SELF-ASSESSMENT

Step 1: What have you already done?

Professional Profile

Name: MPhA Licence No.

Manitoba other than Winnipeg

Winnipeg

EDUCATION:

Manitoba USA

another province another country

Academic degrees:

Year granted University/College Degree

Certificates and Courses:

Year(s) Certifying Body Course Title

CURRENT EMPLOYMENT POSITION:

community pharmacy

hospital/long-term care facility

unemployed

other, please specify

please specify:

Starting Date Place of Employment City/Town Position Skills Acquired

Provide a brief summary of your work, the nature of the patient population and type of health professionals with whom you interact.

Previous Work Experience:

From(m/y) To(m/y) Pharmacy/Institution/Organization City/Town Position

Recognition/Awards:

Year awarded Awarding Body Award

Current Professional Memberships:

From (m/y) Professional Body


Presentations:

Date (m/y) Topic Audience

Publications:

Date (m/y) Topic Publication Source

Volunteer Work: Service to Profession and/or Community

From (m/y) To (m/y) Volunteer Service

Step 2: Do you meet the Standards?

Model Standards of Practice for Canadian Pharmacists (NAPRA)

Date Completed:

Place a checkmark in the box beneath the circle that corresponds to your rating.

Standard #1

Ability to Practice Pharmaceutical Care

The pharmacist, using unique knowledge and skills to meet a patient’s drug-related needs,

practices patient-focused care in partnership with patients and other health care providers, to achieve positive health outcomes and/or to maintain or improve quality of life for the patient.

RATING

(mark appropriate number)
Benefit from Improvement / Feel
Comfortable / Particularly Strong / Not
Applicable
1. / I develop a trusting, professional relationship with individual patients and/or their agents /
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2. / I make an effort to dialogue with the patient /
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3. / I am accessible to patients and/or their agents /
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4. / I listen actively and interpret the information provided /
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5. / I gather patient, disease and drug information and assess its relevance /
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6. / I integrate the relevant information collected in order to identify the patient’s actual and potential health care needs/drug-related problems /
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RATING

(mark appropriate number)
Benefit from Improvement / Feel
Comfortable / Particularly Strong / Not
Applicable
7. / I can work with individual patients to help them develop therapeutic options based on their needs /
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8. / I recognize drug interactions and their relevance to the patient /
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9. / I recognize toxic effects of pharmacotherapy /
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10. / I develop a plan of care for the patient /
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11. / I explain the indications, contraindications and problems of pharmacotherapy to the patient /
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12. / I communicate follow-up plans to the patients and when appropriate to other members of the health care team /
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13. / I regularly evaluate and modify the plan of care based on the patient’s response, their feedback, and outcomes /
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14. / I develop a professional relationship with a patient’s other health care providers /
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15. / I appropriately refer patients to alternate sources of care /
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16. / I identify the information that I should document as part of the pharmaceutical care process /
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17. / I document my interventions and follow-up, as well as their outcomes /
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18. / I document communications with other health care providers /
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19. / I maintain medication profiles, medical histories and patient information /
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20. / I store data in an easily accessible and retrievable manner /
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Standard #2

Ability to Assume Ethical, Legal and Professional Responsibilities

The pharmacist practices within legal requirements and ethical principles, demonstrates professional integrity, and acts to uphold professional standards of practice.

RATING

(mark appropriate number)
Benefit from Improvement / Feel
Comfortable / Particularly Strong / Not
Applicable
1. / I identify the changing needs of patients and gaps in service /
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2. / I understand how social and economic changes in the community can impact on a patient’s physical and psychological health /
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3. / I fulfill the legal requirements pertaining to narcotics and controlled drugs /
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4. / I comply with the legislative requirements for health and safety in the workplace /
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5. / I transfer and obtain copies of prescriptions following appropriate procedures including accurate documentation /
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6. / I know where to obtain information about the legislative and regulatory requirements for documentation /
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7. / I follow the proper procedures to refill prescriptions /
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8. / I have a working knowledge of labour legislation /
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9. / I apply legislative principles and current MPhA policy affecting the operation of pharmacies and sales of drugs /
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10. / I maintain knowledge of changing standards of professional practice and practice accordingly /
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11. / I practice pharmacy in a manner consistent with the professional code of ethics / /
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12. / I maintain appropriate boundaries with patients, staff and allied health professional according to established ethical and professional practice guidelines /
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13. / I respect confidentiality related to patients’ issues and information /
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14. / I respect the right of patients to make their own choices / /
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RATING

(mark appropriate number)
Benefit from Improvement / Feel
Comfortable / Particularly Strong / Not
Applicable
15. / I network and advocate for the patients in the health care system as well as with community groups, agencies and social services /
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16. / I can explain the pharmacist’s role in the health care system / /
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17. / I readily approach peers, co-workers or allied professionals for assistance as necessary /
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18. / I assess my level of knowledge about a patient’s disease and therapies and attain the required level of knowledge to address the patient’s needs /
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19. / I identify areas of my knowledge, skills or values which require improvement to meet current practice needs and standards /
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20. / I identify appropriate resources and activities which are available for learning /
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21. / I apply new knowledge obtained from education into my daily practice /
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22. / I modify my behaviour in response to feedback from peers, co-workers or allied health professionals / / /
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23 / I accept responsibility for my actions and decisions /
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24. / I understand the need for planning as it relates to life long learning /
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25. / I maintain a log of professional and personal education /
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Standard #3

Ability to Access, Retrieve, Evaluate and Disseminate Relevant Information

The pharmacist identifies, retrieves, evaluates, interprets and provides appropriate drug and pharmacy practice information to achieve safe and effective patient care.

RATING

(mark appropriate number)

Benefit from Improvement / Feel
Comfortable / Particularly Strong / Not Applicable
1. / I know the type of information contained in a variety of drug information resources / / /
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2. / I identify sources and/or supply educational materials for patients and/or other health professionals / /
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3. / I am aware of current professional and public issues / / / /
4. / I identify a client’s need for information about drug products and critically evaluate drug information obtained / /
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5. / I consider the relevance of drug information to the client’s needs /
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6. / I assess whether the information provided fulfilled the client’s needs /
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7. / I seek feedback from the patient to assess his/her level of understanding of the information provided /
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8. / I document my responses to drug information requests / /
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9. / I identify relevant pharmacy practice issues that I should evaluate for the benefit of my practice /
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10. / I am able to determine whether I have the knowledge, skills and resources necessary to undertake a project /
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11. / I am able to assess the appropriate research method (e.g., data collection method, statistical significance, etc.) for various types of research questions /
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12. / I am able to analyze and interpret the results of the data collected /
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RATING

(mark appropriate number)

Benefit from Improvement / Feel
Comfortable / Particularly Strong / Not Applicable
13. / I can identify the limitations of a research project and its results /
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14. / I can extrapolate the significance of the results when applied to other practice sites /
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15. / I can integrate the results of research projects, where appropriate, into my daily practice /
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16. / I assess the outcome of the changes implemented /
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17. / I understand the importance of documenting and communicating the results of research /
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Standard #4

Ability to Communicate and Educate Effectively

While respecting the patient’s right to confidentiality, the pharmacist communicates and educates to provide optimal patient care and promote health.

RATING

(mark appropriate number)

Benefit from Improvement / Feel
Comfortable / Particularly Strong / Not
Applicable
1. / I write in an understandable and legible manner (logical, concise, well-organized, appropriate level) for the intended audience /
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2. / I use correct spelling and grammar in my written communication /
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3. / I speak clearly (at an appropriate rate, and modulate my tone of voice according to each patient’s needs) /
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4. / I use nonverbal skills effectively /
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5. / I identify barriers to effective communication and attempt to overcome them / / / /
6. / I communicate effectively with patients in person / / / /
7. / I communicate effectively with patients by telephone /
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8. / I communicate effectively with other health professional in person /
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9. / I communicate effectively with other health professionals by telephone / / / /
10. / I am able to interpret written and verbal health care information and present it to the client in an appropriate verbal and/or written manner / / / /
11. / I demonstrate consideration, sensitivity, empathy and respect when dealing with others /
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12. / I use appropriate interviewing skills /
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13. / I use the various health-related promotion services available within the community, e.g., AIDS support groups / /
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RATING

(mark appropriate number)

Benefit from Improvement / Feel
Comfortable / Particularly Strong / Not
Applicable
14. / I assist with the development and implementation of plans and resources to prevent or overcome identified barriers to wellness /
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15. / I evaluate cost savings associated with the provision of health and wellness information / / / /
16. / I actively seek opportunities to develop partnerships with key stakeholders in the provision of health care / /
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17. / When giving a presentation, I identify the educational needs of individual learners and/or groups /
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18. / When giving a presentation, I develop a presentation outline that defines learning objectives and expected outcomes / / / /
19. / When giving a presentation, I present in a confident, clear and easy to understand manner / /
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20. / When giving a presentation, I apply time management principles in the development and delivery of a presentation / / /
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21. / When giving a presentation, I select educational methods, resources, technology, and content to meet the needs of the audience / / /
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22. / When giving a presentation, I assess whether the learners’ needs were met /
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Standard #5

Ability to Manage Drug Distribution

The pharmacist manages drug distribution by performing, supervising, or reviewing the functions of selection, preparation, distribution and storage of drugs to ensure safety, accuracy, and quality of supplied products.

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RATING

(mark appropriate number)
Benefit from Improvement / Feel
Comfortable / Particularly Strong / Not
Applicable
1. / I prepare prescriptions accurately /
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2. / To satisfy patient needs, I distinguish between the various drug dosage forms when dispensing /
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3. / I calculate doses accurately /
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4. / I identify and resolve issues related to the quality of manufactured and/or compounded products (i.e., potency, sterility, stability, compatibility, delivery system) /
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5. / I compound extemporaneous and/or sterile products following designated procedures /
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6. / I have a knowledge of the equipment and technology used at my practice site /
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7. / I select the most appropriate means of ensuring the delivery of the completed prescription order to the patient /
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8. / I ensure that regulatory requirements for documentation of compounding and distribution are met, including the sale of such items to other practice sites / /
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9. / I supervise support personnel performing specialized functions /
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10. / I assess the authenticity of a prescription /
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11. / I recognize drugs that have addiction potential /
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12. / I recognize and resolve patterns of inappropriate drug use /
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13. / I detect and respond appropriately to incidents of drug diversion when detected / /
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Standard #6