MyDispense offers a number of different exercises to simulate community pharmacy practice.  If a pharmacy student works as a technician, they often gain valuable hands-on experience with both OTC counseling and dispensing.   However, one area in which all students lack experience with is verifying prescriptions.  Reviewing a prescription and a patient’s profile is often reserved for the pharmacist on duty and student technicians do not get the opportunity to practice this skill in busy community pharmacy settings. 

I have found that validation exercises in MyDispense are a perfect educational tool to teach and assess the students’ ability to verify prescriptions.  In the validation exercises, you can create an unlimited number of prescriptions and pharmacy profiles that the student needs to review and determine if the prescription can be dispensed as written.  In a validation exercise the student is able to view the prescription (Figure 1), the patient profile (Figure 2) and then determine if the prescription can be dispensed. 

Figure 1 – Example Prescription
Figure 2 – Example Patient Profile

The prescriptions can be designed with a number of different errors depending on the information that is being covered in class.  For example, errors such as dispensing limits for controlled-substances could be developed or identification of a potential drug interaction as shown in figure 1 and 2.  Once the student reviews the prescription, they must select whether they would dispense or not dispense the prescription.  I instruct students if there are no issues at all to select “dispense.”  When students select “do not dispense” it prompts them to select the concerns they have identified from a list of potential errors (figure 3).

Figure 3: Selecting Errors

The first year I used validation exercises I only had the students mark the error in the exercise but not provide any notes.  For example, in figure 1 and 2, where there is an interaction between amiodarone and digoxin, students would select “Potential interaction with a medicine the patient is taking.”  (See Figure 3)  However, I found that students could easily select that answer but not truly understand the severity of the interaction or determine the next steps to resolve the drug related problem.  When I spoke to students they would say I would call the doctor to inform them of the interaction but they would not have a specific recommendation in mind.  Depending on the level of the student, this may be a sufficient use of the validation exercises.  However, in our curriculum this is used in a skills based course in one of their final didactic quarters, so I felt it was necessary for students to develop a reasonable solution that did not just include “I would call the doctor for an alternative.”   

To address this, I created the guide in Figure 4.  I instructed students that if they selected any of the following errors they needed to answer the provided question(s) in the notes section.  There are more potential errors than what is listed in figure 4; however, I felt those did not require additional information.  For example, if a prescriber’s signature was missing then there is really nothing else a student would need to add.  For higher level errors such as dosing or drug interactions, I created these prompts to guide the student on what information they needed in the notes section. 

What is wrong with the date?
Script expired Why is it expired?  (e.g. a CII Rx is only good for XX days)
What is wrong with item/medication?
Fault/Error Options to Select Details you need to provide in NOTES section
Overdose (Strength) What dose would you recommend and why?
Subtherapeutic dose (Strength) What dose would you recommend and why?
Form inappropriate (Form) What form would you recommend and why?
Incomplete (Directions) What is missing from the directions?
Overdose (Directions) What dose would you recommend and why?
Subtherapeutic dose (Directions) What dose would you recommend and why?
Quantity is more than can be supplied (Quantity) What is the maximum that can be supplied?
Quantity is insufficient for the directions (Quantity) What should the quantity be?
Too many refills (Refills) How many refills are allowed for such a prescription? 
Refill too soon (Refills) Why is it refill too soon and when can it be filled?
Potential interaction with a medicine the patient is taking (Other) What is the interaction and what is your recommendation?  (For example: Do you recommend switching to another agent? If so what agent and what dose.  If you recommend monitoring only, what would monitor?)
Suspicion of abuse (Other) Why is abuse is suspected?
Contraindication with patient’s existing condition (Other) What is the contraindication and what is your recommendation?  (see interaction above for examples)
Patient has allergy to prescribed medicine (Other) What are recommended alternatives? 

Continuing with the example of the amiodarone and digoxin interaction, students would need to provide their response to the question “What is the interaction and what is your recommendation” in the notes section of the exercise (Figure 5).  I use this notes section as an opportunity to train the students that they want to be pharmacists that provide solutions to drug therapy problems not just identify them.  Computerized dispensing software can identify problems, but recommendations on how to solve these problems are what a pharmacist can contribute to the healthcare team.  I further demonstrate how important the notes are by allotting more points to the notes section than the error identification when these exercises are used as assessments.  For example, if each prescription was worth 3 points the error identified would be only worth 1 point while the information provided in the notes would be worth 2 points.  I assign more value to it so the students can see that the solution to the drug therapy problem is more significant.

Figure 5 – Example Notes Section

Personally, of all the exercises available in MyDispense I have found the validation exercises to be the most valuable.  It provides students an opportunity to identify prescription errors and drug therapy problems.  Now, with the development of our guide students can also practice developing a solution for the identified problems.

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