Orientation, Training and Competency Evaluation Checklist
Pharmacy Department
Employee Name:
Employee ID #:
Position:
Hire Date:
COMPETENCY STATEMENT: The following criteria are assessed to demonstrate the understanding and skills necessary to ensure the ability to perform the
skill safely, correctly, efficiently and in accordance with professional standards of practice; law and regulation and hospital policy. Competency assessment
must be complete and documented before independently performing a skill.
VALIDATION METHODS
V = VERBAL O = OBSERVATION D = SKILLS DEMONSTRATION
W = WRITTEN TEST C = CHARTING AUDIT
Note: Unless documented otherwise, competency assessment is complete on the date noted when initialed by both the trainee and the preceptor. As
new skills are assessed a copy of this form should be turned into the Director of Pharmacy, or his or her designee, for review and placement into the HR
file.
Competency/Criteria
Orientation to Hospital and Polices (day 1-90)
Locates and describes use of:
Policy & Procedure Manuals
Infection Control Manual
Safety Data Sheets (SDS) and GHS
Emergency Preparedness Manual
Locates:
Fire Alarms
Fire Doors/Exits
Fire Extinguishers
Personal Protective Equipment
RACE
Date
Validation
Method
Click here
Click here
1
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Preceptor’s Initials
Comments
NA- Not applicable
Orientation, Training and Competency Evaluation Checklist
Pharmacy Department
Competency/Criteria
Understands and identifies the need to report
safety concerns and near misses:
Understands event reporting process
Demonstrates access and ability to
complete a variance report
Verbalizes understanding of an accountable just
culture.
Describes and understands role in Emergency Codes:
Code Red
Code Blue
Code Pink
Code Orange
Code Grey/Black
Code Brown
Code Purple
Professionalism and HIPAA Training (day 1-90)
Demonstrates awareness of professional
standards:
Business Casual Dress Code
Professional Ethics
Hospital Mission Statement
HIPAA Training (hospital)
Telephone Etiquette
Date
Validation
Method
Click here
Click here
Click here
2
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Preceptor’s Initials
Comments
NA- Not applicable
Orientation, Training and Competency Evaluation Checklist
Pharmacy Department
Competency/Criteria
Date
Core Competencies (ASHP) (day 1-90)
Confidentiality and Patient Rights
Information Management
Infection Control
Hazardous Materials
Fire Safety (hospital or ASHP)
Security
Emergency Management
Site Specific Hospital Requirements
<List site specific hospital requirements below>
Validation
Method
Click here
Initial Assessment of Pharmacy Core Competencies (day 1-90)
Pharmaceutical Abbreviations
Pharmaceutical Conversions
Pharmaceutical Calculations
Fraud, Waste and Abuse Training (day 1-90)
Retail Outpatient Pharmacy Only
Click here
Click here
3
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Preceptor’s Initials
Comments
NA- Not applicable
Orientation, Training and Competency Evaluation Checklist
Pharmacy Department
Competency/Criteria
Date
Validation
Preceptor’s
Method
Initials
Order Review and Processing (Direct Observation Required to Demonstrate Skills) (day 1-90)
Interprets order accurately
Click here
Accurately and correctly profiles orders
Click here
Verifies weight based dosing per hospital policy
(pharmacists)
Performs a clinical review of drug therapy (pharmacists
only)
Click here
Click here
Responds appropriately to computer alerts (i.e.
drug/food interaction, duplicate therapy, allergies, dose
limits, etc.)
