BUILDING YOURSELF AS AN EFFECTIVE PROBLEM SOLVER
Pharmacy is built firmly on the concept of technical rationality. The idea states that practitioners are primarily problem solvers who select rational ways to serve particular purposes.
If I can use two words to describe what pharmaceutical care is, then I will say it is a RESPONSIBLE PROVISION. We provide treatment when we dispense medicines; it does not become pharmaceutical care until when we ensure that our dispensing is done responsibly. I do not want to bore you with the long definition of pharmaceutical care that has been repeated over and over, and has been ringing in the years of all pharmacists who want to understand what pharmaceutical care is; and how it can be implemented in their daily practice so that they can make the difference they have always striven to. It goes like this: Pharmaceutical Care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.
Pharmaceutical care is essentially a process and is as follows:
Step ONE: Identify any DRUG-RELATED PROBLEM (actual or potential);
Step TWO: Resolve the DRUG-RELATED PROBLEMS that actually develop.
STEP THREE: Prevent all potential DRUG-RELATED PROBLEMS from developing
We usually start out with a lot of energy as rigorous ‘young’ practitioners, who are ready to solve well-formed problems (those that should be straight forward if all other practitioners did their part right) by applying theory and technique from systematic and scientifically derived knowledge. However as we become oriented to the ‘fuzzy” problems of daily practice, we find that the problems we encounter are not that straight-forward but rather “messy indeterminate situations”.
It does not take long for us, novice practitioners, to learn that we really don’t know how to solve many problems we face in practice. We learn quickly that defining the actual problem that needs to be solved is difficult and sometimes results in no clear solution.
Working Groups have been used in medicine (and pharmacy) for a long time to crack very important issues of practice that were not clear-cut from the outset. All of us know that all Cancer Chemotherapy protocols/regimens are product of focused Working Groups (or if you like Study Groups). A Pharmaceutical Care Working Group is an idea that has already taken off, and a handful of dedicated volunteer pharmacists will see to it that it changes the practice of clinical pharmacy in Kenya.
We will start from scratch and build working systems that pharmacists will rely on to practice. The moment we realized that no one but us can build our practice was the moment we decided to bid farewell to ambiguity. If only the vigour shown by these patriotic Kenyans can have a snowballing effect on every Kenyan pharmacist involved in patient care, and shake each and every barrier that has stood on our road to Pharmaceutical care!
The Pharmaceutical Care Working Group will provide a systematic method to collect and assess the clinical information used to determine patient’s problems and health needs. With repetition and practice, you can become proficient at “framing” the patient’s problems, achieving concordance with your own professional viewpoint and the patient. That is why it is called Pharmacy Practice!
Wednesday, June 22, 2011
Wednesday, May 4, 2011
HOW I WILL CONTRIBUTE TO ATTAIN THIS VISION FOR PHARMACY IN KENYA (See the vision in the immediate older post of this blog)
How can i contribute as an individual to attain this vision?
Individual level
Ensure that all chronic care patients who are sent to me have an implementation (pharmaceutical care) plan for their treatment, follow up on them and track their future appointments so that I use that opportunity to evaluate treatment outcomes and set new goals.
I will keep a register of all the patients I provide chronic care to be available for scrutiny by my peers and colleagues, so as to achieve a sustainable continuity of care.
I will encourage the people who I will have the privilege to mentor, to embrace pharmaceutical care so that we can be members of a larger team who we can hand over care of our patients between us whenever we are not available to offer the essential service, with the goal of making sure that chronic care of patients is not an intermittent process but a long term continuous commitment.
I will keep records of my interventions for scrutiny by me and my peers both for accountability and for opportunity for me and my peers to learn and improve our practice.
I will teach, mentor and grow pharmacists younger than me to reach where I have not reached, to offer services that make more impact than I was able to, with or without compensation or remuneration of any kind.
When my time comes I will provide leadership to pharmacists that will ensure that they realize their goals and have professional satisfaction.
