Rotation Structure Worksheet – Home Infusion Company/Site: ______________________________________________________________________________________________________________________ Participant: ___________________________________ E-mail:_______________________________________ Contact #: _______________________________ Competency Activity (How is it achieved?) Teaching Method Assessment/Documentation Status IP/TBD Time Frame 1 Speak and write clearly using logical patterns of organization. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 2 Demonstrate sensitivity and tolerance within a culturally diverse society. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 3 Demonstrate an appreciation of the obligation to participate in efforts to help individuals and to improve society and the health care system. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 4 Promote intellectual growth and continued professional competence through selflearning. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 5 Demonstrate knowledge and recommend proper selection, use and care of medical/ancillary supplies or devices, durable medical equipment and medication administration equipment. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing Status: IP – In Progress / TBD – To Be Developed Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG - Ongoing Page 1 Communicate and collaborate with physicians, other health care professionals, patients and caregivers to foster patientcentered care team approach. 7 Identify assessments for appropriateness of home care according to practice standards and guidelines of governing accrediting and professional organizations. 8 Document and evaluate clinical status of patient and response to medication through collection and review of lab tests, physical and nutritional assessments and oral communication with patient, caregiver, nurse and physician. 9 Provide education and counseling to the patient and/or caregiver about patient’s medication therapy, therapeutic outcomes, self-assessing techniques for monitoring effectiveness and proper aseptic techniques. 10 Determine and communicate accuracy, completeness and appropriateness of prescription orders. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 11 Follow JCAHO guidelines and/or ASHP standards relating to aseptic IV compounding techniques. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 6 Status: IP – In Progress / TBD – To Be Developed Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG - Ongoing Page 2 12 Collect accurate and comprehensive information to be used in monitoring therapeutic outcomes. 13 Review patient profiles or medication administration records to determine the adequacy of patient therapeutic self-management. Interview the patient/caregiver to help determine the adequacy of 14 patient therapeutic selfmanagement. 15 Communicate alternative dosage strategies to the prescriber to help resolve specific patient therapeutic self-management problems. 16 Monitor the safety and efficacy of therapeutic plans. 17 Evaluate research studies. 18 Collaborate with physicians, other health care professionals, patients, and/or their caregivers to formulate a pharmaceutical care plan. 19 Integrate basic knowledge as needed to design, implement, and evaluate patient-specific pharmacotherapeutic regimens. Status: IP – In Progress / TBD – To Be Developed □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG - Ongoing Page 3 □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ IP □ TBD □ 1st half □ 2nd half □ Ongoing Document pharmaceutical care 22 activity in the patient's medical record to facilitate communication and collaboration among providers. 23 Record information related to the provision of pharmaceutical care to individual patients. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 24 Display the attitudes, habits, and values required to render pharmaceutical care. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 20 Integrate patient and drug information with drug dosing methods to calculate appropriate dosage adjustments. 21 Counsel patients/caregivers on prescription medications. 25 Use pharmacoeconomic data in the selection of drug delivery form, amount, and brand vs. generic of a drug product. 26 Comply with federal, state, and local laws and related regulations that affect the practice of pharmacy. 27 Apply principles of pharmacoeconomics in making pharmaceutical care decisions. Status: IP – In Progress / TBD – To Be Developed Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG - Ongoing Page 4 28 Apply principles of humanistic outcomes in determining impact of pharmaceutical care services on patient’s quality of life. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 29 Identify and use appropriate drug information resources to respond to patient specific drug problems or inquiries from other health professionals. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 30 Develop and present educational materials tailored to the needs and educational background of a given audience (e.g. case presentation, journal clubs, etc.) 31 Demonstrate judgment, initiative, responsibility, and maturity. Displays a cooperative attitude and is receptive to feedback. 32 Responds to assignments and responsibilities in a timely manner. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 33 Reports to rotation site, patient care activities, group discussions, and meetings on time. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 34 Exhibits neatness and professionalism in appearance and work. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing Status: IP – In Progress / TBD – To Be Developed Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG - Ongoing Page 5 35 Maintains confidentiality. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 36 Demonstrates tact when dealing with staff, patients, and other health professionals. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing Status: IP – In Progress / TBD – To Be Developed Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG - Ongoing Page 6