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
(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
(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
(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).
IO P8.1.2 (Application) Document
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
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 firstname.lastname@example.org.
Resident: Obtain program director signature, then file hard copy in your residency notebook.