APPE Manual - Temple University

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					                                        Table of Contents

Advanced Pharmacy Practice Experience
Faculty and Administrative Coordinators                                       3
Advanced Pharmacy Practice Experience Policies and Procedures                 4
       Attendance                                                             4
       Health and Injury                                                      5
       Professional Conduct                                                   6
       Professional Dress                                                     7
       Temple University Policies                                             7-8
Advanced Pharmacy Practice Experience Schedule                                9
Reporting Internship Hours to Pennsylvania State Board                        10
Grading                                                                       10

Global and Pharmacy Professional Educational
APPE Educational Competencies                                                 11
Longitudinal Evaluation of Educational Outcomes                               12-14

Practice Guideline

        #1 An Approach to Developing a Pharmacist‘s Care Plan                 15-23
        #2 Conducting a Medication History                                    24-25
        #3 Evaluating and Presenting an article from the medical literature   26-28
        #4 Preparing and Presenting an In-Service                             29-31
        #5Assessing and Reporting Adverse Drug Reactions                      32-36
Clinical Inpatient Rotation                                                   38-52
        Student Responsibilities/Preceptor Responsibilities                   37-39
        Patient Monitoring Form/Data Collection Card                          40
        Pharmacy Documentation of Intervention Form                           41-42
        In-Service Presentation Evaluation Form                               43-46
        Journal Club Evaluation Observational Study                           47-49
        Journal Club Evaluation Randomized Controlled Trials                  50-52
        Evaluation of Clinical Documentation/Interventions                    53
        Patient Counseling Evaluation Form                                    54-56
        Inpatient Student Evaluation                                          57-60
Clinical Ambulatory Rotation
        Student Responsibilities/Preceptor Responsibilities                   61-63
        Patient Monitoring Form/Data Collection Card                          40
        Pharmacy Documentation of Intervention Form                           41-42
        In-Service Presentation Evaluation Form                               43-46
        Journal Club Evaluation Observational Study                           47-49
        Journal Club Evaluation Randomized Controlled Trials                  50-52
        Evaluation of Clinical Documentation/Interventions                    53
        Patient Counseling Evaluation Form                                    54-56
        Ambulatory Student Evaluation                                         64-67



Temple University School of Pharmacy                                                 1
Institutional Rotation

        Student Responsibilities/Preceptor Responsibilities   68-69
        Daily Activity Log                                    70-73
        Institutional Student Evaluation                      74-77

Community Rotation
    Student Responsibilities/Preceptor Responsibilities       78-79
    Daily Activity Log                                        80-82
    Community Pharmacy Activities Workbook                    83-101
    Community Student Evaluation                              102-105
Specialty/Elective Rotation
       Specialty/Elective Rotation                            106-107
       Nuclear Pharmacy Rotation Evaluation                   108-110
       Nuclear Pharmacy PET Rotation Evaluation               111-113
       Specialty/Elective Student Evaluation                  114-117
Preceptor/Site Evaluations                                    118-143




Temple University School of Pharmacy                                 2
                            Temple University School of Pharmacy
                         Advanced Pharmacy Practice Experience Program
                              Faculty/Administrative Coordinators


Rotations                                         Faculty/Administrative Coordinators
Inpatient/Ambulatory Rotations                    Michael R. Jacobs, Pharm.D.
Institutional Rotations                           Lisa Becker, R.Ph.
Community/Chain Pharmacy                          Leigh Webber, R.Ph.

                                                  Experiential Education Office
                                                  Room: #501 and #524
                                                  Phone: 215-707-4934/9379/9378


Specialty Rotations


Pharmaceutical Industry                           Rachel Clark-Vetri, Pharm.D.

Nuclear Pharmacy                                  Elaine Mackowiak, Ph.D.



Administrative Assistant to the
Office of Experiential Education                  Elaine Muraresku




All other APPE’s inquiries contact the Office of Experiential Education appe@temple.edu




Temple University School of Pharmacy                                                3
A. Purpose of the Advanced Pharmacy Practice Experience Component of the Curriculum.
         The experiential portion of the Doctor of Pharmacy Program is a critical component of the
curriculum. Advanced Pharmacy Practice Experiences are designed to help students gain confidence in
their ability to be an active and useful participant in the health care system. The site preceptor will serve
as a role model and will assist the students in applying their knowledge in the clinical setting to develop
and refine the skills necessary to provide comprehensive pharmacy care to their patients. The students
will gain practice experience providing care to a diverse patient population in inpatient and outpatient
settings.

B. Advanced Pharmacy Practice Experience Policies and Procedures
1.         Attendance and Punctuality
1.1        You are required to notify your preceptor AND The Office of Experiential Education (215-707-
           4934/9379/9378) or appe@temple.edu if you have to be absent from your site due to illness or
           an emergency. Students are expected to notify the above individuals by the start of the working
           day or by 9 AM (whichever is earlier). The student must have the consent of their preceptor
           and must notify The Office of Experiential Education if they will be arriving late to their site or
           leaving early due to illness or an emergency.
           Failure to notify school and your preceptor of your need to be absent, arrive late or leave
           early will result in an unexcused absence. Students will be required to write a 10-page
           evidence based research paper to make-up each unexcused absence. The student must
           receive a passing grade for the research paper(s) in order to pass the rotation.
     1.2   Student Health Services or your personal physician must document any absence due to illness
           that exceeds two days.
     1.3   All absences must be made up at a time convenient to the preceptor. It is the student‘s
           responsibility to initiate discussions regarding a revised schedule upon his/her return.
     1.4   Participation in the professional activities at the site is essential to a valuable Advanced
           Pharmacy Practice experience. Absences deprive the student of necessary experiences and
           disrupt the continuity of the rotation. Students are not entitled to take days off. Missed
           days must be made up on a time table determined by the preceptor before the end of the
           Advanced Pharmacy Practice Experience. An Incomplete Grade will be assigned for any
           rotation during which a student missed days and did not make up the time. An Incomplete
           grade will default to a “F” grade as stated in the Incomplete Agreement signed by the
           student. The student will be required to repeat the specific rotation in order to receive a
           grade for the rotation. Rotations to be repeated will be scheduled during the next academic
           year.
     1.5   Should Temple University be closed and all classes cancelled due to inclement weather, only
           those sites affected by the weather are closed. Students who are completing their APPE at
           sites that are not affected by the weather are expected to be at their site.

     1.6   You may be asked to precept a second-year student who will be assigned to ―shadow‖ you at your
           site for part of a morning or afternoon. You will be given notice of the assignment 2-3 days
           before this experience. It is your responsibility as a senior student, to orient the PY-2 students to
           the inpatient clinical setting by reviewing at least one patient chart, a medication profile and
           involving students in the clinical activities of the day. If you fail to meet the second-year student,
           you will be asked to write a 5-page paper assigned by the Office of Experiential Education




Temple University School of Pharmacy                                                               4
  1.7      Other activities may require you to be absent from your assigned rotation. You must request
           permission from The Office of Experiential Education or appe@temple.edu prior to starting any
           of the activities.
                 1.7a.   Residency/Job Interviews are not excused absences. Time away from the
                         rotation site must be made up.
                 1.7b.   Attendance at a professional meeting is allowed. A maximum of three days
                         may be taken off to attend one professional meeting for the entire academic
                         year. Students will not be required to make up this time.

2.       Student Health and Injury
     2.1 Requirements

         Tuberculosis Skin Test
         A PPD is necessary at the start of each year.
         Measles
         Proof of Immune antibody titer is necessary.
         Rubella
         Proof of Positive antibody titer (History of disease is never acceptable).
         Mumps
         Proof of Positive antibody titer (History of disease is never acceptable).

         Hepatitis B
         Proof of Positive antibody titer is necessary

         Varicella/Chicken Pox
         Proof of Positive antibody titer is necessary (History of disease is never acceptable).
     2.2 Recommendations
         Influenza
         National guidelines suggest that in order to protect patients, individuals working with critically ill
         patients, be immunized against influenza in accordance with the annual GOC guidelines. This
         vaccine is given yearly in October and November. (In addition to the flu shot, some sites might
         require other vaccines).
     2.3 Students are strongly encouraged to have medical insurance. Neither the school nor the
         affiliate institution will be responsible for health care costs arising during the Advanced
         Pharmacy Practice Experience rotations.
     2.4 Students are required to attend the blood borne pathogens session as required by OSHA and the
         University prior to the first day of Advanced Pharmacy Practice Experience. Information
         regarding needle stick injuries will be provided. A copy of the Temple University Hospital policy
         on needle stick injuries is on file with The Office of Experiential Education.

     2.5 Students are required to attend HIPAA (Health Insurance Portability and Accountability Act) as
         required by the University prior to the first day of Advanced Pharmacy Practice Experience.




Temple University School of Pharmacy                                                                5
3.      Removal of a Student from a Practice Site
        Preceptors may recommend that a student be removed from a specific rotation when the student is
        perceived to be apathetic, disinterested, or unmotivated. [The student will be required to
        complete the rotation during the next academic year.]

4.      Illegal or Unethical Practices at an Experience Site
        If a preceptor, employee, or student at the Advanced Pharmacy Practice Experience site is
        involved or appears to be involved with a violation of law, regulation, or unethical practice, the
        preceptor and the site shall be re-evaluated for continued participation in the Advanced Pharmacy
        Practice Experience program. The Rotation Coordinator in consultation with the Director of the
        Advanced Pharmacy Practice Experience Program will take appropriate action.

5.      Name Tag
        All students shall wear their Temple University student photo I.D. and a nametag including their
        name and one of the following titles:
        5.1   Doctor of Pharmacy Student
        5.2   Pharm.D. Student
6.      Restrictions on Advanced Pharmacy Practice Experience Site Selection
        6.1     The student is not permitted to work with a preceptor or in an institution for which he/she
                is presently or has in the past worked for a salary.
        6.2     The student will not be allowed to work with a preceptor to whom he/she is related.
        6.3     The student will not be allowed to work with a preceptor that they are in a relationship
                with.

        The student will repeat rotations completed under the above circumstances.
7.      Professional Conduct
        7.1     The student shall conduct himself/herself as a professional and as a representative of
                Temple University School of Pharmacy at all times.
        7.2     The student should recognize that the primary objective of the Advanced Pharmacy
                Practice Experience is learning, and that learning is not a passive process, but requires
                active participation by the student.
        7.3     The student shall always observe the federal and state laws and regulations, which govern
                the practice of pharmacy.
        7.4     The student should never publicly question the advice or directions of his/her preceptor,
                but discuss any disagreements in private.
        7.5     The student should not hesitate to admit that he/she does not know an answer and should
                request guidance from the preceptor when needed.
        7.6     The student shall respect any and all confidences revealed during any segment of the
                Advanced Pharmacy Practice Experience.
        7.7     The student must not accept any form of payment, financial or otherwise, for his/her
                work experience while participating in the Advanced Pharmacy Practice Experience
                Program.




Temple University School of Pharmacy                                                              6
8.      Professional Dress Code
        Men: Pants, shirt and tie. No low riding pants and no jeans of any kind. No undergarments
        should be showing. Shoes should be closed toe shoes (no sandals, flip flops, or sneakers).

        Women: Business dress, skirt or dress pants. No crop pants or capris. No jean skirts or pants.
        Low-rise pants are not acceptable. No undergarments should be showing. Skirt/dress must be at
        or just above the knee. Blouse or shirt should completely cover the stomach area. No belly shirt
        or spaghetti strap shirt of any kind is acceptable. Blouse, shirt, or dress should be modest. Shoes
        should be closed toe (no sandals, flip flops or sneakers).

        All Students are expected to wear a clean, white Lab Coat with the Pharmacy Temple emblem on
        the left arm and a name tag over the breast pocket during their APPE.

9.      Temple University Policies
        Students are responsible to adhere to the Temple University policies that are listed online
        at http://policies.temple.edu:

        University Policy on Academic Rights and Responsibilities, Student And
        Faculty (Policy # 03.70.02)
        http://policies.temple.edu/getdoc.asp?policy_no=03.70.02

        Student Code of Conduct #03.70.12
        http://policies.temple.edu/getdoc.asp?policy_no=03.70.12

        Policy on Sexual Assault #04.82.02
        http://policies.temple.edu/getdoc.asp?policy_no=04.82.02

        Policy on Sexual Harassment #04.82.01
        http://policies.temple.edu/getdoc.asp?policy_no=04.82.01

        University Policy—Aids #04.83.01
        http://policies.temple.edu/getdoc.asp?policy_no=04.83.01

        General Policy Statement on Smoking # 04.62.11
        http://policies.temple.edu/getdoc.asp?policy_no=04.62.11

        Policy Regarding Confidentiality of Student Records # 03.20.11
        http://policies.temple.edu/getdoc.asp?policy_no=03.20.11

        Temple University Computer Usage Policy #04.71.11
        http://policies.temple.edu/getdoc.asp?policy_no=04.71.11

        Computer and Network Security Policy
        http://policies.temple.edu/getdoc.asp?policy_no=04.72.12

        Temple University Software Policy
        http://policies.temple.edu/getdoc.asp?policy_no=04.71.12




Temple University School of Pharmacy                                                             7
IT IS TEMPLE UNIVERSITY‘S POLICY to provide to all students, upon request, a copy
of the University‘s policies and procedures regarding CAMPUS SECURITY AND SAFETY,
as well as crime rates and statistics for the most recent three-year period. In doing so,
Temple University complies with two important pieces of legislation: the Pennsylvania
College and University Security Information Act and the federal Right- to-Know
and Campus Security Act. To receive a copy of ―You and Campus Safety,‖ which
provides important information about campus safety and the Department of
Security and Protection, write to the Office of the Associate Vice President for
Security and Protection, Temple University, Philadelphia, PA 19122, or call (215) 204-6262.




Temple University School of Pharmacy                                                 8
                                 TEMPLE UNIVERSITY SCHOOL OF PHARMACY
                                ADVANCED PHARMACY PRACTICE EXPERIENCE
                                      ACADEMIC CALENDAR 2010-2011
                                        EIGHT BLOCKS (Six Weeks)
                                   FOURTH PROFESSIONAL YEAR STUDENTS

ORIENTATION ...................................................................................................................... MAY 17, 2010
APPE ROTATIONS BEGIN ................................................................................................. .MAY 18, 2010
BLOCK 1 ............................................................................................................ ..MAY 18 – JUNE 25, 2010
HOLIDAY........................................................................................................................ .. MAY 31, 2010
BLOCK 2 ......................................................................................................... JUNE 28 – AUGUST 6, 2010
HOLIDAY............................................................................................................................ JULY 5, 2010
BLOCK 3 ........................................................................................... AUGUST 9 – SEPTEMBER 16, 2010
HOLIDAY............................................................................................................... SEPTEMBER 6, 2010
ORIENTATION ........................................................................................................ SEPTEMBER 17, 2010
BLOCK 4 .......................................................................................SEPTEMBER 20 – OCTOBER 28, 2010
ORIENTATION .............................................................................................................OCTOBER 29, 2010
BLOCK 5 ...................................................................................... NOVEMBER 1 – DECEMBER 10, 2010

HOLIDAY............................................................................................... NOVEMBER 25 AND 26, 2010
IMMUNIZATIONS ............................................................................................ DECEMBER 13 - 17, 2010
ORIENTATION ...............................................................................................................JANUARY 3, 2011
BLOCK 6 .......................................................................................... JANUARY 4 – FEBRUARY 11, 2011
HOLIDAY................................................................................................................. JANUARY 17, 2011
KAPLAN REVIEW (FRIDAY, SATURDAY, SUNDAY) ...............................MARCH 11, 12, 13, 2011
BLOCK 7 ............................................................................................ FEBRUARY 14 – MARCH 24, 2011
ORIENTATION .................................................................................................................MARCH 25, 2011
BLOCK 8 ........................................................................................................... MARCH 28 – MAY 5, 2011
FOCUS GROUP/ORIENTATION ......................................................................................... MAY 6, 2011
UNIVERSITY COMMENCEMENT ................................................................................... MAY 12, 2011

__________________________________________________________________________________




       Temple University School of Pharmacy                                                                                       9
C. Reporting Internship Hours to the Pennsylvania State Board of Pharmacy
1. The Pennsylvania State Board of Pharmacy allows credit for 750 of the hours earned during the
   Advanced Pharmacy Practice Experience to be applied towards the 1500 internship hours required to
   take the Pharmacy Board examination in Pennsylvania.

2. The School of Pharmacy will certify that the student has completed 750 internship hours upon the
   successful completion of the Advanced Pharmacy Practice Experience requirements.

3. The Pennsylvania State Board of Pharmacy only permits the Schools of Pharmacy to certify Advanced
   Pharmacy Practice Experience hours once a year in May.
D. Grading
1.   The Inpatient and Ambulatory Clinical Rotations will be graded. Students receive a letter grade (A,
     A-, B+, B, B-, C+, C, C-, D+, D, D- or F). The Institutional Pharmacy, Community Pharmacy, and
     Elective Rotations will be graded on pass, or fail basis. Each rotation has a specific Evaluation
     Form(s) to be used to assess the student‘s ability to achieve the outcomes for the rotation.
2.   Preceptors evaluate students weekly during the Inpatient and Ambulatory Clinical Rotations. For
     all other rotations, the preceptor is expected to evaluate the student at the end of three weeks
     (midpoint) and at the end of the rotation using the appropriate evaluation form for the rotation. The
     midpoint evaluation is to inform the student of his/her strengths and weaknesses. Students should
     request a written evaluation at the midpoint and end of each rotation. Contact The Office of
     Experiential Education (215-707-4934/9379/9378) or appe@temple.edu if you do not receive an
     evaluation. The midpoint evaluation should be used to establish goals for the last three weeks of
     the rotation. The final evaluation should be discussed with the student at the end of the rotation.
     The evaluation should be returned to The Office of Experiential Education as soon as possible.
3.   At the start of each clinical rotation the student will complete a self-assessment of their ability to
     perform each of the outcomes required of that rotation. The student will review this assessment
     form with the preceptor at the midpoint and end of each rotation to monitor their growth across the
     rotation.
4.   Calculation of the Course Grade
      4.1 The preceptor will evaluate the student's performance using a scale of 0 to 4. The preceptor
          should select the statement that best describes the student's behavior, knowledge, and or ability
          in each assessment area. The Advanced Pharmacy Practice Experience Director will be
          responsible for submitting the grade. An assessment of 1 is failing in that dimension.
          Students must receive an overall grade of 2 or higher in order to pass the rotation.

      4.2 The student will be required to repeat any rotation for which he/she receives a failing grade. A
          remedial program will be developed to address the student‘s deficiencies. The Advanced
          Pharmacy Practice Experience rotation must be repeated and successfully completed prior to
          graduation.

E. PRECEPTOR EVALUATIONS
Upon successful completion of the rotation, students are required to evaluate each preceptor. These
evaluation forms are on the Course Eval web site and will correspond to your rotation. Copies of these
evaluations are located at end of the manual. These evaluations are critical to insure that quality
educational experiences are being provided to students at each Advanced Pharmacy Practice Experience
site. Failure to complete evaluation forms will result in an incomplete grade for that rotation. Your
comments will remain confidential.




Temple University School of Pharmacy                                                           10
 Number            Educational Competencies                          APPE       APPE Clin.   APPE   APPE Inst
 Outcomes                                                            Clin Inp     Amb.       Comm
 PharmD SLO 01     Think critically and solve complex problems
                                                                        X           X          X        X

 PharmD SLO 02     Communicate effectively verbally and in
                   writing                                              X           X          X        X

 PharmD SLO 03     Demonstrate interpersonal skills and a
                   professional demeanor.                               X           X          X        X

 PharmD SLO 04     Make rational, legal, ethical and responsible
                   decisions.                                           X           X          X        X

 PharmD SLO 05     Demonstrate sensitivity and tolerance of the
                   cultural, societal and economic diversity.           X           X          X        X

 PharmD SLO 06     Assume responsibility for optimizing patient
                   outcomes related to medication therapy.              X           X          X        X

 PharmD SLO 07     Self-assess learning needs and implement a
                   plan to address these needs                          X           X          X        X

 PharmD SLO 08     Design evidence based pharmacy care plans
                                                                                    X          X
 PharmD SLO08.a    Integrate and apply evidence-based knowledge
                   of the biomedical, pharmaceutical and clinical       X           X          X        X
                   sciences.
 PharmD SLO08.b    Collect information to prevent, identify and
                   solve drug related problems.                         X           X          X        X

 PharmD SLO08.c    Retrieve, analyze, and interpret the
                   professional, lay, and scientific literature to      X           X          X        X
                   provide DI and counseling.

 PharmD SLO08.d    Develop a patient centered pharmacy care
                   plan.                                                X           X          X        X

 PharmD SLO08.e    Monitor patients to determine if the therapy is
                   appropriate, effective and safe.                     X           X          X        X

 PharmD SLO08.f     Effectively communicate information to
                   patients, caregivers and other health
                   professionals regarding rational drug therapy,       X           X          X        X
                   wellness and health promotion.
 PharmD SLO08.g     Document interventions and outcomes in
                   writing.                                             X           X          X        X

 PharmD SLO08.h    Provide initial emergency care by becoming
                   certified in first-aid and CPR.

 PharmD SLO08.i    Identify, prevent, manage and document
                   adverse outcomes of drug therapy                     X           X          X        X

 PharmD SLO09      Discuss successful practices used to market
                   and obtain reimbursement for patient care
                   services including medication therapy                X           X          X        X
                   management activities

 PharmD SLO10      Provide population based care.                       X           X          X        X
 PharmD SLO11 .    Provide, assess and coordinate safe accurate
                   and time-sensitive medication distribution                                  X        X

 PharmD SLO12      Manage medication use systems                        X           X          X        X
 PharmD SLO12.a    Evaluate drug orders or prescriptions                X           X          X        X
 PharmD SLO 12.b   Accurately and safely compound and dispense
                   drugs                                                                       X        X

 PharmD SLO12.c    Perform pharmaceutical calculations                  X           X          X        X
                    Insure that medications are properly
                   administered.                                        X           X          X        X
 PharmD SLO12d
                   Demonstrate competence in informatics                X           X          X        X
 PharmD SLO12e
 PharmD SLO13      Promote health improvement, wellness, and
                   disease prevention.                                  X           X          X        X



Temple University School of Pharmacy                                                                       11
                                       Temple University School of Pharmacy
                                  Longitudinal Evaluation of Educational Outcomes

         Student Name:

         Student Rotations in Order of Attendance                  Primary Preceptor

         1.

         2.

         3.

         4.

         5.

         6.

         The Advanced Pharmacy Practice Experience manual outlines in substantial detail the competencies, learning
         objective, and related activities students should achieve during their rotations. At the end of each rotation, the
         student and preceptor should use the following scale to evaluate the student‘s ability to demonstrate each
         competency. The student should use the gray spaces and the preceptor, the white spaces. The completed
         evaluation form should be discussed and then a hard copy signed by the preceptor. Students are required
         to upload this form into their portfolio after each rotation, and to hand in a hard copy to the Office of
         Experiential Education by their last orientation.

         EX = Performance exceeds expectations at this point in the program
         ME = Performance appropriate at this point in the program
         NI = Needs Improvement
         NA = Not Applicable
         Student fills in shaded areas.

         Preceptor fills in non-shaded area.

                                                                           Advanced Pharmacy Practice
                                                               1           2       3       4          5               6
        Preceptor Insert Date of Evaluation

Think    Think critically     and      solve   complex
        problems.


        Communicate effectively verbally and in
        writing.


        Demonstrate interpersonal skills and a
        professional demeanor.


        Make     rational,    legal,     ethical     and
        responsible decisions.




         Temple University School of Pharmacy                                                                 12
                                                      1   2   3   4   5        6
Demonstrate sensitivity and tolerance of the
cultural, societal and economic diversity.


Assume responsibility for optimizing patient
outcomes related to medication therapy.


Self-assess learning needs and implement a plan to
address these needs.

Design evidence based pharmacy care plans.



Integrate and apply evidence-based knowledge of
the biomedical, pharmaceutical and clinical
sciences.

Collect information to prevent, identify and solve
drug related problems.


Retrieve, analyze, and interpret the professional,
lay, and scientific literature to provide DI and
counseling.

Develop a patient centered pharmacy care plan


Monitor patients to determine if the therapy is
appropriate, effective and safe.


Effectively communicate information to patients,
caregivers and other health professionals regarding
rational drug therapy, wellness and health
promotion.
Document interventions and outcomes in writing.



Provide initial emergency care by becoming
certified in first-aid and CPR.


Identify, prevent, manage and document adverse
outcomes of drug therapy.




Discuss successful practices used to market and
obtain reimbursement for patient care services
including medication therapy management
activities.




  Temple University School of Pharmacy                                   13
Provide population based care.




Provide, assess and coordinate safe accurate and
time-sensitive medication distribution.



Manage medication use systems.




Evaluate drug orders or prescriptions.




Accurately and safely compound and dispense
drugs.



Perform pharmaceutical calculations.




Insure that medications are properly administered.




Demonstrate competence in informatics




Promote health improvement, wellness, and
disease prevention.




  Temple University School of Pharmacy              14
                                        Practice Guidelines

The following Practice Guidelines have been developed to help you successfully complete the
activities related to your Advanced Pharmacy Practice Experiences.

Practice Guideline 1
                        An Approach to Developing a Pharmacist‟s Care Plan

I.     Establish the Pharmacist-Patient Relationship

         Many patients continue to associate the pharmacist with a product. It is important to
         change the patient‘s perspective so they are receptive and understand the importance of
         the role the pharmacist plays in insuring that:

         A. The proper medication regimen is selected.
         B. The patient is appropriately monitored in order to determine if the desired therapeutic
            outcome(s) is being achieved and/or if the patient is experiencing an adverse drug
            reaction or drug interaction.
         C. The patient or care giver has the knowledge skills and resources to comply with the
            medication regimen.

         In order to provide your patient with comprehensive pharmacist care services, you need
         to establish a relationship with your patient by completing the following activities:

         A. Introduce yourself.
         B. Explain the services you wish to provide to the patient.
         C. Conduct a medication history.
         D. Give the patient a written record of their medications.
         E. For patients with a complicated medication regimen develop an administration
            schedule in collaboration with the patient.
         F. If time will not permit adequate patient education, make an appointment for a follow-
            up visit.

