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A Competency Framework forSingHealth

Pharmacists to provide

Minimum Standard of General Pharmacy Practice:

The General Level FrameworkHandbook

First EditionFebruary 2011

Adapted with permission from the Safe Medication Practice Unit, Queensland Health and the NHS London and South East - Competency

Development and Evaluation Group.

Contents

Acknowledgements…………………………………………………………………………………….

Background……………………………………………………………………………………………... Page 3

Introduction……………………………………………………………………………………………... Page 4

Assessment Rating…………………………………………………………………………………….. Page 5

Assessment Tools…………………………………………………………………………………….. Page 6

Mini-Clinical Evaluation Exercise (Mini-CEX)……………………………………………………….. Page 7

Case based Discussions (CbD)………………………………………………………………………. Page 8

Medication Review & Dispensing Observations……………………………………………………. Page 10

1. Delivery of Patient Care Competencies………………………………………………………….. Page 13

2. Problem Solving Competencies………………………………………………………………...... Page 33

3. Professional Competencies……………………………………………………………………….. Page 41

At The End of The Assessment Period……………………………………………………………… Page 48

Appendix 1: The General Level Framework

Appendix 2: GLF Mapping

Appendix 3: Mini-Clinical Evaluation Exercise (Mini-CEX) Form

Appendix 4: Case based Discussion (CbD) Form

Appendix 5A: Medication Review / Dispensing Observation for GLF Pharmacist

Appendix 5B: Dispensing Observation for GLF Pharmacist

Appendix 6: GLF Assessment Summary

Acknowledgements The following people are acknowledged for their contributions and efforts towards the

production of this handbook:

- Angelina Tan Hui Min, Pharmacy, Singapore General Hospital

- Camilla Wong Ming Lee, Allied Health Division, Singapore General Hospital

- Jacqueline Ong Kia Geok, Allied Health Division, Singapore General Hospital

- Lim Kiat Wee, Pharmacy, Singapore General Hospital

- Lim Paik Shia, Pharmacy, Singapore General Hospital

- Yee Mei Ling, Pharmacy, Singapore General Hospital

- Patricia Ng Lai Lin, SingHealth Academy (Editorial Support)

- Anita Binte Mohamed Sani, Pharmacy, Singapore General Hospital (Cover Page Design)

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Background

The scope of pharmacy practice in Singapore has increased tremendously in recent

years. It is crucial that pharmacists have adequate postgraduate education, training

and guidance to enable them to perform competently so as to ensure safe and

effective patient care.

In 2007 the Singapore General Hospital (SGH), a member of the Singapore Health

Services (Singhealth) group, started collaborations with the UK Competency

Development and Evaluation Group (CoDEG) to adapt their General Level

Framework (GLF) for use in SGH. The GLF is an assessment and developmental

tool that encompasses the holistic scope of pharmacy practice, namely knowledge,

skills and attitudes. Ultimately, the aim is to develop competent pharmacists who will

provide safe and effective healthcare to the nation.

In May 2009, an adapted version of the GLF was initiated within the Department of

Pharmacy. In December of the same year, experts from CoDEG visited Singapore

and a Memorandum of Understanding was exchanged between CoDEG and

Singhealth, a milestone in the continued collaboration between the two parties. In

addition, the experts conducted a GLF training programme that included a ‘train the

trainers’ session in which Singhealth pharmacists were educated and trained on the

framework’s concepts and processes, and who then took the lead in the training of

other GLF assessors within their own institutions. In 2010, all of the Singhealth

pharmacy leaders agreed to adopt a unified ‘SingHealth’ GLF. This was a major

breakthrough.

Recent developments have also seen the Singapore Ministry of Health (MOH)

endorse the use of such competency frameworks as part of the new national career

pathway for pharmacists. This is an exciting development, which has put

Singhealth’s competency training initiatives at the forefront of the profession’s

development in Singapore.

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Introduction

The purpose of this document is to provide guidance on the Singhealth General

Level Competency Framework. (Refer to Appendix 1)

A competency framework is a collection of competencies that are thought to be

central to effective performance. Competency frameworks can be used to support a

range of different things. Typically, they are used to help with:

Training and development;

Performance review.

It is envisaged that this framework will be used to help with pharmacist training and

developmental activities. However, as the pharmacist develops, the framework also

has the potential to be used as a tool to help in appraisal and to track performance.

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Assessment Rating

The assessment rating is on a 4-point scale i.e. “Rarely”, “Sometimes”, “Usually” and

“Consistently” (see Table 1). An ‘Unable to Assess’ option is available for occasions

when a competency cannot be observed or is not appropriate.

Assessment should be referenced to the standard expected at a particular level of

practice. This may vary between levels of practitioners (for example, that expected of

a newly registered pharmacist will differ from that expected of a more experienced

pharmacist). Please refer to Appendix 2 for the current Singhealth mapping

reference.

Table 1: Frequency Ranges for Assessment Ratings

Rating Definition Percentage

Expression

Consistently Consistently demonstrates the expected standard

practice, with very rare lapses.

85–100%

Usually Demonstrates expected standard practice with

occasional lapses.

51–84%

Sometimes Demonstrates expected standard practice in less than

half the time observed. Much more haphazard than

“usually”.

25–50%

Rarely Very rarely meets the standard expected. No logical

thought process appears to apply.

0–24%

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Assessment Tools

As a result of ongoing implementation of the framework, various other assessment

tools have been developed. These tools provide formative assessments which are

designed to complement the GLF and help to identify areas for development and

monitor performance. They have been adapted from similar tools developed by

CoDEG and include:

Mini-Clinical Evaluation Exercise (Mini-CEX) — Refer to Appendix 3;

Case-based Discussions (CbD) — Refer to Appendix 4;

Medication Review and Dispensing Observations - Refer to Appendices 5A

and 5B.

A portfolio (based on this framework) and the associated assessment tools can be

used to demonstrate a pharmacist’s ability to work at a general level. This provides a

platform for further development to a higher practice level.

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Mini-Clinical Evaluation Exercise (Mini-CEX)

Purpose: The Mini-CEX is designed to assess the skills essential to the provision of

pharmaceutical care.

Competencies assessed: The pharmacist will be assessed on the competencies of

gathering and analysing information, evaluating appropriateness of drug selection

and providing the necessary patient education. Communication skills with the other

healthcare providers, patients and caregivers will also reflect the pharmacist’s

problem-solving skills and professionalism.

Setting: It is preferable to discuss cases that are currently under the pharmacist’s

care i.e. inpatients or outpatients.

Feedback: Timely feedback should be provided after each encounter by the

assessor. In keeping with the quality improvement assessment model, strengths and

areas for development will be identified following each Mini-CEX.

The documentation (or a copy) of a Mini-CEX should be retained by the pharmacist in his / her career portfolio. The assessment should end with formulating at least one learning objective for the next encounter with the assessor.

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Case-based Discussions (CbD)

Purpose: CbD is designed to assess analytical skills and decision making, as well as

the clinical application of pharmaceutical knowledge in the care of the pharmacist’s

own patients. It also enables the discussion of professionalism and the ethical

aspects of practice, and in all instances, allows pharmacists to discuss why they

acted as they did.

Competencies assessed: The pharmacist’s ability to identify drug-related problems,

analysis and treatment recommendations, follow-up and monitoring, communication

with other healthcare professionals, consideration of patient concordance,

professionalism and overall clinical judgement will be assessed. Refer to Table 2 for

the relevant descriptors.

Setting: It is preferable that each CbD focus on a clinical area which the pharmacist

has been involved in. The case discussion could be conducted retrospectively, i.e.

after counselling or patient discharge. A variety of areas should be covered through

a number of CbDs.



areas for development will be identified following each CbD.

The documentation (or a copy) of a CbD should be retained by the pharmacist in his

/ her career portfolio. The assessment should end with formulating at least one

learning objective for the next encounter with the assessor.

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Table 2: Competency Areas and Relevant Descriptors

Competency Areas Descriptor

Identification of

drug-related

problems (DRP)

Able to correctly identify and prioritise DRPs.

Analysis and

treatment

recommendations

Able to discuss treatment of the main medical problems

including drug therapy (mechanism of action of drugs, dosage

range, key pharmacokinetic consideration, cautions,

contraindications, common side effects, major drug / food

interactions, patient counselling points), utilising evidence-

based treatment guidelines where appropriate.

Follow-up and

monitoring

Able to discuss the rationale for pharmaceutical care.

Able to demonstrate appropriate monitoring of therapy

(including renal function test, full blood count, drug levels etc)

Professionalism Able to prioritise activities and demonstrate timeliness.

Is ethical and aware of any relevant legal frameworks.

Has insight into own limitations.

Overall clinical care Able to demonstrate sound judgement in the provision of

patient care.

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Medication Review and Dispensing Observations

Purpose: The Medication Review / Dispensing Observations tool document findings

during medication review and dispensing for pharmacists.

Competencies assessed: The pharmacist will be assessed on the ability to manage

the patients assigned, prioritising the tasks and handling urgent and important

interventions appropriately as well as showing effective communication skills.

Setting: Inpatient - During medication review round, and / or bedside / counter

dispensing. Outpatient - During medication review at ambulatory clinics and / or

counter dispensing.



areas for development will be identified following each observation.

The documentation (or a copy) of the findings should be retained by the pharmacist in his / her career portfolio. The assessment should end with formulating at least one learning objective for the next encounter with the assessor.

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The General Level Framework

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Section One

Delivery of Patient Care Competencies

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1. Delivery of Patient Care Competencies

PATIENT CONSULTATION

This competency incorporates the structure and processes needed to obtain and

document information relating to the patient’s visit / admission, which will provide a

baseline for ongoing pharmaceutical care. The personal skills needed for effective

communication in this process are described in the professional competencies.

1.1 Opening the Consultation

A pharmacist should always provide clear introduction to the consultation and agree

on an agenda with the patient. After determining the ability of the patient to

communicate, confirming the time is convenient to the patient and adopting a

suitable position to enable the consultation to take place comfortably, the pharmacist

should:

greet the patient or caregiver and establish his / her identity;

introduce himself / herself and other colleagues if present;

explain what the pharmacist is hoping to achieve, e.g. taking medication

history, drug specific counselling or a medication chart review;

respect the patient’s right to decline an interview or consultation, or choose a

more appropriate time for the interview.

1.2 Questioning

Pharmacists must determine the specific goals of the interview and tailor the

questions and discussion to obtain the necessary data. The pharmacist must talk at

a level which enables the patient to hear, but does not compromise patient

confidentiality. Appropriate language must be used i.e. non judgemental, non

alarmist, reassuring, and using terminology that the patient will understand.

Questions must be relevant and succinct, as exhaustive interviews may be counter-

productive. Appropriate questioning makes it easier to obtain relevant information

from the patient. For example, begin the medication history interview with open-

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ended questions to encourage the patient to explain and elaborate, then move to

close-ended questions to systematically minimise omissions. Leading questions

should be avoided as they can result in false information.

