DISEASE STATE MANAGEMENT CLINICAL COMPETENCY ASSESSMENT for PHARMACISTS

Clinical Pharmacist Competencies as suggested by ACCP (Pharmacotherapy 2008;28(6):806-815.) Employee Name:

Rating Period:

* Initial Training Method & Development Plan includes,

but is not limited to the following methods: (Insert hyperlinks, pdf/Word files, etc.. in column)

** Competency Level (Mandatory) ***Competency Assessment Codes

One-on-one Training Article Review In-service

Training F – Assessed fully competent – No further action. O- Observation R- Document/Record Review

CBT Practice Observe another N – Non-compliant, requires focused development D- Employee Demonstration

T- Written Review

Mentor / Preceptor Video Academic

program P – Partially compliant, needs additional development V- Employee Verbalization

Columns 1; 2; 3; 7; 8 must be completed for each competency assigned. Columns 4; 5; 9 must be completed on each competency where employee was only partially or non-compliant with a particular competency.

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** CLINICAL PROBLEM SOLVING, JUDGMENT, AND DECISION MAKING Demonstrate knowledge and application of disease state guidelines and current literature in the following areas:

I.A.5. Identify patient-specific goals of therapy.

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** I.A.6. Prospectively develop a plan for ongoing evaluation of progression of disease, development of disease-related complications, efficacy of drug therapy, and development of drug-related adverse effects.

Clinical Observation

I.B.1, I.B.2. Organize, interpret and analyze patient-specific data to form assessment.

I.C.7. Assess patient compliance and factors that may influence compliance.

I.E.3. Manage time appropriately to be well prepared for clinical activities.

COMMUNICATION AND EDUCATION II.A.3. Use appropriate educational methods to educate patients regarding drug therapy.

II.B.3. Communicate recommendations or relevant information to health care professionals in a manner appropriate to their training, skills, and needs.

II.B.4. Provide background information and primary literature to health care professionals as needed.

II.D.1. Clearly document drug therapy reconciliation and other patient-related interventions.

II.D.2. Effectively communicate assessment, including supporting subjective and objective data.

II.D.3. Effectively communicate the therapeutic plan.

DIABETES DISEASE STATE MANAGEMENT COMPETENCY ASSESSMENT for PHARMACISTS

Employee Name:

Rating Period:

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** CLINICAL PROBLEM SOLVING, JUDGMENT, AND DECISION MAKING Demonstrate knowledge and application of disease state guidelines and current literature in the following areas:

Demonstrates knowledge and understanding of the most recent DM guidelines

ADA Diabetes Standards

AACE Guidelines

Able to establish glycemic goals based on guidelines and patient specific factors.

Demonstrates the ability to ask open-ended questions and can provide appropriate follow-up questions when clarification is needed.

Demonstrates ability to obtain an accurate medication history that includes a thorough assessment of med adherence

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** Understands complications associated with DM 1. Retinopathy screening (dilated eye exam) 2. Neuropathy screening (Foot exam) 3. Immunizations 4. Nephropathy screening (urine albumin) 5. CVD prevention (blood pressure, lipids, ASA)

Demonstrates appropriate assessment of laboratory values to include but not limited to: Hgba1c, FBG, PPBG, C-Peptide, fructosamine, lipid profile, metabolic profile, TSH, etc.

DM TREATMENT SKILLS Understands and implements appropriate individualized DM diet and exercise plans including carbohydrate counting if appropriate

Diabetes Standards

AACE Guidelines

Understands how to utilize oral diabetic agents in the treatment of DM and can initiate and adjust oral agents appropriately to maximize outcomes while minimizing side-effects.

Knows how to address ADRs associated with DM treatment including dosage adjustment, discontinuation, therapy changes, and patient education.

