BC Residency Oral Assessment Guide April 2008

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British Columbia
Pharmacy Practice Residency Programs
Comprehensive Oral Assessment
A Resident’s Guide
Provided by the
BC Pharmacy Practice Residency Coordinators Committee
April 2008
Comprehensive Oral Assessment Guide for Residents – updated Apr 2008
British Columbia Pharmacy Practice Residency Programs
Comprehensive Oral Assessment
This document is provided as a general outline to Pharmacy Practice Residents to
guide you in your preparation for your comprehensive oral assessment.
Please address any questions you have with your Residency Program Coordinator.
General Information:
The oral assessment is designed to evaluate your ability to evaluate a patient,
systematically create a comprehensive pharmacy care plan and present your findings
and recommendations to qualified examiners. The assessment focuses primarily on
process, but relevant pathophysiologic, pharmacologic, and therapeutic knowledge will
be required to successfully complete it.
Relevant CHPRB Standards: [revise for 2010 standards when finalized]
3.3.1.1. “The resident shall develop the knowledge and skills necessary to provide direct patient care
using pharmaceutical care principles.”
3.1.1., Requirement 17: “By the end of the program, the resident shall be able to function as an independent
practitioner.”
Goals:
1. To provide residents with an opportunity to demonstrate competence in all
aspects of the pharmaceutical care process through workup and presentation
of an actual patient case.
2. To provide Residency Coordinators with a basis for evaluation of successful
fulfillment of the relevant objectives of the residency program and the CHPRB
Standards.
Timing:
Individual residency programs will determine when during the residency program oral
assessments will be administered.
Assessment Format:
The assessment has two parts.
Part 1:
Data gathering, analysis, problem identification & plan
You will be assigned an active patient within your organization (unless
previously instructed otherwise) and given 2 hours to independently
review the patient’s medical records (chart, Pharmanet, etc), gather
PWDT Standards & Form – Acknowledgement to PHC
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Comprehensive Oral Assessment Guide for Residents – updated Apr 2008
information, interview the patient, discuss any issues with any available
health care providers, conduct any research (e.g., literature search, etc)
you may need in order to resolve the patient’s drug-related problems
(DRP’s) and prepare your pharmacy care plan. The patient will be chosen
on the basis of having a variety of conditions requiring pharmacotherapy
that you are expected to be competent in managing.
Part 2:
Presentation of clinical case, pharmacy care plan and justification.
You will meet with at least one qualified examiner for approximately 45
minutes to present the case, identify all the patient’s DRPs and then focus
on the two most important ones (including justification for each identified
problem), discuss your pharmacy care plan (therapeutic recommendations
and monitoring) and answer any questions pertinent to the case posed by
the examiner(s). (See evaluation form – Appendix B)
What to bring to the exam:




A writing instrument
Blank paper for notes
A calculator
PDA, notes, textbooks, or any other reference you would normally use when
evaluating patients.
Passing the Exam:
In order to pass the exam, you will need to satisfy the examiner(s) that you have
achieved a satisfactory level of competence in the components of the exam.
Each component of the exam will be graded as pass/fail (Appendix A). Upon
completion of the exam the examiner(s) will evaluate your overall performance and
determine either an overall pass or a fail.
In the event that you do not pass the exam, you will be given constructive feedback and
another opportunity for reassessment at an appropriate time thereafter. One of the
evaluators for the reassessment will be a person not involved in the prior evaluation(s).
Preparation:
The best preparation is continuing to work on your pharmacist work-up of drug therapy
process and being disciplined so that interesting but irrelevant information when working
up the case does not distract you from your purpose. Residents may wish to ask
rotation preceptors to stage a mock exam for them.
Evaluation:
The evaluation form used by the examiner(s) is attached (Appendix A). If you have any
questions please discuss these with your residency program coordinator.
