University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Preface ………………………………………………………………………………..
3
Calendar ………………………………………………………………………………
4
5
Introduction …………………………………………………………………………..
6
Description ………………………………………………………………………........ 7
References ………………………………………………………………………........
7
Competencies …………………………………………………………………………
8
General Information and Policies…………………………………………………….. 9
Assignment and Hours Requirements……………………………………….. 9
Compensation ………………………………………………………………… 10
Registration as a Pharmacy Intern …………………………………………… 10
Health Insurance Requirement ………………………………….……………. 10
Background Checks and Drug Screening …………………………………….. 10
Immunization Requirements …………………………………………………. 11
Experiential Courses and Internship Hours ………………………………….. 11
Courses Grades and Consequence of Failing ………………………………….. 11
Liability Insurance Provided………………………………………………… 11
CPR Certification…………..………………………………………………… 11
Practice Experience Policies and Requirements………………………………………. 12
Adherence to Policies and Procedures………………….…………………….. 12
Dress Code………………………………………….. ……………………….. 12
Parking, and Room and Board and Others……………………………………... 12
Patient Confidentiality and Compliance with HIPAA and Other Issues with
Medical Records ………………………………………………………………. 13
Attendance Policies……………………………………………………………. 13
Attendance Definitions………………………………………………………. 14
Honor Code Violations………………………………………………………….. 15
Personal Counseling Services………………………………………………….. 15
Grading Criteria and Exams …………………………………………………… 16
………………………………………………… 18
Internship Hours Documentation……………………………………………… 18
Evaluations…………………………………………………………………….. 18
Evaluation of Pharmacy Practice Experiences…………………………………. 19
Intern Evaluation Form ……………………………………………………….. 20
Experience Checklist …………………………………………………………. 27
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Preface
The mission of Pharmacy is to serve society as the profession responsible for the appropriate use of medications, devices and services to achieve optimal therapeutic outcomes.
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
May 19-20………………………...………………………………..……... Orientation at UH - TMC
May 20 …………………………………………………………………………………………….CPR
Block 1A May 27 through June 20, 2014
May 27………………………………………………………………………Start at Site
June 3.………………………………………………………………………Week 1 Check-in
June 6…………………………………………Preceptor’s Midterm Evaluation of Student
June 20...…………….….… On Campus Day (Exams, Evaluation, Document Submission)
Block 1B June 23 through July 18, 2014
June 30……………………………………………………………………. Week 1 Check-in
July 3.….……………………...…….....……..Preceptor’s Midterm Evaluation of Student
July 18..…………….……...On Campus Day (Exams, Evaluation, Document Submission)
Block 1C July 21 through August 15, 2014
July 28…………………………………………………………………….. Week 1 Check-in
August 4……..…………………………………Preceptor’s Midterm Evaluation of Student
August 15…………………On Campus Day (Exams, Evaluation, Document Submission)
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Pharmacy practice experiences are designed to apply principles learned in the class room to real practice settings, under the supervision of a licensed, practicing pharmacist. Practice experiences serve a dual purpose of satisfying the experiential component of the College curriculum, while also meeting experiential (internship) requirements for licensure by the Texas State Board of Pharmacy. During practice experiences, students participate in a wide range of activities in ambulatory and institutional settings, so they will be prepared to practice pharmacy in any setting. The primary purpose of these experiences is to assure that each student develops the knowledge, skills, attitudes, and values (KSAVs) needed to attain the competencies required for making professional judgments and actions that ensure positive patient outcomes.
In this introductory pharmacy practice experiences, students works under the supervision of selected preceptors, who are either full-time, adjunct, or voluntary faculty members of the College of Pharmacy.
Through the Introductory Community Pharmacy experience, preceptors facilitate student learning by guiding students in the achievement of course competencies, which are designed to make the student competent in all technical and dispensing activities, while also introducing them to higher level patient-oriented practice in a community pharmacy setting.
Students and preceptors should realize that the KSAVs attained in this introductory course do not indicate the ultimate level of practice expected of them as community pharmacists. Once students attain
“Pharm.D. Candidate” status, in the 4 th
year of the curriculum, they will complete Advanced Community Pharmacy, providing them more patient-oriented competencies, needed to achieves positive patient outcomes – assuring improvement of the disease or condition, while minimizing adverse effects. This level of practice will only be achieved by pharmacists who provide all of the clinical and therapeutic services their patients deserve.
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
PHAR 5493
UNIVERSITY OF HOUSTON COLLEGE OF PHARMACY
The Introductory Community Pharmacy experience provides a structured pharmacy experience in ambulatory care and various community pharmacy practices. Community Pharmacy practice involves the preparing, packaging, compounding, and/or labeling of a prescription drug or device, and the dispensing of this product, with proper instruction/counseling to a patient or the patient’s agent, followed by monitoring of patient response to assure attainment of the intended purpose of the drug, and absence of adverse effects. For prescription drugs this activity takes place only under the lawful order of a physician or other health care provider, who is authorized to prescribe for the particular disease or condition. It is imperative that students understand that the pharmacist’s responsibility and duty to the patient is not the mere dispensing of the product ordered by prescription, but the assurance that the prescription is appropriate for the patient and that there is a reasonable expectation that the drug will achieve its purpose without causing undue harm, and further that the pharmacist take responsibility for the ultimate outcome of the treatment. Significant communication with physicians, other healthcare professionals, and patients is imperative for the pharmacist to carry out these professional responsibilities.
