Fundamental Pharmacy Practice Skills for Acute Care Settings Certificate

   
The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education with Commendation.

This self-guided, online learning activity is intended for pharmacists who are or are considering a transition into hospital practice from community or retail practice and need to learn or refresh practice skills unique to or required in acute care settings.

Accreditation and Regulatory Compliance in Hospitals
ACPE: 0204-0000-24-780-H04-P
CE Hours: 1.5 contact hours
Activity Type: Application-based

• Identify the federal agency that sets the requirements for hospitals.
• List the accreditation organizations deemed by Medicare to survey hospitals.
• State the pharmaceutical services Hospital Conditions of Participation.
• Recall other sections of the Hospital Conditions of Participation that deal with medications.
• Identify the scope of state board of pharmacy regulations.
• Describe an approach to ensure continuous preparedness.
• Identify federal and related organizations that impact hospital accreditation.
• Differentiate organizations that create and promulgate standards, regulations, and best practices. 

Getting Started in Sterile Compounding
ACPE: 0204-0000-24-781-H07-P
CE Hours: 3 contact hours
Activity Type: Application-based

• List the standards of practice that apply to sterile compounding in the United States.
• Identify best practices to ensure sterile compounding safety.
• Explain the role of the compounder in assuring the safety of compounded sterile preparations.
• Describe the primary engineering controls used in sterile compounding.
• Explain the principles of generating a laminar airflow environment in the primary engineering control.
• Identify the secondary engineering control elements in a clean room environment.
• Identify sources of contamination within the cleanroom.
• List work behaviors required to prevent the introduction of contaminants into the cleanroom environment.
• Evaluate appropriate hand hygiene technique.
• Describe donning and doffing procedures for personal protective equipment used in cleanrooms.
• Contrast garb and glove requirements and procedures for non-hazardous and hazardous compounding.
• List basic compounding supplies.
• Differentiate between the critical sites and non-critical sites on syringes, needles, vials, and bags.
• Assess a vial’s medication label to determine number of doses and ingredients.
• Select appropriate compounding materials based on review of medication order.
• Differentiate between the types of automated compounder pumps used in compounding sterile preparations.
• Choose the appropriate compounding equipment needed for various situations. 

Compounding Sterile Preparations
ACPE: 0204-0000-24-782-H07-P
CE Hours: 3.5 contact hours
Activity Type: Application-based

• List factors that influence beyond-use date assignments for compounded sterile preparations.
• Describe physical and chemical compatibility criteria for components.
• Apply USP <797> risk categories to assigning a proper beyond-use date for compounded sterile preparations.
• Contrast the airflow in the primary and secondary engineering controls.
• Explain the key concepts of first air, direct compounding area, and critical sites.
• Describe how airflow visualization studies are used to locate the direct compounding area of a PEC.
• Distinguish workflow steps and best practices associated with compounding in a horizontal laminar airflow workbench and a compounding aseptic isolator.
• Describe techniques for reconstituting sterile powders.
• Evaluate placement of hands to prevent disruption of airflow to critical sites when reconstituting powders and withdrawing diluent or medication from vials.
• Summarize various strategies used to prevent the potential for coring vial stoppers.
• Recommend compounding techniques and behaviors that should be used to prevent and address a sharps injury.• Describe the dosage forms, preparation requirements, and routes of administration.
• Differentiate between small and large volume parenterals.
• Discuss appropriate routes of administration for compounded sterile preparations. 

Lab Monitoring and Pharmacokinetics
ACPE: 0204-0000-24-783-H01-P
CE Hours: 2.75 contact hours
Activity Type: Application-based

• Evaluate laboratory data commonly encountered when caring for hospitalized patients.
• Identify common issues that can lead to misinterpretation of laboratory data.
• Differentiate between laboratory values used to assess hepatic injury and hepatic synthetic function.
• Describe the impact of timing on the interpretation of drug levels used in pharmacokinetic monitoring.
• Restate the definitions of half-life, elimination rate constant, volume of distribution, clearance, and steady state.
• Recognize multi-compartment and one-compartment distribution from plots of log concentration vs. time.
• Describe first-order, Michaelis-Menten, and zero-order elimination.
• Use half-life to estimate time to steady state and how much time must elapse for a concentration to decrease to a new concentration.
• Discuss population pharmacokinetic values and dosing strategies for select drugs that take into account patient characteristics.
• Identify the appropriate equations that describe how doses are administered.
• Use population pharmacokinetic values and appropriate equations to determine dosing regimens to produce desired drug concentrations.
• Use formulas to estimate renal function in adults and children based on serum creatinine and patient characteristics.
• Adjust the dose and/or interval of drugs with significant renal elimination based on estimates of diminished renal function. 

Pharmacy Calculations Refresher
ACPE: 0204-0000-24-784-H01-P
CE Hours: 1 contact hour
Activity Type: Application-based

• Calculate a specific strength of a medication using higher and lower strength components using allegation.
• Recommend a measurable dose, volume, and/or weight using an aliquot.
• Calculate rate or unit changes of intravenous (IV) infusions.
• Calculate milliequivalent (mEq) weight and convert millimoles (mmol) volume.
• Discuss situations when calculations are used to adjust doses for renal insufficiency. 

Fluids, Electrolytes, and Nutrition Support Basics
ACPE: 0204-0000-24-785-H01-P
CE Hours: 2 contact hours
Activity Type: Application-based

• Describe the distribution of total body fluid and expected distribution of various intravenous fluids.
• Compare examples of a hypotonic fluid, isotonic fluid, and hypertonic fluid.
• Recommend pharmacotherapy interventions based on patient criteria and electrolyte abnormalities.
• Describe the role of key components of the nephron.
• Explain how glomerular filtration, active secretion, and passive reabsorption contribute to renal clearance.
• Select the medication dose for the Cockcroft-Gault equation.
• Explain the role of parenteral nutrition.
• List basic components in parenteral nutrition.
• Describe parenteral nutrition preparation using automatic compounding devices.
• Review parenteral nutrition orders, verification, and administration processes.
• Describe nutritional requirements.
• Compare and contrast enteral and parenteral nutrition in hospitalized patients.
• Identify the signs and symptoms of refeeding syndrome. 

Basics of Critical Care
ACPE: 0204-0000-24-786-H01-P
CE Hours: 2 contact hours
Activity Type: Application-based

• Describe common medication related challenges in critically ill patients.
• Identify drug related problems in the intensive care unit.
• Apply guideline-based interventions in patients with sepsis.
• Contrast treatment approaches for analgesia and sedation in critically ill patients.
• Assess how to treat and prevent delirium in the intensive care unit.
• Describe nutritional requirements.
• Compare nutrition approaches for hospitalized patients.
• Identify the signs and symptoms of refeeding syndrome.
• Describe clinical pharmacodynamics as it relates to medication dosing.
• Describe the role of pharmacokinetics in therapeutic drug monitoring for vancomycin and aminoglycosides.
• Differentiate between pharmacokinetics and pharmacodynamics.
• Describe the basic functions of lines, tubes, and drains used during patient care.
• List safety considerations associated with lines, tubes, and drains.
• Identify safe practices for maintaining access to lines, tubes, and drains.
• Discuss recommendations for safely administering pharmacologic therapies via lines and tubes. 

Cardiovascular Basics
ACPE: 0204-0000-24-787-H01-P
CE Hours: 3 contact hours
Activity Type: Application-based

• Define hypertensive urgency and hypertensive emergency, including the differences in diagnostic criteria.
• Calculate a mean arterial pressure.
• Recommend goals and management strategies for blood pressure lowering in the treatment of hypertensive urgency and hypertensive emergency.
• Recommend appropriate initial pharmacotherapy options in patients with acute coronary syndrome.
• Evaluate initial anticoagulation therapy options in patients presenting with acute coronary syndrome.
• Compare antiplatelet pharmacotherapy options in patients with acute coronary syndrome.
• Select an appropriate treatment duration for dual antiplatelet therapy to minimize both ischemic and bleeding risk in patients with acute coronary syndrome.
• Develop a pharmacotherapy plan to reduce cardiovascular risk in patients with acute coronary syndrome.
• Develop a patient-specific drug therapy plan for a patient with acute decompensated heart failure.
• Apply strategies for reducing hospital readmission rates and improving outcomes in patients with heart failure.
• Recommend a treatment plan for a patient with ischemic stroke or transient ischemic attack (TIA).
• Differentiate between treatment options for acute management and secondary prevention of ischemic stroke and transient ischemic attack (TIA).
• Assess patients with atrial fibrillation to guide the development of evidence-based pharmacologic recommendations.
• Recommend evidence-based pharmacologic therapy for either rate or rhythm control in patients with atrial fibrillation.
• Develop monitoring plans for patients with atrial fibrillation receiving pharmacologic therapy, taking adverse drug reactions and interactions into consideration.
• Assess patients with atrial fibrillation to guide the development of evidence-based pharmacologic recommendations.
• Recommend evidence-based pharmacologic therapy for either rate or rhythm control in patients with atrial fibrillation.
• Evaluate the risks and benefits of anticoagulation for stroke prevention in patients with atrial fibrillation, taking patient-specific factors into consideration.
• Recommend evidence-based pharmacologic therapy to reduce the risk of stroke in patients with atrial fibrillation.
• Develop monitoring plans for patients with atrial fibrillation receiving pharmacologic therapy, taking adverse drug reactions and interactions into consideration. 

Anticoagulation: Heparin, Low Molecular Weight Heparin, and Venous Thromboembolism
ACPE: 0204-0000-24-788-H01-P
CE Hours: 3.75 contact hours
Activity Type: Application-based

• Identify the differences among unfractionated heparin, low molecular weight heparin (LMWH), and fondaparinux.
• Explain how to initiate and monitor heparin, low molecular weight heparin, and fondaparinux for various indications.
• Recommend dose adjustments of heparin, low molecular weight heparin, and fondaparinux based on patient specific considerations.
• Apply a venous thromboembolism risk assessment model to determine risk for venous thrombosis in medical or surgical patients.
• Compare the difference in safety and efficacy of venous thromboembolism prophylaxis regimens in medical or surgical patients.
• Design an optimal VTE prophylaxis regimen in medical or surgical patients.
• Describe how acute venous thromboembolism (VTE) is diagnosed.
• Identify evidence-based anticoagulant options with recommended dosing for initial VTE treatment.
• Design an individualized anticoagulant plan for a patient with an acute VTE case including risk-benefit assessment and determination of duration of anticoagulant therapy. 

Anticoagulation: Warfarin and Direct Oral Anticoagulants
ACPE: 0204-0000-24-789-H01-P
CE Hours: 3 contact hours
Activity Type: Application-based

• Select an appropriate starting dose, INR follow-up plan, and key patient education points for a patient starting warfarin therapy.
• Determine an appropriate dosing/management strategy based on the clinical situation when a patient on warfarin presents to the hospital.
• Determine an appropriate dosing/management strategy based on the clinical situation when a hospitalized patient on warfarin transitions to a different level of care (critical care, sub-acute, home).
• Compare appropriate clinical and patient specific characteristics for DOAC and warfarin therapy.
• Identify potential organ system and drug interactions with DOACs.
• Design appropriate management strategies for a patient with organ system and drug interaction with DOACs.
• Develop a plan to successfully convert a patient from warfarin to a DOAC. 

Antimicrobial Stewardship
ACPE: 0204-0000-24-790-H01-P
CE Hours: 1 contact hour
Activity Type: Knowledge-based

• Discuss the role of the pharmacist in antimicrobial stewardship.
• List three considerations for both inpatient and ambulatory antimicrobial stewardship programs.
• Describe ways pharmacists can use pre-prescription authorization and post-prescription review and feedback in antimicrobial stewardship.
• Describe adverse effects associated with antimicrobial use.
• Summarize common antimicrobial stewardship initiatives.
• Identify program strategies to mitigate risks associated with antimicrobial use. 

Glycemic Management
ACPE: 0204-0000-24-791-H01-P
CE Hours: 2 contact hours
Activity Type: Application-based

• Compare various approaches to achieving good glycemic management in the hospital setting.
• Apply current standards of inpatient care to manage hospitalized patients with hyperglycemia or diabetes.
• Use effective strategies to safely optimize the glycemic management of hospitalized patients with diabetes and hyperglycemia.
• Interpret blood glucose data to improve glycemic management across the hospital.
• Differentiate the pathophysiology behind diabetic ketoacidosis and hyperosmolar hyperglycemic state.
• Design an appropriate treatment plan for managing hyperglycemic crises. 

Pediatrics Overview
ACPE: 0204-0000-24-792-H01-P
CE Hours: 2 contact hours
Activity Type: Application-based

• Recognize normal growth, lab values, and vital signs for a pediatric patient.
• Apply principles of pharmacokinetic changes during growth while assessing medication orders for pediatric patients.
• Calculate creatinine clearance for a pediatric patient.
• Use resources for answering medication questions related to pediatrics, pregnancy, and lactation.
• Calculate and double check a weight-based or body surface area-based dose for a pediatric patient.
• Identify common dosage formulation issues for pediatric patients.
• Discuss pediatric specific concepts and challenges related to sterile and non-sterile compounding.
• Identify appropriate devices and techniques to ensure safe medication administration and adherence in pediatric patients. 

Pharmacy Operations and Drug Distribution
ACPE: 0204-0000-24-793-H04-P
CE Hours: 1.5 contact hours
Activity Type: Application-based

• Describe methods for drug storage, security, and control for different patient care areas (inpatient, procedural, ambulatory, clinic, provider offices, urgent care, and off-site locations).
• Explain regulatory requirements related to receipt, storage, and distribution of drugs.
• Categorize drug storage temperatures based on USP definitions.
• Discuss required components of medication orders.
• List pharmacy records that must be maintained.
• Describe best practices for drug repackaging.
• Describe the evolution of medication distribution systems in health systems.
• Evaluate current medication distribution systems.
• Explain advantages and disadvantages of various distribution systems.
• Summarize how medication distribution systems support pharmacy practice models. 

Medication History-Taking and Reconciliation
ACPE: 0204-0000-24-788-H01-P
CE Hours: 3 contact hours
Activity Type: Application-based

• Explain the goals of obtaining an accurate and comprehensive medication history.
• Identify the essential components of a medication history.
• Identify sources of information about patients’ medication regimens that can be utilized when obtaining medication histories.
• Explain the advantages and limitations of different sources of medication regimen information.
• Explain the process of obtaining home medication information, comparing information from multiple sources to identify discrepancies, and resolving discrepancies.
• Give examples of interview questions that increase the likelihood of obtaining complete and accurate home medication information.
• Identify components of medication history documentation.
• Explain the clinical decision-making questions related to ordering home medications at admission, and when performing medication reconciliation during transfers and at discharge.

In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company.

An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience. 

The following persons in control of activity content have relevant financial relationships:

• Snehal H. Bhatt - Janssen Pharmaceuticals: Speakers bureau
• Michael P. Gulseth
  • Janssen Pharmaceuticals: Speaker
  • CSL Behring: Speakers bureau
  • Diagnostica Stago, Inc. (“Stago U.S.”): Speakers bureau 

All other persons in control of content do not have any relevant financial relationships with an ineligible company. 

As defined by the Standards of Integrity and Independence in Accredited Education definition of ineligible company. All relevant financial relationships have been mitigated prior to the CE activity. 

Each activity consists of audio, video, and/or PDFs and evaluations. Learners must review all content and complete the evaluations to receive continuing pharmacy education credit for each activity.

Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity. 

Important Note – ACPE 60 Day Deadline:

Per ACPE requirements, CPE credit must be claimed within 60 days of being earned. To verify that you have completed the required steps and to ensure your credits have been reported to CPE Monitor, check your NABP profile account to validate that your credits were transferred successfully before the ACPE 60-day deadline. After the 60-day deadline, ASHP will no longer be able to award credit for this activity. 

ASHP PROFESSIONAL CERTIFICATES℠ educational product line contains learning activities that are ACPE-accredited knowledge and application-based continuing education. This is not an ACPE Certificate Program. Upon successful completion of the activities, the learner will be able to download an ASHP Professional Certificate.