From competence to excellence: CPD in action

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Patients need assurances of continuing professional development by those responsible for MTM

When boarding an airplane, passengers assume that the pilots are competent—that they not only passed a written test, but have also demonstrated that they can fly the plane. The pilots’ knowledge and skills are tested on an ongoing basis as new planes and technologies are introduced, and lessons are learned when things go awry.

With implementation of health care reform and endeavors such as the American Society of Health-System Pharmacists (ASHP) Pharmacy Practice Model Initiative (PPMI), pharmacists and pharmacy technicians are taking on new roles, and patients need similar assurances of continuing professional development (CPD) by those responsible for medication therapy management. “As the sophistication of practice, drug therapy regimens, and customized therapeutic options such as personalized medicine grow, we need pharmacists more than ever to move beyond the limitations of older methods of providing health care,” said Kelly Smith, PharmD, BCPS, FASHP, FCCP, Associate Dean, Academic and Student Affairs at the University of Kentucky College of Pharmacy. The challenge, however, is to identify what the new pharmacy functions will be and to figure out the best way for pharmacists and pharmacy technicians to demonstrate that they understand and can successfully implement the knowledge needed for expanded roles.

Just as most passengers expect airline pilots to be competent, patients expect the pharmacists and pharmacy technicians that manage their medications to be competent. “As a profession, we have often assumed that licensure and certification was equivalent to competence,” said Philip J. Trapskin, PharmD, BCPS, Manager of Patient Care Services at the University of Wisconsin Hospital and Clinics. “As the profession takes increasing accountability for medication use outcomes, it is our duty to ensure that pharmacists and technicians are competent.”

Although traditional continuing pharmacy education (CPE) helps pharmacists and pharmacy technicians stay current with their knowledge, “they don’t necessarily have to demonstrate any competency to get the CPE credit,” said John A. Armitstead, BSPharm, MS, FASHP, System Director of Pharmacy Services at Lee Memorial Health System in Fort Myers and Cape Coral, FL.

Developing CPD programs

Five sessions at the ASHP summer meeting in June focused on promoting CPD and establishing methods for monitoring and measuring competency for pharmacists and technicians. According to Trapskin, the concepts of competency, CPD, and practice advancement are interrelated. “It is not possible to advance the profession without a competent workforce,” he said.

The best way to ensure competence is to measure it in an ongoing fashion through a robust CPD program. “Most pharmacy departments don’t have a well-defined structure for putting together competency programs, and with proactive model change, now is a perfect time to develop such programs,” said Armitstead, who along with Trapskin, Smith, and their colleagues Lee B. Murdaugh, BSPharm, PhD, Director of Accreditation and Medication Safety at Cardinal Health, and Lindsey B. Poppe, PharmD, BCPS, Clinical Manager at the Department of Pharmacy at the University of North Carolina Hospitals, provided a template to help ASHP meeting attendees develop CPD programs at their respective institutions.

Real-world implementation

Once Armitstead and the group presented a competency program structure, the attendees broke out into small groups to discuss areas where CPD programs are needed in their own institutions. The next day, Armitstead and his colleagues showed the attendees how to develop CPD programs in the areas that discussed in the breakout sessions.

For example, Armitstead presented the necessary steps for an institution to implement a program where pharmacy technicians were responsible for recording patient medication histories (Table 1). Identifying each element in the structure is a prerequisite for developing a CPD program. “No matter what the new competency will be, you need to first define your audience,” said Armitstead. “Many leaders erroneously say that the competency applies to all technicians or all pharmacists, but it usually doesn’t. Target your programs for those who are performing the functions.” Once the target audience is identified, the next step is coming up the critical knowledge, skills, and abilities (KSAs) that are essential for that competency. After identifying the prerequisite KSAs, various methods of testing and assessment can be developed.

Table 1. Structure of a continuing professional development program for technicians taking patient medication histories

Elements Applications for medication histories
Target audience Pharmacy technicians or pharmacy interns performing initial patient medication histories
Critical knowledge, skills, and abilities (KSAs) Patient-centered communication skills
Understand brand/generic names
Common indications
Computer skills
Problem-solving skills
Look-alike/sound-alike error avoidance
Prerequisite KSAs Interpersonal and communication skills
Motivation to interact with patients
Training and education Didactic training: customer service module, audio/visual instruction, policy review, top 200 drugs
Medication error prevention
Practical training: systems training, patient simulation interviewing
Assessment: performance criteria/method Customer service computer module
Knowledge-based exam: matching and multiple choice (brand/generic names and indications)
Case-based examination
Practical examination
Assessment: threshold 100%: customer service
≥90%: knowledge, case-based, and practical examinations
Qualifications of assessor Pharmacist
Remedial actions Must be completed before resuming medication histories
Reassessment frequency Annually

Source: John A. Armitstead, BSPharm, MS, FASHP

Institutions can use the structure as a template to develop a wide variety of CPD programs for pharmacists and technicians. The elements remain the same, but the applications can be customized to fit an institution’s needs, such as creating a competency program for pharmacists in pediatric pharmacokinetic dosing and monitoring, or developing technician competency in the preparation of sterile products.

Skipping ahead to simply offering a test is not recommended. “If, say, 100% of the technicians all pass a test the first time, then perhaps you didn’t write the test hard enough,” said Armistead. “Or maybe you wrote a difficult test, but the technicians are still underperforming in the functions you need them to perform in.” A true CPD program includes evaluating how well pharmacists or technicians are able to perform functions. “Testing alone isn’t a good policy; you need some demonstration of competency,” added Armitstead.

The structure also applies to implementing CPD programs for pharmacists. “If the PPMI is changing pharmacy practice and pharmacist roles are expanding, then we need to not only train pharmacists in advanced functions but also measure how well they are able to complete those functions,” said Armitstead.

One step at a time

The implementation of a CPD program may appear daunting. “The key is to start and build over time. It is a marathon, not a sprint,” said Trapskin. He suggested that pharmacy leadership align competency development to support practice model advancement and optimizing medication use outcomes.

Collaboration among health care providers may also help facilitate the development of pharmacy CPD programs. “As pharmacy continues to mature as a profession, we will likely need to look to our counterparts in other professions to learn lessons about their competency and development processes,” said Smith. For example, most nursing departments have programmatic efforts to ensure a highly skilled workforce. “Pharmacy is at the intersection of the most critical points in a patient’s care, and the quality of that care that we provide should be valued and measured as rigorously as other professions,” said Smith.

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