Mp Assessment Notes

Assessment Notes

Grading the assessment - Rating Scale: The rating scale should be viewed as a continuum, from 1-6. 1 is the worst and 6 is the best. When choosing a point on the scale for each competency, decide how well the pharmacist is performing compared to a pharmacist of similar experience who is “meeting your expectations” and whom you forsee completing the programme successfully at the end of the 3 years.

• Significantly below - Performs poorly; very rarely meets the standard expected
• Below - Performs poorly; meets standard required occasionally
• Borderline - Performs satisfactorily; with appropriate support and direction should meet expectations
• Meets expectations - Performs well and to the standard expected of a pharmacist with a similar level of experience
• Above - Performs to a standard higher than what you would expect from a pharmacist with a similar level of experience
• Significantly above - Performs to an excellent standard; student is ahead of his/her peer group
• U/C - Unable to comment, as performance not observed whilst s/he was here

Explanations of the categories and how to fill then in.

1 Patient consultation

This competency incorporates the structure and processes needed to provide a patient with advice. This advice may be part of a request for the treatment of symptoms e.g. pain, whether coming from an in-patient or an out-patient in hospital or in the community.

2 Need for drug

In providing pharmaceutical care for a patient it is essential that background information about the patient’s health and social status is identified. Without this information it is difficult to establish the existence of, or potential for, medication related problems. Review of prescriptions without this information risks flawed judgements on the appropriateness of therapy for that individual. The detail required will vary depending on the circumstances. Sources of patient information include medical, nursing and electronic records, as well as directly from the patient or carer themselves.

3 Selection of drug

This relates to the principles of evidence-based medicine, clinical and cost-effectiveness in the selection of the most appropriate drug, dose and formulation for an individual patient. General level pharmacists are not expected to know the full breadth of clinical evidence for all conditions, but should familiarise themselves with and be able to demonstrate appreciation of key literature relevant to their current field of practice e.g. for respiratory conditions they should know the BTS/SIGN guidelines on the management of asthma, COPD etc. Pharmacists should also be aware of local trust formularies

4 Drug specific issues

The pharmacist should ensure that the medicine as prescribed can be administered safely and effectively to the individual patient. The pharmacist should:

• Assess the prescription to ensure that the dose is appropriate.
• Is the prescribed route available for that patient and appropriate for that patient?
• Is the medicine available in a suitable form for administration via the prescribed route?
• Do the nurses or care staff require any specific information in order to administer the medicine safely?
• Are aids required to ensure safe and effective administration?
• Documentation should be completed to ensure the safe and effective administration of the medicine.

Particular attention should be paid to the monitoring of parenteral therapy, which carries the additional risk of extravasation, infection and administration errors.

5 Provision of drug product

The pharmacist is responsible for the efficient supply of medicines to patients. When supplying a medicine for an individual patient the pharmacist should:

• Ensure the prescription is clear, unambiguous and legal in the country it is being dispensed in.
• Consider the availability of the drug within the hospital or community (i.e. formulary, drug tariff and local shared care policy).
• Consider whether the prescribed indication is within the medicine’s license (unlicensed drugs procedure).
• Follow local guidelines to obtain unlicensed and non-formulary medicines and ensure that appropriate documentation is completed.
• Communicate clearly with the relevant people to ensure the efficient and safe supply of medicines.
• Ensure continuity of supply for in-patient use, discharge and in the community.
• Document supply issues clearly on the drug chart or prescription and ensure that all instructions are clear. In secondary care endorsement of drug chart should follow local trust guidelines.
• Ensure medicines are labeled accurately e.g. with clear dosage instructions.
• Ensure medicines are labeled appropriately for the patient e.g. the visually impaired, non English speakers.

6 Medicines information and patient education

It is expected that the pharmacist will provide medicine and health information and advice, both to patients, carers and medical staff. This may be in response to information requested by an individual, but the pharmacist should also seek actively, opportunities to provide this aspect of the pharmacy service.

7 Monitoring drug therapy

Once a drug has been appropriately selected for a patient, supplied and administered, ongoing use of the drug should be assessed, both for the desired therapeutic effect and the appearance of adverse reactions. Therapeutic drug monitoring (TDM) is an essential duty for hospital pharmacists. Pharmacists in primary care may not always have access to this information but need to be aware of its importance.

