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CLEAR 2008 Annual Conference Anchorage, Alaska “Approaches to Continuing Competency – Challenges and Opportunities” Danielle Fagnan, Quebec Order of Pharmacists.

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Presentation on theme: "CLEAR 2008 Annual Conference Anchorage, Alaska “Approaches to Continuing Competency – Challenges and Opportunities” Danielle Fagnan, Quebec Order of Pharmacists."— Presentation transcript:

1 CLEAR 2008 Annual Conference Anchorage, Alaska “Approaches to Continuing Competency – Challenges and Opportunities” Danielle Fagnan, Quebec Order of Pharmacists Ashifa Keshavji, College of Pharmacists of British Columbia Sandra Winkelbauer, Ontario College of Pharmacists Moderator: Della Croteau, Ontario College of Pharmacists

2 CLEAR 2008 Annual Conference Anchorage, Alaska Why Continuing Competency? public expectations increased accountability competency throughout practice governments now legislating

3 CLEAR 2008 Annual Conference Anchorage, Alaska Three Different Approaches Description Outcomes and Challenges Future Directions How does this compare to your program?

4 CLEAR 2008 Annual Conference Anchorage, Alaska College of Pharmacists of British Columbia Ashifa Keshavji

5 CLEAR 2008 Annual Conference Anchorage, Alaska Objective To provide an overview of the College of Pharmacists of BC’s quality assurance program – the Professional Development and Assessment Program (PDAP) To share the challenges faced

6 CLEAR 2008 Annual Conference Anchorage, Alaska Professional and Legal Mandates Code of Ethics PDAP FPP Legisl a- tion

7 CLEAR 2008 Annual Conference Anchorage, Alaska Program Purpose To support the college’s mission to ensure pharmacists provide safe and effective pharmacy care to help people achieve better health To promote continuous learning and professional development

8 CLEAR 2008 Annual Conference Anchorage, Alaska Program Philosophy & Principles Uses the Framework of Professional Practice as the foundation Focus should be on professional development Program must build on what pharmacists already do in their practices Built-in opportunity for reflection and self-assessment Pharmacists must have an opportunity to demonstrate their public accountability (essential to self-regulation) Fair and valid assessments support the legislated mandate of the profession Evaluate the program on a regular and on-going basis

9 CLEAR 2008 Annual Conference Anchorage, Alaska The Framework of Professional Practice (FPP) A comprehensive description of the work pharmacists do Based on the outcome of an occupational analysis, beginning with defining the purpose of the profession Validated by registrants Serves as BC’s standards of practice Foundation for PDAP and all other college programs and services – including site visits/inspections

10 CLEAR 2008 Annual Conference Anchorage, Alaska Professional Development and Assessment Program (PDAP): Structure and timelines Six-year cycle –One-half the membership participates every 3 years –The entire membership participates over a 6-year period First cycle - September 2003 Second cycle - September 2006 Each cycle consists of three phases

11 CLEAR 2008 Annual Conference Anchorage, Alaska PDAP: Phase 1 (September 2003-February 2005) Professional development and preliminary assessment Complete a Self-Assessment Select one of two options: –Knowledge Assessment –Learning and Practice Portfolio

12 CLEAR 2008 Annual Conference Anchorage, Alaska PDAP: Phase 2 (September 2005 – August 2006) Professional development and secondary assessment Complete a self-assessment Select one of four options: –Knowledge Assessment –Learn ing and Practice Portfolio –Practice Audit –Objective Structured Clinical Examination (OSCE)

13 CLEAR 2008 Annual Conference Anchorage, Alaska PDAP: Phase 3 (Began September 2006) Individualized remediation and reassessment Peer Practice Committee and college staff review assessment results Work with participant to develop an individualized remediation plan and define re-assessment requirements

14 CLEAR 2008 Annual Conference Anchorage, Alaska Self-Assessment Based on the Framework of Professional Practice Compare one’s own standard of practice to those reflected in the FPP Identify strengths and limitations and map out a professional development plan

15 CLEAR 2008 Annual Conference Anchorage, Alaska The Knowledge Assessment… Linked to the Framework of Professional Practice Standardized MCQ exam –2&1/2 hours, 65 questions, open book Covers clinical decision making and ethical issues in therapeutics, pharmacology and pharmaceutics Scoring is criterion referenced Feedback received: –Standards met/standards not met –Domain and disease states answered correctly or incorrectly

16 CLEAR 2008 Annual Conference Anchorage, Alaska Learning and Practice Portfolio… Linked to the Framework of Professional Practice Individualized to reflect one’s needs, PD preferences and practice priorities A compilation of how one has planned, implemented and evaluated their learning and practice achievements Feedback received: –Standards met/standards not met –Based on the published criteria –Individualized based on content and nature of the learning and practice achievements