In addition to responsibilities associated with prescription drugs, the pharmacists also provides recommendations on the selection of non-prescription drugs and healthcare supplies, supported by sound evidence-based principles. The pharmacist, as the most accessible health care professional, also serves an important role in disease prevention and patient wellness. The pharmacist is a member of an interdisciplinary team that serves the patient’s interest above all other concerns.
References:
Texas Pharmacy Laws and Regulations
Dipiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach
Berardi RR, et. al (Editors), Handbook of Nonprescription Drugs, American Pharmaceutical
Association.
Ansel, 13th ed., Pharmaceutical Calculations
U.S.P. Dispensing Information
Facts and Comparisons, Physicians’ Desk Reference, Pharm Index, or American Drug Index,
Lexicomp®
Primary Literature
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Upon completion of Community Pharmacy (PHAR 5493), the student will be able to:
2.
3.
4.
5.
6.
1.
7.
Collect, assimilate, interpret, and input patient specific data into a patient care management database.
Determine patient needs, and select or recommend appropriate OTC products.
Assist in CPR treatment in an emergency.
Retrieve and interpret prescription orders from an automated recording system.
Review, interpret, evaluate, and dispense prescriptions or medication orders.
Perform calculations necessary to assure proper quantities for reconstituting or compounding prescriptions.
Upon prescription or medication order, compound products that are accurate and suitable for dispensing.
8. Interview a patient to determine patient needs, or problems with drug therapy.
9.
Communicate with other healthcare professionals clearly concerning a patient’s prescription and over the counter drug medications and usage.
10. Communicate with a patient and provide counseling that assures understanding and promotes compliance.
11. Identify, retrieve, interpret and evaluate drug information used in community pharmacy.
12. Practice pharmacy in compliance with all laws.
13. Direct supportive personnel in filing claims for third party payment of prescriptions.
14. Perform prospective drug utilization review.
15. Implement procedures that provide drug security, storage, and control.
16. Implement basic pharmaceutical care in the community pharmacy setting.
17. Maintain appropriate documentation for products dispensed and pharmaceutical care services provided.
18.
Communicate with other healthcare professionals concerning a patient’s needs or problems with their drug therapy.
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual

The primary goal of experiential training is learning. Learning is not a passive process; it requires active participation and communication. Internships/practice experiences serve as a transition from the classroom to pharmacy practice.
 The student should recognize that the preceptor’s responsibility is to facilitate the student’s learning, not to teach. The student must accept the responsibility for learning.

The student should recognize that the optimum learning experience requires mutual respect and courtesy between the preceptor and student. All criticism or constructive feedback should be viewed as a means of facilitating learning.

Students should be encouraged to communicate with all those involved in their training including pharmacists, physicians, other health care professionals, and patients.

The student should gain experience in making professional decisions (i.e., evaluating and dispensing prescriptions, counseling patients, making therapeutic decisions, advising patients on the choice of nonprescription drugs). The preceptor should provide positive criticism, allowing the student increasing responsibility as competence and confidence are demonstrated.

The student should take the initiative in communicating with physicians and patients in a manner consistent with professional courtesy.

Students should appreciate the time and expertise that preceptors are providing for their education and training. Students should understand that often preceptors will be called upon to provide reference concerning their knowledge, skills, and attitude – even when not requested.
1.
Assignment and Hours Requirement
Each student who has met the prerequisites is assigned to a Preceptor for a four-week
(minimum of 160 hours) practice experience. The College of Pharmacy attempts to assign students to their preferred location; however, the student must be prepared to accept assignments to experiential sites outside of preferred location.
Contacting Preceptor: Unless otherwise instructed, at least two weeks prior to the beginning of the experience, students must contact their preceptor to determine the reporting place and time. In some cases, certain sites will require three weeks notice prior to the beginning of experiential course. Unless otherwise instructed, the student should get confirmation from the preceptor either verbally or by email that plans for starting the experiential course have been confirmed.
Supervised Hours are granted only for time at the site, evaluation and orientation on campus, and for approved college activities. Hours are not awarded for lunch, travel to and from the site, study time, or homework. Holidays are not observed in any practice experience course and hours will not be awarded for holidays.
The UH College of
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Pharmacy Experiential Programs schedule does not follow holidays designated by the
University. Students may be required to be present at their practice site on weekends, evening, and holidays. Any time missed from site will be required to be made-up. An average of 8 hours/day will provide the minimum 160 hours.
Special Activities Hours : Due to the short nature of the Introductory Pharmacy Practice
Experiences, there will be no Special Activities Hours awarded for PHAR 5493.