As a member of team
I will accept to carry out assignments and responsibilities assigned to me by my peers and professional colleagues that aim to improve the practice of pharmacy.
I will be part of the process that ensures that there is a lifelong learning process going on for me and my fellow practitioners.
I will take advantage of all opportunities to generate new knowledge in my area of practice and specialization, and target to carry at least one research or clinical audit each year which can be appraised by my supervisor.
I will participate actively participate in a society, working group or an association that works to further the interests of the profession.
In the Regulation of Pharmacy Practice
I will push for creation of working groups to come up with standards of practice for all the different specializations in pharmacy.
I will call for the hospital pharmacy representative to the Pharmacy and Poisons Board (PPB) to buy the idea that regulation should always promote the provision of pharmaceutical care and ensure that the Board makes advancement of pharmacy practice a priority.
I will mobilize the pharmacy practitioners and other stakeholders to keep the laws regulating pharmacy practice up to date and make the medicines that were registered after the last revision of Poisons List legal to be prescribed in Kenya.
o I will make my colleagues aware that the Poisons List Confirmation Order-which gave rise to a Poisons List [5] with two parts, (Part 1 and 2), in the Subsidiary Legislation to section 25 (Order under section 25) of the Pharmacy and Poisons Act-is now obsolete and need revision.
o That the revision of the list (addition or removal of medicines) together with its schedules be revised on an annual basis by pharmacists who have significant knowledge base and skills, and spend most of their time providing care directly to patients.
o That the reclassification of medicines from one prescription status to another is done in a structured way and the changes communicated efficiently to all pharmacists and other interested practitioners.
REFERENCES
1. New Statesman, 21 April 1917, article by Sidney Webb and Beatrice Webb quoted with approval at paragraph 123 of a report by the UK Competition Commission, dated 8 November 1977, entitled Architects Services (in Chapter 7).
2. Pharmaceutical Society of Australia: National Competency Standards Framework for Pharmacists in Australia 2010. http://www.psa.org.au/site.php?id=6782
3. Board of Pharmacy Specialties http://www.bpsweb.org/about/vision.cfm
4. Graham Copeland. A Practical Handbook for Clinical Audit. Clinical Audit Support Team, NHS http://www.wales.nhs.uk/sites3/Documents/501/Practical_Clinical_Audit_Handbook_v1_1.pdf
5. Pharmacy and Poisons Act, CAP 244 of the Laws of Kenya
Individual level
Ensure that all chronic care patients who are sent to me have an implementation (pharmaceutical care) plan for their treatment, follow up on them and track their future appointments so that I use that opportunity to evaluate treatment outcomes and set new goals.
I will keep a register of all the patients I provide chronic care to be available for scrutiny by my peers and colleagues, so as to achieve a sustainable continuity of care.
I will encourage the people who I will have the privilege to mentor, to embrace pharmaceutical care so that we can be members of a larger team who we can hand over care of our patients between us whenever we are not available to offer the essential service, with the goal of making sure that chronic care of patients is not an intermittent process but a long term continuous commitment.
I will keep records of my interventions for scrutiny by me and my peers both for accountability and for opportunity for me and my peers to learn and improve our practice.
I will teach, mentor and grow pharmacists younger than me to reach where I have not reached, to offer services that make more impact than I was able to, with or without compensation or remuneration of any kind.
When my time comes I will provide leadership to pharmacists that will ensure that they realize their goals and have professional satisfaction.
As a member of team
I will accept to carry out assignments and responsibilities assigned to me by my peers and professional colleagues that aim to improve the practice of pharmacy.
I will be part of the process that ensures that there is a lifelong learning process going on for me and my fellow practitioners.
I will take advantage of all opportunities to generate new knowledge in my area of practice and specialization, and target to carry at least one research or clinical audit each year which can be appraised by my supervisor.
I will participate actively participate in a society, working group or an association that works to further the interests of the profession.
In the Regulation of Pharmacy Practice
I will push for creation of working groups to come up with standards of practice for all the different specializations in pharmacy.
I will call for the hospital pharmacy representative to the Pharmacy and Poisons Board (PPB) to buy the idea that regulation should always promote the provision of pharmaceutical care and ensure that the Board makes advancement of pharmacy practice a priority.
I will mobilize the pharmacy practitioners and other stakeholders to keep the laws regulating pharmacy practice up to date and make the medicines that were registered after the last revision of Poisons List legal to be prescribed in Kenya.
o I will make my colleagues aware that the Poisons List Confirmation Order-which gave rise to a Poisons List [5] with two parts, (Part 1 and 2), in the Subsidiary Legislation to section 25 (Order under section 25) of the Pharmacy and Poisons Act-is now obsolete and need revision.
o That the revision of the list (addition or removal of medicines) together with its schedules be revised on an annual basis by pharmacists who have significant knowledge base and skills, and spend most of their time providing care directly to patients.
o That the reclassification of medicines from one prescription status to another is done in a structured way and the changes communicated efficiently to all pharmacists and other interested practitioners.
REFERENCES
1. New Statesman, 21 April 1917, article by Sidney Webb and Beatrice Webb quoted with approval at paragraph 123 of a report by the UK Competition Commission, dated 8 November 1977, entitled Architects Services (in Chapter 7).
2. Pharmaceutical Society of Australia: National Competency Standards Framework for Pharmacists in Australia 2010. http://www.psa.org.au/site.php?id=6782
3. Board of Pharmacy Specialties http://www.bpsweb.org/about/vision.cfm
4. Graham Copeland. A Practical Handbook for Clinical Audit. Clinical Audit Support Team, NHS http://www.wales.nhs.uk/sites3/Documents/501/Practical_Clinical_Audit_Handbook_v1_1.pdf
5. Pharmacy and Poisons Act, CAP 244 of the Laws of Kenya
MY VISION FOR THE CLINICAL PHARMACY PROFESSION
A pharmacy professional
A profession [1] is a vocation founded upon specialised educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain (Webb S, 1997).
Pharmacists are professionals who have the abilities and skills which are necessary to achieve outcomes related to:
• Providing pharmaceutical care to patients
• Developing and managing medication distribution and control systems
• Managing the pharmacy
• Promoting public health
• Providing drug information and education
While these outcomes seem easy to achieve, there is still a huge gap between what is expected of pharmacists [2] and what pharmacists actually achieve.
Clinical Pharmacist Training
The clinical component of pharmacist’s work need to improve the most and training for this role must meet the following objectives:
• to develop students' communication skills for effective interaction with patients and with practitioners of other health professions,
• to help students develop a patient awareness in the practice of pharmacy
• to enable students to integrate the knowledge acquired in course work prior to clinical exposure, and to apply it to the solution of real problem
• to develop students' awareness of their responsibility for monitoring the drugs taken by patients and,
• to help students become more aware of the general methods of diagnosis and patient care specifically related to drug therapy
Lifelong learning and professional growth
A good training in clinical pharmacy and the subsequent qualification as a practitioner is just but the beginning of a long journey towards developing competent professionals who will make an impact to the society. My desire is that pharmacists themselves will find it in their interest to develop, implement and sustain an internal mechanism where pharmacists’ knowledge, skills and attitudes are evaluated and improved.
Specialization
My vision for clinical pharmacy and pharmacy profession as a whole is that one day pharmacists will realize that it is not possible for an individual to accumulate enough knowledge in a lifetime to be an authority on all aspects of clinical pharmacy or general pharmacy. Some pharmacists have already realized this and are trying their best to fill the gap in the health care provision. The areas of specializations must however be relevant to the current needs, and must be continually reviewed to go with the times.
Certification
From patient to provider, the value of a certified practitioner registers throughout the health care continuum. This provides a legal basis and right to provide care in any clinical environment. For pharmacy professionals, documentation of specialized experience and skills yields the additional benefits of personal satisfaction, financial rewards and career advancement.
How do we get there?
• The current clinical pharmacy training undergraduates are receiving in the University of Nairobi is much better than a decade ago; this is obvious when one engages a student on a clinical approach discussion. This needs to be sustained and even improved further.
• The undergraduate students in pharmacy should spend an extra year in training to be in line with internationally accepted standards for pharmacy training for students who have spent four years in high school or less than twelve years of pre-university education. This will give the pharmacists in training more time to accumulate knowledge, skills and attitude required to practice top level pharmacy.
• The internship should be done in areas where there is at least one preceptor per intern. The preceptor must have at least three years of experience in pharmacy practice post-registration and must be available at all times for consultation during the entire period of internship. The preceptor must demonstrate to have the knowledge, skills and attitudes required to train a highly motivated intern to have a successful professional life after registration before recertification.
• The pharmacist should be registered only if they pass pre-registration assessment that focuses on competencies expected of an entry level pharmacist. After that, annual practicing licence can be issued to a registered pharmacist without the need to sit for an exam, so long as there is evidence of continuous professional development (CPD) and the required CPD threshold has been achieved or exceeded.
• Only registered pharmacists should be allowed to practice pharmacy. Peer-led professional audits can be done on a regular basis to ensure that minimum standards required of a practice are maintained in all pharmacies.
• The current advanced training in clinical pharmacy needs to take at least 3 years with the pharmacist getting full residency status as their medical colleagues. The classes should be peripheral in term of time allocation, and real work environment practice to take the centre stage.
The first half of the first year, can be fully academic, where an emphasis is placed on physiology, epidemiology, evidence-based healthcare and biostatistics. The second-half can the concentrate on pathophysiology, biopharmaceutics, pharmacokinetics, drug information and pharmacy management, toxicology, patient assessment, clinical chemistry and introduction to therapeutics and pharmaceutical care.
The second year can be a year of problem-based learning where students need to build relationship with patients, other health care professionals and more importantly other pharmacists. The emphasis will be on the continuum of care, where there are multiple contacts between a student and an individual patient and student must have a plan for the patient who will be both in patient records and school of pharmacy records. The classes during this time will be mainly therapeutics, with numerous student presentations and faculty moderation. An adjunct class of advanced pharmacokinetics will be useful during this period. Some exposure to research methods can also be useful at this time
The final year will concentrate on individual research work completion, more exposure to clinical areas of sub-specialization, and some level of participation in teaching more junior members so as to learn more. Communication and presentation skills, together with clinical audit [4] skills need to be enhanced at this stage. There should be evidence that the expected activities were actually carried out. Short-term exposure to other hospitals which are regional centres of excellence should be encouraged during this period.
• The newly qualified clinical pharmacists should practice for one year in the areas of their sub-specialty (residency) before they are awarded a board certification.
• The pharmacists to patient ratio should increase, and there should be presence of clinical pharmacists in all major specialties in major hospitals first, then to all other hospitals. The pharmacy specialist skills should not be spread thin, as there will be little or no overall impact. These specialists should be concentrated where they are needed most and should not be involved in primary care which registered pharmacists can provide with the help of lower cadre pharmaceutical professionals (technologists and technicians).
• The clinical pharmacists can harness their skills and knowledge by sharing information and experiences. They must have forums where they can communicate and influence the growth of the profession. Associations will leverage the growth of the profession by growing the capacity of the profession from within, and also by the lobbying forces outside the profession to further their interests.
• There must be a certification and recertification regulatory board [3] to certify pharmacists who meet the requirements to practice in their specialty areas, and prevent those who do not qualify from practicing.
• The clinical pharmacists should be able to motivate others to advance the practice of pharmacy. They should carry out clinical audits on a regular basis to demonstrate that the practice has improved. A clinical audit [4] is a cyclical process, involving the identification of a process to intervene, setting or adopting already available standards, comparing practice with the standards, implementing changes and monitoring the effect of those changes. Its purpose is to improve the quality of clinical care.
• There must be a standards body to force all healthcare providing institutions to meet certain minimum standards to be allowed to operate. Pharmacy practice can only excel if the pharmacists are well equipped to provide care.
REFERENCES
1. New Statesman, 21 April 1917, article by Sidney Webb and Beatrice Webb quoted with approval at paragraph 123 of a report by the UK Competition Commission, dated 8 November 1977, entitled Architects Services (in Chapter 7).
2. Pharmaceutical Society of Australia: National Competency Standards Framework for Pharmacists in Australia 2010. http://www.psa.org.au/site.php?id=6782
3. Board of Pharmacy Specialties http://www.bpsweb.org/about/vision.cfm
4. Graham Copeland. A Practical Handbook for Clinical Audit. Clinical Audit Support Team, NHS http://www.wales.nhs.uk/sites3/Documents/501/Practical_Clinical_Audit_Handbook_v1_1.pdf
5. Pharmacy and Poisons Act, CAP 244 of the Laws of Kenya
A profession [1] is a vocation founded upon specialised educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain (Webb S, 1997).
Pharmacists are professionals who have the abilities and skills which are necessary to achieve outcomes related to:
• Providing pharmaceutical care to patients
• Developing and managing medication distribution and control systems
• Managing the pharmacy
• Promoting public health
• Providing drug information and education
While these outcomes seem easy to achieve, there is still a huge gap between what is expected of pharmacists [2] and what pharmacists actually achieve.
Clinical Pharmacist Training
The clinical component of pharmacist’s work need to improve the most and training for this role must meet the following objectives:
• to develop students' communication skills for effective interaction with patients and with practitioners of other health professions,
• to help students develop a patient awareness in the practice of pharmacy
• to enable students to integrate the knowledge acquired in course work prior to clinical exposure, and to apply it to the solution of real problem
• to develop students' awareness of their responsibility for monitoring the drugs taken by patients and,
• to help students become more aware of the general methods of diagnosis and patient care specifically related to drug therapy
Lifelong learning and professional growth
A good training in clinical pharmacy and the subsequent qualification as a practitioner is just but the beginning of a long journey towards developing competent professionals who will make an impact to the society. My desire is that pharmacists themselves will find it in their interest to develop, implement and sustain an internal mechanism where pharmacists’ knowledge, skills and attitudes are evaluated and improved.
Specialization
My vision for clinical pharmacy and pharmacy profession as a whole is that one day pharmacists will realize that it is not possible for an individual to accumulate enough knowledge in a lifetime to be an authority on all aspects of clinical pharmacy or general pharmacy. Some pharmacists have already realized this and are trying their best to fill the gap in the health care provision. The areas of specializations must however be relevant to the current needs, and must be continually reviewed to go with the times.
Certification
From patient to provider, the value of a certified practitioner registers throughout the health care continuum. This provides a legal basis and right to provide care in any clinical environment. For pharmacy professionals, documentation of specialized experience and skills yields the additional benefits of personal satisfaction, financial rewards and career advancement.
How do we get there?
• The current clinical pharmacy training undergraduates are receiving in the University of Nairobi is much better than a decade ago; this is obvious when one engages a student on a clinical approach discussion. This needs to be sustained and even improved further.
• The undergraduate students in pharmacy should spend an extra year in training to be in line with internationally accepted standards for pharmacy training for students who have spent four years in high school or less than twelve years of pre-university education. This will give the pharmacists in training more time to accumulate knowledge, skills and attitude required to practice top level pharmacy.
• The internship should be done in areas where there is at least one preceptor per intern. The preceptor must have at least three years of experience in pharmacy practice post-registration and must be available at all times for consultation during the entire period of internship. The preceptor must demonstrate to have the knowledge, skills and attitudes required to train a highly motivated intern to have a successful professional life after registration before recertification.
• The pharmacist should be registered only if they pass pre-registration assessment that focuses on competencies expected of an entry level pharmacist. After that, annual practicing licence can be issued to a registered pharmacist without the need to sit for an exam, so long as there is evidence of continuous professional development (CPD) and the required CPD threshold has been achieved or exceeded.
• Only registered pharmacists should be allowed to practice pharmacy. Peer-led professional audits can be done on a regular basis to ensure that minimum standards required of a practice are maintained in all pharmacies.
• The current advanced training in clinical pharmacy needs to take at least 3 years with the pharmacist getting full residency status as their medical colleagues. The classes should be peripheral in term of time allocation, and real work environment practice to take the centre stage.
The first half of the first year, can be fully academic, where an emphasis is placed on physiology, epidemiology, evidence-based healthcare and biostatistics. The second-half can the concentrate on pathophysiology, biopharmaceutics, pharmacokinetics, drug information and pharmacy management, toxicology, patient assessment, clinical chemistry and introduction to therapeutics and pharmaceutical care.
The second year can be a year of problem-based learning where students need to build relationship with patients, other health care professionals and more importantly other pharmacists. The emphasis will be on the continuum of care, where there are multiple contacts between a student and an individual patient and student must have a plan for the patient who will be both in patient records and school of pharmacy records. The classes during this time will be mainly therapeutics, with numerous student presentations and faculty moderation. An adjunct class of advanced pharmacokinetics will be useful during this period. Some exposure to research methods can also be useful at this time
The final year will concentrate on individual research work completion, more exposure to clinical areas of sub-specialization, and some level of participation in teaching more junior members so as to learn more. Communication and presentation skills, together with clinical audit [4] skills need to be enhanced at this stage. There should be evidence that the expected activities were actually carried out. Short-term exposure to other hospitals which are regional centres of excellence should be encouraged during this period.
• The newly qualified clinical pharmacists should practice for one year in the areas of their sub-specialty (residency) before they are awarded a board certification.
• The pharmacists to patient ratio should increase, and there should be presence of clinical pharmacists in all major specialties in major hospitals first, then to all other hospitals. The pharmacy specialist skills should not be spread thin, as there will be little or no overall impact. These specialists should be concentrated where they are needed most and should not be involved in primary care which registered pharmacists can provide with the help of lower cadre pharmaceutical professionals (technologists and technicians).
• The clinical pharmacists can harness their skills and knowledge by sharing information and experiences. They must have forums where they can communicate and influence the growth of the profession. Associations will leverage the growth of the profession by growing the capacity of the profession from within, and also by the lobbying forces outside the profession to further their interests.
• There must be a certification and recertification regulatory board [3] to certify pharmacists who meet the requirements to practice in their specialty areas, and prevent those who do not qualify from practicing.
• The clinical pharmacists should be able to motivate others to advance the practice of pharmacy. They should carry out clinical audits on a regular basis to demonstrate that the practice has improved. A clinical audit [4] is a cyclical process, involving the identification of a process to intervene, setting or adopting already available standards, comparing practice with the standards, implementing changes and monitoring the effect of those changes. Its purpose is to improve the quality of clinical care.
• There must be a standards body to force all healthcare providing institutions to meet certain minimum standards to be allowed to operate. Pharmacy practice can only excel if the pharmacists are well equipped to provide care.
REFERENCES
1. New Statesman, 21 April 1917, article by Sidney Webb and Beatrice Webb quoted with approval at paragraph 123 of a report by the UK Competition Commission, dated 8 November 1977, entitled Architects Services (in Chapter 7).
2. Pharmaceutical Society of Australia: National Competency Standards Framework for Pharmacists in Australia 2010. http://www.psa.org.au/site.php?id=6782
3. Board of Pharmacy Specialties http://www.bpsweb.org/about/vision.cfm
4. Graham Copeland. A Practical Handbook for Clinical Audit. Clinical Audit Support Team, NHS http://www.wales.nhs.uk/sites3/Documents/501/Practical_Clinical_Audit_Handbook_v1_1.pdf
5. Pharmacy and Poisons Act, CAP 244 of the Laws of Kenya
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