17 CLEAR 2008 Annual Conference Anchorage, Alaska Practice Audit On-site process where a trained peer auditor observes performance based on FPP Includes follow-up interview, if required Feedback includes: –Standards met/standards not met –Individualized report and overall summary of performance by FPP Role, on areas of strength and those needing improvement

18 CLEAR 2008 Annual Conference Anchorage, Alaska OSCE Practical examination that assesses communication, problem-solving skills and overall performance Series of 7-minute simulated tasks commonly encountered in practice Feedback includes: –Standards met/standards not met –Individual average score in communication, outcome and overall performance –Overall score in competency areas –Comparison to group average

19 CLEAR 2008 Annual Conference Anchorage, Alaska Phase 1, Phase 2 Participants 104 (87%)82 (48%)1258 (91%) Total 15 (80%)- OSCE - PA 2 (100%)198 (90%) LPP 60 (83%)56 (36%)1060 (91%) KA VolunteerPhase 2Phase 1Tool Program Evaluation Total 1 (0%)- OSCE 27 (96%)10 (60%)- PA 2 (100%)15 (80%) LPP KA VolunteerPhase 2Phase 1Tool Program Evaluation

20 CLEAR 2008 Annual Conference Anchorage, Alaska Challenges Emphasize each tool follows the CPD cycle Encourage participants to engage in an on-going PD cycle Confirm the validity of the assessment tools in meeting the program purpose Explore the motivational factors by which assessment tools are selected Keep communicating with and engaging registrants

21 CLEAR 2008 Annual Conference Anchorage, Alaska Ontario College of Pharmacists Sandra Winkelbauer

22 CLEAR 2008 Annual Conference Anchorage, Alaska OCP Program Description Quality Assurance Continuing Competency Department Pharmacy Practice Department 1. Learning Portfolio 4. Pharmacy Inspections 2. Self-Assessment 3. Peer Review and Remediation

23 CLEAR 2008 Annual Conference Anchorage, Alaska OCP Program Description A Quality Assurance program is mandated for all regulated health professions in Ontario Based on Standards of Practice Two-part Register –Part A – patient care –Part B – no patient care

24 CLEAR 2008 Annual Conference Anchorage, Alaska Learning Portfolio All Ontario pharmacists, Part A and Part B, required to maintain a learning portfolio On-line tool available Tool helps to plan and document CE activities Non-traditional learning activities are recognized Submitted upon request

25 CLEAR 2008 Annual Conference Anchorage, Alaska Self-Assessment Tool 20 % of Part A pharmacists each year (100 % of Part A pharmacists over 5 years) On-line tool Tool helps to identify learning needs and plan learning Includes clinical knowledge assessment Information is confidential

26 CLEAR 2008 Annual Conference Anchorage, Alaska Peer Review ~ 2.3 % of Part A pharmacists each year Randomly selected Also for movement from Part B to Part A Consists of: –clinical knowledge assessment –standardized patient interviews –learning portfolio sharing session

27 CLEAR 2008 Annual Conference Anchorage, Alaska Peer Review Components assessed: –Clinical knowledge –Gathering information –Patient management and follow-up –Communication skills

28 CLEAR 2008 Annual Conference Anchorage, Alaska Peer Review - Validity Clinical knowledge assessment cases –3 different committees of practicing pharmacists write, review and set standards for each case Standardized patient scenarios –3 different committees of practicing pharmacists write, review and set standards for each scenario

29 CLEAR 2008 Annual Conference Anchorage, Alaska Peer Review - Remediation Professional Development Advisor Peer Support Group Professional Development Workshop

30 CLEAR 2008 Annual Conference Anchorage, Alaska Outcomes Quality Assurance program has been in place for 11 years 10 year review conducted last year

31 CLEAR 2008 Annual Conference Anchorage, Alaska Outcomes – Place of Graduation

32 CLEAR 2008 Annual Conference Anchorage, Alaska Outcomes – Place of Practice

33 CLEAR 2008 Annual Conference Anchorage, Alaska Outcomes - Results

34 CLEAR 2008 Annual Conference Anchorage, Alaska Outcomes – Years since Graduation

35 CLEAR 2008 Annual Conference Anchorage, Alaska Outcomes – Place of Graduation

36 CLEAR 2008 Annual Conference Anchorage, Alaska Challenges Resistance from members Not assessing actual practice Defining the number of pharmacists that should ideally undergo peer review Cost Difficult remediation cases Need to create QA program for pharmacy technicians

37 CLEAR 2008 Annual Conference Anchorage, Alaska Future Directions Evaluation and enhancement of the on- line Self-Assessment and Learning Portfolio Evaluation of Peer Review process addressing: –Affect of changing scope of practice –Numbers chosen for quality assurance –Effectiveness versus other processes QA program for pharmacy technicians

38 CLEAR 2008 Annual Conference Anchorage, Alaska Speaker Contact Information Sandra Winkelbauer Manager, Continuing Competency Ontario College of Pharmacists (insert OCP logo)

39 CLEAR 2008 Annual Conference Anchorage, Alaska Quebec Order of Pharmacists Danielle Fagnan

40 CLEAR 2008 Annual Conference Anchorage, Alaska Mandatory statute of professional inspection in Quebec Supervise professional practice Inquire into the professional competence of any member of the Order

41 CLEAR 2008 Annual Conference Anchorage, Alaska Pharmacy in Quebec 7262 members (62,9% F – 37,1% M) 1669 community pharmacies (1690 owned, 3354 pharmacists) 128 health care facilities (1316 pharmacists) 158 pharmacists (replacement) 744 pharmacists (others) 4 inspectors for community pharmacies 2 inspectors for health care communities

42 CLEAR 2008 Annual Conference Anchorage, Alaska Professional inspection in Quebec General assessment of practice sites and of pharmacists if needed Evaluation according to specific indicators based on a minimum standard of quality practice Self-assessment/pre-inspection questionnaire filled by each pharmacist

43 CLEAR 2008 Annual Conference Anchorage, Alaska Evaluation in community pharmacies Professional practice (technical aspect) –Staff –Workload –Work organization –Hygiene –Equipment

44 CLEAR 2008 Annual Conference Anchorage, Alaska Evaluation in community pharmacies Respect of laws and regulations –Standards of practice –Labeling –Outdated products –Confidentiality –Ethics, etc.

45 CLEAR 2008 Annual Conference Anchorage, Alaska Evaluation in community pharmacies Evaluation of Clinical aspect Assessment based on clinical indicators reflecting minimum standards of patient’s quality of care and pharmaceutical services (indicators related to antibiotic therapy, asthma, hormonal contraception, depression, diabetes, dyslipidemia, hypertension, hormonal replacement, insomnia, inflammatory diseases and palliative care) Data collection from 25 patients’ chart

46 CLEAR 2008 Annual Conference Anchorage, Alaska Evaluation in community pharmacies Self-assessment On site assessment (data collection, observation, coaching and recommendations) Evaluation report presented to our professional inspection committee Discussion on general recommendations and official agreement on identified problems requiring more aggressive interventions such as follow up with written engagement from the owner, control inspection or information to Syndic

47 CLEAR 2008 Annual Conference Anchorage, Alaska Evaluation in health care facilities Policies and procedures Medication distribution and control Sterile products and chemotherapy preparation Services and clinical programs Medication and clinical studies Human and material resources Quality control

48 CLEAR 2008 Annual Conference Anchorage, Alaska Evaluation in health care facilities Clinical evaluation according to specific indicators of quality practice based on a level II of pharmaceutical care (selective monitoring of pharmacotherapy) –> 65 y. o –>7 drugs –Narrow therapeutic index –Major interactions –Duplication –Pertinence and clarity of communications with other health care professionals

49 CLEAR 2008 Annual Conference Anchorage, Alaska Assessment of individual competency Request from Committee of discipline, Executive Committee/Bureau, Professional inspection Committee Following a professional inspection Thoroughly regulated process Decisions with important consequences Validity and reliability of tools SOI (structured oral interview) used as a diagnostic tool Individualized pedagogic prescription and remedial (course, training, limitation of practice)

50 CLEAR 2008 Annual Conference Anchorage, Alaska Challenges 5-year cycle for inspection More general inspection of sites and less pharmacists’ individual assessment Evaluation according to specific minimum standards of quality practice Regular updates of our standards of practice, practice guides, publications of professional information and clinical cases for SOI

51 CLEAR 2008 Annual Conference Anchorage, Alaska Challenges Urgent need to rethink our processes and develop a strategic plan

52 CLEAR 2008 Annual Conference Anchorage, Alaska Future Use benchmarks/best practices/pilot projects to set up and update standards of practice (pro activity and improvement of practice) Be able to target practice sites and individual pharmacists with problems (efficacy and efficiency) Develop different mechanisms to be able to evaluate our membership in order to sustain a 5-year cycle Link with self-assessment, CPD and prevention activities Develop strategies to address overall performance and the relative influence of these determinants

53 CLEAR 2008 Annual Conference Anchorage, Alaska Speaker Contact Information Danielle Fagnan Director of professional services Quebec Order of pharmacists

54 CLEAR 2008 Annual Conference Anchorage, Alaska QUESTIONS?

55 CLEAR 2008 Annual Conference Anchorage, Alaska Does anyone have any suggestions for improvement of these programs?

56 CLEAR 2008 Annual Conference Anchorage, Alaska Do you think public safety is protected by such a program?

57 CLEAR 2008 Annual Conference Anchorage, Alaska What are similar issues in your profession, and how have you approached quality assurance?


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