For documentation of internship hours, students are required to complete the designated electronic internship hour documentation as designated by the Office of Experiential
Programs.
The form must be verified by the preceptor and signed by the preceptor electronically.
2.
Compensation
Students may not be compensated for experiential training. Each student who successfully completes the internship receives academic credit from the College and internship hours credited to the Texas State Board of Pharmacy internship requirement for licensure.
3.
Registration as a Pharmacy Intern
Each student must be registered as a pharmacy intern with the Texas State Board of
Pharmacy and must comply with the Texas State Board of Pharmacy Rules and
Regulations including notification to the Texas State Board of Pharmacy of change of mailing address within ten days. Student internship expires 6 months after graduation.
4.
Health Insurance Requirement
The College does not provide healthcare insurance coverage. It is the policy of the
University of Houston College of Pharmacy that students maintain health insurance.
Health insurance can be purchased through the Student Health Service, as a part of coverage on their parent’s policy, or other sources. Compliance with this policy is necessary to meet requirements of experiential sites, which require health insurance as a condition for accepting and precepting our students for experiential training (i.e.,
IPPEs and APPEs). If students fail to obtain health insurance will not be eligible to start their IPPEs or APPEs or be removed from site.
5.
Background Checks and Drug Screening
Many experiential training sites require criminal background checks and/or drug screening of their employees and students. As a pre-requisite for practice experiences, students are required to undergo a criminal background check. If required by the assigned site, the student will also be required to submit samples for drug screening. Students are responsible for obtaining and paying for background checks and drug screening, from a third-party vendor contracted by the College.
Unless required otherwise by affiliation agreement with a particular site, results will be reported directly by the student to the facility, according to the instructions given by the Practice Programs Office. Failure to receive background check clearance and/or drug screening clearance for any practice experiences will prevent the student from beginning experiential training, and meeting graduation requirements.
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
6.
Immunization Requirements a.
Students are responsible for complying with site policies and state law concerning infection control. Universal Precautions will be observed to prevent contact with blood and other potentially infectious materials. b.
All students are required to have the following immunizations or immunity documentation: i.
Hepatitis B vaccination or acceptable proof of immunity ii.
MMR vaccination or acceptable proof of immunity – (2 MMR) iii.
Negative Tuberculosis Skin Test (PPD) or chest X-Ray or blood test – annual basis iv.
Varicella (chicken pox) or acceptable proof of immunity v.
Tetanus/diphtheria within the last ten years - Tdap vi.
Influenza vaccination each year vii.
Any vaccination required during the internship year, due to pandemics. c.
It is the student’s responsibility to provide proof of immunization to the preceptor or practice site, and the College of Pharmacy.
7.
Experiential Courses Credit and Internship Credit
It is the responsibility of the student to register and pay for courses in a timely manner, otherwise, the student will not receive credit for the course or the hours obtained in the experiential course. The 160 hours received for the Introductory
Community Pharmacy are hours eligible for internship credit and will be submitted to the Texas State Board of Pharmacy. Students submitting credit for hours to other boards of pharmacy have the responsibility for checking with the specific board of pharmacy, to determine the maximum number of hours the state will allow for our internship program.
8.
Course Grades and Consequences of Failing an Experiential Course
Introductory Pharmacy Practice Experienced will be graded as “S” – Satisfactory or
“U” – Unsatisfactory. Students receiving a grade of “U” on a practice experience must make up that experience after the end of an academic year (i.e., not before the following summer semester). There will be no retake or remediation practice experiences during the internship year.
9.
Liability Insurance Provided
The College of Pharmacy is enrolled in a malpractice insurance policy, which covers students and faculty.
10.
CPR Certification
All students must have CPR certification. All students must take the Basic Life Support
(BLS) for Healthcare Providers course prior to practice experiences.
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
1.
Students will abide by both College and facility policies. If the student displays egregious unprofessional conduct or violates the site’s policies and procedures, a preceptor may expel a student from the site. Expulsion from the site will also result in a failing grade for the experiential course.
2.
The student will obey the laws and regulations that govern pharmacy practice, and seek clarification of any issues that are not clear.
3.
Students at the practice site are recognized by patients and other professionals as part of the
College of Pharmacy. The student also represents the practice site. Students must be courteous and professional at all times. Students not complying with policies may be expelled from the experiential site.
1.
The student must exhibit a professional appearance in manner and dress. Internship time lost due to inappropriate attire must be made up The student MUST conform to the following dress code: a.
All students must maintain good hygiene, and wear neat, clean, college-approved white laboratory jackets of appropriate length with embroidered school logo. White coats will be worn for all experiential activities at sites and at the College of Pharmacy facilities
(SR2 and TMC building). b.
All students must have a University of Houston College of Pharmacy student nametag.
Preceptors may require an alternate dress code and nametags. Nametags from places of employment as sole form of identification are unacceptable. Nametags will be worn in the TMC building at all times. c.
Female students may wear skirts, dresses, or dress slacks of appropriate length with appropriate hosiery and shoes. Leggings are not permissible. d.