II.      Baseline Information Needed for All Patients. See Guidelines For Conducting a Medication
         History.
         A. Patient Description - Age, gender, race, weight (calculate ideal body weight), height.
         B. Current medications.
         C. Allergies/Adverse drug reactions (include description of reaction)
         D. Medical problem list.
         E. Medication history
         F. Patient compliance with medication
         G. Information regarding prescription plan.

III.    Gathering and Assessing Information.

         A. Review the patient‘s current medication list.
         B. For each medication collect and assess the following information (I - X) in order to
             answer the questions listed on the next pages.




Temple University School of Pharmacy                                                              15
Assessment Question                      Information to Collect and                Potential Drug Related
                                         Analyze                                   Problems Identified
l. Indication                            1. Diagnosis(es)                           The patient is on an unnecessary
   -What is the medical indication?          -patient profile, medical record       medication (no medically valid
   -Are there any untreated medical          -discussions on rounds or with         indication).
    conditions?                               care-givers
                                                                                                Or
                                             -patient
                                         2. Signs, symptoms and physical            The patient has a medical
                                            findings consistent with the            condition that requires drug
                                            medical diagnosis(es).                  therapy, but is not receiving a
                                         3. Lab tests and study results             drug for that indication.
                                            consistent with the diagnosis(es).
11. Drug Selection                       1. Review the relevant medical            The patient is not receiving the
   -What is the comparative                Literature.                              correct drug for his or her condition.
   efficacy of the selected                 - Practice guidelines
   medication?                              - Literature                                     And/Or
   -What is the relative safety             - Text books
   profile?                              2. Consider any contraindications to       The patient has a
   -What is the relative potential          therapy that your patient may have.     contraindication to therapy
   for a drug interaction with other        -Allergies                              (allergy or intolerance).
    medication currently being              -ADRs
    prescribed?                             -Concomitant medical
   -Will the patient be compliant?          conditions which may affect
   -Is there a more cost effective          drug selection.
   medication which would be                -Concomitant medications
   therapeutically equivalent in
   this patient?
   lll. Drug Regimen                     1. Look up the medication using            The drug regimen is not appropriate
   -Is the prescribed dose and               appropriate references.                 for this particular patient.
   frequency appropriate for this        2. Review the complete medication
   patient (i.e., within the usual           order consider:
   therapeutic range and/or                  -dose
   modified for the individual               -route
   patient?                                  -dosage formulation
   -Is the route and dosage form             -frequency of administration
   appropriate for this patient, after       -duration of therapy
   considering efficacy, safety,         3. Factors which may affect drug
   convenience patient limitations          distribution or activity.
   and cost?                                 -Age, race
   -Are doses scheduled appro-               -Renal function
   priately to maximize the thera-           -Liver function
   peutic benefit and compliance;            -Concurrent medical conditions/
   to minimize the potential for              drugs
   adverse drug reactions and drug       4. Serum drug concentrations.
   interactions?                         5. Compliance history of the patient.
   -If PRN, is this method of            6. Physical limitations of the patient.
   administration appropriate for the
   condition being treated?
   -Is the planned length of
   treatment appropriate?




Temple University School of Pharmacy                                                                      16
Assessment Question                      Information to Collect and                  Potential Drug Related
                                         Analyze                                     Problems Identified
IV. Drug Allergy or Intolerance          1.   Medication history-ask your                The patient has a
  -Is the patient allergic to or              patient.                                   contraindication to therapy
   intolerant of any medications (or     2.   Check patient profile and/or               (allergy or intolerance).
   chemically related medications)            medical record for allergies
   currently prescribed?                      or adverse drug reactions.
  -Does the patient use any method       3.   Medical alert bracelet,
   to alert health care providers of          necklace etc.
   allergy or intolerance to a
   medication?
Adverse Drug Reactions                   1.   Look up the medication using             The patient is experiencing
   -Are there any symptoms,                   appropriate references.                   an ADR.
     physical findings and/or            2.   Review the medical record for
     laboratory results that suggest          complaints, physical exam
     an adverse drug reaction?                findings and lab results that
                                              might be due to the drug.
                                         3.   Ask the patient about any
                                              symptoms that might be due
                                              to the drug.
                                         4.   Examine the patient for physical
                                              findings that might be due to an
                                              adverse drug effect.
VI. Interactions                         1.   Look up the medication in                  The patient‘s therapeutic
    -Are there any drug interactions          appropriate references.                    regimen has a drug-drug
    which are clinically significant?    2.   Review the patient‘s medica-               interaction, a nutrient-drug
    -Are there any drug-nutrient              tion list.                                 interaction and/or a drug-
    interactions which are               3.   Review all dietary orders                  laboratory test interaction.
    clinically significant?                   (inpatient or chronic care
    Are there any drug-laboratory             patients)
    test interactions which are          4.   Medical history (include OTC
    clinically significant?                   mediations).
                                         5.   Ask patient about any special
                                              dietary requirements or
                                              preferences.
                                         6.   Check if patient has had any
                                              laboratory tests which might
                                              be affected by the medication.
VII. Lifestyle Choices                   1.   Patient interview/medication               The patient‘s lifestyle is
    -Are there any lifestyle choices          history.                                    causing or contributing to
    (diet, lack of exercise,             2.   Review medication list for                  a medical problem.
    recreational drug or alcohol use)         potential drug interaction.
    that may cause/worsen any of the     3.   Review symptoms, physical
    patient‘s disease states or               exam findings, and laboratory
    symptoms?                                 results for consistent with findings
    -Are there any drug interactions          substance abuse or withdrawal.
    between the patient‘s prescribed     4.   Urine toxicology screen.
    medications and those being used
    recreationally?
    -Could the sudden decrease or
    discontinuation of recreational
    drugs be related to this patient‘s
    symptoms (i.e., withdrawal)




Temple University School of Pharmacy                                                                       17
Assessment Question                     Information to Collect and                Potential Drug Related
                                        Analyze                                   Problems Identified
VIII. Adherence                         1.   Conduct a medication history.          The patient is not receiving
   -Has the patient failed to receive   2.   Ask the patient about any social,      the medication correctly.
   medication due to an error in the         culture, or lifestyle issues that      The patient has a medical
   system or due to noncompliance?           might affect compliance.               problem that is a result of
   -Can the patient afford the          3.   Check patient‘s administration         not receiving the medication
   medication?                               technique when indicated.              in the correct manner (e.g.,
   -Is there any physical, psycho-      4.   Review medication regimen to           for pharmaceutical psycho-
   logical or social barrier to the          determine the complexity.              logical, social, cultural or
   patient taking the medication.                                                    financial reasons).
   -Can the complexity of the
   medication regimen be
   decreased?
IX. Pharmacoeconomics                   1.   Review the appropriate literature.    The patient is not receiving
    -Is the chosen medication cost      2.   Interview with the patient            the ―best‖ drug for his/her
    effective?                               diplomatically investigating             condition.
    -Does the cost of the medication         potential financial barriers.
    represent a financial burden to
    the patient/family?
X. Patient Knowledge                    1.   Interview with the patient.           The patient is not receiving
   -Does the patient understand why     2.   Review patient teaching aids          the medication correctly. The
   the medication was ordered?               available for your use in             patient has a medical problem
   -Would the patient benefit from           educating patients.                   that is a result of not receiving
   education (verbal, written,                                                     the medication in the correct
   reminder packages, or other                                                      manner (e.g., for
   adherence assistance?)                                                           pharmaceutical psychological,
                                                                                    social, cultural or financial
                                                                                    reasons).




Temple University School of Pharmacy                                                                     18
IV.         Identifying Drug Related Problems
            Based on your assessment of the data collected in sections II and III and your answers to
            the questions in Section III, you are ready to develop a drug related problem list for your
            patient. You should consider acute (or current) problems and potential problems. When
            you develop your therapeutic plan, you will need to solve current problems and identify
            strategies to prevent potential problems. Most drug-related problems fall into one of the
            following categories:
      1. The patient is on an unnecessary medication (no medically valid indication).
      2. The patient has a medical condition that requires drug therapy, but is not receiving a drug
         for that indication.
      3. The patient is not receiving the correct drug for his or her condition.
      4. The drug regimen is not appropriate for this particular patient.
      5. The patient has a contraindication to therapy (allergy or intolerance).
      6. The patient is experiencing an ADR.
      7. The patient's therapeutic regimen has a drug-drug interaction, a nutrient-drug interaction
         and/or a drug-laboratory test interaction.
      8. The patient's use of recreational substances is causing a medical problem.
      9. The patient is not receiving the medication correctly. The patient has a medical problem
         that is a result of not receiving the medication in the correct manner (e.g., for
         pharmaceutical, psychological, social, cultural or financial reasons).
      10. The patient is not receiving appropriate monitoring to ensure continued safety/efficacy
         of a prescribed drug.
V.      Developing and Implementing a Therapeutic Plan.
        A. Once a drug-related problem list has been generated for your patient, prioritize your
           patient's problem list in order to solve the most urgent problem(s) first. Obviously,
           current (acute) problems must be addressed, but it is also important to develop a
           pharmacotherapeutic plan to prevent potential drug related problems.




Temple University School of Pharmacy                                                              19
        B. Developing the Pharmacy Plan
                i. For each actual or potential problem clearly identify the pharmacotherapeutic
                  goal(s) for the patient (What do you want to achieve as a result of the
                  medication regimen recommended?)
                     (1) Examples of Pharmacotherapeutic goals:
                             (a) Relieve chronic pain caused by prostate cancer.
                             (b) Decrease the patient‘s LDL to < 130 mcg/dL.
                ii. When recommending adding or discontinuing one or more drugs, consider the
                  following:

Patient Related Factors                                Drug Related
Age                                                   Efficacy
Sex                                                   Safety
Renal function                                        Drug or food interactions
Hepatic function                                      Convenience
Concurrent illness                                    Cost
Pregnancy                                             Availability
Allergies                                             Miscellaneous
Adverse drug reactions                                Insurance coverage
Cost of therapy                                       Availability of therapy

                iii. Recommend the dose, frequency of administration, route of administration
                    and duration of therapy appropriate for the patient. When planning a dose
                    regimen consider:
                       (1) For Dose/Frequency of Administration Consider:
                             (a) Age
                             (b) Weight
                             (c) Renal function (for drugs eliminated by the kidney)
                             (d) Hepatic function (for drugs that undergo metabolism)
                       (2) For Route of Administration Consider:
                             (a) Available dosage formulations
                             (b) Bioavailability
                             (c) IV Access
                             (d) NPO
                             (e) NG-tube
                             (f) Factors affecting bioavailability
                             (g) Ability to administer drug via a specific route
                       (3) For Duration of Therapy Consider:
                             (a) Indication
                             (b) Pharmacotherapeutic goal(s)
                iv. Select monitoring parameters in order to assess the safety and efficacy of the
                    medication regimen. When selecting parameters to monitor you will need to
                    consider subjective data and objective data. Examples of subjective data
                    include pain, feeling tired, nausea. Examples of objective data include
                    physical exam findings, laboratory results and results from diagnostic tests.
                    When selecting parameters to follow consider the following:
                       (1) Pharmacokinetic characteristics of the drug.
                             (a) Factors affecting bioavailability
                             (b) Factors affecting volume of distribution
                             (c) Protein binding
                             (d) Metabolism and route of elimination
                             (e) Availability of serum drug concentrations



Temple University School of Pharmacy                                                            20
                     (2) Parameters reflecting desired physiologic changes that occur as a result
                         of drug therapy (efficacy).
                     (3) Parameters reflecting undesired physiologic changes that occur as a
                         result of drug therapy (adverse effects).

                v. Determine Monitoring Frequency. Deciding when and how often to monitor a
                    specific parameter is difficult. Factors to consider:
                     (1) Specific needs of the patient.
                            (a) Sicker patients will require more frequent monitoring. For
                               example, a patient with Stage 1 stable hypertension starting a new
                               medication may require less frequent blood pressure checks than a
                               patient admitted to the hospital with hypertensive emergency.
                            (b) The renal function in a patient with changing renal status who is
                               receiving aminoglycoside therapy may need to be monitored daily
                               while a patient with normal renal function could be monitored
                               every three days.

                     (2) How long the patient has been receiving a medication. Generally
                         monitoring is more intense when therapy is first initiated, when a new
                         drug is added or discontinued or if the patient‘s clinical status changes.
                     (3) If there is a pattern with regard to when a specific adverse effect is
                         expected to occur, this might affect when to check a specific monitoring
                         parameter.
                             (a) Hematological toxicity due to carbamazepine usually occurs early
                                  in therapy, thus it is recommended to check a CBC before
                                  starting therapy, then monthly for the first two months then
                                  every 6-12 months while on therapy.
                             (b) Vitamin D deficiency due to combined therapy with
                                  phenobarbital and phenytoin does not occur until the patient has
                                  received at least 6 months of therapy, thus it is not necessary to
                                  check an alkaline phosphatase level until after six months of
                                  treatment.
                     (4) Principles of Therapeutic Drug Monitoring. When serum
                              concentrations are indicated consider:
                             (a) Whether you want to measure a steady-state and/or a non-steady-
                                 state serum concentration. This will determine when and how
                                 often to draw blood for serum drug concentrations.
                             (b) Whether you want to measure a peak and/or a trough
                                 concentration. This will determine when the blood sample(s)
                                 should be drawn in relation to the dose.
                             (c) Once a patient has achieved a therapeutic serum concentration(s),
                                 additional drug levels are not indicated unless the dose or dosage
                                 form is changed or a significant change in concurrent drug
                                 therapy or disease state occurs.
                             (d) Cost availability and practicality of monitoring compared to the
                                 benefit of monitoring to the patient.




Temple University School of Pharmacy                                                            21
VI.         Documenting Therapeutic Interventions (Written Pharmacy Notes)
            A. Rationale

            It is critical to document (in writing) your therapeutic interventions and the rationale behind
            your recommendations. All physicians and nurses document their patient care plan in
            writing. In order to be an active and visible member of the health care team the pharmacist
            must also document their patient care plan in writing. Written documentation insures
            accurate communication of information to all health care professionals who care for the
            patient. As pharmacists begin to provide more cognitive services to patients, it is essential
            that these less visible services be documented. This will demonstrate the contribution
            pharmacists make to improving the patient's health care.

            B. Format
            The SOAP format has been adopted by most health professionals to describe their patient
            care plan in an organized manner. Below is an explanation of the SOAP format for
            documenting patient care plans. This method may seem cumbersome at first, but it helps
            organize information so that you can accurately assess the problem and develop a plan.
            Although the format is the same as that used by other health professions, the content is
            specific to drug related issues.

Descriptor:          General Patient Information
Age, gender, race, hospital day (if applicable), chief complaint and other significant disease
states (ex: history of hypertension, end stage renal dysfunction). This is a short description of
how the patient is presenting and should be complete in one or two lines.

Subjective Data: What the patient tells you or information found in a patient chart that is
pertinent to the case and cannot be objectively measured (ex: signs and symptoms, history of
present illness).

Objective Data:      Include pertinent data from the following categories:
                        Allergies (include manifestation)
                        Past and current medication regimens (include drug, dose, route,
                           frequency, and indication for use)
                        Past medical history
                        Social history
                        Family history
                        Pertinent physical findings (Physical Exam, or ―PE‖). This should
                           include vital signs, ―VS‖, and review of systems, ―ROS‖.
                        Pertinent lab findings or results of diagnostic tests

Assessment:          Evaluate the subjective and objective data for actual or potential drug related
problems. Each assessment should be written as a drug related problem and ranked in order of
clinical significance. Always include a rationale for each assessment. Include information from
the subjective and objective data which provides a rationale for the assessment. For instance,
―Based upon a SrCr of 2.6 and a CrCl of 25 ml/min, the dosing regimen of Bactrim is not
appropriate for this patient‖.




Temple University School of Pharmacy                                                             22
Choose from the following drug related problems to formulate your assessments:
              1. The patient is on an unnecessary medication (no medically valid indication).
              2. The patient has a medical condition that requires drug therapy, but is not
                  receiving a drug for that indication.
              3. The patient is not receiving the correct drug for his or her condition.
              4. The drug regimen is not appropriate for this particular patient.
              5. The patient has a contraindication to therapy.
              6. The patient is experiencing an adverse drug reaction.
              7. The patient‘s therapeutic regimen has a drug-drug interaction, a drug-nutrient
                  interaction, and/or a drug-laboratory test interaction.
              8. The patient‘s use of a recreational substance is causing a medical problem.
              9. The patient is not receiving the medication correctly. The patient is having a
                  medical problem that is a result of not receiving the drug in the correct
                  manner.
              10. The patient is receiving appropriate therapy for a specific disease state, but
                  requires monitoring to ensure continued safety and efficacy.

Plan:             This is the most important part of your note.
A specific plan should be developed for each drug related problem identified in the assessment.
Consider to whom the note in directed when writing your plan. For instance, extensive
counseling information is not necessary if your note is intended for a hospitalized patient‘s care
team, especially when the patient will not be discharged for some time. Also, be specific when
writing your plan; health care providers should be able to implement the plan from the
information you provide. Your plan should include the following information when appropriate:

                   Your recommended medication regimen. Be specific and include the drug,
                    dose, route and dosing interval.
                   Duration of drug therapy
                   Monitoring parameters for efficacy and toxicity. Be specific and include time
                    intervals for monitoring. For example, ―Recommend monitoring LFTs at
                    baseline and every 6 months thereafter‖.
                   Goals of therapy
                   Patient counseling points, if pertinent
Signature:          Always include your signature and credentials. For example, ―Jane Smith,
                    PharmD Candidate‖
A Few Additional Considerations:
    Review your note for grammar and spelling errors.
    Avoid using unsafe abbreviations (ex: ―QD‖ should be written as ―daily‖, ―U‖ should be
      written as ―Units‖, etc.) and unapproved abbreviations.
VII.            Follow-Up
                The pharmacist must accept responsibility for the patient's drug therapy. If the
                patient's medication regimen is inadequate it is the pharmacist's responsibility to
                intervene. It is, therefore, essential that the pharmacists follow-up to learn the
                results of their interventions and to make further recommendations as needed.




Temple University School of Pharmacy                                                            23
       Practice Guideline 2
                                               Conducting a Medication History
       The following should serve as a guide in taking medication histories:

I.          Social Considerations:
               A. Introduce yourself to the patient (who you are, what you are doing, and why).

               B. Respect the patient (privacy, timing, do not talk ―down‖ to or over the patient‘s head,
                  and address the patient as Mr./Mrs./Miss unless permitted to do otherwise).

               C. Assess the patient‘s level of communication (i.e., does a language barrier exist? Is the
                  patient visually/hearing impaired? What is the patient‘s level of education?).

II.         Chief Complaint and History of Present Illness
III.        Allergies
               A. Document type of allergy (food, drug, plant, dye, etc.) and type of reaction
                   experienced.
               B. If an allergy exists, some possible questions to ask:
                        i. When did you first notice it?
                        ii. What type of reaction was it?
                        iii. Can you describe the reaction?
                        iv. How severe was the reaction?
                        v. How long did the reaction last?
                        vi. Did you seek medical attention for the reaction?
                        vii. Was the reaction treated? If so, how and by whom?
                        viii. What was the route of administration was of the offending agent?
                        ix. Was the patient re challenged?

IV.         Medications Prior to Admissions

               A. Note all prescription and over-the-counter medications taken prior to admission.
               B. For each agent, the following questions may be asked:
                       i. What do you take the drug for?
                       ii. When did you start taking the medication?
                       iii. How do you presently take the medication?
                       iv. How often do you miss doses, if any?
                       v. What do you do if you miss a dose?
                       vi. Does the drug cause any ―adverse reactions‖?
                       vii. When did you take the last dose?
               C. Using non-medical language ask the patient if they take any of the following:
                            Pain medication                    Ulcer medications
                            Birth control pills                Eye/ear medications
                            Sleeping pills                     Bowel medications
                            Heart medications                  Lung/asthma medications
                            Topical medications                Blood pressure medications
                            Water pills




       Temple University School of Pharmacy                                                           24
              D. Ask about OTC medications:
                          Amino Acid Products                     Laxatives/antidiarrheals
                          Vitamins                                Cough/cold preparations
                          Allergy products                        Rectal/topical products
                          Inhalers                                Vaginal products
                          Antacids                                Analgesics
                          Herbal/natural products

V.         Vaccination History
              -Influenza
              -Pneumococcal
              -Hepatitis B
              -Measles, mumps, rubella

VI.        Inquire about social habits:
              A.   Tobacco use, packs per day for # of years (pack years)
              B.   Coffee consumption: cups per day other forms of caffeine (soda, tea)
              C.   Alcohol use; amount per day, for how long
              D.   Illicit drug use (parenteral, oral, or inhaled; Do not forget about products not typically
                   considered to be drugs, such as solvents, rubber adhesives, and volatile liquids)

VII.       Assess about the patient’s adherence with medications.
              A. If patient is not adherent, why?
                       i. -Financially unable (medication is not covered by medical insurer or patient has
                          no prescription coverage at all and cannot afford medication)
                       ii. -Physically unable (patient needs a caretaker to administer medications, but
                            does not have one; i.e., blind, senile, debilitated, or other reason)
                       iii. Requires additional drug/disease education.

VIII.      Evaluate whether or not pertinent drug related problems exist based on the
           information collected.
              A. Drug interactions
              B. Inappropriate agent (dose, indication, agent)
              C. Toxicity
              D. Adherence




      Temple University School of Pharmacy                                                               25
     Practice Guideline 3
                       Evaluating and presenting an article from the medical literature

     Journal Club

     Purpose: To provide a mechanism for maximizing the information reviewed by pharmacists and pharmacy
     students and to discuss with peers the clinical significance and potential application of current medical research with
     participants of the journal club.

     Method: Select a current journal article (preferably published in the last 3 months) during the first week of the
     rotation, copy the article and have it approved by your preceptor. A handout is required using the format below.
     Each handout should be a maximum of 3 typed pages. The presentation should be a maximum of 30 minutes:
     Background and study overview: 5-10 minutes and study strengths/weaknesses as well as clinical relevance: 20
     minutes.

     Journal selection: The article chosen by the student should be from a peer-reviewed journal in the medical or
     pharmacy literature.

                                                    Title/Name/Citation

                                       BACKGROUND & STUDY OVERVIEW
Background
Previous trials
Describe the research
question/rationale for
conducting the study.
Authors‘ affiliation/study
support
Methods/Study Design               - Describe the study design: case-control, cohort, controlled, etc.
                                   - Type of design: cross-over, parallel, etc.
                                   - Randomization
                                   - Blinding
                                   - Setting: how enrolled/from where?
                                   - Comparative groups and # enrolled per group
Inclusion/exclusion criteria
Duration of study and follow-up
Interventions                      - List the medications the study subjects received, dose, duration and placebo, if applicable.
Objectives and outcome             - Describe the primary, secondary and other endpoints and
measures                           - Outcome measures

Statistical analysis               - Tests used
                                   - Power of study
                                   - Discuss if the study was powered and  or p-value at which the results would be considered
                                   significant.
Results                            Explain/describe the main results found in the study:
                                   - Include results of each outcome measure:
                                        - confidence intervals
                                        - p-values
                                        - compliance
                                   - Adverse effects: if reported in the study and are relevant (or new) – you should mention them
Conclusion                         Summarize the authors‘ conclusions of the study.




     Temple University School of Pharmacy                                                                      26
                                          STUDY ANALYSIS AND CRITIQUE
This section of your presentation is simply your impression of the strengths and weaknesses/limitations of the study.
Be prepared to state why you believe the factor in question is a study strength or weakness. The student should refer the participants
to a specific table, text, data point or graphical representation of the data to support their major points.
             Authors/Introduction:
                  ●If potential conflicts of interest exist, did they appear to influence the study objective, method or conclusion?
                  ●Was an appropriate scientific background and rationale provided?
                  ●Was the study question sufficiently described?
             Methods:
             Study Design:
                  ●Was the study design appropriate to answer the study question?
                  ●Were subjects appropriate to the study question? Were control subjects appropriate?
                  ●If blinding of investigators to intervention was possible, was it reported?
                  ●Was approval from an institutional review board explicitly reported?
             Inclusion/exclusion criteria:
                  ●Were the inclusion/exclusion criteria appropriate? What additional criteria would have strengthened the study?
             Intervention:
                  ●Was the intervention appropriate (medication used, dose, interval, duration, monitoring)?
                  ●If an active control was used, was it an appropriate selection?
                  ●Were subjects randomly selected from the target population and was the method of randomization sufficiently
                  described?
                  ●Were the drugs administered for a sufficient duration?
             Objectives and outcome measures:
                  ●Were the primary and secondary measures clearly defined?
                  ●Were outcome measures appropriate given the study objective? Were the therapeutic outcomes measured in the
                  study important?
                  ●Was timing of outcome measurements appropriate and of adequate frequency and duration?
             Statistical analysis:
                  ●Was there a sample size justification before the study?
                  ●Was power appropriate for all primary and secondary outcomes? If subgroup analyses performed, was power
                  sufficient?
                  ●Were post-hoc power calculations or confidence intervals reported for statistically non-significant results?
                  ●Were statistical analyses appropriate? Were exact p-values or confidence intervals reported for each test?
             Results:
                  ●For those subjects who completed the study, were the results completely reported?
                  ●Was the number of patients accounted for at each step of the study?
                  ●Were any significant differences apparent among groups at baseline that could influence study results?
                  ●Were results reported for each measure described in the methods section?
                  ●Were the findings statistically and clinically significant?
                  ●Were there factors (e.g. study setting, diet, and other confounding variables) besides the treatments used that
                  could have affected the results?
                  ●Were differences in adverse effects among groups statistically analyzed?
             Discussion/Conclusion:
                  ●Do the findings support the conclusion?
                  ●Did the authors explain key limitations and discrepancies from other similar studies.