1. Hypoglycemia 2. Edema 3. GI upset 4. Weight gain (insulin, sulfonylureas,TZD’s)

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** Demonstrates appropriate knowledge of insulins and is able to initiate and adjust insulin regimens

1. Basal/Bolus (fixed dose or flexible dosing) 2. Mixed Insulin regimens 3. Once daily intermediate or long acting insulin 4. Continuous subcutaneous insulin infusion(if

seeting requires)

COMMUNICATION AND EDUCATION Educates all new patients initiated on diabetes medications including insulin: Side effects, efficacy, prescribed dosage, administration, timing/frequency

1. Missed/delayed doses 2. Storage 3. Travel 4. Safety

AADE7™ http://www.diabeteseducator.org/ProfessionalResources/AADE7/

Educates patient as required on diet, drug interactions, exercise, self-monitoring, management of hypoglycemia and hyperglycemia, and adherence

Educates patient on how to use glucose meter Communicates effectively Ability to counsel patients on all diabetes medications

Diabetes Standards 2014: http://care.diabetesjournals.org/content/36/Supplement_1/S11.full.pdf+html AACE Diabetes Guidelines: https://www.aace.com/files/dm-guidelines-ccp.p

HYPERTENSION DISEASE STATE MANAGEMENT COMPETENCY ASSESSMENT for PHARMACISTS

Employee Name:

Rating Period:

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training

Method* Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** PATIENT ASSESSMENT SKILLS Demonstrates knowledge and understanding of the most recent HTN guidelines

AHA Guidelines http://circ.ahajournals.org/cgi/reprint/115/21/2761 JNC 7 http://jama.jamanetwork.com/article.aspx?articleid=196589 JNC 8 http://jama.jamanetwork.com/article.aspx?articleid=1791497

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training

Method* Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** Able to establish blood pressure goals based on guidelines and patient specific factors

DM CHF CAD/Post MI Elderly African Americans Kidney Disease

Demonstrate the ability to appropriately conduct physical assessment –can check manual blood pressure and pulse using proper technique

http://www.nejm.org/doi/full/10.1056/NEJMvcm0800157

Demonstrates the ability to ask open-ended questions and can provide appropriate follow-up questions when clarification is needed

Demonstrates ability to obtain an accurate medication history that includes a thorough assessment of medication adherence and methods to improve adherence

Understands complications associated with HTN Such as renal failure, MI, CVA, CHF, Retinopathy, etc.

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training

Method* Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** Demonstrates appropriate assessment of laboratory values to include but not limited to: BMP, LFTs, Pro-BNP, urinalysis, PRA, aldosterone, plasma metanephrines

Assess for resistant HTN by demonstrating knowledge of secondary causes of HTN and when to refer patients for the treatment of secondary causes (i.e Renal consult)

AHA Guidelines to Resistant HTN http://circ.ahajournals.org/cgi/reprint/117/25/e510

HTN TREATMENT SKILLS Understands and implements appropriate individualized lifestyle modifications such as: smoking cessation, low sodium diet, exercise, weight reduction, limiting caffeine and alcohol intake

Understands how to initiate and adjust antihypertensives to maximize outcomes while minimizing side-effects and drug interactions; monitor laboratory values appropriately and ensuring appropriate clinic follow-up

Knows how to address and treat ADRs associated with HTN treatment including adjustment of medication regimen and patient education. (ex. dizziness, fatigue, le edema, h/a, orthostatic hypotension, dry mouth, ED, gout, cough, angioedema, depression, bradycardia, , electrolyte disturbances etc. )

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training

Method* Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** Ability to recognize and treat hypertensive urgencies- Know when to refer patients to the ED

Cleveland Clinic Review/Algorithm for Hypertensive Crisis http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/hypertensive-crises/

PROVIDES PATIENT EDUCATION Educates all new patients initiated on HTN medications including: Side effects, efficacy, prescribed dosage, administration, timing/frequency, potential drug interactions

Educates patient as required on diet, drug interactions, exercise, self-monitoring and adherence

Educates patient on how to use home blood pressure monitor

Communicates effectively Ability to counsel patients on all hypertensive medications

AHA Guidelines: http://circ.ahajournals.org/content/115/21/2761.full.pdf+html

JNC 7 & 8 Guidelines: http://jama.jamanetwork.com/article.aspx?articleid=196589 http://jama.jamanetwork.com/article.aspx?articleid=1791497