Male students must wear dress slacks, collared shirts, ties, socks and appropriate shoes. e.
Jeans, shorts, mini-skirts, sandals, T-shirts, jogging suits, hats, caps, etc., are inappropriate dress and are not allowed. f.
Students not complying with the dress code will be sent home. Time must be made up and accountability/Directors points will be deducted from grade.
2.
Parking: If parking is not free at the site, the student is responsible for parking fees. It is not the responsibility of the College to cover these fees.
3.
Room and Board: Student is responsible for room and board.
4.
Communication: Student must have a form of communication (cell phone with texting capability) throughout the experiential courses. In addition, the student must provide the
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual college with appropriate contact information. Students are expected to check their University of Houston College of Pharmacy email daily throughout the experiential academic year.
Students will utilize the electronic management of experiential courses (E*Value and
Blackboard Learn).
5.
Students should not seek medical advice or treatment for themselves or family members through medical staff or other personnel at assigned sites. A student should not ask for a discount to purchase prescription or nonprescription medications, or services.
1.
Out of respect for patients and in compliance with the Health Information Portability and
Accountability Act (HIPAA), the student will respect confidences revealed during his/her assignment including patient medical records, pharmacy records, fee systems, etc.
2.
Patient names, medical record numbers, social security numbers, date of birth, and other patient identifiers will not be used in discussion of cases or experiences outside the responsibilities at the site. Furthermore, no other information will be used that would provide a “statistical disclosure” of the patient’s identity.
3.
In addition, students will not discuss patient care or patient cases with anyone, including other healthcare providers who are not participating in the patient’s care, except for permissible communication on behalf of the patient’s continuity of care or for permissible educational purposes. Students must be careful to discuss permissible case information in private areas only.
4.
Proprietary information of the site, including fees and special formulations, must also be kept confidential.
5.
The use of cameras and other photographic devices in patient areas is strictly forbidden.
Taking a photograph in a patient area, whether or not a patient is photographed, will result in dismissal from the site, assignment of a failing grade for the practice experience, and possible suspension from the College.
6.
Students should not view their own health records without obtaining proper consent of the facility.
7.
Students must take care handling patient monitoring forms and students must follow policies of the facilities with regards to patient monitoring forms.
Attendance is a grading criterion as well as a requirement for certification of internship hours to the Texas State Board of Pharmacy. Attendance is essential for academic credit to be awarded and internship hours accrued. a) The student should be punctual in meeting the schedule, and must adhere to the internship schedule agreed upon with the preceptor. For the student's benefit, it may be necessary to devote more than the scheduled time. Students will follow a schedule as if they were employees. As stated before, the UH College of Pharmacy Experiential
Programs schedule does not follow holidays designated by the University. Students may be required to be present at their practice site on weekends, evenings, and holidays. b) If the student will be absent or late, he/she must notify the preceptor as soon as possible.
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
In addition, the student must notify the designated Experiential Director if he/she will be absent/late from the site. BOTH the preceptor and the Experiential Director must be notified of any absences and tardies. Failure to do so will result in deduction of
Responsibility Points. Students are required to check in and check out with their preceptor every day. c) Students are responsible for maintaining a record of their internship hours through documentation designated by the Office of Experiential Programs. The electronic internship hours document must be completed by the student and verified by the preceptor at the completion of the course or no grade will be assigned. The electronic internship hours document is a legal document. Falsifying information on this form is an honor code violation and can cause a student to fail the course, be suspended, and/or jeopardize obtaining licensure in the future.
Students will follow a schedule as if they were employees.
1.
Excused Absence
An absence is excused when the Preceptor and Director are notified in advance with an acceptable reason and both the Preceptor and Director give approval. The missed time from an excused absence must be made up at a time acceptable to the Preceptor. After three (3) excused absences, the student must make an appointment with the Experiential Director and/or Assistant Dean for Experiential Programs. All absences must be made up.
Illnesses- The student will be required to submit documentation of illness from physician. In addition, documentation of clearance to return to site will also be required in cases where the
Experiential Programs Office deems necessary.
2.
Unexcused Absence
This is an absence from the assigned site (whether it is not coming in to the practice site or leaving early without permission) without advanced notification to the Preceptor and
Experiential Director, or advanced approval by the Preceptor and Experiential Director or without acceptable reason. The student must make an appointment with the Experiential
Director and/or Assistant Dean for Experiential Programs to determine need for corrective action. Students will lose 1 letter grade for each unexcused absence from the final grade .
3.
Tardiness
A student who is tardy on 3 occasions will earn an unexcused absence , and must make an appointment with the Experiential Director and/or Assistant Dean for Experiential Programs.
Continued tardiness will result in a failing the course.
4.
Leaving Site Early
A student who leaves site early on 3 occasions will earn an unexcused absence , and must make an appointment with the Experiential Director and/or Assistant Dean for Experiential
Programs. Students who leave the experiential site to work at an outside job fall in the unexcused category.
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
5.
