SELF EVALUATION TEMPLATE
PHARMACY LEARNING OBJECTIVES FOR STROKE CARE
NAME: ___________________________
*Opportunities for baseline, mid, and final assessments are provided in the self-rating column as recommendation only.
Users are encouraged to modify the form and its use to serve their purposes.
Self Rating: Using the rating scale provided below, enter a number that most closely reflects your knowledge/skill/
experience with respect to the learning objectives listed for this Learning Area.
NONE or MINIMAL
Knowledge/Skill/Experience
1
2
3
LEARNING AREA
Principles of Stroke Care
1. There are no pharmacy learning objectives for
Principles of Stroke Care.
4
SOME
Knowledge/Skill/Experience
5
Date
6
*SELF-RATING
Base Mid Final
EXTENSIVE
Knowledge/Skill/Experience
7
8
9
Comments
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Anatomy and Physiology
of Stroke
1. Demonstrates knowledge of the penumbra and its
significance to functional recovery.
2. Demonstrates knowledge of the rationale for the
diagnostic tests used in the assessment and
management of stroke and incorporates results as
appropriate into the plan of care.
3. Demonstrates knowledge of applicable
standardized assessment tools, and the ability to
administer the appropriate tools to systematically
assess the stroke survivor.
4. Demonstrates knowledge of:
Acute Medical Management
 Thrombolytics
 Hypertension (e.g., angiotensin-converting



enzyme inhibitors, or angiotensin II receptor
blocker or ARB)
Lipid therapy e.g., Statins
Antiplatelet and/or anticoagulants (e.g., ASA,
Aggrenox, Clopidogrel)
Diabetes management.
5. Integrates knowledge of the stroke sequelae and
potential stroke complications into the plan of
care to prevent and/or treat complications.
6. Demonstrates knowledge of the pharmacological
management of secondary stroke complications
including:
 Hemorrhagic transformation
 Reperfusion injury
 Increased intracranial pressure
 Cerebral edema
 Seizures
 Recurrent stroke
Interprofessional Learning Objectives for Stroke, Pharmacy Template
2
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
7. Demonstrates the ability to assess the stroke
survivor’s medications to identify, prevent and
resolve drug-related reactions and problems, and
drug efficacy.
8. Demonstrates the ability to provide medication
education to the stroke survivor and caregiver.
9. Communicates observations about medication
changes with the team.
Interprofessional Learning Objectives for Stroke, Pharmacy Template
3
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Cardiovascular and Respiratory Effects
1. Demonstrates knowledge of the anatomy and
physiology of normal and abnormal
cardiovascular and respiratory systems.
2. Demonstrates the ability to identify the signs and
symptoms of cardiovascular and respiratory
systems complications, and an understanding of
the management of:
 Deep vein thrombosis
 Pulmonary embolism
 Myocardial infarctions.
Interprofessional Learning Objectives for Stroke, Pharmacy Template
4
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Psychosocial Effects
1. Demonstrates awareness of the signs and
symptoms of anxiety, depression and selfdestructive behaviour.
2. Demonstrates knowledge of the pharmacological
agents used (such as psychotropic medications,
and their potential side effects), and an awareness
of non-pharmacological treatments.
3. Recognizes various psychosocial issues that
occur following stroke, and adjusts assessment
and treatment strategies accordingly to meet the
individual needs of the stroke survivor and
caregiver.
4. Demonstrates knowledge of how the psychosocial
effects of stroke affect self-care, productivity and
leisure (e.g., self medical administration).
5. Demonstrates an awareness of the social
implications of illness (e.g., financial issues
related to medication choices and affordability).
6. Demonstrates knowledge of the support systems
available within and outside the organization for
stroke survivors and caregivers (especially in the
community pharmacy).
7. Demonstrates knowledge of the social system
(e.g., social, government and financial programs
such as the Ontario Disability Support Program,
the Trillium Drug Program, the Assistive Devices
Program, and the Canada Pension Plan).
Interprofessional Learning Objectives for Stroke, Pharmacy Template
5
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Communication
1. Demonstrates the ability to use alternative
communication strategies and/or devices as
recommended by speech-language pathology.
2. Communicates with stroke survivors to ensure
that, upon discharge, they understand their
medications including how to take them, what to
look for regarding side effects, and the importance
of secondary prevention.
Interprofessional Learning Objectives for Stroke, Pharmacy Template
6
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Independence in Mobility And Prevention Of
Complications Of Immobility
There are no pharmacy learning objectives for
Independence in Mobility and Prevention of
Complications of Immobility.
Interprofessional Learning Objectives for Stroke, Pharmacy Template
7
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Routine Activities of
Daily Living (ADL)
1. Demonstrates the ability to recommend
pharmacological interventions that may aid
performance of ADLs (e.g., medication for
spasticity)
Interprofessional Learning Objectives for Stroke, Pharmacy Template
8
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Instrumental Activities of Daily Living (IADL)
1. In collaboration with occupational therapy,
demonstrates the ability to recommend assistive
devices to assist the stroke survivor to take
his/her medications independently, (e.g., ability to
open pill bottles, dosettes, etc.).
2. Demonstrates an understanding of safety issues
related to medication administration as a result of
stroke, and identifies and applies strategies to
address these issues (e.g., cognitive deficits).
Interprofessional Learning Objectives for Stroke, Pharmacy Template
9
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Cognitive, Perceptual and Behavioural
Changes Following Stroke
1. Demonstrates knowledge of and implements
pharmacological management strategies used
with stroke survivors who demonstrate cognitive,
perceptual and behavioural changes following
stroke.
2. Collaborates with team members to implement
and evaluate a comprehensive plan of care.
Interprofessional Learning Objectives for Stroke, Pharmacy Template
10
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Sexuality
1. Demonstrates the ability to assist the stroke
survivor/partner with pharmacological strategies
that may assist their sexual function.
Interprofessional Learning Objectives for Stroke, Pharmacy Template
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LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Nutrition
1. Demonstrates an awareness of the various
alternative-feeding methods such as enteral
feeding or total parenteral nutrition used with
stroke survivors, and the implications these may
have for the plan of care.
2. Demonstrates knowledge of the use and
preparation of total parenteral nutrition.
3. Collaborates with dietetics on pharmaceuticals
such as diet and cholesterol lowering agents,
decreasing sodium, vitamin/mineral supplements,
etc.).
Interprofessional Learning Objectives for Stroke, Pharmacy Template
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LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Dysphagia
1.
Demonstrates the ability to adjust the medication
regime as required based on the swallowing and
feeding recommendations outlined by the team.
Interprofessional Learning Objectives for Stroke, Pharmacy Template
13
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Skin Care
1.
Demonstrates the ability to recommend
pharmacological interventions for skin care
management (e.g., regranex in diabetic ulcers,
etc.).
Interprofessional Learning Objectives for Stroke, Pharmacy Template
14
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Continence Management
1.
Demonstrates basic knowledge of anatomy and
physiology of normal bladder function, and
effects of age, co-morbidities, etc.
2.
Demonstrates the ability to recognize bladder
impairment based on assessment:
 Urinary retention with overflow
incontinence/voiding.
 Urgency incontinence.
 Functional Incontinence
3.
Demonstrates knowledge of pharmacological
management of impaired bladder and acts as a
resource to the team.
4.
Demonstrates the ability to evaluate the
effectiveness of the pharmacological treatment
plan on improving bladder functioning.
5.
Demonstrates the ability to support and educate
the stroke survivor and caregiver related to the
impairment of bowel functioning and its
management.
Interprofessional Learning Objectives for Stroke, Pharmacy Template
15
LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Primary and Secondary Stroke Prevention
1.
Demonstrates the ability to identify strokerelated risk factors and their management
including:

