Resident Training Program – Application for Community Pharmacy Site Accreditation Form questions for reference (pdf) "*" indicates required fields Step 1 of 7 – PART 1: GENERAL DETAILS 14% Details of person completing the formBy completing this application, you acknowledge that you have the authority of the Franchisee (Pharmacy Owner/Proprietor) of the Community Pharmacy to submit this application. This person may be contacted to confirm this authority. Name* Dr.MissMr.Mrs.Ms.Mx.Prof.Assoc. Prof. Preferred title First name Last name Position* Phone*Email* Are you an AdPha member?* Yes No If Yes, what is your AdPha member number* Franchisee of the Community Pharmacy (Owner/Proprietor)Are these details the same as the person above? Yes Name* Dr.MissMr.Mrs.Ms.Mx.Prof.Assoc. Prof. Preferred title First name Last name Franchisee (Owner/Proprietor) email* Name of Pharmacy* Name of Banner Group* Suburb of Pharmacy* Post code of Pharmacy* Consent*By completing this application, you consent to your Community Pharmacy being listed and named by AdPha as an applicant or approved site in AdPha communications, which may appear in both online and offline media. Do you consent to AdPha using your application to consider your accreditation as an AdPha Resident Training Program Community Pharmacy Site? Yes, I consent Note: If any of the following standards are managed by the Franchisor of the Banner Group rather than the Franchisee, please indicate that accordingly in each of the responses.Describe the process your pharmacy uses to ensure currency of Pharmacy Board registration of its pharmacist staff. (Standard 1.1)*From the list below, please select all the core professional pharmacy services (from Table 1a of the Training Program Framework) offered by your pharmacy. (Standard 1.2)* Dispensing medication Medication packing (staged supply and/or emergency supply) S2 and S3 medication supply Simple compounding Staged Supply Vaccinations From the list below, please select all the core professional pharmacy services (from Table 1b of the Training Program Framework) offered by your pharmacy. (Standard 1.2)* Blood glucose monitoring Blood pressure monitoring Dose Administration Aids Health Promotion Activities Medicines by injection Opioid Replacement Therapy Screening and Risk Assessment Services Weight management services From the list below, please select all the elective professional pharmacy services (from Table 1c of the Training Program Framework) offered by your pharmacy. (Standard 1.2)* HMRs Medication Use Evaluation Services MedsChecks Minor Ailment Services RMMRs Sleep Apnoea Services Sterile or complex compounding Tele-pharmacy Services Wound Care Services None of the above Provide a list of any additional professional pharmacy services offered by your pharmacy that are not listed above (Standard 1.2)*Provide evidence that your pharmacy is Quality Care Pharmacy Program (QCPP) accredited. (Standard 1.3)*Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB.Will anyone from your pharmacy be part of the Resident Training Program Support Group? (Standard 2.1)* Yes No Unsure If yes, who?* Describe how you encourage and provide opportunities for pharmacists to attend in-house education provided by the Banner Group. (Standard 2.2)*Provide an outline of your pharmacy’s broad commitment to the betterment of the pharmacy profession and public health overall through active involvement in external advisory groups, professional committees, community health promotions, and staff membership of professional bodies. (Standard 2.3)* Describe any peer-learning training opportunities for pharmacy staff at your pharmacy. How do you support the ongoing professional development of staff in addition to what is offered by the Banner Group. (Standard 3.1)*Describe your existing commitment to pharmacy student education and training. (Standard 3.1)*Describe your existing commitment to the education and training of pharmacist interns. (Standard 3.1)*Describe any additional links with universities (in addition to taking student placements). (Standard 3.1)*Describe how pharmacists are involved in inter-disciplinary collaborative care at the pharmacy. (Standard 3.2)*Describe how the pharmacy is involved in continuous quality improvement activities such as audits and/or reviews of Standard Operating Procedures or Medication Use Evaluations. (Standard 3.3)*Describe leadership and management training opportunities for pharmacists and how a Resident Candidate can be involved in developing skills outside of clinical expertise. (Standard 3.4)*Describe the opportunities that pharmacists in the pharmacy have for training other pharmacists and members of the pharmacy team or the greater Banner Group. (Standard 3.5)*Describe how pharmacists can access support as a practitioner within the pharmacy and/or Banner Group. (Standard 3.6)* Describe how the pharmacy plans to identify and recruit pharmacists suitable for the Resident Training Program. (Standard 4.1)*Describe your existing orientation process for new pharmacist staff to the pharmacy. (Standard 4.2)*What clinical resources will be available to Resident Candidates? (Standard 4.3)*e.g. Online/hard copy texts and referencesWhat existing programs/arrangements do you have to support staff? (Standard 4.4)*e.g. Employee assistance program, psychological support, educator for learning and development needs, buddy program for new staff etc Outline the types of performance evaluation tools and assessment you currently utilise in your community pharmacy. (Standard 5.1)*Describe how these tools are used, including by who and when, as part of an overall professional development plan for staff. (Standard 5.1)*How often do staff performance appraisals occur? (Standard 5.2)*Provide evidence/examples of performance evaluation documentation (de-identified). Drop files here or Select files Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB, Max. files: 5. Describe how pharmacists can partake in peer-based learning such as case-based discussions, journal clubs, case presentations etc. (Standard 5.3)* Additional Rotation SitesThe breadth of Resident Candidate’s experiences may be offered at an additional Community Pharmacy Site (Rotational Pharmacy Site) in addition to the primary Community Pharmacy Site. A ‘Rotational Pharmacy Site’ is a site, other than the Residency Site, at which part of the Resident Training Program is undertaken. A Rotational Pharmacy Site may be appropriate where a Candidate works across 2 community pharmacies or where the training program experience would be enhanced being split between two Community Pharmacy Sites.Will Resident Candidates at your primary site be required to undergo a rotation elsewhere?* Yes No What is the name of the other community pharmacy site?* What is the reason for utilising a Rotational Pharmacy Site?*eg. provide details of the gaps in the primary Community Pharmacy Site Accreditation that will be addressed by utilising the Rotational Pharmacy Site Resident Training Program*By checking this box, you acknowledge that the Community Pharmacy Site will deliver a Resident Training Program in accordance with AdPha’s requirements as outlined in the AdPha Community Pharmacy Resident Training Program Framework and the AdPha Accreditation Standards for Community Pharmacy Resident Training Programs. I agreePrivacy Policy*You agree to the AdPha privacy policy available at https://www.adpha.au/privacy-policy I agreeDeclaration*By checking this box, you declare that the information you have provided is true and correct and in no way misleading. I agreeEmailThis field is for validation purposes and should be left unchanged.