Dismissal from a site
Students are expected to behave in a courteous and professional manner. If for any reason a
Preceptor asks that a student be removed from the site, the student will be required to make an appointment with the Experiential Director and/or Assistant Dean for Experiential
Programs for further evaluation of the problem. A student will be assigned a failing grade
(“F” or “U”) at any site from which he/she has been appropriately dismissed. A student who withdraws from a site without approval will be assigned a grade of “F” or “U”.
6.
Professional Meetings
Attendance at professional meetings is encouraged, but due to the short time frame of PHAR
5493 Introductory Community Pharmacy Practice Experience course, professional leave hours will not be given.
Neither plagiarism nor cheating in any form will be tolerated. This form of dishonesty is an honor code violation and will result in the student receiving a failing grade (“F” or “U”) for the course, and possibly suspension. In compliance with the instructions of the Practice
Experience Directors or the Assistant Dean for Experiential Programs, students will be required to submit papers and written forms of presentations to turnitin.com or to other sites for screening by plagiarism-checking software. See the UH College of Pharmacy Student
Handbook: http://pharmacy.uh.edu/cs/pdf/UHCOP_Student_Handbook.pdf
.
The University of Houston College of Pharmacy and the University of Houston provides personal counseling services. Students who need personal counseling services may obtain these services through the UHCOP Student Services and the University of Houston
Counseling and Psychological Services (CAPS).
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Grading Criteria is competency based. Minimal passing performance is 210 points or 70%.
A total of 500 points may be achieved upon completion of the PHAR 5493 Introductory
Community Pharmacy Rotation. These points are composed of scores from the pharmacy practice examination, the Preceptor’s grades and evaluation, and the Practice
Experience Director’s points. Assignment(s) may also be required. The following maximum point values may be achieved in each of the areas:
Pharmacy Practice Examination
Mid-term Evaluation from preceptor
Final Evaluation from preceptor
Preceptor Experiential Grade
300 points
*P/F
*P/F
100 points**
Practice Experience Director Grade __
TOTAL
100 points***
500 points
*In order to receive a passing grade for the experiential course the intern:
1.
Must NOT receive four (4) or more “2” ratings on the end of experiential course evaluation in the first 18 dimensions.
2.
Must NOT receive a “1” rating on the end of experiential course evaluation on dimensions 1 – 22.
** Preceptor Grade is based on the following:
Meets Stated Goals and Objectives 25
Professionalism 25
Communication/Interpersonal Skills 25
Initiative/Attitude 25
Total
*** Practice Experience Director Grade – Accountability points
**To obtain a grade of “S” the student must: a. Earn a minimum of 210 points (70%) on the Written Examination. b. c.
Follow guidelines of the Internship and Attendance Policies.
Submit all required experiential course paperwork, documentations, and evaluations by the appropriate deadlines.
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
1.
Exam Retake
At the discretion of the Assistant Dean for Experiential Programs and the Practice
Experience Directors, a retake exam may be given to students who have failed the pharmacy practice exam for Introductory Community Pharmacy Practice. If a student passes the retake, a grade of “S” will be assigned for the course. If the student fails the retake exam, then a grade of “U” will be assigned and the student will repeat the course. Exam retakes must be taken by the following semester after the initial has been taken.
2.
Failing a Course or Starting Practice Experiences Late due to Failing Milemarker
If a student fails a course or starts practice experiences late due to failing the Milemarker
Exam, the student cannot make up the missed course until the summer after the current internship year. There will be no remediation experiential courses offered during the internship year.
3. Assignments and Deadlines
– At the end of the 1 st
week:
•
Post an update on your experience to E*Value -(3-5 sentences on how the site is going, how you are getting along with the preceptor, etc.)
–
At the end of the 2 nd
week: Midterm evaluation due
– Continuing Education – submitted to E*Value
–
PxDx – complete 8 on E*Value
–
Evaluations: Start, Mid, End
– On-campus day (end of 4 th
wk):
•
Internship Hours – Verified by preceptor on E*Value
•
Intern Evaluation – completed with grade on E*Value
•
Your Community Pharmacy Experience Checklist
•
Your mind fully prepared for the written and practical examination
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Evaluations
Prior to the last day of each practice experience, students are required to complete online evaluations of their experiential courses. In addition, students are required to complete assessments of their perception of their abilities learned through the experiential course.
These assessments will be coordinated by a member of the Assessment Office.
Preceptors must complete a mid-point and final evaluation and submit the form to the practice experience director on the indicated dates. After completion, these forms must be signed by the student and preceptor electronically.
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Students have the responsibility to assist in their progress during their practice experiences and to ensure communication between the practice experience director, preceptor and themselves. The Intern Evaluation Form will be used at the beginning, midpoint and end of each practice experience for preceptor evaluations of students. The form will also be used by students to evaluate themselves.
There are 22 competency dimensions on the Intern Evaluation Form . Descriptions exist for each of these and assist in assessing the competency score. Students will score themselves on the performance criteria scale of 1-5, or not applicable (n/a). There is also space for comment on each of the competency dimensions. The first 18 competency dimensions constitute the core performance areas. Competency dimensions 19 - 22 include more subjective assessments and 23
- 24 allow more global assessment of the student’s performance.
