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 imperative. (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 procedures. 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 procedures. (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. process. 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 necessary. 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 email@example.com. Resident: Obtain program director signature, then file hard copy in your residency notebook.
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