Pharm Tech Practicum Workbook

Fall
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pharmacytechnicianpracticumworkbook
Programguidelines,expectations,andevaluation
DepartmentofPHARMACYTECHNOLOGY
Department of Pharmacy Technology

Pharmacy Technician Training Program
Pharmacy Technician Practicum PHRA 2266/2066

Synonym 36896 002
Fall 2011 Office Hours: T-Th 11a 12:00; W 11a-1pm; room 9214
Austin Community College, Eastview Campusw 3401 Webberville Road Austin, TX 78702
Lisa McCartney, AAS, CPhT, PhTR Pharmacy Technician Program Department Chair Practicum Coordinator Phone: (512) 223-5949 Fax: (512) 223-5895 Email: lmccartn@austincc.edu http://www.austincc.edu/health/phra/
Required Texts: None
2005 to 2011 Austin Community College
The Pharmacy Technician Program conducted by Austin Community College, Austin, Texas, is accredited by the American Society of Health-System Pharmacists.
For more information concerning accreditation, please Visit the ASHP website at www.ashp.org.
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Practicum Eligibility
The Pharmacy Practicum is in the second semester of the program. The student must have completed the following courses with a C or higher prior to their practicum semester: Essentials of Medical Terminology, HPRS 1106 or HPRS 1206 Drug Classification, PHRA 1205 Introduction to Pharmacy, PHRA 1301 Pharmaceutical Mathematics, PHRA 1309 Community Pharmacy Practice, PHRA 1313 Institutional Pharmacy Practice, PHRA 1349 The student must also have either completed, or be currently enrolled in: Intravenous Admixture and Sterile Compounding, PHRA 1345 Pharmacy Drug Therapy and Treatment, PHRA 1441 In addition to the above academic requirements, students must have completed the following immunization requirements: Hepatitis-B Series (3 injections) Varicella Measles, Mumps, Rubella Measles (Second Vaccination) Tetanus/Diphtheria Received a non-reactive, two-step, (TB) PPD (Purified Protein Derivative) skin test for Tuberculosis within the last calendar year which will not lapse during their practicum semester. Documentation of the two-step PPD skin test must be made on a completed Health Data Form. Finally, students must complete this State legal and regulatory requirement: Register and maintain valid registration as a Technician Trainee with the Texas State Board of Pharmacy which will not expire during the Practicum semester, OR Register and maintain valid registration as a Registered Pharmacy Technician with the Texas State Board of Pharmacy Failure to comply with these established eligibility guidelines constitutes ineligibility to participate in the Practicum, which may lead to disciplinary action up to and/or including dismissal from the Program. Additional Practicum Facility Requirements Practicum facilities reserve the right and the discretion to accept or reject students and to impose further and/or more stringent screening standards, including and not limited to additional criminal background checks, drug testing, or other screening processes. Students assigned to these facilities must comply with such requests. Additional fees may apply for these screening processes.
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If a student is found to be ineligible for practicum placement any time during the program, the student is unable to meet practicum learning objectives and will be subject to disciplinary action, up to and including dismissal from the program. Placement Criteria
Students are assigned to a practicum facility based upon evaluation from Program faculty and the Practicum Coordinator. Students are not permitted to select their practicum assignments, the geographic area of their assignments, or the order in which their rotations are completed. Students are, however, permitted to submit requests to the Practicum Coordinator at the time of the petition. Such requests may be taken into consideration; however, they cannot always be honored when assigning students to practicum facilities as placement is at the discretion of the Program. At the end of each practical and laboratory course, faculty assigned to the course shall complete an evaluation form and make a recommendation as to the students practicum placement. The form is then placed in the students file and reviewed by the Practicum Coordinator during the placement process. Placement Criteria, in alphabetical order, includes: Academic Performance Behavioral and Social Skills Communication Skills Intellectual Skills Laboratory Skills and Performance evaluations in PHRA 1313 and PHRA 1349 Motor Skills Observational Skills (Visual and Auditory) Other skills and criteria as outlined within the Technical Standards in the Pharmacy Technology Student Handbook Prompt return of the practicum petition and site rotation request form Students seeking further explanation of the placement process may contact the Practicum Coordinator or the Department Chair for more information.
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TABLE OF CONTENTS
Practicum Coordinator Contact Information ...i ASHP Accreditation Statement ... ii Practicum Eligibility ...iii Practicum Placement ...iv Table of Contents ..v Program Goals .. 1 Responsibilities ................ 3 Practicum Rotation Information .. 5 Schedule.... 5 Evaluation and Grading .. 6 State Board of Pharmacy Reporting Procedures 7 Practicum Goal Statements and Objectives . 9 Appraisal Systems and Rotation Documentation for the Student and Preceptor 21 Class A Documentation Timesheet. 23 Class A Midterm Student Performance Appraisal 25 Class A Final Student Performance Appraisal . 27 Class A Performance Appraisal Checklist . 29 Class C Documentation Timesheet. 31 Class C Midterm Student Performance Appraisal 33 Class C Final Student Performance Appraisal . 35 Class C Performance Appraisal Checklist . 37 Appraisal Systems and Rotation Documentation for the Student .. 39 Class A Pharmacy Student Site Appraisal 41 Class C Pharmacy Student Site Appraisal 45 Appraisal Systems and Rotation Documentation for the Practicum Coordinator . 49 Class A Pharmacy Site Checklist 51 Class C Pharmacy Site Checklist ... 55 Pipeline Information and Creation of Profile.59 Agreement of Understanding Form60
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Program Goals
The Program Goals are based on the recommended goals as listed in ASHP Model Curriculum for Technician Training. These goals are used as terminal learning objectives for Pharmacy Practicum since the practicum requires the use of the information and skills learned in all of the Pharmacy Technician Training Program classes. 1. Assist the pharmacist in collecting, organizing, and evaluating information for direct patient care, medication use review, and departmental management. 2. Receive and screen prescriptions/medication orders for completeness and authenticity. 3. Prepare medications for distribution. 4. Verify the measurements, preparation, and/or packaging of medications produced by other technicians. 5. Distribute medications. 6. Assist the pharmacist in the administration of immunizations. 7. Assist the pharmacist in the identification of patients who desire/require counseling to optimize the use of medications, equipment, and devices. 8. Initiate, verify, assist in the adjudication of, and collect payment and/or initiate billing for pharmacy services and goods. 9. Purchase pharmaceuticals, devices, and supplies according to an established purchasing program. 10. Control the inventory of medications, equipment, and devices according to an established plan. 11. Assist the pharmacist in monitoring the practice site and/or service area for compliance with federal, state, and local laws; regulations; and professional standards. 12. Maintain pharmacy equipment and facilities. 13. Assist the pharmacist in preparing, storing, and distributing investigational medication products. 14. Assist the pharmacist in the monitoring of medication therapy. 15. Participate in the pharmacy departments process for preventing medication misadventures. 16. Take personal responsibilities for assisting the pharmacist in improving direct patient care. 17. Display ethical conduct in all job-related activities. 18. Maintain an image appropriate for the profession of pharmacy.
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19. Resolve conflicts through negotiation. 20. Understand the principles for managing change. 21. Appreciate the need to adapt direct patient care to meet the needs of diversity. 22. Appreciate the benefits of active involvement in local, state, and national technician and other pharmacy organizations. 23. Appreciate the value of obtaining technician certification. 24. Understand the importance of and resources for staying current with changes in pharmacy practice. 25. Communicate clearly when speaking and or in writing. 26. Maximize work efficiency through the use of technology. 27. Efficiently solve problems commonly encountered in ones own work. 28. Display a caring attitude toward patients in all aspects of job responsibilities. 29. Maintain confidentiality of patient and proprietary business information. 30. Understand direct patient care delivery systems in multiple practice settings. 31. Efficiently manage ones work whether performed alone or as part of a team. 32. Function effectively as a member of the health care team. 33. Balance obligations to ones self, relationships, and work in a way that minimizes stress. 34. Understand the use and side effects of prescription and nonprescription medications used to treat common disease states. 35. Assist the pharmacist in assuring the quality of all pharmaceutical services.
Responsibilities
Student Responsibilities A. Attendance The student is expected to attend ALL scheduled practicum sessions. When a student is unable to attend, the preceptor at the site should be notified immediately. It will be the students responsibility to reschedule a missed session with the preceptor. It will also be the responsibility of the student to notify the Practicum Coordinator of any missed sessions. The student is expected to arrive to the practice site on time. If the student displays poor work ethic, such as arriving late to work, improper dress, failure to arrive at scheduled times, etc., the preceptor is to contact the Practicum Coordinator immediately. B. Transportation The student must provide his or her own transportation. C. Dress Code The student should be appropriately dressed according to the standards of the site and the profession. If the site does not have a specific dress code policy, the student shall follow the dress code policy outlined in the Pharmacy Technician Student Handbook. The student will need to purchase TEAL colored scrubs for the institutional rotation that meet the dress code requirements of the site. The student must wear their ACC picture ID badge and Pharmacy Technician Trainee badge at all times. D. Registration Enrollment in the practicum, including the payment of all appropriate fees should be completed during the colleges regular registration period. Extra practicum fees will cover the liability insurance required of every student performing on-the-job training. E. Patient Confidentiality The student is required to respect all confidences revealed while he/she is performing the practicum. No information regarding fee systems, patient records, policies and procedures, etc. should be discussed or revealed. F. On-the-job Performance The pharmacy technician student should: 1. be an active participant in the learning experience. 2. have mutual respect and courtesy for the preceptor and professional staff, and always communicate in a professional manner. 3. interact privately with the preceptor if there is a disagreement. 4. check with the preceptor when making professional decisions, especially those dealing with prescription orders. 5. view criticism as a learning experience. 6. be aware of the laws and regulations governing the practice of pharmacy. 7. not accept or receive any form of payment, financial or otherwise, from the assigned site for work performed as part of the practicum. (Employment of the student outside of practicum hours must be discussed with the Program Coordinator.) 8. always use common sense.
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9. complete site specific training and testing as requested by practicum preceptor or practicum coordinator. 10. follow all site rules including no smoking regulations. G. Academic The pharmacy technician student shall complete all academic standards and requirements set forth within this handbook and the Pharmacy Technician Program Student Handbook. The student is required to provide the practicum coordinator with his/her schedule each week. The student is required to attend all requested meetings with the practicum coordinator. H. Regulatory 1. The student shall maintain good-standing registration as a Technician Trainee or as a Registered Pharmacy Technician, which will not expire or be in a pending status during the practicum semester. 2. The student shall report worksites to the State Board of Pharmacy within 3 calendar days of starting the rotation. See page 7 for procedures. 3. If the student wishes to take the PTCE prior to the end of their practicum semester, the student should NOT register as a Pharmacy Technician until the practicum semester is completed. Please see the practicum coordinator prior to signing up for the PTCE. Preceptor Responsibilities A. Practicum Information Source The preceptor should explain to the student what is expected of him/her, particularly with regard to: appearance, attitude, scheduling of hours, and general characteristics of the practice site. B. Role Model The preceptor should instill in the student a sense of professional ethics and pride, as well as encourage communication, trust, respect and understanding. C. Student Learning Experience The preceptor should not assume the students competency but determine it through discussion, observation and experience. It is the preceptors responsibility to expose the student to all aspects of professional practice, and not use the student as an extra pair of hands. D. Evaluations Performance appraisals should be conveyed to the student in private. Criticism should be constructive. The preceptor is responsible for any evaluation forms on student progress. The preceptor must complete the midsemester and final evaluations, as well as the performance appraisal checklist. The preceptor should meet with the student to discuss the evaluations and checklist. Both the student and the preceptor must sign and date all forms. The preceptor (or their designee) must initial all timesheets. E. Staff Information The preceptor should discuss the objectives of the practicum with all pharmacy employees to avoid misunderstanding and conflict about the students role during the practicum.
Site Responsibilities A. Dress Code The preceptor will explain to the student what the site considers an acceptable dress code. B. Parking The preceptor will provide the student with information about parking places. C. Miscellaneous The practicum site will provide the student with a private place to store personal belongings in a safe and secure manner.
Practicum Rotation Information

The student will be assigned to complete a minimum of 256 hours of on-the-job training. The student must complete 128 hours in a community or other Class A pharmacy, and 128 hours in an institutional or other Class C pharmacy. The student is assigned to one facility at a time. A minimum and maximum number of allowable work hours and a maximum time limitation has been established to allow for effective scheduling and optimal practicum experiences. Once the student has completed their first rotation, the second rotation may begin; however, student start dates are dependent on the completion of the rotation by other student(s) currently assigned to the facility. Schedule The student will be assigned to complete 128 hours of on-the-job training during each practicum rotation. The schedule is flexible but is contingent upon an agreement between the student and the preceptor. The student is allowed a maximum of eight (8) weeks in the fall and spring semesters (five and one-half (5) weeks in the summer) to complete each rotation. Students are not permitted to work longer than the established eight-week (fall/spring) or five and one-half-week (summer) time period in each rotation. Students not completing each rotation within the established time limit will not earn a passing grade for the rotation and will therefore not pass the practicum. Grades of Incomplete will not be issued for this course. The student must also work a minimum number of hours each week to successfully complete the rotation. In the fall and spring semesters, students must work a minimum of sixteen (16) hours per week to complete each rotation in an eight-week timeframe. In the summer semesters, students must work a minimum of 24 hours per week to complete each rotation in five and one-half-week timeframe. The student may work no more than ten (10) hours per day or 40 hours per week. Any requests for exceptions to these requirements must be submitted to the Practicum Coordinator via email (decisions on any requests will be received within two business days). Once the student has been assigned, they are required to immediately contact their preceptor. At that time, the student and preceptor need to agree upon the students schedule. The student must provide that schedule to the Practicum Coordinator as soon as it established. The student is required to provide the Practicum Coordinator with their schedule at least two weeks before it is in effect, except for the first two weeks of the semester. The student may
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begin work immediately after they have provided the Practicum Coordinator with their first schedule. A timesheet is included in this manual for the convenience of monitoring the students hours. The timesheet must be initialed weekly by the preceptor (or the preceptors designee), and turned in to the Practicum Coordinator at the end of the semester. The Practicum Coordinator may request to evaluate the students timesheet at any time during the semester to ensure accuracy and completeness. The student must inform the preceptor and the Practicum Coordinator of any tardies, absences, and/or schedule changes (anticipated or unexpected). Failure to do so will affect the final grade and status in the practicum. Under no circumstances should the student be at the practicum site without prior notification to the Practicum Coordinator. The Practicum Coordinator, (and Preceptor) must know when students are at their rotation site at all times. Again, failure to keep the Practicum Coordinator apprised of their schedule at all times, the students final grade will decrease by one full letter grade.
Evaluation and Grading for the Practicum Course All paperwork including the summary report, site evaluation forms, revised resume, and Student Self-Evaluation are due during or prior to the final meeting with the practicum coordinator. The mock interview and pre-employment exam will be completed during the final meeting with the practicum coordinator. Please allow two hours for your final meeting, the meeting must be scheduled in advance with the practicum coordinator. Summary Report (worth 25% of overall grade) Students must write a reflective report on their experience during the practicum and throughout the entire pharmacy program. This report should be a minimum length of three full pages. The report should address the following topics: Did your practicum rotation change your thoughts about which practice setting you want to work in (retail or hospital)? Why or why not? Feedback on the program o Were you well prepared for your practicum? In what ways were you well prepared? What areas/duties do you wish you would have had more experience in prior to the practicum? Student learning curve o Based on your experience in the practicum, in what areas do you have room to grow and learn? Describe any unique experiences. These may be experiences with a colleague or patients. Examples of these activities include interesting discussions, unique interactions/conversations, prescription processing issues, medication errors, legal issues, teachable moments, aggressive patients, etc. Any other details you wish to include Formatting The essay should have one-inch margins on all sides of the paper, be double spaced, and be written in a 10- or 12-point font in Arial or Times New Roman only. Be sure to include a title page with an essay title, your name, the course name, the date, and my name. Please include a page header with your name and the page number.
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Site Evaluations (worth 50% of overall grade) The preceptor will complete two evaluation forms in order to evaluate the students progress. The first evaluation, the Midterm Student Performance Appraisal, should be completed prior to the student reaching their 64th work hour. The second evaluation, the Final Student Performance Appraisal, and the Performance Appraisal Checklist should be completed shortly before, or immediately after the student has worked the full 128 hours at the site. During the assigned practicum time, a number of experiences should be discussed and demonstrated for the student. Whenever possible, the student should be allowed to perform the tasks associated with a specific experience. The Program understands, however, that the student cannot perform all activities. In such cases, the student should observe the activities being performed. By the end of the site rotation it is hoped that the student will demonstrate competency for each goal. During the final evaluation, the students level of mastery for each goal will be indicated on the evaluation form. The preceptor will be responsible for evaluating the students performance during their externship rotation. Completed evaluations (mid-semester, final, appraisal checklist, and timesheets) may be submitted via fax, post, or email, this is at the discretion of the site preceptor. The student may NOT deliver the paperwork to the practicum coordinator. It must be submitted directly from the preceptor to the practicum coordinator. The student is responsible for ensuring that the signed and dated midsemester performance appraisal, final performance appraisal, performance appraisal checklist, timesheet, and student site evaluations for BOTH practicum sites are turned in to the practicum coordinator by mail, email, or fax, before the due date. Paperwork must be sent directly from the preceptor to the practicum coordinator and may NOT be turned in by the student. Failure to turn in paperwork = zero points for the site evaluation section of the grading scale (worth 50% of possible points). Current Resume (worth 10% of overall grade) Student must provide the practicum coordinator with a current resume by the due date. Resume should be updated to reflect students learning in lab courses, practicum rotations, ACPE certification, intent to take PTEC, etc. The student has the option to email a copy of their revised resume to the practicum coordinator (AT LEAST three weeks prior to the end of the semester) for feedback prior to turning their final resume. Interview and Pre-Employment Exam (worth 10% of overall grade) Student must complete a written hospital and retail pre-employment exam and undergo a mock interview with the practicum coordinator. This will be scheduled during midsemester meeting with practicum coordinator and will take place during the final meeting. The final meeting will take approximately 2 hours to complete. Student Self-Evaluation, Program Exit Survey, Communication, TSBP Reporting, etc. (worth 5% of overall grade) Students must check Blackboard and email regularly, and must respond to practicum coordinator calls and emails within 24 hours. Students must submit self evaluation and program exit survey forms no later than the final meeting. Students must stay in close communication with their preceptors and call them immediately if they are going to be late or absent from the workplace. Students must also report their workplace to the State Board of Pharmacy. See below for reporting procedures.
State Board of Pharmacy Reporting Procedures

