hospital pharmacy survey tool.pdf
TRANSCRIPT
Pharmacy Internship Program UST Faculty of Pharmacy (AY 2011-2012) Page 1
NAME__________________________________________ Yr. & Section _______________
Name of Hospital _______________________________________________________________
Address ______________________________________________________________________
Date of Internship ______________________________________________________________
SURVEY TOOL FOR HOSPITAL PHARMACY
Dear Students:
You are requested to fill up completely this evaluation tool. There is no right or wrong answer.
Your honest evaluation is important to have an accurate conclusion. Thank you for your time.
Pharmacy Internship Committee
DIRECTIONS: Using the scale below, please encircle the code opposite each item to rate the
extent by which each item is practiced in the hospital pharmacy.
4 = Great Extent (GE) 2 = Little Extent
3 = Moderate Extent (ME) 1 = Negligible or Not At All
I. General Provisions:
1. The hospital pharmacy conducts training of pharmacy students
affiliated with the hospital that meets the requirements of the
DOH NCATS/RCATS. (AO 70-A s. 1989)
4 3 2 1
2. There is a well-organized Pharmacy Service conducted in
accordance with ethical and professional practices and properly
licensed by the BFAD in the issuance of an LTO in accordance
with the Food, Drugs, Devices and Cosmetics Act ([FDDCA] RA
3720 as amended) and the Bureau of Licensing in accordance
with the Hospital Licensure Act (RA 4226) and the Dangerous
Drugs Act.
4 3 2 1
3. The hospital pharmacy provides orientation to the interns prior to
the start of the internship.
4 3 2 1
4. There is a registered pharmacist who supervises the intern during
the internship.
4 3 2 1
5. The physical presence of a licensed pharmacist is ensured
especially when the pharmacy is open for service and/or the
pharmacy renders 24 hours service.
4 3 2 1
6. There is a PTC that provides rational drug therapy.
7. The hospital pharmacy ensures continuous supply of drugs and
medicines of the highest standards to patients by maintaining an
adequate quantity of stocks in the hospital pharmacy.
8. The hospital pharmacy conducts the preparation and compounding
of bulk sterile and non sterile pharmaceuticals approved by PTC.
Pharmacy Internship Program UST Faculty of Pharmacy (AY 2011-2012) Page 2
9. Provides IV admixture program.
10. There are adequate provisions for equipment, chemicals for
compounding and dispensing (standard laboratory equipment,
laminar flowhood, prescription balance, pill tile, mortar and
pestle, etc.
4 3 2 1
11. There are adequate provisions for reference books and record
books duly registered with BFAD (PNDF, USP/NF RPS,
Goodman and Gilman Pharmacological Basis of Therapeutics,
R.A. 6675, R.A. 5921, R.A. 8203, Prescription Book and
Dangerous Drug Book,
Exempt Preparation and Poison Book)
4 3 2 1
12. The hospital pharmacy conducts the screening, filling and proper
dispensing of drugs in accordance with the laws, rules and
regulations pertinent thereto. (RA Nos. 5921, 3720, 6425, 6675)
13. Maintains records, files and submit reports on dangerous drugs
and other pharmaceuticals in compliance with pertinent laws,
rules and regulations.
14. The hospital pharmacy controls the labeling and packaging of
drugs that complies with standards and legal requirements.
15. There is enough space for a pharmacist to observe and supervise
all interns assigned in the pharmacy department.
4 3 2 1
16. There is a Policy and Procedure Manual on training/internship
which is implemented consistently.
4 3 2 1
17. The physical-set up of the pharmacy department is in accordance
to the acceptable standard.
4 3 2 1
18. The hospital pharmacy serves as Drug Information Center to all
hospital personnel, students and patients.
4 3 2 1
19. The hospital pharmacy is properly lighted, well-ventilated and has
an area of not less than 15 sq. m. with concrete tile or wooden
flooring.
4 3 2 1
20. There is a unit dose drug distribution system used in the hospital.
21. The arrangement of furniture allows enough space for movement
and work.
4 3 2 1
22. The pharmacy department provides a suitable place for adequate
storage of drugs and biological products specified on the labels.
4 3 2 1
23. The appearance of the pharmacy department is aesthetically neat
and orderly.