Clarifies incomplete or unclear orders with the
provider before dispensing
Documents clinical interventions (pharmacists)
Click here
Click here
Click here
Fills order with correct medications
Click here
Verifies labeling requirements are met
Click here
Implements double checks for defined lookalike/sound alike medications, high alert medications and
medications for high risk patient populations (i.e.,
pediatrics)
Click here
4
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Comments
NA- Not applicable
Orientation, Training and Competency Evaluation Checklist
Pharmacy Department
Competency/Criteria
Date
Validation
Method
Medication Storage and Preparation (ASHP) (first 6 months)
Medication Area Inspections
Click here
Repackaging Medication
Click here
Controlled Substance Distribution and Control
Click here
Sterile Compounding (first 6 months)
Hand Hygiene and Garbing
Click here
Aseptic Technique
Click here
Disinfecting and Cleaning
Click here
ASHP: Compounded Sterile Preparations & Laminar
Airflow Hoods
Click here
ASHP: Compounding Sterile Preparation and
Click here
Biological Safety Cabinets
Click here
Hand Hygiene and Garbing
Click here
5
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Preceptor’s
Initials
Comments
NA- Not applicable
Orientation, Training and Competency Evaluation Checklist
Pharmacy Department
Competency/Criteria
Date
Validation
Method
Drug Therapy Monitoring (first 9 months)
ASHP Patient Counseling
Preceptor’s
Initials
Comments
NA- Not applicable
Click here
ASHP Medication Safety
Click here
Date
Validation
Method
Age Specific Competencies (ASHP) (first 6 months)
Neonatal and Infant
Click here
Pediatric and Adolescent
Click here
Adult
Click here
Geriatric
Click here
6
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Comments
NA- Not applicable
Click here
ASHP Drug Reaction Reporting
Competency/Criteria
Preceptor’s
Initials
Orientation, Training and Competency Evaluation Checklist
Pharmacy Department
Competency/Criteria
Date
Validation
Method
Medication Storage and Preparation (ASHP) (first 6 months)
ASHP Pain Management
Click here
ASHP Antibiotic Streamlining
Click here
ASHP Intravenous to Oral Therapy Conversion
Click here
ASHP Renal Dosing
Click here
ASHP Adult Enteral Nutrition
Click here
ASHP Adult Parenteral Nutrition
Click here
Pharmacist Clinical Competencies (first 12 - 24 months)
CPS IV to Oral Conversion
Click here
CPS Renal Dosing
Click here
CPS Pharmacokinetics
Click here
CPS High Alert
Click here
CPS Medication Utilization Evaluation
Click here
CPS Pediatric Safety
Click here
CPS Geriatric Safety
Click here
7
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Preceptor’s
Initials
Comments
NA- Not applicable
Orientation, Training and Competency Evaluation Checklist
Pharmacy Department
Competency/Criteria
Date
Validation
Method
Pharmacist Clinical Competencies (first 12 - 24 months) - continued
CPS Chemotherapy Safety
Click here
CPS Pain Management
Click here
CPS Pharmacy and Therapeutics
Click here
Date
Validation
Method
Disease Specific ASHP (as assigned )
Obstetric
Click here
Oncology
Click here
Psychiatric
Click here
Staff Development Site Specific Requirements
< List site specific requirements>
Click here
Click here
Click here
8
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Comments
NA- Not applicable
Preceptor’s
Initials
Comments
NA- Not applicable
Click here
CPS Parenteral Nutrition
Competency/Criteria
Preceptor’s
Initials
Orientation, Training and Competency Evaluation Checklist
Pharmacy Department
Preceptor’s Assessment of Competency Skills and Needs:
______________________________________________________________________________________________________________________
Instructional Strategies: Strategies should be instituted for individual performance criteria that were not met or achieved. Instructional strategies may
include policy and procedure review, study modules, videos and/or hands on instruction. The criteria not met will need to be re-evaluated after the
following strategies have been completed.
Instructional strategy(ies) implemented:
9
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Orientation, Training and Competency Evaluation Checklist
Pharmacy Department
Preceptor Initials
_______________
Preceptor Signatures:
_________________________________________
_______________
_________________________________________
______________
_________________________________________
______________
_________________________________________
______________
_________________________________________
_______________
_________________________________________
Employee’s Initials
Employee’s Signature:
_______________
________________________________________
Pharmacy Director
Date:
3 Month Review: _______________________________
6 Month Review: _______________________________
12 Month Review: _____________________________
10
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