The Texas State Board of Pharmacy requires any person licensed or registered by the Board to report their place of employment or work. As a Technician Trainee working in a pharmacy, even if it is unpaid, you must report your places of employment.
One piece of information you will need to the pharmacy license number. To locate a pharmacy license number, follow these steps: 1. Visit the Boards website at www.tsbp.state.tx.us 2. Click on the link for License Verification 3. Click on the link for Pharmacy Search 4. Using the search fields, enter the name of your site, and the city. 5. A results listing will appear, look for the name of the pharmacy where you will be working, and click on the name. 6. A detailed view will appear. In the title of the page, just below the State Boards name, you will see (in bold black letters) the license number. 7. Write this number down. To add a pharmacy to your registration record, follow these steps: 1. Visit the Boards website at www.tsbp.state.tx.us 2. Scroll down to the bottom of the page, and click on the link for Change of Address and Employment Online Submission 3. Click on the link for Pharmacy Technician Change of Address, Telephone Number, and Employment 4. Scroll down to New Users 5. Click on Register for a Secure Online 6. Follow the steps to set up your account 7. When your profile appears, click on the link for Add Employment 8. Enter the Pharmacy License Number, and click the button Add Employment. 9. Youre done!!
Practicum Goal Statements and Objectives

The student should demonstrate competency in each of the goal areas listed. The learning objectives are listed to assist the preceptor and student in identifying the activities and/or qualities that should be observed to demonstrate competency. Goal 1: Assist the pharmacist in collecting, organizing, and evaluating information for direct patient care, medication use review, and departmental management. OBJ 1.1 (Comprehension) Explain how state laws and regulations determine what activities associated with collection of patient specific information can be delegated by the pharmacist to technicians. OBJ 1.2 (Application) When presented with a specific patient case, collect pertinent patient information for use by the pharmacist from the medical chart, patient profile or medical record with efficiency and accuracy. OBJ 1.3 (Application) Effectively interview patients, their representatives, or their caregivers to collect pertinent patient information for use by the pharmacist. OBJ 1.4 (Application) Effectively query other health care professionals to collect pertinent patient information for use by the pharmacist. OBJ 1.5 (Application) Follow an established system for organizing collected patient-specific information in a useful electronic or manual format. OBJ 1.6 (Evaluation) When collecting patient-specific information for use by the pharmacist, identify situations where the patient requires the attention of the pharmacist. OBJ 1.7 (Application) Follow an established program to efficiently and accurately collect data for use by the pharmacist in medication use review. OBJ 1.8 (Application) Follow an established program to efficiently and accurately collect data for use by the pharmacist in managing pharmacy services. Goal 2: Receive and screen prescription/medication orders for completeness and authenticity. OBJ 2.1 (Comprehension) Explain how state laws and regulations determine what activities associated with receiving and screening prescription/medication orders for completeness and authenticity can be delegated by pharmacists to technicians. OBJ 2.2 (Application) Exercise skill in the use of first-person and electronic systems to receive prescription/medication orders. OBJ 2.3 (Analysis) When presented with a prescription/medication order, accurately and efficiently assess for completeness.
OBJ 2.4 (Application) Efficiently secure information to complete a prescription/medication order. OBJ 2.5 (Analysis) When presented with a prescription/medication order, accurately and efficiently screen for authenticity. OBJ 2.6 (Comprehension) Explain common situations when screening refills and renewals when the technician should notify the pharmacist of potential inappropriateness. Goal 3: Prepare medications for distribution. OBJ 3.1 (Comprehension) Explain how state laws and regulations determine what activities associated with preparing medications for distribution can be delegated by pharmacists to technicians. OBJ 3.2 (Application) Accurately create a new patient profile or enter data into an existing profile according to an established manual procedure or electronic procedure. OBJ 3.3 (Application) Follow established laws and protocols to select the appropriate product. OBJ 3.4 (Application) Use knowledge of a site's storage system to efficiently secure the prescribed medications or devices from inventory. OBJ 3.5 (Application) Accurately count or measure finished dosage forms as specified by the prescription/medication order. OBJ 3.6 (Application) Collect the correct ingredients for sterile or non-sterile products that require compounding. OBJ 3.7 (Application) Accurately determine the correct amounts of ingredients for a compounded product. OBJ 3.8 (Complex Overt Response) Compound sterile products using appropriate techniques, equipment and devices. OBJ 3.9 (Complex Overt Response) Compound non sterile products using appropriate technique. OBJ 3.10 (Complex Overt Response) Compound cytotoxic and other hazardous medication products using appropriate technique. OBJ 3.11 (Application) Follow safety policies and procedures in the preparation of all medications. OBJ 3.12 (Application) Follow safety policies and procedures in the disposal of all hazardous and non hazardous wastes generated during medication preparation. OBJ 3.13 (Application) Package the product in the appropriate type and size of container using a manual process or automated system.
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OBJ 3.14 (Application) Follow an established manual procedure or electronic procedure to generate accurate and complete product labels. OBJ 3.15 (Application) Affix the appropriate primary and auxiliary labels to containers. OBJ 3.16 (Application) Follow protocol to assemble appropriate patient information materials. OBJ 3.17 (Application) Follow established policies and procedures for recording the preparation of bulk, unit dose, and special doses of medications prepared for immediate or in anticipation of future use OBJ 3.18 (Application) Follow established policies and procedures for recording the preparation of controlled substances. OBJ 3.19 (Application) Follow the manufacturer's recommendation and/or the pharmacy's guidelines for storage of all medications prior to distribution. Goal 4: Verify the measurements, preparation, and/or packaging of medications produced by other technicians. OBJ 4.1 (Comprehension) Explain how state laws and regulations determine what activities associated with verifying the measurements, preparation, and/or packaging of medications produced by other technicians can be delegated by pharmacists to technicians. OBJ 4.2: (Evaluation) Accurately assess the correctness of medications produced by other technicians including measurements, preparation technique, and packaging. Goal 5: Distribute medications. OBJ 5.1 (Application) Efficiently deliver the correct medication, equipment, device, or supplies to the correct patient or patient's representative. OBJ 5.2 (Application) Follow established policies and procedures to record the distribution of prescription medications. OBJ 5.3 (Application) Follow established policies and procedures to record the distribution of controlled substances. OBJ 5.4 (Evaluation) Monitor utilization of medications to assure that use is congruent with the prescription/medication order for the patient. Goal 6: Assist the pharmacist in the administration of immunizations. OBJ 6.1 (Comprehension) Explain how state laws and regulations determine what activities associated with the administration of immunizations can be delegated by pharmacists to technicians.
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OBJ 6.2 (Complex Overt Response) Exercise skill in the administration of selected immunizations. Goal 7: Assist the pharmacist in the identification of patients who desire/require counseling to optimize the use of medications, equipment, and devices. OBJ 7.1 (Comprehension) Explain how state laws and regulations determine what activities associated with patient counseling to optimize the use of medications, equipment, and devices can be delegated by pharmacists to technicians. OBJ 7.2 (Application) Use effective communication skills to elicit from the patient or caregiver the desire for the pharmacist to provide counseling on the use of medications. Goal 8: Initiate, verify, assist in the adjudication of, and collect payment and/or initiate billing for pharmacy services and goods. OBJ 8.1 (Application) Accurately identify the customer's/patient's method of payment for a prescription/medication order. OBJ 8.2 (Application) When presented with a new customer/patient for whom all required patient-specific information has not been obtained, use an appropriate interview strategy to secure the information. OBJ 8.3 (Analysis) Exercise skill in the use of electronic systems to input third party information and to verify third party coverage for a prescription/medication order. OBJ 8.4 (Application) When needed, accurately verify third party coverage for a prescription/medication order by phone. OBJ 8.5 (Application) When appropriate, use knowledge of 3rd party insurance billing procedures to identify the reason for a rejected claim and to convey that information accurately to the pharmacist. OBJ 8.6 (Synthesis) Formulate an effective strategy that is sensitive to the concerns of the customer/patient for conveying third party payment coverage information and further action to be taken. OBJ 8.7 (Application) Accurately complete third party claims forms. OBJ 8.8 (Application) Accurately record the receipt of payment for pharmaceutical goods and services. OBJ 8.9 (Complex Overt Response) Demonstrate skill in the operation of a cash register. OBJ 8.10 (Application) Accurately make change. OBJ 8.11 (Application) Accurately determine those items which are taxable. OBJ 8.12 (Application) Determine payment due the health system for medication
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orders. Goal 9: Purchase pharmaceuticals, devices, and supplies according to an established purchasing program. OBJ 9.1 (Application) Follow an established procedure for purchasing pharmaceuticals, devices, and supplies. Goal 10: Control the inventory of medications, equipment, and devices according to an established plan. OBJ 10.1 (Knowledge) Describe the various methods of inventory control (e.g., prime vendor, just-in-time). OBJ 10.2 (Application) Follow established policies and procedures for receiving goods and verifying specifications on the original order. OBJ 10.3 (Application) Follow established policies and procedures for placing pharmaceuticals, durable medical equipment, devices, and supplies in inventory under proper storage conditions. OBJ 10.4 (Application) Follow established policies and procedures for removing from inventory expired/discontinued pharmaceuticals, durable medical equipment, devices, supplies, or recalled items in these same categories. OBJ 10.5 (Application) Follow established policies and procedures for documenting repackaging or the removal from inventory of expired/discontinued pharmaceuticals, durable medical equipment, devices, supplies, or recalled items in these same categories. OBJ 10.6 (Analysis ) Identify pharmaceuticals, durable medical equipment, devices, and supplies to be ordered (e.g., "want book"). OBJ 10.7 (Comprehension) Explain alternative strategies for securing a pharmacy item that is not available. OBJ 10.8 (Comprehension) Explain acceptable methods for communicating changes in product availability to patients, caregivers, and/or health care professionals. OBJ 10.9 (Application) Follow established policies and procedures to deter theft and/or medication diversion. OBJ 10.10 (Application) Follow established policies and procedures to maintain a record of controlled substances received, stored, and removed from inventory. Goal 11: Assist the pharmacist in monitoring the practice site and/or service area for compliance with federal, state, and local laws, regulations, and professional standards. OBJ 11.1 (Application) Follow established policies and procedures for monitoring the practice site and/or service area for compliance with federal, state, and local laws; regulations; and professional standards.
