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Geropsych
Pharmacy 4XXX
Geropsych Clerkship
6 Credits
COURSE MANUAL
The material contained in the manual is for the restricted use of the candidates and faculty at the School of Pharmacy at Texas Tech University Health Sciences Center as an aid in teaching. This material may not be duplicated without the written consent of the Faculty Coordinators at the School of Pharmacy.
© Department of Pharmacy Practice,
School of Pharmacy,
Texas Tech University Health Sciences Center, 2001
1300 Coulter, Room 206
Amarillo, TX 79106
806-356-4000, ext 333
| TABLE OF CONTENTS SECTION I. GEROPSYCH COURSE INFORMATION 1. Course Competencies . 3-6 2. Course Requirements . 7-8 3. Texas Administrative Code Internship Requirements . 9-12 Pharmacist-Intern Duties . 12 Preceptor Requirements 13 4. Pharmacy Ethical Considerations . 14 Section II. Course Syllabus .. 14-18 Section III. PHARM. D. Candidate PRELIMINARY COURSE Tools 1. Autobiographical Data Form .. 20-21 2. Experiential Site Activity Checklist 22-23 Section IV. PHARM. d. Candidate PROJECT/ASSIGNMENT Tool S 1. Description of Graded Exercises for Pharmacy 4XXX 25 2. Journal Club Presentation Guidelines 26 3. SOAP Note Guidelines .. 27 Section V. PRECEPTOR Assessment Tools/PORTFOLIO 1. Grade Summary Sheet .... 29 2. SOAP Note Grading Forms . 30-33 3. Journal Club Presentation Evaluation Form 34 4. Pharmacy Activities Evaluation Form 35 5. Patient Interaction Evaluation Form .. 36 6. Presentation Evaluation Form . 37 7. Texas State Board of Pharmacy Intern Clerkship Evaluation Forms . 38-44 8. Weekly Activity Sheet 45 9. Candidate's Evaluation of Experience . 46 |
CANDIDATE INFORMATION FOR GEROPSYCH CLERKSHIP - PHARMACY 4XXX
COURSE COMPETENCIES
1. ACCOUNTABILITY
Competency Definition: Pharmacists fulfill multiple responsibilities simultaneously. Central to all pharmacists' responsibilities is self- accountability to ensure that responsibilities are fulfilled to the fullest extent, within the expected time frames, and appropriate follow-up mechanisms are created, implemented, and monitored.
The P4 clerkship student shall be able to:
1. place the care of patients above all other responsibilities.
2. perform patient care functions in a punctual and professional manner.
3. ensure that all patient care functions are performed prior to leaving for the day.
4. provide optimal care for patients so that practice accountability will be applied to patient care post graduation.
5. understand a pharmacist's role in patient care and be accountable for the provision of pharmaceutical care to patients.
6. learn to prioritize and complete the multiple responsibilities of a health care provider.
As assessed by Intern Clerkship Evaluation form items #13,15,16
2. INDIVIDUAL PATIENT CARE
Competency Definition: Pharmacists base their clinical decision making on an understanding of the most common disease entities. Therefore, students must learn the most common disease states encountered in each clerkship course (e.g. pathophysiology, diagnosis and diagnostic studies, clinical laboratory medicine, treatment regimens, and monitoring parameters) and apply this knowledge to direct patient care.
The P4 clerkship student shall be able to:
1. demonstrate an understanding of the pathophysiology, clinical presentation, diagnostic studies, treatment and monitoring of those disease states specified in individual clerkship course manuals.
2. apply knowledge gained from previous coursework to individual patient care.
3. demonstrate the ability to create and assess an appropriate pharmacotherapeutic regimen using knowledge gained from coursework in pharmacology, pharmaceutical care, pharmacokinetics, dynamics, pharmacotherapy, and practice management.
4. integrate knowledge of the basic sciences to differentiate among pharmacologic agents within the same class.
As assessed by Intern Clerkship Evaluation form items #9-12
3. TEAMWORK
Competency Definition: Teamwork is work done by several associates with each doing a part, but, all subordinating personal prominence to the efficiency of the whole. Pharmacists function as an integral component of a team whose ultimate goal is to provide the best patient care possible.
The P4 clerkship student shall be able to:
1. function effectively within the team to optimize patient outcomes.
2. communicate effectively within the team.
3. handle an appropriate level of responsibility within the team.
4. interact appropriately with different members of the team (e.g. pharmacists, patients, caregivers, physicians, medical students, nurses, therapists);
5. sacrifice personal gain for the good of the team and its patient.
As assessed by Intern Clerkship Evaluation form item #8
4. LITERATURE EVALUATION AND APPLICATION
Competency Definition: Pharmacists should consistently exhibit leadership in providing drug information using multiple state-of-the-art resources for both patient-specific drug therapy and system-wide drug therapy issues (e.g. creation of clinical practice guidelines or formulary backgrounds).
The P4 clerkship student shall be able to:
1. demonstrate the ability to make rational, patient-specific therapeutic decisions, based upon critical evaluation of the literature and clinical experience.
2. locate and analyze literature to solve a therapeutic dilemma in a timely fashion.
3. make a recommendation to health care colleagues or a team.
4. display the ability to find and accurately disseminate medical information through formal and informal presentations, discussions, and written communications.
5. develop a personal method of staying current with the medical and pharmacy literature, including development of a filing system and/or a "peripheral brain."
As assessed by Intern Clerkship Evaluation form item #5
5. INTERPRETATION AND APPLICATION OF PHYSICAL ASSESSMENT DATA
Competency Definition: Interpretation of physical assessment data and its application to creating and modifying drug therapy regimens is fundamental to pharmacy practice. Students shall incorporate physical assessment data into the provision of patient care and initiation, modification, and monitoring of drug therapy regimens.
The P4 clerkship student shall be able to:
1. demonstrate skill in identifying and interpreting results of general and targeted physical exams (performed by any health care practitioner).
2. apply physical exam data to the initiation and modification, and monitoring of drug therapy regimens.
As demonstrated by the student's ability to develop and document a plan of care (SOAP note) and as graded by the SOAP note grading form.
6. DOCUMENTATION OF PHARMACY SERVICES
Competency Definition:Documentation of pharmacy services is an essential activity. Documentation in pharmacy practice includes activities such as: writing a SOAP note in the medical record, providing written pharmacotherapeutic consultations, maintaining required prescription and patient profiles, and submitting proof of pharmaceutical services to third party payers. All documentation is written. Pharmacy services, which are not documented, are considered as never occurring.
The P4 clerkship student shall be able to demonstrate:
1. proficiency in providing succinct and accurate patient-specific information related to drug therapy management.
2. the proper procedures for generating pharmacist's notes to be placed in the patient's legal medical record.
3. the ability to document patient care in a manner which supports reimbursement for pharmacists' activities beyond dispensing pharmaceuticals.
4. confidence regarding the information / knowledge provided by providing such notes in the patient's pharmacy/ medical record.
As demonstrated by the student's ability to document a plan of care (SOAP note) and as graded by the SOAP note grading form.
7. COMMUNICATION
Competency Definition : Pharmacists effect patient care and the delivery of health care using timely, efficient, and appropriately targeted communication skills. Communication skills provide the foundation for patient - pharmacist relationships as well as relationships with other health care providers and payers.
7.1 General Communication
The P4 clerkship student shall be able to:
1. present (both orally and in written format) a therapeutic issue or concept with confidence and independent proficiency to patients, fellow health care providers, and the lay public.
2. develop presentation skills by delivering inservices to other health care professionals and the health care team by adapting content to the level of the audience.
3. demonstrate good human relation skills.
4. consistently, accurately, and succinctly relay drug information to patients and colleagues
5. recognize their knowledge and experience limitations ("I don't know, however, I will investigate and give you a call.")
7.2 Communication with the Patient or Caregiver Interview
Competency Definition: Conducting and recording a thorough patient interview (medical history and medication history) enables creation and implementation of a drug therapy related problem list and pharmacist's care plan.
The P4 clerkship student shall be able to:
1. conduct and document a thorough patient interview that includes the following components: chief complaint, history of present illness, past medical history, social history, family history, and medication history (e.g. prescription medications, drug therapy related devices, nonprescription medications, alternative therapies including herbals, vaccination history, drug and food allergies.
2. create a patient work up of drug therapy related problems.
3. create a drug therapy related problem list.
4. effectively interact with patients who are cognitively or physically impaired ( e.g. interviewing proxies and caregivers).
5. communicate an educational message to a patient appropriate to a selected clinical situation.
6. communicate with a patient or patient's agent at an appropriate level.
7.3. Patient Education
Competency Definition: Enhancement of a patient's knowledge and understanding of medical care and related drug therapy related plans will improve patient compliance and translate into improved patient economic, clinical, and health outcomes.
The P4 clerkship student shall be able to:
1. interview the patient or caregiver obtaining information necessary to assess the need for additional information, education, and counseling.
2. provide written patient information in a form that the patient can understand.
3. identify, analyze and use commercially available patient information monographs.
4. create patient information monographs.
5. provide oral consultation concerning the patient's medical care in a manner the patient perceives as empathetic, tactful, and appropriate.
6. prepare written patient information that is appropriate to the needs and educational level of the patient within a specific healthcare institution or community.
As assessed by Intern Clerkship Evaluation form items # 6-12.
8. CALCULATION, PREPARATION, AND ASSESSMENT OF APPROPRIATE DOSES
Competency Definition: Pharmacists perform a unique "safeguard" role in health care by consistently assessing the appropriateness of doses so as to avoid both supertherapeutic and subtherapeutic doses. A pharmacist's mathematical abilities are combined with knowledge of pharmaceutical products and their delivery to create systems approaches to ensuring safe and appropriate doses. The calculation, preparation and assessment of parenteral and nonparenteral doses are central to the pharmaceutical care process in all practice settings.