     Temple University School of Pharmacy                                                                       27
                                    CLINICAL IMPLICATIONS
           ●Evaluate the clinical usefulness of the study and how it would impact the practice of a
           clinical pharmacy practitioner.
           ●Can the results of the study be applied to the general population? Is there a specific patient
           population that would benefit from the therapy? Could this therapy potentially harm a specific
           patient population?
           ●Is there anything that could be done to potentially improve the study?




Temple University School of Pharmacy                                                  28
Practice Guideline 4
                              Preparing and Presenting an In-Service

Description of the In-Service Presentation

Each student will present a 20-30 minute lecture to faculty, pharmacists, and their colleagues. The
purpose of an in-service is to give other health professionals pertinent information about a drug related
subject. Usually the topic selected for this kind of presentation focuses on a new drug, a new indication
for a drug or a novel dosage formulation. Once you select your topic you should think about the kind of
information that your audience will be interested in learning about. Choose a topic that is focused enough
to complete within the allotted time. For example, the pharmacotherapy of pneumonia is a broad topic
that cannot be adequately discussed during 20 minutes, but the pharmacotherapy of ventilator-associated
pneumonia caused by MRSA may be. You must be selective about the information you choose to
include in your presentation as you only have 20 minutes.

A two to three page handout must be prepared to supplement your lecture – ask your preceptor for
guidance about the type of handout that he or she prefers.

General Guidelines for Giving a Good Presentation

       Be prepared; know your subject well.

       Choose a topic of interest to both you and your audience, and find literature about it. Do not read
        package inserts to your audience – your presentation should be more sophisticated than that.
        Consider using a patient case that you‘ve encountered during your clerkship as the basis for a
        presentation – this method both keeps the audience‘s interest and shows the relevance of the of
        the evidence-based information that you presented to patient care.

       Do not include unnecessary information. You cannot cover every aspect of your topic in 20
        minutes. Select the information that you think is relevant to your audience. Remember that you
        are a pharmacist (almost) – focus on pharmacotherapy, not the diagnosis of a disease.

       Organize your presentation. Rambling, disorganized presentations are difficult for listeners to
        follow.

       Do not read your presentation.

       Do not speak in a monotone or rush through your presentation. Emphasize important points to
        hold your audience‘s interest.

       Speak up so that the audience can hear you.

       PRACTICE your presentation.




Temple University School of Pharmacy                                                           29
Preparing Your In-Service Presentation

1.      Select a topic/target audience from the list available from your preceptor.

2.      Think about your target audience and make a list of the information the particular audience would
        be interested in learning.

3.      Review the relevant literature. Search MEDLINE (PubMed, Ovid) for relevant literature –
        preferably at least 2 references from the primary literature should be used, along with appropriate
        tertiary literature for your background. Do NOT cite your professors‘ notes! Instead, search for
        the references that they used.

4.      Read and critique the articles. Be sure to look for the key points of each article that you present.

5.      Develop an outline of the information you want to cover. Remember to be selective; you can‘t
        cover everything in 20 minutes. The outline helps you organize your talk and is an effective way
        to avoid omitting information that should be included.

6.      Some speakers develop a comprehensive outline and can give an effective presentation; other
        people need to write out the entire talk. You should decide what would work for you.

7.      Do not memorize your talk unless you have a perfect memory. You may forget a segment of the
        talk and be unable to continue. Practicing your talk five or six times will make you comfortable
        with the material.

8.      If you plan to use notes to assist you during your presentation use index cards. It is easier to use
        cards during your presentation and it is less distracting than rustling papers.

9.      There will be five minutes at the end of each presentation for questions. Try to anticipate
        questions before your presentation.

10.     Practice your talk at least five times prior to your presentation.

Preparing Your Handout

1.      The information contained in your handout should supplement your lecture. Be sure the order of
        information presented is the same in the handout as in your lecture. If you wish the audience to
        refer to a section of the handout during your presentation, identify where in the handout the
        participant should look in order to avoid confusion.

2.      Use figures and/or tables to explain or summarize information. Be sure to cite the reference(s)
        for any data taken directly from a reference source(s).

3.      If using PowerPoint slides as your handout, include important figures and tables that may be
        difficult to read as separate pages.

4.      Be sure to number the pages in your handout.




Temple University School of Pharmacy                                                             30
5.      You must include a reference list at the end of the handout listing articles that you based your
        presentation on. Be sure to reference your presentation as well. References should be properly
        formatted using the AMA Style Guide a summary of this document can be viewed at:
        www.samford.edu/schools/pharmacy/dic/amaquickref07.pdf

6.       If using PowerPoint slides, you may use a ‗short form‘ reference at the bottom of your slides, as
        long as the complete reference appears at the end of the presentation.

        For example:
        DeEugenio DL, Ruggiero NJ, Thomson LJ, Menajovsky LB, Herman JH. Early-onset heparin-
        induced thrombocytopenia after a 165-day heparin-free interval: case report and review of the
        literature. Pharmacotherapy. 2005 Apr;25(4):615-9.
        May be abbreviated on individual slides to:

        DeEugenio DL, et al. Pharmacotherapy 2005;25:615-9

 7.      The term „plagiarism‖ includes, but is not limited to, the use, by paraphrase or direct quotation,
        of the published or unpublished work of another person without full and clear
        acknowledgment. It also includes the unacknowledged use of materials prepared by another
        person or agency engaged in the selling of term papers or other academic materials. (Student
        Code of Conduct #03.70.12 August 31, 2009 Page 2)




Temple University School of Pharmacy                                                            31
Practice Guideline 5
                         Assessing and Reporting Adverse Drug Reactions



Adverse drug reactions (ADRs) are a significant cause of morbidity and mortality. In the United States,
the total cost of these events has been estimated at nearly $150 billion. Within the past decade, ADRs
have been the focus of many studies in patient safety and quality control, and have been recognized as a
top priority in safety efforts due to their iatrogenic nature.

What is an Adverse Drug Reaction (ADR)?

The World Health Organization defines an adverse drug reaction as:

―any response to a drug that is noxious and unintended, and that occurs at doses normally used in man for
the prophylaxis, diagnosis, or therapy of disease."

Classification of ADRs

ADRs generally are assigned to 1 of 2 subgroups (see table 1). Events that fall within the first subgroup
are known as Type A reactions: an ―A‖ugmentation of a drug‘s primary or secondary pharmacologic
effect. A simple example of a Type A reaction is coagulopathy with warfarin. The primary therapeutic
effect is to interfere with the hepatic synthesis of vitamin K-dependent coagulation factors, but when there
is too much inhibition, unwanted hypoprothrombinemia and bleeding episodes may result.


The other general subgroup of ADRs encompasses Type B reactions, which are considered ―B‖izarre, or
idiosyncratic, in nature. Such reactions are not related to a drug‘s primary or even secondary
pharmacologic effect. The best examples in this group are allergic reactions such as rashes, hives, and
systemic anaphylaxis.


Table 1: Descriptions of Adverse Drug Reactions (ADRs)
Subgroup        Type A                             Type B
Mechanism       Related to a drug‘s pharmacologic  Idiosyncratic; not related to a pharmacologic
                effect                             effect
Occurrence      80-90% of all ADRs                 10-20% of all ADRs
Severity        Mild to life-threatening           Mild to life-threatening
Predictability  Predictable                        Unpredictable
Preventability Often preventable                   Rarely preventable




Temple University School of Pharmacy                                                           32
Determining Causality of ADRs

Causality comes into play with adverse drug reactions. In these cases, there is a defined temporal
relationship between the adverse event and the administration of the drug. To report, there need not be a
―100% causality‖ but the association of the event with the start of the drug therapy.


Causality can be further assessed objectively using the tool called the Naranjo Scale. (see figure 1) You
answer a series of questions regarding the event identified in relationship to the initiation, discontinuation
or reintroduction to the suspect drug. This tool is most useful when one cannot fully determine if the
event is solely related to drug therapy.


Figure 1: Naranjo Algorithm*
Question                                               Yes       No      Do Not           Score
                                                                         Know
1. Are there previous conclusive reports on this       +1        0       0
reaction?
2. Did the adverse reaction appear when the drug       +2        -1      0
was administered?
3. Did the adverse reaction improve when the drug      +1        0       0
was discontinued or a specific antagonist was
administered?
4. Did the adverse reaction reappear when the drug     +2        -1      0
was re-administered?
5. Are there alternate causes (other than the drug)    -1        +2      0
that could solely have caused reaction?
6. Did the reaction reappear when a placebo was        -1        +1      0
given?
7. Was the drug detected in the blood (or other        +1        0       0
fluids) in a concentration known to be toxic?
8. Was the reaction more severe when the dose          +1        0       0
was increased,, or less severe when the dose was
decreased?
9. Did the patient have a similar reaction to the      +1        0       0
same or similar drugs in any previous exposure?
10. Was the adverse event confirmed by objective       +1        0       0
evidence?

                                                                                          Total
                                                                                          Score
Score:

0-1 Doubtful
2-4 Possible
5-8 Probable
>9 Definite
* Adapted from Naranjo CA, Busto U, Sellars EM, et al, Clin Pharmacol Ther. 1981; 30:239-245




Temple University School of Pharmacy                                                              33
What to report as an ADR

For healthcare professionals, it can be a challenge to know what, when, and where to report an adverse
drug event. The FDA's MedWatch program was created to collect reports of serious adverse events. The
agency has defined an ADR as "serious" when one or more of the following patient outcomes occur as a
result of the ADR:
        Death
        Life-threatening condition*
        New hospitalization*
        Prolonged hospitalization*
        Permanent disability or damage
        Congenital anomaly or birth defect in a fetus

*These will be the most common serious ADRs that students will find on rotation.

Although filing a report is usually voluntary, the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) does require that hospitals have procedures and methods in place so that
employees can report ADEs. In fact, the establishment of such a reporting system is a key element in
hospital accreditation evaluations. The JCAHO medication management standard MM.6.20 also
requires that the hospital respond appropriately to actual or potential adverse drug events that are
reported.

Students should refer to their individual pharmacy preceptors within institutions for their procedures.

                                             Drug Triggers

Although pharmacists tend to be the lead reporters of adverse drug events within institutions they may not
be one witnessing the event. However, there sometimes are ―triggers‖ in a patient medication profile that
may indicate that an ADR has occurred.

―Triggers‖ are surrogate markers suggesting that some unfavorable outcome has occurred with a drug
therapy. One of the simplest ways to identify triggers is to review a patient's medication profile and
search for any drugs that were recently or abruptly discontinued. Although there are many reasons why a
drug might have been discontinued, at least one possibility is that the patient experienced an ADR.

Clinicians also can review a patient's medication profile and look for any new allergies that have been
added to the patient's history. For example, if someone is listed as ―no known drug allergies‖ (NKDA)
upon hospital admission, but then a new drug allergy is added to the patient's chart during the
hospitalization, that would suggest that an adverse event may have occurred, such as an allergic reaction
to a prescribed drug. Similarly, a review of the patient's medication profile may reveal new orders for
medications that are antidotes or alternative therapies, which also may suggest that an ADR has occurred.
(see table 2)




Temple University School of Pharmacy                                                            34
Table 2: Drug “Triggers”
New medication                   Potential reason for new drug being added
antihistamines                   Allergic reactions
atropine                         Drug-induced bradycardia
aztreonam                        Allergic reaction to beta lactam antibiotics
benztropine                      Drug-induced extra-pyramidal ADRs from neuroleptics
corticosteroids                  Allergic reactions
cyproheptadine                   Serotonin syndrome
dantrolene IV                    Neuroleptic malignant syndrome
dextrose 50%                     Drug-induced hypoglycemia
digoxin immune Fab               Digoxin toxicity
flumazenil                       Benzodiazepine overdose
epinephrine                      Anaphylaxis
filgrastim                       Drug-induced neutropenia
lepirudin; argatroban            Heparin-induced thrombocytopenia
naloxone                         Opiate overdose
n-acetyl cysteine (oral or IV)   Acetaminophen overdose
phytonadione (Vitamin K)         Warfarin-induced coagulopathy and hypoprothrombinemia
protamine sulfate                Over-anticoagulation with heparin
sodium polystyrene               Drug-induced hyperkalemia
oral vancomycin                  Antibiotic-associated diarrhea from Clostridium difficile

Preventability Analyses and Prevention Efforts
Once an event has been identified as an ADR (and, hopefully, reported to the appropriate organizations),
students with their preceptors may wish to conduct an analysis that will help determine whether is was
potentially preventable. Several questions can be asked to help determine preventability:

    1. Was the drug involved in the ADE inappropriate for the patient‘s clinical condition, or was it
       contraindicated?
    2. Were the dose, route, and frequency of administration inappropriate for the patient‘s weight, renal
       function, or disease state?
    3. Were there lapses or other problems with required therapeutic drug monitoring or necessary
       laboratory tests?
    4. Did the patient have a history of allergy or previous reaction to the drug?
    5. Was there a drug interaction involved in the event?
    6. Did the event involve poor patient compliance with prescribed therapies, or did the patient exhibit
       knowledge deficits regarding their drug therapy?

This analysis stage is often the most difficult barrier for healthcare workers to overcome, as the results
may reveal the iatrogenic aspect of adverse events. Most preventable ADRs actually represent
medication error.

Individual practice settings may have their own forms/methods for reporting ADRs, but listed below is a
sample form that includes all information for proper ADR reporting and analysis.




Temple University School of Pharmacy                                                             35
                                   Sample ADR Reporting Form

Patient Name/Identifier _________________________________________________________
Age _____            Gender_______ Weight____________ Height ___________________
ADR reaction onset date ____________ Date of Hospital Admission ___________________
Primary Diagnosis _____________________________________________________________
Pre-existing Conditions/Past Medical History ______________________________________
Allergy History ________________________________________________________________
Attending Physician or Prescriber________________________________________________
Name of Reporter ______________________________________________________________

Suspect Drug or Drugs [include dose, route, frequency, start and stop dates)




Reaction Type based on Organ System:

Reaction: ______________________            Organ System: ____________________
Reaction: ______________________            Organ System: ____________________
Reaction: ______________________            Organ System: ____________________

Reaction Sequence History/Narrative:




Objective Findings (Physical Exam/Laboratory, et al.):




Concomitant Drug Therapies (include OTC, folk/herbal remedies):




If causality determination is needed; assess by Naranjo Scale
Score: ______________________ Causality___________________




Temple University School of Pharmacy                                            36
     Inpatient Clinical Advanced Pharmacy Practice Experience Rotation Requirements

I.        Student Responsibilities for Patient Care
          A. Attend and actively participate in rounds or clinics. You are expected to be an active
              member of your health care team. If you identify a drug-related problem, you should
              discuss the problem and potential solutions with the resident responsible for that
              patient. Utilize the method for monitoring patients described under Practice Guideline
              1. (See page 15) This method will help you to collect and to organize data to identify
              and solve drug-related problems.

           B. Conduct a medication history on any patient with a confusing or complicated
              medication regimen.

           C. Maintain a complete patient monitoring form for each patient that you are following..
              You are expected to write/present a daily SOAP note for each patient‘s active drug-
              related problems.

           D. Check the medication administration record to insure that all medications are being
              administered properly, especially for patients in the following situations:

           i.     Patients with drug levels that are being ordered.
           ii.    Patients who appear to have a toxic reaction to a medication.
           iii.   Patients who do not appear to be responding to the medication regimen.
           iv.    Insure that every patient is discharged on medications covered by their insurance plan.
           v.     Insure that each patient that you are monitoring knows how to take their medications
                   and has no obstacles (physical, psychological, economic) to being compliant with their
                   medication regimen.

           E. Document all significant patient interventions using the tool(s) used at the
              hospital/clinic that you are assigned. For students at sites where interventions are
              documented on paper a ―Documentation of Intervention Form‖ has been provided in
              your manual. Additional copies can be obtained on the APPE Blackboard site.
              Student interventions are used to help document the value added to patient care by our
              students.

           F. Accurately answer any questions relating to medications that arise on your medical
              service, and document this activity on the Drug Information Intervention Form. Return
              the documentation forms to your preceptor at the end of the rotation.

           G. Identify and report adverse drug reactions (ADR) that occur in any of your patients.
                  Complete an ADR report (forms available in the Drug Information Center or online at
                  http://www.fda.gov/medwatch/getforms.htm).




     Temple University School of Pharmacy                                                            37
II.         Specific Assignments

               A. Complete the student section of the Longitudinal Evaluation of Educational Outcomes
                  Form at the end of every rotation.

               B. Complete the student portion of the Clinical Advanced Pharmacy Practice Experience
                  Student Evaluation Form at the end of the first week of the rotation so that you and
                  your preceptor can develop an educational plan to help you achieve the outcomes for
                  the rotation..

               C. Be prepared to verbally present and discuss your patients to the faculty preceptor
                  during case conferences.

               D. For inpatient rotations: Maintain a complete patient monitoring form for each patient
                  that you are following.

               E. Write a minimum of one SOAP note per rotation

               F. Complete one patient related written assignment each week (five written assignments
                  in addition to the SOAP note). Your preceptor will determine the type of written
                  assignments most applicable to their rotation site. Types of written assignments could
                  include, but are not limited to:

                                      SOAP notes
                                      Consult notes
                                      Drug information response
                                      Pharmacy Care Plan
                                      Documentation of MTM activities
                                      Other type of written assignment

               G. One Journal Club Present one current research article from the medical literature in
                  (See Practice Guideline 3 on page 26).

               H. Present one In-Service Lecture (See Practice Guideline 4 on page 29)

               I.   Report or analyze one Adverse Drug Reaction. (See Practice Guideline 5 on page 33)

               J. Complete a Pharmacy Intervention Form to document all significant patient
                     interventions.

               k. Upload designated assignments in eportfolio.

III.        Conference Attendance

               A. Meet regularly (minimum 3 times/week) with your faculty preceptor and be prepared
                  to present and discuss your patients' therapeutic problems.

               B. Attend Grand Rounds and other appropriate educational conferences at the hospital or
                  clinic.




       Temple University School of Pharmacy                                                         38
IV.        Preceptor Responsibilities
              A. Meet with students on a regular basis to discuss patients.

              B. Serve as a resource for students, guiding them in finding solutions to drug related
                 problems. The faculty preceptor is not responsible to answer questions for students,
                 but is available to help students find answers on their own.

              C. Attend scheduled conferences during which your students are presenting.

              D. Complete the Clinical Advanced Pharmacy Practice Experience Student Evaluation
                 Form.

              E. Complete the Longitudinal Competency Achievement Form (see page 12-14) at the
                 end of the rotation. Return this to the student who will carry this to the next rotation.

              F. Grade weekly write-ups and assess student performance in a timely manner.

              G. Return completed and signed evaluation forms to the Office of Experiential Education
                 at the end of the rotation.

V.         Grading

                 The Inpatient Clinical Advanced Pharmacy Practice Experience is graded using the
                 following scale (A, A-, B+, B, B-, C+, C, C-, D+, D, D- and F). The faculty
                 preceptor will review the goals, objectives, and student responsibilities with the
                 student at the start of the rotation. The student will be evaluated using the evaluation
                 forms listed below. Evaluations may be formatted differently but the content is the
                 same. Students should notify the Office of Experiential Education if they are not
                 receiving feedback on their performance in a timely manner. Student grades are
                 derived in the following manner:

                                  Assignment                           % of Grade

                       Advanced Pharmacy Practice                             60
                       Evaluations
                       Journal Club                                           10
                       In-Service Lecture                                     15
                       Documentation                                          15




      Temple University School of Pharmacy                                                            39
                                      Sample Data Collection Card
 Name:                         Room: ______     DOA: / /         DOB: / /                            Age:      Sex:
 Ht: ____ TBW:             IBW: ____kg          Insurance: ___________________                 Pharmacy: __________________

 CC:
                                                                         SHx: ( ) Tob                   PE (admission):
 HPI:                                                                         ( ) EtOH
                                                                              ( ) IVDA

 PMH:
 ________________________       ________________________                 FH:
 ________________________       ________________________
 ________________________       ________________________
 ________________________       ________________________                 Admission Vitals: BP___ HR:__              RR: _       T:
 ________________________       ________________________                  _____
                                                                                               Microbiology
 Allergies/ADRs:                                                          Date    Source      Organism              Sensitivities


 Meds PTA:
 ________________________       ________________________
 ________________________       ________________________
 ________________________       ________________________
 ________________________       ________________________
 ________________________       ________________________
 ________________________       ________________________



 Hospital Course/Labs:                  Follow up on:            Labs:
                                                                                Adm




Date:                                                          Date
                                                              Temp
                                                              BP
                                                              HR
                                                              RR
                                                              Pain Score
                                                               Na
Date:                                                         K
                                                              Cl
                                                              CO2
                                                              BUN
                                                              SCr
                                                              Glucose
                                                               CrCl
                                                               Ca
Date:                           
                                                               P04
                                                              Mg
                                                              WBC
                                                              MCV
                                                              Hgb
                                                              Hct
                                                               PLT
Date:                                                         Bands
                                                              Lymph
                                                              Gran
                                                               Eos
                                
                                                               PT
                                
                                                               INR
                                
                                                               PTT
                                                               Alb
                                                               TB/ DB
                                                               Alk Phos
                                                               ALT
        Temple University School of Pharmacy                  AST                                                40
                                                                                      Micro:
                Temple University School of Pharmacy Documentation of Interventions Form

  Student Name: ____________________________________                           Preceptor Name: ________________________________________

  Rotation Date: ____________________________________                          Rotation Type/Site: _____________________________________

                                                                                                                          Recommended
            Intervention              Brief description of the                Recommendation/Answer and                   to: MD/DO, RN,          Accepted?
 Date
                Type                  Intervention/Question                         Action taken                        RPh, patient, other HC       Time?
                                                                                                                              provider?

                                                                                                                                                    Yes/No
                                                                                                                                                   _____min



                                                                                                                                                    Yes/No
                                                                                                                                                   _____min



                                                                                                                                                    Yes/No
                                                                                                                                                   _____min


Intervention Types:
(1)Drug allergy (2)Appropriate therapy (3)Chart/Medication review (4)Dose issue/question (5)Drug interaction (6)Duplicate therapy (7)IV to PO (8)Formulary issue
(9)Adverse Drug Reaction (10)Med error (11)Drug Info Question (12)Medication reconciliation (13)Medication history (14)Patient counseling (15)Contraindication




  Temple University School of Pharmacy                                                               41
                                                                                                                           Recommended
               Intervention              Brief description of the                Recommendation/Answer and                 to: Preceptor,        Accepted?
   Date
                   Type                  Intervention/Question                         Action taken                        MD, RN, RPh,         Time spent?
                                                                                                                               other?

                                                                                                                                                    Yes/No
                                                                                                                                                  _____min



                                                                                                                                                    Yes/No
                                                                                                                                                  _____min




                                                                                                                                                    Yes/No
                                                                                                                                                  _____min




                                                                                                                                                    Yes/No
                                                                                                                                                  _____min




                                                                                                                                                    Yes/No
                                                                                                                                                  _____min

Intervention Types:
(1)Drug allergy (2)Appropriate therapy (3)Chart/Medication review (4)Dose issue/question (5)Drug interaction (6)Duplicate therapy (7)IV to PO (8)Formulary issue
(9)Adverse Drug Reaction (10)Med error (11)Drug Info Question (12)Medication reconciliation (13)Medication history (14)Patient counseling (15)Contraindication

  Temple University School of Pharmacy                                                               42
                                         In-Service Presentation Evaluation Form

   Name:______________________________________________Date:_______________________

   Title of Presentation:_____________________________________________________________

                             Needs                                                         Competent/
                          Improvement             Developing          Competent            Exemplary         Score        Grade


    Topic                       [0]                   [1]                 [2]                   [3]



                                                                                         The topic
                                                                                         discussed met all
                                                                                         criteria
                                                                                         including: 1)
                                                                                         suitable for this
                                                                                         assignment
                                                                                         2) appropriate
                                                                                         for the audience
                                                                                         3) focused
                                                                                         enough to be
                                                                                         adequately
                         Missing three                             Missing one           covered in the
                         criteria             Missing 2 criteria   criteria              time allotted.
       Introduction -             [0]                 [1]                                         [2]
          Purpose

                         The purpose/goal     The purpose/goal                           The purpose/goal
                         was not stated.      was not clearly                            was clearly
                                              stated.                                    stated.

     Introduction: The          [0]                                       [1]                   [2]
           Hook

                         The speaker did                           The speaker           An effective
                         not try to engage                         attempted to          strategy was
                         the audience‘s                            engage the            used to get the
                         interest in the                           audience's            audience
                         topic OR The                              interest in the       interested in the
                         speaker used an                           topic, but was        topic being
                         inappropriate or                          not completely        discussed.
                         insensitive                               successful.
                         strategy to engage
                         the audience‘s
                         interest




     Content/Knowledge          [0 ]                 [2-4 ]               [8 ]                 [10 ]



                         Presenter did not    Information          Presenter was         The presenter
                         demonstrate a        presented was too    knowledgeable,        was very
                         clear                superficial.         but needed a          knowledgeable
                         understanding of                          little more detail    about the topic
                         the topic being                           or provided so        and covered the
                         discussed.                                much                  subject in
                                                                   information that      appropriate
                                                                   it was difficult to   depth.
                                                                   follow.




Temple University School of Pharmacy                                                                                43
     Content – Accuracy            [0]                   [0]                  [3]                 [5]
                                                                                                               Score        Grade

                           > one                                        Most               All information
                           misconception or                             information        was accurate
                           inaccurate                                   accurate, one
                           information                                  minor
                           presented during                             misconception.
                           lecture.