VA/DOD Guidelines: Currently being updated http://www.healthquality.va.gov/htn/ http://www.healthquality.va.gov/htn/htn04_pdf1.pdf

INITIAL DYSLIPIDEMIA COMPETENCY ASSESSMENT for PHARMACISTS Employee Name:

Rating Period:

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** PATIENT ASSESSMENT SKILLS Demonstrates knowledge and understanding of the most recent dyslipidemia treatment guidelines

VA/DoD

Demonstrates ability to determine patient’s cardiovascular risk and set treatment goals based on current treatment guidelines and individualized patient information

Clinical Practice Guideline for the Management of Dyslipidemia

2013 ACC/AHA Cholesterol Guideline

ATP-3/NCEP Guideline for Triglycerides Managment

AACE Guidelines

Demonstrates appropriate assessment of laboratory values including, but not limited to: lipid panel, apolipoprotein B, metabolic profile, thyroid panel, liver panel, creatinine kinase, etc…

HYPERLIPIDEMIA TREATMENT SKILLS Understands and implements appropriate individualized diet and exercise regimens including DASH diet and Mediterranean diets.

2013 ACC/AHA Cholesterol Guideline

ATP-3/NCEP Guideline for Triglycerides Managment

2013 ACC/AHA Guideline on Lifestyle Management

Understands how to modify cardiovascular risk and minimize adverse drug events though the initiation, monitoring, and adjustment of appropriate-intensity statin therapy

Demonstrates ability to address ADEs associated with statin treatment including dose and frequency adjustments, therapy discontinuation, medication substitutions, and patient education

Demonstrates appropriate knowledge of nonstatin therapies, when to initiate treatment, when to modify treatment, and how to manage treatment-related ADEs

PROVIDES PATIENT EDUCATION

Educates all new patients initiated on statin and non-statin therapy regarding expected efficacy, potential adverse drug events and interactions, prescribed dosage, administration, and timing/frequency of doses

INITIAL ANTICOAGULATION COMPETENCY ASSESSMENT for PHARMACISTS Employee Name:

Rating Period:

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** PATIENT ASSESSMENT SKILLS Demonstrates practice based upon guidelines of protocol Chest

Guidelines 2013

http://journal.publications.chestnet.org/issue.aspx?journalid=99&issueid=23443

Demonstrates ability to determine optimal anticoagulant therapy treatment goals based on current treatment guidelines and individualized patient information

Demonstrates appropriate assessment of laboratory values including, but not limited to: PT/INR, antifactor Xa levels, CBC, and aPTT.

ANTICOAGULATION TREATMENT SKILLS Understands and implements appropriate individualized diet regimens for patients on warfarin

Demonstrates ability to perform the following: 1) Interview patient a. Asks open-ended questions b. Obtains accurate medication history 2) Determine patient compliance with regimen 3) Determine dietary impact/alcohol 4) Determine any signs and symptoms of bleeding 5) Determine any signs and symptoms of reoccurrence of thrombotic or embolic event B. Maintains appropriate patient follow up C. Maintains appropriate documentation in coag program

Demonstrates ability to: 1) Adjust dose of Coumadin 2) Hold dosing of Coumadin when appropriate When reversal of Coumadin is appropriate 3) Various antidotes for reversal of Coumadin 4) Which antidote to select 5) Dosing of vitamin K for various INR’s 6) Patient assessment for signs of bleeding 7) Patient follow up requirements after vitamin K administration

Demonstrates knowledge of: 1) Adjustment procedures for patients with MVR/AVR 2) Adjustment procedures for patients with AFIB, DVT, PE 3) Adjustment procedures for recent embolic event 3) Adjustment procedures for various surgical procedures 4) Adjustment procedures for dental procedures

Demonstrates: 1) Knowledge of conditions requiring referral to physician for evaluation 2) Demonstrates ability to contact appropriate physician.

PROVIDES PATIENT EDUCATION

Demonstrates: 1) Ability to counsel patients on Coumadin 2) Knowledge of dietary restrictions, drug interactions, signs and symptoms of bleeding, and safety measures B. Demonstrates ability to periodically re-assess patient and provide information for identified knowledge deficits C. Patient demonstrates understanding of instructions given by the provider.

