Aim To review competency evaluations of pharmacists working with children to determine strengths and weaknesses in practice and identify priority areas for professional development.
Methods Competency evaluations were undertaken using an Australian adaptation of the “General Level Framework” (GLF).1 The format of this tool included 102 individual competency elements grouped under three main domains: “Delivery of Patient Care”, “Problem Solving” and “Professional Competencies”. Pharmacists undertook a self-assessment using ratings of “Rarely”, “Sometimes”, “Usually”, “Consistently” or “Unable to Comment”. An evaluator rated the pharmacist using the same tool and scale during a period of direct observation of approximately 2–3 hours. GLF evaluations with pharmacists working in paediatric hospital wards in Queensland, Australia were retrospectively reviewed. Each competency element was reviewed to identify areas where <80% of pharmacists completed the competency either “Usually” or “Consistently” (excluding “Unable to Comment” responses). Results from specialist paediatric hospitals were compared to regional general hospitals. Fisher's Exact Test was used to assess the strength of association between the variables. This study was approved by the hospital Health Research Ethics Committee and the University of Queensland Ethics Committee.
Results 50 evaluations were identified and reviewed from 2006 to 2011, including 35 from paediatric hospitals and 15 from regional hospitals. Most areas were completed well, with 78 of the 102 competency elements achieving at least 80% of the evaluations “usually” or “consistently” undertaking that competency. 21 elements had 100% result, including important elements such as complying with code of ethics and patient confidentiality, communication and effective teamwork within pharmacy and multidisciplinary teams, and ensuring prescriptions are legible, legal and an appropriate dose.
Gaps were identified with communication with children and their families, particularly patient history taking which included obtaining patient/carer consent (45%), and assessment of patient's understanding of illness and treatment (45%). Other gaps involved documentation issues e.g. pharmacist interventions (45%), medication action plans (37%) and signing for clinical pharmaceutical review (67%). Consideration of non-drug alternatives (24%) and providing lifestyle advice (18%) were undertaken less frequently, however these are less commonly required in the paediatric population.
Comparing regional hospitals with paediatric hospitals, some competency elements were poorer, including knowledge of pathophysiology (45% vs 83%, p=0.02), medication reconciliation on admission (67% vs 97%, p=0.03), communication with patient/carer (63% vs 97%, p=0.02), aspects of patient history taking including assessment of patient's experience (33% vs 80%, p=0.03) and management of medicines (17% vs 73%, p=0.02).
Conclusion Analysis of competency evaluations of hospital pharmacists working with children using a standardised tool for direct observation identified gaps in practice related to communication with children and their families particularly related to patient history taking, and pathophysiology in children. Pharmacists in regional hospitals were particularly in need of support. These gaps have been used to develop face-to-face interactive workshops and online learning modules for pharmacists working in paediatrics.