Contributions to the literature
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Behavioural specificity within pharmacy professional practice standards has not been previously explored.
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Behaviours in practice standards need to be specified appropriately to ensure that 1) the user can read, understand and action them and 2) it is possible to observe, measure and assess influences on, the said behaviours to improve quality of care.
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The researchers applied the Actor, Action, Context, Target, Time (AACTT) behavioural specification framework to review, for the first time, the specificity of behaviours in the Australian professional practice standards for pharmacists and found that the behaviours are poorly specified.
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Thus, these standards cannot be used in their current form to assess and review the behaviour of pharmacists for professional development or to support behaviour change intervention development.
Background
Methods
Professional practice standards for Australian pharmacists
Familiarisation and identification of behaviours
Data extraction
Deductive codebook development
Criteria* | AACTT Criteria original definition [23] | AACTT Criteria adjusted definition | Allocated codes and definitions | Examples from Professional Practice Standards for Australian Pharmacists |
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ACTION Is an action specified per the review definition? | A discrete observable behaviour that needs to change, in terms that can be observed or measured. | A discrete observable behaviour…in terms that can be observed or measured. | Discrete action: A single self-contained action without consideration to whether there are ancillary actions that may precede or proceed on from that single self-contained action. A non-discrete action may be the result of a series of discrete actions (e.g. the dispensing process or the medicine reconciliation process) though were considered non-discrete if it is stated without further description of the process. The assessment of whether the action is discrete includes an assessment of whether the reader is provided with the full details of the action or expected to bring pre-existing knowledge to interpret the action in a consistent manner. Observable action: Specified as an externally visible manifestation and/or the direct outcome of the action would be a physical object. Non-observable actions are those where there is no external physical sign that an action is performed. Yes - There is an action(s) that is/are discrete and observable in the statement. No - There is no discrete and observable action(s) present in the statement. | Example Yes: ‘Obtains informed consent before delivery of services’ Example No: ‘Supports principles of equity in the delivery of healthcare services’ |
ACTION* Reference to another document or guideline Is there reference to another guideline or document in the action statement? | Additional criterion added by research team. | Yes - One or more guidelines or documents are mentioned in the statement. No - No guidelines or documents are mentioned in the statement. | Example Yes: Understands and upholds relevant codes of ethics and codes of conduct. Example No: ‘Provides a setting for information exchange and service delivery that is appropriate to the patient.’ | |
ACTION* Referenced guideline named and accessible If there is reference to another guideline or document. Is it clear what the document/guideline is and how it can be accessed? | Additional criterion added by research team. | Yes - Guideline or document has been explicitly named and where it can be accessed in the statement. No -The guideline has not been explicitly named and where to access it has not been specified in the document. MIN -The guideline or document has been explicitly named OR how to access it is stated but not both. | Example Yes: ‘Facilitates proactive referral and follow-up, as required. See Appendix 3: Template referral letter.’ Example No: ‘Uses equipment for complex compounding that meets relevant Australian Standards’ Example MIN: ‘This may include: preparation details (refer to ‘Extemporaneous dispensing’ in the current edition of Australian Pharmaceutical Formulary and Handbook)’ | |
ACTOR Is actor(s) specified per the review definition? | The individual or group of individuals who perform (or should/could) the Action. | The individual or group of individuals who perform (or should/could) the Action. | Yes -Explicitly names the person OR persons responsible for performing the action. No - No one is explicitly named to perform the action OR assumptions of responsible person need to made to interpret. | Example Yes: ‘The accredited pharmacist …’ Example No: ‘Self’ or ‘own’ |
CONTEXT Is context specified per the review definition? | The physical location, emotional or social setting in which the Actor performs (or should/ could) the Action. | The physical location, emotional or social setting in which the Actor performs (or should/ could) the Action. | Yes - A location/context for the action has been explicitly named. No -A location/context has not been named OR assumptions need to be made to interpret the context. MIN -A location/context has been named but there could be multiple OR a reference to location/context is made but more information would be needed to interpret OR when nonspecific terms are used to refer to the context that could have multiple meanings and have not been predefined | Example Yes: ‘Records in the dispensing history or patient healthcare plan and on the medicine label when initial brand substitution occurs.’ Example No:’ Undertakes a risk analysis before implementing services.’ Example MIN: ‘service environment’ or ‘workplace’ |
TARGET Is target(s) specified per the review definition? | The individual or group of individuals for/ with/ on behalf of whom the Actor performs the Action. | The individual or group of individuals for/ with/ on behalf of whom the Actor performs the Action. | Yes -An individual or group that the action is with/for AND on behalf of is named. No - No individual or group that the action is with/for AND on behalf of is specified OR assumptions need to be made to interpret who the target is. MIN -When a reference to target is made but more information would be needed to interpret which specific individuals are the target OR one of with/for/behalf of is missing and shouldn’t be. NN - The action doesn’t require a target OR the target is also the actor. | Example Yes: ‘with the patient’ or ‘discusses with the prescriber’ Example No: ‘Communicates the evidence for the use of therapeutic goods clearly and transparently.’ Example MIN: ‘Others’ or ‘staff’ or ‘team’ or ‘healthcare professionals’ (could be more specific eg. Pharmacy assistants or compounding technicians or prescriber, dentist, physiotherapist) Example NN: ‘Self-assess own knowledge and skills’ |
