Pharmacist Clinical Services Performance Evaluation - American ...

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PurposeThe Pharmacist Clinical Services Performance Evaluation is a tool for evaluating pharmacists who arecoordinating, developing, and/or actively providing medication therapy management (MTM) and otherclinical services.BackgroundProviders may have several responsibilities, ranging from managerial and/or dispensing services to providingMTM and other clinical services. While all facets are important, this tool specifically addresses the provider’sperformance in the area of clinical service delivery. The evaluation is designed to be accentuated with additionalqualitative and quantitative criteria as deemed appropriate. Some examples include the type of interventionsmade by the provider, the effectiveness of interventions made, and the number of services provided. Thesupervisor may also incorporate components of the form into an existing evaluation tool or use the form in itsentirety.Instructions for useCarefully read through each clinical core competency. Depending on your practice, you may not need toevaluate the provider on each core competency. In the far left column, place an X next to the competencies thatwill be evaluated during the current evaluation period. Next, select the performance rating that best describesthe practitioner’s performance for the specific clinical core competency. Check the corresponding number in therighthand columns and fill in any necessary information if applicable; see the following example:To BeEvaluatedX1.6 Use appropriate technique(s) and clinical skills to administer medications,including immunizations• Use appropriate technique(s) on a consistent basis• Follows policies and procedures on a consistent basis• Number of immunizations administered over 6 months: 500Performance Rating5 4 3 2 1XAfter rating each competency, calculate the overall performance rating using thedirections provided in Section IV.Please note the following when using this evaluation instrument:• Additional competencies or further qualitative and quantitative expectations may be added to theevaluation that are specific to the provider’s professional goals.• Other evaluations, such as responses to patient satisfaction surveys or other similar instruments, maybe used to supplement this evaluation instrument.• Alternative formulas may be used in the overall scoring of the employee’s performance to weight moresignificantly than other evaluation criteria those specific competencies deemed most critical by theemployer to the job performance.2
Employee Name: ___________________________________________________________________________Employee Position/Title: _____________________________________________________________________Hire Date: _________________________________________________________________________________Supervisor Name: ___________________________________________________________________________Supervisor Position/Title: ____________________________________________________________________Evaluation Date: ____________________________________________________________________________Evaluation Period: __________________________________________________________________________Clinical Practitioner’s Professional GoalsDate(s) of previous evaluation period:______________________Professional goals established during previous evaluation period:1. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3.4.5._________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3
Page 1: • • • • • • • • •
Page 5 and 6: Section I : Clinical Core Competenc
Page 7 and 8: Evaluation of Patient Care Programs
Page 9 and 10: Professional/Community Outreach (5.
Page 11 and 12: Section IV : Calculation of Perform

Pharmacist Clinical Services Performance Evaluation - American ...

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