      Content- Sources             [0]                   [1]                  [2 ]                [4 ]



                           Unable to            Supported               Used references,   Utilized
                           identify sources     information from a      but missed a key   appropriate, up-
                           for information      reliable source(s),     source providing   to-date
                           OR sources are       but did not use         relevent           references from
                           not reliable         enough references       information on     reliable sources
                                                for the topic.          the topic.         to prepare
                                                                        information.       presentation




     Research Articles -           [0]                   [2]                  [4]                 [6]
       Summary and
         Annalysis
                           Missing all or       Missing all or part     Missing all or     The presenter
                           part of 3 criteria   of 2 criteria           part of 1          accurately
                           or did not                                   criteria.          1) summarized
                                                                                           the purpose of
                                                                                           the study, the
                                                                                           primary and/or
                                                                                           secondary
                                                                                           outcomes,
                                                                                           methods, results
                                                                                           and conclusion
                                                                                           in adequate
                                                                                           detail. 2)
                                                                                           identified
                                                                                           strengths and
                                                                                           weaknesses of
                                                                                           the trial(s)
                                                                                           3) Explained
                                                                                           clinical
                                                                                           relevance


        Conclusion                 [0]                   [2]                                      [5 ]



                           The presentation     There was a                                 A clear
                           did not have a       conclusion, but it                         conclusion was
                           conclusion           did not include a                          presented that
                                                summary of key                             summarized the
                                                points and/or did                          key points and
                                                not reflect the                            was supported
                                                information                                by the
                                                presented during                           information
                                                the body of the talk.                      presented in the
                                                                                           body of the talk.




Temple University School of Pharmacy                                                                                  44
     Questions- Answer              [0 ]                   [2 ]                  [4 ]                 [6 ]
                                                                                                                    Score        Grade

                            Unable to answer       Unable to answer       Answers              Answers
                            questions and or       one question OR        questions            questions clearly
                            tries to bluff one     the answers to         correctly, but       and concisely.
                            or more answers.       questions are          needs to be more     When necessary
                                                   confusing.             concise.             elaborates on
                                                                                               answer.


        Organization                [0 ]                   [1 ]                  [3 ]                 [5 ]



                            Audience cannot        The presentation is    Presents             All concepts
                            understand             difficult to follow    information in a     were presented
                            presentation           because the            logical sequence.    in a logical
                            because there is       presenter jumps        Need to improve      interesting
                            no clear sequence      around or does not     transitions          manner with
                            of information         present information    between              smooth
                                                   in a logical           concepts and/or      transitions
                                                   sequence or does       integrating slides   between
                                                   not transition         and/or handout       concepts. Slides
                                                   smoothly from one      into the             and handout
                                                   topic to the next.     presentation         integrated into
                                                                                               presentation.
          Handout                   [0 ]                   [2 ]                  [6 ]                 [8 ]


                            Did not have a         Handout was either:    Missing one          Will be a useful
                            handout or the         Too superficial,       element              resource on this
                            handout was a          disorganized or        described under      subject. Provides
                            deficit to the         contained              proficient.          accurate
                            presentation.          inaccurate                                  information in an
                                                   information.                                organized easy
                                                                                               to follow
                                                                                               manner.
                                                                                               Contained tables,
                                                                                               charts
                                                                                               illustrations that
                                                                                               helped clarify
                                                                                               concepts.
                                                                                               Presenter utilized
                                                                                               handout
                                                                                               effectively
                                                                                               References cited
                                                                                               correctly

     Spelling/Grammar/              [0 ]                   [1 ]                  [2 ]                 [4]
        Punctuation


                                > 3 errors          3 errors identified      1-2 errors        No errors in the
                             identified in the       in the handout.      identified in the    handout
                                handouts.                                     handout

     Presentation- Style-           [0]                    [2]                   [3]                  [5]
        Elocution and
       Professionalism


                            All criteria in this   Two criteria need      One criteria         Spoke at an
                            category need to       improvement            needs                appropriate pace,
                            be improved.                                  improvement.         in a clear voice
                                                                                               that can be heard
                                                                                               by the
                                                                                               participants, and
                                                                                               pronounces
                                                                                               words correctly.
                                                                                               Looks and acts
                                                                                               professional


Temple University School of Pharmacy                                                                                       45
     Presentation – Eye          [0 ]                [1 ]                   [2]                 [4]
          Contact                                                                                             Score        Grade

                          Does not attempt   Read notes, looked      Read notes,         Consistently
                          to look at         at monitor or slides    looked at           looks at the
                          audience at all,   25-50% of the time      monitor or slides   audience without
                          read notes or                              < 25% of the        focusing on one
                          monitor the                                time                individual or
                          majority of the                                                group.
                          time


          Timing                 [0]                  [0]                   [1]                 [3]



                           Presentation is                            Presentation is    Presentation falls
                              too short                                  too long            within the
                                                                                           required time
                                                                                               frame
           Slides                [0]                  [1]                   [3]                  [4]


                          Slides detracted   Slides were difficult   Missing one         Enhanced
                          from the           to read or were         element             audience
                          presentation.      mostly word slides      described under     understanding of
                                             containing the same     proficient and/or   the material.
                                             information as in       used animations     Slides were well
                                             the handout.            that were           designed, and
                                                                     distracting.        easy to read
                                                                                         Used pictures to
                                                                                         help clarify
                                                                                         complex
                                                                                         concepts or to
                                                                                         show/analyze
                                                                                         data. Used
                                                                                         animations
                                                                                         effectively.
                                                                                         Material
                                                                                         properly
                                                                                         referenced




Temple University School of Pharmacy                                                                                 46
                               Journal Club Evaluation: Observational Study

        Student’s Name:_____________________________________Date:_______________

        Evaluator:______________________________________________________________

        Journal Article Title:______________________________________________________

        Overview: Defined               [0]            [1]              [2]
           rationale for
         conducting the         Did not         Discussed in     Discussed in
         research study.        discuss         detail with      detail without
                                                some             inaccuracies
                                                inaccuracies
            Overview:.                  [0]            [1]              [2]
         Correctly defined
           primary and          Did not         Discussed in     Discussed in
            secondary           discuss         detail with      detail without
        objective(s) of the                     some             inaccuracies
               study                            inaccuracies
            Overview:                   [0]            [1]              [2]
        Correctly identified
                                Did not         Identified       Identified all
           the outcome
                                discuss         some, but not    outcome
            parameters
                                                all outcome      parameters.
                                                parameters.
            Overview:                   [0]            [2]
        Correctly identified
         the type of study      Did not         Identified the
                                identify the    type of study
                                type of study
             Overview:                 [0]             [1]              [2]
        Correctly identified
         the inclusion and
         exclusion criteria     Did not         Discussed in     Discussed in
                                discuss         detail with      detail without
                                                some             inaccuracies
                                                inaccuracies
            Overview:                   [0]            [2]
         Correctly defined
                                Did not         Correctly
         the study setting
                                discuss         defined the
                                                study setting.
             Overview:                  [0]            [1]              [2]
             Correctly
           discussed the        Did not         Discussed in     Discussed in
           results of the       discuss         detail with      detail with no
               study                            some             inaccuracies
                                                inaccuracies
             Methods:           [0]             [2]              [3]              [4]
          Assessed if the
         study design was       Not discussed   Superficial      Discussed in     Discussed in
           a strength or                        discussion or    detail with      detail with no
            weakness in                         major            minor            inaccuracies
          determining the                       inaccuracies     inaccuracies
         primary objective



Temple University School of Pharmacy                                                       47
                                        [0]          [2]             [3]             [4]
             Methods:
           Assessed the        Not discussed   Superficial     Discussed in   Discussed in
        appropriateness of                     discussion or   detail with    detail with no
             the drugs                         major           minor          inaccuracies
          evaluated in the                     inaccuracies    inaccuracies
                study
        Methods:Assessed                [0]          [2]             [3]             [4]
            if outcome
        measures for each      Not discussed   Superficial     Discussed in   Discussed in
         objective are well                    discussion or   detail with    detail with no
            defined and                        major           minor          inaccuracies
            appropriate                        inaccuracies    inaccuracies
        Methods:Assessed                [0]          [2]             [3]             [4]
        power of the study
                               Not discussed   Superficial     Discussed in   Discussed in
                                               discussion or   detail with    detail with no
                                               major           minor          inaccuracies
                                               inaccuracies    inaccuracies
             Methods:                   [0]          [2]             [3]             [4]
          Evaluated the
         statistical tests     Not discussed   Superficial     Discussed in   Discussed in
        used in the article                    discussion or   detail with    detail with no
                for                            major           minor          inaccuracies
         appropriateness                       inaccuracies    inaccuracies
        Results: Assessed               [0]          [2]             [3]             [4]
           the baseline
          characteristics      Not discussed   Superficial     Discussed in   Discussed in
                                               discussion or   detail with    detail with no
                                               major           minor          inaccuracies
                                               inaccuracies    inaccuracies
        Results: Assessed               [0]          [2]             [3]             [4]
          if results were
                               Not discussed   Superficial     Discussed in   Discussed in
        reported for each
                                               discussion or   detail with    detail with no
        outcome measure
                                               major           minor          inaccuracies
                                               inaccuracies    inaccuracies
        Results: Identified             [0]          [2]             [3]             [4]
              potential        Not discussed   Superficial     Discussed in   Discussed in
           confounding                         discussion or   detail with    detail with no
          variables and                        major           minor          inaccuracies
         assessed their                        inaccuracies    inaccuracies
          impact on the
           study results
        Results: Assessed               [0]          [2]             [3]             [4]
          if the adverse       Not discussed   Superficial     Discussed in   Discussed in
             effects of                        discussion or   detail with    detail with no
         treatment were                        major inaccu    minor          inaccuracies
          systematically                       racies          inaccuracies
         monitored and
              reported

        Results: Assessed               [0]          [2]             [3]             [4]
            if patients’
           adherence to
           therapy was
          systematically
         monitored and
              reported
Temple University School of Pharmacy                                                      48
                                        [0]          [2]             [3]             [4]
            Conclusion:        Not discussed   Superficial     Discussed in   Discussed in
          Assessed if the                      discussion or   detail with    detail with no
           study findings                      major           minor          inaccuracies
            supports the                       inaccuracies    inaccuracies
             conclusion
            Conclusion:                 [0]          [2]             [3]             [4]
           Evaluated the
        clinical usefulness    Not discussed   Superficial     Discussed in   Discussed in
         of the study and                      discussion or   detail with    detail with no
        how it may impact                      major           minor          inaccuracies
        pharmacy practice                      inaccuracies    inaccuracies
            Conclusion:                 [0]          [2]             [3]             [4]
        Assessed how the
           data from the       Not discussed   Superficial     Discussed in   Discussed in
            study can be                       discussion or   detail with    detail with no
            applied to an                      major           minor          inaccuracies
         expanded patient                      inaccuracies    inaccuracies
             population
            Conclusion:                 [0]          [2]             [3]             [4]
           Assessed the
        potential impact of    Not discussed   Superficial     Discussed in   Discussed in
             sponsor or                        discussion or   detail with    detail with no
            funding bias                       major           minor          inaccuracies
                                               inaccuracies    inaccuracies
            Conclusion:                 [0]          [2]             [3]             [4]
        Discussed if there
          is anything that     Not discussed   Superficial     Discussed in   Discussed in
         could be done to                      discussion or   detail with    detail with no
             potentially                       major           minor          inaccuracies
        improve the study                      inaccuracies    inaccuracies




Temple University School of Pharmacy                                                      49
                       Journal Club Evaluation: Randomized Controlled Trials


        Student’s Name:_____________________________________Date:______________

        Evaluator:_____________________________________________________________

        Journal Article Title:____________________________________________________


         Overview: Defined              [0]           [1]               [2]
            rationale for
          conducting the        Did not         Discussed in     Discussed in
          research study.       discuss         detail with      detail without
                                                some             inaccuracies
                                                inaccuracies
             Overview:.                 [0]            [1]              [2]
          Correctly defined     Did not         Discussed in     Discussed in
            primary and         discuss         detail with      detail without
             secondary                          some             inaccuracies
         objective(s) of the                    inaccuracies
                study
             Overview:                  [0]           [1]               [2]
         Correctly identified
                                Did not         Identified       Correctly
            the outcome
                                discuss         some, but not    identified all
             parameters
                                                all outcome      outcome
                                                parameters       parameters
             Overview:                  [0]           [1]
         Correctly identified   Did not         Identified the
          the type of study     identify the    type of study
                                type of study
              Overview:                [0]            [1]               [2]
         Correctly identified
          the inclusion and     Did not         Identified       Correctly
          exclusion criteria    discuss         some, but not    identified all
                                                all inclusion    inclusion and
                                                and exclusion    exclusion
                                                criteria OR      criteria
                                                incorrectly
                                                identified a
                                                criteria
             Overview:                  [0]             [2]
          Correctly defined
                                Did not         Correctly
          the study setting
                                discuss         defined the
                                                study setting
              Overview:                 [0]           [1]               [2]
         Correctly identified
          the intervention      Did not         Explained the    Correctly
            and blinding        discuss         intervention     explained the
             techniques                         and blinding     interventions
                                                techniques       and blinding
                                                with minor       techniques.
                                                inaccuracies



Temple University School of Pharmacy                                             50
              Overview:                 [0]           [1]             [2]
              Correctly
            discussed the       Did not         Discussed in    Discussed in
            results of the      discuss         detail with     detail without
                study                           some            inaccuracies
                                                inaccuracies

               Methods:                 [0]           [2]             [3]              [4]
           Assessed if the      Not discussed   Superficial     Discussed in     Discussed in
         study design was                       discussion or   detail with      detail with no
             a strength or                      major           minor            inaccuracies
             weakness in                        inaccuracies    inaccuracies
           determining the
         primary objective
               Methods:                 [0]           [2]             [3]              [4]
            Evaluated the
            inclusion and       Not discussed   Superficial     Discussed in     Discussed in
          exclusion criteria                    discussion or   detail with      detail with no
           as they apply to                     major           minor            inaccuracies
           the selection of                     inaccuracies    inaccuracies
         appropriate study
                patients
         Methods:Assessed               [0]           [2]             [3]              [4]
            if the blinding
          techniques were       Not discussed   Superficial     Discussed in     Discussed in
          adequate to limit                     discussion or   detail with      detail with no
            observer bias                       major           minor            inaccuracies
                                                inaccuracies    inaccuracies
         Methods:Assessed               [0]           [2]             [3]              [4]
                  the
         appropriateness of     Not discussed   Superficial     Discussed in     Discussed in
              the drugs                         discussion or   detail with      detail with no
           evaluated in the                     major           minor            inaccuracies
                 study                          inaccuracies    inaccuracies
         Methods:Assessed               [0]           [2]             [3]              [4]
             if outcome
         measures for each      Not discussed   Superficial     Discussed in     Discussed in
          objective are well                    discussion or   detail with      detail with no
             defined and                        major           minor            inaccuracies
             appropriate                        inaccuracies    inaccuracies
         Methods:Assessed               [0]           [2]             [3]              [4]
         power of the study     Not discussed   Superficial     Discussed in     Discussed in
                                                discussion or   detail with      detail with no
                                                major           minor            inaccuracies
                                                inaccuracies    inaccuracies
             Methods:                   [0]           [2]             [3]              [4]
           Evaluated the
          statistical tests                                     Discussed in     Discussed in
         used in the article    Not discussed   Superficial     detail with      detail with no
                 for                            discussion or   minor            inaccuracies
          appropriateness                       major           inaccuracies
                                                inaccuracies

         Results: Assessed            [0]             [2]              [3]              [4]
           the baseline         Not discussed   Superficial     Discussed in     Discussed in
          characteristics                       discussion or   detail with      detail with no
                                                major           minor            inaccuracies
                                                inaccuracies    inaccuracies

Temple University School of Pharmacy                                                        51
         Results: Assessed if           [0]              [2]             [3]                 [4]
            results were
          reported for each       Not discussed   Superficial     Discussed in        Discussed in
          outcome measure                         discussion or   detail with minor   detail with no
                                                  major           inaccuracies        inaccuracies
                                                  inaccuracies

          Results: Identified           [0]              [2]             [3]                 [4]
              potential
                                  Not discussed   Superficial     Discussed in        Discussed in
            confounding
                                                  discussion or   detail with minor   detail with no
            variables and
                                                  major           inaccuracies        inaccuracies
           assessed their
                                                  inaccuracies
         impact on the study
               results


         Results: Assessed if           [0]              [2]             [3]                 [4]
          the adverse effects
           of treatment were      Not discussed   Superficial     Discussed in        Discussed in
            systematically                        discussion or   detail with minor   detail with no
            monitored and                         major           inaccuracies        inaccuracies
                reported                          inaccuracies

         Results: Assessed if           [0]              [2]             [3]                 [4]
         patients’ adherence
           to therapy was         Not discussed   Superficial     Discussed in        Discussed in
           systematically                         discussion or   detail with minor   detail with no
           monitored and                          major           inaccuracies        inaccuracies
               reported                           inaccuracies

             Conclusion:                [0]              [2]             [3]                 [4]
            Assessed if the
            study findings        Not discussed   Superficial     Discussed in        Discussed in
             supports the                         discussion or   detail with minor   detail with no
              conclusion                          major           inaccuracies        inaccuracies
                                                  inaccuracies

              Conclusion:               [0]              [2]             [3]                 [4]
             Evaluated the
         clinical usefulness of   Not discussed   Superficial     Discussed in        Discussed in
         the study and how it                     discussion or   detail with minor   detail with no
               may impact                         major           inaccuracies        inaccuracies
          pharmacy practice                       inaccuracies

             Conclusion:                [0]              [2]             [3]                 [4]
          Assessed how the
         data from the study      Not discussed   Superficial     Discussed in        Discussed in
         can be applied to an                     discussion or   detail with minor   detail with no
          expanded patient                        major           inaccuracies        inaccuracies
             population                           inaccuracies

             Conclusion:                [0]             [2]              [3]                 [4]
            Assessed the
          potential impact of     Not discussed   Superficial     Discussed in        Discussed in
          sponsor or funding                      discussion or   detail with         detail with no
                 bias                             major           minor               inaccuracies
                                                  inaccuracies    inaccuracies
             Conclusion:                 [0]             [2]              [3]                 [4]
         Discussed if there is    Not discussed   Superficial     Discussed in        Discussed in
         anything that could                      discussion or   detail with minor   detail with no
             be done to                           major           inaccuracies        inaccuracies
         potentially improve                      inaccuracies
              the study.




Temple University School of Pharmacy                                                              52
Evaluation of Clinical Documentation/Interventions

Evaluate each of the activities using the following scale.


                                                                2               3            4
                                                      1
Activity                                                                                  Always
                                                    Never     Rarely        Frequently
                                                                    (Circle One)
1. Interventions are preformed in a timely
                                                       1        2                  3          4
   manner
2. Prioritizes interventions based on
                                                       1        2                  3          4
   significance
3. Displays appropriate follow up on
                                                       1        2                  3          4
   interventions
4. Communicates interventions to preceptor
                                                       1        2                  3          4
   prior to making recommendation
5. Uses appropriate communication skills
                                                       1        2                  3          4
   when making interventions

6. Interventions are documented properly               1        2                  3          4


Percent Conversion
   Score       % Score        Score     % Score       Score   % Score          Score     % Score
     6           25            11         46           16       67              21          88
     7           29            12         50           17       71              22          92
     8           33            13         54           18       75              23          96
     9           38            14         58           19       79              24         100
                  42           15          63           20      83


Comments:




Temple University School of Pharmacy                                                    53
                              APPE Patient Counseling Evaluation Form

       Name:______________________________________________Date:_______________

         CRITERIA                 NOT MET              PARTIALLY MET           COMPLETELY MET
                                    [0]                      [3]                     [5]


                                                                              Introduced yourself by
                                                                              stating your name and
                                                                              that you are a
                                                                              Pharmacy Student.
         Introduction                                 Introduced              Conducts counseling
                                                      yourself, but did       session in a
                            Did not introduce         not state that you      professional manner.
                            yourself and/or           are a pharmacy          Addresses the patient
                            conducted                 student, and/or one     by Mr/Mrs; dressed
                            interview in an           aspect of               appropriately and
                            unprofessional            interaction was         wearing a clean lab
                            manner.                   unprofessional.         coat.
                                        [0]                    [3]                      [5]
                            Displays any two of       Displays one of the     Displays appropriate
                            the following             following nonverbal     nonverbal behaviors
                            nonverbal behaviors:      behaviors: Poor eye     throughout the patient
                            Poor eye contact:         contact: Speaking       interaction including
                            Speaking too loudly       too loudly or softly;   appropriate: eye
         Communication      or softly; Too close      Too close or far from   contact; voice level;
         Skills:            or far from the           the patient; Body       personal distance; body
         Nonverbal          patient; Body             language was            language
         Behaviors          language was              unprofessional;
                            unprofessional;           indicated lack of
                            indicated lack of         interest or empathy;
                            interest ; appeared       appeared
                            uncomfortable when        uncomfortable when
                            interacting with the      interacting with the
                            patient.                  patient.

                                        [0]                    [3]                      [5]
                             Spoke to the patient     Explanation contains           Effectively
                              in terms that were       some terminology            communicates
         Communication
                               too difficult or too   that is inappropriate     information utilizing
             Skills:
                                   simplistic.         for a lay person or     appropriate lay person
          Terminology
                            Instructions were not          some of the            terminology and
                                      clear.             instructions are       instructions that are
                                                            confusing.          easy to understand.

                                        [0]                    [3]                      [5]


         Communication       Does not use open-        Uses some open-        Consistently uses open-
         Skills: Question     ended questions.         ended questions          ended questions to
              format                                                            direct conversation.




Temple University School of Pharmacy                                                          54
                                        [0]                  [3]                       [5]
         Communication
                               Does not verify        Partially verifies        Verifies patient
              Skills:
                                   patient                 patient            understanding at the
          Verification of
                             understanding at the   understanding at the       conclusion of the
             Patient
                              conclusion of the      conclusion of the        counseling session.
         Understanding
                             counseling session.    counseling session.

                                        [0]                  [3]                       [5]


                                                    Does not
         Communication                              consistently display
         Skills: Empathy    Does not dispaly        empathy                 Displays empathy for
                            empathy during the      throughout the          the patient throughout
                            counseling              counseling              the counseling
                            session.                session.                session.
                                        [0]                  [3]                       [5]
                             Missing two or more        Missing one          Verifies the following
         Assessment:
                             components of the        component of the        components of the
         Patient History
                               patient history.        patient history.      Patient History: PMH
                                                                               SH FH Lifestyle
                                        [0]                  [3]                       [5]
                            Does not obtain a       Asks about              Completely verifies
         Assessment:
                            history about           allergy/ADRs history,   allergy/ADRs history.
         Allergies/ADR
                            allergies/ADRs.         but does not follow-
                                                    up completely.
                                        [0]                  [3]                       [5]
                            Forgets to ask about    Asks about              Conducts a complete
                            prescription            prescription            medication history
                            medications and/or      medications, but        including:
         Assessment:        forgets to ask about    forgets to ask about    - prescription
         Medication         2 or more other         one other category of   medications - OTC
         History            category of             medications             medications        -
                            medications.                                    Herbal agents
                                                                            - Nutritional
                                                                            supplements -
                                                                            Immunizations
                                        [0]                  [3]                        [5]
         Assessment:
                            Does not assess         Assessed adherence      Assesses medication
         Medication
                            adherence.              for most medications.   adherence for all
         Adherence
                                                                            medications.
                                        [0]                  [3]                       [5]
                            Does not state the      Identifies all          Identifies all medications
         Communication      name of one or more     medications, but        by the generic and
         of Information -
                            medications             does not include both   brand name of the
         Name of
                                                    generic and brand (if   medication.
         Medication
                                                    applicable) name for
                                                    all medications.

                                        [0]                  [3]                       [5]
         Communication
         of Information:    Does not identify       Does not identify
         Indication         indication for 2 or     indication for one       Identifies indication
                            more medications.       medication.             for all medications.

Temple University School of Pharmacy                                                          55
                                        [0]                   [3]                         [5]
                            Omits > two              Omits one element of     Completely reviews
                            important elements       the directions.          Directions for use
         Communication      of the directions                                 including: - How, how
         of Information:                                                      much, how often - How
         Directions                                                           long to continue and
                                                                              refill information -
                                                                              Missed dose
                                                                              instructions - Storage
                                        [0]                   [3]                          [5]
                            Omits > two              Omits one element of     Provides directions for
         Communication      important elements       the directions.          monitoring efficacy
         of Information:    of the directions                                 including: - Desired
         Monitoring
                                                                              therapeutic effect. - s/sx
         efficacy
                                                                              of improvement - time
                                                                              course for improvement

                                        [0]                   [3]                         [5]
                            Omits > two              Omits one element of     Provides directions for
         Communication
                            important elements       the directions.          monitoring safety
         of Information:
                            of the directions                                 including: - Common
         Monitoring                                                           side effects - ADRs -
         Safety                                                               Toxicities - Drug
                                                                              interactions

                                        [0]                   [3]                         [5]
                            Does not provide an      Provides an action       Provides a clear and
         Communication
                            action plan.             plan that is             complete action plan for
         of Information:
                                                     incomplete and or        unwanted/poor
         Action Plan
                                                     difficult to             outcomes.
                                                     understand.

                                        [0]                   [3]                         [5]
         Communicating
                            Does not answer          Answers to questions     Answers questions
         Information:
                            questions correctly.     are correct, but         correctly in appropriate
         Answering
                                                     difficult to             language that is easy to
         Questions
                                                     understand.              understand.
                                        [0]                   [3]                         [5]
         Communicating
         Infromation:       Does not provide         Partially provides       Provides patient
         Patient Specific   patient specific         patient specific         complete specific
         Information        information.             information              information.
                                        [0]                   [3]                         [5]
         Communicating
         Information:          Does not provide       Omits one piece of        Provides all relevant
         Additional           additional relevant    relevant information           information.
         relevant                information.        or includes irrelevant
         information                                      information.
                                        [0]                   [0]                         [5]
         Communicating
         Information:
         Correct            Provision of incorrect
         Information        information that                                  All information provided
                            causes major harm.                                is correct.




Temple University School of Pharmacy                                                             56
                                        Temple University School of Pharmacy
                           Clinical Advanced Pharmacy Practice Experience Evaluation Form

     Student Name:__________________________________ Inpatient ________ Ambulatory ______________
     Site ________________________ Preceptor__________________ Rotation Dates____________________

     Instructions to Preceptors:
     1. Evaluate each of the learning dimensions using the following scale.

