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S afe M edication Practice Unit State-wide adoption of a Competency Presentation title Framework for Pharmaceutical Review Presenter Coombes I, Coombes J, Cardiff L,name Bettenay K, Chuan F, Stowasser D Safe Medication Practice Unit, Queensland Health “Welcome to the hospital”, “You have been allocated the general surgical ward, Off you go then !!!!! Pharmaceutical Review Definition [Health Ministers commitment 04/04] A minimum standard of systematic appraisal of all aspects of patients’ medication management within an institution Conducted (or supervised) by a qualified and suitably trained health professional (ideally a pharmacist) acting as part of a multidisciplinary team. It includes objective review of medication prescribing, dispensing, distribution, administration, monitoring of outcomes and documentation of medication related information in order to optimise the Quality Use of Medicines. Rate of pharmacy review - Site Comparison N = Number of patients audited How well do your pharmacists perform? Target = 100% (Percentage patients “reviewed”) 100% 80% 60% 40% 20% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Sites Why develop and implement a competency framework? • Optimising individual practice and systems of care • Identify areas of unknown behaviour, knowledge or skill to assist practitioner development • Identify training requirement’s for the workforce • Put into operation national standards and deliverables Mapping Standards to Actions APAC Guidelines Cont QUM •Guiding principle – linked to Pharmaceutical reform QH Service Capability Framework for Pharmacy Services •ADRs •History •Review •Evaluation SHPA Clinical Pharmacy Standards •8 Activities/ procedures link to MAP PSA/ Guild/ SHPA Competency Standards •History •Review •Plan •Provide information QH Pharmaceutical review Activities Individual behaviors – combined to competencies •Patient selection to discharge •Patient Care •Problem solving •Professional competencies Competency Matrix for General Level Clinical Practice PERSONAL Organisation, Team working, Communication, Professionalism Assertiveness Initiative Confidentiality DELIVERY OF PATIENT CARE Drug use process Drug history taking Interaction identification Patient counselling PROBLEM MANAGEMENT Gathers information Knowledge Analyses Information Provides information Follows up and reflects Assesses information Provides - Accurate relevant, Timely 20 in June 2007 now 27 sites utilise GLF, proposal for National GLF Alw ays Usually Sometimes Never Missing QH General Level Framew ork Baseline (n=165) Pharmacists (165) Patient History Consolidated scores 180 160 140 120 100 80 60 40 20 0 109 95 83 66 55 55 47 35 17 2 2 Opening Consultation Introduction 26 22 19 3 Opening Consultation Agenda 86 9 0 Questioning Competency 3329 4 4 Patient Consent 15 0 9 Allergy/ADR Review QH General Level Framew ork Baseline (n=165) Alw ays Communication Consolidated Scores Usually Pharmacists (165) Sometimes Never 180 160 140 120 100 80 60 40 20 0 Missing 85 84 83 72 61 59 55 55 52 45 34 20 1 0 Clear / Precise / Appropriate 29 21 4 Involves Patient in M ed M anagement 9 0 Prescribers Competency 21 5 0 Nursing Staff 27 3 0 Other Health Care Professionals QH General Level Framew ork baseline (n=165) Alw ays Medicines Information and Patient Education Usually Pharmacists (165) Sometimes 180 160 140 120 100 80 60 40 20 0 Never Missing 101 75 72 63 46 55 49 45 33 26 14 4 Need Identified 8 4 0 Cultural / Social Background 29 26 1 Accurate Information Retrieved Competency 7 2 Oral / Written Information Pharmacist feedback n =154 (median score) Fair 7 6 5 s 3 2 1 Unfair Positive experience 7 6 5 4 3 2 1 Negative experience Non-Taxing 7 6 5 4 3 2 1 Taxing Was helpful to me 7 6 5 4 3 2 1 Was unhelpful Fair reflection of what 7 I usually “do” 6 5 4 3 2 1 Unfair reflection Useful 7 6 5 4 3 2 1 Useless Evaluated my skills 7 6 5 4 3 2 1 Did not evaluate skills Evaluated my knowledge 7 6 5 4 3 2 1 Did not evaluate knowledge Evaluated my attitudes 7 6 5 4 3 2 1 Did not evaluate attitudes Practical 7 6 5 4 3 2 1 Theoretical Inspiring 7 6 5 4 3 2 1 Crushing 3 2 8 2 8 15 18 8 7 32 5 7 17 1 1 2 1 7 2 5 8 7 12 Conclusion • • • • Acceptance Practitioner development Reflection of service delivery Sustainability • Progression