Académique Documents
Professionnel Documents
Culture Documents
PHARMACY
PERSONAL PARTICULARS
[To Be Completed By the Provisionally Registered Pharmacist (PRP)]
1. Name (in capital letters)
5. Home Address
6. E-mail Address
8. Scholarship/Sponsor (Federal/MARA/Others):
Signature:
Date:
Page 1
1.
INTRODUCTION
1.1
1.2
1.3
The Pharmacy Board may extend the one year period of employment of a PRP if
the Board is not satisfied with the performance of that person as a PRP.
1.4
1.5
Page 2
2.
2.1
This record book is designed primarily to guide the provisionally pharmacists and
their preceptors of various pharmacy disciplines in the training hospital/institution
in coordinating activities and programmes during the one-year provisional training.
2.2
The number of cases in this logbook serves as a guideline and is subject to the
capacity of individual hospital.
2.3
This record book will be the basis for the appraisal by all of the trainers and
preceptors, which shall be submitted to the Pharmacy Board for the purpose of
registration as a fully registered pharmacist at the end of the training.
2.4
2.5
2.4.1
2.4.2
Endorse the completion of each task with signature, name and date in
the column provided.
2.5.2
unsatisfactory
satisfactory
good
excellent or
Not applicable
2.5.3
2.5.4
Page 3
3.
3.1
Type of preceptors
3.1.1
Hospital Pharmacy:
Preceptor
3.2
Responsibilities of A Preceptor
3.2.1
3.2.2
3.2.3
3.2.4
3.2.5
Page 4
4.
A PROVISIONALLY
4.2
4.3
4.4
Recognise that not all of the preceptors time can be devoted to teach you
and you should therefore actively acquire knowledge and skills by
observation, reading and questioning others.
4.5
Be aware that, in addition to the daily activities, your time should be set
aside to consider activities outside working hours.
4.6
4.7
(ii)
Page 5
4.8
Module
Private
Gazetted
Hospital/ Health
Clinic
Ward Pharmacy
Outpatient Services
16
Inpatient Pharmacy
16
Clinical Pharmacokinetics
Parenteral Nutrition
Oncology Pharmacy
Drug Info
Manufacturing
Total
42
10
Page 6
2.
3.
4.
5.
Patient drug history taking for all new admissions in the designated ward within
24 hours of admission.
6.
7.
8.
Medication counseling.
9.
Case reporting.
Page 7
WEEK 1
Date
MRN
Allergy Detected
(/ when detected)
Compliance Evaluation
(/ when done)
Preceptors Initial
Page 8
SECTION 1:
WEEK 2
Date
MRN
Allergy Detected
(/ when detected)
Compliance Evaluation
(/ when done)
Preceptors Initial
Page 9
SECTION 1:
WEEK 3
Date
MRN
Allergy Detected
(/ when detected)
Compliance Evaluation
(/ when done)
Preceptors Initial
Page 10
SECTION 1:
WEEK 4
Date
MRN
Allergy Detected
(/ when detected)
Compliance Evaluation
(/ when done)
Preceptors Initial
Page 11
SECTION 2: CLERKING & REVIEWING [PLEASE USE THE PHARMACOTHERAPY REVIEW FORM (CP2)]
(Min: 10 cases/ week)
To assess the ability of the PRP to read, comprehend patients case notes and identify Pharmaceutical Care Issues
(PCI, minimum: 10 issues/ week)
WEEK 1
No.
Date
Patients
R/N
No. of PCI(s)
identified
No. of
Intervention
Remarks
Preceptors
Initial
Page 12
SECTION 2: CLERKING & REVIEWING [PLEASE USE THE PHARMACOTHERAPY REVIEW FORM (CP2)]
(Min: 10 cases/ week)
To assess the ability of the PRP to read, comprehend patients case notes and identify Pharmaceutical Care Issues
(PCI, minimum: 10 issues/ week)
WEEK 2
No.
Date
Patients
R/N
No. of PCI(s)
identified
No. of
Intervention
Remarks
Preceptors
Initial
Page 13
SECTION 2: CLERKING & REVIEWING [PLEASE USE THE PHARMACOTHERAPY REVIEW FORM (CP2)]
(Min: 10 cases/ week)
To assess the ability of the PRP to read, comprehend patients case notes and identify Pharmaceutical Care Issues
(PCI, minimum: 10 issues/ week)
WEEK 3
No.
Date
Patients
R/N
No. of PCI(s)
identified
No. of
Intervention
Remarks
Preceptors
Initial
Page 14
SECTION 2: CLERKING & REVIEWING [PLEASE USE THE PHARMACOTHERAPY REVIEW FORM (CP2)]
(Min: 10 cases/ week)
To assess the ability of the PRP to read, comprehend patients case notes and identify Pharmaceutical Care Issues
(PCI, minimum: 10 issues/ week)
WEEK 4
No.