Printed Name Signature Date Trainee Trainer

Associate Chief of Clinical and Educational Programs.

CHRONIC PAIN DISEASE STATE MANAGEMENT COMPETENCY ASSESSMENT for PHARMACISTS

Employee Name:

Rating Period:

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** CLINICAL PROBLEM SOLVING, JUDGMENT, AND DECISION MAKING Demonstrate knowledge and application of disease state guidelines and current literature in the following areas:

Demonstrates knowledge and understanding of the most recent chronic pain management guidelines

Chronic

Opioid Therapy -- Safe Prescribing in Primary Care, parts I, II, and III

Neuropathic

Pain: Stepped, Integrated Care

Able to establish pain related goals based on guidelines and patient specific factors.

Demonstrates the ability to ask open-ended questions and can provide appropriate follow-up questions when clarification is needed.

Demonstrates ability to obtain an accurate medication history that includes a thorough assessment of med adherence, past use of pain modalities both pharmacologic and non-pharmcologic

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** Understands non-opioid management of chronic pain, and makes appropriate recommendations including but not limited to the following medication classes:

1. Non-steroidal anti-inflammatories (NSAIDs) 2. Anti-depressants 3. Anti-convulsants 4. Topical agents 5. Acetaminophen

Pharmacological Management of Persistent Pain in Older Persons

Clinical

Guidelines for Opioid Use in Chronic Non cancer Pain

*Links at bottom

Demonstrates appropriate assessment of markers of adherence including but not limited to: accessing the state prescription drug monitoring program, ordering and interpreting appropriate urine drug tests, and executing pill counts

PAIN TREATMENT SKILLS Understands and implements a multi-disciplinary biopsychosocial approach to pain management with emphasis on lifestyle changes

See above

Understands how to utilize oral opioid and non-opioid agents in the treatment of chronic pain and can make recommendations for initiation and adjustment of oral agents appropriately to maximize outcomes while minimizing side-effects.

Understands proper opioid conversions and tapers

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** Knows how to address ADRs associated with chronic pain management treatment including dosage adjustment, discontinuation, therapy changes, and patient education.

1. Constipation (opioids) 2. Nausea/Vomiting 3. Edema (anti-convulsants, NSAIDs) 4. Cognitive dysfunction 5. GI upset or bleed

COMMUNICATION AND EDUCATION Educates all new patients initiated on pain medications including: Side effects, efficacy, prescribed dosage, administration, timing/frequency, Missed/delayed doses, Storage, Travel, Safety

See above *links at bottom

Educates patient as required on drug interactions, monitoring for ADRs, management of side effects and adherence

Current Opioid Misuse Measure (COMM) Screener and Opioid Assessment for Patients in Pain-Revised (SOAPP-R®)

Educates patient on opioid agreement

Ability to counsel patients on all chronic pain management medications

Utilizes proper tools to predict or identify aberrant behavior

APS/AAPM Guidelines on Chronic Opioid Therapy http://www.sciencedirect.com/science/article/pii/S1526590008008316

HEART FAILURE DISEASE STATE MANAGEMENT COMPETENCY ASSESSMENT for PHARMACISTS

Employee Name:

Rating Period:

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** CLINICAL PROBLEM SOLVING, JUDGMENT, AND DECISION MAKING Demonstrate knowledge and application of disease state guidelines and current literature in the following areas:

Demonstrates knowledge and understanding of the most recent heart failure guidelines.

Able to establish goals based on guidelines and patient specific factors.

Demonstrates the ability to ask open-ended questions and can provide appropriate follow-up questions when clarification is needed.

Demonstrates ability to obtain an accurate history that includes a thorough assessment of medications, immunization history, and adherence as well as identification of behaviors that may contribute to HF exacerbations.

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** Demonstrates ability to assess symptoms to establish a baseline, severity, duration, and precipitating/alleviating factors.

Understands complications associated with HF 1. Renal impairment 2. Valvular disease 3. Arrhythmias 4. Hepatic impairment

Demonstrates appropriate assessment of laboratory values to include but not limited to: SCr, BUN, electrolytes (K+, Mg2+, Ca2+), glucose, lipids, CBC, albumin, uric acid, LFTs, TSH.

HF TREATMENT SKILLS Understands and implements appropriate individualized HF diet and exercise plans including salt and fluid restrictions.

Understands how to individualize therapy to address co-morbid conditions, which could contribute to HF (i.e., arrhythmias, obesity, HTN, alcohol abuse, etc.) and ensure immunizations are up-to-date to prevent complications or worsening of condition.

Demonstrates ability to appropriately stage HF to direct therapy.

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** Knows how to address ADRs associated with HF treatment including dosage adjustment, discontinuation, therapy changes, and patient education.

1. Arrhythmias 2. Changes in volume status 3. Changes in blood pressure/pulse 4. Dehydration

COMMUNICATION AND EDUCATION Educates all new patients initiated on HF medications: Side effects, efficacy, prescribed dosage, administration, timing/frequency, missed/delayed doses, and storage.

Educates patient as required on diet, drug interactions, exercise, self-monitoring, smoking cessation, alcohol abstinence, and adherence

Communicates effectively Demonstrates ability to counsel patients on all HF medications

2013 AHA/ACC Guideline for the Management of Heart Failure http://circ.ahajournals.org/content/128/16/e240.extract

COPD/ASTHMA DISEASE STATE MANAGEMENT COMPETENCY ASSESSMENT for PHARMACISTS

Employee Name:

Rating Period:

1 2 3 4 5 6 7 8 9

Competency Expectation Initial Training Method*

Comp F/P/N

**

Development Plan*

(As applicable)

Plan Comp Date

Supervisory Comments Date Assessed

Assess Code ***

Comp F/P/N

** CLINICAL PROBLEM SOLVING, JUDGMENT, AND DECISION MAKING Demonstrate knowledge and application of disease state guidelines and current literature in the following areas:

Demonstrates knowledge and understanding of the most recent COPD/Asthma guidelines.

Able to establish goals based on guidelines and patient specific factors.

Demonstrates the ability to ask open-ended questions and can provide appropriate follow-up questions when clarification is needed.

Demonstrates ability to obtain an accurate history that includes a thorough assessment of medications, immunization history, and adherence as well as identification of behaviors that may contribute to/worsen COPD/Asthma.

Demonstrates ability to assess symptoms to establish a baseline, severity, duration, and precipitating/alleviating factors.

Understands complications associated with COPD/Asthma 1. Respiratory infections 2. Heart Failure 3. Sleep disturbances 4. Osteoporosis

Demonstrates appropriate assessment of laboratory values to include but not limited to: electrolytes, ABG, CBC.

COPD/ASTHMA TREATMENT SKILLS Utilizes spirometry/peak flow and guideline-based classifications to direct therapy.

Understands how to individualize therapy to address co-morbid conditions, which could contribute to COPD/Asthma (i.e., GERD, obesity, sleep apnea, depression, etc.) and ensure immunizations are up-to-date.

Understands how to effectively utilize step up/step down therapy.

Knows how to address ADRs associated with treatment including dosage adjustment, discontinuation, therapy changes, and patient education.

1. Oral thrush 2. Reduced bone mineral density 3. Xerostomia 4. Tachycardia

COMMUNICATION AND EDUCATION Educates all new patients initiated on COPD/Asthma medications on the following: Side effects, efficacy, prescribed dosage, administration, timing/frequency, difference between maintenance and rescue inhalers, order of use if multiple inhalers used at once, drug interactions, missed/delayed doses, storage, and proper inhaler/nebulizer technique.

Educates patient as required on exercise, self-monitoring of symptoms (including use of peak flow meter, if applicable), smoking cessation, identifying and decreasing exposure to triggers, and adherence.

Communicates effectively 2014 GOLD Strategy for the Diagnosis, Management, and Prevention of COPD http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf 2007 NHL Asthma guidelines http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf