attend monthly mentor/preceptor meetings to discuss school and program progress
What are the goals of the program and what will I be doing each year?
First Year
Goal: To work as an accurate and efficient technician, with a good understanding of the inpatient pharmacy distribution system.
· Central responsibilities
o Dispense first fill medications with appropriate labeling
o Prepare unit dose prepackaging and labeling per legal requirements
o Prepare oral syringes
o Understand proper handling of controlled substances
o Refill and update code trays
· Sterile products area responsibilities
o Perform proper laminar airflow hood cleaning
o Prepare sterile products using aseptic technique
o Perform and apply general pharmaceutical calculations
· Decentral responsibilities
o Understand the principles of medication charges and credits
o Refill the Pyxis machine and maintain necessary quality assurance checks
o Deliver medications to patient floors
o Assist in relocating missing medications
o Understand the use of a Medication Administration Record (MAR) and be able to find appropriate information in a patient’s chart
Second Year:
Goal: To work as a decentral technician, while applying new pharmacotherapy skills in the clinical setting.
· Central responsibilities
o Certification in tech-check-tech (TCT)
· Additional decentral responsibilities (built upon 1st year)
o Understand UMMC, F policies and procedures
o Medication order entry
o Renal dosing
o Monitor electrolyte replacement therapy