8 Organisation

The general level pharmacist should be able to prioritise their own work and adjust priorities in response to changing circumstances; for example, knowing which patients/tasks take priority. We recognise that it is not possible or necessary to review the pharmaceutical care of every patient, every day.

9 Effective Communication Skills

Good communication is essential if pharmaceutical care is to be provided for patients. This involves communicating effectively in verbal, electronic and written form, using the language appropriate to the recipient; for example, use of open questions initially followed by appropriate closed questions and supporting any recommendations with evidence.

10 Teamwork

This includes understanding the roles and responsibilities of team members and how the team works. Respecting the skills and contributions of colleagues and directly managed staff as well as recognizing one’s own limitations within the team. Within the pharmacy team, the general level pharmacists should be expected to:

• Be a committed member of the team
• Establish good working relationships with all colleagues
• Accept responsibility for own work (and for those in training where appropriate)
• Give and receive constructive criticism
• Work efficiently in a team
• Share learning experiences with colleagues
• Know when to ask for help
• Understand the roles of all other team members
• Identify when team members need support and provide it
• Understand individuals’ strengths and weaknesses

The pharmacist should recognise the roles and skills of other healthcare professionals and seek to establish co-operative working relationships with colleagues, based on understanding of, and respect for, each other’s roles.

11 Professionalism

As for all health care professionals, pharmacists must respect individuals right to confidentiality, maintain confidentiality and understand the circumstances when information about the patient’s condition can be shared with colleagues. This includes an awareness of local trust policies and relevant legislation e.g. Data Protection Act 1998, Caldicott guidance, Code of Ethics.

12 Gathering Information

The general level pharmacist should be able to demonstrate that they can access all the information necessary in order to undertake a review of the appropriateness, safety and efficacy of the medicines prescribed for a patient. They should be able to access this information from a variety of sources and in the most time-efficient manner. The pharmacist should demonstrate the ability to précis the information, to extract the key points that influence drug therapy and if necessary, be able to relay concisely this information to another colleague. Information needed on a day to day basis should be kept up to date. This will include clinical aspects of the patient’s care and up to date texts and guidelines.

13 Knowledge

• Pathophysiology: The general level pharmacist should be able to clearly describe the pathophysiology relevant to the therapeutic areas in which they are currently working.
• Pharmacology: The general level pharmacist should be able to clearly discuss the mode of action of medicines that they routinely review in the course of their daily practice. An appreciation of the distribution, metabolism and elimination of these medicines and the influence of disease states (e.g. renal failure) and patient factors (e.g. age) should also be demonstrated.
• Side effects: Knowledge of the common and major side effect profile of routinely used medicines must be demonstrated. Pharmacists should be able to both discuss the potential for these with patients and recognise and describe any appropriate monitoring parameters.
• Interactions: The general level pharmacists should be able to describe the different mechanisms of drug interactions and be able to identify which type of interaction applies.

14 Analysing information

The general level pharmacist should demonstrate the ability to effectively evaluate information they have retrieved. This could be for a variety of purposes including designing a local patient information leaflet or critically appraising information about new products. The pharmacist should be able to assess information for the following aspects:

• Reliability of source – depending on the nature of information retrieved, the pharmacist should be able to evaluate the likely accuracy of information and any likelihood of bias (drug company sponsored information).
• Relevance to patient care – the impact or potential impact that the information will have on the pharmaceutical care the patient requires.
• Required response – the pharmacist should demonstrate the ability to identify an appropriate response, both in the nature of the action required and the priority that it should be assigned.

15 Providing information

• Provides accurate information: Whenever information is requested, or a need for information is identified, it is the pharmacist’s responsibility to ensure that the response they give is accurate. Information should be accessed from a reliable source and, if necessary, reference should be made to appropriate literature or to colleagues.
• Provides relevant information: The content and style of presentation should be appropriate to the recipient’s needs. Establishing the reason for the request, and appreciating what action will be taken on receipt of the information, should be a first priority. The general level pharmacist should demonstrate that they have considered these aspects and responded appropriately by tailoring the information that they provide.
• Provides timely information: When information is requested, or the need for information is identified, the pharmacist should provide it in a timely manner. It may be that the information is immediately required for patient care and it will take priority over other activities e.g. management of drug alerts. Conversely, other duties may take precedence over a considered review of the literature.