GATHERING INFORMATION

1.3 Allergies

To document an accurate and comprehensive allergy / adverse drug reaction (ADR)

history, the pharmacist should:

confirm with the patient any history of drug allergies or previous adverse

reactions to any agents;

document the drug, reaction and date of reaction (if known) on the

prescription;

document as “NKDA” (No Known Drug Allergy) on the prescription if the

patient reports no history of ADR or allergy;

notify the doctor-in-charge of the drug allergy and reactions reported by the

patient and document as appropriate in the medication records and / or case

notes, and / or prescriptions, in a timely manner.

It is important to follow institutional policy regarding documentation of allergy / ADR

history in the patient’s case notes. As institutions move towards electronic

medication records, the above should be documented electronically.

1.4 Relevant Patient Background

Background information about the patient’s health and social status is important in

the provision of pharmaceutical care. Without this information it is difficult to establish

the existence of, or potential for, medication-related problems. Review of medication

charts and prescriptions without this information risks flawed judgements on the

appropriateness of therapy for that individual. The details required depend on the

circumstances. The data collected should be succinct and relevant. The key focus

should be on obtaining the most relevant data rather than collection of all

information.

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Details required may include:

Age — the very young and the very old are most at risk of medication-related

problems. A patient’s age will indicate their likely ability to metabolise and

excrete medications and therefore has implications for appropriate selection

of drug dosage.

Gender — may impact on the choice of therapy for certain conditions.

Ethnic background / religion — pharmaceutical implications of this information

include racial pre-dispositions to intolerance or ineffectiveness of drug

classes, e.g. ACE-inhibitors in Afro-Caribbean individuals, or the unsuitability

of drug formulations, e.g. blood products in Jehovah’s Witness patients,

porcine-derived products for Jewish and Muslim patients.

Social background — this may impact on their ability to manage their

medications and influence their pharmaceutical care needs e.g. what are their

home circumstances? Do they live in their own home or in residential

accommodation? Do they have a visiting nurse or caregivers? etc.

Presenting condition — establish what symptoms the patient described and

the signs identified by the doctor on examination. Could these be adverse

effects related to prescribed or purchased medication? Could the lack of

symptom control indicate poor adherence, inadequate dose or inappropriate

agent?

Working diagnosis of the medical team treating the patient — how would this

condition likely be managed? What drug therapy would be considered

appropriate and evidence-based? This will give an indication as to the classes

of medications that one should expect to see on the medication chart.

Previous medical history — concurrent medical conditions may guide the

selection of appropriate therapy. Knowing the patient’s concurrent medical

conditions will help the pharmacist identify potential drug-disease

contraindications and ensure that management of the acute newly diagnosed

problem does not compromise a prior condition.

Relevant laboratory or other findings (if available) — focus on findings that will

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Renal Function

Liver Function

Full Blood Count

Blood Pressure

Cardiac Rhythm

Heart Rate

Temperature

Pain Scores

Consider not only the impact that these findings could have on the ongoing

management of drug therapy e.g. the need for dose adjustments, but also whether

these results could have been caused by an unwanted drug effect.

Establishing this background information will allow you to make a more

accurate assessment of the appropriateness of therapy.

Sources of Patient Information

Obtaining relevant information will depend on your sector of practice. Sources of

patient information include medical, nursing and electronic records, as well as

directly from the patient or carer themselves. The most concise information source

should be used. Routine review of medical notes (if available) and all laboratory tests

may be time consuming, inappropriate and unnecessary for the retrieval of basic

information. Possible sources of information include:

Nurses (including community nurses) – they are the frontline care providers for

the patients in a hospital and increasingly in primary care. Hence developing a

good working relationship with the nursing staff is a valuable exercise. In a

hospital, the nursing team may provide excellent information about the patient’s

current condition.

Patients – they are often able to provide information, particularly in relation to

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Case notes – these will provide the most detailed description of the patient’s care

to date, although they are often lengthy and repetitive and should therefore be

used to confirm findings, rather than as a first source of reference. Previous

hospital admissions and subsequent discharge summaries, or prescriptions are

often useful to clarify medication histories.

Allied health professionals – these professionals e.g. physiotherapists, social

services care workers, occupational therapists etc. may be involved in the

patient’s medicine management e.g. assessing compliance and recommending

compliance aids.

Laboratory results systems – if laboratory results are readily available,

pharmacists should ensure that they have personal access and have been

trained in retrieving correct patient information from the database.

As institutions move towards electronic medical records, the above could be

retrieved electronically. Finally, it should be remembered that all patient information

is CONFIDENTIAL and should not be discussed with anyone not involved in that

patient’s care.

1.5 Medication Reconciliation

An accurate medication history will assist in patient care and should include an

interview with the patient / carer. Taking accurate and complete drug histories has

been shown to have a positive effect on patient care. Pharmacists have

demonstrated an ability to accurately and reliably take medication histories. The

benefit of this to the patient lies in the fact that errors of omission or transcription

would be identified and corrected early, reducing the risk of harm and improving

care.

Queries regarding drug therapy should be clarified with the prescriber, or referred to

a more senior pharmacist. The core components of medication history taking are

listed in Tables 3 and 4.

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Table 3: Core Components of A Complete Medication History

1. Introduce yourself to the patient and explain the purpose of the visit /

consultation.

2. Identify and document any drug allergies or serious ADRs.

3. Determine the individual responsible for administration and management of

medication e.g. patient or carer.

4. Ascertain any information the patient is able to provide about their medication

from (in order of priority):

their own knowledge, the patient’s own medication list, or other

concordance aids;

the medication they brought to the hospital;

the community pharmacy;

repeat prescriptions;

a GP referral letter;

information available in medical notes;

the GP.

5. Ensure the following are recorded:

generic name of the medication (brand name to be recorded where

appropriate);

route / dosage form;

dose;

frequency;

duration of therapy if appropriate (e.g. antibiotics).

6. Document any recent changes to the medication regimen and reason(s) for

discontinuation or alteration of any medicines.

7. Ensure that items such as inhalers, eye drops and topical agents are included

and are used correctly, as patients often do not consider these to be

‘medication’;

8. Identify any self-medications that the patient may be using e.g. OTC, herbal,

homeopathic

(Source: Safe Medication Practice Unit, Queensland 2005)

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Table 4: Medication History Checklist

The patient should be specifically questioned regarding use of the

following items:

Prescription medication

Sleeping tablets

Inhalers: puffers, sprays; sublingual tablets

Oral contraceptives, HRT

OTC, Analgesics esp. - NSAIDS, paracetamol +/- codeine

Gastrointestinal drugs (for reflux, heartburn, constipation, diarrhoea)

Complementary medicines (e.g. herbals, vitamins)

Topical medicines (e.g. patches, creams, ointments)

Inserted medication (e.g. nose/ eye/ ear drops, pessaries, suppositories)

Injected medication (e.g. Insulin)

Intermittent treatments (i.e. weekly, monthly)

Recently completed courses of medicine/ other people’s medicine

Social and recreational drugs;

Any previous allergies or adverse reactions.


Medication History

Although a patient / carer interview should be the primary source of data, a

combination sources can be used to obtain the medication history. If the patient is

not responsible for medication administration or if a reliable medication history

cannot be obtained from the patient / carer, then alternative sources of patient

information must be accessed. The information sources may include:

Medication dispensing history from previous hospital admissions and / or

community pharmacies;

Administration records from nursing homes, community hospitals or other

care facilities;

Other healthcare professionals i.e. GPs, community nurses;

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Patient’s own medication or list of medications;

Patient’s prescriptions (discharge and outpatient prescriptions).

The medication history obtained should be reconciled with that recorded in case

notes by medical staff and also with the inpatient medication record at the time of

admission. The pharmacist must be able to justify changes made to medications

taken prior to and on admission. If any changes of therapy were identified, check the

case notes and ascertain if these variances are intentional. The patient, nursing staff

and medical staff may also be contacted. Unintentional changes should be clarified

and communicated to the primary team medical officers or consultant and staff

nurses as appropriate.

If significant unresolved variances exist, and a medical officer and / or consultant

cannot be contacted, the issues should be documented as a pharmacy intervention

forms or case notes. Inform the nurse looking after the patient of any medication-

related problems. It is imperative that such problems are followed up at a later time

to ensure appropriate resolution.

As part of good pharmacy practice, all interventions (resolved or unresolved)

should be documented in the patient’s case notes.

Medications currently prescribed for the patient must also be reconciled with their

current problems and relevant patient background, for example with respect to

interactions as detailed in section 2.7

Discharge Prescription

Discharge prescription / medication must be checked against the patient’s current

medication record. Reconcile discharged medications prescribed against the current

inpatient active medications list. Ensure that all drugs are reflected accurately on

discharge prescriptions. When discrepancies are identified, ascertain if the difference

is an error or intentional, for example:

“When required” medication used in hospital not required for discharge e.g.

analgesics, anti-emetics;

Regular inpatient medication used in hospital not required for discharge e.g.

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Completed courses of Antibiotics;

Chemotherapy;

Changes intended for discharge documented in case notes.

If discrepancies require clarification, the prescriber(s) should be contacted for

confirmation of drug orders.

Discharge prescription / medication should be checked against admission history.

Reconcile discharge medication against admission medication, thus ensuring:

Ongoing medication is prescribed / supplied / documented as appropriate

according to hospital policy;

Changes made during admission are identified so that details can be relayed

to the patient or community healthcare providers;

Patients’ own medications are checked against discharge prescription if

appropriate;

Patient’s own medication are checked with respect to dose, formulation,

strength, and quantity;

Labels are checked to ensure that they reflect current dosage and frequency

instructions.

PROVISION OF MEDICATION

The pharmacist should ensure that the medication as prescribed can be supplied

and administered safely and effectively to the individual patient. Particular attention

should be paid to the monitoring of parenteral therapy, which carries the additional

risk of extravasation, infection and administration errors.

1.6 Prescription is Unambiguous

Ensure all aspects of the prescription — drug name, dose, administration routes and

times — are clear and legible, in accordance with the medication, drug dispensing

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and controlled drug policy of the respective institutions.

Ensure all medications are prescribed by generic names, except combination

products and some controlled drugs, according to MOH guidelines. To minimise

selection of the wrong drug, prescribing by brand name is sometimes preferred e.g.

in combination products and certain controlled drug formulations. Examples include:

Fungizone® - Amphotericin B vs AmBisome® - Amphotericin (Liposomal) vs

Abelcet ® - Amphotericin (Phospholipid complex)

OxyContin® – Controlled released oxycodone vs OxyNorm® – Immediate

released oxycodone

Humalog Mix (Insulin Lispro / Protamine 30/70) which is not interchangeable with

NovoMix (Insulin Aspart / Protamine 30/70)

1.7 Prescription is Legal

Check that the patient identifiers are present and the prescription is legal:

Drug, form, route, dose, frequency, date and prescriber’s signature;

Quantity and strength are also legal requirements for discharge and

outpatient prescriptions including controlled drugs.

1.8 Labelling of the Medicine

Pharmacists should ensure that the label on the dispensed medicines follow legal

requirements and clearly state the required information, i.e.

Patient name and identification number;

Drug name and strength;

Drug dosage form;

Drug dose and frequency;

Drug quantity

Special administration instructions e.g. do not chew, swallow the whole

tablet;

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Duration (if applicable);

Date of dispensing;

Pharmacy details.

1.9 Medication Supply

The prescribed medication can be made available from the hospital’s

formulary.

Consider whether the prescribed indication is within the drug’s licence

(exemption drugs procedure).

Follow local guidelines and hospital policies to obtain exemption and non-

formulary drugs and ensure that the appropriate documentation is

completed.

Communicate clearly with the relevant people to ensure the efficient and

safe supply of medication.

Ensure continuity of supply for outpatient use, inpatient use and at

discharge that will be sufficient till the next scheduled appointment or date

of expected completion of therapy.

The prescribed medication is supplied accurately and legally

Correct drug, form, strength, quantity, packaging and patient name.

The prescribed medication is labelled accurately and appropriately

As listed in 1.8.

Instructions, as necessary, are provided. Inpatient items often do not

require dosing instructions. Exceptions to this may be items that may

be self administered by the patient and may subsequently be used for

discharge supply for example metered dose aerosols, eye drops, and

topical preparations. All discharge medication supplies must be

labelled with clear dosage instructions and, where appropriate,

ancillary labels.

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Ensure medications are labelled appropriately for the patient e.g. the

visually impaired, non-English speaking patients.

The prescribed medication is provided for the patient in a timely manner

Medication should be made available in the ward for administration at

the prescribed times.

Supply of newly prescribed medication may be prioritised depending

on medical condition of the patient e.g. IV antibiotics for the critically ill.

Document the supply of the drug in the medication record

The pharmacy column in the IMR is annotated in accordance with

hospital medication policy on review and supply workflow, inclusive of

date and amount supplied.

For electronic medication administration records, dispensing system

must be able to record all the relevant information mentioned.

DRUG SPECIFIC ISSUES

1.10 Drug Selection

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, with the consideration of medical condition, co-morbidities,

financial and social issues. Pharmacists are not expected to know the full breadth of

clinical evidence for all conditions, but should have a clear understanding of, and be

able to access, local and other established prescribing guidelines. They should also

familiarise themselves with, and be able to demonstrate appreciation of, key

literature relevant to their current field of practice, for example they should be aware

of the established therapeutic services / departments. Pharmacists should also be

aware of the hospital Formulary Drug List. Postgraduate education and continuing

professional development should be guided by learning needs identified in practice.

1.11 Selection of Formulation, Concentration, Rate and Diluent

Pharmacists should check and be familiar with the following:

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Is the medication available in a suitable form for administration via the prescribed

route?

Is the route / formulation prescribed suitable for the patient e.g. oral liquid or

tablets for paediatric patients or patients fed via the nasogastric tube?

Do the nurses or doctors require any specific information in order to administer

the medication safely (e.g. appropriateness of crushing tablets, dilution

requirements for parenteral medication, rate of administration, IV compatibilities

including syringe drivers)?

Are aids required to ensure safe and effective administration (e.g. volumatic

spacers for inhalers)?

1.12 Checking of Dose, Frequency, Timing, Route and Duration

The pharmacist should assess the prescription to ensure that the dose is

appropriate. This includes adjustments for:

Patient weight;

Patient age;

Disease states e.g. renal / hepatic impairment;

Route and formulation prescribed e.g. IV versus oral metronidazole, IM versus

oral anti-psychotics, liquid versus solid dosage forms;

Concurrent medications e.g. reduction of digoxin dose if used with amiodarone.

The pharmacist should assess the prescription to ensure the prescribed route is

available (e.g. is the patient nil by mouth? Is he / she able to take medicines orally?)

and appropriate (e.g. unnecessary prescription of IV medication when the patient

can swallow, or a solid dosage form when the patient has dysphagia) for that patient.

The pharmacist should assess whether the timing of the dose:

is appropriate with respect to food e.g. before food, after food;

is away from enteral, nasogastric or percutaneous endoscopic gastrostomy

(PEG) feeds where appropriate e.g. phenytoin;

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correlates with medication administration rounds;

help to minimise the side effects, e.g. frusemide in the morning.

The pharmacist should

check the administration records of the medication and ensure that administration

has occurred and has been documented;

check with patients and / or their caregivers to ensure that patients have been

compliant with their medications at home;

identify occasions where drugs have not been administered and, if it was due to

unavailability of drug, ensure initiation of drug supply, or if it was due to non-

compliance, address the issues causing this.

PATIENT EDUCATION

It is expected that the pharmacist will provide medication and health information and

advice to patients, carers and medical staff where appropriate, e.g. in response to

information requested by an individual. In addition, the pharmacist should actively

seek opportunities to provide this aspect of the pharmacy service.

When consulting with patients and carers, the pharmacist should demonstrate a

structured, patient-centred process. The following information should be provided

where appropriate:

Information on why a particular course of action is being suggested and how to

achieve the intended outcomes;

Information on the condition as assessed during the consultation and any

changes that need to be monitored;

Information on the medication / treatment recommended and how to use it;

Advice on when it would be appropriate to seek further advice from either the

pharmacist or someone else if the condition does not improve;

A combination of any of the above.

The pharmacist must take into account the patient’s cultural and social background

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when assessing his / her health needs. This will influence the patient’s health beliefs

and may affect the style of communication adopted. Interpreter services should be

used when needed.

1.13 Patient is Counselled on Medication

In most situations, the pharmacist should personally provide information in order to

facilitate patient compliance. Information can be provided verbally or in writing and

should be provided in a way that is appropriate to the patient’s needs. For example,

information should be provided:

To the appropriate person i.e. patient and / or carer

In a manner that overcomes any potential barriers to successful information

exchange e.g. non-English speaking, cognitive impairment, deafness, visual

impairment, illiteracy

Using a format that can be comprehended e.g. non-medical jargon, appropriate

language (using an interpreter, if required), enlarged font for visually impaired

patients / carers;

Using written information to back up verbal counselling;

To demonstrate devices e.g. inhalers, insulin pens.

The following information should be provided:

Generic and brand names of the drug;

Purpose and action;

Dose, route and administration schedule;

What to do if a dose is missed;

Special directions or precautions;

Common adverse effects, ways in which to minimise them and action required if

they occur;

Details of medications ceased;

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Details of new medications or medication regimens;

Techniques for self monitoring of therapy;

Storage requirements;

Safe ways to dispose of medication;

Relevant drug-drug, drug-food, drug-alcohol and drug-procedure interactions;

Number of days of treatment supplied and the duration of treatment;

How to obtain further supplies;

Patient information leaflet as appropriate;

Relevant contact details of healthcare professionals and health services for any

follow-up information.

The pharmacist should discuss non-drug alternatives (when appropriate) as part of

their information provision, for example:

Anti-embolic stockings for prevention of venous thromboembolism, or for

treatment of deep vein thrombosis and prevention of post-thrombotic syndrome;

Heat packs (usually available from physiotherapy department);

Mobilisation;

Physiotherapy;

Relaxation techniques.

The patient’s comprehension of the information provided should be assessed. The

pharmacist should assess the patient’s understanding of the information provided by:

Asking the patient to describe how they are going to take the medication;

Asking the patient to demonstrate use of a device such as an inhaler.

Gauging the patient’s perception of their illness allows you to understand their

healthcare needs and may be related to their current illness or past medical

conditions. This knowledge will allow the pharmacist to accurately review current

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therapy and provide appropriate medicine information to the patient and / or carer.

Open ended questions such as ‘What has brought you into hospital?’ will often illicit

a patient’s perception of what has happened. This may impact on how the patient

deals with healthcare professionals and the way they use medication. A poor

understanding of their illness may need to be addressed before the patient can fully

understand what treatment is necessary and the rationale for treatment.

Assess the patient’s experience of medication use, specifically regarding:

Perceived effectiveness of medication;

Control of symptoms;

Perceived problems with this or other medication used;

Why the patient stopped / started / changed the medication.

Assess the patient’s understanding and attitude to their therapy and seek specific

information on the following:

Patient’s understanding of rationale for treatment;

Patient’s perception of the purpose of the medication;

Patient’s perception of potential adverse effects.

These perceptions may impact on the patient’s adherence to prescribed treatment.

Pharmacists should actively explore the patient’s need for lifestyle advice e.g. diet,

smoking and exercise. An awareness of local services and initiatives and the referral

process in primary care or discharge planning is essential e.g. Health Promotion

Board (HPB) Quitline, smoking cessation services at the respective hospitals or

community pharmacies.

1.14 Compliance Assessment

Non-adherence may be due to perceived adverse effects, and could be contributing

to the present condition. Use a non-judgemental, empathetic approach and open-

ended questions. Assess the patient’s adherence by normalising poor compliance for

example asking:

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“People often have difficulty taking their medication… Do you have any difficulty

taking your medication?”

“About how often would you say you miss taking your medication?”

How are you taking the medicine? You have the supply at home?” for the

medicines that are always not collected from hospital/ polyclinic pharmacy.

Inform the medical staff if significant areas of poor compliance are identified.

Strategies to address poor compliance include use of dose administration aids, e.g.

education of carers, discharge medication records, a reduction in the number of

medications or simplification of the drug regimen, and / or changing to cheaper

alternatives where appropriate.

Knowing how medicines were managed prior to the patient’s hospital admission

allows therapy to be appropriately tailored to the patient and additional supports to

be initiated if needed. Factors such as cognition, alertness, mental acuity, literacy,

vision impairment and physical disabilities may impact the patient’s ability to manage

his / her medication.

For example:

Patients with impaired cognition or alertness may require medication compliance

aids, dosette boxes or additional supports, such as, community nurse visits or

assistance of family members in medication administration.

Patients with vision impairment, especially common in diabetic patients, may

require large-print labels and written information.

1.15 Need for Information Identified

Individuals have differing information needs. Pharmacists should be cautious about

providing information to patients in a ‘blanket’ format, and should tailor their provision

of information to individual circumstances. For example, general drug-specific

counselling advice may not be appropriate for patients who have been on a

medication long term. These patients will more likely require specific information

relevant to their situation. This will not be established unless the pharmacist allows

the patient an opportunity to ask questions early in the consultation.

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The pharmacist must retrieve information specific to a patient’s needs. Patients

commencing a medication are likely to require general information on indication,

administration, side effects and supply. Patients with ongoing supply may request

specific information regarding side effects they have experienced or use in

circumstances such as pregnancy and lactation.

The information must be accurate and retrieved from a reliable source such as

Lexicomp, SGH ePharmacopoeia, MIMS, product inserts, published literature or

medical databases such as Micromedex®.