Date
Patients
R/N
No. of PCI(s)
identified
No. of
Intervention
Remarks
Preceptors
Initial
Page 15
SECTION 3:
MEDICATION COUNSELING
WEEK 1
Date
Patients
RN
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature of
Preceptor
Page 16
SECTION 3:
MEDICATION COUNSELING
WEEK 2
Date
Patients
RN
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature of
Preceptor
Page 17
SECTION 3:
MEDICATION COUNSELING
WEEK 3
Date
Patients
RN
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature of
Preceptor
Page 18
SECTION 3:
MEDICATION COUNSELING
WEEK 4
Date
Patients
RN
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature of
Preceptor
Page 19
SECTION 4:
Discipline / Ward:
WEEK 1
Date
Number of
Interventions Done
Number of Queries
Responded
Preceptors
Initial
Page 20
SECTION 4:
Discipline / Ward:
WEEK 2
Date
Number of
Interventions Done
Number of Queries
Responded
Preceptors
Initial
Page 21
SECTION 4:
Discipline / Ward:
WEEK 3
Date
Number of
Interventions Done
Number of Queries
Responded
Preceptors
Initial
Page 22
SECTION 4:
Discipline / Ward:
WEEK 4
Date
Number of
Interventions Done
Number of Queries
Responded
Preceptors
Initial
Page 23
SECTION 5:
To assess the ability in clerking case, comprehend patients case note, complete case report study with evidence based
approach and recommend related pharmaceutical care issues of the patients
WEEK 1
Date
MRN
Topic
Remarks
Preceptors Initial
MRN
Topic
Remarks
Preceptors Initial
MRN
Topic
Remarks
Preceptors Initial
MRN
Topic
Remarks
Preceptors Initial
WEEK 2
Date
WEEK 3
Date
WEEK 4
Date
Page 24
SECTION 6:
Remarks
Preceptors
Initial
Page 25
SECTION 7:
Date
MRN
Remarks
Preceptors
Initial
Page 26
ASSESSMENT
Page 27
SECTION 8:
No.
Knowledge
Comments
1
Page 28
NA
SECTION 9:
COMPETENT ASSESSMENT
Level of Performance
Date
Task
Comments
1
Medication Counseling
Case Report
Case Presentation
ADR Report
NA
Page 29
Mark
= ______________ x 100%
48
= ______________ %
NOTE:
1. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF) therefore
has right to disseminate the PRP to other unit/ service.
2. % mark should not less than 60% for every units/ services.
Page 30
Proficient in reading.
Page 31
Screening
Filling
Dispensing
Medication Counseling
Dangerous Drugs & Psychotropic
Page 32
SECTION 1:
SCREENING
WEEK 1
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 33
SECTION 1:
SCREENING
WEEK 2
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 34
SECTION 1:
SCREENING
WEEK 3
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 35
SECTION 1:
SCREENING
WEEK 4
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 36
SECTION 1:
SCREENING
WEEK 5
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 37
SECTION 1:
SCREENING
WEEK 6
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 38
SECTION 1:
SCREENING
WEEK 7
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 39
SECTION 1:
SCREENING
WEEK 8
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 40
SECTION 1:
SCREENING
WEEK 9
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 41
SECTION 1:
SCREENING
WEEK 10
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 42
SECTION 1:
SCREENING
WEEK 11
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 43
SECTION 1:
SCREENING
WEEK 12
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 44
SECTION 1:
SCREENING
WEEK 13
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
5.
6.
7.
8.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 45
SECTION 1:
SCREENING
WEEK 14
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 46
SECTION 1:
SCREENING
WEEK 15
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 47
SECTION 1:
SCREENING
WEEK 16
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of
intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
F: Filling
D: Dispensing
Name of Preceptor:
Signature:
General Remarks:
Page 48
SECTION 2:
Date of
assessment
Patient Particulars
Remarks
Page 49
SECTION 3:
Date
Page 50
SECTION 3:
Date
Page 51
SECTION 4:
MEDICATION COUNSELING (INDIVIDUAL Minimum 3/ week)
WEEK 1
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 52
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 2
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 53
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 3
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 54
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 4
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 55
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 5
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 56
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 6
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 57
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 7
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 58
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 8
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 59
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 9
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 60
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 10
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 61
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 11
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 62
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 12
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 63
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 13
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 64
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 14
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 65
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 15
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 66
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 4:
WEEK 16
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Page 67
Others
(Please
Specify)
Name &
Signature
of
Preceptor
SECTION 5:
Date
Number of
Counseling
Sessions
Antidiabetics
Antihypertensives
Antiasthmatics
Page 68
Name &
Signature of
Preceptor
SECTION 6:
Page 69
SECTION 7:
PREPARATION / OBSERVATION
EXTEMPORANEOUS (MIN 5 EACH)
COUNTER-CHECKING
OF
JOB
SHEET
OF
Extemporaneous Preparations
Date
MRN
Name of Preparation
Remarks
Page 70
Signature of
Preceptor
ASSESSMENT
Page 71
SECTION 8:
Level of Performance
No.