             0                       1                 2                       3                       4                  N/A
      Deficits Exists      Needs                    Competent                 Good                Outstanding
                           Improvement
   Needs extensive         Needs consistent    Requires only           Requires occasional    Requires minimal        Not
   intervention, the       intervention;       moderate                intervention;          intervention;           applicable at
   majority of times the   Preceptor must      intervention            performs within        performs above          this site.
   preceptor must          provide directed    consisting of limited   Expectations.          expectations.
   complete the task.      questioning in a    prompting.
                           problem-solving
                           manner.
     2. Place a number score (0 through 4 or N/A) in the box for each dimension evaluated and put a ( ) by each
        skill which needs improvement.
     3. Each component evaluated corresponds to a global educational competency of the School of Pharmacy. (See
        attached list of educational competencies)
     4. Week 1 should be assessed by the student (S) first and then by the faculty (F)

1. Data Base                                               Week 1          Week 2            Week 3      Week 4         Week 5        Week6
     Demonstrates a good understanding of:                 S       F
     Physiology
     Pathophysiology
     Pharmacology
     Pharmacokinetics
     Therapeutics
     Demonstrates an ability to apply data in the
     clinical setting
     Grasps new concepts and their application
2. Gathers Subjective and Objective
                                                             Week 1         Week 2           Week 3      Week 4         Week 5        Week 6
Information
     Elements necessary to evaluate a patient’s drug       S       F
     therapy:
     Medication list complete and up-to-date
     Pertinent HPI and PMH
     Pertinent physical exam/ROS
     Pertinent laboratory data
     Medication history performed and complete
     (including allergies, ADRs)
     Assessment of patient‘s adherence to drug
     therapy
3. Assesses Information Collected                            Week 1         Week 2           Week 3      Week 4         Week 5        Week 6
     Analyzes patient information to perform the           S       F
     following:
     Identify existing drug related problems
     Identify potential drug related problems
     Support the existence of a drug related problem
     Recognize the need for additional data
     Prioritize drug-related problems.



     Temple University School of Pharmacy                                                                       57
                                                                      Week   Week   Week    Week   Week
4. Recommends Appropriate Therapeutic Plans.                 Week 1
                                                                       2      3      4       5      6
    Resolves or prevents drug related problems by:           S   F
    Recommending appropriate drug therapy
    Selecting appropriate parameters to monitor
    effectiveness and toxicity
    Determines when to re-evaluate patient for
    effectiveness or toxicity
    Determines desired therapeutic outcome and duration
    of therapy
    Bases decisions on clinical research
    Chooses the ―best‖ therapeutic option based on patient
    characteristics
                                                                      Week   Week   Week    Week   Week
5. Drug Information and Critical Thinking                    Week 1
                                                                       2      3      4       5      6
    Recognizes the need for and seeks appropriate            S   F
    additional information.
    Asks questions that get at key issues.
    Uses knowledge of basic science to solve clinical
    problems.
    Selects the best available resources to answer
    questions.
    Evaluates the quality of information obtained.
    Recognizes and evaluates available alternatives.
    Gives thought to possible consequences of decisions.
                                                                      Week   Week   Week    Week   Week
6. Adverse Drug Event Recognition                            Week 1
                                                                       2      3      4       5      6
    Demonstrates a good understanding of Adverse Drug        S   F
    Events (ADEs) in regards to:
    Mechanism of drug-induced diseases
    Probability that event due to drug
    Severity
    Preventability
    Treatment

    Outcomes (patient, financial)
                                                                      Week   Week   Week    Week   Week
7. Written Communication Skills                              Week 1
                                                                       2      3      4       5      6
    Documents pertinent information, assessments, and        S   F
    plans, on all forms of written assignments.
    Information is accurate.
    Information is complete.
    Notes are clear and concise.
    Material is well organized.
    Correct grammar and medical terminology is utilized.
    Rationale behind assessment and plans is included.




   Temple University School of Pharmacy                                               58
8. Verbal Communication Skills                                Week 1            Week 2     Week 3      Week 4    Week 5   Week 6
   Communicates with preceptor, patients, families,           S         F
   and other health care practitioners.
   Prepared to present. (Patient cases, journal club, in-
   service)
   Presents in a clear, organized and concise manner.
   Uses correct format for patient presentations.
   Able to answer questions.
   Communicates effectively with patients and families.
   Communicates with other health care practitioners.
9. Participation in Group Discussions                         Week 1            Week 2     Week 3      Week 4    Week 5   Week 6
   Participation in meetings with other students and          S         F
   preceptor.
   Makes good use of the group‘s time.
   Contributes meaningful information to the discussion.
   Actively participates in discussions.
   Comes to meetings prepared; does appropriate
   background readings.




     Part B
     Instructions: Place a number (0 or 1) that corresponds with your assessment of the student‘s behavior during each week
     of the Clinical Pharmacy Rotation.

                                        0                                             1
                                      Needs                           Behavior consistent with that
                                   Improvement                        of a health-care professional.

10. Demonstrates Human Relations Skills                           Week 1         Week 2     Week 3     Week 4    Week 5   Week 6
                                                                  S      F
     Displays an interest in others.
     Is sensitive to the needs, feelings, and concerns of
     others.
     Shows empathy; listens, is nonjudgmental and
     responds appropriately
     to others' problems.
     Acts in the best interest of others.
11. Maintains Professional/Ethical Standards                      Week 1         Week 2     Week 3     Week 4    Week 5   Week 6
                                                                  S      F
     Complies with laws and regulations.
     Applies good professional judgment in legal
     interpretations.
     Deals professionally and ethically with colleagues and
     patients.
     Maintains confidentiality..




     Temple University School of Pharmacy                                                                  59
                                                             Week            Week         Week           Week       Week   Week
12. Displays Independence/Assertiveness                       1               2            3              4          5      6
                                                             S   F
  Self-directed in undertaking responsibilities.
  Articulates own viewpoint when dealing with others and
  in addressing controversial issues.
  Speaks out against questionable tactics and practices..
                                                             Week            Week         Week           Week       Week   Week
13. Learns in a Self-Directed Manner                          1               2            3              4          5      6
                                                             S   F
  Conducts self-assessment.
  Acting on identified strengths and weaknesses, develops
  a learning plan.
  Pursues further knowledge independently.
  Aware of how professional organizations can facilitate
  life-long learning needs.


     Please add the scores for all 13 dimensions evaluated and use the following scale to provide a weekly
     grade

     Percent Conversion
        Score         % Score         Score        % Score           Score          % Score      Score        % Score
          9             55             17            69               25              78          33             91
         10             58             18            71               26              79          34             92
         11             61             19            72               27              81          35             94
         12             63             20            73               28              82          36             95
         13             65             21            74               29              84          37             96
         14             66             22            75               30              85          38             97
         15             67             23            76               31              88          39             99
         16             68             24            77               32              90          40            100



     _______________________________________________________________________________
             (Preceptor Signature)                                                                  (Date)



     ________________________________________________________________________________________________________
            (Student Signature)                                                       (Date)

     Comments (if needed):




     Temple University School of Pharmacy                                                                   60
        Ambulatory Clinical Advanced Pharmacy Practice Experience Rotation Requirements
I.         Student Responsibilities for Patient Care

              A. Attend clinic and actively participate in seeing and evaluating patients referred. You
                 are expected to be an active member of your health care team. If you identify a drug-
                 related problem, you should discuss the problem and potential solutions with your
                 preceptor and/or the resident/attending responsible for that patient. Utilize the
                 method for monitoring patients described under Practice Guideline 1. (See page 15).
                 This method will help you to collect and to organize data to identify and solve drug-
                 related problems.

              B. Conduct a medication history on every patient. (see Practice Guideline #2 on page
                 24 how to conduct a medication history)

              C. You will interview patients, collect and assess subjective and objective data, evaluate
                 individual drug therapy regimens and disease state control, and provide medication
                 education. You are expected to write/present a SOAP note for each patient‘s active
                 drug related problems.

              D. Document all significant patient interventions using the tool(s) used at the clinic that
                 you are assigned. For students at sites where interventions are documented on paper
                 a ―Documentation of Intervention Form‖ has been provided in your manual.
                 Additional copies can be obtained on the APPE Blackboard site. Student
                 interventions are used to help document the value added to patient care by our
                 students.

              E. Accurately answer any questions relating to medications that arise at your ambulatory
                 care clinical site, and document this activity on the Drug Information Intervention
                 Form. Return the documentation forms to your preceptor at the end of the rotation.

              F. Identify and report adverse drug reactions (ADR) that occur in any of your patients.
                 Complete an ADR report (forms available in the Drug Information Center or online
                 at http://www.fda.gov/medwatch/getforms.htm).

II.        Specific Assignments

              A. Complete the student section of the Longitudinal Evaluation of Educational Outcomes
                 Form at the end of every rotation.

              B. Complete the student portion of the Clinical Advanced Pharmacy Practice Experience
                 Student Evaluation Form at the end of the first week of the rotation so that you and
                 your preceptor can develop an educational plan to help you achieve the outcomes for
                 the rotation.

              C. Be prepared to verbally present and discuss your patients to the faculty preceptor on
                 clinic days.

              D. Write a minimum of one SOAP note per rotation




      Temple University School of Pharmacy                                                           61
               E. Complete one patient related written assignment each week (five written assignments
                  in addition to the SOAP note.) Your preceptor will determine the type of written
                  assignments most applicable to their rotation site. Types of written assignments could
                  include, but are not limited to:

                                      SOAP notes
                                      Consult notes
                                      Drug information response
                                      Pharmacy Care Plan
                                      Documentation of MTM activities
                                      Newsletter
                                      Quality Assurance projects
                                      Other type of written assignment

               F.      One Journal Club Present one current research article from the medical literature
                       in (See Practice Guideline 3 on page 26).

               G.      Present one In-Service Lecture (See Practice Guideline 4 on page 29)

               H.      Report or analyze one Adverse Drug Reaction. (See Practice Guideline 5 on
                       page 32)

               I.      Complete a Pharmacy Intervention Form to document all significant patient
                       interventions.

               J.      Upload designated assignments in eportfolio.

III.        Conference Attendance

               A. Meet regularly (minimum 3 times/week) with your faculty preceptor and be prepared
                  to present and discuss your patients' therapeutic problems.

               B. Attend Grand Rounds and other appropriate educational conferences at the hospital or
                  clinic.

IV.         Preceptor Responsibilities
               A. Meet with students on a regular basis to discuss patients.

               B. Serve as a resource for students, guiding them in finding solutions to drug related
                  problems. The faculty preceptor is not responsible to answer questions for students,
                  but is available to help students find answers on their own.

               C. Attend scheduled conferences during which your students are presenting.

               D. Complete the Clinical Advanced Pharmacy Practice Experience Student Evaluation
                  Form.

               E. Complete the Longitudinal Evaluation of Educational Outcomes Form (see page12) at
                  the end of the rotation. Return this to the student who will carry this to the next
                  rotation.


       Temple University School of Pharmacy                                                         62
             F. Grade weekly write-ups and assess student performance in a timely manner.

             G. Return completed and signed evaluation forms to the Office of Experiential Education
                at the end of the rotation. Student should get an electronic or paper copy of their
                evaluation.

V.        Grading

          The Ambulatory Clinical Advanced Pharmacy Practice Experience is graded using the following
          scale (A, A-, B+, B, B-, C+, C, C-, D+, D, D- and F). The faculty preceptor will review the goals,
          objectives, and student responsibilities with the student at the start of the rotation. The student will
          be evaluated using the evaluation forms listed below. Evaluations may be formatted differently but
          the content is the same. Students should notify the Office of Experiential Education if they are not
          receiving feedback on their performance in a timely manner. Student grades are

                                 Assignment                           % of Grade

                     Advanced Pharmacy Practice                            60
                     Evaluations
                     Journal Club                                          10
                     In-Service Lecture                                    20
                     Documentation                                         10




     Temple University School of Pharmacy                                                            63
                                       Temple University School of Pharmacy
                          Clinical Advanced Pharmacy Practice Experience Evaluation Form

    Student Name:__________________________________ Inpatient ________ Ambulatory ______________
    Site ________________________ Preceptor__________________ Rotation Dates____________________

    Instructions to Preceptors:
    5. Evaluate each of the learning dimensions using the following scale.

            0                       1                 2                       3                     4                   N/A
     Deficits Exists      Needs                    Competent                 Good              Outstanding
                          Improvement
  Needs extensive         Needs consistent    Requires only           Requires occasional   Requires minimal        Not
  intervention, the       intervention;       moderate                intervention;         intervention;           applicable at
  majority of times the   Preceptor must      intervention            performs within       performs above          this site.
  preceptor must          provide directed    consisting of limited   Expectations.         expectations.
  complete the task.      questioning in a    prompting.
                          problem-solving
                          manner.

    6. Place a number score (0 through 4 or N/A) in the box for each dimension evaluated and put a ( ) by each
       skill which needs improvement.
    7. Each component evaluated corresponds to a global educational competency of the School of Pharmacy. (See
       attached list of educational competencies)
    8. Week 1 should be assessed by the student (S) first and then by the faculty (F)
                                                                               Week         Week         Week            Week       Week
1. Data Base                                                      Week 1
                                                                                2            3            4               5          6
   Demonstrates a good understanding of:                         S    F
   Physiology
   Pathophysiology
   Pharmacology
   Pharmacokinetics
   Therapeutics
   Demonstrates an ability to apply data in the clinical
   setting
   Grasps new concepts and their application
                                                                               Week         Week         Week            Week       Week
2. Gathers Subjective and Objective Information                   Week 1
                                                                                2            3            4               5          6
     Elements necessary to evaluate a patient’s drug             S    F
     therapy:
     Medication list complete and up-to-date
     Pertinent HPI and PMH
     Pertinent physical exam/ROS
     Pertinent laboratory data
     Medication history performed and complete (including
     allergies, ADRs)

     Assessment of patient‘s adherence to drug therapy
                                                                               Week         Week         Week            Week       Week
3. Assesses Information Collected                                 Week 1
                                                                                2            3            4               5          6
     Analyzes patient information to perform the                 S    F
     following:
     Identify existing drug related problems
     Identify potential drug related problems
     Support the existence of a drug related problem
     Recognize the need for additional data
     Prioritize drug-related problems.

    Temple University School of Pharmacy                                                                      64
                                                                      Week   Week   Week        Week   Week
4. Recommends Appropriate Therapeutic Plans.                 Week 1
                                                                       2      3      4           5      6
    Resolves or prevents drug related problems by:           S   F
    Recommending appropriate drug therapy
    Selecting appropriate parameters to monitor
    effectiveness and toxicity
    Determines when to re-evaluate patient for
    effectiveness or toxicity
    Determines desired therapeutic outcome and duration
    of therapy
    Bases decisions on clinical research
    Chooses the ―best‖ therapeutic option based on patient
    characteristics
                                                                      Week   Week   Week        Week   Week
5. Drug Information and Critical Thinking                    Week 1
                                                                       2      3      4           5      6
    Recognizes the need for and seeks appropriate            S   F
    additional information.
    Asks questions that get at key issues.
    Uses knowledge of basic science to solve clinical
    problems.
    Selects the best available resources to answer
    questions.
    Evaluates the quality of information obtained.
    Recognizes and evaluates available alternatives.
    Gives thought to possible consequences of decisions.
                                                                      Week   Week   Week        Week   Week
6. Adverse Drug Event Recognition                            Week 1
                                                                       2      3      4           5      6
    Demonstrates a good understanding of Adverse Drug        S   F
    Events (ADEs) in regards to:
    Mechanism of drug-induced diseases
    Probability that event due to drug
    Severity
    Preventability
    Treatment

    Outcomes (patient, financial)
                                                                      Week   Week   Week        Week   Week
7. Written Communication Skills                              Week 1
                                                                       2      3      4           5      6
    Documents pertinent information, assessments, and        S   F
    plans, on all forms of written assignments.
    Information is accurate.
    Information is complete.
    Notes are clear and concise.
    Material is well organized.
    Correct grammar and medical terminology is utilized.
    Rationale behind assessment and plans is included.




      Temple University School of Pharmacy                                                65
                                                                                   Week        Week   Week   Week   Week
8. Verbal Communication Skills                                        Week 1
                                                                                    2           3      4      5      6
    Communicates with preceptor, patients, families, and              S    F
    other health care practitioners.
    Prepared to present. (Patient cases, journal club, in-
    service)
    Presents in a clear, organized and concise manner.
    Uses correct format for patient presentations.
    Able to answer questions.
    Communicates effectively with patients and families.
    Communicates with other health care practitioners.
                                                                                   Week        Week   Week   Week   Week
9. Participation in Group Discussions                                 Week 1
                                                                                    2           3      4      5      6
    Participation in meetings with other students and                 S    F
    preceptor.
    Makes good use of the group‘s time.
    Contributes meaningful information to the discussion.
    Actively participates in discussions.
    Comes to meetings prepared; does appropriate background
    readings.




    Part B
    Instructions: Place a number (0 or 1) that corresponds with your assessment of the student‘s behavior during each week
    of the Clinical Pharmacy Rotation.

                                       0                           1
                                     Needs                         Behavior consistent with that
                                  Improvement                      of a health-care professional.

                                                                                   Week        Week   Week   Week   Week
10. Demonstrates Human Relations Skills                               Week 1
                                                                                    2           3      4      5      6
                                                                      S    F
    Displays an interest in others.
    Is sensitive to the needs, feelings, and concerns of others.
    Shows empathy; listens, is nonjudgmental and responds
    appropriately
    to others' problems.
    Acts in the best interest of others.
                                                                                   Week        Week   Week   Week   Week
11. Maintains Professional/Ethical Standards                          Week 1
                                                                                    2           3      4      5      6
                                                                      S    F
    Complies with laws and regulations.
    Applies good professional judgment in legal
    interpretations.
    Deals professionally and ethically with colleagues and
    patients.
    Maintains confidentiality..




    Temple University School of Pharmacy                                                              66
                                                                               Week      Week       Week    Week   Week
12. Displays Independence/Assertiveness                            Week 1
                                                                                2         3          4       5      6
                                                                   S     F
    Self-directed in undertaking responsibilities.
    Articulates own viewpoint when dealing with others and in
    addressing controversial issues.
    Speaks out against questionable tactics and practices..
                                                                               Week      Week       Week    Week   Week
13. Learns in a Self-Directed Manner                               Week 1
                                                                                2         3          4       5      6
                                                                   S     F
    Conducts self-assessment.
    Acting on identified strengths and weaknesses, develops a
    learning plan.
    Pursues further knowledge independently.
    Aware of how professional organizations can facilitate life-
    long learning needs.


     Please add the scores for all 13 dimensions evaluated and use the following scale to provide a weekly
     grade

     Percent Conversion
        Score          % Score        Score         % Score            Score   % Score      Score     % Score
          9              55            17             69                25       78          33          91
         10              58            18             71                26       79          34          92
         11              61            19             72                27       81          35          94
         12              63            20             73                28       82          36          95
         13              65            21             74                29       84          37          96
         14              66            22             75                30       85          38          97
         15              67            23             76                31       88          39          99
         16              68            24             77                32       90          40         100



     _______________________________________________________________________
              (Preceptor Signature)                                                       (Date)



     _______________________________________________________________________________________________
            (Student Signature)                                                       (Date)

     Comments (if needed):




     Temple University School of Pharmacy                                                           67
               Institutional Pharmacy Advanced Pharmacy Practice Experience Rotation

I.        Student Responsibilities


     A. Full-time attendance (40 hours/week) is required of the students.

     B. The student shall be present at the institution in accordance with the schedule prepared by the
        Preceptor. Students must arrange their work or personal schedule to accommodate this schedule.

     C. In the case of absence, the student must call the hospital pharmacy to insure that their preceptor is
        notified and must inform The Office of Experiential Education (215-707-4934/9379/9378) or
        appe@temple.edu .

     D. Students are to gain knowledge and proficiency by working with the pharmacy staff. This requires
        active participation and involvement, rather than observation.

     E. The student should review the pharmacy department's policy and procedure manual, and should be
        able to comply with these guidelines as they apply to the preparation and dispensing of medications at
        that institution.

     F. Students with extensive hospital pharmacy experience (your resume should indicate this experience)
        will be exposed to all required activities. If the student demonstrates proficiency in particular areas,
        the time spent in these areas will be lessened and additional experiences will be provided in such areas
        as special projects, providing in-service education, drug utilization review, quality assurance, or
        similar appropriate activities.

     G. Complete the Institutional Pharmacy Rotation Student Log.

     H. If any problems arise while on assignment at an institution, call The Office of Experiential Education
        (215-707-4934/9379/9378) or email at appe@temple.edu .

II. Responsibilities of the Pharmacist Preceptor

     A. Complete the preceptor portions of the Institutional Advanced Pharmacy Practice Experience Student
        Evaluation Form.

     B. Provide the student with an orientation to the site. This orientation should include a review of
        pertinent policies and procedures, introductions to the staff, a review of the student schedule, a tour of
        your facility, and a discussion of your expectations for the student.

     C. Discuss issues relevant to your practice with the student.

     D. Within the first few days of starting the rotation, review the course learning objectives with the student
        and determine those that can be reasonably achieved at you institution. Assign the students to
        activities which will allow them to gain experience and proficiency in accomplishing these objectives.

     E. Provide or coordinate proper supervision of the student.




     Temple University School of Pharmacy                                                              68
       F. Advise pharmacists working with the student of the need to document that the student successfully or
          unsuccessfully completed specific pharmacy activities. This information should be documented in the
          student‘s Log Book. Students may be given instruction in specific tasks and multiple opportunities to
          successfully complete each task.

       G. Provide the student with a midpoint written evaluation of his/her performance at the end of three
          weeks and establish goals for the student to accomplish in the last 3 weeks of the rotation.

       H. Complete the final written evaluation of the student's performance and discuss your evaluation with
          the student.

       I. Complete the Longitudinal Evaluation of Educational Outcomes form (see page 12) at the end of the
           rotation. Return this to the student who will carry this to the next rotation

       J. Document the student's attendance hours. (Students are responsible to contact the site preceptor and
          The Office of Experiential Education (215-707-4934/9379/9378) or appe@temple.edu if they will be
          absent.

       K. Contact The Office of Experiential Education (215-707-4934/9379/9378) or appe@temple.edu to
          discuss any problems you are experiencing with the student. Please do not wait until the end of the
          rotation to inform the school of potential problems.

III.       Competency Statements and Learning Objectives ( starting on pages 10)


 IV.       Grading

             The Advanced Pharmacy Practice Experiences are graded on a pass or fail basis. The student must
             be evaluated at the midpoint and end of the rotation using the evaluation form. Evaluations maybe
             formatted differently but the content is the same. Students should notify the Office of Experiential
             Education if they are not receiving feedback on their performance in a timely manner.




       Temple University School of Pharmacy                                                           69
                                  TEMPLE UNIVERSITY
                                 SCHOOL OF PHARMACY



                     INSTITUTIONAL PHARMACY ROTATION
                                STUDENT LOG




Temple University School of Pharmacy                  70
Student Name:______________________________________________________________________________

Pharmacy Student Preceptors:
Please sign off for each activity that the student has successfully completed. Indicate if the student has successfully
completed the task, had difficulty successfully completing an activity, or if the student did not have the opportunity
to accomplish a specific task.
                                         Inpatient Drug Distribution
                                                                             1                   2               N/A
                                                                         unable to         successfully           Not
                                                                         complete           completes        applicable
                                                                           task               task           at this site

1.       Accurately screens prescriptions to determine if the dose       _______           _______           _______
         is correct.

2.       Screens prescriptions to determine if the route of              _______           _______           _______
         administration is appropriate.

