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The observer will listen, complete the rubric below, and offer feedback to the pharmacist when the activity is complete.

Case 1

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FOR THE OBSERVER TO FILL OUT Completed Notes

COLLECT (Information Gathering)

Description of symptoms

S-Symptoms

What is bothering you?

   

C-Characteristics

What are the symptoms like?

   

H-History

What have you tried? Is this a new problem or a recurrence?

   

O-Onset

When or how did it start?

   

L-Location

Where are the problems/symptoms?

   

Description of things that may precipitate, exacerbate, or relieve symptoms

A-Aggravating factors

What makes it worse?

   

R-Remitting factors

What makes it better?

   

Objective information

M-Medications

What prescription, nonprescription, and herbal supplements do you take?

   

A-Allergies

What allergies do you have?

   

C-Coexisting conditions

What other medical conditions do you have?

   

Patient age, sex, height, weight

     

Subjective information

Patient occupation

     

Patient dietary habits

     

Patient sleep habits

     

ASSESS (and Triage)

 

Differentiate signs and symptoms and identify patient’s primary problem

     
 

Is the patient an appropriate candidate for self-care?

Options include:

  1. Refer to a health care provider now

  2. Recommend self-care

  3. Recommend self-care until patient can be seen by health care provider

  4. Take no action

   

PLAN

 

What are the therapeutic options/self-care strategies?

     
 

Describe recommendation and rationale.

     

IMPLEMENT

Provide patient education

Provide specific recommendation—drug, dose, route, frequency, duration, administration instructions, expected time to relief, common side effects

  1. Drug name

  2. Recommend dose and frequency of administration (and any administration instructions)

  3. Duration of therapy

  4. Expected time to relief

  5. Common side effects

  6. Recommendations if condition worsens

  7. Storage requirements

  8. Nondrug recommendations for condition

  9. Solicit follow-up questions from patient

   

*Rubric was created by Bernadette Cornelison.

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