Individual Practitioner (Pharmacist) Assessment Criteria The following chart outlines the practice criteria that is used by Community Practice Advisors (CPAs) when conducting an individual pharmacist assessment during a routine community pharmacy practice assessment. CPAs focus on four key areas (category) taken from the Standards of Practice that have been identified as having the greatest potential impact on patient and public safety. Through a combination of observation and retrospective review of documentation (chart stimulated recall) CPAs evaluate the processes in place for each of these areas with respect to new and refill prescriptions, adaptations/renewals, comprehensive medication reviews and OTC counseling. For each key area (category) specific standards – which describe the minimum practice requirements for all practitioners – are identified from the Standards of Practice. The guidance section illustrates how practitioners would apply the standard in practice and provides examples of activities that support each standard. Pharmacists can use the guidance section to better understand and self-evaluate if their current practice processes, procedures and behaviours are meeting the required standard.
CATEGORY Patient Assessment
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STANDARD(S)
GUIDANCE
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Gathers relevant information through dialogue with the patient and/or patient advocate.
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Gathers relevant information through the review of the patient profile.
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Uses relevant information to identify drug therapy problems and/or issues that have the potential to affect the optimization of patient outcomes
New Prescriptions • Dialogues with patients and/or their advocate to gather relevant and comprehensive information • Asks patient about any changes to health status or allergies • Uses a process to confirm indication(s) for prescription • Reviews (or establishes) patient profile to determine if there are contraindications/precautions or drug interactions and considers: o allergies o medical conditions o patient characteristics, if applicable (e.g. age, weight, lifestyle factors (smoking, diet, alcohol, exercise), family history o prescription medications (incl. those from other pharmacies) As of November 2015
CATEGORY Patient Assessment
2
STANDARD(S)
GUIDANCE o OTCs; herbals etc • Considers appropriateness of prescription (considering indication) o Appropriate drug o Appropriate dose o Duration of therapy o Dosage form • Uses relevant information to identify drug therapy problems and/or issues that have the potential to affect the optimization of health outcomes considering patient specific needs/issues Refill Prescription • Determines if there are any changes (e.g. health status or allergies) or issues through dialogue with patient and review of patient profile before filling a refill o Patient experience adverse effects o New medications/drug interactions o Monitoring issues (e.g. thyroid, diabetes, blood pressure) o Effectiveness • Reviews patient profile and dialogues with patient to determine if there are any adherence or overuse issues (asks about early/late refills) • Completes a therapeutic check to determine if therapy still clinically relevant (is medication still required) and if monitoring questions should be asked • Uses relevant information to identify drug therapy problems and/or issues that have the potential to affect the optimization of health outcomes considering patient specific needs/issues
As of November 2015
CATEGORY Patient Assessment
3
STANDARD(S)
GUIDANCE Adaptations, Renewals, Prescribing • Identifies and prioritizes issues • Identifies options to optimize patient health outcomes • Explains adaptation/renewal/prescribing to patient and obtains consent • Gathers relevant information by dialoguing with patient and reviewing patient profile Comprehensive Medication Reviews • Gathers relevant information from the patient o Additional prescription, OTC, herbal o Changes to health status and allergies • Gathers relevant information from the patient profile o Determines indication based on medication profile and confirms with patient o Any contraindications (e.g. allergies, medical conditions) o Any drug interactions • Identifies and prioritizes drug therapy problems or issues • Identifies options
As of November 2015
CATEGORY STANDARD DecisionMaking
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Makes decisions to minimize risk and optimize patient outcomes.
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Implements decisions.
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Monitors outcomes of decision to ensure it continues to be the best option for the patient.
