introductory pharmacy practice experience (ippe) - amazon s3 · if you need assistance or in the...

INTRODUCTORY PHARMACY

PRACTICE EXPERIENCE

(IPPE)

Student Guidelines and Workbook

Community

Summer 2016

IPPE Community Activity Workbook

Rotation Guidelines and Assignment Instructions

If you need assistance or in the case of emergency during your Community Introductory Pharmacy Practice Experience, please contact:

Lynn Kopack, Assistant Director of Experiential Education

207-221-4153 [email protected]

For general rotation information, contact the Office of Experiential Education: 207-221-4500

Preceptor Evaluation of Student (80% of final grade) Your preceptor will be required to complete an evaluation of your rotation. This evaluation, “Common New England Regional Departments of Experiential Education (NERDEE) Group Community IPPE Evaluation Form” will be available through the Preceptor’s RXpreceptor account and is due by the last day of the rotation. Students are encouraged to review the NERDEE evaluation form with their preceptor midway through and at the end of the IPPE.

Workbook (15% of final grade) Student workbooks will be reviewed by Preceptors during the IPPE. Workbook grades will be recorded with the Preceptor Evaluation of the Student in RXportfolio.com. Workbook activities and grade should be discussed with the preceptor throughout the rotation. The preceptor must initialize the completion of each activity as indicated in the workbook. Students should retain this workbook for future reference.

Reflection Paper – due within 5 days of end of rotation (5% of final grade) Students are responsible for submitting the required reflection paper within 5 business days of rotation completion at the practice site with their name and practice site location at the top right hand side. E-mail your paper to Lynn Kopack at [email protected].

Student Evaluations of Preceptor/Site - due 48 hours prior to the end of rotation (Pass/Fail) Students are responsible for completing a Preceptor/Site Evaluation and a Self-Assessment at the end of the rotation. The evaluation and self-assessment are accessible by logging into www.RXpreceptor.com (academicSuiteRx). Students are encouraged to provide thoughtful, professional evaluations. The information will be compiled, de-identified, and provided to preceptors as a quality measure to affirm best practices and to improve rotations. The Evaluation and Self-Assessment are MANDATORY and should be completed 48 hours before rotation completion.

Students are responsible for updating contact information, education, rotation, and resume information at www.RXportfolios.com.

The College of Pharmacy Code of Professional Conduct and the Technical Standards apply to all students participating in the Experiential Education Program. College policies are applicable at all clinical rotation sites and activities. To view the Code of Conduct or the Technical Standards, you may go to the UNE website or you may contact the Office of the Dean for replacement copies.

mailto:[email protected]


http://www.rxpreceptor.com/

http://www.rxportfolios.com/


1) Counsel and or observe a pharmacist counseling at least 10 patients on a new prescription. List the drug reviewed and the major points you covered during your counseling session.

1) ___________________________________________________________________________

___________________________________________________________________________

2) ___________________________________________________________________________ ____________________________________________________________________________

3) ___________________________________________________________________________ ___________________________________________________________________________ 4) ___________________________________________________________________________ ___________________________________________________________________________ 5) ___________________________________________________________________________ ___________________________________________________________________________ 6) ___________________________________________________________________________ ___________________________________________________________________________ 7) ___________________________________________________________________________ ____________________________________________________________________________ 8) ___________________________________________________________________________


___________________________________________________________________________ 9) ___________________________________________________________________________ ___________________________________________________________________________ 10) __________________________________________________________________________ ___________________________________________________________________________ Preceptor (Initial that student has completed): _______ Date (when completed):____________

Preceptor Comments:


2) Define the FDA categories for drug use during pregnancy.