Start of the Practice Experience
Before the first day of the practice experience, the student will complete the start of practice experience self evaluation using the Intern Evaluation Form . This information may be shared in the first meeting with the student’s preceptor. This is the baseline for measuring progress during the practice experience.
Mid-Practice Experience
During the third week of the practice experience, the student will complete the mid-practice experience self evaluation using the Intern Evaluation Form . The student will ask the preceptor to review the mid-practice experience self evaluation and complete the preceptor’s mid-practice experience evaluation. All items must be rated or marked N/A. The Intern Evaluation Form will be reviewed jointly by the student and preceptor. There is an opportunity for both to comment on the final page. The Intern Evaluation Form will then be copied and delivered or faxed to the practice experience director for review. The coordinator must receive the evaluation by the end of the third week of the practice experience.
End of Practice Experience
During the final week of the practice experience, the student will complete the end of practice experience self evaluation using the Intern Evaluation Form . The student will ask the preceptor to review the end of practice experience self evaluation and complete the preceptor’s end of practice experience evaluation online. All items must be rated or marked N/A. The Intern
Evaluation Form will be reviewed jointly by the student and preceptor. There is an opportunity for both to comment on the final page. The Preceptor and the student will sign (electronically) the Intern Evaluation Form.
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University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Performance Criteria: (This competency assessment rubric was developed by the Joint Committee on Internship Programs.)
The following descriptions should be used as reference points when evaluating the intern’s performance in each dimension. The first eighteen dimensions constitute the core performance areas. Dimensions 19-22 provide the practitioner-faculty member an opportunity to assess the intern on slightly more subjective, yet important, areas.
Dimensions 23-24 allow the practitioner-faculty member and intern to globally assess the intern’s performance to date. It is possible that all bullet points under each dimension are not able to be accomplished in every practice setting for which this form is used. Nevertheless, please evaluate each dimension as appropriate.
5 = Excellent 4.5 = Very Good 4 = Good 3.5 = Minimal
Competency
Student has excelled in performing competency.
Student has exceeded expectations and can function independently at all times
Student performed competency very well.(Is acceptable ≥
90% of time)
Student has met expectations and requires minimal to no guidance from preceptor
(can perform independently ≥
90% of time)
Student performed the competency well.
(Is acceptable ≥
80% of time)
Student has met expectations and can complete task in a supervised situation with limited guidance from preceptor
(can perform independentl y ≥ 80% of time).
Student performed the competency at an acceptable level.
(Is acceptable
≥ 70% of time)
Student has met expectations but requires occasional guidance from preceptor (can perform independently
≥ 70% of time)
3 = Needs
Improvement
Student knows how to achieve competency, but has not consistently demonstrated it at an acceptable level (Is acceptable
<70% of time).
Student requires significant guidance from preceptor (can perform independently
<70% of time).
2 =
Significant
Deficits
Exist
Student knows how to achieve competency, but rarely demonstrate s it (Is acceptable
<50% of time).
Student requires significant guidance from preceptor, and preceptor must often complete it for student
(can perform independentl y <50% of time).
1 =
Unaccepta ble y.
Student does not know how to achieve competenc
Student does not function independen tly and requires direct supervision by preceptor at all times.
N/A
Not applicabl e
Task does not apply to this particular rotation.
In order to receive a passing grade for the rotation, the intern:
1. Must NOT receive four or more “3 or 2” ratings on the end of rotation evaluation in dimensions 1-18.
2. Must not receive a “1” on the end of rotation evaluation in dimensions 1-22.
20

University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Assigned Score
Intern
Start of rotation 1, 2, 3, 3.5,4, 4.5, 5
Mid-rotation
N/A
1, 2, 3, 3.5,4, 4.5, 5
N/A
End of rotation 1, 2, 3, 3.5,4, 4.5, 5
N/A
Preceptor
Mid-rotation 1, 2, 3, 3.5,4, 4.5, 5
N/A
End of rotation 1, 2, 3, 3.5,4, 4.5, 5
N/A
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
COMPETENCIES
1. MANAGES PHARMACY OPERATIONS
• Controls drug inventory
• Provides drug security, storage and control
procedures
• Maintains facilities and equipment
• Participates in basic fiscal procedures
• Participates in personnel management
(pharmacists and technicians)
• Evaluates pharmaceutical care systems to
continually improve patient care
• Utilizes computer skills to provide patient care
and facilitate the management of pharmaceutical care systems
5. RETRIEVES AND EVALUATES DRUG
INFORMATION
• Selects best available resource for answering a
drug related request in a timely fashion.
• Evaluates the quality of information obtained.
• Applies state of the art knowledge of disease
states and drug therapy based on primary and
secondary literature.
• Prepares written reports on general
pharmacotherapy issues, drug therapy
controversies and patient specific topics.
• Retrieves, evaluates and manages drug literature
searches to support pharmaceutical care provisions.