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Goal 12:
Maintain pharmacy equipment and facilities. OBJ 12.1 (Application) Follow policies and procedures for sanitation management, hazardous waste handling (e.g., needles), and infection control (e.g., protective clothing). OBJ 12.2 (Application) Clean laminar flow biological safety cabinets using approved technique. OBJ 12.3 (Application) Maintain a clean and neat work environment. OBJ 12.4 (Application) Given a weighing or counting device, fluid compounder, or syringe pump used at a specific site, accurately calibrate the device, compounder or pump. OBJ 12.5 (Application) Follow manufacturers' guidelines in troubleshooting, maintaining, and repairing electronic devices used by the pharmacy in the preparation and dispensing of medications.
Goal 13:
Assist the pharmacist in preparing, storing, and distributing investigational medication products. OBJ 13.1 (Comprehension) Explain how the practice setting is used to contribute to the development of new medication products. OBJ 13.2 (Application) Follow the established protocol for recording the preparation of an investigational medication product. OBJ 13.3 (Application) Follow the established protocol for storage of investigational medication products. OBJ 13.4 (Application) Follow the established protocol to record the distribution of investigational medication products.
Goal 14:
Assist the pharmacist in the monitoring of medication therapy. OBJ 14.1 (Comprehension) Explain how state laws and regulations determine what activities associated with monitoring of medication therapy can be delegated by pharmacists to technicians. OBJ 14.2 (Comprehension) Explain the purpose of monitoring a patient's medication therapy. OBJ 14.3 (Complex Overt Response) Demonstrate skill in monitoring procedures selected by the program for training (e.g., finger-stick blood draw for glucose monitoring and cholesterol screening, blood pressure, pulse).
Goal 15:
Participate in the pharmacy departments process for preventing medication misadventures. OBJ 15.1: (Comprehension) Explain the characteristics of an effective pharmacy
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department approach to preventing medication misadventures. OBJ 15.2 (Comprehension) Explain the programs currently in place for reporting medication misadventures on a global and institutional level. OBJ 15.3: (Analysis ) When a clinically significant adverse medication event (ADE) is identified, participate in determining the presence of any similar potential ADEs. OBJ 15.4: (Analysis ) When a clinically significant ADE is identified, participate in formulating a strategy for preventing its reoccurrence. Goal 16: Take personal responsibility for assisting the pharmacist in improving direct patient care. OBJ 16.1 (Organization) Take the initiative in identifying changes within one's own work processes which would improve the delivery of direct patient care. Goal 17: Demonstrate ethical conduct in all job-related activities. OBJ 17.1 (Characterization) Act ethically in the conduct of all job-related activities. Goal 18: Maintain an image appropriate for the profession of pharmacy. OBJ 18.1 (Application) Dress in attire that follows the site's dress code. OBJ 18.2 (Application) Maintain personal hygiene. OBJ 18.3 (Characterization) Consistently maintain personal self-control and professional decorum. Goal 19: Resolve conflicts through negotiation. OBJ 19.1 (Application) Use effective negotiation skills to resolve conflicts Goal 20: Understand the principles for managing change. OBJ 20.1 (Comprehension) Explain why dealing with change is an important skill for the pharmacy technician. OBJ 20.2 (Comprehension) Explain the principles of change management. Goal 21: Appreciate the need to adapt direct patient care to meet the needs of diversity. OBJ 21.1 (Comprehension) Explain the need to adapt direct patient care for diversity (e.g., culture, religion, race, age, gender, sexual orientation, disability, economic status) OBJ 21.2 (Comprehension) Explain some typical adaptations made in direct patient care plans to accommodate diversity.
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Goal 22:
Appreciate the benefits of active involvement in local, state, and national technician and other pharmacy organizations. OBJ 22.1 (Comprehension) Explain the benefits of membership in the range of local, state, and national pharmacy organizations. OBJ 22.2 (Knowledge) Describe the local, state, and national pharmacy organizations which offer value for the pharmacy technician.
Goal 23:
Appreciate the value of obtaining technician certification. OBJ 23.1 (Comprehension) Explain the benefits of obtaining technician certification. OBJ 23.2 (Comprehension) Explain the process by which one can become a nationally certified pharmacy technician. OBJ 23.3 (Comprehension) Explain technician certification processes other than the national process and how they may be pursued.
Goal 24:
Understand the importance of and resources for staying current with changes in pharmacy practice. OBJ 24.1 (Comprehension) Explain the necessity for technicians to stay current with advances in pharmacy practice. OBJ 24.2 (Comprehension) Discuss resources (e.g., journals, newsletters, educational conferences) for staying current with advances in pharmacy practice (e.g., automation, medication therapy, devices).
Goal 25:
Communicate clearly when speaking or writing. OBJ 25.1 (Application) Organize all written or oral communication in a logical manner. OBJ 25.2 (Application) Address all communication on the level appropriate for the audience. OBJ 25.3 (Application) Use correct grammar, punctuation, spelling, style, and formatting conventions in preparing all written communications. OBJ 25.4 (Application) Pronounce technical terms correctly. OBJ 25.5 (Application) Use listening skills effectively in performing job functions. OBJ 25.6 (Application) Use effective strategies for communicating with patients who are non-English speakers or who are impaired (e.g. blind, deaf, cognitively impaired, illiterate).
Goal 26:
Maximize work efficiency through the use of technology.
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OBJ 26.1 (Application) Effectively combine a knowledge of medical information systems to increase efficiency in performing practice responsibilities. OBJ 26.2 (Application) Demonstrate proficiency with word processing, spread sheet, and database software. OBJ 26.3 (Application) Demonstrate skill in the use of the internet, e-mail services, and computerized medication information databases. OBJ 26.4 (Comprehension) Explain currently emerging technologies that may impact the practice of pharmacy. Goal 27: Efficiently solve problems commonly encountered in one's own work. OBJ 27.1 (Application) Demonstrate consistent use of a systematic approach to solving problems encountered in one's work as a technician. Goal 28: Display a caring attitude toward patients in all aspects of job responsibilities. OBJ 28.1 (Organization) Combine compassion with the delivery of pharmacy services. OBJ 28.2 (Comprehension) Explain the concept of "caring" within the context of the delivery of pharmaceutical care. OBJ 28.3 (Characterization) Display acceptance of an attitude of "caring" by conveying this attitude in all professional transactions with patients and their caregivers. Goal 29: Maintain confidentiality of patient and proprietary business information. OBJ 29.1 (Application) Observe legal and ethical guidelines for safeguarding the confidentiality of patient information. OBJ 29.2 (Application) Observe organizational policy for the safeguarding of proprietary business information. Goal 30: Understand direct patient care delivery systems in multiple practice settings. OBJ 30.1 (Comprehension) Compare and contrast the provision of direct patient care in various patient-care settings. Goal 31: Efficiently manage one's work whether performed alone or as part of a team. OBJ 31.1 (Application) Use knowledge of workflow management to effectively schedule the performance of one's job responsibilities. Goal 32: Function effectively as a member of the health care team. OBJ 32.1 (Application) Use knowledge of interpersonal skills to effectively
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manage working relationships. Goal 33: Balance obligations to ones self, relationships, and work in a way that minimizes stress. OBJ 33.1 (Synthesis) Devise an effective plan for minimizing stress while attending to personal needs, maintaining relationships, and meeting professional obligations. Goal 34: Understand the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) used to treat common disease states. OBJ 34.1 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies(e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases affecting the cardiovascular system. OBJ 34.2 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases affecting the respiratory system. OBJ 34.3 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases affecting the gastrointestinal system. OBJ 34.4 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases affecting the renal system. OBJ 34.5 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases affecting the nervous system. OBJ 34.6 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases affecting the endocrine system. OBJ 34.7 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases affecting the reproductive systems. OBJ 34.8 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases affecting the immune system.
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OBJ 34.9 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases of the skeletal system (bones and joints). OBJ 34.10 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat disorders of the eyes, ears, nose and throat. OBJ 34.11 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases affecting the dermatologic system. OBJ 34.12 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly used to treat diseases affecting the hematologic system. OBJ 34.13 (Comprehension) Explain the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) commonly to treat diseases of the muscular system. OBJ 34.14 (Comprehension) Explain the role of the FDA in regulating herbal products and dietary supplements. Goal 35: Assist the pharmacist in assuring the quality of all pharmaceutical services. OBJ 35.1 (Application) Apply the principles of quality assurance to all technician activities.
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Appraisal Systems and Rotation Documentation for the Student and Preceptor
The following documentation is used for the evaluation of student performance and progress throughout the Practicum rotation.
This section includes: - Class A Documentation o Timesheet o Mid-Semester Performance Appraisal o Final Performance Appraisal o Performance Appraisal Checklist - Class C Documentation o Timesheet o Mid-Semester Performance Appraisal o Final Performance Appraisal o Performance Appraisal Checklist
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Community (Class A) Pharmacy Rotation Timesheet