Knowledge
Comments
1
NA
Page 72
SECTION 9:
COMPETENT ASSESSMENT
Level of Performance
No.
Task
Screening
Filling of Prescriptions
Dispensing
Medication Counseling
NA
Page 73
Comments
Mark
______________ x 100%
52
______________ %
NOTE:
1. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF) therefore
has right to disseminate the PRP to other unit/ service.
2. % mark should not less than 60% for every units/ services.
Page 74
Page 75
Ward Inspection
11. Stock handling
12. Identify storage requirements
13. Records
Page 76
SECTION 1:
WEEK 1
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 77
SECTION 1:
WEEK 2
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 78
SECTION 1:
WEEK 3
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 79
SECTION 1:
WEEK 4
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 80
SECTION 1:
WEEK 5
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 81
SECTION 1:
WEEK 6
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 82
SECTION 1:
WEEK 7
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 83
SECTION 1:
WEEK 8
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 84
SECTION 1:
WEEK 9
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 85
SECTION 1:
WEEK 10
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 86
SECTION 1:
WEEK 11
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 87
SECTION 1:
WEEK 12
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 88
SECTION 1:
WEEK 13
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 89
SECTION 1:
WEEK 14
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 90
SECTION 1:
WEEK 15
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 91
SECTION 1:
WEEK 16
Date
Number of
profiles
reviewed
Number of
Intervention
Types of
intervention *
Number of
Communications
with doctors
Comments
Signature of
Preceptor
Incomplete Prescription
Polypharmacy
Wrong Dosage Form / Dose
4:
5:
6:
Interaction
Contraindications
Countersignature
Page 92
SECTION 2:
WEEK 1
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 93
SECTION 2:
WEEK 2
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 94
SECTION 2:
WEEK 3
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 95
SECTION 2:
WEEK 4
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 96
SECTION 2:
WEEK 5
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 97
SECTION 2:
WEEK 6
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 98
SECTION 2:
WEEK 7
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 99
SECTION 2:
WEEK 8
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 100
SECTION 2:
WEEK 9
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 101
SECTION 2:
WEEK 10
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 102
SECTION 2:
WEEK 11
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 103
SECTION 2:
WEEK 12
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 104
SECTION 2:
WEEK 13
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 105
SECTION 2:
WEEK 14
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 106
SECTION 2:
WEEK 15
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 107
SECTION 2:
WEEK 16
Date
Number of Prescriptions
/ Indents
Number of Prescriptions
wrongly filled
Descriptions of Error
Signature of
Preceptor
Page 108
SECTION 3:
WEEK 1
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 109
SECTION 3:
WEEK 2
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 110
SECTION 3:
WEEK 3
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 111
SECTION 3:
WEEK 4
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 112
SECTION 3:
WEEK 5
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 113
SECTION 3:
WEEK 6
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 114
SECTION 3:
WEEK 7
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 115
SECTION 3:
WEEK 8
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 116
SECTION 3:
WEEK 9
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 117
SECTION 3:
WEEK 10
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 118
SECTION 3:
WEEK 11
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 119
SECTION 3:
WEEK 12
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 120
SECTION 3:
WEEK 13
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 121
SECTION 3:
WEEK 14
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 122
SECTION 3:
WEEK 15
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 123
SECTION 3:
WEEK 16
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Antidiabetics
Antihypertensives
Antiasthmatics
Antiretrovirals
Anticoagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Page 124
SECTION 4:
Date
Preceptors Signature
Comments
Notes: Ward Inspection Report should be completed and submitted within a week after inspection
Page 125
SECTION 4:
Date
Preceptors Signature
Comments
Notes: Ward Inspection Report should be completed and submitted within a week after inspection
Page 126
SECTION 5:
WEEK 1
Date
Page 127
SECTION 5:
WEEK 2
Date
Page 128
SECTION 5:
WEEK 3
Date
Page 129
SECTION 5:
WEEK 4
Date
Page 130
WEEK 5
Date
Page 131
SECTION 5:
WEEK 6
Date
Page 132
SECTION 5:
WEEK 7
Date
Page 133
SECTION 5:
WEEK 8
Date
Page 134
SECTION 5:
WEEK 9
Date
Page 135
SECTION 5:
WEEK 10
Date
Page 136
SECTION 5:
WEEK 11
Date
Page 137
SECTION 5:
WEEK 12
Date
Page 138
SECTION 5:
WEEK 13
Date
Page 139
SECTION 5:
WEEK 14
Date
Page 140
SECTION 5:
WEEK 15
Date
Page 141
SECTION 5:
WEEK 16
Date
Page 142
SECTION 6:
Extemporaneous Preparations
Date
MRN
Name of Preparation
Remarks
Signature of
Preceptor
Page 143
ASSESSMENT
SECTION 7:
No.