Comments
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
2. MANAGES MEDICATION USE SYSTEMS
• Attends meetings involving pharmacy
representation
• Participates in formulary review
• Maintains quality assurance
• Participates in prospective, concurrent and
retrospective DUE process.
• Participates in managed care issues (e.g.
reimbursement)
3. PROVIDES DRUG PRODUCTS/
DEMONSTRATES ABILITY TO UTILIZE
THE DRUG DISTRIBUTION SYSTEM
• Determines appropriateness of order
• Evaluates and selects product
• Assures product/prescription accuracy
• Assures product/prescription reaches the patient in a timely manner
4. COMPOUNDS
• Utilizes acceptable professional procedures
• Selects appropriate equipment and containers
• Prepares special dosage forms
• Documents calculations and procedures
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________________
_______________________________
_______________________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
21

Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
6. COMMUNICATES WITH
PATIENTS/CAREGIVERS ABOUT
PRESCRIPTIONS DRUGS
• Interviews and counsels patients on drug usage, dosage, packaging and storage.
• Discusses drug cautions, side effects and patient conditions.
• Explains policies on fees and services.
• Relates to patients in a professional manner.
• Interacts to confirm patient understanding.
7. COMMUNICATES WITH
PATIENTS/CAREGIVERS ABOUT
NONPRESCRIPTION PRODUCTS, DEVICES
AND DIAGNOSTICS.
• Questions patients on conditions and intending
drug use.
• Communicates OTC drug dosage, usage,
storage, side effects, and packaging.
• Refers patients to other health professionals.
• Provides information on medical/surgical and
home health care devices, and home diagnostic products.
8. COMMUNICATES WITH HEALTH
PROFESSIONALS
• Obtains and provides accurate and concise
information in a professional manner.
• Uses appropriate oral, written, and nonverbal
language.
• Provides inservice/continuing education
programs to health professionals
9. MONITORS AND EVALUATES DRUG
THERAPY; INITIAL AND ONGOING
• Establishes and interprets databases.
• Database includes active problems, PMH, pertinent PE, lab data and hospital course.
• Medication history performed and complete.
• Medication profile complete and up to date.
• Pharmacokinetic parameters determined.
10. IDENTIFIES DRUG RELATED PROBLEM (S)
• Determines if any drug related problems exist.
• Supports through documentation the drugrelated problems.
• Assesses severity and recommends an appropriate course of action.
_______________________
_______________________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
11. DEVELOPS AND IMPLEMENTS
PHARMACEUTICAL CARE PLAN (S)
• Performs patient triage to determine appropriate medical or pharmaceutical care.
• Demonstrates the ability to develop and implement a pharmaceutical care plan including: a. therapeutic endpoints b. appropriate drug therapy (dose, duration, route, etc.) c. parameters to monitor efficacy and toxicity d. SOAP format for each drug therapy decision
• Is able to apply concepts of quality of life and
Total Quality Improvement in patient care.
_______________________
_______________________________
_______________________________
_______________________
_______________________
_______________________
_______________________
22

University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Mid-rotation
Preceptor
Mid-rotation
End of rotation
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
End of rotation
12. DEVISES FOLLOW-UP PLAN(S)
• Determines appropriate time(s) to re-evaluate
patient and assess efficacy and toxicity.
• Conducts the follow-up in a timely manner.
_______________________
_______________________
_______________________
_______________________
13. 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 professionally and ethically with
colleagues and patients.
• Maintains confidentiality.
14. DEMONSTRATES HUMAN RELATIONS
SKILLS
• Displays an interest in others.
• Is sensitive to the needs, feelings, and concerns
of others.
• Show empathy.
• Listens, is nonjudgmental and responds
appropriately to the problems of others.
• Acts in the best interest of others.
• Respects the patient’s need for information.
15. DISPLAYS CONSCIENTIOUSNESS AND
FOLLOWS THROUGH/HANDLES DETAIL
• 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.
• Keeps people informed.
• Follows up on actions.
16. DEMONSTRATES PERSONAL JUDGEMENT
• Uses good judgment in coming up with
sensible, practical solutions to problems.
• Seeks out and utilizes important facts and
information in decision making.
• Recognizes and evaluates available alternatives.
• Considers possible consequences of decision.
• Weighs costs, risk.
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
17. ORGANIZES/PLANS
• 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.
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________________
_______________________
_______________________
_______________________
_______________________
23

University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
18. PROMOTES PUBLIC HEALTH
• Provides emergency first aid treatment and
cardiopulmonary resuscitation when necessary.
• Provides disease prevention/detection program
to public.
• Provides poison control treatment and
information.
• Demonstrates ability to apply principles of PC to patient populations.
19. DISPLAYS
INDEPENDENCE/ASSERTIVENESS
• Is self-directed in undertaking responsibilities.
• Articulates own viewpoint when dealing with
others and in addressing controversial issues.
• Speaks out against questionable tactics and
practices.
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
Intern
Start of rotation
Mid-rotation
End of rotation
Preceptor
Mid-rotation
End of rotation
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
___________________
___________________
___________________
20. DEMONSTRATES PERSONAL AND
PROFESSIONAL GROWTH
• Conducts self-assessment.