GUIDANCE New Prescriptions • Uses professional judgment to determine whether pharmacist intervention is required (e.g. adaptation, recommendation of alternate therapy to prescriber, prescribing additional therapy, OTC required or needs discontinuation, further discussion with patient etc.) • Considers options and selects an appropriate option based on patient individual needs/issues, best practice and evidence where applicable • Implements decision o Effectively collaborates with and informs health care team where appropriate o Educates patient and/or their advocate • Provides follow up o Develops a monitoring plan if appropriate Refill Prescriptions • Based on assessment of each refill prescription, determines if pharmacist intervention is required (e.g. renewal, adaptation, recommendations for changes to prescriber) • Considers options and selects an appropriate option based on patient individual needs/issues, best practice and evidence where applicable • Implements decision o Effectively collaborates with and informs health care team where appropriate o Educates patient and/or their advocate • Provides follow up As of November 2015
CATEGORY STANDARD DecisionMaking
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GUIDANCE Develops a monitoring plan if appropriate Adaptations, Renewals, Prescribing • Based on patient assessment. determines if pharmacist intervention is required (e.g. renewal, adaptation, recommendations for changes to prescriber) • Considers options and selects an appropriate option based on patient individual needs/issues, best practice and evidence where applicable • Implements decision o Effectively collaborates with and informs health care team where appropriate o Educates patient and/or their advocate • Provides follow up Develops a monitoring plan if appropriate Comprehensive Medication Reviews • Based on patient assessment. determines if pharmacist intervention is required (e.g. renewal, adaptation, recommendations for changes to prescriber) • Considers options and selects an appropriate option based on patient individual needs/issues, best practice and evidence where applicable • Implements decision o Effectively collaborates with and informs health care team where appropriate o Educates patient and/or their advocate • Provides follow up • Develops a monitoring plan if appropriate As of November 2015
CATEGORY
Documentation
STANDARD(S) •
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GUIDANCE
Documents relevant information in the patient New Prescriptions profile, or other appropriate record and • Documents pertinent information in patient record as required, ensures that the information is accessible to including: other pharmacy colleagues. o Information gathered from the patient such as allergies, medical conditions, medications, changes in health, monitoring information (e.g. blood pressure, A1C, pain Documents decisions made, rationale and control) follow up. o Issues identified o Decisions made Documents communication with patients and o Rationale for decisions healthcare team o Communication with patients/healthcare professionals o Follow up required • Information documented is accurate, complete and appropriate Refill Prescriptions • Follows up on issues previously identified in the patient profile • Documents pertinent information in patient record as required, including: o Issues identified o Decisions made o Rationale for decisions o Follow up provided o Communication with patients/healthcare professionals • Documents if further follow up is required Adaptations, Renewals, Prescribing • Documents in patient record for all adaptations, renewals, prescribing: o Issues identified o Information gathered o Decisions made As of November 2015
CATEGORY
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STANDARD(S)
GUIDANCE
o Rationale for decisions o Communication with patients/healthcare professionals o Follow up provided and if further follow up is required Comprehensive Medication Reviews • Documents in patient record for all adaptations, renewals, prescribing: o Issues identified o Information gathered o Decisions made o Rationale for decisions o Communication with patients/healthcare professionals o Follow up provided and if further follow up is required
As of November 2015
CATEGORY
STANDARD(S)
GUIDANCE
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Verbal language and verbal and nonverbal expression are appropriate for audience.
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Responds to feelings and needs with empathy
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Uses a degree of logic, focus and coherence during communication.
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Provides patient education.
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Ensures patient understanding information of communicated.
New Prescriptions • Uses appropriate verbal and non-verbal expression to be understood by and engage an audience • Uses open-ended questions and effective listening • Responds to patient’s needs and cues with empathy • Communication is logically organized, focused and coherent • Provides patient with relevant and comprehensive information • Determines patient understanding though questioning and nonverbal feedback Refill Prescriptions • Has a mechanism/process to ensure communication with patients and/or their advocates when issues identified for refill medications • Provides patient with relevant information and ensures patient understanding o Is responsive to questions from patients and/or their advocates Adaptations, Renewals, Prescribing • Uses appropriate verbal and non-verbal expression to be understood by and engage an audience • Uses open-ended questions and effective listening • Responds to audience’s needs and cues with empathy • Communication is logically organized, focused and coherent • Provides patient with relevant and comprehensive information • Determines patient understanding though questioning and nonverbal feedback o Uses open-ended questions and effective listening
Communication & Education
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As of November 2015
CATEGORY
STANDARD(S)
GUIDANCE
Communication & Education • Communicates with prescriber when required and/or appropriate Comprehensive Medication Reviews • Uses appropriate verbal and non-verbal expression to be understood by and engage an audience • Uses open-ended questions and effective listening • Responds to audience’s needs and cues with empathy • Communication is logically organized, focused and coherent • Provides patient with relevant and comprehensive information • Determines patient understanding though questioning and nonverbal feedback o Uses open-ended questions and effective listening • Communicates with prescriber when required and/or appropriate
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As of November 2015