Category Description

What reference is available in the pharmacy to provide accurate information on pregnancy and lactation? ___________________________________________________________________________

___________________________________________________________________________

Preceptor Initial that student has completed): _______ Date (when completed):____________

Preceptor Comments:


3) Heartburn

What symptoms are consistent with a diagnosis of heartburn? _____________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Individual Agents Available OTC for Heartburn

Specific Products Dose Precautions Counseling Points Calcium Products

1) 2) 3)

Magnesium Products 1) 2)

Combination Antacids

1) 2) 3)

Histamine (H2) Antagonists

1) 2) 3)

Proton Pump Inhibitors

1)

Preceptor Initial that student has completed): _______ Date (when completed):____________


4) Cough and Cold Nonpharmacologic treatment can be recommended to relieve the symptoms of cough. This is especially true in children, where cough and cold products are not recommend in children <2 years of age. List 3 nonpharmacologic options for the treatment of cough:

1. ______________________________________________________________________

2. ______________________________________________________________________

3. _______________________________________________________________________

Explore the cough and cold aisles of the pharmacy and complete the following tables: Find 3 cough and cold products that contain dextromethorphan, including 1 single entity product:

Brand Name Ingredients Dose Counseling Points


Find 3 cough and cold products that contain guaifenesin, including 1 single entity product:

Brand Name Ingredients Dose Counseling Points

Oral decongestants, including pseudoephedrine and phenylephrine, are generally effective for the relief of congestion.

Generic Name Dose Adverse effects Precautions Phenylephrine

Pseudoephedrine

Preceptor Initial that student has completed): _______ Date (when completed): ____________

Preceptor Comments:


5) The Combat Methamphetamine Epidemic Act of 2005 places limits on the sale of pseudoephedrine. Research the specific legal requirements of this Act and discuss with your preceptor and how it impacts that pharmacy and patients. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Preceptor Initial that student has completed): _______ Date (when completed): ____________

Preceptor Comments:


6) Explore the vitamin and alternative medicine section of your pharmacy. Complete the following table: Product Common Uses Precautions/Adverse Effects

Cranberry

Gingko Biloba

St. John’s Wort

Calcium

Vitamin E

Folic Acid

Melatonin

Black Cohosh

Saw Palmetto

Echinacea

Vitamin D

Probiotics

Preceptor (Initial that student has completed): _______ Date (when completed): ____________

Preceptor Comments:


7) Prescription medications are classified as either controlled or non-controlled substances. Controlled medications are assigned to schedules (C-I thru C-V) based on criteria defined in the Controlled Substance Act. Complete the following table pertaining to Schedules:

Schedule

Description Give 5 Examples

C-I

C-II

C-III

C-IV

C-V


Preceptor Comments:


8) Asthma Asthma is a chronic, inflammatory disease of the airways characterized by airway inflammation, bronchoconstriction, and bronchial hyperresponsiveness. Pharmacists play a key role in monitoring patients’ use of medications and if they are using their medications properly. Review with your preceptor the following asthma medications and describe how a patient should utilize each device appropriately.

Name Ingredients Mechanism of Action Directions for Use

ProAir HFA®

Advair Diskus®

Pulmicort Flexhaler®

Foradil®



9) Pain Management Pain management is a common issue that pharmacists must deal with on a regular basis. Patients often ask questions of over-the-counter products and prescription medications for pain are commonly dispensed. Please complete the following activities related to pain management.

Over-the-Counter Analgesics Drug Brand Name Adult Dosing Maximum Adult

Dosing (OTC) Pediatric Dose

Acetaminophen

Aspirin

Ibuprofen

Naproxen

NSAIDS or Non-Steroidal Anti-Inflammatory Drugs are medications that are used for mild to moderate pain, usually associated with an inflammatory process. The adverse effects of NSAIDS may be especially problematic for some patients. List 3 adverse effects associated with NSAIDS

1) ___________________________________________________________

2) ____________________________________________________________

Preceptor Comments:


3) ____________________________________________________________

Complete the following table with 5 prescription only NSAIDS:

Generic Name Brand Name Typical Dose

Opioid analgesic medications exert their activity by blocking the mu (μ) receptors in the central nervous system. Several different opioids are available in both short and long acting formulations. The adverse effects with opioids can be severe and limit their utilizations. List 5 adverse effects: 1) _________________________________________________________

2) _________________________________________________________

3) _________________________________________________________

4) _________________________________________________________

5) _________________________________________________________

Name 3 opioids that are available in a long acting formulation 1) _________________________________________________________

2) _________________________________________________________

3) _________________________________________________________


Preceptor Comments:


10) Diabetes Diabetes mellitus is a chronic condition, affecting over 18 million people each year. It has a significant impact on the healthcare system and community pharmacists are integral members of the healthcare team in the treatment of diabetic patients. Blood glucose monitoring is imperative for optimal treatment and success in achieving treatment goals in diabetic patients. Pharmacists can play an integral role in helping patients understand the disease and its management, particularly in the selection of monitoring devices. Please fill out the following table for blood glucose monitors:

Meter Manufacturer Drop Size Strips Test Time

Other Features


Preceptor Comments:


There are multiple types of insulin available for the treatment of diabetes, as well as different devices to aid in injection of insulin. Complete the following table comparing the different types of insulin: Insulin Type Brand Name Onset

(hrs) Duration (hrs) Dosage Forms

available Room temperature expiration

Insulin lispro

Insulin detemir

Regular insulin

NPH insulin

Insulin glargine

Insulin aspart

Insulin glulisine


Preceptor Comments:

11) Cardiovascular Medications Complete the following table: Generic Name Brand Name FDA Indications Dose Mechanism of Action Major Counseling Points

Lisinopril

Simvistatin

Carvedilol

Felodopine

Verapamil

Olmesartan

Niacin


Generic Name Brand Name FDA Indications Dose Mechanism of Action Major Counseling Points Amiodarone

Metoprolol Succinate

Bumetanide

Doxazosin Clonidine

Hydralazine

Aliskiren


Generic Name Brand Name FDA Indications Dose Mechanism of Action Major Counseling Points Clopidogrel

Ramipril

Chlorthalidone


Preceptor Comments:


12) Black Box Warnings and Medication Guides What is a black box warning? _________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Find 4 drugs with black box warnings:

Drug Description of Warning

What is a medication guide? _________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________


Name 6 drugs with medication guides:

Drug

Overview of Med Guide


Preceptor Comments:


13) Ask your preceptor and other pharmacists at your site the following questions. What do you feel are the most important aspects of running a successful community pharmacy? What do you feel are the biggest challenges facing community pharmacy in the future? _________________________________________________________________________________________

_________________________________________________________________________________________

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_________________________________________________________________________________________ Preceptor Initial that student has completed): _______ Date (when completed): ______

Preceptor Comments:


14. Please describe an ethical situation that could potentially arise in this practice setting. Ask the pharmacist(s) how they would handle the situation. You may have a different opinion. If so, please describe how you would handle the situation. _________________________________________________________________________________________

_________________________________________________________________________________________

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_________________________________________________________________________________________ Preceptor Initial that student has completed): _______ Date (when completed): _______

Preceptor Comments:


Tips on Writing a Reflective Paper

The reflective essay is a personal reflection on how the Introductory Pharmacy Practice

Experience (IPPE) affected you, not a summary of the IPPE. Reflective essays analyze

the goals, core concepts and ideas presented during the IPPE and then summarizes your

feelings about the material/experience.

Recommendations for writing a meaningful reflective paper:

Give your reflection paper structure with an opening paragraph (overall statement of your

perspective based on what you have learned), main body (describe how your experiences

affected your thinking and why) and conclusion. The conclusion may be a summary of

your thoughts as you completed the IPPE; state how the IPPE helped you or did not help

you professionally or personally. The reflective paper should be approximately 500

words.

Begin by jotting down some of the experiences and material that stands out in your mind.

Decide why they stand out to you. You may use the last few pages of your Workbook for

this purpose.

A reflection paper is your identification of the main themes of your classroom and

pharmacy practice experiences and how it affects your thinking and practice.