3.       Prepare and maintain patient medication profiles with
         regard to:
         3.1      Able to input patient information/prescriptions
                  correctly.                                             _______           _______           _______
         3.2      Selects the appropriate information to include in
                  the patient profile.                                   _______           _______           _______
         3.3      Reviews information available in the patient
                  profile to determine if a contraindication to
                  therapy or a drug interaction exists.                  _______           _______           _______
         3.4      Able to compare the pharmacy patient profile to
                  the nurses‘ medication administration record to
                  identify problems in drug administration.              _______           _______           _______

4.       Dispensing Medication:
         4.1     Accurately processes and fills medication orders.       _______           _______           _______

         4.2      Accurately checks medication dispensed                 _______           _______           _______

5.       Assists in a nursing unit inspection.                           _______           _______           _______

6.       Controlled Substances
         6.1      Able to explain laws regarding the regulation
                  controlled substances.                                 _______           _______           _______

         6.2      Able to explain how narcotics are dispensed and
                  what utilization records must be maintained in a
                  hospital setting.                                      _______           _______           _______

         7.2      Able to explain how tax-free alcohol is handled
                  by the pharmacy.                                       _______           _______           _______

7.       Emergency Medication Box/Crash Cart
         7.1    Assist pharmacist in stocking the emergency box.         _______           _______           _______

         7.2      Able to state indications for medications contained
                  in emergency box.                                      _______           _______           _______




Temple University School of Pharmacy                                                                     71
Sterile Products
                                                                       1         2            N/A
1.      Demonstrates proper aseptic techniques when preparing
        sterile products.                                            _______   _______     _______
2.      Identifies and correctly evaluates data in an appropriate
        reference to determine if an IV incompatibility exists.      _______   _______     _______
3.      Able to prepare the following products:

        3.1.     large volume parenterals                            _______   _______     _______

        3.2.     IV piggybacks                                       _______   _______     _______

        3.3.     Syringes                                            _______   _______     _______

        3.4.     Parenteral nutrition solutions                      _______   _______     _______

        3.5.     Anti-cancer drugs                                   _______   _______     _______

4.      Correctly prepares labels for sterile products.              _______   _______     _______
5.      Preparation of Parenteral Nutrition Solutions
        5.1.     Correctly completes calculations necessary to
                 prepare parenteral nutrition solutions.             _______   _______     _______

        5.2.     Determines if a parenteral nutrition order is
                 appropriate based on:
                 5.2.1   caloric content                             _______   _______     _______

                 5.2.2      non-protein calorie to nitrogen ratio    _______   _______     _______

                 5.2.3      nutrient content                         _______   _______     _______

                 5.2.4      electrolyte content                      _______   _______     _______

                 5.2.5      calcium and phosphate compatibility      _______   _______     _______

                 5.2.6      osmolarity (peripheral vs. central)      _______   _______     _______

6.      Able to explain the differences among various infusion
        systems used in your hospital.                               _______   _______     _______
Compounding and Packaging
1.      Repackaging dosage forms
        1.1.     Repackages oral solid dosage forms.                 _______   _______     _______

        1.2.     Repackages liquid dosage forms correctly using
                 pharmaceutical calculations.                        _______   _______     _______

        1.3.     Accurately prepares the label for repackaged
                 products.                                           _______   _______     _______

        1.4.     Accurately records repackaged products in the
                 control log book and/or on control forms used for
                 medications repackaged in the pharmacy.             _______   _______     _______

        1.5.     Correctly locates information needed to compound
                 an extemporaneous product.                          _______   _______     _______



Temple University School of Pharmacy                                                    72
                                                                        1         2                N/A
        1.6.     Correctly uses pharmaceutical calculations in
                 compounding extemporaneous products.                 _______   _______          _______
        1.7.     Able to prepare the following extemporaneous
                 products:

                 1.7.1    capsules                                    _______   _______          _______

                 1.7.2    powder papers                               _______   _______          _______

                 1.7.3    solutions                                   _______   _______          _______

                 1.7.4    creams/ointments                            _______   _______          _______
        1.8.     Accurately records manufactured products in
                 the logbook.                                         _______   _______          _______
Drug Information
1.      Obtains necessary information from the person calling
        the pharmacy for drug information.                            _______   _______          _______

2.      Able to select best reference(s) to answer drug information
        questions.                                                    _______   _______          _______

3.      Able to use the following drug information resources:

        3.1.     Micromedex                                           _______   _______          _______
        3.2.     GratefulMed                                          _______   _______          _______
        3.3.     Poisindex                                            _______   _______          _______
        3.4.     On-line computer searches                            _______   _______          _______

Communication Skills
1.      Able to obtain a medication history from a patient.           _______   _______          _______

2.      Able to conduct discharge-counseling sessions with patients. _______    _______          _______

3.      Effectively communicates with other health professionals.     _______   _______          _______

Please indicate the dates on which the student was exposed to the following activities.
                                                                                              Date
                                                                                          Accomplished
1.      Reviewed policies and procedures for the pharmacy department
2.      Pharmacy administration.
3.      Purchasing
4.      Pharmacy and Therapeutics Committee
5.      Drug utilization evaluations
6.      Attended a code with pharmacy personnel
7.      Other experiences (please list)




Temple University School of Pharmacy                                                         73
                                Temple University School of Pharmacy
                Institutional Advanced Pharmacy Practice Experience Evaluation Form
Student Name: _______________________________Rotation Dates: _________________________
Preceptor Name:______________________________Hospital Name: _________________________

Part A
Instructions to Preceptors:
1. Evaluate each of the learning dimensions using the scale provided for each.
          0                       1                        2                     3                 4               N/A
  Deficits Exists    Needs Improvement                Competent                Good           Outstanding
 Needs extensive     Needs consistent            Requires only           Requires          Requires minimal   Not
 intervention, the   intervention; Preceptor     moderate intervention   occasional        intervention;      applicable
 majority of times   must provide directed       consisting of limited   intervention      performs above     at this site.
 the preceptor       questioning in a problem-   prompting.              performs within   expectations.
 must complete       solving manner.                                     expectations.
 the task.
2. Insert the number (0 to 4 or N/A) in the box and place a ( ) by each skill which needs improvement.
3. Each component evaluated corresponds to a global educational competency of the School of Pharmacy.
   (See attached list of educational competencies)

 1. Provides Drug Products                                                                 Week 3             Weeks 4-6


       Determines appropriateness of order
       Evaluates and selects product
       Assures product/prescription accuracy
 2. Communicates with Patients About Prescription Drugs                                    Week 3             Weeks 4-6

       Interviews and counsels patients on drug indication, usage, dosage,
       packaging, and storage
       Discusses drug cautions and side effects
       Explains policies on fees and services
       Relates to patients in a professional manner
       Interacts to confirm patient understanding
 3. Monitors and Evaluates Drug Therapy (Initial and Ongoing)                              Week 3             Weeks 4-6

       Gathers and interprets patient information as it is related to drug therapy.
       Identifies drug related problem(s).
       Recommends appropriate therapeutic plan(s).
       Recommends appropriate drug therapy (dose, duration, route etc.)
       Selects appropriate parameters to monitor efficacy and toxicity.
       Determines appropriate time(s) to re-evaluate patient and assess efficacy
       and toxicity
       Conducts the follow-up plan in a timely manner.




Temple University School of Pharmacy                                                                         74
 4. Sterile Products                                                             Week 3   Weeks 4-6

      Uses appropriate aseptic technique
      Selects appropriate equipment and containers
      Identifies incompatibilities
      Documents calculations and procedures
 5. Compounding Extemporaneous Products                                          Week 3   Weeks 4-6

      Utilizes acceptable professional procedures
      Selects appropriate equipment and containers
      Prepares special dosage forms
      Documents calculations and procedures
 6. Communicates with Health Professionals                                       Week 3   Weeks 4-6

      Obtains and provides accurate and concise information in a professional
      manner.
      Uses appropriate oral, written and nonverbal language
 7. Retrieves Drug Information                                                   Week 3   Weeks 4-6

      Selects best available resource for answering a drug related request.
      Evaluates the quality of information obtained.
      Responds in a timely fashion.
 8. Handles Detail                                                               Week 3   Weeks 4-6

      Is conscientious in following appropriate work procedures.
      Is attentive to details and technical interrelationships in carrying out
      duties
      Notices discrepancies and irregularities
      Keeps accurate records and documents actions
      Takes steps to ensure accuracy of work
      Provides an appropriate amount of detail
 9. Makes Sound Decisions                                                        Week 3   Weeks 4-6

      Uses good judgment in coming up with sensible, practical solutions to
      problems
      Seeks out and utilizes appropriate facts and information in decision
      making

      Recognizes and evaluates available alternatives
      Gives thought to possible consequences of decisions.




Temple University School of Pharmacy                                                     75
10. Organizes/Plans                                                                   Week 3           Weeks 4-6

     Uses own and others' time effectively and efficiently.

     Is systematic and methodical in approaching activities
     Sets meaningful goals
     Plans activities to meet objectives
     Is well prepared
     Is able to anticipate future needs.
Part B
Instructions: Place a number (0 or 1) that corresponds with your assessment of the student‘s behavior
during each week of the Institutional Pharmacy Rotation.

                         0                                                              1
                 Needs Improvement                                   Behavior consistent with that of a health
                                                                     care professional.


         11. Demonstrates Human Relations Skills                          Week 3                Weeks 4-6

              Displays an interest in others.
              Is sensitive to the needs, feelings, and concerns of
              others.
              Shows empathy; listens, is nonjudgmental and
              responds appropriately
              to others' problems.
              Acts in the best interest of others.
         12. Maintains Professional/Ethical Standards                     Week 3                Weeks 4-6

              Complies with laws and regulations.
              Applies good professional judgment in legal
              interpretations.
              Deals professionally and ethically with
              colleagues and patients.
              Maintains confidentiality..
         13. Displays Independence/Assertiveness                          Week 3                Weeks 4-6

             Self-directed in undertaking responsibilities.
             Articulates own viewpoint when dealing with
             others and in addressing controversial issues.
             Speaks out against questionable tactics and
             practices.
         14. Learns in a Self-Directed Manner                             Week 3                Weeks 4-6

             Conducts self-assessment.
             Acting on identified strengths and weaknesses,
             develops a learning plan.
             Pursues further knowledge independently.
             Aware of how professional organizations can
             facilitate life-long learning needs.




Temple University School of Pharmacy                                                                  76
Part C
Overall assessment: Compared to other pharmacy students I have worked with, I consider this student to be:




Outstanding               Above Average             Average                  Below Average        

Comments:




                                            CERTIFICATION


This is to certify that the above named student was present for _______ hours per day
for _____ days completing this rotation under the supervision of my pharmacy staff and myself.


_______________________________            _____________________________________________
            (Date)                                        Preceptor Signature

Student Review
I have discussed this evaluation with my preceptor.

________________________________           _____________________________________________
             (Date)                                        Student Signature




Temple University School of Pharmacy                                                        77
        COMMUNITY PHARMACY ADVANCED PHARMACY PRACTICE EXPERIENCE
I.         Student Responsibilities

              A. Full-time attendance (40 hours/week) is required of the students.

              B. The student shall be present at the assigned community pharmacy in accordance with the
                 schedule prepared by the community pharmacy preceptor. Usual hours of attendance are 9 AM
                 to 5 PM. Alternate hours may be scheduled by mutual consent to permit a varied experience or
                 to make-up absences. Students must arrange their work or personal schedule to accommodate
                 this schedule.

              C. In the case of absence, the student must call the pharmacy insuring that their preceptor is
                 notified and must inform The Office of Experiential Education (215-707-4934/9379/9378) or
                 appe@temple.edu .

              D. Students are to gain knowledge and proficiency by actively participating in the professional and
                 technical functions of the site that relate to the rotation objectives.

              E. The student will complete The Community Activities Workbook for each community rotation
                 assigned, both required and elective. This Workbook must be reviewed and signed by the
                 precepting Pharmacist. Completed Community Activities Workbook must be submitted to the
                 Office of Experiential Education.

              F. Complete the Community Pharmacy Rotation Log (see page 80).

              G. If any problems arise during the rotation, call The Office of Experiential Education (215-707-
                 4934/9379/9378) or appe@temple.edu .

II.        Responsibilities of the Pharmacist Preceptor

             A. Complete the preceptor portion of the Community Advanced Pharmacy Practice Experience
                Student Evaluation Form.

             B. Provide the student with an orientation to the site. This orientation should include a review of
                pertinent policies and procedures, introductions to the staff, a review of the student schedule, a
                tour of your facility, and a discussion of your expectations for the student.

             C. During the first few days of starting the rotation, review the course learning objectives with the
                student and determine those that can be reasonably achieved at you institution. Assign the
                students to activities which will allow them to gain experience and proficiency in
                accomplishing these objectives.

             D. Discuss issues relevant to your practice with the student.

             E. Review the student's completed Community Activities Workbook with the student.

             F. Provide or coordinate proper supervision of the student. Check the student‘s Community
                Pharmacy Rotation Log to insure that it is accurately completed.




      Temple University School of Pharmacy                                                             78
              G. Provide the student with an evaluation of his/her performance at the end of three weeks and
                 establish goals for the student to accomplish in the last 3 weeks of the rotation.

               H. Complete a written evaluation of the student's performance and discuss your evaluation with
                  the student. (See section F Grading Policy on page 10)

               I. Complete the Longitudinal Evaluation of Educational Outcomes Form at the end of the
                   rotation. Return this to the student who will carry this to the next rotation

               E. Document the student's attendance hours. (Students are responsible to contact the site preceptor
                  and The Office of Experiential Education (215-707-4934/9379/9378) or appe@temple.edu if
                  they will be absent.

               J. Contact The Office of Experiential Education (215-707-4934/9379/9378) or appe@temple.edu
                  to discuss any problems with the student. Please do not wait until the end of the rotation to
                  inform the school of potential problems.


III.        Learning Objectives

               Competency Statements and Learning Objectives beginning on page 8.

 V.          Grading

             The Advanced Pharmacy Practice Experiences are graded on an pass or fail basis. The student must
             be evaluated at the midpoint and end of the rotation using the evaluation form. Evaluations may be
             formatted differently but the content is the same. Students should notify the Office of Experiential
             Education if they are not receiving feedback on their performance in a timely manner.




       Temple University School of Pharmacy                                                          79
                              TEMPLE UNIVERSITY
                             SCHOOL OF PHARMACY



                 COMMUNITY PHARMACY ROTATION
                        STUDENT LOG




Temple University School of Pharmacy             80
Student Name:_______________________________________________________________________

Pharmacy Student Preceptors:

Please sign off for each activity that the student has successfully completed. Indicate if the student h as successfully
completed the task, had difficulty successfully completing an activity, or if the student did not have the opportunity
to accomplish a specific task.

Outpatient Drug Distribution
                                                                             1                    2               N/A
                                                                         unable to          successfully           Not
                                                                         complete            completes        applicable
                                                                           task                task           at this site

1.       Accurately screens prescriptions to determine if the dose       _______            _______           _______
         is correct.
2.       Screens prescriptions to determine if the route of              _______            _______           _______
         administration is appropriate.
3.       Prepare and maintain patient medication profiles:

         3.1      Able to input patient information/prescriptions
                  correctly.                                             _______            _______           _______
         3.2      Selects the appropriate information to include in
                  the patient profile.                                   _______            _______           _______
         3.3      Reviews information available in the patient
                  profile to determine if a contraindication to
                  therapy or a drug interaction exists.                  _______            _______           _______
4.       Dispensing Medication:
         4.1     Accurately assist in filling prescriptions.             _______            _______           _______

         4.2      Accurately labels prescriptions.                       _______            _______           _______

         4.3      Gives patient adequate information (oral
                  and written).                                          _______            _______           _______

         4.4      Accurately checks other pharmacists.                   _______            _______           _______
5.       Controlled Substances
         5.1      Able to explain laws regarding the regulation
                  controlled substances.                                 _______            _______           _______

         5.2      Able to explain narcotics record keeping.              _______            _______           _______

         5.3      Able to explain narcotic reports.                      _______            _______           _______
6.       OTCs

         6.1      Able to make correct decision with regard
                  to self-medication or referral to a physician.         _______            _______           _______
                  If self medicate:
                  a.        concurrent condition/medications             _______            _______           _______

                  b.       lifestyle of patient                          _______            _______           _______

                  c.       select proper medication                      _______            _______           _______




Temple University School of Pharmacy                                                                      81
        6.2      Able to give proper directions for use.

                 a.       when to use it (take)                    _______           _______     _______

                 b.       how to use it (take)                     _______           _______     _______

                 c.       how long to use (take)                   _______           _______     _______

                 d.       adverse effects                          _______           _______     _______

        6.3      Able to answer patients‘ questions/concerns.      _______           _______     _______

7.      Compounding

        7.1      Correctly locates information needed to
                 compound a prescription extemporaneously.         _______           _______     _______

        7.2      Capable of correct pharmaceutical calculations.   _______           _______     _______

        7.3      Able to prepare:

                 a.       capsules                                 _______           _______     _______

                 b.       solutions                                _______           _______     _______

                 c.       cream/ointment                           _______           _______     _______

                 d.       suppositories                            _______           _______     _______

8.      Drug Information/Communication

        8.1      Able to locate requested information.             _______           _______     _______

        8.2      Able to utilize literature/computer.              _______           _______     _______

        8.3      Able to effectively communicate information
                 to patient/other h health professionals.          _______           _______     _______

9.      Please indicate the date(s) on which the student was
        exposed to the following:

        a.       Pharmacy Policies/Procedures                      Date:__________

        b.       Purchasing                                        Date:__________

        c.       Method of Class II control/reporting.             Date:__________

        d.       Procedure for home care/nursing home
                 medication delivering/checking charts.            Date:__________

10.     Other:




Temple University School of Pharmacy                                                          82
                        Temple University
                        School of Pharmacy

           Advanced Pharmacy Practice
                  Experience

                    Community Pharmacy
                    Activities Workbook




Temple University School of Pharmacy        83
                                          Table of Contents


                                        Topic

Description of Activities #1 to Activity #8

        Activity #1: Prescription Processing

        Activity #2: Drug Related Problems

        Activity #3: Over-the-Counter Medications

        Activity #4: Patient Counseling on Prescription Medications

        Activity #5: Medication Adherence Interview

        Activity #6: Pharmacy Calculations/Compounding

        Activity #7: Pharmacy Management

        Activity #8: Drug Information Question


Workbook Verification Sheet




Temple University School of Pharmacy                                 84
Activity # 1: Prescription Processing

                A. Documentation
                             i. 5 formulary issues
                            ii. 5 prior authorization issues

Activity # 2: Drug-related problems

                A. Documentation
                            i. 10 forms ( Short format)

Activity # 3: Over-the-counter drugs

                A. Documentation
                            i. 5 encounter forms (includes counseling)

Activity # 4: Patient counseling

                A. Documentation
                            i. 5 encounter forms (Prescription medications)

Activity # 5: Medication adherence

                A. Documentation
                            i. 2 Morisky scale forms

Activity # 6: Pharmacy calculations/compounding

                A. Documentation
                            i. 5 forms

Activity # 7: Managerial/Inventory control/Controlled substance

                A. Documentation
                            i. 1 form

Activity # 8: Drug information

                A. Documentation (Formally written and well referenced)
                             i. 1 geared toward another Healthcare Professional
                            ii. 1 geared toward a patient




Temple University School of Pharmacy                                             85
Activity #1: Prescription Processing

Directions: During the course of the prescription filling process, please document 5 issues that
involve an insurance formulary substitution and 5 insurance prior authorizations.

  Date       Formulary     Description of issue, method of resolution and outcome
             Issue/Prior   **Note: Do NOT include any patient identifying
             Authorization information (i.e. date of birth, initials, etc)
             (Circle One)
  Date

             Formulary
             Issue/Prior
             Authorization
             (Circle One)


  Date

              Formulary
              Issue/Prior
             Authorization
             (Circle One)




  Date


              Formulary
              Issue/Prior
             Authorization
             (Circle One)



  Date


             Formulary
             Issue/Prior
             Authorization
             (Circle One)



Temple University School of Pharmacy                                                  86
  Date       Formulary     Description of issue, method of resolution and outcome
             Issue/Prior   **Note: Do NOT include any patient identifying
             Authorization information (i.e. date of birth, initials, etc)
             (Circle One)
  Date

             Formulary
             Issue/Prior
             Authorization
             (Circle One)


  Date

              Formulary
              Issue/Prior
             Authorization
             (Circle One)




  Date


              Formulary
              Issue/Prior
             Authorization
             (Circle One)




  Date


             Formulary
             Issue/Prior
             Authorization
             (Circle One)




Temple University School of Pharmacy                                           87
  Date       Formulary     Description of issue, method of resolution and outcome
             Issue/Prior   **Note: Do NOT include any patient identifying
             Authorization information (i.e. date of birth, initials, etc)
             (Circle One)
  Date



             Formulary
             Issue/Prior
             Authorization
             (Circle One)




  Date


             Formulary
             Issue/Prior
             Authorization
             (Circle One)




Temple University School of Pharmacy                                           88
Activity #2: Drug Related Problems

Directions: During the course of the prescription filling process, document 10 drug related
problems that you encounter.


Examples of potential drug-related problems (DRP)

DRP #      Problem Description

1.             The patient has been prescribed a medication for which there is no valid
               (or a questionable) medical condition.

2.              The patient requires drug therapy for a medical indication but is not
                receiving this therapy.

3.             The patient is prescribed the wrong drug or dosage formulation.

4.              The patient has been prescribed a dose that is too low. (consider the dose and
                interval).

5.              The patient has been prescribed a dose that is too high. (consider the dose and
                interval)

6.              The patient is not taking the prescribed medication appropriately.

7.              The patient has been prescribed a medication to which he/she is allergic or had
                an adverse drug reaction, or the patient is experiencing an adverse drug reaction.

8.              There is a drug-drug, drug-food, or drug-disease state interaction.

9.              The drug is not on formulary for the patient’s insurance plan.

10.             Prescription is incomplete or written incorrectly.




Temple University School of Pharmacy                                                     89
Date         DRP # Description of patient specific problem and the solution
                   **Note: Do NOT include any patient identifying information
                   (i.e. date of birth, initials, etc)




Temple University School of Pharmacy                                           90
Date         DRP # Description of patient specific problem and the solution
                   **Note: Do NOT include any patient identifying information
                   (i.e. date of birth, initials, etc)




Temple University School of Pharmacy                                           91
Date         DRP # Description of patient specific problem and the solution
                   **Note: Do NOT include any patient identifying information
                   (i.e. date of birth, initials, etc)




Temple University School of Pharmacy                                           92
Activity # 3: Over-the-Counter Medications.

Directions: Please document 5 patient encounters involving the counseling and/or selection of
over-the-counter medications.

                                        Method of Resolution and Outcome

                                        **Note: This may include referral to Health
Date         OTC Question               Care Provider or Emergency Department
                                        Do NOT include any patient identifying
                                        information (i.e. date of birth, initials, etc)

Date




Date




Date




Temple University School of Pharmacy                                                     93
                                        Method of Resolution and Outcome

                                        **Note: This may include referral to Health
Date         OTC Question               Care Provider or Emergency Department
                                        Do NOT include any patient identifying
                                        information (ie. date of birth, initials, etc)
Date




Date




Temple University School of Pharmacy                                                    94
Activity# 4: Patient Counseling on Prescription Medications.

Directions: Please document 5 encounters involving the patient counseling of prescription
medications.

             Prescriptions              Key Counseling Points
             Medication                 **Note: Do NOT include any patient identifying
                                        information (ie. date of birth, initials, etc)
Date




Temple University School of Pharmacy                                                95
Activity # 5: Medication Adherence Interview                Date completed: __________

Directions: Please utilize this survey and interview a patient to assess adherence to medications.

 Do you sometimes forget to take all of your medications?                        Yes/No

 Over the past 2 weeks, were there any days when you did not take                Yes/No
 all of your prescribed medications?


 Have you ever cut back or stopped taking your medications without               Yes/No
 telling your doctor because you felt worse when you took it?


 When you travel or leave home, do you sometimes forget to bring                 Yes/No
 along your medications?

 Did you take your all of your prescribed medications yesterday?                 Yes/No


 When you feel better, do you sometimes stop taking your                         Yes/No
 medications?

 Taking medication everyday is a real inconvenience for some                     Yes/No
 people. Do you ever feel hassled about sticking to your medication
 treatment plan?


  How often do you have difficulty remembering to take all your             Never/Almost
 prescribed medications?                                                   Never/Sometimes/
                                                                          Quite Often/ Always

Adapted from: Predictive Validity of a Medication Adherence Measure in an
Outpatient Setting
Donald E. Morisky, Alfonso Ang, Marie Krousel-Wood, Harry J. Ward J Clin Hypertens
(Greenwich). 2008;10:348–354.

Questions for the Pharmacist initiated by the patient:




Pharmacist Response:




Temple University School of Pharmacy                                                   96
Activity # 5: Medication Adherence Interview                Date completed: __________

Directions: Please utilize this survey and interview a patient to assess adherence to medications.

 Do you sometimes forget to take all of your medications?                        Yes/No

 Over the past 2 weeks, were there any days when you did not take                Yes/No
 all of your prescribed medications?


 Have you ever cut back or stopped taking your medications without               Yes/No
 telling your doctor because you felt worse when you took it?


 When you travel or leave home, do you sometimes forget to bring                 Yes/No
 along your medications?

 Did you take your all of your prescribed medications yesterday?                 Yes/No


 When you feel better, do you sometimes stop taking your                         Yes/No
 medications?

 Taking medication everyday is a real inconvenience for some                     Yes/No
 people. Do you ever feel hassled about sticking to your medication
 treatment plan?


  How often do you have difficulty remembering to take all your             Never/Almost
 prescribed medications?                                                   Never/Sometimes/
                                                                          Quite Often/ Always

Adapted from: Predictive Validity of a Medication Adherence Measure in an
Outpatient Setting
Donald E. Morisky, Alfonso Ang, Marie Krousel-Wood, Harry J. Ward J Clin Hypertens
(Greenwich). 2008;10:348–354.

Questions for the Pharmacist initiated by the patient:




Pharmacist Response:




Temple University School of Pharmacy                                                   97
Activity #6 Pharmacy Calculations/Compounding

Directions: Calculations are used in many ways during verification and dispensing of
prescriptions. Some examples include weight specific calculations for determining appropriate
adult and pediatric drug dosing, compounding calculations, and dispensing calculations (i.e. how
much volume needs to be dispensed per dose). Please document 5 calculations that you had to
perform during your APPE community experience.

Date         Reason for calculation            Calculation




Temple University School of Pharmacy                                                 98
Activity #7 Pharmacy Management

Directions: Provide a brief description of the following Managerial Activities conducted at your
APPE pharmacy site.

    Scheduling of Pharmacy Personal
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________

    Purchasing and Inventory Control Methods
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________

    Controlled Substances-Ordering, Storage and Record Keeping

    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________




Temple University School of Pharmacy                                                  99
Activity #8: Drug Information Question.

Directions: During your experience, identify and answer two drug information questions. One
will be directed to a Health Care Provider and the other to a Patient. Provide the question and
a well referenced answer on a separate sheet of paper and attach in the log book. Utilize any
available drug information resources (Please remember only primary literature references. Do
not use Google, Wikipedia etc.).


1. Drug Information question from the Health Care Provider:
   (Provide a well-referenced answer on separate paper and attach to the workbook)




2. Drug Information question from the Patient:
   (Provide a well-referenced answer on separate paper and attach to the workbook)




Temple University School of Pharmacy                                                100
                     TEMPLE UNIVERSITY SCHOOL OF PHARMACY
                          VERIFICATION CERTIFICATION




This student,_______________________________________________, has completed all

activities in the Advanced Pharmacy Practice community workbook to my satisfaction.




Preceptor Signature:____________________________________________________________


Preceptor Name (Printed):_______________________________________________________


Date of review of community workbook:____________________________________________




Temple University School of Pharmacy                                             101
                             Temple University School of Pharmacy
                Community Advanced Pharmacy Practice Experience Evaluation Form

Student Name:______ __________________________Rotation Dates: _________________________
Preceptor Name:______________________________ Pharmacy Name:_________________________

Part A
Instructions to Preceptors:
     1. Evaluate each of the learning dimensions using the scale provided for each.
          0                    1                     2                       3                   4               N/A
  Deficits Exists   Needs Improvement           Competent                 Good             Outstanding
Needs extensive     Needs consistent       Requires only           Requires occasional   Requires           Not
intervention, the   intervention;          moderate                intervention;         minimal            applicable at
majority of times   Preceptor must         intervention            performs within       intervention;      this site.
the preceptor       provide directed       consisting of limited   expectations.         performs above
must complete       questioning in a       prompting.                                    expectations.
the task.           problem-solving
                    manner.

     2. Insert the number (0 to 4 or N/A) in the box and place a ( ) by each skill rated less than 2.
     3. Each component evaluated corresponds to a global educational competency of the School of
        Pharmacy.
1. Provides Drug Products                                                            Week 3               Weeks 4 to 6



      Determines appropriateness of order

      Evaluates and selects product
      Assures product/prescription accuracy

2. Communicates with Patients About Prescriptions                                    Week 3               Weeks 4 to 6


      Interviews and counsels patients on drug indication,
      usage, dosage, packaging, and storage
      Discusses drug cautions side effects
      Explains policies on fees and services
      Relates to patients in a professional manner
      Interacts to confirm patient understanding
3. Monitors and Evaluates Drug Therapy                                               Week 3               Weeks 4 to 6


      Identifies drug related problem(s).
      Recommends appropriate therapeutic plans to manage
      incorrect dose, drug reactions, allergies and drug interactions.




Temple University School of Pharmacy                                                                         102
4. Communicates with Patients About Non-Prescription
                                                                            Week 3   Weeks 4 to 6
   Products, Devices and Diagnostics


    Questions patients on conditions and intended drug use.
    Assists in and recommends OTC drug selection
    Provides information on medical/surgical devices
    Provides information on home diagnostic products

5. Compounding                                                              Week 3   Weeks 4 to 6


    Utilizes acceptable professional procedures
    Selects appropriate equipment and containers
    Prepares special dosage forms
    Documents calculations and procedures

6. Communicates with Health Professionals                                   Week 3   Weeks 4 to 6


    Obtains and provides accurate and concise information in a
    professional manner.
    Uses appropriate oral, written and nonverbal language
7. Retrieves Drug Information                                               Week 3   Weeks 4 to 6


    Selects best available resource for answering a drug related request.
    Evaluates the quality of information obtained.
    Responds in a timely fashion.

8. Handles Detail                                                           Week 3   Weeks 4 to 6


    Is conscientious in following appropriate work procedures.
    Is attentive to details and technical interrelationships in
    carrying out duties
    Notices discrepancies and irregularities
    Keeps accurate records and documents actions
    Takes steps to ensure accuracy of work
    Provides an appropriate amount of detail
9. Makes Sound Decisions                                                    Week 3   Weeks 4 to 6


    Uses good judgment in coming up with sensible, practical solutions to
    problems
    Seeks out and utilizes appropriate facts and information in decision
    making
    Recognizes and evaluates available alternatives
    Gives thought to possible consequences of decisions.




Temple University School of Pharmacy                                                     103
10. Organizes/Plans                                                       Week 3       Weeks 4 to 6


     Uses own and others' time effectively and efficiently.
     Is systematic and methodical in approaching activities
     Sets meaningful goals
     Plans activities to meet objectives
     Is well prepared
     Is able to anticipate future needs.
Part B
Instructions: Place a number (0 or 1) that corresponds with your assessment of the student‘s behavior
during each week of the Community Pharmacy Rotation.
                             0                                     1
                           Needs                  Behavior consistent with that
                        improvement               of a health-care professional.

11. Demonstrates Human Relations Skills                                   Week 3        Weeks 4 to 6


    Displays an interest in others.
    Is sensitive to the needs, feelings, and concerns of others.
    Shows empathy; listens, is nonjudgmental and responds appropriately
    to others‘ problems.


12. Maintains Professional/Ethical Standards                              Week 3        Weeks 4 to 6


    Complies with laws and regulations.

    Applies good professional judgment in legal interpretations.
    Deals professionally and ethically with colleagues and patients.
    Maintains confidentiality.

13. Displays Independence/Assertiveness                                   Week 3       Weeks 4 to 6


    Self-directed in undertaking responsibilities.
    Articulates own viewpoint when dealing with others and in
    addressing controversial issues.
    Speaks out against questionable tactics and practices.

14. Learns in a Self-Directed Manner                                      Week 3       Weeks 4 to 6


    Conducts self-assessment.
    Acting on identified strengths and weaknesses, develops a learning
    plan.
    Pursues further knowledge independently.
    Aware of how professional organizations can facilitate life-long
    learning needs.




Temple University School of Pharmacy                                                       104
Part C
Overall assessment: Compared to other pharmacy students I have worked with, I consider this student to be:


Outstanding               Above Average             Average                  Below Average        

Comments:




                                          CERTIFICATION


This is to certify that the above named student was present for _______ hours per day for _____ days
completing this rotation under the supervision of my pharmacy staff and myself.


_____________________________           ____________________________________________________
            (Date)                                     Preceptor Signature

Student Review
I have discussed this evaluation with my preceptor.

______________________________          ____________________________________________________
             (Date)                                      Student Signature




Temple University School of Pharmacy                                                       105
          Pharmaceutical Industry Advanced Pharmacy Practice Experience Rotation
                         Faculty Coordinator: Dr. Rachel Clark-Vetri
                                           rachel.clark-vetri@temple.edu
                                               Phone: 215-707-5113

Goal:
The Pharmaceutical Industry Advanced Pharmacy Practice Experience Rotation will help the
students gain exposure to the roles of pharmacists within the Pharmaceutical Industry.
Things to Know:
●Could include clinical research, drug information, medical information, production, quality
assurance.
●You must be willing to commute 45-60 minutes each way. You must have a car.
●A drug test may also be required.
●You must be comfortable with your verbal and written communication skills.
Student Responsibilities: Prepare a written report documenting activities that you observed/participation
during this rotation and submit report to Dr. Vetri.

              Nuclear Pharmacy Advanced Pharmacy Practice Experience Rotation
                           Faculty Coordinator Dr. Elaine Mackowiak
                                 elaine.mackowiak@temple.edu
                                      Phone: 215-707-4914
Goal:
This Advanced Pharmacy Practice Experience provides students with the opportunity to work with
pharmacists in a centralized nuclear pharmacy where radiopharmaceuticals are compounded and
dispensed daily. Students are expected to work the hours for the various shifts as arranged by the
preceptor.
Description:
The degree of student participation in each of the following activities is the responsibility of the preceptor
and is determined by the level of the student‘s skill and company‘s policies for student interns/externs.
1.      Receive and review prescriptions for clients;
2.      Compound drugs for prescriptions;
3.      Perform quality control analysis for compound drugs;
4.      Calculate appropriate dose required for dispensing;
5.      Measure dose of drug using dose calibrator;
6.      Properly label prescriptions according to Department of Transportation regulations;
7.      Perform wipe test required by NRC regulations;
8.      Review procedures for ordering both radioactive and non-radioactive ingredients required for
        prescription preparation
9.      Elute technetium generators;
10.     Perform quality control for technetium generators;
11.     Perform quality control for dose calibrators;
12.     Review record keeping procedures required by NRC;
13.     Review procedures for drug deliveries to pharmacy to clients


Temple University School of Pharmacy                                                            106
                                           Elective Rotations
Students electing one of the following rotations will be evaluated using the universal competency statements and
learning objectives of the Advanced Pharmacy Practice Experience program and meet the requirements defined for
the program.

Clinical Inpatient

        General Medicine
        Specialty

Clinical Ambulatory Care

Ambulatory Care Clinic or Office Practice, Community/Chain Pharmacy

Institutional Pharmacy Practice



Students electing to complete a rotation in one of the specialty areas listed below will meet with the site preceptor
to agree on the desired educational competencies and learning objectives during the first few days of the rotation.
The site preceptor will identify the daily student responsibilities.

Other

        Managed Care Pharmacy
        Professional Activities
        Mail Order



Evaluations

         The student grade will be based on the preceptor(s) assessment of how successfully the student achieved
the educational competencies and learning objectives for the rotations. Evaluations may be formatted differently
but the content is the same.




Temple University School of Pharmacy                                                           107
                         TEMPLE UNIVERSITY SCHOOL OF PHARMACY
                             EVALUATION OF STUDENT PERFORMANCE
                                 NUCLEAR PHARMACY ROTATION

Student Name:___        _________________________Rotation Dates: _________________________
Preceptor Name: ______________________________ Site: _________________________________

Part A
Instructions to Preceptors:
    1. If you have written goals and objectives please share them with the student.
    2. Sit down with the student and together develop and list below the five most important experiences to
        which the student will be exposed during this rotation. Using the scale provided below, ask the student
        to assess his or her skills and knowledge on day 1 of the rotation. Using the same scale, the preceptor
        should evaluate the student at the end of week 3 and week 6 of the rotation.

                         N = No skills, no knowledge
                         B = Basic skills, basic knowledge
                         F = Functionally adequate skills and knowledge
                         A = Advanced level of skills and knowledge

                                                        Initial Assessment
Experience                                                                     Week 3            Week 6
                                                           (By Student)


Basic radiation physics theory and dosage
                                                           N B F A           N B F A           N B F A
calculations; Basic instrumentation knowledge.


Basic radiation safety knowledge and practices‘;
ALAPA concepts                                             N B F A           N B F A           N B F A



Mo99 – Tc99m generator chemistry, elution, and
                                                           N B F A           N B F A           N B F A
quality assurance procedures.



NRC and DOT regulations and procedures, both
                                                           N B F A           N B F A           N B F A
for deliveries and returns.



Radiopharmaceutical compounding and quality
                                                           N B F A           N B F A           N B F A
control.




Temple University School of Pharmacy                                                        108
Part B
1. Communication Skills                                                  Week 3   Week 6


1    Insecure          Obtains and provides accurate and concise
                       information in a professional manner.
                       Uses appropriate oral, written and nonverbal
5 Self-confident       language
2. Information Retrieval                                                 Week 3   Week 6


1    Unskilled         Selects best available resource for answering a
                       request.
                       Evaluates the quality of information obtained.
                       Responds in a timely fashion.
5    Proficient
3. Handles Detail                                                        Week 3   Week 6


1   Disorganized      Is conscientious in following appropriate work
                      procedures.
                      Is attentive to details and technical
                      interrelationships in carrying out duties
                      Notices discrepancies and irregularities
                      Keeps accurate records and documents actions
                      Takes steps to ensure accuracy of work
5   Methodical        Provides an appropriate amount of detail

4. Makes Sound Decisions                                                 Week 3   Week 6


1    Lack of          Uses good judgment in coming up with sensible,
    Knowledge         practical solutions to problems
                      Seeks out and utilizes appropriate facts and
                      information in decision making
                      Recognizes and evaluates available alternatives
                      Gives thought to possible consequences of
                      decisions.
5    Perceptive
5. Organizes/Plans                                                       Week 3   Week 6


1     Usually         Uses own and others' time effectively and
     Ineffective      efficiently.
                      Is systematic and methodical in approaching
                      activities
                      Sets meaningful goals
                      Plans activities to meet objectives
                      Is well prepared
5 Usually Effective   Is able to anticipate future needs.




Temple University School of Pharmacy                                               109
 Part C
 Instructions: Circle the number that corresponds with your overall assessment of the student's behavior
 during the Specialty Pharmacy Rotation.

          1                                         2
        Needs                      Behavior consistent with that
     improvement                   of a health-care professional.

 1. Demonstrates Human Relations Skills
      Displays an interest in others; is sensitive to the needs, feelings, and concerns of others;
      shows empathy; listens, is nonjudgmental and responds appropriately to others‘
                                                                                                       1           2
      problems; acts in the best interest of others.
 2. Maintains Professional/Ethical Standards
      Complies with laws and regulations; applies good professional judgment in legal
      interpretations; exhibits reliability and credibility in dealing with others; deals
                                                                                                       1           2
      professionally and ethically with colleagues and/or patients; maintains confidentiality.
 3. Displays Independence/Assertiveness
      Self-directed in undertaking responsibilities; articulates own viewpoint when dealing
      with others and in addressing controversial issues; speaks out against questionable
                                                                                                       1           2
      tactics and practices.
 4. Learns in a Self-Directed Manner
      Conducts self-assessment; acting on identified strengths and weaknesses, develops a
      learning plan; pursues further knowledge independently; aware of how professional
                                                                                                       1           2
      organizations can facilitate life-long learning needs.


 Part D
 Overall assessment: Compared to other pharmacy students I have worked with, I consider this student to be:

 ____Outstanding             ____Above Average                     ____Average                 ____Below Average

Comments:




(Preceptor‘s Signature)



(Student‘s Signature)                                                                 Date




 Temple University School of Pharmacy                                                                     110
                         TEMPLE UNIVERSITY SCHOOL OF PHARMACY
                             EVALUATION OF STUDENT PERFORMANCE
                               NUCLEAR PHARMACY ROTATION (PET)

Student Name: _______________________________Rotation Dates: _________________________
Preceptor Name: ______________________________ Site: _________________________________

Part A
Instructions to Preceptors:
    3. If you have written goals and objectives please share them with the student.
    4. Sit down with the student and together develop and list below the five most important experiences to
        which the student will be exposed during this rotation. Using the scale provided below, ask the student
        to assess his or her skills and knowledge on day 1 of the rotation. Using the same scale, the preceptor
        should evaluate the student at the end of week 3 and week 6 of the rotation.

                         N = No skills, no knowledge
                         B = Basic skills, basic knowledge
                         F = Functionally adequate skills and knowledge
                         A = Advanced level of skills and knowledge

                                                      Initial
Experience                                         Assessment          Week 3                 Week 6
                                                   (By Student)


Basic radiation physics theory and dosage
                                                   N B F A            N B F A               N B F A
calculations; Basic instrumentation knowledge.


Basic radiation safety knowledge and practices‘;
ALAPA concepts                                     N B F A            N B F A               N B F A



Operation of a cyclotron and current
                                                   N B F A            N B F A               N B F A
GMPs (good manufacturing practices)



NRC and DOT regulations and procedures, both
                                                   N B F A            N B F A               N B F A
for deliveries and returns.



Radiopharmaceutical compounding and quality
                                                   N B F A            N B F A               N B F A
control.




Temple University School of Pharmacy                                                        111
Part B
1. Communication Skills                                                  Week 3   Week 6


1    Insecure          Obtains and provides accurate and concise
                       information in a professional manner.
                       Uses appropriate oral, written and nonverbal
5 Self-confident       language
2. Information Retrieval                                                 Week 3   Week 6


1    Unskilled         Selects best available resource for answering a
                       request.
                       Evaluates the quality of information obtained.
                       Responds in a timely fashion.
5    Proficient
3. Handles Detail                                                        Week 3   Week 6


1   Disorganized      Is conscientious in following appropriate work
                      procedures.
                      Is attentive to details and technical
                      interrelationships in carrying out duties
                      Notices discrepancies and irregularities
                      Keeps accurate records and documents actions
                      Takes steps to ensure accuracy of work
5   Methodical        Provides an appropriate amount of detail

4. Makes Sound Decisions                                                 Week 3   Week 6


1    Lack of          Uses good judgment in coming up with sensible,
    Knowledge         practical solutions to problems
                      Seeks out and utilizes appropriate facts and
                      information in decision making
                      Recognizes and evaluates available alternatives
                      Gives thought to possible consequences of
                      decisions.
5    Perceptive
5. Organizes/Plans                                                       Week 3   Week 6


1     Usually         Uses own and others' time effectively and
     Ineffective      efficiently.
                      Is systematic and methodical in approaching
                      activities
                      Sets meaningful goals
                      Plans activities to meet objectives
                      Is well prepared
5 Usually Effective   Is able to anticipate future needs.




Temple University School of Pharmacy                                               112
 Part C
 Instructions: Circle the number that corresponds with your overall assessment of the student's behavior
 during the Specialty Pharmacy Rotation.

          1                                         2
        Needs                      Behavior consistent with that
     improvement                   of a health-care professional.

 5. Demonstrates Human Relations Skills
      Displays an interest in others; is sensitive to the needs, feelings, and concerns of others;
      shows empathy; listens, is nonjudgmental and responds appropriately to others‘
                                                                                                       1           2
      problems; acts in the best interest of others.
 6. Maintains Professional/Ethical Standards
      Complies with laws and regulations; applies good professional judgment in legal
      interpretations; exhibits reliability and credibility in dealing with others; deals
                                                                                                       1           2
      professionally and ethically with colleagues and/or patients; maintains confidentiality.
 7. Displays Independence/Assertiveness
      Self-directed in undertaking responsibilities; articulates own viewpoint when dealing
      with others and in addressing controversial issues; speaks out against questionable
                                                                                                       1           2
      tactics and practices.
 8. Learns in a Self-Directed Manner
      Conducts self-assessment; acting on identified strengths and weaknesses, develops a
      learning plan; pursues further knowledge independently; aware of how professional
                                                                                                       1           2
      organizations can facilitate life-long learning needs.


 Part D
 Overall assessment: Compared to other pharmacy students I have worked with, I consider this student to be:

 ____Outstanding             ____Above Average                     ____Average                 ____Below Average

Comments:




(Preceptor‘s Signature)



(Student‘s Signature)                                                                 Date




 Temple University School of Pharmacy                                                                     113
                             Temple University School of Pharmacy
               Specialty Advanced Pharmacy Practice Experience Evaluation Form


 Student Name: ________________________________Rotation Dates: __________________________ _
 Preceptor: _________________________________            NameSite: _________________________________

 Part A
 Instructions to Preceptors:
     5. If you have written goals and objectives please share them with the student.
     6. Sit down with the student and together develop and list below the five most important
         experiences to which the student will be exposed during this rotation. Using the scale
         provided below, ask the student to assess his or her skills and knowledge on day 1
         of the rotation. Using the same scale, the preceptor should evaluate the student at the
         end of week 3 and week 6 of the rotation.
                           N = No skills, no knowledge
                           B = Basic skills, basic knowledge
                           F = Functionally adequate skills and knowledge
                           A = Advanced level of skills and knowledge

                                                       Initial Assessment
Experience                                                                     Week 3          Week 4-6
                                                          (By Student)



                                                          N B F A            N B F A           N B F A




                                                          N B F A            N B F A           N B F A




                                                          N B F A            N B F A           N B F A




                                                          N B F A            N B F A           N B F A




                                                          N B F A            N B F A           N B F A




 Temple University School of Pharmacy                                                             114
  Part B
  Instructions to Preceptors:

       4. Evaluate each of the learning dimensions using the scale provided for each.
          0                        1                    2                       3                     4              N/A
   Deficits Exists      Needs Improvement          Competent                  Good              Outstanding
Needs extensive         Needs consistent       Requires only         Requires occasional       Requires         Not applicable
intervention, the       intervention;          moderate              intervention; performs    minimal          at this site.
majority of times the   Preceptor must         intervention          within                    intervention;
preceptor must          provide directed       consisting of         expectations.             performs
complete the task.      questioning in a       limited                                         above
                        problem-solving        prompting.                                      expectations.
                        manner.

     5. Insert the number (0 to 4 or N/A) in the box and place a ( ) by each skill rated less than 2.
     6. Each component evaluated corresponds to a global educational competency of the School of
        Pharmacy.
 1. Communication Skills                                                 Week 3                Week 4-6


       Obtains and provides accurate and concise information in a
       professional manner.
       Uses appropriate oral, written and nonverbal language
 2. Information Retrieval                                                             Week 3                   Week 4-6


       Selects best available resource for answering a request.
       Evaluates the quality of information obtained.
       Responds in a timely fashion.
 3. Handles Detail                                                                    Week 3                   Week 4-6


       Is conscientious in following appropriate work procedures.
       Is attentive to details and technical interrelationships in carrying out
       duties
       Notices discrepancies and irregularities
       Keeps accurate records and documents actions
       Takes steps to ensure accuracy of work
       Provides an appropriate amount of detail
 4. Makes Sound Decisions                                                             Week 3                   Week 4-6


       Uses good judgment in coming up with sensible, practical solutions to
       problems
       Seeks out and utilizes appropriate facts and information in decision
       making
       Recognizes and evaluates available alternatives
       Gives thought to possible consequences of decisions.




  Temple University School of Pharmacy                                                                          115
5. Organizes/Plans                                                      Week 3            Week 4-6


     Uses own and others' time effectively and efficiently.
     Is systematic and methodical in approaching activities
     Sets meaningful goals
     Plans activities to meet objectives
     Is well prepared
     Is able to anticipate future needs.

 Part C
 Instructions: Place a number (0 or 1) that corresponds with your assessment of the student‘s behavior
 during each week of the Specialty Pharmacy Rotation.
                              0                                    1
                            Needs                  Behavior consistent with that
                         improvement               Of a health-care professional.

6. Demonstrates Human Relations Skills                        Week 3                Weeks 4-6

    Displays an interest in others.
    Is sensitive to the needs, feelings, and concerns of
    others.
    Shows empathy; listens, is nonjudgmental and
    responds appropriately
    to others' problems.
    Acts in the best interest of others.
7. Maintains Professional/Ethical Standards                   Week 3                Weeks 4-6

    Complies with laws and regulations.
    Applies good professional judgment in legal
    interpretations.
    Deals professionally and ethically with colleagues and
    patients.
    Maintains confidentiality..
8. Displays Independence/Assertiveness                        Week 3                Weeks 4-6

    Self-directed in undertaking responsibilities.
    Articulates own viewpoint when dealing with others
    and in addressing controversial issues.
    Speaks out against questionable tactics and practices..




 Temple University School of Pharmacy                                                          116
 9. Learns in a Self-Directed Manner                                Week 3                   Weeks 4-6

     Conducts self-assessment.
     Acting on identified strengths and weaknesses,
     develops a learning plan.
     Pursues further knowledge independently.
     Aware of how professional organizations can facilitate
     life-long learning needs.


  Part D
  Overall assessment: Compared to other pharmacy students I have worked with, I consider this student to be:



Outstanding                   Above Average                 Average                Below Average            

 Comments:




                                                CERTIFICATION


  This is to certify that the above named student was present for _______ hours per day for _____ days
  completing this rotation under the supervision of my pharmacy staff and myself.


  _____________________________               ____________________________________________________
              (Date)                                         Preceptor Signature

  Student Review
  I have discussed this evaluation with my preceptor.

  ______________________________              ___________________________________________________
               (Date)                                       Student Signature




  Temple University School of Pharmacy                                                                  117
Ambulatory Care Preceptor/Site Evaluation

  Course Information
       Course Name: P407 Advanced - Ambulatory Care Rotation
         Department: Pharmacy Practice Experiences
         Instructors:
         Block / Site:

Please respond to each phrase. If a specific statement does not apply to your site, Select N/A




 If you have questions or comments about this survey, click [here] to send a message to the survey administrator.


 Rotation Comments Questions

  1)   What were the most beneficial aspects of this experience?




 2)    What could be done to improve this experience?




 Rotation Site Information

  3)   What was the rotation site name?




 4)    What was the Rotation Site Address (City and State)




Temple University School of Pharmacy                                                                 118
 5)      What was the Primary Preceptor's Name?




      Primary Preceptor

 6) Oriented me to the site (discussed the structure, pharmacy facilities, schedules and the services
    provided.)


            Disagree      Neutral      Agree      Not Applicable


 7)     Discussed the educational goals, objectives and competencies with me at the start of the rotation


            Disagree      Neutral      Agree      Not Applicable


 8)     Attempted to provide experiences to help me meet the goals and objectives for the rotation.


            Disagree      Neutral      Agree      Not Applicable


 9)     Attempted to provide practice experiences to meet my individual needs.


            Disagree      Neutral      Agree      Not Applicable


10) Was available to discuss any problems or concerns.


            Disagree      Neutral      Agree      Not Applicable


11) Evaluated my performance at the end of 2 weeks


            Disagree      Neutral      Agree      Not Applicable


12) Evaluated my performance at the end of 5 weeks.




Temple University School of Pharmacy                                                             119
          Disagree      Neutral      Agree      Not Applicable




13) Evaluated me fairly


          Disagree      Neutral      Agree      Not Applicable



   Preceptor as a teacher

 14)   Was knowledgeable


           Disagree       Neutral      Agree      Not Applicable


 15)   Explained concepts clearly


           Disagree       Neutral      Agree      Not Applicable


 16)   Applied information in terms of patient care


           Disagree       Neutral      Agree      Not Applicable


 17)   Attended all scheduled conferences.


           Disagree       Neutral      Agree      Not Applicable


 18)   Was accessible and willing to answer questions.


           Disagree       Neutral      Agree      Not Applicable


 19)   Motivated me to learn and participate as an active member of the health care team


           Disagree       Neutral      Agree      Not Applicable


 20)   Provide adequate supervision.


           Disagree       Neutral      Agree      Not Applicable




Temple University School of Pharmacy                                                      120
 21)   Showed a genuine interest in students.


           Disagree       Neutral        Agree      Not Applicable




       22) Provide adequate supervision.


                 Disagree        Neutral         Agree


       23) Showed a genuine interest in students.


                 Disagree        Neutral         Agree


       24) Was concerned about the quality of his/her teaching


                 Disagree        Neutral         Agree




        Preceptor as pharmacy practitioner




        Preceptor as a pharmacy practitioner

        25) Is enthusiastic and interested in his/her practice.


                  Disagree          Neutral      Agree


        26) Is respected by other health care professionals.


                  Disagree          Neutral      Agree




Temple University School of Pharmacy                                121
       27) Effectively communicates with patients.


                 Disagree      Neutral     Agree


       28) Is a good role model.


                 Disagree      Neutral     Agree




Temple University School of Pharmacy                122
Institutional Preceptor/Site Evaluation


  Course Information
           Course Name: P409 Advanced - Institutional Rotation
             Department: Pharmacy Practice Experiences
             Instructors:
             Block / Site:




 Rotation Site Information

 1) What was the rotation site name?




2)        What was the Rotation Site Address (City and State)




3)        What was the Primary Preceptor's Name?




 Rotation Comments Questions

     4)     What were the strongest aspects of this rotation?




Temple University School of Pharmacy                            123
  5)   How could this rotation be improved?




  6)   Would you consider being a Hospital Pharmacist after graduation?


            Yes        No


  7)   I would recommend the site to a friend




             Yes

             No

             Highly Recommend

             Recommend



  8)     Did you experience any problems at your site?


             Yes        No


  9)     Please comment on any problems you may have had at your site?