Non-modifiable conditions such as age,
sex, race/ethnicity, genetic factors

Modifiable conditions such as behaviour
(physical inactivity, smoking)

Predisposing conditions such as stroke,
TIA, obesity, acute myocardial infarction,
hypertension, hyperlipidemia, atrial
fibrillation, diabetes mellitus,
atherosclerosis (coronary heart disease,
asymptomatic carotid stenosis, peripheral
vascular disease), other cardiac disease,
coagulation disorders, estrogen/
progestin, replacement therapy

Probable risk factors such as migraine,
oral contraceptive use, alcohol abuse,
stress, sleep apnea, sympathomimetic
agents, illicit drug use, congenital cardiac
anomalies.
2.
Demonstrates the ability to educate the stroke
survivor and caregiver about the rationale
supporting secondary prevention management,
and the benefits of secondary prevention (diet,
exercise) to reduce the probability of subsequent
strokes.
3.
Demonstrates the ability to act as a resource to
other team members about pharmacological
management of secondary stroke prevention,
and to recommend appropriate treatment options
for primary and secondary stroke prevention.
Interprofessional Learning Objectives for Stroke, Pharmacy Template
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LEARNING AREA
Date
*SELF-RATING
Base Mid Final
Comments
Transition Management
1.
Demonstrates the ability to assess medication
administration discharge barriers (e.g.,
requirement for a weekly dosette exchanged by
their retail pharmacy).
2.
Demonstrates the ability to assess the stroke
survivor’s ability to get a prescription filled.
3.
Demonstrates an ability to liaise with the stroke
survivor’s community pharmacy to ensure the
stroke survivor receives medication upon
discharge or transfer to the next care
environment, especially for medications that are
not normally carried by most pharmacies.
4.
Demonstrates the ability to educate caregivers
about medications, side effects, adverse drug
reactions, etc.
Interprofessional Learning Objectives for Stroke, Pharmacy Template
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