A reflection paper is meant to illustrate your understanding of the material presented

during the IPPE and how it affects your ideas and possible practice in the future.

Using the first person singular (“I”), relate the IPPE experiences to your previous

knowledge and experience.

Consider if and how your experience has changed your thinking and how it might affect

your practice in both personal and professional situations.

Criticism is fine; vague whining is not.

The one-page reflective paper (approximately 500 words) is due no later than five days

after the last day of your IPPE; submit electronically to [email protected].


Reflection Paper Use this page to make notes/comments for reference when writing your reflection paper. Do not write your paper in this space. E-mail your paper to Lynn Kopack [email protected] within 5 business days of the completion of the rotation with your name and practice site location at the top right hand side.



IMPORTANT: Students are responsible for obtaining accurate information from any state Boards of Pharmacy to whom they plan to report internship hours in preparation for the NAPLEX and the Jurisprudence Examination. In the case that the student may apply for licensure outside the state of Maine, it is the students’ responsibility to acquire and report the required documentation to the appropriate Board of Pharmacy. This log does not replace any form that may be required by the Board of Pharmacy. Introduction to Pharmacy Practice Hours Log (for student records only) Dates Total Hours Worked Preceptor Signature Week 1

Week 2

Week 3

Week 4

Students are required, as stated in the College of Pharmacy Student Handbook, to attend all classes and therefore you are required to attend all 160 hours of PHP115 – Introductory Pharmacy Practice Experience.


University of New England, College of Pharmacy

Portland, Maine

Title: Introductory Pharmacy Practice Experience - Community

Catalog Number: PHP 115

Credit Hours: 4

Contact Hours: 160 hours

Course Coordinator

James Krebs Pharm.D, Assistant Dean of Experiential Education

Location: Room 226

Email: [email protected]

Phone: 207-221-4515

Office Hours: by appointment

Course Description

The Introductory Pharmacy Practice Experience (IPPE) will provide both the experienced and inexperienced

student, 160 hours of contemporary pharmacy practice in a community pharmacy setting. This IPPE course

will begin immediately following professional year one and conclude before professional year two. The IPPE

will consist of practice site activities as well as supporting activities at the college.

Prerequisites and/or corequisites for PHP 115 Successful completion of the first year curriculum in the Doctor of Pharmacy program, the required

immunizations and state licensing requirements for participation.

Course objectives achieved under preceptor supervision (licensed pharmacist)

1. Describe the role of all pharmacy personnel within the practice organization.

2. Demonstrate an understanding of the pharmacy work flow.

3. Select appropriate OTC medications for patients while supervised by a pharmacist.

4. Explain the entire prescription filling process beginning from purchasing and ending with patient

counseling.

5. Describe potential medical errors and error prevention techniques.

6. Observe a pharmacist counseling patients and demonstrate counseling skills.

7. Demonstrate proficiency in basic pharmaceutical calculations.

8. Describe the basis of pharmacy management.

9. Describe an ethical situation the pharmacist may encounter at this practice site and how it could be

resolved.

10. Describe pharmacy patient care.

11. Demonstrate effective communication skills with pharmacy staff and patients.

12. Evaluate your current pharmacy practice experiences and self-assess your professional interests,

strengths, weaknesses, and development through a reflective exercise.

IPPE Practice Site Identification

Students will select choices from the available IPPE sites per the policy of the Office of Experiential

Education. Students are encouraged to select experiences in a setting different from where they may be

currently working or worked in the past. All placements are subject to preceptor and site availability and may

be adjusted at any time by the Assistant Dean of Experiential Education.