   Primary Preceptor



10) Oriented me to the Department of Pharmacy(discussed the organizational sturcture,pharmacy facilities,
    schedules and the services provided).


         Disagree       Neutral    Agree        Not Applicable




Temple University School of Pharmacy                                                        124
11)   Oriented me to the hospital setting


          Disagree       Neutral       Agree        Not Applicable


12)   Prepared a schedule of activities for me


          Disagree       Neutral       Agree        Not Applicable


13)   Attempted to provide experiences to help me meet the goals and objectives for the rotation


          Disagree       Neutral       Agree        Not Applicable


14)   Attempted to provide practice experiences to meet my individual needs


          Disagree       Neutral       Agree        Not Applicable


15)   Was available to discuss any problems or concerns


          Disagree       Neutral       Agree        Not Applicable


16)   Evaluated my performance at the end of 2 weeks


          Disagree       Neutral       Agree        Not Applicable


17)   Evaluated my performance at the end of 5 weeks.


          Disagree       Neutral       Agree        Not Applicable


18)   Evaluated me fairly


          Disagree       Neutral       Agree        Not Applicable



  Preceptor as a teacher



  19)     Specified what was expected of me


              Disagree       Neutral        Agree       Not Applicable




Temple University School of Pharmacy                                                              125
  20)    Was knowledgeable


             Disagree      Neutral       Agree    Not Applicable




  21)    Explained information clearly


             Disagree      Neutral       Agree    Not Applicable


  22)    Spent adequate time teaching


             Disagree      Neutral       Agree    Not Applicable


  23)    Was organized


             Disagree      Neutral       Agree    Not Applicable


  24)    Encouraged me the ask questions and make comments


             Disagree      Neutral       Agree    Not Applicable


  25)    Motivated me to learn


             Disagree      Neutral       Agree    Not Applicable


  26)    Provided helpful and timely feedback


             Disagree      Neutral       Agree    Not Applicable


  27)    Provided adequate supervision of my activities


             Disagree      Neutral       Agree    Not Applicable



 Preceptor as pharmacy practitioner



  28)    Was a good role model for pharmacy students




Temple University School of Pharmacy                              126
              Disagree       Neutral     Agree         Not Applicable

  29)    Communicated effectively with other health professionals and/or patients


              Disagree       Neutral     Agree         Not Applicable


  30)    Was enthusiastic and interested in his/her practice


              Disagree       Neutral     Agree         Not Applicable



 Hospital Pharmacist Activities



 31)    Review and evaluate physician orders


            Inadequate       Adequate      Excellent


 32)    Communicate with other health professional


            Inadequate       Adequate      Excellent


 33)    Update and maintain patient profiles


            Inadequate       Adequate      Excellent


 34)    Fill cassettes and check.


            Inadequate       Adequate      Excellent


 35)    Review and evaluate IV orders.


            Inadequate       Adequate      Excellent


 36)    Prepare sterile products.


            Inadequate       Adequate      Excellent


 37)    Compound extemporaneous products



Temple University School of Pharmacy                                               127
            Inadequate      Adequate       Excellent


 38)   Work in a satellite pharmacy


            Inadequate      Adequate       Excellent


 39)   Conduct nursing unit inspections


            Inadequate      Adequate       Excellent


 40)   Assist in the maintenance of records for controlled substances


            Inadequate      Adequate       Excellent

 41)   Assist pharmacist(s) providing pharmacokinetic consults


            Inadequate      Adequate       Excellent


 42)   Provide Drug Information


            Inadequate      Adequate       Excellent


 43)   Participate in Drug Utilization Evaluation


            Inadequate      Adequate       Excellent


 44)   Attend P & T committee meeting


            Inadequate      Adequate       Excellent


 45)   Participate in nutritional support services


            Inadequate      Adequate       Excellent

46) Counsel patients


         Inadequate       Adequate        Excellent




Temple University School of Pharmacy                                   128
47) Present in-service lectures to other health professionals


              Inadequate       Adequate       Excellent




Community Preceptor/Site Evaluation

  Course Information
           Course Name: P408 Advanced - Community Pharmacy Rotation
             Department: Pharmacy Practice Experiences
             Instructors:
             Block / Site:




 Rotation Site Information

  1) What was the rotation site name?




 2)        What was the Rotation Site Address (City and State)




 3)        What was the Primary Preceptor's Name?




 Rotation Comments Questions

      4)     Has this clinical experience changed your impression of community pharmacy practice?




Temple University School of Pharmacy                                                           129
             Yes         No


   5)   If yes,


             Favorable         Unfavorable




   6)   What were the strongest aspects of this rotation?




   7)   How could this rotation be improved?




   8)   I would recommend the site to a friend




              Yes

              No

              Highly Recommend

              Recommend




   9)     Did you experience any problems at your site?


                  Yes     No




  10)     Please comment on any problems you may have had at your site?




Temple University School of Pharmacy                                     130
 Primary Preceptor




11) Adequately oriented me to the pharmacy policies and procedures


         Disagree      Neutral     Agree      Not Applicable


12) Introduced me to personnel


         Disagree      Neutral     Agree      Not Applicable


13) Attempted to provide experiences to help me meet the goals and objectives for the rotation


         Disagree      Neutral     Agree      Not Applicable


14) Prepared a daily schedule consistent with the schools's guidelines


         Disagree      Neutral     Agree      Not Applicable


15) Attempted to provide practice experiences to meet my individual needs


         Disagree      Neutral     Agree      Not Applicable


16) Evaluated my performance at the end of 2 weeks


         Disagree      Neutral     Agree      Not Applicable


17) Was available to discuss any problems or concerns




Temple University School of Pharmacy                                                            131
         Disagree     Neutral       Agree     Not Applicable


18) Evaluated my performance at the end of 5 weeks.


         Disagree     Neutral       Agree     Not Applicable


19) Evaluated me fairly


         Disagree     Neutral       Agree     Not Applicable




 Preceptor as a teacher



20) Clearly defined what was expected of me


         Disagree     Neutral       Agree     Not Applicable


21) Was knowledgeable


         Disagree     Neutral       Agree     Not Applicable


22) Explained information clearly


         Disagree     Neutral       Agree     Not Applicable


23) Spent adequate time teaching


         Disagree     Neutral       Agree     Not Applicable


24) Was organized


         Disagree     Neutral       Agree     Not Applicable


25) Encouraged me the ask questions and make comments




Temple University School of Pharmacy                          132
         Disagree      Neutral     Agree       Not Applicable


26) Motivated me to learn


         Disagree      Neutral     Agree       Not Applicable


27) Provided helpful and timely feedback


         Disagree      Neutral     Agree       Not Applicable


28) Provided adequate supervision of my activities


         Disagree      Neutral     Agree       Not Applicable




  Preceptor as pharmacy practitioner



29) Communicated effectively with patients


         Disagree      Neutral     Agree       Not Applicable


30) Was sensitive to the needs of others


         Disagree      Neutral     Agree       Not Applicable


31) Was confident when communicating with physicians


         Disagree      Neutral     Agree       Not Applicable


32) Was enthusiastic and interested in his/her practice


         Disagree      Neutral     Agree       Not Applicable


33) Was a good role model for pharmacy students


         Disagree      Neutral     Agree       Not Applicable




Temple University School of Pharmacy                           133
   Community Pharmacist Activities

 34) Review and evaluate prescription orders


          Inadequate       Adequate      Excellent


35)   Update and maintain patient profiles


          Inadequate       Adequate      Excellent


36)   Fill prescriptions


          Inadequate       Adequate      Excellent


37)   Use the pharmacy's computer


          Inadequate       Adequate      Excellent


38)   Communicate concerns to physicians


          Inadequate       Adequate      Excellent


39)   Compounding (preparation of extemporaneous products)


          Inadequate       Adequate      Excellent


40)   Counsel patients about prescriptions medicines


          Inadequate       Adequate      Excellent


41)   Recommend OTC products


          Inadequate       Adequate      Excellent


42)   Complete third party forms


          Inadequate       Adequate      Excellent



Temple University School of Pharmacy                        134
43)   Fit patients for medical and surgical appliances


          Inadequate       Adequate       Excellent


44)   Consult on nursing home patients


          Inadequate       Adequate       Excellent


45)   Fill nursing home orders


          Inadequate       Adequate       Excellent


      46) Home Health Care Services (i.e. outpatient IV Services)


                Inadequate       Adequate         Excellent


      47) Purchasing practices


                Inadequate       Adequate         Excellent




      48) Marketing Strategies


                Inadequate       Adequate         Excellent




Temple University School of Pharmacy                               135
Elective Preceptor/Site Evaluation



  Course Information
      Course Name: P410 Advanced - Elective Rotation
        Department: Pharmacy Practice Experiences
         Instructors:
         Block / Site:




 If you have questions or comments about this survey, click [here] to send a message to the survey administrator.




 Rotation Site Information




1) What was the rotation site name?




2) What was the Rotation Site Address (City and State)




Temple University School of Pharmacy                                                                 136
3) What was the Primary Preceptor's Name?




 Rotation Comments Questions




4)   List the activities that you participated in or observed during your specialty rotation.




5)   Did this experience enhance your knowledge about careers in pharmacy?


          Yes       No


6)   Explain how this experience enhanced your knowledge about careers in pharmacy.




7)   What were the strongest aspects of this rotation?




Temple University School of Pharmacy                                                           137
8)   How could this rotation be improved?




9)   Would you consider working at this specialty site after graduation? Please Explain.




10) Would you consider working at this specialty site after graduation?


         Yes        No


11) Did you experience any problems at your site?


         Yes        No


12) Please comment on any problems you may have had at your site?




 If you have questions or comments about this survey, click [here] to send a message to the survey administrator




Temple University School of Pharmacy                                                                 138
 Inpatient Clinical Preceptor/Site Evaluation



  Course Information
      Course Name: P406 Advanced - Inpatient Clinical Rotation
        Department: Pharmacy Practice Experiences
         Instructors:
         Block / Site:




 If you have questions or comments about this survey, click [here] to send a message to the survey administrator.




  Rotation Site Information

1) What was the rotation site name?




2) What was the Rotation Site Address (City and State)




Temple University School of Pharmacy                                                                 139
3) What was the Primary Preceptor's Name?




 Rotation Comments Questions




4) What were the most beneficial aspects of this experience?




5) What could be done to improve this experience?




6) Did you experience any problems at your site?


         Yes      No


7) Please comment on any problems you may have had at your site?




Temple University School of Pharmacy                              140
  Primary Preceptor



 8)   Oriented me to the site (discussed the structure, pharmacy facilities, schedules and the services
      provided.)


          Disagree        Neutral       Agree


 9)   Discussed the educational goals, objectives and competencies with me at the start of the rotation


          Disagree        Neutral       Agree


10) Attempted to provide experiences to help me meet the goals and objectives for the rotation.


          Disagree        Neutral       Agree


11) Attempted to provide practice experiences to meet my individual needs.


          Disagree        Neutral       Agree


12) Was available to discuss any problems or concerns.


          Disagree        Neutral       Agree


13) Evaluated my performance weekly


          Disagree        Neutral       Agree


14) Evaluated me fairly


          Disagree        Neutral       Agree




Temple University School of Pharmacy                                                            141
15) Evaluated my performance at the end of 5 weeks.


          Disagree      Neutral         Agree



    Preceptor as a teacher



16) Was knowledgeable


          Disagree      Neutral         Agree


17) Explained concepts clearly


          Disagree      Neutral         Agree




18) Applied information in terms of patient care


          Disagree      Neutral         Agree


19) Attended all scheduled conferences.


          Disagree      Neutral         Agree


20) Was accessible and willing to answer questions.


          Disagree      Neutral         Agree


21) Motivated me to learn and participate as an active member of the health care team


          Disagree      Neutral         Agree


22) Provide adequate supervision.


          Disagree      Neutral         Agree




Temple University School of Pharmacy                                                   142
23) Showed a genuine interest in students.


            Disagree       Neutral       Agree


24) Was concerned about the quality of his/her teaching


            Disagree       Neutral       Agree



      Preceptor as pharmacy practitioner



 25    Is enthusiastic and interested in his/her practice.
  )

            Disagree       Neutral       Agree


 26    Is respected by other health care professionals.
  )

            Disagree       Neutral       Agree


 27    Effectively communicates with patients.
  )

            Disagree       Neutral       Agree


 28    Is a good role model.
  )

            Disagree       Neutral       Agree




 If you have questions or comments about this survey, click [here] to send a message to the survey administrator




Temple University School of Pharmacy                                                                 143
TEMPLE UNIVERSITY
BOARD OF TRUSTEES
POLICIES AND PROCEDURES MANUAL
Title: Student Drug and Alcohol Policy
Policy Number: 03.70.01
Effective Date: September 27, 1990
Issuing Authority: Board of Trustees
Scope of Policy
This Policy applies to all Temple University students.
Statement of Purpose
Temple University seeks to encourage and sustain an academic environment that both
respects individual freedom and promotes the health, safety and welfare of all members
of its community. Members of the University community are expected to conduct
themselves in a manner in which they do not cause harm to themselves or others, and that
they neither break laws nor contribute to the delinquency of others. In keeping with these
objectives, the University has established the following policy governing the unlawful
use, consumption, possession, distribution and manufacture of illicit drugs and alcohol on
University property or as part of University activities.
The unlawful use of controlled substances (drugs) and alcohol misuse and abuse
represent a danger to the health of a student which may result in serious injury or death,
and also poses risks to the health and safety of others in the University community.
Health risks associated with the use of illicit drugs and abuse of alcohol are varied.
Among the many risks to the individual are brain damage, cirrhosis of the liver, cancer,
ulcers, heart ailments, impotence, fetal alcohol syndrome, depression, paranoia, memory
loss, blackouts, psychological and emotional problems, hypertension, eating disorders,
loss of coordination, poor vision, and gastrointestinal problems.
Federal law requires the University to notify annually all students of the University‘s
policy concerning drug and alcohol use, possible sanctions that may be imposed by the
University and law enforcement agencies, the health risks associated with drug and


Temple University School of Pharmacy                                                 144
alcohol use, and available counseling and treatment.

Policy
General Policy Statement on Drug and Alcohol Use
Temple University strictly prohibits the unlawful possession, use, consumption,
distribution or manufacture of drugs and alcohol on University property, or as part of any
University activity. A violation of this policy will subject the student to the range of
sanctions, including, but not limited to, expulsion, as outlined in the Student Code of
Conduct.
Additional Prohibitions
The University‘s Student Code of Conduct and policies approved by the President after
consultation with the cognizant Vice President and relevant administrative departments
(e.g., Recreation Services, Intercollegiate Athletics) and affiliated groups (e.g., Greek
Letter organizations) contain additional requirements and prohibitions regarding the use
of drugs and alcohol. A violation of any of these policies will subject the student to
discipline, including, but not limited to, expulsion.
Legal Sanctions
Any student who violates this policy also will be subject to criminal prosecution under
applicable local, state, and federal laws.
Penalties for Violations of Relevant Drug and Alcohol Statutes
A description of the applicable legal sanctions under local, state, and federal law for the
unlawful possession or distribution of illicit drugs and alcohol is published annually by
Campus Safety Services in ―You & Campus Safety.‖
Counseling and Treatment
Students in need of confidential drug or alcohol counseling may access the following
resources through the University‘s Tuttleman Counseling Services (215-204-7276):
Campus Alcohol and Substance Awareness (CASA)
Psychiatric Services
Psychological Services
Parental Notification
The Dean of Students will notify parents/guardians of students under the age of 21 of
alcohol/drug violations involving the student. Campus Safety Services will notify
parents/guardians of students under the age of 21 upon issuing a citation for an alcohol
violation.
Annual Review
The following departments will be represented on the University‘s Drug and Alcohol
Policy Review Team: Campus Safety Services, University Disciplinary Committee,
University Counsel, Dean of Students, Campus Alcohol and Substance Awareness,
Student Health Services, Recreation Services, Intercollegiate Athletics, Greek Life and
the Provost‘s Office. Annually, the Team will review this Policy to determine its
effectiveness and recommend any necessary changes.
Amendments
The President or his/her designee is authorized to amend this policy in response to
changes in legal requirements or otherwise to effectuate its purpose.
Effect on Prior Policies
This policy supercedes and replaces all prior student drug and alcohol policies.
Notes


Temple University School of Pharmacy                                                  145
      1. Dates of official enactment and amendments:
      Adopted by the Board of Trustees (in Special Executive Session) on
      September 27, 1990.
      Supplemented by the President on August 13, 2003.
      2. History:
      This policy supercedes and replaces all prior student drug and alcohol policies.
      3. Cross References:
      None




                                             Temple University School of Pharmacy
                                                Journal Club Evaluation Tool

Student(s) Name:
_____________________________________________________Date:____________________________

Evaluator:
___________________________________________________________________________________________

Journal Article Title:
___________________________________________________________________________________

The student(s) presenting the journal club article:

                         Study overview                            Did not   Discussed in   Discussed in
                                                                   discuss    detail with   detail without
                                                                                some         inaccuracies
                                                                             inaccuracies
 1.    Discussed the rationale for conducting the research study     0             1              2

 2.    Correctly defined primary and secondary objective(s) of       0              1             2
       the study
 3.    Correctly identified the outcome parameters                   0              1             2

 4.    Correctly identified the type of study                        0              1             2

 5.    Correctly identified the inclusion and exclusion criteria     0              1             2

 6.    Correctly defined the study setting                           0              1             2

 7.    Correctly identified the intervention and blinding            0              1             2
       techniques
 8.    Discussed the results of the study                            0              1             2




      Temple University School of Pharmacy                                                           146
9.    Overview less than 5 minutes                                 No = 0                        Yes =4

Analysis of methods                                           Not            Superficial    Discussed in       Discussed
                                                           discussed        discussion or    detail with     accurately in
                                                                                major          minor             detail
                                                                            inaccuracies    inaccuracies          (No
                                                                                                             inaccuracies)
10. Discussed if the study design was a strength or           0                  2               3                 4
    weakness in determining the primary objective
11. Evaluated the inclusion and exclusion criteria as         0                  2               3                4
    they apply to the selection of appropriate study
    patients
12. Assessed if the blinding techniques were adequate to      0                  2               3                4
    limit observer bias
13. Assessed the appropriateness of the drugs utilized        0                  2               3                4
    for comparison in the study
14. Assessed if the method of randomization was               0                  2               3                4
    adequate to limit selection bias
15. Assessed if outcome measures for each objective are       0                  2               3                4
    well defined and appropriate
16. Assessed if power calculations were reported for          0                  2               3                4
    statistically nonsignificant results and the
    appropriateness of sample size
17. Understood statistical tests used in the article          0                  2               3                4




                                                              Not            Superficial     Discussed         Discussed
Analysis of results                                        discussed        discussion or     in detail      accurately in
                                                                                major        with minor          detail
                                                                            inaccuracies    inaccuracies          (No
                                                                                                             inaccuracies)
18. Assessed if all patients were accounted for at            0                  2               3                 4
the end             of the study
19. Assessed the baseline characteristics                     0                  2               3                4

20. Assessed if results were reported for each outcome        0                  2               3                4
    measure
21. Identified potential confounding variables and            0                  2               3                4
    assessed their impact on the study results
22. Assessed if the adverse effects of treatment were         0                  2               3                4
    systematically monitored and reported
23. Assessed if patients‘ adherence to therapy was            0                  2               3                4
    systematically monitored and reported

Discussion, conclusion and clinical implications

24. Assessed if the study findings supports the                0                  2              3                4
    conclusion
25. Evaluated the clinical usefulness of the study and         0                  2              3                4
    how it may impact pharmacy practice
26. Assessed how the data from the study can be applied        0                  2              3                4
    to an expanded patient population



     Temple University School of Pharmacy                                                             147
    27. Assessed the potential impact of sponsor or funding           0               2             3                  4
        bias
    28. Discussed if there is anything that could be done to          0               2             3                  4
        potentially improve the study

                                                                                 Unacceptable   Acceptable         Outstanding
    Overall presentation

    29. The facilitators were able to keep the discussion focused and lead the        0             2                  4
         group to identify major strengths and limitations of the study


       Total Points = Percent Grade __________

       Comments:




       Student‘s Signature: _______________________________________________________

       Evaluator‘s Signature: _____________________________________________________

       Revised 7/08




           Global and Pharmacy Professional Educational Competencies and Learning Objectives
Global Educational Competencies
       Think critically and solve complex problems.
          Communicate effectively verbally and in writing.
          Demonstrate interpersonal skills and a professional demeanor.
          Make rational, legal, ethical and responsible decisions.
          Demonstrate sensitivity and tolerance of the cultural, societal and economic
             diversity in patients.
          Assume responsibility for optimizing patient outcomes related to medication therapy.
          Identify and analyze emerging issues, products and services, in order to maintain professional
           competency. Self-assess learning needs to design, implement, and evaluate strategies to
           promote intellectual growth and continued professional development.

Pharmacy Professional Educational Competencies


       Temple University School of Pharmacy                                                                 148
         Design, implement, monitor, evaluate, and adjust evidence based pharmacy care plans that
          are patient specific; address health literacy, cultural diversity, behavioral and psychosocial
          issues.
          o Integrate and apply evidence-based knowledge of the biomedical, pharmaceutical and
            clinical sciences.
          o Collect information to prevent, identify and solve drug related problems.
          o Retrieve, analyze, and interpret the professional, lay, and scientific literature to provide
            drug information and counseling to patients, their families or care givers, and other
            involved health care providers
          o Develop a patient centered pharmacy care plan.

          o Monitor patients to determine if the therapy is appropriate, effective and safe.

          o Effectively communicate information to patients, caregivers and other health
            professionals regarding rational drug therapy, wellness and health promotion.

          o Document interventions and outcomes in writing.

          o Provide initial emergency care by becoming certified in first-aid and CPR.

          o Identify, prevent, manage and document adverse outcomes of medication therapy.

         Manage a successful patient-centered practice (including establishing, marketing, and
          being compensated for medication therapy management and patient care services
           rendered).



Pharmacy Professional Educational Competencies (continued)

          Provide population-based care, through the ability to develop and implement population
          specific, evidence-based disease management programs and protocols based upon
          analysis of epidemiologic and pharmacoeconomic data, medication use criteria,
          medication use review, and risk-reduction strategies.

          Manage and use resources of the health care system, in cooperation with
           patients, prescribers, other health care providers, and administrative and
           supportive personnel, to promote health; to provide, assess, and coordinate
           safe, accurate, and time-sensitive medication distribution; and to improve therapeutic
          outcomes of medication use.

         Manage medication use systems, through the ability to apply patient- and
          population-specific data, quality improvement strategies, medication safety and error


      Temple University School of Pharmacy                                                    149
    reduction programs, and research processes to minimize drug misadventures and
    optimize patient outcomes; to participate in the development of medication use criteria
    and health policy; and help design pharmacy benefits.

    o Evaluate drug orders or prescriptions.

    o Accurately and safely compound and dispense drugs

    o Perform pharmaceutical calculations.

    o Insure that medications are properly administered.

    o Demonstrate expertise in informatics

    Note: Competencies in informatics include basic terminology (data, information, knowledge,
    hardware, software, networks, information systems, information systems management);
    reasons for systematic processing of data, information and knowledge in health care; and the
    benefits and current constraints in using information and communication technology in
    health care. (Adapted from recommendations of the International Medical Informatics
    Association).

   Promote health improvement, wellness, and disease prevention in cooperation with patients,
    communities, at-risk populations, and other members of an inter-professional team of health
    care providers.

                 Key • = Competency; 0 = Enabling Competency




                                Temple University School of Pharmacy
                         Clinical Rotation In-Service Presentation Evaluation


Name: _____________________________________________________                     Date:______________
Title of Presentation: __________________________________________________________________
                                               Strongly     Disagree   Neutral      Agree      Strongly
                                               Disagree                                         Agree
1. The presenter demonstrated adequate            1             2          3          4           5
   knowledge about the subject being
   presented.

2. Appropriate information was included in         1            2          3          4           5



Temple University School of Pharmacy                                                       150
                                                 Strongly   Disagree   Neutral   Agree      Strongly
                                                 Disagree                                    Agree
    the presentation.

3. The subject was covered in sufficient            1          2         3         4           5
   depth.

4. The presentation is well organized and           1          2         3         4           5
   easy to follow.

5. The information presented is accurate.           1          2         3         4           5

6. The presenter spoke in a clear, audible          1          2         3         4           5
   voice.

7. The pace of the presentation was                 1          2         3         4           5
   appropriate.

8. Material was presented in a self-                1          2         3         4           5
   confident, assured manner.

9. The presenter made good eye contact.             1          2         3         4           5

10. Important information was emphasized            1          2         3         4           5
    making the presentation interesting.

11. The presenter was precise in answering          1          2         3         4           5
    questions.

12. Questions were answered in an informed          1          2         3         4           5
    confident manner.
13. If the presenter was unsure about an            1          2         3         4           5
    answer, he/she did not attempt to "bluff"
    the audience.
14. The handout is neat, readable and an            1          2         3         4           5
    asset to the presentation.

15. The handout includes accurate                   1          2         3         4           5
    information and will serve as a useful
    resource on the subject.

16. Information on the handout is properly          1          2         3         4           5
    referenced.

17. The references selected are appropriate         1          2         3         4           5
    for the material presented. (Authoritative
    and adequate in number)




Temple University School of Pharmacy                                                    151
   Total Points _________________________                   Percent Grade_____________
   Percent Conversion
Score      %      Score     % Score        Score     %     Score     %     Score     %      Score     %
         Score                                     Score           Score           Score            Score
<48     Repeat      55         67           62      75      69      83      76      90       83       98
 49       60        56         68           63      76      70      84      77      92       84       99
 50       62        57         69           64      77      71      85      78      93       85      100
 51       63        58         70           65      78      72      86      79      94
 52       64        59         72           66      79      73      87      80      95
 53       65        60         73           67      80      74      88      81      96
 54       66        61         74           68      82      75      89      82      97



   Comments:




   ___________________________________________________________                        _____________
   Preceptor's Signature                                                                   Date


   ___________________________________________________________                        _____________
   Student's Signature                                                                    Date




   Temple University School of Pharmacy                                                   152

				
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