Level of Performance
1
Comments
NA
Name &
Signature of
preceptor
Page 145
SECTION 8:
COMPETENT ASSESSMENT
No.
Task
Level of Performance
1
Ward Inspections
Comments
NA
Page 146
= ______________ %
NOTE:
1. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF) therefore
has right to disseminate the PRP to other unit/ service.
2. % mark should not less than 60% for every units/ services.
Page 147
2.
3.
4.
5.
6.
Ability to assist in the provision of after office hour (on call) service
for poisoning and emergencies.
Aminoglycosides Antiepileptics
and Vancomycin
and
Theophylline
Target
( min)
2/ week
2/ week
Digoxin
Others
_______________
1/ week
/1 week
1/ week
1/ week
1/ week
WEEK 1
No.
Date
Patients R/N
Drug
AS: Assistant
Status of
PRP
(O/AS/P)
Comment(s)
P: Performer
Page 149
Aminoglycosides Antiepileptics
and Vancomycin
and
Theophylline
Target
( min)
2/ week
2/ week
Digoxin
Others
_______________
1/ week
/1 week
1/ week
1/ week
1/ week
WEEK 2
No.
Date
Patients R/N
Drug
AS: Assistant
Status of
PRP
(O/AS/P)
Comment(s)
P: Performer
Page 150
Task
Aminoglycosides Antiepileptics
and Vancomycin
and
Theophylline
Target
( min)
2/ week
2/ week
Digoxin
Others
_______________
1/ week
/1 week
1/ week
1/ week
1/ week
WEEK 1
No.
Date
Patients R/N
Status of PRP:
O: Observer
Drug
Status of PRP
(O/AS/P)
AS: Assistant
Comment(s)
P: Performer
Interpretation/ prediction of the results and recommendation (assessment should include the ability of PRP to
communicate results with prescriber using or relate to pharmacokinetic data)
Page 151
Aminoglycosides Antiepileptics
and Vancomycin
and
Theophylline
Target
( min)
2/ week
2/ week
Digoxin
Others
_______________
1/ week
/1 week
1/ week
1/ week
1/ week
WEEK 2
No.
Date
Patients R/N
Status of PRP:
O: Observer
Drug
Status of PRP
(O/AS/P)
AS: Assistant
Comment(s)
P: Performer
Interpretation/ prediction of the results and recommendation (assessment should include the ability of PRP to
communicate results with prescriber using or relate to pharmacokinetic data)
Page 152
Able to read and comprehend patients case notes [Target (min): 3 case notes/ week]
Able to assess patient suitability for therapeutic drug monitoring [Target: 3 cases (min)]
Number of CP cases monitored, Pharmaceutical Care Issues identified (not necessary pertaining
to CP only) and number of intervention done
WEEK 1
No.
Date
Patients R/N
No. of
PCI(s)
identified
No.of
Intervention
CP
Status of PRP:
O: Observer
Status of
PRP
(O/AS/P)
Comments
Others
AS: Assistant
P: Performer
Page 153
Able to read and comprehend patients case notes [Target (min): 3 case notes/ week]
Able to assess patient suitability for therapeutic drug monitoring [Target: 3 cases (min)]
Number of CP cases monitored, Pharmaceutical Care Issues identified (not necessary pertaining
to CP only) and number of intervention done
WEEK 2
No.
Date
Patients R/N
No. of
PCI(s)
identified
No.of
Intervention
CP
Status of PRP:
O: Observer
Status of
PRP
(O/AS/P)
Comments
Others
AS: Assistant
P: Performer
Page 154
Target (min)
Once daily
WEEK 1
No.
Date
Ward/ unit
Page 155
Target (min)
Once daily
WEEK 2
No.
Date
Ward/ unit
Page 156
No.
Date
Task
Target (min)
1 presentation/ week
Patients R/N
Ward/
unit
Diagnosis
Comment(s)
SECTION 3D: ABLE TO HANDLE/ ADVISE ON THE MANAGEMENT OF TOXICOLOGY CASES WITHIN 2 HOURS
OF REQUEST (If applicable)
No.
Date
Task
Target (min)
1 case
Patients R/N
Ward/
unit
Diagnosis
Comment(s)
Page 157
ASSESSMENT
SECTION 4:
Level of Performance
1
Comments
NA
Name &
Signature of
Preceptor
OPERATIONAL TASK
(Analysis Of Serum Drug Concentration)
PHARMACOKINETIC KNOWLEDGE
[Manual Calculation Of Dosage(s)]
CLINICAL ASSESSMENT
Page 159
SECTION 5:
= ______________ %
NOTE:
1. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF) therefore
has right to disseminate the PRP to other unit/ service.
2. % mark should not less than 60% for every units/ services.
Page 160
2.
3.
4.
5.
6.
Calculation/ worksheet.
7.
8.
9.
IV additive if applicable.
INTRODUCTIONS
PARENTERAL NUTRITION / INTRAVENOUS ADDITIVE
Training Period
Name of Preceptor
No.
Date
:
Title
Briefing *
Yes
1.
2.
3.
No
Page 162
SECTION 1:
WEEK 1
No.
Date
Patient R/N
No of
Intervention
*Type of
Invention
Communication
with Prescriber
**Status of
PRP
(O/AS/P)
Name &
Signature of
Preceptor
*Type of Interventions:
Incomplete Prescriptions - (a) Frequency
(b) Duration
Inappropriate Regimens - (a) Medicine
(b) Duration
Inappropriate Prescriptions -(a) Spelling
(b) Wrong identification
Other (a) Not in the hospital drug formulary
(d) Countersignature
(d) Frequency
(e) Contraindication
(c) Illegibility
AS: Assistant
P: Performer
O: Observer
Page 163
SECTION 1:
WEEK 2
No.
Date
Patient R/N
No of
Intervention
*Type of
Invention
Communication
with Prescriber
**Status of
PRP
(O/AS/P)
Name &
Signature of
Preceptor
*Type of Interventions:
Incomplete Prescriptions - (a) Frequency
(b) Duration
Inappropriate Regimens - (a) Medicine
(b) Duration
Inappropriate Prescriptions -(a) Spelling
(b) Wrong identification
Other (a) Not in the hospital drug formulary
(d) Countersignature
(d) Frequency
(e) Contraindication
(c) Illegibility
AS: Assistant
P: Performer
O: Observer
Page 164
Date
Worksheet, Label
Counterchecking
Manual Calculation (min 5 cases)
Patient
R/N
* Status of PRP
Pharmacy Board Malaysia 2012
Type of Cases
(e.g.: Colorectal, Renal, Post Surgery & etc)
O: Observer
AS: Assistant
* Status of PRP
(O/AS/P)
Name &
Signature of
Preceptor
P: Performer
Page 165
Date
Worksheet, Label
Counterchecking
Manual Calculation (min 5 cases)
Patient
R/N
* Status of PRP
Pharmacy Board Malaysia 2012
Type of Cases
(e.g.: Colorectal, Renal, Post Surgery & etc)
O: Observer
AS: Assistant
* Status of PRP
(O/AS/P)
Name &
Signature of
Preceptor
P: Performer
Page 166
SECTION 3: COMPOUNDING
(i) Adult (2 preparations)
(ii) Paediatric (2 preparations)
(iii) IV Additives, where service is available (3 preparations)
*At least 5 reconstitution process must be assessed by preceptor
No.
Date
Patient
R/N
No. of Preparation
Adult
Paediatric
*Status of PRP
(O/AS/P)
IV Additive
Name &
Signature of
Preceptor
Total
* Status of PRP
Pharmacy Board Malaysia 2012
O: Observer
AS: Assistant
P: Performer
Page 167
SECTION 4:
WEEK 1
Date
Patient R/N
*Status of PRP
(O/AS/P)
Total
* Status of PRP
O: Observer
AS: Assistant
P: Performer
Page 168
SECTION 4:
WEEK 2
Date
Patient R/N
*Status of PRP
(O/AS/P)
Total
* Status of PRP
O: Observer
AS: Assistant
P: Performer
Page 169
ASSESSMENT
SECTION 5:
No.
ASSESSMENT OF KNOWLEDGE
Date
Tasks
Grade of performance
1
1.
2.
Comments
3.
4.
Page 171
SECTION 6:
COMPETENT ASSESSMENT
No.
Task
Level of Performance
1
Preparation of worksheet
Reconstitution
Assessment on knowledge
Comments
NA
Page 172
Mark
= ______________ x 100%
20
= ______________ %
NOTE:
1. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF)
therefore has right to disseminate the PRP to other unit/ service.
2. % mark should not less than 60% for every units/ services.
Page 173
SUMMARY OF PERFORMANCE
No
Activity
Assessment of knowledge
Calculation / worksheet
Compounding
Grade of
Performance
(max=4)
Performance
Comments
Preceptors
Names &
Signature
______ x 100%
20
= ________%
TOTAL MARK:
Page 174
:
:
Date
Title
1.
2.
3.
4.
5.
Briefing*
Yes
No
Page 176
SECTION 1:
WEEK 1
Date
Patient
R/N
No of
Intervention
*Type of
Invention
Communication with
Prescriber
**Status of
PRP (O/AS/P)
*Type of Interventions:
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Others
- (a) Frequency
(b) Duration
(c) Signature & Chop
- (a) Medicine
(b) Duration
(c) Dose
-(a) Spelling
(b) Wrong identification (c) Polypharmacy
- (a) Not in the hospital drug formulary
(b) Authenticity
** Status of PRP
O: Observer
AS: Assistant
(d) Countersignature
(d) Frequency
(d) Interaction
(e) Contraindication
(c) Illegibility
P: Performer
Page 177
SECTION 1:
WEEK 2
Date
Patient
R/N
No of
Intervention
*Type of
Invention
Communication with
Prescriber
**Status of
PRP (O/AS/P)
*Type of Interventions:
Incomplete Prescriptions - (a) Frequency
(b) Duration
(c) Signature & Chop
Inappropriate Regimens
- (a) Medicine
(b) Duration
(c) Dose
Inappropriate Prescriptions -(a) Spelling
(b) Wrong identification (c) Polypharmacy
Others
- (a) Not in the hospital drug formulary
(b) Authenticity
** Status of PRP
Pharmacy Board Malaysia 2012
O: Observer
AS: Assistant
(d) Countersignature
(d) Frequency
(d) Interaction
(e) Contraindication
(c) Illegibility
P: Performer
Page 178
SECTION 2:
WEEK 1
Date
Patient
*Status of PRP
O: Observer
*Status of PRP
(O/AS/P)
AS: Assistant
P: Performer
Page 179
SECTION 2:
WEEK 2
Date
Patient
*Status of PRP
O: Observer
*Status of PRP
(O/AS/P)
AS: Assistant
P: Performer
Page 180
SECTION 3:
WEEK 1
Date
Patient R/N
No of Preparation
Name of Drug
*Status of
PRP (O/AS/P)
Total of Preparation =
*Status of PRP
Pharmacy Board Malaysia 2012
O: Observer
AS: Assistant
P: Performer
Page 181
SECTION 3:
WEEK 2
Date
Patient R/N
No of Preparation
Name of Drug
*Status of
PRP (O/AS/P)
Total of Preparation =
*Status of PRP
Pharmacy Board Malaysia 2012
O: Observer
AS: Assistant
P: Performer
Page 182
SECTION 4:
Monitoring
Counseling
WEEK 1
Date
Patient R/N
*Status of PRP
Case Monitoring
O: Observer
Counseling
AS: Assistant
*Status of PRP
(O/AS/P)
P: Performer
Page 183
SECTION 4:
Monitoring
Counseling
WEEK 2
Date
Patient R/N
*Status of PRP
Case Monitoring
O: Observer
Counseling
AS: Assistant
*Status of PRP
(O/AS/P)
P: Performer
Page 184
ASSESSMENT
Date
Tasks
Principles of cytotoxic cabinet and clean room design
5.
6.
3.
4.
Grade of Performance
(max=4)
Comments
Page 186
SECTION 6:
COMPETENT ASSESSMENT
Level of Performance
Comments
Task
1
NA
Preparation of worksheet
Reconstitution
Assessment on knowledge
Page 187
NOTE:
1. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF) therefore
has right to disseminate the PRP to other unit/ service.
2. % mark should not less than 60% for every units/ services.
Page 188
SUMMARY OF PERFORMANCE
No
Activity
Assessment of knowledge
Calculation / worksheet
Grade of
Performance
(max=4)
Performance
Comments
Preceptors
Names &
Signature
________ x 100%
40
Reconstitution
= __________%
TOTAL MARK:
Page 189
12. Ability to detect, compile and report ADR and medication error.
13. Knowledge of QAP indicators, analysis and reporting.
A.
WEEK 1
Date
No. of
Enquiries
Type of Enquiries
Poisoning
Indication/ dose
Interaction
Signature of
Preceptor
Efficacy
Other
Page 192
A.
WEEK 2
Date
No. of
Enquiries
Type of Enquiries
Poisoning
Indication/ dose
Interaction
Signature of
Preceptor
Efficacy
Other
Page 193
A.
WEEK 3
Date
No. of
Enquiries
Type of Enquiries
Poisoning
Indication/ dose
Interaction
Signature of
Preceptor
Efficacy
Other
Page 194
A.