4 3 2 1
24. There are clear provisions in the preparation and signing of the
Requisition Issue Vouchers (RIVs) with complete specifications
of drugs indicating the quantity and cost based on the official
Price Schedule for actual procurement.
4 3 2 1
25. There are clear provisions for the invoices indicating the lot
number/batch number of the manufacture’s stock pursuant to
BFAD, file of prescription filled consecutively numbered, dry
4 3 2 1
Pharmacy Internship Program UST Faculty of Pharmacy (AY 2011-2012) Page 3
seal or rubber stamp, red or white label indicating the number and address of the hospital.
26. There is a summative evaluation of the internship activities and
the student performance upon completion of the required number
of hours by the intern.
4 3 2 1
27. A drug inventory system is maintained by the hospital pharmacy
adopting the FIFO method in dispensing and distributing drug
stocks.
4 3 2 1
28. The institution develops a pharmaceutical research. 4 3 2 1
29. There is a provision for continuing education for pharmacy staff
and support personnel
30. A pharmacist on duty always wears the prescribe uniform 4 3 2 1
II. Pharmacist/Personnel Attitudes and Competencies
1. Plans and conceptualize internship activities 4 3 2 1
2. Meets the needs of the intern 4 3 2 1
4. Is willing to work long in a traditional hours in order to assist
interns.
4 3 2 1
4. Delegates the task fairly 4 3 2 1
5. Guides the interns in their work of:
a. compounding, labeling and packing 4 3 2 1
b. TPN preparation 4 3 2 1
c. preparing stock solution 4 3 2 1
d. handling of ethical and dangerous drugs 4 3 2 1
e. pricing the prescription 4 3 2 1
f. recording of prescription 4 3 2 1
g. dispensing of drugs 4 3 2 1
h. disseminating drug information 4 3 2 1
i. preparing inventory of drugs and other resources of drugstore. 4 3 2 1
6. Monitors and evaluates the activities and performance of the
interns professionally and fairly
4 3 2 1
7. Is willing to share his/her management and professional
experience/training.
4 3 2 1
8. Provides or suggests solutions to problems 4 3 2 1
9. Inspires the interns to work with commitment. 4 3 2 1
10. Encourages the interns to be respectable and trustworthy. 4 3 2 1
11. Performs consistently the tasks (student related activity) within the
Drugstore.
4 3 2 1
12. Adapts easily to constant change of people, places and things. 4 3 2 1
13. Treats all interns fairly and honestly. 4 3 2 1
14. Is courteous and tactful to interns. 4 3 2 1
15. Relates well to staff and interns 4 3 2 1
Pharmacy Internship Program UST Faculty of Pharmacy (AY 2011-2012) Page 4
III. Facilities
1. Sufficient facilities in good condition are available. 4 3 2 1
2. Up-to-date facilities are available 4 3 2 1
3. The physical and material resources are arranged orderly. 4 3 2 1
4. There is flexibility for the physical and material resources. 4 3 2 1
5. The physical facilities and compounding areas are clean. 4 3 2 1
6. The interior design of the hospital pharmacy is simple and attractive. 4 3 2 1
IV. Location
1. The site is convenient to patients 4 3 2 1
2. The hospital pharmacy is accessible to public transportation. 4 3 2 1
3. The hospital pharmacy has enough parking space 4 3 2 1
4. The hospital pharmacy has adequate provision for expansion. 4 3 2 1
5. The hospital pharmacy has enough security measures for safety i.e
adequate lights, presence of security guard
4 3 2 1
V. Patient Service
1. The hospital pharmacist has the competencies required. 4 3 2 1
2. The hospital pharmacist renders prompt and quality service 4 3 2 1
3. The hospital pharmacists are courteous and approachable. 4 3 2 1
4. The frontline staff is friendly. 4 3 2 1
5. The hospital pharmacist communicates clearly with the patients
specially on dosing regimen and how the drug should be taken
4 3 2 1
6. The hospital pharmacists attend to patients’ comments and
feedbacks.
4 3 2 1
Pls. rate the hospital pharmacy as a whole from 1-5 with 5 as the highest point. _________.
Would you personally recommend this hospital pharmacy as a training site for Pharmacy
students in Hospital Pharmacy? A. Yes B. No
Remarks:
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