D McRobbie

Information about medicines to cardiac in-patients: Patient satisfaction alongside the role perceptions and practices of doctors, nurses and pharmacists

OBJECTIVE To explore the satisfaction of cardiac in-patients regarding the information they received about their medicines, and the role perceptions and practices of practitioners whose responsibility it was to provide such information. METHOD A questionnaire was constructed by selecting medicine information topics from a validated instrument, the Satisfaction with Information about Medicines Scale. Patients and practitioners were recruited from cardiac wards at a London teaching hospital providing tertiary care. RESULTS Questionnaires were returned by 140 patients and 52 doctors, 53 nurses and 4 pharmacists. Patients were satisfied with information about the action and usage of medicines but were significantly less satisfied with information about potential problems with their medicines. In parallel, practitioners provided more information about the action and usage of medicines than its potential problems. CONCLUSIONS Information gaps existed largely around potential problems with medicines which reflected the general lack of focus on these issues by the healthcare professionals studied. There was no consensus between doctors, nurses and pharmacists on perceptions of role responsibility of information provision. PRACTICE IMPLICATIONS Patients may become non-adherent to their medicines if insufficient information is provided. Role responsibilities should be co-ordinated when information about medicines is provided by a range of practitioners.

Assessment of Clinical Competence: Designing a Competence Grid for Junior Pharmacists

Aim. This paper describes the development of a competency framework for clinical practice undertaken by junior pharmacists. Method. A peer group consisting of clinical practitioners and academics developed competency clusters. Competencies were assigned to each cluster and the associated behaviours described. The resulting “grids” were circulated to clinical practitioners, senior pharmacy managers and junior pharmacists for comment. A four point scale was developed to evaluate performance of the junior pharmacist for each behaviour. Outputs. The competency grids comprise three clusters: personal, problem solving and clinical. These are currently under investigation to determine their measurement properties.

Evaluating skills and competencies of pre-registration pharmacists using objective structured clinical examinations (OSCEs)

Introduction: This paper describes data collected over a period of 4 years in the former South Thames Region, UK, where objective structured clinical examination (OSCEs) have been used to assess pre-registration pharmacists in a secondary care setting. The study aims to describe a quantitative measure of competence using OSCE style assessments of graduate, pre- registration pharmacists. Method: All pre-registration pharmacists within the South Thames Region undertook a series of OSCEs; data were collected over a period of 4 years. Competence was assessed in each OSCE workstation using a pre-defined checklist. Results: In total, 223 pre-registration graduates participated; two thirds (67.9%) were female and the majority (62.7%) were trained in district general hospitals. Overall, 17.2% of graduates were deemed competent at the beginning of their pre- registration year compared to 68.3% at the end. This represents a significant improvement in clinical skills performance over the year (Wilcoxon signed rank test, Z 1⁄4 212.024; p 1⁄4 0.005). Discussion: The training program undertaken by pre-registration pharmacists significantly improved the clinical competence of these graduates in the areas measured, with two thirds considered competent overall at the end of the year. Of particular concern is the apparent inability of graduates to monitor prescriptions appropriately. The findings of this study have significant implications for workforce training and career planning. New graduates should not be working in isolation but should be considered as training grades and given support within the clinical team to develop their skills. Newly registered pharmacists should not be expected to undertake the range of tasks currently allocated to them, without appropriate supervision and further competency assessment.

A pilot study to evaluate clinical competence in junior grade pharmacy practitioners

This pilot project investigated pharmacists’ performance, using a previously designed and evaluated competency assessment grid, over a 12 week period in eight active and one control sites. At baseline and 12 weeks later, assessors defined the clinical service provision “expected” and then assessed junior pharmacists’ service against these specifications. The observed and expected competencies for each task were then compared. A number of assessors from the active sites were interviewed to determine the ease of use, the process adopted and the time taken to carry out the assessment of a student. Over the 12 week period students in the active group (n 5 24) showed a significant improvement in their ability to perform key tasks in all but one area whilst there was no significant change in performance in the control group (n 5 4). Evidence indicated that a variety of approaches were used when carrying out assessments using the grids by the five assessors interviewed. Additionally, the effects of using the grid on the assessment process had a range of organisational benefits across the active sites, highlighting the flexibility of the grids in diverse departments. The results indicate that the competency assessment grids can detect a change in pharmacists’ performance and that this might reflect the pharmacists’ awareness of the behaviours being assessed.