"A"=Yes / "B"=No
For each task in the following group, choose response below that best describes your experience and/or training. Darken the oval corresponding to that statement in Section 25 of the Qualifications and Availability Form C. Please select only one letter for each item.A- Yes.
1. Are you a U.S. Citizen?
Select appropriate answer to each of the following questions below.
2. Are you a graduate of a degree program in pharmacy from an accredited United States college or university?
3. Are you a graduate of a foreign pharmacy degree program that meets the education requirement of a degree found to be equivalent to degree programs recognized by the American Council on Pharmaceutical Education (ACPE)?
4. Do you have a full, active and unrestricted license to practice pharmacy in a State, Territory, Commonwealth of the United States, or the District of Columbia?
5. Do you possess one year of creditable experience equivalent to the GS-12 grade level, as substantiated in your resume, which is directly related to the position to be filled; or board certification recognized by the American Pharmaceutical Association's Board of Pharmaceutical Specialties, or the American Society of Consultant Pharmacists (or equivalent); or completion of a two year post Pharm.D. fellowship in a clinical or specialized program?
CHOOSE RESPONSE BELOW THAT BEST DESCRIBES YOUR EXPERIENCE AND/OR TRAINING.
For each task in the following group, choose the statement from the list below that best describes your experience and/or training. Darken the oval corresponding to that statement in Section 25 of the Qualifications and Availability Form C. Please select only one letter for each item.A- I have not had education, training or experience in performing this task.
6. Expert knowledge of a specialized area of clinical pharmacy practice or specialty area of pharmacy such as patient safety, quality assurance/utilization review, informatics systems, drug information, etc.
7. Expert knowledge of pharmaceuticals, pharmacokinetics, pharmacodynamics, pharmacoeconomics, and pharmacotherapeutics.
8. Advanced skill in monitoring and assessing the outcome of drug therapies including physical assessment and interpretation of laboratory and other diagnostic parameters.
9. Ability to communicate orally to persuade and influence clinical and management decisions.
10. Ability to communicate in writing to persuade and influence clinical and management decisions.
11. Designs, coordinates, and evaluates pharmacy-based initiatives aimed at optimizing the safe use of medications throughout the organization.
12. Identifies and reports medication variances, tracks and trends data, prepares quarterly variance reports, works with supervisors to resolve issues or implement system changes to prevent further variances.
13. Identifies and reports adverse drug reactions, reviews reports for causality and preventability, prepares management reports, submits reports to FDA MedWatch and P&T Committee.
14. Knowledge of and experience in patient safety analysis techniques (methods), including Root Cause Analysis and Healthcare Failure Mode and Effects Analysis.
15. Establishes quality assurance (QA) monitors, tracks and trends data, assures compliance with monitors, works with supervisors to address areas of non-compliance.
16. Utilizes information management and analysis software, including Word, Excel, Outlook, Access, and other data, graphics, and flowcharting software.
17. Member of a hospital or VISN level committee. Functions as the Co-Chair of the Medication Safety Committee (prepares agendas, minutes, providing follow up).
18. Demonstrates an expert understanding of regulatory and quality standards for all medications including investigational drugs (e.g., VHA, DEA, Joint Commission, USP, EPA, etc).
19. Identifies areas of regulatory non-compliance, develops action plans, implements system changes along with supervisors, and provides status reports to upper management.
20. Demonstrates accurate and effective pharmacy and health care system policy and procedure writing. This includes independently researching the topic, coordinating the discussion with stakeholders to obtain input and concurrence, writing/updating memoranda and policies.
21. Collaborates with management officials from a variety of disciplines (Quality Management, Nursing, Medicine/Surgery, etc.) and presents reports (oral and written) to upper management (Director, Chief of Staff, etc.)
22. Proactively identifies staff educational deficits pertaining to regulatory compliance and develops, modifies, and provides staff education (modules or inservices).
23. Works collaboratively with Pharmacy Management Team to identify performance improvement initiatives for the service, with special emphasis of medication safety, regulatory compliance, quality assurance and operational deficiencies.
24. Guides and facilitates performance improvement teams to attain specific measurable goals utilizing PDCA cycle and appropriate tools.
25. Proactively identifies staff educational deficiencies pertaining to performance improvement philosophy and develops, modifies, and provides staff education.
26. Manages the Pharmacy Service Strategic Plan, including tracking and trending goal attainment, performing new SWOT analysis or other mechanisms to obtain feedback, and developing new goals for each fiscal year.
27. Provides leadership in the service and mentoring of staff.
Select the appropriate answer to the statement below. Failure to provide an answer will be result in your not being considered for this position.
28. I certify that to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct and provided in good faith. I understand that if I make an intentionally false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C. 1001); my eligibilities may be cancelled; I may be denied an appointment; or I may be removed and debarred from the Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated and that responding "No" or providing no response to this item will result in my not being considered for this position.A. Yes, I understand the information provided above and certify that the information provided in this questionnaire is true, correct, and provided in good faith.
Transcript Reminder - If you are basing qualifications on education (or a combination of education and experience) you must submitted a copy of your transcripts (official or unofficial) or an appropriate course listing with your application.
Resume Reminder - Your resume must include the following information for each job listed:
Duties (be as detailed as possible)
Month & year start/end dates (e.g. June 2007 to April 2008)
Full-time or part-time status (include hours works per week)