RISK MANAGEMENT & SERVICE IMPROVEMENT

1.16 Risk Management

The pharmacist should be aware of and keep updated on the established policies

and procedures with respect to medication error prevention and reporting.

Pharmacist active participation is essential for ongoing analysis and monitoring of

medication errors. Suggestions to initiate safety measures should be discussed and

actively implemented and lessons learned should be disseminated in department

meetings.

In the medication review process and multidisciplinary ward rounds, pharmacists

should actively take the initiative to monitor, report and prevent medication errors

and adverse drug reactions.

1.17 Service Improvement

The pharmacist should routinely participate in quality improvement activities related

to the distribution, administration and use of medications particularly at ward level

and at the department level in general. In delivering patient care, the pharmacist

should proactively identify issues, discuss and ensure compliance to medication-

related policies and procedures. In providing service to patients, the pharmacist

should constantly seek quality improvement when applicable and should integrate

the practice standards with the hospital policies and procedures.

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Constructive feedback to the relevant individuals / pharmacists about the quality

achieved should be encouraged. It will not only help the pharmacist but the rest of

the team to strive towards a higher standard of service to patients.

Reflection and evaluation of practice is essential if an individual pharmacist is going

to undertake effective work-based learning. Contributions to care should be recorded

and followed up where possible to establish the outcomes of individual actions. It

may not be appropriate or possible for a pharmacist to follow the care of an

individual patient in every case, but effective communication with colleagues will

often establish outcomes. Pharmacists can assure evaluation of contribution by

reflecting on service delivery or patient encounter and identifying a resultant service

improvement or learning need.

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2. Problem Solving Competencies

PROBLEM IDENTIFICATION

2.1 Identification of Drug-related Problems

The pharmacist should be able to identify high risk medications and patients for

whom ongoing monitoring of therapy is required. The pharmacist should monitor for

effectiveness of treatment and potential adverse effects, and also establish and

maintain a plan for reviewing the therapeutic objective / end point of treatment.

High Risk Medications

Anticoagulants (warfarin, heparin, enoxaparin)

Drugs with narrow therapeutic range (e.g. digoxin, lithium, theophylline, immuno-

suppressants)

NSAID or opiate analgesic

IV antibiotics (e.g. gentamicin, vancomycin)

Chemotherapy

Electrolyte supplementation (IV potassium, IV magnesium)

Drugs requiring TDM + interpretation

Anti-epileptics (phenytoin, valproic acid, carbamazepine)

Insulin

High Risk Patient Groups

Renal impairment

Cardiac

Liver disease

Transplantation

Mental health

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Cancer

Paediatrics

Elderly

Unstable clinical condition

The pharmacist should be able to prioritise the medication management problems of

both individual patients and the group of patients for whom they are responsible.

2.2 Prioritisation

Once a problem has been identified, the pharmacist must be able to identify the

urgency of resolution and appropriately prioritise their actions. Factors that may be

considered include:

Is the patient likely to be harmed?

When is the next dose due?

Can the dose be withheld until the problem is resolved?

What do I need to do to resolve this problem?

Who do I need to inform regarding this problem e.g. nurse, doctor, patient?

Having identified and prioritised drug-related problems, the pharmacist should

ensure that an appropriate course of action is identified and implemented. If actions

by multiple healthcare professionals are required for resolution of the problems, the

pharmacist should accurately communicate to the relevant personnel the action

required and the urgency of that action. At all times, the pharmacist must ensure that

no harm comes to the patient.

2.3 Consultation or Referral

The pharmacist should be aware of his / her own limitations and always consult a

more senior colleague if necessary or refer the patient appropriately to another

healthcare professional. Referral can occur at different points during an episode of

care, for example:

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On the first review, when there is inappropriateness of medication management;

At the end of the consultation with the patient, when drug-related problems have

been identified and referral is needed to medical staff and community health

support.

The referral and consultation process should form part of continuing professional

development and it is expected that during the course of an individual’s work,

repeated exposure to similar pharmaceutical problems will result in development of

the pharmacist’s experience and competence.

KNOWLEDGE

2.4 Pathophysiology

An understanding of normal organ function and the effect of disease state on this is

relevant to the effects of, and the effects on, drug therapy. The pharmacist should be

able to clearly describe the pathophysiology relevant to the therapeutic areas in

which they are currently working and apply this knowledge when reviewing the

therapeutic use of drugs.

2.5 Pharmacology

The pharmacist should be able to clearly discuss the mode of action of medications

that they routinely review in the course of their daily practice. An appreciation of the

absorption, distribution, metabolism and elimination of these medications and the

influence of disease states (e.g. renal failure) and patient factors (e.g. age) should

also be demonstrated.

2.6 Side Effects and Monitoring

Knowledge of the common and major side effect profile of routinely used

medications must be demonstrated. The pharmacist should be able to both discuss

the potential for these with patients and recognise and describe any appropriate

monitoring parameters.

2.7 Interactions (Drug / Disease / Special Patient Groups)

The pharmacist should be able to describe the different mechanisms of drug

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interactions and be able to identify which type of interaction applies.

With the appropriate use of reference material, pharmacists are expected to:

Identify common, well-documented, clinically significant drug interactions

(including complementary medication);

Identify the mechanism by which the interaction occurs;

Be able to recognise medications with increased risk of potential interactions, e.g.

those with narrow therapeutic indices, those metabolised by the CYP450 system

and those which are inducers or inhibitors of the CYP450 system;

Assess the actual or potential interaction for clinical significance and

management options, prioritise the problem and refer as appropriate, using Table

4 as a guide

With regards to individual, patient-specific interactions and contra indications /

cautions to medication in certain patient groups, a pharmacist should:

Understand the potential for unwanted effects of medications, e.g. allergies and

other adverse drug reactions (ADRs);

Ensure that any allergy or ADR is identified and documented;

Review the prescription to ensure that no medications likely to cause harm have

been prescribed;

Assess actual or potential interaction for clinical significance and management

options, prioritise the problem and refer as appropriate using Table 4 as a guide.

With regards to contraindications / cautions that should be applied to the use of

individual drugs in a range of pathophysiological conditions, a pharmacist should be

able to:

Understand the mode of action and pharmacokinetics of the medications;

Understand how these mechanisms may be altered by the disease (e.g. renal

impairment);

Assess the actual or potential interaction for clinical significance and

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Table 5: Prioritising Action (Risk Rating based on Harm)

Extreme Consequence major or extreme OR probability

of occurrence likely or almost certain OR time

frame to harm is < 1 hour

Act Now

Very High Consequence moderate OR possibly will

occur OR time frame to harm is < 4 hours

Act < 4 hours

High / Medium Consequence minor OR unlikely to occur OR

time frame to harm is today

Before leaving

work

Low Consequence negligible OR harm rare OR not

likely to impact on patient outcome today

Tomorrow


ANALYSIS AND RECOMMENDATIONS

2.8 Use of Guidelines and Evidence

A pharmacist should be able to demonstrate an awareness of guidelines available

for the clinical field in which they are practising. Pharmacists should also know the

practical implications of these guidelines. Guidelines may be local policies or national

guidelines from established groups (e.g. MOH Clinical Practice Guidelines,

AHA/ACC guidelines). The pharmacist should be able to utilise guidelines and be

aware of both the advantages and disadvantages of their use, and show regard for

individual patient need when using guidelines.

Following review of the guidelines, the pharmacist should demonstrate the ability to

summarise the information and extract the key points that influence drug therapy.

The pharmacist should demonstrate the ability to effectively evaluate information

they have retrieved. This could be for a variety of purposes including designing a

patient information leaflet or critically appraising information about new products. The

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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 (e.g. pharmaceutical company sponsored information).

Relevance to patient care — the impact or potential impact that the information

has on the pharmaceutical care of the individual patient or group of patients.

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.

The pharmacist should demonstrate that they have considered the various options

available to them to resolve a problem. They should consider the possible outcomes

of any action and recognise the pros and cons of the various options. In order to

achieve this, the pharmacist should determine the goal of treatment. This might be

one of the following:

Curing a disease or disorder;

Reducing or eliminating a symptom;

Arresting or slowing disease progression;

Preventing a disease;

A combination of any of the above.

Having appraised a selection of options, the pharmacist should be able to identify the

most appropriate solution and be able to justify the decision taken. However,

pharmacists should recognise their personal limitations and seek advice from

another colleague wherever necessary.

2.9 Information Provision to Other Healthcare Professionals

Whenever medication-related 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 assessed from reliable sources and, if necessary,

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reference should be made to appropriate literature or to colleagues.

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 pharmacist should

demonstrate that they have considered these aspects and respond appropriately by

tailoring the information that they provide.

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 in the critically ill.

FOLLOW-UP

2.10 Documentation of Drug-related Problems

It is necessary to document medication-related problems so there is a record of

pharmaceutical input to the patient’s care. This facilitates follow-up by other

healthcare professionals, ensures resolution of medication-related problems and

ensures documentation of ongoing monitoring requirements. Documentation can be

made in pharmaceutical care plans, in pharmacy intervention forms, in patients’

medical record or on locally accepted tools, e.g. clinical pathways. Include all

relevant information pertaining to pharmaceutical care for example:

Relevant background information;

Problems identified and resolution gained;

Results of relevant laboratory tests / investigations;

Ongoing monitoring requirements;

Education needs;

Compliance issues / aids.

Intervention should be documented in accordance with the hospital pharmacy

department policy.

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2.11 Monitoring and Problem Resolution

Once a medication 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. Assessment involves

the following steps:

1. Identify patients at high risk of drug-related problems;

2. Identify monitoring parameters for ongoing disease management, e.g. BP,

cholesterol, etc.;

3. Evaluate the patient against these parameters;

4. Recommend appropriate monitoring to medical staff;

5. Discuss with a colleague if necessary;

6. Review ALL current inpatient medication records (including IV fluids, heparin,

insulin, eye drops and PCA charts etc.) and if needed, patient clinical charts/

flowsheets;

7. Discuss changes to medication with medical staff if required.

If a problem is identified by or reported to a pharmacist, it is his / her responsibility to

ensure that it is appropriately resolved. This may not require his / her direct action,

but he / she must ensure that the appropriate person is alerted to the situation and

that accurate information is given to the other party. As a minimum, the pharmacist

must ensure that no harm comes to the patient.

For development purposes, the pharmacist should seek to follow up on problems,

both those that they had dealt with directly and those that were referred to another

party, and reflect on the outcomes.

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3. Professional Competencies

ORGANISATION

3.1 Prioritisation

The pharmacist should be able to prioritise his / her own work and adjust priorities in

response to changing circumstances; for example, knowing which patients / tasks

should take priority. Prioritisation of clinical workload may include:

Identifying all new patient admissions;

Obtaining and recording a complete medication history for new patients;

Identifying patients approaching discharge and establishing their need for

discharge medications and information;

Ensuring that all medications are appropriate and that the patient is informed

about their medications;

Ensuring newly prescribed medications are safe for the patients and sufficient

supplies are available;

Monitoring narrow therapeutic index drugs and other identified monitoring

parameters;

Monitoring parenteral therapy;

Evaluating current medication for safety and effectiveness.