WEEK 4
Date
No. of
Enquiries
Type of Enquiries
Poisoning
Indication/ dose
Interaction
Signature of
Preceptor
Efficacy
Other
Page 195
Investigate and
compile ADR
(Minimum 4
report/ year)
i)
Title of study:
ii)
iii)
CPD
presentation
(Minimum 3/
year)
Ability to appraise
clinical paper
(Minimum 2)
*Project
[Clinical study
(one/ year)]
Bulletin,
newsletter
publication
(once)
Signature of
Preceptor
Page 196
ASSESSMENT
SECTION 2:
No.
Level of Performance
1
Comments
NA
Name &
Signature of
preceptor
Page 198
SECTION 3:
COMPETENT ASSESSMENT
No.
Task
Level of Performance
1
Comments
NA
Page 199
Mark
= ______________ x 100%
32
= ______________ %
NOTE:
1. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF) therefore
has right to disseminate the PRP to other unit/ service.
2. % mark should not less than 60% for every units/ services.
Page 200
Galenical Manufacturing
Pre-packing
Page 201
SECTION
1:
Name of Preparation
Batch number
Remarks
Page 202
Signature of
Preceptor
Date
Name of Preparation
Batch number
Remarks
Page 203
Signature of
Preceptor
ASSESSMENT
Page 204
Type of Task
Comment
1
1.
2.
3.
4.
Page 205
Level of Performance
No
Type of Task
Comments
1
1.
2.
Management
repacking
of
manufacturing
NA
&
Page 206
Mark
= ______________ x 100%
24
= ______________ %
NOTE:
1. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF) therefore
has right to disseminate the PRP to other unit/ service.
2. % mark should not less than 60% for every units/ services.
Page 207
Financial management
No. of orders processed
Quotations
Receiving of goods
Data and statistical compilation and analysis for
preparation of Drug Committee Meeting
SECTION 3: STORAGE
Knowledge of storage of biological, handling of cytotoxic drugs,
refrigerated items, inflammables and corrosive items, safety
measures, maintenance of cold chain on transit and storage in
accordance to Good Storage Practice (GSP).
Page 208
SECTION 5: DISPOSAL
Knowledge of disposal procedures and its documentation.
Page 209
Task
1
Level of Performance
2
3
4
NA
Page 210
Comments
Name and
Signature of
Preceptor
Date
Task
Level of Performance
1
RECEIVING OF GOODS
APPL receive (min. 10)
Non APPL receive (min.10)
Asset (min. 1)
Page 211
NA
Comments
Name and
Signature of
Preceptor
SECTION 3 : STORAGE
Knowledge of storage in accordance to Good Storage Practice
Date
Task
Level of Performance
1
equipments monitoring
documentation
Page 212
NA
Comments
Name and
Signature of
Preceptor
SECTION 4
: INVENTORY CONTROL
Knowledge and understanding of drug usage patterns, identification of slow and non-moving stocks, maximum and minimum
stock levels, cost accounting, and expiry date monitoring
Date
Task
Level of Performance
1
Page 213
NA
Comments
Name and
Signature of
Preceptor
SECTION 5: DISPOSAL
Knowledge of disposal procedures and documentation
Write off/ disposal
Date
Task
Level of Performance
1
DISPOSAL PROCESS
Able to understand the workflow
FORMS USED FOR DISPOSAL
Able to name the form
LIST OF EXPIRED ITEMS
Able to extract list from HIS system
APPROVAL FOR DISPOSAL
Able to understand procedure
DISPOSAL AREA
Able to locate area identified
Page 214
NA
Comments
Name and
Signature of
Preceptor
Date
Task
Level of Performance
1
NA
PROCESS
Able to understand and explain workflow
RETRIEVAL OF DATA
Able to check with the system of batches
RETRIEVAL OF PRODUCT
Replace/Return product from/to user/ supplier.
DOCUMENTATION
Document, report to respective authority and file
complaint
Page 215
Comments
Name and
Signature of
Preceptor
Date
Task
Level of Performance
1
PROCESS
Able to understand and explain workflow
RETRIEVAL OF DATA
Able to check with the system of batches/location
involved
RETRIEVAL OF PRODUCT
Able to recall product from location identified.
REPLACEMENT OF PRODUCT
Return and replace product to/from supplier/user
DOCUMENTATION
Document and File recall
Page 216
NA
Comments
Name and
Signature of
Preceptor
Date
Task
Level of Performance
1
do proper documentation
Page 217
NA
Comments
Name and
Signature of
Preceptor
Mark
= ______________ %
NOTE:
1. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF) therefore has
right to disseminate the PRP to other unit/ service.
2. % mark should not less than 60% for every units/ services.
Page 218
I/C Number: .
Photo (to be
affixed here)
I certify that the above PRP has completed his/ her training as required under
subsection 6A (2) of the Registration of Pharmacists Act 1951.
1. Proposal:
1A. The above PRP has obtained average mark of: __________ % and
1B. He/ She has *passed/ failed the Pharmacy Jurisprudence Examination
1C. Certificate of satisfactory experience in accordance to sub-regulation 7(1)
Registration of Pharmacists Regulations 2004 is recommended to be
given to him/ her.
1D. Certificate of satisfactory experience in accordance to sub-regulation 7(1)
Registration of Pharmacists Regulations 2004 is not recommended to
be given to *him/ her and
1E. *He/ she needs to extend the training for another ________month/s;
in Unit/Section ________________________________
*or/and
*He/ She needs
Examination
to
pass
the
Pharmacy
Jurisprudence
Page 219
I certify that the above PRP has completed his/ her training as required under
subsection 6A (2) of the Registration of Pharmacists Act 1951.
1. Proposal:
1A. Certificate of satisfactory experience in accordance to sub-regulation 7(1)
Registration of Pharmacists Regulations 2004 is *recommended/ not
recommended to be given to him/ her and he/ she is *qualified/ not
qualified for Full Registration.
1B. *He/ she needs to extend the training for another ___________month/s
from (date):_____________to_______________ (date).
1C. The extension of the training is because;
i) His /her performance was below 60% or /and
ii) He/ she needs to pass the Pharmacy Jurisprudence Examination
2. Master Preceptors detail:
2.1
2.2
2.3
2.4
Name:
Office address:
Master Preceptors signature: .
Date:
Page 220
I have undergone training at the above place from (date): __________to: _______(date)
Grade
Subject
1=
2=
3=
unsatisfactory satisfactory good
4=
N/A = not
excellent applicable
A. Facilities of
Training
Place
Comment (how things can be improved); Please make attachment where necessary)
Page 221
B. Professional
Exposure by
Preceptors
Comment (how things can be improved); Please make attachment where necessary)
C. Professional
Guidance by
Preceptors
Comment (how things can be improved); Please make attachment where necessary)
D. Training
Skills of The
Preceptors
Comment (how things can be improved); Please make attachment where necessary)
Page 222
HospitalTertiary
HospitalSecondary
Page 223
HospitalTertiary
HospitalSecondary
HospitalTertiary
HospitalSecondary
Page 224
Communication Skills
Assessment
Hospital
-Tertiary
1.
2.
3.
4.
5.
6.
7.
8.
9.
HospitalSecondary
INDICATORS
1.
2.
3.
4.
Demonstrate a
Professional
Approach
Work Effectively
as Part of a
Team
Undertake
Personal and
Professional
Development
Communication
Skills
PERFORMANCE
(%)
AVERAGE (%)
Page 225
Appendix A
Section
Mark (%)
Page 226
Appendix A1
(TO BE FILLED BY PRINCIPAL PRECEPTOR FOR THOSE EXTENDED)
SUMMARY OF PERFORMANCE (%) FOR EACH CLINICAL SECTION
MARK (%) FOR EACH CLINICAL SECTION
No.
Section
Mark %
prior to
extension
period
Mark % after
extension
period
Actual
extension
period
Page 227
ACKNOWLEDGEMENTS
Advisor
Dr.Salmah binti Bahri
Pharmaceutical Services Division, Ministry of Health Malaysia
Committee Members/Participants during Bengkel Penyediaan Buku Log PRP
2012, Kuala Terengganu, 26-29 March 2012
Mr. Amrahi bin Buang
University Malaya Medical Centre
Mdm. Zainon bt. Abudin
Selayang Hospital, Ministry of Health Malaysia
Miss Salmi binti Abd.Razak
Putrajaya Hospital, Ministry of Health Malaysia
Miss Lee Seng Dee
Pantai Medical Centre
Mdm. Zarihasyum Wan Zein
KPJ Tawakkal Specialist Hospital
Mdm.Sherry Woo
Sunway Medical Centre
Mdm. Eliza Basir
Sime Darby Healthcare
Miss Yong Yin May
Sime Darby Healthcare
Mdm. Irene Kwan Yee Man
Assunta Hospital
Reviewer
Mr.Azman bin Yahya
Pharmaceutical Services Division, Ministry of Health Malaysia
Secretariat
Mdm. Nur Hunaina binti Md.Yusuf
Pharmaceutical Services Division, Ministry of Health Malaysia
Mdm. Zunaidah binti Abdul Rashid
Pharmaceutical Services Division Terengganu, Ministry of Health Malaysia
Mdm.Sarinah binti Embong
Pharmaceutical Services Division Terengganu, Ministry of Health Malaysia
Page 228