Student: Pharmacy License #___________ Pharmacy Name:___________________________________ Pharmacy address_____________________________________ Is Preceptor a RPh?____ CPhT?___ PhTR?____
Preceptor Name: ____________________
Attention Preceptors: Please send all timesheet, evaluation, and checklist forms directly to the practicum coordinator either by mail to: ACC-PHRA, attn: Lisa McCartney, 3401 Webberville Road, Austin TX 78702, scan/email to lmccartn@austincc.edu or fax to my attention at 512-223-5895.Please review and sign all forms with the students. Keep a copy for your records, give the student a copy, and send me the original, signed, and dated forms. All forms must be sent directly to the practicum coordinator, and may not be delivered by the student. Date Range
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total # Preceptor/ # of hours # of hours # of hours # of hours # of hours # of hours # of hours hours for Trainer worked worked worked worked worked worked worked the week Initials
Week
TOTAL HOURS
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Community (Class A) Pharmacy Rotation

Midterm Student Performance Appraisal Eight areas of performance have been listed to help evaluate the student. A comment may be written beside each area or they may be combined in one all-inclusive evaluation. This appraisal should be reviewed with the student at the midpoint of their practicum experience (64 hours). Both the preceptor and the student should sign and date the forms. The completed appraisal should be returned directly to the Pharmacy Technician Practicum Coordinator. Attention Preceptors: Please send all timesheet, evaluation, and checklist forms directly to the practicum coordinator either by mail to: ACC-PHRA, attn: Lisa McCartney, 3401 Webberville Road, Austin TX 78702, scan/email to lmccartn@austincc.edu or fax to my attention at 512-223-5895.Please review and sign all forms with the students. Keep a copy for yourself, give the student a copy, and send me the original, signed, and dated forms. For security reasons, all forms must be sent directly to the practicum coordinator and may not be delivered by the student.
Knowledge
Consider knowledge learned at the site as well as acquired classroom knowledge and how it was put to use.
Ability to learn new concepts

Consider how well the student asked questions and attempted new things.
Initiative
Consider how well and how often the student asked question or offered ideas.
Quality of work
Consider how neat, accurate and dependable the student was.
Quantity of work
Consider the amount of work completed compared to the level of pharmacy technician experience.
Communication
Consider how well the student interacted with others.
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Judgment:
Consider how logically the student thought and acted.
Attitude
Consider the students overall attitude about the practicum as well as toward being a pharmacy technician.
Attendance
Consider the students promptness and consistency while assigned to the site.
Other Comments
__________________________________ Student Signature
__________________________________ Preceptor Signature
__________________________________ Date of Appraisal Review
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Final Student Performance Appraisal Student Name: ______________________________________ Date ___________________ Preceptor: __________________________________________ Pharmacy: __________________________________________ Eight areas of performance have been listed to help evaluate the student. A comment may be written beside each area or they may be combined in one all-inclusive evaluation. This appraisal should be reviewed with the student at the completion of their practicum experience (128 hours). Both the preceptor and the student should sign and date the forms. The completed appraisal, including the Performance Appraisal Checklist, should be returned directly to the Pharmacy Technician Practicum Coordinator. Attention Preceptors: Please send all timesheet, evaluation, and checklist forms directly to the practicum coordinator either by mail to: ACC-PHRA, attn: Lisa McCartney, 3401 Webberville Road, Austin TX 78702, scan/email to lmccartn@austincc.edu or fax to my attention at 512-223-5895.Please review and sign all forms with the students. Keep a copy for your records, give the student a copy, and send me the original, signed, and dated forms. For security reasons, all forms must be sent directly to the practicum coordinator and may not be delivered by the student.
Knowledge

Initiative
Quality of work
Quantity of work
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Communication
Judgment:
Attitude
Attendance
Other Comments
Using the five-letter scale, what estimated grade would you assign the student upon completion of their rotation? (A: Excellent; B: Good; C: Average; D: Below Average; F: Failing)_______
____________________________________ Date of Appraisal Review
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Performance Appraisal Checklist
This appraisal should be filled out throughout the students practicum experience and submitted as a part of the Final Evaluation. Consider the students performance and experience and indicate whether the student has demonstrated minimum competency in the goal area or not. Note: There may be some goal statements that not apply directly to duties that are performed by technicians within your specific practice setting. In those cases, leave both check boxes blank. Please do not mark either box for that competency. For competencies that are not demonstrated in your practice area, the student will receive instruction in the classroom and pharmacy lab that satisfies the goal statement in that area.
C = Competent (minimal, basic competency skills noted) NI = Needs Improvement (minimal, basic competency skills lacking)
Goal Statements C NI
Assist the pharmacist in collecting, organizing, and evaluating information for direct patient care, medication use review, and departmental management. Receive and screen prescription/medication orders for completeness and authenticity. Prepare medications for distribution. Verify the measurements, preparation, and/or packaging of medications produced by other technicians. Distribute medications. Assist the pharmacist in the administration of immunizations. Assist the pharmacist in the identification of patients who desire/require counseling to optimize the use of medications, equipment, and devices. Initiate, verify, assist in the adjudication of, and collect payment and/or initiate billing for pharmacy services and goods. Purchase pharmaceuticals, devices, and supplies according to an established purchasing program. Control the inventory of medications, equipment, and devices according to an established plan. Assist the pharmacist in monitoring the practice site and/or service area for compliance with federal, state, and local laws, regulations, and professional standards. Maintain pharmacy equipment and facilities. Assist the pharmacist in preparing, storing, and distributing investigational medication products. Assist the pharmacist in the monitoring of medicating therapy.
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Goal Statements
NI
Take personal responsibility for assisting the pharmacist in improving direct patient care. Demonstrate ethical conduct in all job-related activities. Maintain an image appropriate for the profession of pharmacy. Resolve conflicts through negotiation. Understand the principles for managing change. Participate in the pharmacy department's process for preventing medication misadventures. Appreciate the need to adapt direct patient care to meet the needs of diversity. Appreciate the benefits of active involvement in local, state, and national technician and other pharmacy organizations. Appreciate the value of obtaining technician certification. Understand the importance of and resources for staying current with changes in pharmacy practice. Communicate clearly when speaking or writing. Maximize work efficiency through the use of technology. Efficiently solve problems commonly encountered in one's own work. Display a caring attitude toward patients in all aspects of job responsibilities. Maintain confidentiality of patient and proprietary business information. Understand direct patient care delivery systems in multiple practice settings. Efficiently manage one's work whether performed alone or as part of a team. Function effectively as a member of the health care team. Balance obligations to one's self, relationships, and work in a way that minimizes stress. Understand the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) used to treat common disease states. Assist the pharmacist in assuring the quality of all pharmaceutical services.
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Additional Comments:
Preceptor TSBP License or Registration #__________________________ Preceptor TSBP License or Registration Expiration Date_______________ Preceptor PTCB Certification Number (if applicable)___________________ Preceptor PTCB Expiration Date (if applicable)_______________________
Please review the timesheet, mid-rotation evaluation, final evaluation, and preceptor checklist with the student and have them sign. The preceptor or evaluator should also sign, date, and complete the licensing information. Give a signed copy to the student, keep a signed copy for your records, and then send to the originals (ALL must be signed and dated) to the ACC practicum coordinator by one of the following methods: Email: Fax: Mail: lmccartn@austincc.edu 512-223-5895 Lisa McCartney, Practicum Coordinator ACC Eastview PHRA 3401 Webberville Road Austin TX 78702
Note: ALL forms must be completed (MUST be signed and dated) and submitted to the practicum coordinator in order to meet our ASHP Accreditation requirements. Please let me know if you have any questions.
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Institutional (Class C) Pharmacy Rotation Timesheet

Student: ____________________ Pharmacy License #___________ Pharmacy Name___________________________ Pharmacy address_________________________
Preceptor Name: ______________ Is Preceptor a RPh?____ CPhT?___ PhTR?____ Attn: Preceptors please send all timesheet, evaluation, and checklist forms directly to the practicum coordinator either by mail to: ACC-PHRA, attn: Lisa McCartney, 3401 Webberville Road, Austin TX 78702, scan/email to lmccartn@austincc.edu or fax to my attention at 512-223-5895.Please review and sign all forms with the students. Keep a copy for yourself, give the student a copy, and send me the original, signed, and dated forms. For security reasons, all forms must be sent directly to the practicum coordinator and may not be delivered by the student. Date Range
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total # Preceptor/ # of hours # of hours # of hours # of hours # of hours # of hours # of hours hours for Trainer worked worked worked worked worked worked worked the week Initials
Week
TOTAL HOURS
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Institutional (Class C) Pharmacy Rotation

Midterm Student Performance Appraisal Student Name: ______________________________________ Date ___________________ Preceptor: __________________________________________ Pharmacy: __________________________________________ Eight areas of performance have been listed to help evaluate the student. A comment may be written beside each area or they may be combined in one all-inclusive evaluation. This appraisal should be reviewed with the student at the midpoint of their practicum experience (64 hours). Both the preceptor and the student should sign and date the forms. The completed appraisal should be returned directly to the Pharmacy Technician Practicum Coordinator. Attention Preceptors: Please send all timesheet, evaluation, and checklist forms directly to the practicum coordinator either by mail to: ACC-PHRA, attn: Lisa McCartney, 3401 Webberville Road, Austin TX 78702, scan/email to lmccartn@austincc.edu or fax to my attention at 512-223-5895.Please review and sign all forms with the students. Keep a copy for yourself, give the student a copy, and send me the original, signed, and dated forms. For security reasons, all forms must be sent directly to the practicum coordinator and may not be delivered by the student.
Knowledge

Initiative
Quality of work
Quantity of work
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Communication
Judgment:
Attitude
Attendance
Other Comments
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Institutional (Class C) Pharmacy Rotation Final Student Performance Appraisal