3.2 Punctuality

The pharmacist should ensure he / she attends appointments and meetings on time,

and is there to provide cover at previously agreed times, e.g. back from lunch or the

ward as rostered.

3.3 Time Management

The pharmacist should organise his /her time effectively, assigning appropriate

amounts of time to different tasks with regular review and revision of time frames and

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deadlines. For example, a pharmacist may be allocated a morning to cover a ward.

He / she may spend his / her time seeing new patients, reviewing existing patients,

providing counselling and organising discharges. If any of these time lines slip, the

others have to be adjusted to allow the work on the ward to be completed in the

allocated time.

Pharmacists should be able to use their time productively with minimum waste. For

example, only review the renal function of patients taking medications that may

require dose adjustment, rather than routinely check and record the renal function of

the all patients regardless of medical conditions.

The pharmacist should be able to complete tasks within a previously agreed time

frame. This time frame may be set by a pharmacy manager, supervisor, or someone

outside the pharmacy department (e.g. consultant or nurse manager). For example,

reviewing and conducting medication reconciliation for new cases of the allocated

ward on a daily basis; or having discharge medication ready prior to the patient

leaving by ambulance.

3.4 Initiative

The pharmacist should demonstrate initiative in solving a problem or taking on a new

opportunity / task without the prompting from others, and demonstrate the ability to

work independently within their limitations.

PROFESSIONALISM

3.5 Professional Code of Ethics

The pharmacist must behave in an ethical manner in accordance with professional

codes such as:

Singapore Pharmacy Council (SPC) Code of Ethics

Singapore Pharmacy Competency Standards (MOH/SPC)

3.6 Confidentiality

As it is with all healthcare professionals, pharmacists must respect individuals’ right

to privacy, maintain confidentiality and understand the circumstances when

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information about the patient’s condition can be shared with colleagues. This

includes an awareness of hospital policies and relevant legislation, e.g. Code of

Ethics.

3.7 Confidence

All pharmacists must be confident of their own abilities and portray an image of

confidence to patients and other healthcare professionals.

3.8 Responsibility

Professional responsibility may be defined as the ability to provide an account of

professional judgements, acts and omissions in relation to a professional’s role. This

therefore requires accountability for professional practice.

In professional ethics, accountability is of paramount importance. The SPC Code of

Ethics states that, ‘A pharmacist shall take responsibility for all work done personally

and ensure that those under his direct supervision are able to carry out their duty

competently.’

The pharmacist should adopt a non-discriminatory attitude to all patients and

recognise their needs as individuals. As part of their responsibility, pharmacists

should recognise when to ask for advice and be willing to consult others. They

should act upon actual or potential errors and ensure resolution of identified issues.

The pharmacist should understand the need and take personal responsibility for

Continuing Professional Development. This involves:

Reflecting on his / her own practice, e.g. using critical incident review;

Maintaining current awareness of professional, pharmaceutical and clinical

issues (e.g. attend in-house pharmacy presentations, continuing professional

education and professional conferences as appropriate);

Maintaining a broad background clinical knowledge;

Recognising and using relevant learning opportunities;

Evaluating learning;

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Being self-motivated and eager to learn;

Showing willingness to learn from others;

Being willing to accept criticism for the benefit of his / her own development;

3.9 Organisational

The pharmacist is able to describe the structure and appreciate value of the

employing organisation. Pharmacists should take responsibility to keep themselves

updated with departmental goals and how they are aligned with institutional strategic

goals. This will provide direction to pharmacists during planning and implementation

of department work plans.

Pharmacists must develop a logical approach to their work. The competency

framework is intended to guide the activities that should be undertaken for each

patient or task, to ensure that points are not overlooked. Pharmacists should be able

to demonstrate that they use relevant and up-to-date procedure and a logical

process when delivering the assigned tasks or reviewing a prescription. This process

identifies the key action points that need to be addressed for that patient. It is

recognised, however, that individuals can use different approaches to problem

solving and still achieve the required outcome.

COMMUNICATION SKILLS

Good communication is an essential component of pharmaceutical care. It 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.

3.10 Communication

Effective communication encompasses the following skills:

Questioning;

Explaining;

Listening — active listening demonstrates genuine respect and concern for the

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Feedback — to ensure that the message is understood. It can take the form of

appropriate questions and asking the individual to demonstrate that they have

understood or can now do what you have explained;

Empathy — seeking to understand where other people are coming from and what

their wants and needs are;

Non-verbal communication;

Overcoming physical and emotional barriers to effective communication, e.g.

speech difficulties, fear and aggression;

Negotiating;

Influencing.

The desired outcome of using effective communication skills should be a concordant

relationship. There are three aspects of concordance with medicines:

1. Patients as partners: the patient and the healthcare team participate as

partners to reach an agreement on the illness and its treatment;

2. Patients’ beliefs: the agreement on treatment draws on the experiences,

beliefs and wishes of the patient to decide when, how and why to use

medicines;

3. Professional partnerships: healthcare staff treat one another as partners and

recognise each other’s skills to improve the patient’s participation.

The ‘patient’ in this context means any person the pharmacist provides any

pharmaceutical service to. The ‘carer’ may be a relative or friend of the patient as

well as a social services or private agency care worker.

Healthcare professionals include doctors, nurses, and the other Allied Health

professionals (e.g. dietitians, medical social workers, physiotherapists, occupational

therapists, podiatrists, speech therapists, etc) as well as ward clerks, cleaners, GP

receptionists and medical secretaries.

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The pharmacist must take into account the patient’s cultural and social background

when assessing his / her needs and understanding. This will influence his / her

interpretation and may affect the style of communication adopted. Interpreter service

should be used when needed.

3.11 Staff Development

The pharmacist must interact with colleagues both within the pharmacy department

and outside to convey information gained both within the hospital and externally. For

example, the pharmacist must:

Relay information learnt at continuing education sessions, training sessions,

conferences, etc.;

Contribute to departmental training sessions, journal clubs, etc.;

Relay patient safety issues;

Contribute to staff meetings;

Share with colleagues new information / journal articles if relevant.

TEAMWORK

It is important for the pharmacist to be a team player. 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;

Recognising one’s own limitations within the team.

3.12 Pharmacy Team

Within the pharmacy team, the pharmacist should be expected to:

Be a committed member of the team;

Understand the roles of all other team members;

Understand individuals’ strengths and weaknesses;

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Identify when team members need support and provide it;

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 the team;

Know when to ask for help;

Share and / or hand over information to avoid duplication of work by team

members.

3.13 Multidisciplinary Team

The pharmacist should recognise the roles and skills of other healthcare

professionals and seek to establish cooperative working relationships with

colleagues, based on an understanding of and respect for each other’s roles.

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AT THE END OF THE ASSESSMENT PERIOD

At the end of the GLF assessment period, a summary sheet (Appendix 6) should be

completed to highlight the pharmacist’s strengths, areas for development and the

objectives to be achieved for the next assessment.

Appendix 1 – The General Level Framework

A Competency Framework for Pharmacy Practitioners General Level Pharmacist Name: ___________________ Date of assessment: Baseline/end of 1st rotation/ end of 2nd rotation/ end of 3rd rotation/end of 4th rotation

UNABLE TO ASSESS ( UA)

CONSISTENTLY (100 - 85%) USUALLY (84 - 51%) SOMETIMES (50 - 21%) RARELY (<20%)

Record as UA under comments

Demonstrates the expected standard of practice with very rare lapses

Implies standard practice with occasional lapses

Much more haphazard than ‘usually’

Very rarely meets the standard expected. No logical thought process appears to apply

© 2004 CoDEG General Level Framework (GLF) used with permission from the Competency Development and Evaluation Group (CoDEG), South East England, UK, and the Medicines Safety Unit, Queensland, Australia. Adapted for use in Singapore General Hospital by Victoria Coleman and Camilla Wong, April 2009. Updated in Jan 2010.

2

1. Delivery of Patient Care Competencies a = baseline facilitated assessment b = 4 month facilitated assessment c = 8 month facilitated assessment d = 12 month facilitated assessment

PATIENT CONSULTATION

a b a b a b a b 1.1 Opening the consultation

CONSISTENTLY provides clear introduction to the consultation c d

USUALLY provides clear introduction to the consultation c d

SOMETIMES provides clear introduction to the consultation c d

RARELY provides clear introduction to the consultation c d

Comments

a b a b a b a b 1.2 Questioning CONSISTENTLY uses appropriate questioning to obtain relevant information from patient

c d

USUALLY uses appropriate questioning to obtain relevant information from patient c d

SOMETIMES uses appropriate questioning to obtain relevant information from patient

c d

RARELY use appropriate questioning to obtain relevant information from patient c d

Comments GATHERING INFORMATION

a b a b a b a b 1.3 Allergies CONSISTENTLY confirms or documents accurate and comprehensive allergy and/or adverse drug reaction history

c d

USUALLY confirms or documents accurate and comprehensive allergy and/or adverse drug reaction history

c d

SOMETIMES confirms or documents accurate and comprehensive allergy and/or adverse drug reaction history

c d

RARELY confirms or documents accurate and comprehensive allergy and/or adverse drug reaction history

c d

Comments

a b a b a b a b 1.4 Relevant patient background

CONSISTENTLY retrieves all relevant medical information from medical, nursing and electronic records

c d

USUALLY retrieves all relevant medical information from medical, nursing and electronic records

c d

SOMETIMES retrieves all relevant medical information from medical, nursing and electronic records

c d

RARELY retrieve all relevant medical information from medical, nursing and electronic records

c d

Comments



a b a b a b a b CONSISTENTLY takes or

checks for an accurate and comprehensive medication history where appropriate

c d

USUALLY takes or checks for an accurate and comprehensive medication history where appropriate

c d

SOMETIMES takes or checks for an accurate and comprehensive medication history where appropriate

c d

RARELY takes or checks for an accurate and comprehensive medication history where appropriate

c d

a b a b a b a b CONSISTENTLY reconciles medication history with current medication prescribed, medical history and current condition where appropriate (including reconciling transcribed IMRs and discharge prescriptions)

c d

USUALLY reconciles medication history with current medication prescribed, medical history and current condition where appropriate (including reconciling transcribed IMRs and discharge prescriptions)

c d

SOMETIMES reconciles medication history with current medication prescribed, medical history and current condition where appropriate (including reconciling transcribed IMRs and discharge prescriptions)

c d

RARELY reconciles medication history with current medication prescribed, medical history and current condition where appropriate (including reconciling transcribed IMRs and discharge prescriptions)

c d

a b a b a b a b

1.5 Medication reconciliation

CONSISTENTLY consults appropriately on any inconsistencies

c d

USUALLY consults appropriately on any inconsistencies

c d

SOMETIMES consults appropriately on any inconsistencies

c d

RARELY consults appropriately on any inconsistencies

c d

Comments PROVISION OF MEDICATION

a b a b a b a b 1.6 Prescription is unambiguous

CONSISTENTLY ensures clarity of the prescription

c d

USUALLY ensures clarity of the prescription

c d

SOMETIMES ensures clarity of the prescription

c d

RARELY ensures clarity of the prescription

c d Comments

a b a b a b a b 1.7 Prescription is legal

CONSISTENTLY ensures legality of prescription c d

USUALLY ensures legality of prescription c d

SOMETIMES ensures legality of prescription c d

RARELY ensures legality of prescription c d

Comments

a b a b a b a b 1.8 Labeling of the medicine

The label on the dispensed medicine CONSISTENTLY includes required information

c d

The label on the dispensed medicine USUALLY includes required information

c d

The label on the dispensed medicine SOMETIMES includes required information

c d

The label on the dispensed medicine RARELY includes required information

c d

Comments









3



a b a b a b a b CONSISTENTLY ensures availability of medication (Example: procedure to obtain exemption drugs)

c d

USUALLY ensures availability of medication (Example: procedure to obtain exemption drugs)

c d

SOMETIMES ensures availability of medication (Example: procedure to obtain exemption drugs)

c d

RARELY ensures availability of medication (Example: procedure to obtain exemption drugs)

c d

a b a b a b a b CONSISTENTLY ensures that the right medication is supplied to the right patient with the right labeling

c d

USUALLY ensures that the right medication is supplied to the right patient with the right labeling

c d

SOMETIMES ensures that the right medication is supplied to the right patient with the right labeling

c d

RARELY ensures that the right medication is supplied to the right patient with the right labeling

c d

a b a b a b a b

1.9 Medication supply

CONSISTENTLY ensures the supply of the drug is documented

c d

USUALLY ensures the supply of the drug is documented

c d

SOMETIMES ensures the supply of the drug is documented

c d

RARELY ensures the supply of the drug is documented

c d

Comments DRUG SPECIFIC ISSUES Check for the 8 ‘Rs’ : Right patient, medication, dose, route, time and frequency, duration, diluent, rate of infusion

a b a b a b a b CONSISTENTLY ensures need for the drug c d

USUALLY ensures need for the drug c d

SOMETIMES ensures need for the drug c d

RARELY ensures need for the drug c d

a b a b a b a b

1.10 Drug selection

CONSISTENTLY ensures cost-effectiveness of medication use

c d

USUALLY ensures cost-effectiveness of medication use

c d

SOMETIMES ensures cost-effectiveness of medication use

c d

RARELY ensures cost-effectiveness of medication use

c d

Comments

a b a b a b a b 1.11 Selection of formulation, concentration, rate and diluent

CONSISTENTLY ensures appropriate formulation and dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs

c d

USUALLY ensures appropriate formulation and dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs

c d

SOMETIMES ensures appropriate formulation and dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs

c d

RARELY ensures appropriate formulation and dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs

c d

Comments









4



a b a b a b a b 1.12 Checking of dose, frequency, timing, route and duration

CONSISTENTLY checks that patient has received the correct dose and frequency, at the correct time via most appropriate route for the right duration

c d

USUALLY checks that patient has received the correct dose and frequency, at the correct time via most appropriate route for the right duration

c d

SOMETIMES checks that patient has received the correct dose and frequency, at the correct time via most appropriate route for the right duration

c d

RARELY checks that patient has received the correct dose and frequency, at the correct time via most appropriate route for the right duration

c d

Comments PATIENT EDUCATION

a b a b a b a b CONSISTENTLY ensures appropriate oral/written information is provided to patient

c d

USUALLY ensures appropriate oral/written information is provided to patient.

c d

SOMETIMES ensures appropriate oral/written information is provided to patient.

c d

RARELY ensures appropriate oral/written information is provided to patient. c d

a b a b a b a b CONSISTENTLY ensures advice given on non-pharmacological therapy when appropriate

c d

USUALLY ensures advice given on non-pharmacological therapy when appropriate c d

SOMETIMES ensures advice given on non-pharmacological therapy when appropriate c d

RARELY ensures advice given on non-pharmacological therapy when appropriate c d

a b a b a b a b

1.13 Patient is counseled on medication

CONSISTENTLY assesses patient’s comprehension of information

c d

USUALLY assesses patient’s comprehension of information c d

SOMETIMES assesses patient’s comprehension of information

c d

RARELY assesses patient’s comprehension of information c d

Comments

a b a b a b a b 1.14 Compliance assessment

CONSISTENTLY identifies patients with compliance issues and manages appropriately (Example: literacy, visual impairment, disability, cognition/memory)

c d

USUALLY identifies patients with compliance issues and manages appropriately (Example: literacy, visual impairment, disability, cognition/memory)

c d

SOMETIMES identifies patients with compliance issues and manages appropriately (Example: literacy, visual impairment, disability, cognition/memory)

c d

RARELY identifies patients with compliance issues and manages appropriately. (Example: literacy, visual impairment, disability, cognition/memory)

c d

Comments









5










6


a b a b a b a b 1.15 Need for information identified

CONSISTENTLY identifies and responds appropriately to patient’s need for more information

c d

USUALLY identifies and responds appropriately to patient’s need for more information

c d

SOMETIMES identifies and responds appropriately to patient’s need for more information

c d

RARELY identifies and responds appropriately to patient’s need for more information

c d

Comments RISK MANAGEMENT & SERVICE IMPROVEMENT

a b a b a b a b 1.16 Risk

management CONSISTENTLY documents medication errors c d

USUALLY documents medication errors c d

SOMETIMES documents medication errors c d

RARELY documents medication errors c d

Comments

a b a b a b a b 1.17 Service improvement

CONSISTENTLY looks to improve quality of service

c d

USUALLY looks to improve quality of service c d

SOMETIMES looks to improve quality of service c d

RARELY looks to improve quality of service c d

Comments










7

2. Problem Solving Competencies a = baseline facilitated assessment b = 4 month facilitated assessment c = 8 month facilitated assessment d = 12 month facilitated assessment

PROBLEM IDENTIFICATION

a b a b a b a b CONSISTENTLY identifies drug-drug interactions (including complementary medicines)

c d

USUALLY identifies drug-drug interactions (including complementary medicines) c d

SOMETIMES identifies drug-drug interactions (including complementary medicines) c d

RARELY identifies drug-drug interactions (including complementary medicines) c d

a b a b a b a b CONSISTENTLY identifies drug-related problems in special patient groups (Example: Use of warfarin in an alcoholic creates unwarranted level of risk, tube feeding, paediatric/elderly, G6PD)

c d

USUALLY identifies drug-related problems in special patient groups (Example: Use of warfarin in an alcoholic creates unwarranted level of risk, tube feeding, paediatric/elderly, G6PD)

c d

SOMETIMES identifies drug-related problems in special patient groups (Example: Use of warfarin in an alcoholic creates unwarranted level of risk, tube feeding, paediatric/elderly, G6PD)

c d

RARELY identifies drug-related problems in special patient groups (Example: Use of warfarin in an alcoholic creates unwarranted level of risk, tube feeding, paediatric/elderly, G6PD)

c d

a b a b a b a b

2.1 Identification of drug-related problems

CONSISTENTLY identifies drug-disease interactions (Example: NSAID in HF)

c d

USUALLY identifies drug-disease interactions (Example: NSAID in HF)

c d

SOMETIMES identifies drug-disease interactions. (Example: NSAID in HF)

c d

RARELY identifies drug-disease interactions (Example: NSAID in HF)

c d

Comments

a b a b a b a b 2.2 Prioritization CONSISTENTLY prioritizes drug-related problems appropriately

c cd

USUALLY prioritizes drug-related problems appropriately d

SOMETIMES prioritizes drug-related problems appropriately c d

RARELY prioritizes drug-related problems appropriately c d

Comments

a b a b a b a b 2.3 Consultation or referral

CONSISTENTLY understands own limitations, considers most appropriate referral point, refers in a logical, clear and concise manner

c d

USUALLY understands own limitations, considers most appropriate referral point, refers in a logical, clear and concise manner

c d

SOMETIMES understands own limitations, considers most appropriate referral point, refers in a logical, clear and concise manner

c d

RARELY understands own limitations, considers most appropriate referral point, refers in a logical, clear and concise manner

c d

Comments










8

2. Problem Solving Competencies a = baseline facilitated assessment b = 4 month facilitated assessment c = 8 month facilitated assessment d = 12 month facilitated assessment

KNOWLEDGE

a b a b a b a b 2.4 Pathophysiology

CONSISTENTLY able to discuss (or able to access information and use this to describe) the underlying pathophysiology of disease

c d

USUALLY able to discuss (or able to access information and use this to describe) the underlying pathophysiology of disease

c d

SOMETIMES able to discuss (or able to access information and use this to describe) the underlying pathophysiology of disease

c d

RARELY able to discuss (or able to access information and use this to describe) the underlying pathophysiology of disease

c d

Comments

a b a b a b a b 2.5 Pharmacology CONSISTENTLY able to discuss (or able to access information and use this to describe) how drugs work

c d

USUALLY able to discuss (or able to access information and use this to describe) how drugs work

c d

SOMETIMES able to discuss (or able to access information and use this to describe) how drugs work

c d

RARELY able to discuss (or able to access information and use this to describe) how drugs work

c d

Comments

a b a b a b a b 2.6 Side-effects and monitoring

CONSISTENTLY able to describe major side-effects and monitoring parameters

c cd

USUALLY able to describe major side-effects and monitoring parameters

d

SOMETIMES able to describe major side-effects and monitoring parameters

c d

RARELY able to describe major side-effects and monitoring parameters

c d

Comments

a b a b a b a b 2.7 Interactions (drug/disease/ special patient groups)

CONSISTENTLY able to describe mechanisms of interactions c d

USUALLY able to describe mechanisms of interactions

c d

SOMETIMES able to describe mechanisms of interactions

c d

RARELY able to describe mechanisms of interactions

c d

Comments


2. Problem Solving Competencies a = baseline facilitated assessment b = 4/6 month facilitated assessment c = 8/12 month facilitated assessment d = 12/18 month facilitated assessment

ANALYSIS & RECOMENDATIONS

a b a b a b a b CONSISTENTLY able to access recent clinical guidelines and/or relevant references

c d

USUALLY able to access recent clinical guidelines and/or relevant references c d

SOMETIMES able to access recent clinical guidelines and/or relevant references c d

RARELY able to access recent clinical guidelines and/or relevant references c d

a b a b a b a b CONSISTENTLY able to analyze information and critically appraise literature c d

USUALLY able to analyze information and critically appraise literature c d

SOMETIMES able to analyze information and critically appraise literature c d

RARELY able to analyze information and critically appraise literature c d

a b a b a b a b CONSISTENTLY able to identify evidence gaps









9

c d

USUALLY able to identify evidence gaps

c d

SOMETIMES able to identify evidence gaps

c d

RARELY able to identify evidence gaps

c d

a b a b a b a b

2.8 Use of guidelines and evidence

CONSISTENTLY demonstrates clear decision making

c d

USUALLY demonstrates clear decision making c d

SOMETIMES demonstrates clear decision making c d

RARELY demonstrates clear decision making c d

Comments

a b a b a b a b CONSISTENTLY provides accurate information c d

USUALLY provides accurate information c d

SOMETIMES provides accurate information c d

RARELY provides accurate information c d

a b a b a b a b CONSISTENTLY provides relevant information c d

USUALLY provides relevant information c d

SOMETIMES provides relevant information c d

RARELY provides relevant information c d

a b a b a b a b

2.9 Information provision to other healthcare professionals

CONSISTENTLY provides timely information c d

USUALLY provides timely information c d

SOMETIMES provides timely information c d

RARELY provides timely information c d

Comments


2. Problem Solving Competencies a = baseline facilitated assessment b = 4/6 month facilitated assessment c = 8/12 month facilitated assessment d = 12/18 month facilitated assessment

a b a b a b a b 2.10 Documentation of drug-related problems

CONSISTENTLY documents drug-related problems using appropriate styles and methods (Example: intervention forms, case notes, prescriptions, ADR reports)

c d

USUALLY documents drug-related problems using appropriate styles and methods (Example: intervention forms, case notes, prescriptions, ADR reports)

c d

SOMETIMES documents drug-related problems using appropriate styles and methods (Example: intervention forms, case notes, prescriptions, ADR reports)

c d

RARELY documents drug-related problems using appropriate styles and methods. (Example: intervention forms, case notes, prescriptions, ADR reports)

c d

Comments FOLLOW UP

a b a b a b a b CONSISTENTLY L monitors drug therapy appropriately. (Example: TDM, high risk drugs/diseases/special patient groups)

c d

USUALLY monitors drug therapy appropriately. (Example: TDM, high risk drugs/diseases/special patient groups)

c d

SOMETIMES monitors drug therapy appropriately. (Example: TDM, high risk drugs/diseases/special patient groups)

c d

RARELY monitors drug therapy appropriately. (Example: TDM, high risk drugs/diseases/special patient groups)

c d

a b a b a b a b

2.11 Monitoring & problem resolution

CONSISTENTLY ensures drug-related problems are resolved (including following up interventions)

c d

USUALLY ensures drug-related problems are resolved (including following up interventions)

c d

SOMETIMES ensures drug-related problems are resolved (including following up interventions)

c d

RARELY ensures drug-related problems are resolved (including following up interventions)

c d

Comments









10










11

3. Professional Competencies a = baseline facilitated assessment b = 4/6 month facilitated assessment c = 8/12 month facilitated assessment d = 12/18 month facilitated assessment

ORGANIZATION

a b a b a b a b 3.1 Prioritization CONSISTENTLY prioritizes work well c cd

USUALLY prioritizes work well d

SOMETIMES prioritizes work well c d

RARELY prioritizes work well c d

Comments

a b a b a b a b 3.2 Punctuality CONSISTENTLY punctual c d

USUALLY punctual c d

SOMETIMES punctual c d

RARELY punctual c d

Comments

a b a b a b a b 3.3 Time management

CONSISTENTLY uses time efficiently resulting in tasks being completed within agreed deadlines

c d

USUALLY uses time efficiently resulting in tasks being completed within agreed deadlines

c d

SOMETIMES uses time efficiently resulting in tasks being completed within agreed deadlines

c d

RARELY uses time efficiently resulting in tasks being completed within agreed deadlines

c d

Comments

a b a b a b a b 3.4 Initiative CONSISTENTLY demonstrates appropriate initiative when required

c d

USUALLY demonstrates appropriate initiative when required

c d

SOMETIMES demonstrates appropriate initiative when required

c d

RARELY demonstrates appropriate initiative when required

c d

Comments










12


PROFESSIONALISM

a b a b a b a b 3.5 Professional code of ethics

CONSISTENTLY practices within Code of Ethics c d

USUALLY practices within Code of Ethics c d

SOMETIMES practices within Code of Ethics c d

RARELY practices within Code of Ethics c d

Comments

a b a b a b a b 3.6 Confidentiality CONSISTENTLY maintains confidentiality c d

USUALLY maintains confidentiality c cd

SOMETIMES maintains confidentiality c d

RARELY maintains confidentiality d

Comments

a b a b a b a b 3.7 Confidence CONSISTENTLY demonstrates confidence, inspires confidence in others c d

USUALLY demonstrates confidence, inspires confidence in others c d

SOMETIMES demonstrates confidence, inspires confidence in others c d

RARELY demonstrates confidence, inspires confidence in others c d

Comments

a b a b a b a b 3.8 Responsibility CONSISTENTLY takes responsibility for own actions and for patient care c d

USUALLY takes responsibility for own actions and for patient care c d

SOMETIMES takes responsibility for own actions and for patient care c d

RARELY takes responsibility for own actions and for patient care c d

Comments

a b a b a b a b Can CONSISTENTLY describe the structure and values of employing organization

c d

Can USUALLY describe the structure and values of employing organization c d

Can SOMETIMES describe the structure and values of employing organization c d

Can RARELY describe the structure and values of employing organization c d

a b a b a b a b

3.9 Organizational

CONSISTENTLY uses relevant and up to date procedures for practice c d

USUALLY uses relevant and up to date procedures for practice c d

SOMETIMES uses relevant and up to date procedures for practice c d

RARELY use relevant and up to date procedures for practice

c d

Comments










13


COMMUNICATION SKILLS

a b a b a b a b CONSISTENTLY ensures communication with patients is clear, precise and appropriate

c d

USUALLY ensures communication with patients is clear, precise and appropriate

c d

SOMETIMES ensures communication with patients is clear, precise and appropriate

c d

RARELY ensures communication with patients is clear, precise and appropriate

c d

a b a b a b a b CONSISTENTLY ensures communication with prescribers is clear, precise and appropriate

c d

USUALLY ensures communication with prescribers is clear, precise and appropriate

c d

SOMETIMES ensures communication with prescribers is clear, precise and appropriate

c d

RARELY ensures communication with prescribers is clear, precise and appropriate

c d

a b a b a b a b

3.10 Communication

CONSISTENTLY ensures communication with nursing staff and other members of the health care team is clear, precise and appropriate

c d

USUALLY ensures communication with nursing staff and other members of the health care team is clear, precise and appropriate

c d

SOMETIMES ensures communication with nursing staff and other members of the health care team is clear, precise and appropriate

c d

RARELY ensures communication with nursing staff and other members of the health care team is clear, precise and appropriate

c d

Comments

a b a b a b a b CONSISTENTLY willing to share learning experiences and give feedback/guidance to support staff development

c d

USUALLY willing to share learning experiences and give feedback/guidance to support staff development

c d

SOMETIMES willing to share learning experiences and give feedback/guidance to support staff development

c d

RARELY willing to share learning experiences and give feedback/guidance to support staff development

c d

a b a b a b a b

3.11 Staff development

CONSISTENTLY active in educating and training healthcare professionals c d

USUALLY active in educating and training healthcare professionals c d

SOMETIMES active in educating and training healthcare professionals c d

RARELY active in educating and training healthcare professionals c d

Comments










14


TEAM WORK

a b a b a b a b CONSISTENTLY recognizes the value of team members c d

USUALLY recognizes the value of team members c d

SOMETIMES recognizes the value of team members c d

RARELY recognizes the value of team members c d

a b a b a b a b CONSISTENTLY works effectively as part of a team c d

USUALLY works effectively as part of a team c d

SOMETIMES works effectively as part of a team c d

RARELY works effectively as part of a team c d

a b a b a b a b

3.12 Pharmacy team

CONSISTENTLY passes on relevant information c d

USUALLY passes on relevant information c d

SOMETIMES passes on relevant information c d

RARELY passes on relevant information c d

Comments

a b a b a b a b CONSISTENTLY recognizes value of other team members c cd

USUALLY recognizes value of other team members d

SOMETIMES recognizes value of other team members c d

RARELY recognizes value of other team members c d

a b a b a b a b

3.13 Multidisciplinary team CONSISTENTLY works

effectively as part of a team c d USUALLY works effectively as part of a team c d

SOMETIMES works effectively as part of a team c d

RARELY works effectively as part of a team c d

Comments

Appendix 2 – GLF Mapping

General Level Framework Mapping

1. DELIVERY OF PATIENT CARE COMPETENCIES

C=CONSISTENTLY; U=USUALLY; S=SOMETIMES; R=RARELY; C = Clinical track; R = Research track; P = Professional track

*Also to fulfil minimum criteria on ALF depending on the track to pursue – see point 4 2

Suggested Timeframe

Assessment Phase

End Yr1 End Yr2

3a/Clinical Gateway

End Yr3*

Prerequisite to Senior/ Research Gateway

GLF Behaviour Descriptor Minimum Performance Level PATIENT CONSULTATION 1.1 Opening the consultation

Provides clear introduction to the consultation C C C

1.2 Questioning Uses appropriate questioning to obtain relevant information from patient

U C C

GATHERING INFORMATION 1.3 Allergies Confirms or documents accurate and

comprehensive allergy and/or adverse drug reaction history

C C C

1.4 Relevant patient background

Retrieves all relevant medical information from medical, nursing and electronic records

U C C

Takes or checks for an accurate and comprehensive medication history where appropriate

C C C

Reconciles medication history with current medication prescribed, medical history and current condition where appropriate (including reconciling transcribed IMRs and discharge prescriptions)

U C C

1.5 Medication reconciliation

Consults appropriately on any inconsistencies C C C PROVISION OF MEDICATION 1.6 Prescription is unambiguous

Ensures the clarity of the prescription C C C

1.7 Prescription is legal

Ensures legality of prescription C C C

1.8 Labelling of the medicine

The label on the dispensed medicine includes required information

C C C

Ensures availability of medication (Example: procedure to obtain exemption drugs)

C C C

Ensures that the right medication is supplied to the right patient with the right labelling

C C C

1.9 Medication supply

The supply of the drug is documented C C C DRUG SPECIFIC ISSUES

Ensures need for the drug U C C 1.10 Drug selection Ensures cost-effectiveness of medication use S U C

1.11 Selection of formulation, concentration, rate and diluent

Ensures appropriate formulation and dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs

C C C

1.12 Checking of dose, frequency, timing, route and duration

Checks that patient has received the correct dose and frequency, at the correct time via most appropriate route for the right duration

C C C

PATIENT EDUCATION Ensures appropriate oral/written information is provided to patient

C C C

Ensures advice given on non-pharmacological therapy when appropriate

S U C

1.13 Patient is counselled on medication

Assesses patient’s comprehension of information

U C C

1.14 Compliance assessment

Identifies patients with compliance issues and manages appropriately. (Example: literacy, visual impairment, disability, cognition/memory).