PWDT Standards & Form – Acknowledgement to PHC
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Comprehensive Oral Assessment Guide for Residents – updated Apr 2008
Note that you will be expected to provide a detailed assessment of the highest-priority
Drug-Related Problem and write an appropriately structured note suitable for placement
in the patient’s health record for THIS PROBLEM ONLY.
You will be asked to turn in a copy of all written materials you compose during the
assessment. These will be used by the examiners to better understand your thought
processes in cases where this is not clear from the oral discussion.
Pharmacist Work-up of Drug Therapy (PWDT) - Sample
Remember that the PWDT is a systematic process which is meant to serve as a guide
for the pharmacist when performing their patient care function. It is not simply a form to
be completed on each patient seen.
Appendix B contains a sample PWDT-form. You may use this form or any other form or
process that you are most familiar with. Remember it’s not the data collection tool that
you will be evaluated on, but rather on your process and synthesis.
PWDT Standards & Form – Acknowledgement to PHC
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Comprehensive Oral Assessment Guide for Residents – updated Apr 2008
Appendix A
British Columbia Pharmacy Practice Residency
Comprehensive Oral Assessment
Date: _____________ Resident: ____________________Evaluator: ____________________
PWDT - Component
Standard
Medical History:
The resident should be able to
clearly and succinctly provide
the necessary background
information for the evaluators
to understand the case.
Description of patient, medical
problem list, HPI
Drug History
Prescription drugs, OTCs,
Alternative therapies,
Smoking/ Alcohol, Street
drugs, allergies,
immunizations
The resident should be
able to provide all objective
pertinent findings and be able
to explain the significance of
the findings.
Drug Related Problems
The resident should be able to
identify, justify, and prioritize
the drug related problems.
Desired Outcomes
For the #1 DRP
The resident should be able to
state the desired therapeutic
outcomes for the most
important DRP, which
incorporate the patient's goals
and desired outcomes.
The resident should be able to
discuss the pros/cons of viable
therapeutic alternatives to
resolve the most important
DRP
Therapeutic
Recommendations
For the #1 DRP
Comments
The resident should be able to
provide a complete medication
history through a review of the
patient chart and initial patient
interview. The resident should
be able to state the indication
and duration of therapy for all
drugs the patient was receiving
prior to admission.
Review of Systems
Therapeutic Alternatives
For the #1 DRP
P/F
The resident should be able to
list, prioritize, and defend the
choice of therapeutic
recommendations for the #1
DRP.
PWDT Standards & Form – Acknowledgement to PHC
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Comprehensive Oral Assessment Guide for Residents – updated Apr 2008
PWDT - Component
Standard
Monitoring
Parameters/Follow-up
The resident should recognize
the implications for the
recommendations, and be able
to identify and state the
frequency of monitoring
parameters for efficacy and
toxicity.
For the #1 DRP
Patient Education Issues
Written Documentation for
DRP #1
Pharmacy care Plan
for # 2 DRP (if time allows)
General questions
P/F
Comments
The resident should be able to
identify the patient education
and counselling issues for the
# 1 DRP and make an
assessment of the patient's
ability to comply with the
pharmaceutical care plan on
discharge
Write a pharmaceutical care
note suitable for documentation
in the patient's health record
Same as above. No written
note required.
The resident should be able to
provide justifications and/or
concepts, theories & specific
information, as requested by
the examiners in the course of
discussing the case
Other Evaluator Comments
PWDT Standards & Form – Acknowledgement to PHC
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Comprehensive Oral Assessment Guide for Residents – updated Apr 2008
Appendix B
PATIENT WORKUP OF DRUG THERAPY FORM
This data collection form is provided as an example only. If you wish to use a form, feel free to
use the one that you have become accustomed to for this purpose. Remember that you are being
evaluated on your process and not how well you fill out any form.
Patient Initials: ________ Record # ___________
A.
PHN ________________
MEDICAL HISTORY
Description of Patient:
History of Present Illness:
Acute Conditions:
DISEASE / SYMPTOMS
DURATION
INVESTIGATIONS
DURATION
INVESTIGATIONS
Chronic Conditions:
DISEASE / SYMPTOMS
PWDT Standards & Form – Acknowledgement to PHC
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Comprehensive Oral Assessment Guide for Residents – updated Apr 2008
B.
Appendix B
DRUG HISTORY
Prescription
Indications
Duration
If in Hosp
Medications
Compliance or Other
issues
OTC MEDS
Recreational Drugs
Smoking
Alcohol
Cocaine
Heroin
Marijuana
Other (specify)
Alternative Therapies
Allergies
Immunizations
PWDT Standards & Form – Acknowledgement to PHC
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Comprehensive Oral Assessment Guide for Residents – updated Apr 2008
Appendix B
C.
REVIEW OF SYSTEMS
Vital Signs
Neuro
Psych
EENT
Cardiovascular
Pulmonary
GI
Liver
Renal
Fluid/Electrolytes
Endocrine
Hematology
MS
Skin
PWDT Standards & Form – Acknowledgement to PHC
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Comprehensive Oral Assessment Guide for Residents – updated Apr 2008
D.
LIST THE DRUG RELATED PROBLEMS
A patient is having a drug related problem because:
1.
Is taking a drug for which there is no medically valid indication.
2.
Needs a drug and one has not been prescribed or suggested.
3.
Is taking the wrong drug or drug product.
4.
Is taking too little of the right drug.
5.
Is taking too much of the right drug.
6.
Needs a drug, has been prescribed or suggested one, but is not actually taking it or
is not taking it appropriately.
7.
Is experiencing an adverse effect.
8.
Is experiencing a drug interaction.
Cipole RJ, Strand LM, and Morley PC further elaborate upon this in the 2nd edition of
Pharmaceutical Care Practice “The Clinician’s Guide”
1. Indication
- Unnecessary drug
o
o
o
-
o
o
o
o
No medical indication
Duplicate therapy
Non-drug therapy
indicated
Addictive/recreational
o
Needs additional therapy
o
o
o
o
o
o
More effective drug
available
Condition refractory to
drug
Dosage form
inappropriate
Not effective for
condition
Dosage too low
o
o
o
o
o
o
Untreated indication
Preventative/prophylactic
2. Effectiveness
- Needs a different drug
product
-
3. Safety
- ADR
Wrong dose
Frequency inappropriate
Drug interaction
Duration appropriate
PWDT Standards & Form – Acknowledgement to PHC
-
Undesirable effect
Unsafe drug for pt
Drug interaction
Dosage administered or
changed too rapidly
Allergic reaction
Contraindications
present
Dosage too high
o
o
o
o
Wrong dose
Frequency inappropriate
Drug interaction
Incorrect administration
4. Compliance
- Non-compliance
o
o
o
o
o
o
Directions not
understood
Pt prefers not to take
Pt forgets to take
Drug product too
expensive
Cannot
swallow/administer
Drug product not
available
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Comprehensive Oral Assessment Guide for Residents – updated Apr 2008
Appendix B
E.
OUTCOME AND TREATMENT OPTIONS
DESIRED OUTCOME
TREATMENT OPTIONS
* Cure a disease
* Arrest or slow a disease
process
* Decrease or eliminate a
patient's symptoms
* Prevent a disease or
symptoms
* Normalize a physiologic
parameter
* Effectiveness or ability to prevent or resolve DRP
* Time Frame (onset and duration)
* Safety or potential to cause toxicities
* Convenience of use (available dosage forms, admin
schedules, special handing or storage)
* Potential for interactions with other drugs, food, laboratory
tests of disease states
* Cost
DRUG RELATED PROBLEM:
DESIRED OUTCOME:
THERAPEUTIC OPTIONS:
RECOMMENDATION:
MONITORING PARAMETERS:
PATIENT EDUCATION ISSUES AND FOLLOW-UP
PWDT Standards & Form – Acknowledgement to PHC
11
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