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Auditor: ___________________

Pharmacy: ___________________

Date: ___________________

A. Promotion of Services

This section asks questions about how well the pharmacy tells patients about its services and also how "user-friendly" the physical environment of the pharmacy is, especially for patients with limited literacy.

Please check the ONE response that most accurately describes the pharmacy today, using the following rating scale:

1. This is something the pharmacy does not appear to be doing.
2. The pharmacy is doing this but could make some improvements.
3. The pharmacy is doing this well.
N/A Not applicable

1. When staff give verbal or written directions for finding the pharmacy, they refer to familiar landmarks and bus stops.

To assess this item, please call the pharmacy number at three different times.

To be completed by calling the pharmacy at: (____)______-________

Assess driving directions as well as directions using public transportation. This is particularly important in urban areas where public transportation is a significant and even primary mode of transportation for patients utilizing pharmacy services. For each option, the pharmacy should be contacted at least three different times (for a total of six calls). Verify accuracy of directions with maps and/or a "test drive."

2. The pharmacy logo illustrates the service that the pharmacy provides in the community (e.g., graphic depiction of dispensing medication).

3. The phone number is easy for everyone to find on all promotional or informational materials.

4. The pharmacy's name and symbol are clearly displayed at the entrance to the pharmacy.

If the pharmacy is part of a multipurpose building and not free-standing, this item is intended to assess the entrance to the pharmacy. For free-standing pharmacies this applies to the main area of entry.

5. Clear signs and symbols direct people from the building entrance to the pharmacy.

This item is intended for pharmacies located in a multipurpose building (e.g., part of a hospital or clinic). N/A is appropriate for free-standing pharmacies.

6. The difference between check in/prescription drop-off areas and prescription pick-up areas is clear to patients when they enter the pharmacy.

7. The walls and bulletin boards in the pharmacy are not covered with a lot of printed notices. It's easy for anyone to pick out the important information on them.

8. The pharmacy displays pamphlets and educational brochures in a way that makes it easy for people to find the information they need or want.

9. The pharmacy uses a variety of ways to inform patients about its services within the physical structure of the pharmacy: video and/or computer, as well as printed materials.

Comments:

B. Print Materials

This section assesses the accessibility of the print materials used in the pharmacy, such as prescription labels, prescription inserts, brochures, and posters to patients with limited literacy. Obtain from pharmacy staff samples of any materials that are not readily available. This will likely include prescription information leaflets, warning labels, and bottle labels. This should be done at the end of the Assessment Tour. Look at three different examples of each of the materials listed (if available) to assess these items.

Many of these statements are about writing in plain language, that is, writing in a way that everyone can understand. When materials are written in plain language they:

• Use simple, everyday words.
• Organize the information so it is easy to identify the most important points.
• Are designed in a layout that has a lot of white space on the page, so the reader is not overwhelmed with words.

Please check the ONE response that most accurately describes the pharmacy today, using the following rating scale:

1. This is something the pharmacy does not appear to be doing.
2. The pharmacy is doing this but could make some improvements.
3. The pharmacy is doing this well.
N/A Not applicable

10. The pharmacy uses printed materials to advise patients about its services in different parts of the hospital or clinic.

Applicable only to pharmacies that are located in hospital or clinic buildings.

   a. Emergency room waiting area.

   b. Primary care areas.

   c. Information booth in lobby.

11. The following print materials are written in simple and clear language, avoiding the use of technical jargon and medical terms:

   a. Prescription information leaflets that the pharmacist prints out.

   b. Patient education brochures that the patient takes home.

   c. Informational posters and signs on the pharmacy walls.

   d. Bottle labels.

   e. Warning labels.

   f. Information booth in lobby.

12. The following print materials are designed with lots of clear space to provide relief from the print:

   a. Prescription information leaflets that the pharmacist prints out.

   b. Patient education brochures that the patient takes home.

   c. Informational posters and signs on the pharmacy walls.

13. The pharmacy uses visual graphics or illustrations in the following print materials (graphics should be simple and convey the meaning of the text in a way that decreases dependency on the text for comprehension):

   a. Prescription information leaflets that the pharmacist prints out.

   b. Patient education brochures that the patient takes home.

   c. Informational posters and signs on the pharmacy walls.

14. If appropriate, these print materials are available in languages other than English:

   a. Prescription information leaflets that the pharmacist prints out.

   b. Patient education brochures that the patient takes home.

   c. Informational posters and signs on the pharmacy walls.

15. The pharmacy uses a print size of 12 pt. or higher in the following print materials (other observations about print—use of bold, italics, etc.—may be recorded in the "comments" box at the end of the section):

   a. Prescription information leaflets that the pharmacist prints out.

   b. Patient education brochures that the patient takes home.

   c. Informational posters and signs on the pharmacy walls.

16. Overall, these print materials are easy for adults with limited literacy skills to understand:

   a. Prescription information leaflets that the pharmacist prints out.

   b. Patient education brochures that the patient takes home.

   c. Informational posters and signs on the pharmacy walls.

Comments:

C. Clear Verbal Communication

This section assesses the communication between pharmacy staff and patients—particularly those patients with limited literacy. This section must be completed through discrete direct observation of patient-pharmacist interactions.

Please check the ONE response that most accurately describes the pharmacy today, using the following rating scale:

1. This is something the pharmacy does not appear to be doing.
2. The pharmacy is doing this but could make some improvements.
3. The pharmacy is doing this well.
N/A Not applicable

17. Pharmacy staff avoid using medical jargon when they communicate verbally with patients (e.g., words and phrases like "anticoagulant," "oral hypoglycemic," "hypertension," "npo," "OTC," or "prn").

18. The pharmacy offers and provides interpreters to patients for whom English is a second language.

This item may be addressed by simply asking if there is an interpreter on the premises to assess the "in-person" portion of the question. You may assess the "on the telephone" portion by noting if an automated option for an alternate language is offered when calling the main pharmacy number and if pharmacy staff can appropriately redirect callers when they ask for an interpreter.

   a. In person.

   b. On the telephone.

19. The pharmacy has the following:

   a. A window between pharmacy staff and the patient.

     If yes, is there a small hole or open space in this window for verbal communication?

   b. A raised platform between pharmacy staff and the patient.

   c. Information sheets to inform patients on disease states and drugs to help them understand their condition and treatment.

   d. A call-in telephone line for patients to ask questions.

The call-in telephone number should be correct and lead you to someone who can answer specific questions about medication indication, dosing, and side effects.

Comments: