SGH Competency Framework: GLF

Transcription

1 SGH Competency Framework: GLF 6 th December 2009 Dr Camilla Wong Deputy Director, Allied Health Division 6 DECEMBER 2009

2 Set up Adapted CoDEG GLF to SGH setting & mapped competencies to experience of pharmacist Formed into CGs based on: Pharmacist expertise Types of wards & groupings No. beds per pharmacist 1 CG leader (assessor) : ~4 pharmacists Trained clinical group (CG) leaders & all inpatient pharmacists Started in Inpatient Pharmacy in May

3 Mapping Competencies Suggested Timeframe Assessment Phase End Yr1 End Yr2 3a/Clinical Gateway End Yr3 Prerequisite to Senior/ Research Gateway ANALYSIS & RECOMMENDATIONS 2.8 Use of guidelines and evidence Able to access recent clinical guidelines and/or relevant references Able to analyse information and critically appraise literature U U/A C A U U/A C A Able to identify evidence gaps U U U/A R Demonstrates clear decision making U U/A C A

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 Min ALF Competen cy to be Attained N/A N/A FOUNDATION Level in Building Working Relationships plus FOUNDATION Level in ONE of: Management P Expert Professional Practice C Research & Evaluation R Depending on track to pursue See ALF Mapping Document

5 Set up Adapted CoDEG GLF to SGH setting & mapped competencies to experience of pharmacist Formed into CGs based on: Pharmacist expertise Types of wards & groupings No. beds per pharmacist 1 CG leader (assessor) : ~4 pharmacists Trained clinical group (CG) leaders & all inpatient pharmacists Started in Inpatient Pharmacy in May

6 DIM (General) Beds Discipline CGL: XXX FTE P:B 46B1 17 Endo/Gastro CGL 1 46B2 36 Endo/Gastro Y3 1 46C 20 Endo/Gastro Y3 63(11/12) 15 DIM Y2 1 63(13/14) 17 DIM Y1a 1 63(15/16) 17 DIM /Geriatric Y1a 63(17/18) 17 DIM /Geriatric Y1a 63(19/20) 17 DIM Y1a 63(21/22) 17 DIM Y2 73A 26 DIM Y1b 1 73B 36 DIM Y1a 73C 21 DIM Y1a Total

7 Set up Adapted CoDEG GLF to SGH setting & mapped competencies to experience of pharmacist Formed into CGs based on: Pharmacist expertise Types of wards & groupings No. beds per pharmacist 1 CG leader (assessor) : ~4 pharmacists Trained clinical group (CG) leaders & all inpatient pharmacists Started in Inpatient Pharmacy in May

8 Clinical Groups Cardiology, Haematology/Oncology, Infectious Diseases, Neurology, Renal, Internal Medicine (general), Internal Medicine (ICU), Surgery Specific objectives for CG Meet weekly for about 2-3 hours Case-based discussion, journal clubs & other related presentations 8

9 Example of Surgical CG Objectives Therapeutic Areas: 1.Post-op pain management 2.Post op nausea and vomiting management 3.Antibiotic prophylaxis (pre and post) 4.Treatment of osteomylitis and prosthetic infection 5.DVT prophylaxis 6.Perioperative mangemenet of anticoagulation 7.Glucose control post op 8.Obstetrics and Gynaecology 9.Eye surgery 10.Orthopaedic surgery 11.Post op constipation management 12.Fluids and electrolytes management 9

10 Application to patient Identify all drug-drug interactions between patients previous drug history and the drugs used to manage. Identify all drug-patient interactions between patients previous medical history and the drugs used to manage Identify all drug-disease interactions between patients previous medical history and the drugs used to manage Prioritise all drug-related interactions (ie drug-drug, drug-disease, drug-patient) between patients previous medical history and the drugs used to manage Suggest suitable actions for all drug-related interactions (ie drug-drug, drug-disease, drug-patient) between patients previous medical history and the drugs used to manage Describe the risks and benefits of any actions suggested to both the management of the disease and the co-morbidities Substantiate your argument using the appropriate local and/or international guidelines Substantiate your argument using the appropriate primary evidence base. Interpret new evidence Knowledge and skills that should be demonstrated by pre-reg pharmacists Knowledge and skills that should be demonstrated by Y1 pharmacists Advanced knowledge and skills that should be demonstrated by Y3 pharmacists and above (specialist rotation) Specialist knowledge & skills that should be demonstrated by senior pharmacists and above (Specialist - ALF)

11 Clinical Groups Cardiology, Haematology/Oncology, Infectious Diseases, Neurology, Renal, Internal Medicine (general), Internal Medicine (ICU), Surgery Specific objectives for CG Meet weekly for about 2-3 hours Case-based discussion, journal clubs & other related presentations 11

12 Assessments Rotation Frequency to CG Yr 1: 4 monthly Yr 2,3,4: 6 monthly Assessments At the end of each rotation Tools: Mini-clinical evaluation exercise, Case-based discussion form, GLF Assessment form, Summary Assessment & Clinical Objectives form Meet with CG leaders to discuss findings 12

13 GLF Competency Assessment Results

14 Assessment Results Compared Baseline to 4 th month (May to Aug 2009) May 2009 to April 2010 But baseline assessments completed in June 2009 June, Aug, Nov, Mar Met with CG leaders to discuss findings Highlighted competencies with more Not met to Met 14

15 GLF Competency Assessment Results 1.5 Medication reconciliation

16 Overall GLF Results for Delivery of Patient Care 16

17 1.5 Medication reconciliation: Takes or checks for an accurate & comprehensive medication history where appropriate Baseline Period - June pharmacists did not meet requirements while 7 met 17

18 1.5 Medication reconciliation: Takes or checks for an accurate & comprehensive medication history where appropriate Year 1 Results Baseline Period - June 2009 All 6 pharmacists did not meet requirements Assessment Period - Aug 2009 Only 2 (out of 5) pharmacists did not meet requirements 18

19 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 1.5 Medication reconciliation: Takes or checks for an accurate & comprehensive medication history where appropriate Issues Raised Frequency Vs Performance Pharmacists do not have sufficient opportunities to conduct medication reconciliation It s about the ability to conduct medication reconciliation when the need arises Addition of Not Assessable option Prompt to assess at next assessment period 19

20 GLF Competency Assessment Results 1.11 Selection of formulation, concentration, rate and diluent

21 Overall GLF Results for Delivery of Patient Care 21

22 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 1.11 Selection of formulation, concentration, rate and diluent: Ensures appropriate formulation & dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs Baseline Period - June pharmacists did not meet requirements while 7 met 22

23 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 1.11 Selection of formulation, concentration, rate and diluent: Ensures appropriate formulation & dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs Year 1 Results Baseline Period - June (out of 6) Y1 pharmacists did not meet requirements Assessment Period - Aug (out of 5) Y1 pharmacists did not meet requirements 23

24 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 1.11 Selection of formulation, concentration, rate and diluent: Ensures appropriate formulation & dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs Year 2 Results X Baseline Period - June (out of 5) pharmacists did not meet requirements 24

25 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 1.11 Selection of formulation, concentration, rate and diluent: Ensures appropriate formulation & dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs Year 3 Results X Baseline Period - June (out of 5) pharmacists did not meet requirements 25

26 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 1.11 Selection of formulation, concentration, rate and diluent: Ensures appropriate formulation & dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs Year 4 Results X Baseline Period - June (out of 4) pharmacists did not meet requirements 26

27 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 1.11 Selection of formulation, concentration, rate and diluent: Ensures appropriate formulation & dose equivalents taken into account. Appropriate information given for concentration/rate/diluent of parenteral drugs Issues Raised How was this assessed? Can give bolus? How do you dilute the drug? Follow hospital guidelines e.g. ICU dilution table? 27

28 GLF Competency Assessment Results 1.12 Checking of dose, frequency, timing, route and duration

29 Overall GLF Results for Delivery of Patient Care 29

30 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 1.12 Checks Checking that patient of dose, has frequency, received the timing, correct route dose and and duration: frequency, at the correct time via most appropriate route for the right duration Baseline Period - June pharmacists did not meet requirements while 9 met 30

31 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 1.12 Checks Checking that patient of dose, has frequency, received the timing, correct route dose and and duration: frequency, at the correct time via most appropriate route for the right duration Year 1 Results Baseline Period - June 2009 All 6 pharmacists did not meet requirements Assessment Period - Aug (out of 5) Y1 pharmacists did not meet requirements Issues Raised: Assessment of Administration Process Vs Prescription Process 31

32 GLF Competency Assessment Results 1.12 Identification of drugrelated problems

33 Overall GLF Results for Problem Solving 33

34 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 2.1 Identification of drug-related problems: Identifies drug-drug interactions (including complementary medicines) Baseline Period - June pharmacists did not meet requirements while 4 met 34

35 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 2.1 Identification of drug-related problems: Identifies drug-drug interactions (including complementary medicines) Year 1 Results Baseline Period - June (out of 6) pharmacists did not meet requirements Assessment Period Aug 2009 All 5 pharmacists met requirements 35

36 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 2.1 Identification of drug-related problems: Identifies drug-drug interactions (including complementary medicines) Year 2 Results Year 3 Results Year 4 Results Baseline Period - June 2009 Majority of the Y2,3,4 pharmacists did not meet requirements 36

37 1.5 Medication reconciliation (A) Y1 Issues & Y2 Raised Results 2.1 Identification of drug-related problems: Identifies drug-drug interactions (including complementary medicines) Issues Raised New Rotation to Clinical Groups There are concerns that pharmacists may not be familiar with specialty topics in the Clinical Group Need to await the next period results For Y2,3,4 Met = always Many (pharmacists & CG leaders) take it to be 100% & not % 37

38 GLF Competency Assessment Results 2.8 Use of guidelines and evidence

39 Overall GLF Results for Problem Solving 39

40 2.8 Use of Guidelines and Evidence: Able to analyse information and critically appraise literature Baseline Period - June pharmacists did not meet requirements while 6 met 40

41 2.8 Use of Guidelines and Evidence: Able to analyse information and critically appraise literature Year 1 Results Baseline Period - June (out of 6) pharmacists did not meet requirements Assessment Period Aug 2009 All 5 pharmacists did not meet requirements 41

42 2.8 Use of Guidelines and Evidence: Able to analyse information and critically appraise literature Year 2 Results X Baseline Period - June 2009 All 5 pharmacists did not meet requirements 42

43 2.8 Use of Guidelines and Evidence: Able to analyse information and critically appraise literature Year 3 Results X Baseline Period - June 2009 All 5 pharmacists did not meet requirements 43

44 2.8 Use of Guidelines and Evidence: Able to analyse information and critically appraise literature Year 4 Results X Baseline Period - June (out of 4) pharmacists did not meet requirements 44

45 2.8 Use of Guidelines and Evidence: Demonstrates clear decision making Baseline Period - June pharmacists did not meet requirements while 3 met 45

46 2.8 Use of Guidelines and Evidence: Demonstrates clear decision making Year 1 Results Baseline Period - June (out of 6) pharmacists did not meet requirements Assessment Period Aug (out of 5) pharmacists did not meet requirements 46

47 2.8 Use of Guidelines and Evidence Issues Raised Uploading of Guidelines A copy of guidelines will be uploaded to J Drive and made available for all pharmacists reference Able to access guidelines & identify gaps but had trouble analyzing & making decisions based on evidence 47

48 GLF Competency Assessment Results 3.9 Organizational

49 Overall GLF Results for Professional 49

50 3.9 Organizational: Describe the structure and values of employing organization Baseline Period - June 2009 Overall, 13 pharmacists did not meet requirements while 7 met requirements 50

51 3.9 Organizational: Describe the structure and values of employing organization Issues Raised Improve upon sectional orientation sessions 3.9 Organizational (A) covers the organization s structure & values Therefore, sectional orientation sessions should reiterate and reinforce points covered by the general orientation 51

52 Other Issues Misreading of Grading Format Pharmacists may have missed out reading the % & the corresponding grade at the bottom of the GLF document as they are in fine print Always=100-85%, Usually=84-51%, Sometimes=50-25%, Never<24% Assessors to reinforce the grading format Mentality of Self-Assessment Pharmacists tend to feel uncomfortable giving themselves higher grades even though they rightfully deserve it How pharmacy management might utilise information Tailored Education Trg sessions for pharmacists in the various years 52

53 GLF Survey Results 26 th Nov 2 nd Dec 2009 Inpatient Pharmacists

54 GLF Survey Results Survey Respondents Online survey was conducted for inpatient pharmacists who are currently undergoing GLF assessment Rating 1: Lowest, 5: Highest Total of 21 respondents Majority of survey respondents were Y1 & Y2 pharmacists Year Distribution of GLF Survey Respondents 53% 47% Y1 Y2 Y3 Y4 54

55 GLF Survey Results Demographics of Survey Respondents CG Distribution of GLF Survey Respondents 5% 5% Cardiology 16% 21% Haemato/Oncology Infectious Disease Neurology 21% 16% 16% Renal DIM (General) DIM (ICU) Surgery Majority of respondents were from the DIM (General) and Infectious Disease CG 55

56 GLF Survey Results Preferred Frequency of CG Overall Preferred Frequency of CG 13% 87% Weekly Fortnightly 3-weekly 6-Weekly The most preferred frequency of CG was found to be on a weekly basis Keeps the momentum, More learning opportunities, keeps people on their toes 56

57 GLF Survey Results Preferred Duration of CG Overall Preferred Duration of CG 4% 13% 66% 17% 1½ hrs 2 hrs 2½ hrs 3 hrs The most preferred duration of CG was found to be 2 hrs Optimal duration for focus of attention, Sufficient time to complete discussion of intended topic yet not too long 57

58 GLF Survey Results Preferred Timing of CG Overall Preferred Timing of CG 4% 8.30am 10.00am 3.00pm 6.00pm 96% The most preferred timing of CG was found to be 3-6pm Less disruptive to workflow, too rushed in the morning 58

59 GLF Survey Results Rotation frequency adequate for learning experience Do you think that the current rotation duration of 3 6 months for CG is adequate for your learning experience? 10% Yes No 90% 90% (19) feel that the current rotation duration is adequate 4 mths instead of 6 mths (too long) making it 4 monthly ensures a person to be rotated to 3 disciplines in a year 59

60 GLF Survey Results Sufficiency of CG Activities Sufficiency of CG Activities 14% 86% Yes No 86% (18) feel that the current range of CG activities are sufficient for their learning experience We use the CG time to do a variety of stuff beyond the above stated 60

61 GLF Survey Results Sufficiency of CG Activities Case Presentations prefer to discuss case in ward instead of clerking case & discussing it retrospectively in pharmacy Case should be summarised, highlighting on the drug-related problems & plan for the patient Case presentations should be spaced apart & not done by the same individuals weekly as it might be too tedious Journal Club Allow discussion on newer practices/medicines Too few journal clubs are presented 61

62 GLF Survey Results Value of CG Assessment Tools in Learning Experience Value of CG Assessment Tools in Learning Experience 19% 81% Yes No 81% (17) feel that the CG assessment tools do add value to their learning experience 62

63 GLF Survey Results Value of CG Assessment Tools in Learning Experience It provides a proper structural framework to assess pharmacists' clinical knowledge. Enables me to keep track of my learning & do self-reflection CBD & mini-cex allows us to apply our knowledge into clinical practice. The GLF assessments allows us to gauge which stage we are at & allows us to identify the areas for improvements Does give a broad assessment of skills & knowledge Unnecessary to keep doing this every few months esp if the pharmacists are already performing well Too long. Very subjective 63

64 GLF Survey Results CG Discussion: Topics Discussed Sufficient CG Discussion - Sufficiency of Topics Covered for Learning 10% Yes No 90% 90% (18) feel that the topics covered in the CG discussions are sufficient May still need to cover some basic concepts before advancing to higher level knowledge 64

65 GLF Survey Results Overall Rating of CG Leader Overall Rating of CG leader 16% 21% 63% Excellent Good Satisfactory Less than satisfactory Ineffective 63% (12) rated their CG leader as Good None of the respondents rated their CG leader as Less than satisfactory or Ineffective 65

66 GLF Survey Results Rating of CG Leader from 1 (low) to 5 (high) 80% (15) rated their CG leaders a 4 or 5 in facilitating sessions 74% (13) rated their CG leader as 4 or 5 in planning for learning experience 63% (10) rated their CG leader as 4 or 5 in following up on progression 79% (15) rated their CG leader as 4 or 5 in assessing performance 66

67 GLF Survey Results Overall Rating of CG Leader Good facilitation, Well-planned, Gives me suggestions on ways to improve, Fair in assessment Asks questions that make us think deeper into the topic CG leader may be too busy sometimes Summarising the pearls of what we are suppose to learn for the day could help Needs to clarify overview of objective / topic before going on to discussion. Getting better at time management. Knowledgewise, ok Effectiveness seen in planning of topics for discussion Having rotated thru more than 1 rotation some CG leaders better than others A lot left to self-directed learning 67

68 GLF Survey Results Value of GLF in terms of Professional Development Value of GLF in terms of Professional Development 11% 5% 52% 32% % (12) rated a 4 or 5 Good for entry-level pharmacists - more structured approach Ensures that junior pharmacists are under proper tutelage and guidance 68

69 GLF Survey Results Value of CG in terms of Professional Development Value of CG in terms of Professional Development. 16% 5% 26% % 5 69% (13) rated a 4 or 5 Peer-driven learning, Helps by giving chance to present more and also observe more presentations done by others, Sets aside time to allow for growth in the clinical aspect 69

70 Overall Feedback on Competency Framework What you like most: I enjoy having regular discussion as it provokes learning. Preparing for the sessions have also allowed me to visit certain learning areas in depth. It gives an opportunity for exposure to different specialties Structured and focus, gives direction What you disliked most: Very tedious filling up all the assessment forms & rather stressful at times repetitious Lengthy assessments It brings about longer working hours as we need to stay back to clerk cases & do up presentation slides at home Was quite taxing as our CG was very small. Hence, need to prepare for presentation every week. Others: This framework would be useful if the initial & final assessment was done by the same person. 70

71 Outpatient Pharmacists: Set up Utilised the same adapted CoDEG GLF & mapping as inpatient Formed into CGs based on: Pharmacist expertise Types of ambulatory services 1 CG leader (assessor) : ~5 pharmacists Trained clinical group (CG) leaders & all outpatient pharmacist Started in Outpatient Pharmacy in Aug

72 Outpatient Pharmacists: CG Group 1: Geriatrics/Renal/General Surgery Group 2: Haematology/Endocrinology Group 3: IBD/Gastroenterology/Behavioural Med Group 4: Rheumatology/Neurology/Dermatology Group 5: Gynaecology/Urology/Orthopedics and Pain Group 6: Respiratory/ENT/Internal med Specific objectives for CG Meet 6-weekly for about 2 hours in the morning Case-based discussion, journal clubs & other related presentations 72

73 Outpatient Pharmacists: Assessments Rotation Frequency to CG Yr 1: 4 monthly Yr 2,3,4: 6 monthly Assessments At the end of each rotation Tools: Mini-clinical evaluation exercise, Case-based discussion form, GLF Assessment form, Summary Assessment & Clinical Objectives form 73

74 Thank you