The P4 student shall be able to:
1. define the normal dose and number of dosage units for any drug product (prescription and nonprescription) used in any of their patient's regimens.
2. calculate the appropriate dose for any drug product using mathematical skills and mathematical reasoning.
3. provide the reasoning behind commercial and noncommercial dosing charts and confirm the accuracy of dosing charts.
4. recognize both supertherapeutic and subtherapeutics doses.
5. adjust doses based on patient specific parameters such as renal or hepatic dysfunction.
6. calculate infusion rates and teach nursing staff how to safely administer infusion medications.
7. convert doses based upon different dosage forms of a pharmaceutical product.
As assessed by Intern Clerkship Evaluation form items #9 & 12.
9. INDEPENDENCE, INITIATIVE, AND LIFELONG LEARNING
Independence. One of the primary aspects of independence will be the demonstration of independent learning skills, as shown in preparation for patient care and clerkship assignments. An important aspect of independence is demonstration of appropriate flexibility in delivery of pharmaceutical care.
Initiative. The student shall demonstrate self-motivation. Some of the qualities seen in the individuals will be the ability to work to their personal and professional limits while taking responsibility for patient care, outcomes, and other clerkship assignments. The student shall be able to understand when to question the statements of others and appropriately gather information related to these statements (e.g., not accepting the statements of others as gospel, but rather independently verify these statements by consulting appropriate references). The student will demonstrate independent initiative by delivering pharmaceutical care to their personal and professional limits and consulting with others when the situation is beyond those limits.
Lifelong learning. Students shall demonstrate the desire, even the thirst for knowledge, a commitment to continuous, lifelong learning. They should be able to learn in a self-directed manner, investigating new situations presented to them in the delivery of pharmaceutical care. The student must acknowledge personal responsibility for continuous, lifelong learning.
Composite Competency Definition:Pharmacists should demonstrate comfort, effectiveness, and efficiency in the independent initiation of clinical decision-making and appropriate consequent action in dispatching the functions associated with the delivery of pharmaceutical care, in accordance with valid therapeutic judgment, ethical practice, and sound management principles.
The P-4 clerkship student shall demonstrate the ability and initiative to:
(assessment tools will be indicated by parentheses)
1. be a self-starter (TSBP Form, Sections 5-12,15-17,19-22 ; Pharmacy Activities) .
2. function as an independent, in-depth learner (TSBP form Sections 5-12,15-17,19-22; Pharmacy Activities; Case-based exam).
3. make independent judgments (TSBP Form Sections 5-12,15-17,19-22; patient interaction; SOAP notes).
4. carry-out the functions of the contemporary pharmacist independently (TSBP Form sections 1-12,17-22; Pharmacy activities; Journal Club / DI).
5. evaluate the judgments of other health care providers independently (TSBP Form, sections 5,8,10,11-17,19,21-22; SOAP notes; Case-based examination; DI).
6. initiate self-assessment (TSBP Form sections 20,22; SOAP notes; Patient interaction).
7. initiate an ongoing process of self-education (TSBP Form sections 5-12,15-17,19-20,22; SOAP notes; Case-based examination).
8. self-educate independently (TSBP Form ; sections 5-12,15-17,19-20,22; Case-based examination; Pharmacy activities).
9. initiate interdisciplinary cross-talk (TSBP Form sections 5,8,10,12-17,19-21; SOAP notes; Pharmacy activities; Journal Club / DI).
10. initiate a comprehensive planning process (TSBP Form sections 5-12,15-17,19-22; SOAP notes; Case-based examination; Journal Club / DI; Pharmacy activities).
11. initiate appropriate change (TSBP Form sections 1-2,10-12,15-17,19-22; SOAP notes; patient interaction; Journal Club / DI; Case-based examination).
12. initiate appropriate intervention (TSBP Form sections 1-2,10-12,15-17,19-22; patient interaction; Case-based examination.
10. PRACTICE MANAGEMENT
Competency Definition:All pharmacists require practice management skills regardless of their specific practice setting or orientation. Frontline practicing pharmacists must participate in planning, organizing, leading and controlling organizational resources in the pharmacy environment. They may be responsible for demonstrating the outcomes of their practice to supervisors, other health care providers and payers. Other pharmacists may assume a more direct management role of technicians, other pharmacists, and operations.
The P4 clerkship student shall:
1. gradually assume larger patient care loads and pharmacy services work loads approaching the level of an entry level pharmacist near graduation (TSBP Form sections 1-10,15,17-22; patient interaction; Pharmacy activities)
2. demonstrate time management skills (TSBP Form sections 1-5,11-12,15,17,19-22; SOAP Notes; Pharmacy activities; Journal Club / DI).
3. identify the appropriate costs and benefits for any set of alternatives to a given action or program initiative (TSBP Form sections 1-7,10-12,15-17,19-22; Pharmacy activities; case-based examination; Journal Club / DI).
4. identify the cultural differences among patients and the impact these differences have on the delivery of
pharmaceutical care (TSBP Form sections 13-16,18-19; patient interaction; DI; Pharmacy activities).
5. describe the patient outcomes of a pharmaceutical intervention and develop a methodology to measure those outcomes (TSBP Form sections 5,8-12,15-17,19; patient interaction; DI; Case-based examination)
6. describe the operation aspects of pharmacy practice setting: staffing model deployed, systems of drug
distribution, reimbursement strategies, methods of financial control, methods of quality management (TSBP Form sections 1-5,13-22; Pharmacy activities).
11. PATIENT CARE PLANS
Competency Definition:Central to provision of patient care is creation of a pharmacist's care plan. The major steps in care plan creation, implementation, and modification include: data gathering, patient assessment, care plan formulation/implementation, modification of care plan and implementation of a follow-up plan. Communication of the care plan to the patient and other health care professionals is fundamental to improving patient health care outcomes.
The P4 clerkship student shall be able to:
1. accurately and efficiently locate information in the medical chart or other records and apply this information to patient care (TSBP Form sections 5-12; SOAP notes; patient interaction; DI).
2. demonstrate effective data gathering skills and be able to report this data in an organized and concise format (TSBP Form sections 5-12,17,19,22; SOAP Notes; DI; Pharmacy activities; Case-based examination)).
3. identify both active and potential drug-related problems (TSBP Form sections 9-12,16-17,19,21; SOAP notes; patient interaction; Pharmacy activities; Case-based examination).
4. integrate both objective and subjective patient information in the development of the patient care plan (TSBP Form sections 9-12; SOAP notes; DI; case-based examination; patient interaction).
5. assess, evaluate, and apply drug information/clinical data to promote optimal health care for an individual patient and for patient populations (TSBP Form sections 5-12,15-17,19; DI; Pharmacy activities; Case-based examination).
6. develop a pharmacotherapy plan complete with alternative solutions to treat, improve, and solve drug related problems (TSBP Form sections 5-12,15-17,19-22; SOAP notes; Case-based examination).
7. implement a rational pharmacotherapy plan and follow-up for an individual patient (TSBP Form sections 5-12,15-17,19-22; SOAP notes; patient interaction; Case-based examination).
8. write a complete, problem-oriented, SOAP note using data gathered from an appropriately conducted medical history, systems review, targeted physical exam, and clinical laboratory test analysis (TSBP Form sections 5-12,15-17; SOAP notes ).
12. ETHICS AND PROFESSIONALISM
Competency Definition:Pharmacists should conduct their professional and personal lives in accordance with a set of moral principles and values. These principles govern pharmacists' individual and collective group activities.
Professionalism entails adherence to moral, ethical and technical codes of conduct as well as supporting the entire body of persons committed to the pharmacy profession.
The P4 clerkship student shall be able to:
1. Establish and maintain professionalism within all practice settings (TSBP Form sections 6-8,13-16,18-21; Pharmacy activities; patient interaction).
2. Demonstrate the ability to develop and maintain ethical standards in pharmacy practice (TSBP Form sections 6-8,13-16,18-21; Pharmacy activities; Case-based examination).
GEROPSYCH CLERKSHIP REQUIREMENTS
The main objective of the geropsych clerkship is to acquaint the candidate with the practice of geropsychiatric pharmacotherapy and provide the candidate with a basic foundation of key areas of geropsychiatric pharmacology and common psychiatric disease states. This will be accomplished by providing the candidate an experience and overview of why geriatric patients with psychiatric diseases are a unique population who require specialized care.
Weekly Discussions: Students will attend and lead discussions with the site preceptor. The preceptor will provide a list of 2-4 key papers in the relevant area that the student is responsible for obtaining and reading prior to the discussions. Each student will discuss their findings and apply the reading to their patients. One student will be responsible for finding one relevant paper on the subject and discuss this paper indepth. There will be 6 topic discussion sessions. The topics (reference list below) are as follows:
Week 1: No discussion
Week 2: Geriatric Depression
Week 3: Though Disorders including Schizophrenia
Week 4: Hyperactive states including Bipolar Affective Disorder
Week 5: Sleep Disorders in the Elderly
Week 6: Anxiety Disorders in the Elderly
SPECIFIC COMPETENCIES
Upon completion of the Geropsych clerkship, the candidate will be demonstrate the following compentencies:
[NB: The following competencies may be used by the preceptor and the student, as an aid to map the student's progress over the course of the clerkship]
Though Disorders including Schizophrenia: By the end of the rotation, through discussion or active patient contact, the student should be able to:
1. Describe the prevalence and clinical presentation of though disorders in the elderly
2. Explain the clinical presentation of these disorders and recommend appropriate first line therapy.
3. Utilize validated assessment tools to assess though disorders in the elderly
4. Describe the use of neuroleptics in geriatric patients (acute and long term).
5. Describe the side effects of neuroleptics in geriatric patients and construct management programs.
Depression: By the end of the rotation, through discussion or active patient contact, the student should be able to:
1. Describe the prevalence and clinical presentation of depression in the elderly
2. Utilize validated assessment tools to assess depression in the elderly
3. Recommend appropriate therapy for depression in elderly patients, including drug selection, dose, titration, and monitoring.
4. Describe the prevalence of weight loss / cachexia in the elderly.
5. Describe the use of antidepressants in geriatric patients (acute and long term).
6. Describe the side effects of neuroleptics in geriatric patients and construct management programs.
Hyperactive States Including Bipolar Affective Disorder
1. Describe the prevalence and clinical presentation of bipolar affective disorder in the elderly.
2. Explain the clinical presentation of this disorder and recommend appropriate first line therapy.
3. Utilize validated assessment tools to assess bipolar affective disorder in the elderly.
4. Recommend appropriate therapy for mood stabilization in elderly patients, including drug selection, dose, titration, and monitoring.
5. Describe the side effects of mood stabilizers in geriatric patients and construct management programs.
Sleep Disorders
1. Describe the prevalence and clinical presentation of insomnia disorder in the elderly.
2. Explain the clinical presentation of this disorder and recommend appropriate first line therapy.
3. Utilize validated assessment tools to assess sleep disorders in the elderly.
4. Recommend appropriate therapy (drug and non-drug) for insomnia in elderly patients, including drug selection, dose, titration, and monitoring.
5. Describe the side effects of sleep medication in geriatric patients and construct management programs.
Anxiety Disorders
1. Describe the prevalence and clinical presentation of anxiety disorders in the elderly.
2. Explain the clinical presentation of this disorder and recommend appropriate first line therapy.
3. Utilize validated assessment tools to assess anxiety disorders in the elderly.
4. Recommend appropriate therapy for anxiety disorders in elderly patients, including drug selection, dose, titration, and monitoring.
5. Describe the side effects of antianxiety medications in geriatric patients and construct management programs.
The required references for these discussions are listed below and will be posted on the web so that students may access them.
Please note:
1) The references below are the MINIMUM required readings. The student is expected to supplement these readings with additional pertinent literature.
2) The student is responsible for identifying weaknesses in their knowledge of the clinical pharmacology of drugs relevant to particular topics. As such, it is the student's responsibility to obtain appropriate primary literature to rectify these weaknesses.
3) The assigned readings are NOT to be considered "journal club" readings. That is, the student is NOT expected to critique these papers, rather to read them and obtain the key "take home" messages from the papers.
Week 2: Though Disorders
Sunderland T. Treatment of elderly suffering from psychosis and dementia. J. Clin. Psychiatry 1996;57(supp 9):53-56.
Jeste DV, Eastham JH, Lacro JP, et al. Management of late life psychosis. J Clin Psychiatry 1996;57(supp 3):39-45.
Targum SD, Abbott JL. Psychosis in the elderly: a spectrum of disorders. J. Clin Psychiatry 1999;60(supp 8)4-10.
Week 2: Depression
Rothschild AJ. The diagnosis and treatment of late-life depression. J Clin Psychiatry 1996;57(supp 5):5-11.
Finkel SI, Efficacy and tolerability of antidepressant therapy in the old-old. J Clin Psychiatry 1996;57(supp 5):23-28.
Newhouse PA. Use of serotonin selective reuptake inhibitors in geriatric depression. J Clin Psychiatry 1996;57(supp 5):12-22.
Devane CL, Pollock BG. Pharmacokinetic considerations of antidepressant use in the elderly. J Clin Psychiatry 1999;60(supp 20):
38-44.
Salzman C. Practical considerations for the treatment of depression in elderly and very elderly long-term care patients. J. Clin
Psychiatry 1999;60(supp 20):30-33.
Mulsant BH, Ganguli M. Epidemiology and diagnosis of depression in late life. J Clin Psychiatry 1999;60(supp 20):9-15.
Pollock BG. Adverse reactions of antidepressants in elderly patients. J. Clin Psychiatry 1999;60(supp 20):4-8.
Week 3: Hyperactive States
Goldberg FJ. Treatment guidelines: current and future management of bipolar disorder. J. Clin Psychiatry 2000;61(supp 13):12-18.
McDonald WM. Epidemiology, etiology, and treatment of geriatric mania. J. Clin Psychiatry 2000:61(supp 13):3-11.
Week 4: Sleep Disorders
Sncoli-Isreal S., Kripke DF. Chapter 23 Sleep and Ageing. Practice of Geriatrics, 3rd ed., W.B. Saunders Co, 1998.
Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late life insomnia- A randomized
controlled trial. JAMA 1999;281:991-999.
Kupfer DJ, Reynolds CF. Management of Insomnia, NEJM 1997;336:341-346.
Week 5: Anxiety Disorders
Small GW, Recognizing and treating anxiety in the elderly, J Clin Psychiatry 1997;58(supp 3)41-47.
Texas Administrative Code
TITLE 22 EXAMINING BOARDS
PART 15 TEXAS STATE BOARD OF PHARMACY
CHAPTER 283 LICENSING REQUIREMENTS FOR PHARMACISTS
RULE § 283.4 Internship Requirements
____________________________________________________________________________________________________________
(a) Goals and competency objectives of internship.
(1) The goal of internship is for the pharmacist-intern to attain the knowledge, skills, and abilities to safely, efficiently, and effectively provide pharmaceutical care to individual patients and practice pharmacy under the laws and regulations of the State of Texas.
(2) The following competency objectives are necessary to accomplish the goal of internship in paragraph (1) of this subsection.
(A) Provides drug products. The pharmacist-intern shall acquire competence in determining the appropriateness of prescription drug orders and medication orders; evaluating and selecting products; and assuring the accuracy of the product/prescription dispensing process.
(B) Communicates with patients and/or their care givers about prescription drugs. The pharmacist-intern shall acquire competence in interviewing and counseling patients, and/or their care givers, on drug usage, dosage, packaging, and storage; discussing drug cautions, side effects, and patient conditions; explaining policies on fees and services; relating to patients in a professional manner; and interacting to confirm patient understanding.
(C) Communicates with patients and/or their care givers about nonprescription products, devices, and diagnostic aids. The pharmacist-intern shall acquire competence in interviewing and counseling patients and/or their care givers on conditions and intended drug use; assisting in and recommending drug selection; referring patients to other health professionals; providing information on medical/surgical and home health-care devices and home diagnostic products; and providing poison control treatment information and referral.
(D) Communicates with health professionals and the public. The pharmacist-intern shall acquire competence in obtaining and providing accurate and concise information in a professional manner and using appropriate oral, written, and nonverbal language.
(E) Collaborates with physicians, other health-care professionals, patients and/or their care givers to develop a therapeutic plan which will include monitoring and evaluating drug therapy. The pharmacist-intern shall acquire competence in collaborating with physicians, other health care professionals, patients, and/or their care givers to formulate a therapeutic plan. The pharmacist-intern shall acquire competence in establishing and interpreting data-bases, identifying drug-related problems and recommending appropriate pharmacotherapy specific to patient needs and devising follow-up plans.
(F) Maintains professional-ethical standards. The pharmacist-intern is required to comply with laws and regulations pertaining to pharmacy practice; to learn to apply good professional judgment; to exhibit reliability and credibility in dealing with others; to deal professionally and ethically with colleagues and patients; to demonstrate sensitivity and empathy for patients/care givers; and to maintain confidentiality.
(G) Compounds. The pharmacist-intern shall acquire competence in using acceptable professional procedures; selecting appropriate equipment and containers; appropriately preparing compounded dosage forms; and documenting calculations and procedures.
(H) Retrieves and evaluates drug information. The pharmacist-intern shall acquire competence in selecting best available resources for answering a drug-related request in a timely fashion and in interpreting the information obtained and judging its relevance.
(I) Manages general pharmacy operations. The pharmacist-intern shall develop a general understanding of planning and policy-making. The pharmacist-intern shall have an understanding of drug security, storage and control procedures, and maintaining quality assurance. The pharmacist-intern shall learn to notice and document discrepancies and irregularities, keep accurate records and document actions. The pharmacist-intern shall attend meetings requiring pharmacy representation.
(J) Understands the necessity of participating in public health and professional activities. The pharmacist-intern shall develop basic knowledge and skills needed to become an effective health educator and active participant in public health programs and professional organizations.
(K) Conducts research. The pharmacist-intern may develop research skills to expand and/or refine knowledge in the areas of pharmaceutical sciences or pharmaceutical services. This includes data collection and analysis of scientific, clinical, sociological, and/or economic impacts of pharmaceuticals (including investigational drugs), pharmaceutical care, and patient behaviors, with dissemination of findings to the scientific community and the public.
(b) Hours requirement.
(1) The board requires 1,500 hours of internship for licensure. These hours may be obtained through one of more of the following methods:
(A) in a board approved student internship program, as specified in subsection (c) of this section;
(B) in a board-approved extended-internship program as specified in subsection (d) of this section; and/or
(C) through internship hours approved and certified to the board by another state board of pharmacy.
(2) Pharmacist-interns participating in an internship may be credited no more than 50 hours per week of internship experience.
(3) Internship hours may be used for the purpose of licensure for no longer than two years from the date the internship is completed.
(c) Student Internship Programs.
(1) Texas colleges of pharmacy internship programs.
(A) The board shall review for approval Texas colleges of pharmacy internship programs on or before September 1 of each fiscal year. The purpose of the board review will be to determine if such internship programs demonstrate that the competency objectives listed in subsection (a) of this section are capable of being met by each student-intern completing the internship. The board reserves the right to set conditions relating to the approval of such programs.
(B) The Texas colleges of pharmacy shall determine through examinations that each student-intern completing the college internship program meets the competency objectives listed in subsection (a) of this section.
(C) Internship experience shall be gained under:
(i) a pharmacist licensed by the board and approved as a preceptor by the board; or
(ii) a pharmacist licensed in a state other than Texas when working in a federal facility and serving as an instructor for a Texas
college-based internship program.
(D) All internship experience shall be approved by the board and shall occur in sites and under conditions which teach one or more of the competency objectives listed in subsection (a) of this section.
(E) Prior to taking the licensure examination any applicant participating in a Texas college-based internship shall complete the requirements of such internship.
(F) Pharmacist-interns completing a board-approved Texas college-based structured internship will be awarded 1,500 hours of internship experience, or the number of hours actually obtained if greater than 1,500. No credit shall be awarded for didactic experience.
(2) Internship experience acquired by student-interns not in a Texas College of Pharmacy Internship Program.
(A) A person may be designated a student-intern provided he/she meets all of the following requirements:
(i) has made application to the board;
(ii) is enrolled in the professional sequence of a college of pharmacy whose professional degree program has been accredited by
ACPE and approved by the board; and
(iii) has completed 30 credit hours of work towards a professional degree in pharmacy.
(B) The terms of the student internship shall be as follows.
(i) The internship shall be gained concurrent with college attendance, which may include:
(I) partial semester breaks such as spring breaks;
(II) between semesters; and
(III) whole semester breaks provided the student-intern attended the college in the immediate preceding semester and is scheduled with the college to attend in the immediate subsequent semester.
(ii)The student internship shall be board-approved and gained in a pharmacy licensed by the board, or a federal government pharmacy participating in a board-approved internship program.
(iii) The student internship shall be in the presence of and under the direct supervision of a board-approved preceptor who is licensed by the board.
(C) None of the internship hours acquired may be substituted for any of the hours required in the Texas college of pharmacy internship program.
(3) Expiration date for student-intern designation. The student-internship remains in effect until the earlier of the following occurs:
(A) the student-intern voluntarily or involuntarily ceases enrollment in a college of pharmacy whose professional degree program has been accredited by ACPE and approved by the board;
(B) the failure of the student-intern to take the NAPLEX and Texas Jurisprudence Examinations within three calendar months after graduation;
(C) upon receipt of the results of the NAPLEX and Texas Jurisprudence Examinations specified in this section.
(D) Extended-internship program.
(1) A person may be designated an extended-intern provided he/she has made application to the board and met one of the following
requirements:
(A) passed NAPLEX and the Texas Pharmacy Jurisprudence Examination but lacks the required number of internship for licensure;
(B) applied to the board to take the NAPLEX and Texas Jurisprudence Examinations within three calendar months after graduation
and has:
(i) graduated and received a professional degree from a college of pharmacy the professional degree program of which has been
accredited by ACPE and approved by the board; or
(ii) completed all of the requirements for graduation and receipt of a professional degree from a college of pharmacy the
professional degree program of which has been accredited by ACPE and approved by the board; or
(C) applied to the board to take the NAPLEX and Texas Jurisprudence Examinations within three calendar months after obtaining
full certification from the Foreign Pharmacy Graduate Equivalency Commission;
(D) applied to the board for re-issuance of a pharmacist license which has expired for more than two years but less than ten years
and has successfully passed the Texas pharmacy jurisprudence examination, but lacks the required number of hours of internship or continuing education required for licensure; or
(E) been ordered by the Board to complete an internship.
(2) The terms of the extended-internship shall be as follows.
(A) The extended-internship shall be board-approved and gained in a pharmacy licensed by the board, or a federal government
pharmacy participating in a board-approved internship program.
(B) The extended-internship shall be in the presence of and under the direct supervision of a board-approved preceptor who is licensed by the board.
(3) The extended internship remains in effect until the earlier of the following occurs:
(A) the failure of the extended-intern to take the NAPLEX and Texas Jurisprudence Examinations within three calendar months
after graduation or Foreign Pharmacy Graduate Equivalency Commission (FPGEC) certification;
(B) the failure of the extended-intern to pass the NAPLEX and Texas Jurisprudence Examinations specified in this section; or
(C) the failure of the extended-intern to complete the requirements for licensure within two years after passing the required
examination(s).
(4) An applicant for licensure who has completed less than 500 hours of internship at the time of application shall complete the
remainder of the 1,500 hours of internship and have the preceptor certify that the applicant has met the objectives listed in subsection (a) of this section.
(e) Pharmacist-intern identification.
(1) The board shall provide the pharmacist-intern written documentation of his or her designation as a pharmacist-intern. This
written documentation serves as identification and authorization to perform the duties of a pharmacist-intern as described in §283.5 of this title (relating to Pharmacist-Intern Duties).
(2) Pharmacist-interns shall keep this written documentation with them at all times they are serving as a pharmacist-intern and
make it available for inspection by board agents.
(3) All pharmacist-interns shall wear an identification tag or badge which bears the person's name and identifies him or her as a pharmacist-intern.
____________________________________________________________________________________________________________
Source Note: The provisions of this §283.4 adopted to be effective February 17, 1988, 13 TexReg 610; amended to be effective June 15, 1990, 15 TexReg 3334; amended to be effective June 1, 1994, 19 TexReg 3920; amended to be effective February 1, 1996, 21 TexReg 110; amended to be effective December 31, 1996, 21 TexReg 12297; amended to be effective June 30, 1997, 22 TexReg 5924; amended to be effective March 19, 1998, 23 TexReg 2814.
//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////
Texas Administrative Code
TITLE 22 EXAMINING BOARDS
PART 15 TEXAS STATE BOARD OF PHARMACY
CHAPTER 283 LICENSING REQUIREMENTS FOR PHARMACISTS
RULE § 283.5 Pharmacist-Intern Duties
____________________________________________________________________________________________________________
(a) A pharmacist-intern participating in a board-approved internship program may perform any duty of a pharmacist provided he or
she is under the direct supervision of:
(1) a pharmacist licensed by the board and approved as a preceptor by the board; or
(2) a pharmacist licensed in a state other than Texas when working in a federal facility and serving as an instructor for a Texas
college-based internship program.
(b) A pharmacist-intern may not:
(1) present or identify himself/herself as a pharmacist;
(2) sign or initial any document which is required to be signed or initialed by a pharmacist unless a preceptor cosigns the document;
or
(3) supervise supportive personnel.
____________________________________________________________________________________________________________
Source Note: The provisions of this §283.5 adopted to be effective February 15, 1988, 13 TexReg 610; amended to be effective February 1, 1996, 21 TexReg 110; amended to be effective June 30, 1997, 22 TexReg 5924.
Texas Administrative Code
TITLE 22 EXAMINING BOARDS
PART 15 TEXAS STATE BOARD OF PHARMACY
CHAPTER 283 LICENSING REQUIREMENTS FOR PHARMACISTS
RULE § 283.6 Preceptor Requirements
____________________________________________________________________________________________________________
(a) Preceptors shall be pharmacists whose license to practice pharmacy in Texas is current and not on inactive status with the board.
(b) Preceptors are required to be approved and certified by the board. A preceptor shall publicly display the preceptor certificate
with his/her license to practice pharmacy and the license renewal certificate.
(c) For certification as a preceptor a pharmacist must:
(1) after September 1, 1997, have at least one year of experience in the type of internship practice setting;
(2) after September 1, 1998:
(A) have completed 3 hours of preceptor training developed by a Texas college of pharmacy and provided by an ACPE approved
provider within the previous 3 years;
(B) complete 3 hours of preceptor training developed by a Texas college of pharmacy and provided by an ACPE approved provider
every 3 years; and
(3) meet the requirements of subsection (f) of this section.
(d) Any preceptor approved and certified by the board shall be approved and certified for a three-year period commencing on the
date of such approval and certification.
(e) A preceptor may supervise only one pharmacist-intern at any given time. Texas Colleges of Pharmacy may request a different
preceptor to pharmacist-intern ratio during the board's annual review and approval of their college based, structured internship program. Any such ratio shall apply only to the internship experience acquired as a part of the college based, structured internship program. For the purpose of this subsection, the approval of internship programs previously granted by the Board shall remain in effect through August 31, 1996.
(f) No pharmacist may serve as a preceptor if his or her license to practice pharmacy has been the subject of an order of the board imposing any penalty set out in the Act, §28(a), during the period he or she is serving as a preceptor or within the three-year period immediately preceding application for approval as a preceptor. Provided, however, a pharmacist who has been the subject of such an order of the board may petition the board, in writing, for approval to act as a preceptor.
____________________________________________________________________________________________________________
Source Note: The provisions of this §283.6 adopted to be effective February 17, 1988, 13 TexReg 610; amended to be effective February 1, 1996, 21 TexReg 110; amended to be effective January 12, 1998, 23 TexReg 134; amended to be effective October 4, 1998, 23 TexReg 9745.
PHARMACY ETHICS
The Pharmacist's Duty to the Patient
MONITORING MEDICAL TREATMENT
It is simplistic but accurate to say that the pharmacist's first duty in monitoring medical treatment is to maintain the health and safety of the patient. In so concluding, questions arise as to how this duty should be carried out and, given the physician's proper role in initiating therapy, to whom the duty is owed.
When therapeutic problems are encountered, the pharmacist's first duty is one of inquiry to determine the nature of the problem. This duty arises anytime there is a substantial risk of harm that would be realized if left unheeded. An issue may develop as to where the pharmacist should turn to make the inquiry. Usually the patient is nearby and can easily be consulted. However, this approach may suggest the existence of a problem where simple clarification of the facts may reveal that no difficulty actually exists. Consultation with the patient in the first instance could lead the patient to unnecessarily question the physician's skills and ability. For these reasons, an oftentimes more desirable approach to satisfying the pharmacist's duty of inquiry is to approach the prescribing physician directly. Problems may arise, however, if the physician is unavailable. Thus, a balance of convenience and necessity must be struck by the pharmacist in deciding where to direct inquiries.
At this stage, it should be understood that concomitant with the duty of inquiry, the pharmacist also has a right to be answered. It is not sufficient for a patient or physician to tell the pharmacist, "Just fill the prescription" or "This is none of your business," where the inquiry is aimed at clarifying a therapeutic question.
Where the initial inquiry does not satisfy a perceived problem, the pharmacist may have a duty to further investigate to determine the true state of facts. Again, there is a question of who should be consulted as between the patient and physician. Here, however, it is somewhat clearer that the physician would usually be in a better position to assist the pharmacist in fulfilling this duty. Questions about the nature of a risk, what goals are trying to be accomplished by an unusual therapy or whether some less risky alternative is available are generally beyond the knowledge of most patients.
If the pharmacist is still not satisfied with the explanations received, he or she has a duty to directly discuss the problem with the patient to determine if the risks are fully understood. At this stage, the pharmacist may also have a duty to explain the risks or refer the patient back to the physician for an explanation.
Finally, the pharmacist may have a duty not to fill a prescription if the three previous levels of clarification, investigation and explanation do not alleviate the therapeutic problem. It is exceedingly rare that this level of duty will be reached. It is also very different to say that the pharmacist has an ethical duty not to fill a prescription as opposed to claiming such a right. The duty here is to not fill the prescription only when doing so will harm the patient. There is no inherent right in this situation.
SOCIOECONOMIC CONCERNS
In general, the patient has a right to choose a pharmacist and expect full service in consideration of payment for services rendered, including fees associated with the medications purchased. In these situations, the pharmacist's duty is to the individual patient. Respect for the patient's wishes should ordinarily be decisive in ethical dilemmas.
In rare situations, however, the pharmacist must make decisions without considering a particular patient or a particular patient's needs. In these cases, the pharmacist's duty would be owed to all patients, the profession and other health care practitioners. Here, no one patient can demand a right to the particular service under consideration. Examples might include whether the pharmacist should offer patient profiles, medication delivery, or 24-hour on-call service. Consideration of these factors recognizes the role of the pharmacist in society.
TRUTH TELLING
Pharmacists have a duty to uphold and follow the desires and wishes of their patients with respect to treatment and health care needs. Oftentimes, however, pharmacists are asked to participate by physician or other health care professionals in a deceitful scheme in the name of a greater good for a patient's welfare. This might involve placebo "therapy" or a request that the pharmacist not disclose the name of, or other information about, a prescribed medication. Such requests place the pharmacist in conflict with the duty owed to the patient.
Before engaging in deceitful behavior, the pharmacist should attempt to clarify whether the deception is necessary for the patient's own well-being. This involves communication with the patient to determine competence and with the other health care practitioners who are advocating the deception. If the pharmacist believes deception is not justified, he or she should be an active participant, fully explaining the reasons therefore. In a rare situation where a patient indicates no desire to hear the truth or appears not competent to understand it, the pharmacist may cooperate with deceitful conduct to the least extent possible to achieve the results of care determined by others to be in the best interests of the patient. The pharmacist must always take care not to substitute his or her own judgment about what is "best" for the patient with the wishes of the patient or patient's agent.
COMPLIANCE
The traditional model of pharmacy practice is a technical model. The pharmacist who functions as a technician performs mechanical functions such as interpreting prescriptions, typing labels, and counting and packaging pills. The technical model may also include monitoring drug therapy (for allergies, drug interactions, etc.) and counseling of patients (to avoid alcohol, continue taking medication for a specified period of time, etc.). While the technical pharmacist's role is generally seen as the processing of prescriptions, gratuitous actions may be taken for the benefit of the patient, if time and circumstances permit.
The developing clinical model goes a step beyond the technical model to include the promotion of "rational" drug therapy. The clinical pharmacist is considered to have a professional duty to encourage compliance with what the doctor and pharmacist have decided is the right way to use the medication. This usually includes sympathetic assurance that the doctor knows what is best. The clinical model stresses the importance of the "health care team," on which the patient is seldom if every included as a member. Patients who use their medication correctly are "compliant" and "good." Patients who use their medication incorrectly are "noncompliant" and "bad." These latter patients are sometimes viewed as being ungrateful and not deserving of productive therapeutic outcomes.
Pharmacists must understand that if patients' decisions about drug therapy are inappropriately made, then pharmacists are at least partially responsible. As a protected monopoly, pharmacists are officially recognized by society as guardians of the nation's drug supply. The knowledge pharmacists possess about drugs gives them power over those who are less knowledgeable, but that power relates primarily to the scientific uncertainty associated with the safety and efficacy of drugs. Pharmacists have a duty not to misuse this power. They have a duty to engage in meaningful dialogue with patients, so that a relationship of trust will develop, from which there will evolve a willingness to guide patients based upon the patients' values and attitudes.
Section II: GEROPSYCH Clerkship SYLLABUS
Course Title: GEROPSYCH CLERKSHIP
Course Number: PHARMACY 4XXX
Team Leader: C. A. Bond, PharmD, FASHP, FCCP; telephone (806) 356-4000, ext 244;
email: cbond@cortex.ama.ttuhsc.edu, pager (888) 341-5635, Fax:(806)356-4018
Team Members:
C. A. (Cab) Bond, PharmD, FCCP, FASHP; (806) 356-4012, Fax:(806)356-4018 cbond@cortex.ama.ttuhsc.edu
Rotation Coordinators: Dr. Bond
Clerkship Coordinator: Loree Allen, School of Pharmacy, 1300 Coulter, Room 206, Amarillo, TX 79106, (806)356-4000 Ext. 306,
Fax: (806)356-4018, loree@cortex.ama.ttuhsc.edu;.
Daily Schedule: Monday to Friday, Generally 8:00 a.m. to 5:00 pm.
Please note: Clerkship may start earlier or later based on the service model of the clerkship site. Furthermore, although the "at site" time may be approximately 8 hours or so, candidates should understand that required readings and other assignments will likely require independent work outside the typical daily routine.
Required Readings:
Textbooks:
1. Pharmacy 4XXX Clerkship Manual
2. Kaplan HI, Sadock BJ. Comprehensive Textbook of Psychiatry, 7th edition, Williams and Wilkins, 1999.
3. DSM-IV, American Psychiatric Association, 4th edition. 1994.
2. Hazzard WR. Blass JP, Ettinger WH, Halter JB, Ouslander JG. Eds. Principles of Geriatric medicine and gerontology, 4th ed. McGraw-Hill. Each site will have one copy for student use.
Prerequisites: P-4 standing as per Student Credentialling Committee.
Catalog Description: A formative clerkship to develop clinical skills with geriatric patients with psychiatric disorders.
Course Philosophy (Mission): The mission of this clerkship is to develop clinical skills and to deliver pharmaceutical care to Geriatric patients with psychiatric disorders. This clerkship is designed to enhance patient care and to improve the student's ability to provide pharmaceutical care to seniors with psychiatric diseases.
· Tech's Top Ten and Course Objectives: Upon completion of this course, the candidates shall have practice and assessment in:
· Communication
Demonstrate an organized, complete and personable approach to taking a medication history (where applicable ) directly from the patient
· Using scientific explanation in the practice of pharmacy
Integrate basic science and clinical skills in developing a drug therapy plan
Assist in a pharmacotherapy consultation
· Problem solving and scientific inquiry
Be able to efficiently extract relevant data from chart
Identify a drug therapy related problem in an active patient's chart
Devise a pharmacotherapy plan addressing the drug therapy related problem
Be able to discuss alternatives to your drug therapy plan
Be able to justify drug solutions within your plan
Critically evaluate and present an article at the weekly discussions
· Social and professional interaction and teamwork
Devise a plan on how to present your pharmacotherapy plan to the team
Demonstrate an ability to prioritize elements of your pharmacotherapy plan
Be able to explain the roles of various members of the health care team
· Providing pharmaceutical care to individual patients
Write a drug therapy plan for an active patient
Orally present a drug therapy plan for an active patient
Ethical standards: The ethics standards for the School of Pharmacy and the School of Pharmacy Code of Ethics is in effect for all components of this course. Candidates found in violation of ethical standards will receive (0) points for the work in question and will be reported to the Credentialling and Student Affairs committees of the School of Pharmacy.
Teaching methods: This experiential course will be delivered in practice settings where students will provide clinical services under the supervision of pharmacy practice faculty/preceptors.
Overview of assessment methods: Candidates will provide care daily under supervision of a preceptor. Grading will be based on overall performance, professional performance and SOAP notes.
Assessment tools developed by the faculty will be used in evaluating activities.
Grading:
This course is graded on a 0 - 100 point scale, with a minimum score of 70 out of 100 points required to pass.
The grading criteria are as follows:
- Texas State Board of Pharmacy Intern-Clerkship Evaluation Form...... ............. 10%
- Delivering Pharmaceutical Care
· SOAP Notes ...... 30%
· Pharmacy Activities 20%
- Patient Interaction .. 20%
- Presentation 10%
- Journal Rounds OR Drug Information .. 10%
Total= . 100%
ATTENDANCE IS MANDATORY AT ALL DISCUSSION SECTIONS
It is the responsibility of the candidate to see that the assignment(s) are turned in or presented on time.
The approximate timeline for preparing assignment(s)will be as follows:
Activity Suggested time Frame
1. Journal Club or Drug information by the end of week 5
2. Verbal SOAP Presentation Every week
3. Mid-Term Evaluation by the end of week 3
Ø Descriptions of assignment(s) and grading criteria will appear later in the clerkship manual.
NOTE: NO CREDIT GIVEN FOR ASSIGNMENTS TURNED IN OR PRESENTED AFTER THE DUE DATE.
INTELLECTUAL INTEGRITY: All work completed in this course is expected to be from the candidate him/herself. All paraphrased work that is not original, must be referenced to the appropriate source. Word-for-word copying of another's work is unacceptable unless it is surrounded by quotation marks and is referenced. Violations of intellectual integrity will result in removal from the clerkship with a grade of 0% being assigned and will be reported to the Credentialling and Student Affairs committees of the School of Pharmacy.
ATTENDANCE: In order to achieve the objectives of the course, direct "hands-on" experience is the key. For this reason the candidate is required to attend all sessions on site as well as the classroom sessions. Excused absences will be given only for documented illness, death/serious illness in the immediate family, other significant [NB- to be determined on a case to case basis by the preceptor] personal/family issues, and other professional obligations. In the event of illness, the preceptor and/or clerkship coordinator's office must be notified within an hour of business opening. You must notify your preceptor and/or the clerkship coordinator on each morning when you will be absent from the clerkship. Excused absences must be made up at the times convenient for the preceptor. One of the course coordinators must be informed of all absences from the clerkship site. Unexcused absences cannot be made up and will result in a 10% deduction off the final course grade for each day of unexcused absence. (Example: If your final score is 80%, it will be reduced to a 70% with one day of unexcused absence). All absences must be made up prior to the last day of class. Each site will develop a calendar of and schedule activities. Any student that misses more than one week (for any reason) will need to repeat the clerkship.
CLASS TIMELINESS/TARDINESS: Timeliness promotes and maximizes the benefits of clerkship time for all candidates and preceptors. Therefore, all candidates are expected to uphold a professional level of respect for their fellow classmates and preceptors, by arriving on time to all clerkship sessions. The following Clerkship policy has been adopted to discourage tardiness:
1. One excused tardy up to 30 minutes. After 30 minutes the tardiness becomes an absence. Please see the Attendance policy for the rotation stated above and within this syllabus.
2. The 2nd tardy (and all subsequent tardiness) will result in a 2% (a 2 point) reduction per incidence in the final grade for the clerkship. Example: If there are 3 tardiness total, 1 is excused and the other 2 will result in a 2% deduction per incidence, for a total of 4 points deducted, this an 84% final grade will be reduced to an 80% per this example.
DRESS: You are expected to dress appropriately (i.e., professionally). Men must wear a shirt and tie. Women may wear dresses, skirts and/or pants. You must wear your nametag at all times (this is a course, University and Texas State Board of Pharmacy requirement). White coats (i.e., hip length, long coats not allowed) should be worn as appropriate for your site. If you are not dressed appropriately, the preceptor will ask you to leave and you will be given an unexcused absence for that day. You must also meet all dress requirements of the practice site.
COMMUNICATION: The student's communication must be both ethical and professional. Intentional misrepresentation of a colleague to another (e.g., physician, nurse) will result in immediate dismissal from the clerkship and the student will receive a grade of 0%. The candidate is responsible for promoting good communication between the pharmacist, patients, physicians, and the School. Learn from your preceptors how to handle conflicts and discuss any disagreements with your preceptor in private, not in front of patients, customers or other employees. Learning is not passive, and the more you question and pursue, the more prepared you will be to practice when you graduate. Constructive criticism is a means of learning and is not meant to embarrass. Any conflicts, which may arise between the candidate and the preceptor, should first be handled by discussing with one another. If resolution of the conflict is not achieved, then bringing the issue to the attention of the course coordinator and/or clerkship coordinator is strongly encouraged. Our goal is to ensure the most amicable clerkship environment possible!
AUTOBIOGRAPHICAL DATA FORM: At least 2 weeks prior to start of clerkship, the candidate must mail the Autobiographical Data form by first class mail to the assigned site and call their preceptor at their assigned site by phone to arrange a starting time. Failure to provide the autobiographical form in a timely fashion may result in a deduction of points from the final grade.
STUDENT RESPONSIBILITIES: The completed forms (weekly activity sheets and course/preceptor evaluations) are due by the end of the business day, following the last clerkship day. Failure to submit the signed forms will result in the withholding of the grades. Failure to clear a withheld grade by the start of the next semester, or summer session, will result in a grade of 50% for the class.
SECOND CHANCE POLICY: There is no second chance policy.
CLERKSHIP ETIQUETTE: Candidates are expected to respect the learning environment and exhibit professional behavior at all times. Candidates will not have access to printers during class presentation time. Candidates should concentrate their computer activities on this clerkship. Surfing the Internet is inappropriate during this clerkship and associated sessions. Under no circumstances will food and drinks be allowed in the sessions. Candidates, who in the observations of the faculty are disrupting learning, may be asked to leave the clerkship site or session resulting in a grade deduction. Return to the session will be considered following a meeting with the preceptor and demonstration of appropriate understanding of professional behavior.
CLERKSHIP CONDUCT: Students are expected to behave in a professional manner during this clerkship. Do not discuss your patient with other patients. Do not discuss patients cases in a public forum. Do not leave confidential documents (profiles, charts, prescriptions, etc.) in public places. You will excuse yourself from the cases of School of Pharmacy faculty, students or staff who may be patients. You will not look at their charts. Be sure to address adult patients by their surnames (Mr., Mrs., Ms., etc.) unless given permission by the patient to do otherwise. Professional conduct is expected at all times. Failure to adhere to confidentiality requirement could result in the School's loss of the practice site. You may be required to sign a confidentiality statement. Do no lie about patient care activities (e.g., if you did not check your patient's PT this morning, do not lie and say it is unchanged or isn't back yet). The team reserves the right to remove the student from the site for inappropriate clerkship conduct (e.g., breach of confidentiality). The student will be afforded the opportunity to present their case to the team. The decision to remove the student from the site, however, rests with the team. Removal from the clerkship will result in failure of the course.
CANDIDATE DISABILITY: Any candidate with a disability that may potentially interfere with their performance in this course, should contact the course coordinator on the first day of the clerkship.
CANDIDATE INQUIRIES: Questions or comments should be directed to the clerkship coordinator, Dr. Bond, 896-356-4000 Ext. 244.
FACILITIES: The clerkship will be conducted at individual clinical sites. Group sessions (e.g., oral presentations of drug therapy plans), may be held in a classroom at the clinical site or at the School of Pharmacy.
SPECIAL CONCERNS/ISSUES: Any conflicts, which may arise between the candidate and the preceptor/others at the site, should first be handled by discussing with one another. If resolution of the conflict is not achieved, then bringing the issue to the attention of the team leader and /or the clerkship coordinator is strongly encouraged. Our goal is to ensure the most amicable clerkship environment possible!
IMMUNIZATIONS:Before reporting to a clerkship site, candidates must have completed all immunizations required by the Texas Tech University Health Sciences Center and their clinical site. It is the responsibility of each student to present a current copy of their immunization record (see required immunization list below) to each site, upon arrival for day one orientation. Candidates who have not completed the required immunizations or do not have their record of these required immunizations will not be allowed to start at the site. Failure to comply will result in an unexcused absence for each day missed until the required immunization record is presented to the Primary Preceptor of Record.
Flu required annually at some sites (e.g., Craig Methodist Center)
TB required annually
MMR 2 doses - many of you received these as a child
DT within the last ten years
Hepatitis B 3 doses - a 6 month process from the first shot
(1st day, 30 days and 6 months from day of 1st shot)
Chicken Pox Vaccination: In August, 1999 the State passed a new law regarding vaccinations for health care providers. It is now required that all health care providers be vaccinated for chicken pox (2 doses if received after 13th birthday). Please obtain this vaccination and provide written proof to Student Services Office. To self report, you must make a written statement giving month, day and year of infection and given written signature. Emails are not acceptable.
REMOVAL FROM THE PRACTICE SITE: Students must adhere to the policies and procedures of the practice site. If a procedure/policy is violated, the Director of Pharmacy may request that the School immediately remove the student from the practice site. At that point, the faculty coordinator will remove the student from the practice site and start an administrative review. The results of the review will dictate any further administrative action to be taken or reassignment.
MATERNITY NOTIFICATION: To further protect students and their families, every student who is or becomes pregnant during a clerkship rotation must notify the Preceptor and Clerkship Office immediately. Safety precautions will be initiated upon notification, which will include notifying pertinent preceptors. The privacy of each student will be maintained, to the fullest extent possible.
EXPOSURE REPORTING: TTUHSC School of Pharmacy Students who have a known or suspected exposure to an infectious disease during the performance of academic responsibilities must report that incident promptly to their immediate Preceptor/Supervisor, the Clerkship Office, and family Physician to seek immediate care.
CANDIDATE PROFESSIONAL LEAVE POLICY: Candidates will be granted 15 days of professional leave time at the time of enrollment in P-1 year. Professional leave may be used to attend professional meetings/events anytime the candidate is enrolled in professional curriculum. This leave cannot be used for any other purposes. Candidates will be responsible for class information/materials during their leave. Prior to the beginning of each term a list of approved meetings/events will be sent to the faculty with the request to please not schedule exams during these times. The Office of Student Affairs will be responsible for establishing working policies, approving candidate leave requests, keeping records, and approving professional meetings/events for professional leave. The Office of Student Affairs will inform faculty about candidates who will be on professional leave and be absent from their classes. Candidates who obtain professional leave and do not attend the professional meeting/event will be in violation of the Code of Professional and Academic Conduct of the School of Pharmacy.
Completed Intern-packets from each rotation will need to be faxed or mailed to Regional School of Pharmacy campus office:
PLEASE DO NOT SEND COMPLETED PACKETS VIA THE CLERKSHIP STUDENTS.
**Footnote: Completed Clerkship packets from Section V (Preceptor Assessment Tools/Portfolio) will need to be faxed or mailed to Texas Tech School of Pharmacy. The pages to be mailed or faxed will state "Send this form to Texas Tech School of Pharmacy" in the bottom left hand corner of the sheets.
| SECTION III PHARM. D. CANDIDATE PRELIMINARY COURSE TOOLS |
A. Autobiographical Data Sheet
B. Experiential Site Activity Checklist
AUTOBIOGRAPHICAL DATA FORM
PHARMACY 4XXX
Last Name:
First Name:
Male: Female: E-mail Address:
I. Current address
| CAMPUS ADDRESS: | HOME ADDRESS WHILE AT CURRENT ROTATION SITE: |
| PHONE NUMBER: | HOME PHONE NUMBER WHILE AT CURRENT ROTATION SITE: |
II. Past Clerkships
| CLERKSHIP LOCATION | PRECEPTOR | COURSE NO. | |
| 1. | |||
| 2. | |||
| 3. | |||
| 4. | |||
| 5. |
**Send to Preceptor
III. List all elective didactic coursework you have taken that may prepare you for this clerkship.
IV. Have you been employed in a pharmacy practice site? YES NO
(list all employment experience)
If yes, where? Position? City?
V. What are your goals for this course?
VI. What are your career aspirations following graduation and an area in which you plan to specialize (if known)?
VII. Do you have any anticipated scheduling problems that may lead to inconsistent attendance at site, i.e., scheduled meetings (requires instructor consent to attend) transportation problems?
Yes No If yes, what?
VIII. Is there any other information that you can provide which may be helpful to your preceptor?
| REMINDER: Mail directly to each site instructor 2 weeks prior to your arrival. Please call clinical site instructor directly 2 weeks prior to your arrival to confirm starting time, etc. |
**Send to Preceptor
Texas Tech University Health Sciences Center School of Pharmacy
Geropsych Clerkship 4XXX
EXPERIENTIAL SITE ACTIVITY CHECKLIST
A TOOL FOR BOTH CANDIDATE AND INSTRUCTOR
THIS IS NOT TO TURN IN, BUT IS FOR YOUR OWN REFERENCE DURING THIS CLERKSHIP!!!!!!!!!!!
| GOAL: Provide candidate with a professionally oriented practice setting, with direct patient/professional contact, which includes drug therapy monitoring. | |
| Check List | PRIOR TO ROTATION |
| 1. Candidate phones preceptor/instructor 2 weeks prior to start and sends autobiographical data form. | |
| 2.Preceptor sends map/parking/bus schedule information to candidate if requested by candidate. | |
| 3. Review unique health status requirements. Candidate should have copies of forms for sites needing actual documents. | |
| 4. Discuss personal requirements (housing, nametag, white coat, calculator, background reading, etc.) | |
| Check List | FIRST DAY OF ROTATION (arrange time to meet in uninterrupted environment) Check to see if student has internship license in wallet. |
| 1.Give a schedule (hours to attend, etc.) to each other; discuss days off work, weekend coverage, workflow, and candidate responsibilities. Discuss policy on days missed in order to attend professional meetings. | |
| 2. Computer access, security system, paging. | |
| 3. Library clearance, photocopying. | |
| 4. Medical Record review and/or profile review. | |
| 5. Policy and procedures, health policy and universal precautions. | |
| 6. Introduction to all pharmacy staff and other personnel (i.e., tour unit or clinic, orient to store, etc. as appropriate). | |
| 7. Location of references. | |
| 8. Candidate Evaluation Form discussion and candidate assessment of baseline knowledge. Identify candidate interests. | |
| 9. Review "OBJECTIVES" of course and site. Discuss goals based on candidate skill and experience. | |
| 10. Discuss conduct and ethics, and confidentiality issues. | |
| 11. Candidate completes self-assessment at the beginning (day 1), at mid-rotation and end-of-rotation on Intern Clerkship Evaluation forms. The forms are shared each time with the preceptor. 12. Candidate provides immunization information to site preceptor. | |
| Check list | CONTINUOUS THROUGHOUT ROTATION |
| 1. Have conferences at appropriate intervals between candidate and instructor. | |
| 2. Give immediate and specific feedback when needed. | |
| 3. Notify faculty coordinator immediately regarding candidates with poor attendance or performance. 4.Candidates should provide the Office of Clerkship Coordinator with a hard copy of all Assignments 5. Instructors please provide a copy of all Candidate Evaluations to the Office of Clerkship Coordinator. 6. Special course specific information if needed. | |
| Check list | MIDWAY THROUGH ROTATION (arrange time to meet in uninterrupted environment) |
| 1. Schedule verbal evaluation stating accomplishments, problems and concerns; and new goal setting for remainder of rotation. Use grading sheet and discuss progress. Use Intern Clerkship Evaluation form and discuss progress. | |
| Check List | LAST DAY OF ROTATION (arrange time to meet in uninterrupted environment) |
| 1. .Candidate to return computer access card, etc 2. Turn in copies of assignments to preceptor at site. 3. Review grading sheet or content of grade sheet (formal written evaluation) with candidate. 4. Turn in candidate evaluation and assignments to Clerkship Coordinator. (Preceptor) 5. Instructor records numbers on Intern Clerkship Evaluation forms and discusses with candidate. 6..Preceptor, please fax or mail completed Grade Summary Sheet and TSBP Intern- Clerkship Evaluation forms to Clerkship Coordinator within 48 hours. **Please do not send completed clerkship packets via the student | |
| 7. Course Specific Information if needed. | |
| SECTION IV PHARM. D. CANDIDATE PROJECT/ASSIGNMENT TOOLS |
1. Description of Graded Exercises for Pharmacy 4XXX
2. Journal Club Presentation Guidelines
3. SOAP Note Guidelines
Description of Graded Exercises for Geropsych Clerkship 4XXX
Pharmaceutical care:
Ø SOAP notes:
Three formal, written SOAP notes are required to demonstrate candidate ability to communicate, in writing, the therapeutic needs of the patient. Each SOAP note individually will count as 10% of the total grade, for a combined total of 30%. (See SOAP grading form)
Based upon this format, Subjective and Objective information is worth 20%, Assessment and Plan sections are worth of total of 40% and finally students are graded in 10% increments for accuracy, literature support, presentation style, and overall SOAP note.
Ø Pharmacy activities:
Depending on the Regional campus, these activities may vary and can potentially include the students' performance on Pharmacy rounds, therapeutic discussions, drug distribution activities, clinic activities, etc Specific site activities will be discussed with the preceptor at the start of rotation.
Ø Patient interaction:
Again, depending on the Regional campus, these activities may vary. Students may be required to assess patients' symptomatology & response to medications, and should be able to identify appropriate monitoring parameters and tools to accomplish this. Students may be required, as appropriate, to administer screening tools and assessment scales such as the MMSE, depression scales, behavior scales and others. Students may be required to interview patients, take a drug history, or counsel about medications. Specific site activities should be discussed with the preceptor at the start of rotation. In general good communication skills and accurate retrieval of patient information will be assessed.
Presentation:
As the Geriatric rotation is a core rotation, the students are required to give a formal presentation to meet the requirements of the Grand Rounds course. Students are also required to attend the presentations of their peers. The specific requirements for each presentation are the discretion of the Preceptor. Presentation topics, dates, length and target audience should be established for each individual rotation site.
TSBP forms:
These forms are required by the Texas State board of Pharmacy and encompass a broad range of student performance throughout the course of the rotation. The grade generated here is based on Preceptor judgment, and will include overall evaluations of student's professionalism, work ethic, competency and ability to function independently in a geriatric clinical setting. These forms are provided by the State Board and are worth 10% of the final grade.
Drug-information or journal club
The student will have a choice of either presenting a journal club presentation or formally answering a drug information question. In either case, the % of the final grade from this activity will be 10%.
JOURNAL CLUB PRESENTATION GUIDELINES
The journal article discussion will be based on a presentation and critique of pivotal studies published in the medical literature. Journal articles are subject to the approval by the students' clinical preceptor and must be relevant to geriatrics. The students will lead discussions. Non-presenting students are expected to prepare for discussion by reviewing the article prior to the meeting/presentation. The presentation and discussion should be 15-20 minutes in length.
Objective(s):
1. To learn to critically read journal articles
2. To keep abreast of recent discoveries and interventions in medical science.
3. To train oneself to be a life-long scholar.
Process:
· Brief outline of patient case to which this article is related.
· State the elements of the study in proper order: background, purpose, methods, results, conclusions and applications.
· Summary of methods: including patient population, inclusion/exclusion criteria, blinding/randomization, regimens,
monitoring, evaluation, endpoints, and statistics.
· Presentation of results and conclusions: this should not be solely a reiteration of the author's conclusion but also a product
of the presenter's thought.
· Describe how this article impacts your patient case and why or why not you would use it in formulating a pharmaceutical
care plan for your patient.
· The presenter should understand and be familiar with all aspects of the study discussed [NB- this may entail having to
read other papers or references!
Suggested items to consider when evaluating a journal article. (NB - All the following may not always apply to the study.)
OVERVIEW
1. What is the journal's reputation? Are the articles referenced?
2. Is the title or abstract misleading? Does the author's bias show?
3. Are the researchers qualified to undertake this study?
4. Is the location of the study adequate or appropriate?
5. Is the article referenced with key up-to-date articles?
INTRODUCTION
Is there a brief review of previous work and background on why the study was done?
Is the hypothesis or objective(s) of the study clearly stated?
OVERALL STUDY DESIGN
8. Was the study design appropriate to the hypothesis? Ethical?
METHODOLOGY
6. 9. Was subject selection and exclusion criteria clearly detailed? Was subject selection adequate for extrapolation to the appropriate
population?