• Identifies strengths and weaknesses.
• Acting on identified strengths and weaknesses,
develops a learning plan.
• Pursues further knowledge independently.
• Utilizes study design principles to gain
experience in the conduct of pharmacy practice research.
• Participates in professional organizations.
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
21. PROMOTES TEAM BUILDING
• Participates in social and professional interaction
and teamwork:
- Inception(forming)
- Conflict resolution (storming)
_______________________
_______________________
_______________________
- Problem Solving (norming)
- Execution (performing).
• Promotes a team approach to healthcare.
• Demonstrates trust, leadership, delegation, and
interdependence.
22. DEMONSTRATES SCIENTIFIC
INQUIRY/EXPLANATION IN PRACTICE.
• Defines and states problems.
• Identifies assumptions – develops hypothesis.
• Organizes information.
• Identifies potential problems.
• Commits to solutions.
• Implements solutions (plans)
• Assesses solution or outcome.
• Monitors for new information.
• Adjusts plan.
_______________________
_______________________
_______________________
_______________________
_______________________________
_______________________
_______________________
_______________________
_______________________
24

University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
23. MID-POINT EVALUATION
Preceptor’s Signature
Intern’s Signature
Intern’s Comments
Preceptor’s Comments
24. FINAL EVALUATION
Preceptor’s Signature
Intern’s Signature
Intern’s Comments
Preceptor’s Comments
25
Date
Date
Date
Date

University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
PHAR 5493
INTRODUCTORY COMMUNITY PHARMACY
Student Name:_______________________________ Rotation :___________________
Preceptor Name:_____________________________
Preceptor Name:_____________________________
License Number: _______________
License Number: _______________
Site Name:____________________________________________________________________
It is the student’s responsibility to demonstrate competency in each objective/skill and have the preceptor initial and date each on the Experience Checklist form. This must be submitted to the course coordinator at the final examination to receive credit for PHAR 5493.
The preceptor is responsible for directing, monitoring, and evaluating the student’s progress.
Preceptors and students work together in a joint effort to ensure that all the objectives and competencies have been met and initialed appropriately before the end of the rotation.
These objectives/skills are specific performance objectives intended to assist the preceptor and student. This allows both the preceptor and student to track experiences of the student while on rotation.
Objective/Skill Competent/Completed
( Preceptor Initials)
Date Comments
1. Given a prescription order(s), the student is able to demonstrate the ability to gather, accurately interpret, or evaluate the information
2. Given a prescription order(s), the student is able to make a professional judgment whether or not the prescription order should be dispensed.
3. The student is able to accurately complete (fill) prescription orders.
a. review, interpret, evaluate
and dispense prescriptions.
b. from initial order entry to
final check – prior to
final R.Ph. check
26

University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Objective/Skill
4. The student is able to accurately retrieve, transcribe, and interpret new prescription orders form an automated recording system.
5. The student is able to accurately transcribe new prescriptions from one to one telephone conversations.
6. The student is able to identify a drug or product ingredient in a prescription order by its generic, trade, or common name.
7. The student is able to identify the therapeutic use or pharmacological rationale for prescribed drugs.
8. Given a prescription order, the student is able to identify or explain the rational for the dosage regimen.
9. Given a prescription order, the student is able to select the proper auxiliary/cautionary labeling and explain why such labeling is appropriate.
10. Given a prescription order for a compound, the student is able to demonstrate competent professional judgment and proper technique in compounding and dispensing the order.
11. Given a prescription order, the student is able to perform calculations required to compound or dispense. (including reconstituting medications)
12. The student demonstrates knowledge of requirements related to proper storage for drugs
(manufactured or compounded preparations) in accordance with temperature, light, and/or, humidity.
Competent/Completed
( Preceptor Initials)
Date Comments
27

University of Houston College of Pharmacy
Introductory Community Pharmacy Manual
Objective/Skill Competent/Completed
( Preceptor Initials)
13. Given a medical history and/or a set of prescription orders, the student is able to identify interactions or contraindications involving prescription and/or OTC products in drug therapy. (i.e. drugdrug, drug-food, drug-disease, etc. interactions)
14. Given a medical history and/or a set of prescription orders, the student is able to identify the warnings, untoward effects, or major precautions associated with a patient’s drug therapy.
15. The student is able to counsel a patient, patient’s caregiver, or health care professional regarding the indications, benefits, administration, storage, and adverse/side effects of prescription and OTC medications.
16. The student is able to interview a patient or patient’s caregiver to determine their needs, or problems with drug therapy.
17. The student is able to clearly communicate with other healthcare professionals concerning a patient’s prescription order and/ or OTC medications and usage.
18. The student is able to identify the name, therapeutic classification, pharmacological action, ingredients, physical description or dosage form of prescription and
OTC products.
19. The student is able to practice pharmacy in compliance with the law.
20. The student maintains professional and ethical standards.
Date
28
Comments