S U C

1.15 Need for information identified

Identifies and responds appropriately to patient’s need for more information

S U C

RISK MANAGEMENT& SERVICE IMPROVEMENT 1.16 Risk management

Documents medication errors C C C

1.17 Service improvement

Looks to improve quality of service S U C


2. PROBLEM SOLVING COMPETENCIES

ANALYSIS & RECOMMENDATIONS Able to access recent clinical guidelines and/or relevant references

U U/CC C

Able to analyse information and critically appraise literature

U U/CC C

Able to identify evidence gaps U U U/CR

2.8 Use of guidelines and evidence

Demonstrates clear decision making U U/CC C Provides accurate information C C C Provides relevant information U U/CC C

2.9 Information provision to other healthcare professionals Provides timely information U C C 2.10 Documentation of drug-related problems

Documents drug-related problems using appropriate styles and methods. Example: intervention forms, case notes, prescriptions, ADR reports

C C C

FOLLOW UP Monitors drug therapy appropriately. Example: TDM, high risk drugs/diseases/special patient groups

U U/CC C 2.11 Monitoring & problem resolution

Ensures drug-related problems are resolved (including following up interventions)

C C C

Suggested Timeframe

Assessment Phase

End Yr1 End Yr2

3a/Clinical Gateway

End Yr3*

Prerequisite to Senior/ Research Gateway

GLF Behaviour Descriptor Minimum Performance Level PROBLEM IDENTIFICATION

Identifies drug-drug interactions (including complementary medicines)

U U/CC C

Identifies drug-related problems in special patient groups. Example: Use of warfarin in an alcoholic creates unwarranted level of risk, tube feeding, paediatric/elderly, G6PD.

U U/CC C

2.1 Identification of drug-related problems

Identifies drug-disease interactions. Example: NSAID in HF

U U/CC C

2.2 Prioritization Prioritizes drug-related problems appropriately U U/CC C 2.3 Consultation or referral

Understands own limitations, considers most appropriate referral point, refers in a logical, clear and concise manner

U C C

KNOWLEDGE 2.4 Pathophysiology Able to discuss (or able to access information

and use this to describe) the underlying pathophysiology of disease.

U U/CC C

2.5 Pharmacology Able to discuss (or able to access information and use this to describe) how drugs work

U U/CC C

2.6 Side-effects and monitoring

Able to describe major side-effects and monitoring parameters

U U/CC C

2.7 Interactions (drug/disease/ special patient groups)

Able to describe mechanisms of interactions U U/CC C






3. PROFESSIONAL COMPETENCIES

Suggested Timeframe

Assessment Phase

End Yr1 End Yr2

3a/Clinical Gateway

End Yr3*

Prerequisite to Senior/

Research Gateway

GLF Behaviour Descriptor Minimum Performance Level ORGANISATION 3.1 Prioritization Prioritizes work well S U C 3.2 Punctuality Punctual C C C 3.3 Time management

Uses time efficiently resulting in tasks being completed within agreed deadlines

S U C

3.4 Initiative Demonstrates appropriate initiative when required

S U C

PROFESSIONALISM 3.5 Professional code of ethics

Practices within Code of Ethics C C C

3.6 Confidentiality Maintains confidentiality C C C 3.7 Confidence Demonstrates confidence, inspires confidence

in others S U C

3.8 Responsibility Takes responsibility for own actions and for patient care

C C C

Describe the structure and values of employing organization

C C C 3.9 Organizational

Uses relevant and up to date procedures for practice

C C C

COMMUNICATION SKILLS Ensures communication with patients is clear, precise and appropriate

U C C

Ensures communication with prescribers is clear, precise and appropriate

U C C

3.10 Communication

Ensures communication with nursing staff and other members of the health care team is clear, precise and appropriate

U C C

Willing to share learning experiences and give feedback/guidance to support staff development

U C C 3.11 Staff development

Active in educating and training healthcare professionals

S U C

TEAM WORK Recognizes the value of team members U C C Works effectively as part of a team U C C

3.12 Pharmacy team

Passes on relevant information U C C Recognizes value of other team members U C C 3.13

Multidisciplinary team

Works effectively as part of a team S C C

Suggested Timeframe

Assessment Phase

End Yr1 End Yr2

3a/Clinical Gateway

End Yr3*

Prerequisite to Senior/

Research Gateway

4. Overlap of ALF Competencies

Suggested Timeframe End Yr1 End Yr2

3a/Clinical Gateway

End Yr3* Prerequisite to Senior/ Research Gateway

End Yr4 Senior/ Research

Gateway

Minimum ALF Competency

to be Attained

N/A N/A FOUNDATION Level in Building Working Relationships

plus FOUNDATION Level in ONE of: ManagementP Expert Professional PracticeC Research & EvaluationR Depending on track to pursue

See ALF Mapping

Document

Appendix 3 – Mini-Clinical Evaluation Exercise (mini-CEX) Form

© 2007 CoDEG Mini-CEX used with permission from the Competency Development and Evaluation Group (CoDEG), South East England, UK. Adapted for use in Singapore by Victoria Coleman, Holly Lee Ho-Yan and Camilla Wong, April 2009.

Mini-clinical Evaluation Exercise (mini-CEX) This tool is designed to be used on the ward/in the clinic, to assess the pharmacist’s provision of pharmaceutical care to new patients. The purpose is to assess the thought process and overall performance of the GLF pharmacist, not necessarily the depth of their clinical knowledge. Minimum frequency requirement: ONE every 4 months Estimated time required: 20 mins (15mins for assessment, 5 mins for feedback)

Pharmacist name:

Clinical Area: Topic: Date: Please grade the following areas using the scale below:

Significantly below

Below

Borderline

Meets expectations

Above

Significantly above

Not observed

Delivery of Patient Care Patient consultation

Retrieves relevant medical/drug information (including allergies)

Evaluates the appropriateness of drug selection

Appropriate patient education given

Professionalism

Problem Solving Identifies drug-related problems

Demonstrates required drug-related knowledge

Analyzes information and makes appropriate recommendations

Overall clinical care

© 2007 CoDEG Mini-CEX used with permission from the Competency Development and Evaluation Group (CoDEG), South East England, UK. Adapted for use in Singapore by Victoria Coleman, Holly Lee Ho-Yan and Camilla Wong, April 2009.

Anything especially good? Suggestions for development

Agreed action (Be specific and include time frame)

Follow up (To be completed at a later date by next preceptor) Action completed? Comments (if any)

Reviewer

Name: Signature: Date:

Trainee satisfaction with performance: (please circle)

Not at all Highly 1 2 3 4 5

Assessor satisfaction with overall performance of trainee: (please circle)


Assessor name: ________________________________ Assessor signature: _____________________________ Date: ________

Appendix 4 - Case Based Discussion (CbD) Form

Case Based Discussion (CBD) This tool is designed to assess clinical decision-making and the application or use of pharmaceutical knowledge in a patient they have managed. It may be used during clinical rounds or formal case presentations, where the pharmacist has had time to prepare and research the case. Minimum frequency requirement: ONE every 4 months Estimated time required: 20 mins (15mins for assessment, 5 mins for feedback)

Pharmacist name:

Clinical Area: Topic:

Date:

Please grade the following areas using the scale below:

Significantly below

Below

Borderline

Meets expectations

Above

Significantly above

Not observed

(please tick if unable to comment)

Identification of drug-related problems

Analysis and recommendations

Follow up and monitoring

Professionalism

Overall clinical judgment

© 2007 CoDEG CBD used with permission from the Competency Development and Evaluation Group (CoDEG), South East England, UK. Adapted for use in Singapore by Victoria Coleman, Holly Lee Ho-Yan and Camilla Wong, April 2009.

2

© 2007 CoDEG CBD used with permission from the Competency Development and Evaluation Group (CoDEG), South East England, UK. Adapted for use in Singapore by Victoria Coleman, Holly Lee Ho-Yan and Camilla Wong, April 2009.

3

Anything especially good? Suggestions for development

Agreed action Follow up (To be completed at a later date by next preceptor) Action completed? Comments (if any)

Reviewer

Name: Signature: Date:

Trainee satisfaction with performance: (please circle)


Assessor satisfaction with overall performance of trainee: (please circle)


Assessor name: ________________________________ Assessor signature: _____________________________ Date: ________

Appendix 5A: Medication Review/ Dispensing Observation for GLF Pharmacist

Pharmacist: Ward covered: Clinical Group (CG): Rotation period:

Date of Ward Visit: 1.__________________ Date of Ward Visit 2._________________ Note: if more ward observations performed, please record in another new document.

1. Medication Review Activities during Medication Review Round

Comments / Remarks (Please specify the date)

Suggestions for Development

Visit 1

Visit 1 Retrieves relevant medical / drug information (including allergies)



Identifies drug-related problems

Analyses information and makes appropriate recommendations

Able to prioritise tasks and handle urgent and important intervention appropriately

Appropriate administration instruction given to patient / SN / Doctor

Communicate clearly and effectively with other healthcare providers (doctors, nurses etc

Visit 2

Visit 2

2. Dispensing (Bedside / Counter Dispensing) Activities during Prescriptions Dispensing



Visit 1

Visit 1 Patient consultation






Able to perform intervention with respective doctors appropriately

Identifies potential compliance issue

Visit 2

Visit 2

Summary Aspects Observed/ Findings Feedback/ Suggested

Development Clinical knowledge

Clinical skills

Decision making (prioritisation, counselling arrangement, handling enquiries etc)

Communication

Confidence level

Overall

Documented by CG Leader: _____________ Signature: _____________ Date:_________

Appendix 5B: Dispensing Observation for GLF Pharmacist

Pharmacist: Date: Clinical Group (CG): Rotation period:

Note: This assessment will be conducted for ALL pharmacists at the end of each rotation. However, for new pharmacists joining the department, a baseline assessment will be completed.

1. Dispensing (Counter Dispensing) Activities during Prescriptions Dispensing



Patient consultation






Able to perform intervention with respective doctors appropriately

Identifies potential compliance issue

Billing (optional)

Summary Aspects Observed/ Findings Feedback/ Suggested

Development

Clinical knowledge

Clinical skills

Decision making (prioritisation, counselling

arrangement, handling enquiries

etc)

Communication

Confidence level

Overall

Documented by CG Leader: _____________ Signature: _____________ Date:_________

Appendix 6 - GLF Assessment Summary Pharmacist’s name: Rotation/clinical area: Dates that assessment covers:

Anything especially good? Suggestions for development?

Overall impression: (please circle)

Poor Borderline Satisfactory Good Very good

Assessor Name: Assessor Signature: Pharmacist Signature: Date:

Action Completed Clinical Objectives to be Achieved (Be specific e.g. case presentation on HF) (To be filled by next CG leaders)

Date Comment

Assessor Name: Assessor Signature: Pharmacist Signature: Date: