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Student Name: Evaluator:
Criteria

Excellent

(20 total)

Meets Expectations (10 total) Needs Development (5 total)

Unacceptable

(0 total)

Score

Accuracy of home medication history/list

(7.82 Points)

Student identifies ALL initial inaccuracies on home medication history/list

(3.91 Points)

Student identifies SOME (>1, but not all) initial inaccuracies on home medication history/list

(1.96 Points)

Student identifies only ONE initial inaccuracy on home medication history/list

(0 Points)

Student identifies NO initial inaccuracies on home medication history/list

 

Errors of omission or untreated diagnosis

(5.22 Points)

Student identifies ALL missing medication(s) for past medical history or disease state that has no treatment (or missing treatment) originally listed in chart

(2.61 Points)

Student identifies MOST missing medication(s) for past medical history or disease state that has no treatment (or missing treatment) originally listed in chart

(1.3 Points)

Student identifies AT LEAST ONE missing medication for past medical history or disease state that has no treatment (or missing treatment) originally listed in chart

(0 Points)

Student does NOT identify missing medication for past medical history or disease state that has no treatment (or missing treatment) originally listed in chart

 

Therapeutic duplications, formulation, frequency, or usage discrepancies (eg, IR vs ER, tid vs qday, PRN vs scheduled)

(5.22 Points)

Student identifies ALL potential therapeutic duplication(s), formulation, frequency, or usage discrepancies

(2.61 Points)

Student identifies MOST potential therapeutic duplication(s), formulation, frequency, or usage discrepancies

(1.3 Points)

Student identifies AT LEAST ONE potential therapeutic duplication(s), formulation, frequency, or usage discrepancies

(0 Points)

Student does NOT identify therapeutic duplication(s), formulation, frequency, or usage discrepancies

 

Documentation

(1.74 Points)

Documentation in A/P contains ALL pertinent information (drug name, salt formulation/ER {when appropriate}, dose, route, frequency)

(0.87 Point)

Documentation in A/P contains MOST pertinent information (drug name, salt formulation/ER {when appropriate}, dose, route, frequency)

(0.44 Point)

Documentation in A/P is missing 3–4 pertinent pieces of information (drug name, salt formulation/ER {when appropriate}, dose, route, frequency)

(0 Points)

Documentation in A/P is missing >/=5 pertinent pieces of information (drug name, salt formulation/ER {when appropriate}, dose, route, frequency)

 

Total Grade (20 total possible points)

 

*Rubric was created by and used with permission from Kacie Monson, PharmD, BCPS.

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