Student: __________________ Pharmacy License #__________ _ Preceptor Name: ______________ __ Pharmacy Name_________________________ __
Pharmacy address_________
________________
Is Preceptor a RPh?____ CPhT?___ PhTR?____
Eight areas of performance have been listed to help evaluate the student. A comment may be written beside each area or they may be combined in one all-inclusive evaluation. This appraisal should be reviewed with the student at the completion of their practicum experience (128 hours). Both the preceptor and the student should sign and date the forms. The completed appraisal, including the Performance Appraisal Checklist, should be returned directly to the Pharmacy Technician Practicum Coordinator. Attention Preceptors: Please send all timesheet, evaluation, and checklist forms directly to the practicum coordinator either by mail to: ACC-PHRA, attn: Lisa McCartney, 3401 Webberville Road, Austin TX 78702, scan/email to lmccartn@austincc.edu or fax to my attention at 512-223-5895.Please review and sign all forms with the student. Keep a copy for yourself, give the student a copy, and send me the original, signed, and dated forms. For security reasons, all forms must be sent directly to the practicum coordinator and may not be delivered by the student.
Knowledge

Initiative
Quality of work
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Quantity of work
Communication
Judgment:
Attitude
Attendance
Other Comments
Using the five-letter scale, what estimated grade would you assign the student upon completion of their rotation? (A: Excellent; B: Good; C: Average; D: Below Average; F: Failing: ________

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Institutional (Class C) Pharmacy Rotation

Performance Appraisal Checklist
This appraisal should be filled out throughout the students practicum experience and submitted as a part of the Final Evaluation. Consider the students performance and experience and indicate whether the student has demonstrated minimum competency in the goal area or not. Note: There may be some goal statements that not apply directly to duties that are performed by technicians within your specific practice setting. In those cases, leave both check boxes blank. Please do not mark either box for that competency. For competencies that are not demonstrated in your practice area, the student will receive instruction in the classroom and pharmacy lab that satisfies the goal statement in that area. C = Competency (minimal, basic competency skills noted) NI (minimal, basic competency skills lacking)= Needs Improvement
Goal Statements Assist the pharmacist in collecting, organizing, and evaluating information for direct patient care, medication use review, and departmental management. Receive and screen prescription/medication orders for completeness and authenticity. e Prepare medications for distribution. Verify the measurements, preparation, and/or packaging of medications produced by other technicians. Distribute medications. Assist the pharmacist in the administration of immunizations. Assist the pharmacist in the identification of patients who desire/require counseling to optimize the use of medications, equipment, and devices. Initiate, verify, assist in the adjudication of, and collect payment and/or initiate billing for pharmacy services and goods. Purchase pharmaceuticals, devices, and supplies according to an established purchasing program. Control the inventory of medications, equipment, and devices according to an established plan. Assist the pharmacist in monitoring the practice site and/or service area for compliance with federal, state, and local laws, regulations, and professional standards. Maintain pharmacy equipment and facilities. Assist the pharmacist in preparing, storing, and distributing investigational medication products. Assist the pharmacist in the monitoring of medicating therapy. Participate in the pharmacy department's process for preventing medication misadventures. Take personal responsibility for assisting the pharmacist in improving direct patient care.
NI
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Demonstrate ethical conduct in all job-related activities. Maintain an image appropriate for the profession of pharmacy. Resolve conflicts through negotiation. Understand the principles for managing change. Appreciate the need to adapt direct patient care to meet the needs of diversity. Appreciate the benefits of active involvement in local, state, and national technician and other pharmacy organizations. Appreciate the value of obtaining technician certification. Understand the importance of and resources for staying current with changes in pharmacy practice. Communicate clearly when speaking or writing. Maximize work efficiency through the use of technology. Efficiently solve problems commonly encountered in one's own work. Display a caring attitude toward patients in all aspects of job responsibilities. Maintain confidentiality of patient and proprietary business information. Understand direct patient care delivery systems in multiple practice settings. Efficiently manage one's work whether performed alone or as part of a team. Function effectively as a member of the health care team. Balance obligations to one's self, relationships, and work in a way that minimizes stress. Understand the use and side effects of prescription medications, nonprescription medications, and alternative therapies (e.g., herbal products, dietary supplements, homeopathy, lifestyle modification) used to treat common disease states. Assist the pharmacist in assuring the quality of all pharmaceutical services.

38
Preceptor TSBP License or Registration #__________________________
Preceptor TSBP License or Registration Expiration Date_______________
Preceptor PTCB Certification Number (if applicable)___________________
Preceptor PTCB Expiration Date (if applicable)_______________________
Please review the timesheet, mid-rotation evaluation, final evaluation, and preceptor checklist with the student and have them sign. The preceptor or evaluator should also sign, date, and complete the licensing information. Give a signed copy to the student, keep a signed copy for your records, and then send to the originals (ALL must be signed and dated) to the ACC practicum coordinator by one of the following methods:
Email: Fax: Mail:
lmccartn@austincc.edu 512-223-5895 Lisa McCartney, Practicum Coordinator ACC Eastview PHRA 3401 Webberville Road Austin TX 78702
Note: ALL forms must be completed (MUST be signed and dated) and submitted to the practicum coordinator in order to meet our ASHP Accreditation requirements. Please let me know if you have any questions.
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Student Site Appraisal Documentation

The following Site Appraisals will be used by the Student to evaluate the facility and the site and preceptor assigned to each student. The checklist will be used by the faculty and the advisory committee of the Pharmacy Technician Program to ensure that we are providing our students with the best possible learning sites available. If you have any questions regarding the checklist or its use, please contact the Practicum Coordinator or Program Department Chair. Results of these surveys will be communicated either in writing or verbally once the student has completed the Practicum. Results will be distributed to the corporate or district contact through which the rotation was arranged, or their designee. The student is responsible for filling out the Community Pharmacy Student Site Appraisal and the Institutional Pharmacy Student Site Appraisal upon completion of each of their practicum rotations. The site appraisal forms must be turned in during the students final meeting with the practicum coordinator.
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Community (Class A) Pharmacy Student Site Appraisal

Student Name ________________________________________________________________ Pharmacy ___________________________________________________________________ Preceptor ___________________________________________________________________ Date ______________________ Student Signature ________________________________
If you require more space to explain your answers, please use the blank page located just after this site evaluation. 1. Did you complete all study units listed in the practicum manual? Yes _____ No _____ If no, why? _______________________________
______________________________________________________________________ ______________________________________________________________________
2. List the study units you would like to have had more experience with, if any. ______________________________________________________________________ ______________________________________________________________________
3. Do you feel you were allowed adequate opportunity to perform pharmacy training activities? Yes _____ No _____ If no, why? _______________________________
______________________________________________________________________ ______________________________________________________________________
4. Most supervised instruction was provided by: Pharmacist _____ Technician _____ Others _____
5. How would you describe your supervision? Close (constant) _____ Infrequent (seldom) _____ Frequent _____ Inadequate (almost none) _____
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6. Did your preceptor instruct and guide you through procedures? Definitely _____ Some _____ Little _____ No _____
7. Did you receive immediate feedback on performed activities? Yes _____ No _____
8. Was the feedback constructive? Yes _____ No _____
If no, please explain: _____________________________________________________ ______________________________________________________________________ ______________________________________________________________________
9. Was the rotation Too long _____ Adequate _____ Too short _____
Explain your answer: _______________________________________________ ______________________________________________________________________ ______________________________________________________________________
10. How would you rate this experience? Exceptional _____ Unsatisfactory _____ Needs improvement _____ Satisfactory _____ Above Average _____
11. In your opinion, what changes would improve this experience?
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Please, use this page to complete your thought from the survey if you did not have adequate space provided for your answers.
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Institutional (Class C) Pharmacy Student Site Appraisal

Student Name ________________________________________________________________ Pharmacy ___________________________________________________________________ Preceptor ___________________________________________________________________ Date ______________________ Student Signature ________________________________
If you require more space to explain your answers, please use the blank page located just after this site evaluation. 1. Did you complete all study units listed in the practicum manual? Yes _____ No _____ If no, why? _______________________________
______________________________________________________________________ ______________________________________________________________________
2. List the study units you would like to have had more experience with, if any. ______________________________________________________________________ ______________________________________________________________________
3. Do you feel you were allowed adequate opportunity to perform pharmacy training activities? Yes _____ No _____ If no, why? _______________________________
______________________________________________________________________ ______________________________________________________________________
4. Most supervised instruction was provided by: Pharmacist _____ Technician _____ Others _____
5. How would you describe your supervision? Close (constant) _____ Infrequent (seldom) _____ Frequent _____ Inadequate (almost none) _____
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6. Did your preceptor instruct and guide you through procedures? Definitely _____ Some _____ Little _____ No _____
7. Did you receive immediate feedback on performed activities? Yes _____ No _____
8. Was the feedback constructive? Yes _____ No _____
If no, please explain: _____________________________________________________ ______________________________________________________________________ ______________________________________________________________________
9. Was the rotation Too long _____ Adequate _____ Too short _____
Explain your answer: _______________________________________________ ______________________________________________________________________ ______________________________________________________________________
10. How would you rate this experience? Exceptional _____ Unsatisfactory _____ Needs improvement _____ Satisfactory _____ Above Average _____
11. In your opinion, what changes would improve this experience?
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Please, use this page to complete your thought from the survey if you did not have adequate space provided for your answers.
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Appraisal Systems and Rotation Documentation for the Practicum Coordinator
The following Practicum Site Checklists will be used by the Practicum Coordinator to evaluate the facility and the preceptor assigned to each student. The checklist will be used by the faculty and the advisory committee of the Pharmacy Technician Program to ensure that we are providing our students with the best possible learning sites available. If you have any questions regarding the checklist or its use, please contact the Practicum Coordinator or Department Chair.
The forms in the following section are to be filled out by the ACC Practicum Coordinator
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Community (Class A) Pharmacy Site Checklist

