QUARTERLY SUMMATIVE EVALUATION

                                                        HOSPITAL PHARMACY PRACTICE

Resident:                                                                             Date Completed:

Preceptor:                                                                            Time Period of Learning Experience:

   This form documents resident attainment of goal areas formally taught in the learning experience. Evaluation of goal mastery is based on preceptor judgment of resident
     performance on the associated objectives listed below each goal.
   There are two categories of evaluation. The first category is an evaluation of goals designated for formal evaluation. The second category is of goals selected to be formally
     taught in the learning experience, but not chosen for formal evaluation.
   Preceptor will provide a narrative commentary for each goal in the first category of evaluation which is based on current resident performance level and reflects the aggregate
     resident activity during the rotation.

NI = Needs Improvement; SP = Satisfactory Progress; ACH = Achieved

                                                         Category 1: Goals Designated for Formal Evaluation
        GOALS AND ASSOCIATED OBJECTIVES                                       DESCRIPTION OF                          NARRATIVE      NI      SP      ACH
                                                                              REQUIREMENTS                           COMMENTARY
(Quarters: 1, 2, 3, 4)                                              The resident is expected to be punctual for
Goal S3:    Demonstrate the characteristics of a professional.      assigned shifts. Initiative on the part of the
         OBJ S3.1          (Organization) Choose daily              resident is expected to gain competency at
                           activities so that they reflect the      tasks required by a pharmacist to staff
                                                                    assigned area. Resident is expected to be
                           pursuit of expertise in the              present for entire assigned shift. Daily
                           development of direct patient-care       activity is directed toward improved patient
                           problem-solving skills.                  outcomes and documentation of time,
         OBJ S3.3          (Application) Dress in attire that       interventions and communications with
                           conveys a professional image.            patients and other health care professionals
         OBJ S3.4          (Characterization) Consistently          is expected. Findings regarding medication
                           maintain personal self-control and       problems, omissions, and needs are
                           professional decorum.                    communicated to the health care team and
         OBJ S3.5          (Characterization) Demonstrate           resolved appropriately. The resident shows
                                                                    progress in designing and managing their
                           acceptance of one's professional         day for efficiency, and these activities are
                           responsibility toward colleagues and     timely.
                           the health system through
                           commitment to one's team.
     OBJ S3.7(Organization) Present pharmacy concerns,
                 solutions, and interests in an assertive manner.
(Quarters 3 and 4)                                                  The resident gathers appropriate
Goal S9:      Solve practice problems efficiently.                 information and engages assistance of
           OBJ S9.1        (Application) Demonstrate               others when necessary to resolve problems.
                           consistent use of a systematic          Actions taken in the pharmacy are
                           approach to problem solving.            presented without undue emotion and
                                                                   differences and conflicts are handled
           OBJ S9.2        (Application) Use consensus-            professionally, without patient
                           building skills.                        involvement. The resident directs energy
                                                                   and goals to the good of the patient and the
                                                                   institution. The resident is as assertive as
                                                                   necessary without alienating another
                                                                   member or pharmacy as a service.These
                                                                   should be documented and part of the
                                                                   monthly review with the resident’s
                                                                   staffing mentor.
(Quarters 1, 2, 3, 4)                                              Residents are responsible for assuring
Goal S19:         Manage time effectively to fulfill practice      coverage of assigned shifts. Missing a shift
              responsibilities.                                    is not an option unless agreed upon by the
                                                                   preceptor. Follow up with pharmacy
                                                                   personnel prior to leaving a shift on
                                                                   outstanding questions or issues are
(Quarters 1, 2, 3, 4)                                              Work to understand the motivations,
Goal P1: Establish a collaborative working relationship with       requirements, needs and challenges of the
               physicians and other health care providers in the   customers of the pharmacy (nurses,
               health system.                                      doctors, patients, pharmacists, etc) and to
                                                                   better support them and their patient related
                                                                   activities. Attempt to anticipate their needs
                                                                   and surpass them.
(Quarters 1, 2, 3, 4)                                              Drug information questions, queries,
Goal P3:     Provide concise, applicable, comprehensive, and       analysis, etc, will be the responsibility of
             timely responses to requests for drug information     the resident. Guidance by other pharmacy
             from patients, health care providers, and the         staff should be sought as needed. Proper
                                                                   sources for answering questions are
             public.                                               available in the pharmacy and should be
                                                                   used. Delivery of the answer to the
                                                                   question must be pertinent to the patient
                                                                   situation and to the practitioner. These
                                                                   should be documented and part of the
                                                                   monthly review with the resident’s
                                                                   staffing mentor.
(Quarters 1, 2, 3, 4)                                              Residents are expected to carry out
Goal P8:     Prepare and dispense medications following            pharmacist duties in assigned shifts.
             existing standards of practice and the health         These include “vopping” medication
             system’s policies and procedures.                     orders, checking medications prior to
         OBJ P8.1          (Evaluation) Interpret the              dispensing; assuring dispensing is in
                           appropriateness of a medication         accordance with all legal requirements
                           order before preparing or permitting    as well as department safety
                           the distribution of the first dose.     requirements. All interventions, drug
                  IO P8.1.1          (Application) Use effective   information and problems
                                     prescriber education          encountered during dispensing are
                                     techniques to secure          documented and turned in to mentor
                                     agreement on                  on a monthly basis (or sooner if
                                     modifications to              situation necessitates).
                                     medication orders.
                  IO P8.1.2          (Application) Document
                                     modifications to
                                     medication orders
                                     according to the health
                                     system’s policies and
         OBJ P8.2          (Application) Follow the health
                           system’s policies and procedures to
                           maintain the accuracy of the
                           patient’s medication profile.
         OBJ P8.3          (Application) Prepare medication
                           using appropriate techniques and
                           following the health system’s
                           policies and procedures.
   OBJ P8.4       (Application) Dispense medication products
               following the health system’s policies and
(Quarters 1, 2, 3, 4)                                              The resident is expected to participate
Goal M13: Participate in the departmental performance              in the daily pyxis and cart fill log
             improvement program.                                  sheet. Participation will be reviewed
OBJ M13.1 (Application) Effectively apply the guidelines of        on an ongoing basis by the mentor
             the department’s performance improvement              team.

                           Category 2: Goals Selected to Be Formally Taught But Not Formally Evaluated
       GOALS AND ASSOCIATED OBJECTIVES                                                   NEEDS ATTENTION
Goal S8:     Maximize work efficiency through the use of           The resident is expected to utilize HEO/WizOrder,
                computers and information systems.                 HMM series, StarPanel/StarChart to process
                                                                   medication orders. The resident should be familiar
                                                                   with Pyxis. The resident is expected to become
                                                                   familiar with and utilize the electronic drug
                                                                   information databases as appropriate and

  Goal S11:   Display a caring attitude toward patients in all       The resident considers working with patients a
                  aspects of job responsibilities.                   privilege, and considers the patient and their
                                                                     companions guests in the institution. The resident
                                                                     works to assure the patient is as comfortable, as
                                                                     informed, and as cared for as possible. The
                                                                     resident shows the patient respect, and shows
                                                                     compassion and assurance as the patient attempts
                                                                     to succeed in caring for themselves.
  Goal S12:   Maintain confidentiality of patient and proprietary    Patient information, business information, research
                 business information.                               information and the personal information of co-
                                                                     workers are to be protected. Verbal, electronic,
                                                                     written and implied communication of this
                                                                     information is not tolerated and jeopardizes the
                                                                     trust instilled in employees, and the trust built
                                                                     between practitioners and patients. Policy of the
                                                                     institution is to be read, and honored.
  Goal S15:   Understand direct patient care delivery systems in     Residents will spend some time in the various
                 multiple practice settings.                         satellites to understand to pharmacy processes
                                                                     utilized to maximize patient care.
  Goal M1:    Identify a core library, including electronic media,   The resident will be given guidelines for
              appropriate for a specific practice setting.           developing a personal library in the hospital
                                                                     pharmacy practice setting. This library should be
                                                                     utilized with emphasis on the patient situations
                                                                     encountered to gain efficiency and confidence.
  Goal M10:   Understand steps that must be taken to ensure          The resident will be familiar with the steps the
              departmental compliance with accreditation,            department takes to be compliant with regulatory,
              legal, regulatory, and safety requirements (e.g.,      safety, and legal requirements through orientation
              NCQA and JCAHO requirements; ASHP                      activities as well as specific task training.
              standards, statements, and guidelines; state and
              federal laws regulating pharmacy practice; and
              OSHA regulations).

  Overall Comments:

  Areas of strength (required):

  Areas to focus on for enhancement/improvement (required):

  ____________________                        ________________________________                                     _________________________________
  Resident Signature                          Preceptor Signature                                                  Program Director Signature

Preceptor: Review with Resident, print, sign and give to resident. Also, forward an electronic copy to cori.nelsen@vanderbilt.edu.
Resident: Obtain program director signature, then file hard copy in your residency notebook.

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