Course Delivery and Student Evaluation

This introduction to the practice of pharmacy will provide the student with the ability to integrate first-hand

practical experience with their didactic and laboratory coursework. Students who present with an extensive

background in a particular setting e.g., as a pharmacy technician in a chain drug store, may be assigned to

complete the IPPE requirement in an alternative practice setting e.g., an independent community pharmacy or

a compounding practice. The IPPE will allow the student, under adequate professional supervision, to be

directly involved with patients and their care. Based on prior pharmacy experience in a particular setting, the

student’s direct participation in providing patient-centered care will gradually progress allowing the student

and preceptor to feel confident in the student’s ability to interact with patients. This will provide an

opportunity for students to gain an appreciation for the career opportunities available in community pharmacy.

Completion of the IPPE program is a prerequisite for beginning the APPE (Advanced Pharmacy Practice

Experience) program.

Each IPPE site will have a designated preceptor who will supervise the student while he or she performs

activities devoted to the processing of a prescription order including: receiving the order, data entry, reviewing

a patient profile, drug selection, preparing the prescription and counseling the patient. The student may also be

involved with drug information questions, compounding, dosage calculations, drug utilization review,

ordering, stocking shelves, record keeping and the use of medical supplies and devices. Each site will employ

specific written and/or oral assignments and may require the student to perform some work at home. Students

are required to maintain a portfolio documenting the completion of course competencies and requirements.

Preceptors will evaluate the student using a Student Evaluation Form with specific competencies that must be

achieved.

Student Evaluation and Grading

The final grade will consist of:

Preceptor Evaluation of Student 80%

Student Workbook 15%

Student Reflection Paper 5%

(due within 5 business days of rotation completion)

Incomplete or late assignments will receive no credit. Student Self-Assessment (mandatory) **Pass/Fail

Preceptor/Site Evaluation (mandatory) **Pass/Fail

**If the student does not complete the Self-Assessment and the Preceptor/Site Evaluation located in the student’s

RXpreceptor account within the specified timeframe at the end of the IPPE, the student is subject to fail the

rotation.

Grading Scale 93-100 Points: A

90-92.9 Points: A-

87-89.9 Points: B+

83-86.9 Points: B

80-82.9 Points: B-

77-79.9 Points: C+

73-76.9 Points: C

<73 Points: F

As stated in the College of Pharmacy Student Handbook, the minimum passing grade for IPPE and for APPE

will be C. Any course that receives a grade less than minimum for passing will require remediation of the

course, as dictated by the Academic Progression Committee.

Attendance Policy

The student must complete all required hours during this rotation. The day-to-day schedule of the required

hours throughout the rotation should be planned with the preceptor at the beginning of the rotation. The student

should not work-over to “get-ahead” in hours so as to complete the rotation early. If you miss a day because of

an excused or unexcused absence, you must contact your preceptor and the Assistant Dean of Experiential


Education immediately. In cases of tardiness, sickness, holidays, or any other excused or unexcused absence,

the student pharmacist is responsible for making arrangements to make-up the time missed time before the end

of the rotation.

It is the preceptor’s decision whether or not hours missed can be made up. Students are responsible for the

completion all assignments and learning activities, regardless of attendance when activities have been

scheduled. A single unexcused absence may result in the reduction of the overall course grade by 10%. More

than one unexcused absence may result in a failure of this rotation. Excused absences should be minimized.

Any deviation from this attendance policy or related issues will be addressed by the Office of Experiential

Education.

Student Travel

All excused absences that result from attendance by students at professional and other meetings must be

approved in advance by the Assistant Dean Experiential Education and preceptor using the student travel

permission form, available in the Dean's office.

ADA Syllabus Statement

The University of New England does not discriminate in its education and employment programs on the basis

of age, race, color, gender, sexual orientation, national origin, disability, or religion. The College complies

with Title VI of the Civil Rights Act of 1964, Title IX Education Amendments of 1972, Section 504 of the

Rehabilitation Act of 1973, and the Americans with Disabilities Act (ADA) of 1990.

Inquiries regarding Title VI and Title IX may be made to the Affirmative Action Officer.

Telephone: (207) 741-5798

If you have a disabling condition and wish to request accommodations in order to have reasonable access to

programs and services offered by UNE, you must register with the ADA Services Coordinator.

HIPAA Compliance All courses at the University of New England College of Pharmacy will follow all HIPAA guidelines

published and will be consistent with state and federal law, as well as UNE policy.

STUDENT RESPONSIBILITIES

The success of the IPPE Program is dependent upon a number of variables. A key variable is the student's

contribution to the learning process. Learning is an active process and requires the active participation of the

student. The following list represents student requirements for the IPPE Program:

* Successful completion of all courses required before entry into the IPPE.

* Completion of all paperwork specifying site preferences. It is the student's responsibility to obtain,

complete and return all information requested to the Office of Experiential Education by the time specified.

* All health clearances must be completed at least two weeks prior to the general orientation before

beginning the first year experiential rotation.

* Attendance at the Experiential Education Program orientation is MANDATORY. This orientation is

held on campus prior to the start of the rotation start date.

* Each student will spend at least 8 hours per day at the experiential site or at approved alternate sites

completing required activities.


* The student is to conduct himself/herself in a manner, which is professional, courteous and reflects

positively on the individual, the preceptor and the College of Pharmacy.

* Students are obliged to respect any and all confidential information revealed during the experiential

rotations including, but not limited to patient information, pharmacy records, pricing systems, and professional

policies. At NO time are students to discuss patients by name and/or information from their charts in public

areas. Charts are NEVER to be removed from the patient care unit area. Students may be required to sign a

confidentiality agreement before beginning certain rotations.

* Students must keep in mind that the primary purpose of the IPPE is learning and that learning is not a

passive process, but an active process that requires a serious commitment on their part.

* A student should discuss their progress development or any disagreements with the preceptor in private.

All criticism should be viewed as a means of learning and not embarrassment.

* The student will notify the Assistant Dean of Experiential Education at the College of Pharmacy of any

issues (program, transportation, scheduling, etc.) at the earliest possible time so that an acceptable solution can

be found.

* The student must be punctual in meeting his/her rotation schedule.

* Transportation to and from the experiential rotation site as well as parking costs incurred will be the

responsibility of the student.

* Housing during IPPE program is the responsibility of the student.

* Students are responsible for completing evaluations of their preceptors/sites to the within five business

days of the completion of the rotation.

* Students should be aware of and comply with all laws, rules and regulations, which govern pharmacy

practice. Students should seek clarification of such in order to avoid any infringement that might be

detrimental to the students, the preceptor, the patient or the experiential rotation site.

* Students should make sure their professional decisions and activities are monitored adequately. No

student is to dispense a final product or make a recommendation without first consulting the pharmacists’

preceptor for review and approval.

* The student will not be allowed to work with a preceptor with whom they are related in any way.

* The student will not receive any financial remuneration from the preceptor during the rotation.

* The student schedule will not necessarily comply with the University of Graduate Programs Academic

calendar in regards to vacation periods and holidays, but will adhere to the schedule mutually agreed upon with

the preceptor.

* The student should take the initiative in communicating with physicians, patients and other health

professionals but should not step beyond the realm of professional courtesy and common sense.

* Students are expected to dress in a professional manner at all times. Proper dress usually includes a

short white laboratory coat. For safety reasons, open toed shoes are not appropriate and jewelry in any body

piercing other than the ears is not permitted. A nametag is necessary to identify you as a student in the various


health environments and therefore should be worn at all times. Some experiential sites have specific dress

codes for all of their professional staff. Students are expected to abide by their regulations while on site.

* The College of Pharmacy Code of Professional Conduct and the Technical Standards apply to all

students participating in the Experiential Education Program. College policies are applicable at all clinical

rotation sites and activities. To view the Code of Conduct or the Technical Standards, you may go to the UNE

website or you may contact the Office of the Dean for replacement copies.


Common New England Regional Departments of Experiential Education (NERDEE) Group Community IPPE

Evaluation Form (completed by preceptor)

The following is used to assess the student’s ability to handle the functions within a pharmacy. In each section please circle the appropriate number that corresponds to the student’s performance using the scale below:

Rotation Information:

Student Name: Class of:

Site:

Address: City: State:

Preceptor:

Grading Scale: 3 = Requires little or no intervention. Significantly exceeds expectations. Displays ability to work unsupervised. I feel the student is able to perform the listed function with a high degree of competence.

2 = Requires targeted interventions. Performs within expectations. Can perform some tasks without supervision. I feel the student is able to perform the listed function with acceptable competence.

1 = Unable to perform tasks or complete assignments. Incomplete understanding of basic concepts. Requires extensive remedial training. Displays inappropriate and/or unethical behavior. I feel the student is unable to perform this educational outcome competently.

N/A = Not applicable

Community Practice Skills Assessment Dispensing of Medications The student was able to gather and organize accurate and

comprehensive patient specific information. 3 2 1 N/A

The student can accurately evaluate and process a new prescription or prescription refill in a time-sensitive matter in accordance with the law.

3 2 1 N/A

The student was able to correctly interpret/translate prescription abbreviations.

3 2 1 N/A

The student was able to select the correct drug product, manufacturer, dose, and dosage form and prepare it for labeling and dispensing.

3 2 1 N/A

The student was able to correctly adjudicate third party insurance submissions and assist patients with any problems.

3 2 1 N/A

The student was able to compound non-parenteral drug products using accurate calculations and techniques.

3 2 1 N/A

The student was able to recall the brand/generic names and indications of the top 200 medications.

3 2 1 N/A

Communication Skills

The student spoke to the patients, caregivers, and other health providers using appropriate verbal, non-verbal, and written communication at a suitable level.

3 2 1 N/A


The student was able to properly communicate with the pharmacy staff and interacted appropriately with colleagues at this site.

3 2 1 N/A

The student was able to promote the importance of health and wellness in disease prevention.

3 2 1 N/A

The student was able to counsel patients on proper self-care and preventative care to an appropriate level.

3 2 1 N/A

The student was able to provide basic medication counseling to a patient or caregiver receiving a medication to an appropriate level.

3 2 1 N/A

The student was able to demonstrate and/or describe proper administration techniques for various drug delivery systems (e.g. inhalers, eye drops, etc.).

3 2 1 N/A

Interprofessional Education The student can describe interprofessional roles and responsibilities and the importance of contributing to a team-based model of patient care.

3 2 1 N/A

The student engaged in effective interprofessional communication. 3 2 1 N/A The student participated in interprofessional healthcare team

activities designed to advance interprofessional team effectiveness. 3 2 1 N/A

Professionalism

The student was punctual and communicated delays or absences effectively with the preceptor.

3 2 1 N/A

The student adhered to the dress code required by the site. 3 2 1 N/A The student demonstrated caring, ethical, and professional behavior when interacting with peers, patients, and caregivers.

3 2 1 N/A

The student demonstrated sensitivity, respect, and empathy for each individual’s needs, values, and beliefs, including cultural factors, religious beliefs, language barriers, cognitive abilities, and socioeconomic status.

3 2 1 N/A

The student was self-directed and demonstrated initiative in undertaking tasks and completing assignments.

3 2 1 N/A

Pharmacy Operations

The student demonstrated an understanding of the principles of inventory management during filling and ordering processes.

3 2 1 N/A

The student understood the importance of adhering to controlled substance inventory and ordering procedures.

3 2 1 N/A

The student demonstrated application of both the state and federal laws and regulations pertaining to the practice of pharmacy.

3 2 1 N/A

The students maintained patient confidentiality and followed HIPAA regulations.

3 2 1 N/A

The student was able to identify and efficiently utilize appropriate drug information resources.

3 2 1 N/A

Preceptor Comments


Preceptor Signature Date Student Signature Date

FOR REFERENCE ONLY -

PRECEPTOR WILL

COMPLETE EVALUATION

USING RXPRECEPTOR.COM

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