10. Was the number of subjects enrolled adequate?
1. Was the subject sample described sufficiently (age range, sex, severity of disease) to make sure groups were comparable?
Were group differences subjected to statistical analysis?
12. Were appropriate controls used?
13. Was allocation to treatment groups truly random?
14. Were doses, schedules, and duration of drug treatment adequate and comparable?
15. Were washouts used? Were they of sufficient duration?
16. Was concurrent therapy allowed? Controlled?
17. Was the study blinded? Was it truly blinded?
18. Were observers identified? Were they qualified? Were they blinded?
19. Were the test measures used indicative of therapeutic efficacy?
20. Did the test measurements used subjective or objective assessment?
21. What is the test measurement's sensitivity, specificity and reliability? Could a more reliable test measurement have been used?
22. How long were subjects followed? Was it long enough?
RESULTS
23. Were the results clearly, accurately and adequately presented?
24. Were all the results presented?
25. Were dropouts adequately accounted for?
26. Was an appropriate statistical method used?
27. Does a statistically significant difference necessarily imply clinical significance?
DISCUSSION AND CONCLUSIONS
28. Were valid conclusions based upon the results presented?
29. Were valid conclusions based upon the hypothesis of the study?
30. Does the discussion place the results of this study into the perspective of previous studies comparing and contrasting results? Does the discussion honestly outline the study's shortcomings?
Preceptors will evaluate the Journal Club Presentation.
SOAP NOTE GUIDELINES
Developing and Presenting a Patient Case in the SOAP Format
Please note that this is just a guide that will help with creating a SOAP note. Please adjust format according to your individual instructor's wishes.
Candidates are encouraged to develop an organized presentation of information. The following format is routinely employed in the clinical setting.
I. Patient Specific Information (Divided into "S" and "O")
Patient demographics (name, age, sex, race, height, weight, etc.)
Subjective
1. Chief Complaint [CC] (reason for admission)
2. History of Present Illness [HPI] and Hospital Course (if patient)
3. Past Medical/Surgical History [PMH/PSH]
4. Social History [SH] (smoking, alcohol, IV/illicit drug use)
5. Family History [FH
1. 6. Medications Prior to Admission [Meds PTA] [medication history (inc. OTC), duration of Rx, & compliance]
7. Immunizations
8. Allergies and types of adverse drug reactions
9. Vital Signs
10. Physical Exam [PE]
11. Laboratory/Diagnostic Findings [Labs]
II. Suggestions for Assessing Disease States or Health Conditions
1. For Established Health Conditions/Disease States: What are the desired therapeutic outcomes (i.e.: short- and long-term goals)? To ensure that all possible outcome parameters are considered, it may be helpful to do a review of systems for a particular drug (e.g.: CNS, HEENT, CV, PULM, GI, GU, SKIN, MUSCULOSKELETAL, ENDOCRINE, etc.). This will enable one to determine if the desired goals are being reached and that undesired toxicity is not occurring.
2. Prevention of Health Conditions: Is the patient at risk for any health conditions due to their age, family hx, social hx, or current disease states? Any immunizations or preventative therapies needed?
Suggestions for Assessing Pharmacotherapy
When assessing a patient's pharmacotherapy, it is often helpful to identify all problems AND prioritize each in order of severity or significance. Each drug currently being administered and every new drug should be evaluated by asking questions such as:
1. Is the drug appropriate for a designated indication? (i.e.: what is it being used for?)
· Is there a need for this medication?
· Is a drug for a particular problem/indication missing?
· Is the wrong drug being utilized for a particular problem/indication?
· Is the correct drug employed but for the wrong indication?
2. Is this the drug of choice and are there any alternatives?
3. Is this therapy cost-effective?
4. Has the dosage been adjusted for patient-specific parameters (i.e.: renal/liver disease, age, weight, medical conditions, etc.)?
· subtherapeutic dosing
· overdosing
· pharmacokinetic consultation required
5. Are the route and timing of administration appropriate?
6. What adverse drug reactions are possible and are they more/less likely to occur in this patient? Does the patient currently have any of these side effects?
7. Are there any potentially significant drug interactions? How can they be managed?
8. Is there therapeutic duplication?
9. Is the patient compliant and/or receiving all of the indicated medications?
III. Suggestions for Establishing the "Plan"
1. These will include the prospective, proactive interventions designed to optimize the patient's care:
· should reflect proposed or already developed action plan(s)
· non-pharmacologic recommendations MUST be included
· consideration MUST be given to available therapeutic options - candidates should be encouraged to provide a rationale (e.g.: literature support) for selected options not merely a list of options
· proper drugs (if necessary to resolve problem), doses, routes, schedules, and duration of therapy MUST be given whenever a specific therapy is recommended
· alternative regimens are STRONGLY encouraged (e.g.: what could be employed if the primary regimen fails, induces unacceptable adverse effects, is too expensive, or cannot be used due to drug allergy, etc.)
· patient counseling may be provided or may be part of an oral examination during each case study
2. The plan should be clear-cut and concise not simply a regurgitation of information from a standard textbook source. For example: if a student recommends monitoring/testing for adverse effects - the most common, most serious, or most likely adverse effects for that particular patient should be identified rather than every adverse effect known to man and adverse effects unlikely to occur in particular individual. Similarly, monitoring for GI upset is an unacceptable answer. A more specific monitoring parameter such as checking for the presence of diarrhea or dyspepsia is expected.)
| SECTION V PRECEPTOR ASSESSMENT TOOLS/PORTFOLIO |
1. Grade Summary Sheet
2. SOAP Note Evaluation Form
3. Journal Club Presentation Evaluation Form
4. Pharmacy Activities Evaluation Form
5. Patient Interaction Evaluation Form
6. Presentation Evaluation Form
7. Texas State Board of Pharmacy Intern-Clerkship Evaluation Forms
8. Weekly Activity Sheet
9. Candidate's Evaluation of Experience
GEROPSYCH CLERKSHIP
PHARMACY 4XXX
Preceptor Evaluation of Candidate
Grade Summary Sheet
Candidate Name: ___________________________ Course: ____ Dates: ____________ to ____________
Preceptor: ___________________________________ Site: _________________________________________
This course is graded on a 0 - 100 point scale, with a minimum score of 70 out of 100 required to pass.
| Summary Grid of Rotation | Weighing factor (% of Final Grade) | Student's Earned Grade | Calculation | Final Points: | |
| Delivering pharmaceutical care | /////////// | /////////// | ///////////// | ////////// | |
| SOAP notes (three graded notes on weeks 2,4, and 6) | 30 | _____ x 0.30 | |||
| Pharmacy activities | 20 | _____ x 0.10 | |||
| Patient interaction | 20 | _____ x 0.10 | |||
| Presentation | 10 | _____ x 0.10 | |||
| Texas State Board of Pharmacy Intern-Clerkship Evaluation Forms | 10 | _____ x 0.10 | |||
| *** Journal club OR Drug information **** | 10 | _____ x 0.10 | |||
| Deductions for tardiness / late work | See manual | (-) | |||
| Total Score/Total Grade for Rotation | /100% | ||||
Preceptor Signature: _________________________________________Date: _________________________
Completed Intern-packets from each rotation will need to be faxed or mailed to the following Regional School of Pharmacy Campus Office:
PLEASE DO NOT SEND COMPLETED PACKETS VIA THE CLERKSHIP STUDENTS
| Amarillo: Loree Allen, Clerkship Coordinator, School of Pharmacy, 1300 Coulter, Room 206, Amarillo, TX 79106; Fax: (806) 356-4018; Phone: (806) 356-4000, ext. 306; Email: loree@cortex.ama.ttuhsc.edu |
**Send this form to Texas Tech School of Pharmacy
SOAP Note Grading Forms
Candidate: ______________________________________________________ SOAP note #:______________
Preceptor: _____________________________________ Rotation: _______________ Date: _______________
| I. S/O: Patient information: Chart review Ø Demographic information Ø Physician Ø Reason for admission OR Chief complaint Ø Diagnosis list Ø Medication list | Ø Past medical history Ø Allergies Ø Family / social history Ø Physical exam Ø Vitals Ø Labs (including CrCl) | |||
| 6.0 points | Poor | Information poorly gathered from chart: >5 omissions -OR- inaccurate information present. Student makes no attempt to gather information not readily available in patient record. | ||
| 7.0 points | Fair | Gathered some information from chart, but lacks 3-5 required elements -OR- does not make attempt to gather information not readily available from patient record | ||
| 8.0 points | Good | Gathered moderately complete information, but lacks two required elements. Student made some attempt to gather information not readily available from patient record. | ||
| 9.0 points | Very good | Gathered moderately complete information, but lacks one required element. Student made some attempt to gather information not readily available from patient record. | ||
| 10.0 points | Outstanding | All required information was gathered, no items missing. Student made extra efforts to gather information not readily available from the patient record. | ||
| II. S/O: Patient info: Patient evaluation Ø Utilizes other sources of information Ø Interviews facility staff as appropriate Ø Interviews or observes patient (Interacts with patient on ongoing basis) | Ø Gathers pertinent information from patient encounter. Incorporates into note (including observing and documenting symptoms and other objective physical / clinical signs). Ø Utilizes assessment tools as appropriate | |||
| 6.0 points | Poor | Student does not attempt to interact with patient or staff. -Or- Student does not attempt to use assessment tools. Poor documentation of objective data, many elements missing. | ||
| 7.0 points | Fair | Student gathered some information, some holes in objective info gathered. Inconsistent interaction with patient of staff, or inconsistent use of assessment tools. >3 required items missing. | ||
| 8.0 points | Good | Student gathered moderately complete information, attempting to observe and document objective information. Attempts to use assessment tools. Two required items missing. | ||
| 9.0 points | Very good | Student gathered moderately complete informatio | ||