Name of Facility: Facility Location: _____________________________________________________ _____________________________________________________
Name of Preceptor: _____________________________________________________ Description of Facility Requirements

Facility allows student to enter prescriptions into the computer system. Facility allows student to greet customers and process prescription orders. Facility allows student to answer the phone and assist patients and medical personnel. Facility allows student to assist in processing insurance and/or third party payment plans. Facility has adequate equipment and allows student to type prescription labels. Facility is set up in an organized fashion so that student can locate medications and/or supplies for filling prescriptions. Facility is licensed by the Texas State Board of Pharmacy. Facility has the appropriate reference manuals.
Meets Minimum Requirement
Does Not Meet Minimum Requirement
Comments
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Facility stores all supplies and medications appropriately. Facility maintains a Texas licensed pharmacist on duty at all times while open. Facility maintains prescriptions and records appropriately according to state and federal laws. Facility follows appropriate protocol for disposing of expired or damaged supplies/medications. Facility follows appropriate procedures for storage and handling of controlled substances. Facility has adequate security and space to provide a proper learning environment. Facility personnel are cooperative and able to assist student with basic training. Facility has designated area for which we can meet with the student privately if necessary. Facility follows appropriate guidelines for ordering, pricing, and distributing various inventory and supplies.
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Facility follows proper guidelines for shipping, packaging, dispensing, and/or delivering of all types of medications and supplies. Facility uses the appropriate forms and methods of documenting, batching, compounding, packaging, etc.
License Number: _______________________ Expiration Date: __________________ Semester Evaluated: ____________________ Year: _____________________
Evaluated by: __________________________________________________________
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Institutional (Class C) Pharmacy Site Checklist

Name of Facility: Facility Location: _____________________________________________________ _____________________________________________________
Name of Preceptor: _____________________________________________________ Does Not Meet Minimum Requirement
Description of Facility Requirements

Facility allows student to enter prescriptions (physicians orders) into the computer system Facility allows student to process physicians orders Facility allows students to answer the phone and assist medical personnel Facility has adequate equipment and allows student to type medication labels Facility is set up in an organized fashion so that student can locate medications/ supplies for filling prescriptions Facility is accredited by the appropriate agency and meets minimum standard Facility is licensed by the Texas State Board of Pharmacy Facility has the appropriate reference manuals Facility stores all supplies and medications appropriately Facility maintains a Texas licensed pharmacist on duty at all times while open
Meets Minimum Requirement
Comments
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Facility maintains prescriptions and records appropriately Facility follows appropriate protocol for disposing of expired or damaged supplies/medications Facility follow aseptic technique when compounding non-sterile and/or sterile products Facility stores and handles hazardous and/or cytotoxic agents appropriately and has appropriate spill kits Facility follows appropriate procedures for storage and handling of controlled substances Facility has adequate security and space to provide a proper learning atmosphere Facility personnel are cooperate and able to assist student with basic training Facility has a designated area where we can meet with the student privately, if necessary Facility has appropriate equipment and supplies for the preparation of compounding products Facility has designated area (clean room) appropriate for the preparation of sterile products Facility follows appropriate dress and hand washing techniques for sterile product preparations
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Facility follows appropriate techniques for each type of sterile product being prepared (i.e. TPN, Chemo, Epidural, IVPB, etc.) Facility follows proper procedures for disposal of all hazardous cytotoxic, and/or sharps materials Facility follows proper technique for utilizing computerized technology in batching, compounding, or sterile product preparation Facility follows appropriate guidelines for ordering, pricing, and distributing various inventory and supplies Facility follows Texas State Board of Pharmacy rules and guidelines for preparation of sterile and/or non-sterile products Facility follows proper guidelines for shipping, packaging, dispensing, and/or delivering of all types of medications and supplies Facility has appropriate guidelines and follows these guidelines for handling and cleaning all returned equipment, supplies and medication Facility follows appropriate ASHP guidelines for quality assurance testing of products, supplies, equipment, and personnel Facility used the appropriate forms and methods of documenting, batching, compounding, packaging, etc.
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Facility follows appropriate procedures for dispensing and preparation of unit dose medication system Facility follows appropriate protocol for handling, dispensing, and disposal of investigational drugs Facility follows appropriate procedures for handling automated unit dose dispensing technology and robotics
Is this site accredited by JCAHO?
Yes
No
License Number: _______________________ Expiration Date: __________________ Semester Evaluated: ____________________ Year: _____________________ Evaluated by: __________________________________________________________
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ACC Pharmacy Practicum Orientation Agreement of Understanding By initialing before each statement, I fully agree to the following: 1) I understand that I will not be allowed to take the practicum course this semester if I have not successfully completed all prerequisites and submitted a voucher. I will read the entire practicum workbook no later than contact my instructor immediately if I have any questions. . I will
2)
3)
I will abide by all of the guidelines and rules contained in the practicum workbook. I will provide my instructor with an e-mail copy of my schedule as soon as it is confirmed. I will provide my instructor with an updated schedule as soon as I receive it. At no time will I be at my practicum site without my instructors knowledge. I will call my preceptor immediately if I am going to be late or miss work. I will email my instructor immediately if I should miss one of my scheduled rotation days, or if my schedule changes. At no time will I be at my practicum site without my preceptors knowledge. If the day to be missed or rescheduled is less than 48 hours away, I will ALSO call my instructor and leave a message regarding the change. I will notify my instructor, via email, immediately upon any change in my contact information. I will immediately register my training site with the State Board of Pharmacy once I have been assigned to each of my practicum sites. I will maintain an active ACC gmail address and check both my email and the Blackboard announcements page at least twice per week during the semester. I agree to respond to my instructors emails and calls within 24 hours. I will arrive to my assigned practice site on time, focused, and ready to learn and work. I will not do my homework or other non-practicum related work during my assigned practicum hours. I will avoid discussing personal issues at my practicum site. I will not make or receive personal phone calls at my practicum site.
4)
5)
6)
7)
8)
9)
10) 11)
12) 13)
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14)
I will maintain a positive attitude, and will always communicate in a professional manner. I will use every experience as an opportunity to learn and grow.
15)___ I will conduct myself in a professional manner at all times. 16)___ I will follow the rules and regulations of my practicum site, including complying with no-smoking regulations. 17)___I understand that, due to the sensitive nature of the pharmacy environment, I may be asked to undergo a drug screen at any time before or during my practicum rotations. (refer to the Pharmacy Technician Program Handbook, Health Sciences Division Policy and Procedure section, for further information on our drug screening policy) 18)___I understand that, due to the sensitive nature of the pharmacy environment, my practicum sites have the authority to search my belongings, including my car, while I am on their property during my rotation. 19) I understand that I MUST contact my preceptor immediately if I am going to be late or am going to miss a shift at my practicum site. Failure to do so will result in your receiving a no call, no show and may lead to your withdrawal from the practicum site. Being asked not to return to a practicum site is very serious and may result in you receiving failing grade for the course.
20)___I understand the importance of the relationship between the ACC pharmacy technician program and each of the practicum sites. I will always behave in such a manner that supports the growth and continuance of that relationship.
I have carefully read and agree to each of the statements in the practicum agreement of understanding letter. I have been fully informed of what is expected of me during my practicum rotation. I have completed the mandatory practicum orientation session.
Signed_____________________________________________
Printed Name_______________________________________
Date______________________________________________
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Program Student Learning Outcomes See the Pharmacy Technician Program student handbook (provided to you during program orientation) for a list of the program student learning outcomes.
Use of ACC Email All College e-mail communication to students will be sent solely to the students ACCmail account, with the expectation that such communications will be read in a timely fashion. ACC will send important information and will notify you of any college related emergencies using this account. Students should only expect to receive email communication from their instructor using this account. Likewise, students should use their ACCmail account when communicating with instructors and staff. Instructions for activating an ACCmail account can be found at http://www.austincc.edu/accmail/index.php. Computer Skills Requirement
All of the pharmacy technician courses (both the distance learning and live course sections) require the use of a computer. You must have regular access to the Blackboard system. You must be able to use Blackboards Digital Drobpox. If you are new to Blackboard, please complete the Blackboard tutorial at acconline.austincc.edu You will be required to submit college level papers written according to specific formatting instructions using Microsoft Word (or similar). You will be trained on various pharmacy specific computer programs once you progress to the pharmacy laboratory course. You must have basic computer experience in order to be successful in pharmacy program courses. If you do not have basic computer skills you may wish to take a computer course such as COSC 1301 Introduction to Computing. Computers and computer support are available on all ACC campus at the Learning Laboratories. http://www.austincc.edu/tutor/
Tutoring
Free tutoring is available all ACC learning labs. Students are strongly encouraged to have tutors proof read all written assignments before submitting them for a grade. For more information: http://www.austincc.edu/tutor/ The pharmacy department has a pharmacy-specific tutor who is happy to assist you with any questions that you may have about any assignments from any of your pharmacy courses. Please contact Macy Moreno at 223-5941 or lmoreno@austincc.edu for the tutors contact information.
Mandatory Mid-Semester Meeting

All students are required to meet with the pharmacy department chair at the mid-point of the semester to complete mandatory paperwork and discuss course/program progression. I will contact you via email to set up this meeting. You will not be allowed for the next semester until your mid-semester and associated paperwork has been completed.
Student concerns
Any student who has a complaint involving the course should first attempt to resolve the matter with the instructor directly involved. If the student is unable to resolve the complaint with the instructor, the student must contact the department chair in writing by email in an attempt to resolve the matter.
SCANS Competencies
In 1990, the U.S. Department of Labor established the Secretarys Commission on Achieving Necessary Skills (SCANS) to examine the demands of the workplace and whether our nations students are capable of meeting those demands. The Commission determined that todays jobs generally require competencies in the following areas: Resources: Identifies, organizes, plans and allocates resources Interpersonal: Works with others Information: Acquires and uses information Systems: Understands complex interrelationships Technology: Works with a variety of technologies The Texas Higher Education Coordinating Board requires that all degree plans in institutions of higher education incorporate these competencies and identify to the student how these competencies are achieved
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in course objectives. This course, Introduction to Pharmacy, incorporates the SCANS competencies in the following ways: Resources Manages time for completing assignments Selects appropriate references for given drug information Interpersonal 36. Negotiates to arrive at a decision when determining methods and references in the ordering of pharmaceuticals and devices 37. Participates as a member of a team when completing group assignments Information D. Acquires and evaluates information presented in lectures E. Organizes and maintains information required for passing examinations Systems I. Understands systems used for answering drug information questions J. Understands systems used for securing pharmaceuticals Technology 11. Uses computer to complete assignments 12. Uses computer references for answering drug information questions Basic Skills F. Demonstrates ability to read assignments and textbook G. Demonstrates ability to write when completing assignments that must be turned in H. Demonstrates ability to listen to lectures Thinking Skills Demonstrates creative thinking when preparing assignments, such as job interviews and resumes Demonstrates ability to make decisions when answering drug information questions, and selecting ordering methods Demonstrates ability to solve problems when interpreting prescriptions and medication orders Personal Qualities Demonstrates responsibility through attendance Demonstrates responsibility through assignment completion in a timely manner Demonstrates self-management when completing assignments Demonstrates integrity and honesty when completing assignments.
Statement on Students with Disabilities Each ACC campus offers support services for students with documented disabilities. Students with disabilities who need classroom, academic or other accommodations must request them through the Office for Students with Disabilities (OSD). Students are encouraged to request accommodations when they register for courses or at least three weeks before the start of the semester, otherwise the provision of accommodations may be delayed. Students who have received approval for accommodations from OSD for this course must provide the instructor with the Notice of Approved Accommodations from OSD before accommodations will be provided. Arrangements for academic accommodations can only be made after the instructor receives the Notice of Approved Accommodations from the student. Students with approved accommodations are encouraged to submit the Notice of Approved Accommodations to the instructor at the beginning of the semester because a reasonable amount of time may be needed to prepare and arrange for the accommodations. Additional information about the Office for Students with Disabilities is available at http://www.austincc.edu/support/osd/ Safety Statement Austin Community College is committed to providing a safe and healthy environment for study and work. You are expected to learn and comply with ACC environmental, health and safety procedures and agree to follow ACC safety policies. Additional information on these can be found at http://www.austincc.edu/ehs. 63
Because some health and safety circumstances are beyond our control, we ask that you become familiar with the Emergency Procedures poster and Campus Safety Plan map in each classroom. Additional information about emergency procedures and how to sign up for ACC Emergency Alerts to be notified in the event of a serious emergency can be found at http://www.austincc.edu/emergency/. You are expected to conduct yourself professionally with respect and courtesy to all. Anyone who thoughtlessly or intentionally jeopardizes the health or safety of another individual will be immediately dismissed from the days activity, may be withdrawn from the class, and/or barred from attending future activities. Student and Instructional Services ACC strives to provide exemplary support to its students and offers a broad variety of opportunities and services. Information on these services and support systems is available at: http://www.austincc.edu/s4/ Links to many student services and other information can be found at: http://www.austincc.edu/current/ ACC Learning Labs provide free tutoring services to all ACC students currently enrolled in the course to be tutored. The tutor schedule for each Learning Lab may be found at: http://www.autincc.edu/tutor/students/tutoring.php For help setting up your ACCeID, ACC Gmail, or ACC Blackboard, see a Learning Lab Technician at any ACC Learning Lab. Statement on Scholastic Dishonesty A student attending ACC assumes responsibility for conduct compatible with the mission of the college as an educational institution. Students have the responsibility to submit coursework that is the result of their own thought, research, or self-expression. Students must follow all instructions given by faculty or designated college representatives when taking examinations, placement assessments, tests, quizzes, and evaluations. Actions constituting scholastic dishonesty include, but are not limited to, plagiarism, cheating, fabrication, collusion, and falsifying documents. Penalties for scholastic dishonesty will depend upon the nature of the violation and may range from lowering a grade on one assignment to an F in the course and/or expulsion from the college. See the Student Standards of Conduct and Disciplinary Process and other policies at http://www.austincc.edu/current/needtoknow Student Rights and Responsibilities Students at the college have the rights accorded by the U.S. Constitution to freedom of speech, peaceful assembly, petition, and association. These rights carry with them the responsibility to accord the same rights to others in the college community and not to interfere with or disrupt the educational process. Opportunity for students to examine and question pertinent data and assumptions of a given discipline, guided by the evidence of scholarly research, is appropriate in a learning environment. This concept is accompanied by an equally demanding concept of responsibility on the part of the student. As willing partners in learning, students must comply with college rules and procedures. Statement on Academic Freedom Institutions of higher education are conducted for the common good. The common good depends upon a search for truth and upon free expression. In this course the professor and students shall strive to protect free inquiry and the open exchange of facts, ideas, and opinions. Students are free to take exception to views offered in this course and to reserve judgment about debatable issues. Grades will not be affected by personal views. With this freedom comes the responsibility of civility and a respect for a diversity of ideas and opinions. This means that students must take turns speaking, listen to others speak without interruption, and refrain from name-calling or other personal attacks. Testing Center Policy Under certain circumstances, an instructor may have students take an examination in a testing center. Students using the Academic Testing Center must govern themselves according to the Student Guide for Use of ACC Testing Centers and should read the entire guide before going to take the exam. To request an exam, one must have: 64
ACC Photo ID Course Abbreviation (e.g., ENGL) Course Number (e.g.,1301) Course Synonym (e.g., 10123) Course Section (e.g., 005) Instructor's Name Do NOT bring cell phones to the Testing Center. Having your cell phone in the testing room, regardless of whether it is on or off, will revoke your testing privileges for the remainder of the semester. ACC Testing Center policies can be found at http://www.austincc.edu/testctr/
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Pharm Tech Practicum Workbook

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Pharm Tech Practicum Workbook

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Fall

Department of Pharmacy Technology

Pharmacy Technician Practicum PHRA 2266/2066

Required Texts: None

2005 to 2011 Austin Community College

Practicum Rotation Information

State Board of Pharmacy Reporting Procedures

Practicum Goal Statements and Objectives

Maximize work efficiency through the use of technology.

Community (Class A) Pharmacy Rotation Timesheet

Preceptor Name: ____________________

Community (Class A) Pharmacy Rotation

Ability to learn new concepts

__________________________________ Student Signature

__________________________________ Preceptor Signature

__________________________________ Date of Appraisal Review

Community (Class A) Pharmacy Rotation

Ability to learn new concepts

__________________________________ Student Signature

__________________________________ Preceptor Signature

____________________________________ Date of Appraisal Review

Community (Class A) Pharmacy Rotation

__________________________________ Student Signature

__________________________________ Preceptor Signature

____________________________________ Date of Appraisal Review

Institutional (Class C) Pharmacy Rotation Timesheet

Institutional (Class C) Pharmacy Rotation

Ability to learn new concepts

__________________________________ Student Signature

__________________________________ Preceptor Signature

____________________________________ Date of Appraisal Review

Institutional (Class C) Pharmacy Rotation Final Student Performance Appraisal

Is Preceptor a RPh?____ CPhT?___ PhTR?____

Ability to learn new concepts

__________________________________ Student Signature

__________________________________ Preceptor Signature

____________________________________ Date of Appraisal Review

Institutional (Class C) Pharmacy Rotation

__________________________________ Student Signature

__________________________________ Preceptor Signature

____________________________________ Date of Appraisal Review

Preceptor TSBP License or Registration #__________________________

Preceptor TSBP License or Registration Expiration Date_______________

Preceptor PTCB Certification Number (if applicable)___________________

Preceptor PTCB Expiration Date (if applicable)_______________________

Email: Fax: Mail:

Student Site Appraisal Documentation

Community (Class A) Pharmacy Student Site Appraisal

8. Was the feedback constructive? Yes _____ No _____

If no, please explain: _____________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Explain your answer: _______________________________________________ ______________________________________________________________________ ______________________________________________________________________

11. In your opinion, what changes would improve this experience?

Institutional (Class C) Pharmacy Student Site Appraisal

8. Was the feedback constructive? Yes _____ No _____

If no, please explain: _____________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Explain your answer: _______________________________________________ ______________________________________________________________________ ______________________________________________________________________

11. In your opinion, what changes would improve this experience?

Appraisal Systems and Rotation Documentation for the Practicum Coordinator

Community (Class A) Pharmacy Site Checklist

Name of Preceptor: _____________________________________________________ Description of Facility Requirements

Meets Minimum Requirement

Does Not Meet Minimum Requirement

Evaluated by: __________________________________________________________

Institutional (Class C) Pharmacy Site Checklist

Is Preceptor a RPh?__ CPhT?_ PhTR?____

8. Was the feedback constructive? Yes _ No _

If no, please explain: _ ____________________

Explain your answer: _ __________________________

8. Was the feedback constructive? Yes _ No _

If no, please explain: _ ____________________

Explain your answer: _ __________________________