TIME Is time specified per the review definition? | The time period and duration that the Actor performs the Action in the Context with/for the Target. | The time period and duration that the Actor performs the Action in the Context with/for the Target. (For this study the research team will also consider where time is dependent on a set of circumstances if these have been explicitly stated.) | Yes - Time period and duration if relevant and explicitly specified OR if states the situation when the action should occur. No -No time period or duration is specified, OR assumptions were made about them. MIN - When a reference to time is made but more information would be needed to interpret or assumptions would need to be made to interpret OR duration and/or frequency are present but not both. | Example Yes: ‘Before supply of medication’ or ‘all mentoring opportunities’ or ‘when services are provided or refused’ Example No: ‘Stores records safely, securely and in a dedicated location’ Example MIN: ‘Timely’ or ‘regularly’ or ‘maintains’ or ‘as required’ |
Action word | Relevant dictionary definitions from Macquarie Online Dictionary [32] | Interpretation of discrete and observable for review |
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Ensure | 1. To secure, or bring surely, as to a person: this letter will ensure you a hearing. 2. To make sure or certain to come, occur, etc.: measures to ensure the success of an undertaking. 3. To make secure or safe, as from harm. | For all definitions: Not discrete as likely to take multiple successive actions. Not observable as not enough detail to know what the physical outcomes would be or what actions are needed. |
Maintain | 1. To keep in existence or continuance; preserve; retain: to maintain good relations with New Zealand. 2. To keep in due condition, operation, or force; keep unimpaired: to maintain order; maintain public highways. 3. To keep in a specified state, position, etc. 4. To affirm; assert (with a clause, or with an object and infinitive): maintain that it is right; maintain it to be true. | For all definitions: Not discrete and would take multiple successive actions. Some outcomes are possibly observable but adequate description of the action and outcome would be needed. |
Uses | 1. To employ for some purpose; put into service; turn to account: use a knife to cut; use a new method. 2. To avail oneself of; apply to one’s own purposes: use the front room for a conference. 3. To utter (words) or speak (a language). 4. To operate or put into effect. | For all definitions: Possibly discrete but dependent on if there is enough explanation as to ‘how’ to use the object, article etc. If ‘how’ is not clearly detailed then the action would be considered non-discrete. Some outcomes are possibly observable but adequate description of the action and outcome would be needed. |
Refer | 1. To direct the attention or thoughts of: the asterisk refers the reader to a footnote. 2. To direct for information or for anything required: to refer students to books on a subject. 3. (of a medical practitioner) to direct (a patient) to another doctor, usually a specialist, for further consultation or treatment. 4. To have recourse or resort; turn, as for aid or information: to refer to one’s notes. | For definitions 1,2 and 4: Possibly discrete but dependent on if there is enough explanation as to ‘how’ and ‘what’ to refer the object, article etc. If ‘how’ and ‘what’ is not clearly detailed then the action would be considered non-discrete. Some outcomes are possibly observable but adequate description of the action and outcome would be needed. For definition 3: If referring to another health profession then this is likely discrete and observable. |
Identify | 1. To recognise or establish as being a particular person or thing; attest or prove to be as claimed or asserted: to identify handwriting; to identify the bearer of a cheque. 2. To serve as a means of identification for: this card identifies the bearer as a member. | For all definitions: Possibly discrete but dependent on if there is enough explanation as to ‘how’ and ‘what’ to refer the object, article etc. If ‘how’ and ‘what’ is not clearly detailed then the action would be considered non-discrete. Some outcomes are possibly observable but adequate description of the action and outcome would be needed. |
Liaise | 1. To maintain contact and act in concert. | Not discrete as likely to take multiple successive actions. To be discrete would need an explanation of ‘how’ this is being done. Possibly observable but this is dependent on specific outcome or action. |
Monitor | 1. To check, observe, or record the operation of (a machine, etc.), without interfering with the operation. 2. To supervise; observe critically. | For all definitions: Not discrete as likely to take multiple successive actions. To be discrete would need an explanation of ‘how’ this is being done. Possibly observable but this is dependent on specific outcome or action. |
Adhere | 1. To be devoted to; be attached to as a follower or upholder: to adhere to a party; to adhere to a leader; to adhere to a church; to adhere to a creed. 2. To hold closely or firmly to: to adhere to a plan. | For all definitions: Not discrete as likely to take multiple successive actions. To be discrete would need an explanation of ‘how’ this is being done and ‘what’ is being adhered to. Possibly observable but this is dependent on specific outcome or action. |
Implement | 1. To put (a plan, proposal, etc.) into effect | Not discrete as likely to take multiple successive actions. Not observable as not enough detail to know what the physical outcomes would be or what actions are needed. |
Consider | 1. To contemplate mentally; meditate or reflect on. 2. To regard as or deem to be: I consider the examination is justified. 3. To think; suppose. 4. To make allowance for. 5. To pay attention to; regard: he never considers others.to view attentively, or scrutinise. | For all definitions: Most likely not discrete and observable as is an internal thought process, may take multiple actions in succession to achieve and will not necessarily always have a physical outcome. |
Review | 1. To inspect, especially formally or officially. 2. To look back upon; view retrospectively. | For all definitions: Not discrete as likely to take multiple successive actions. To be discrete would need an explanation of ‘how’ this is being done and ‘what’ is being reviewed. Possibly observable but this is dependent on specific outcome or action. |
Appraise | 1. To estimate generally, as to quality, size, weight, etc. 2. To value in current money; estimate the value of. | For all definitions: Not discrete as likely to take multiple successive actions. To be discrete would need an explanation of ‘how’ this is being done and ‘what’ is being appraised. Possibly observable but this is dependent on specific outcome or action. |
Evaluate | 1. To ascertain the value or amount of; appraise carefully. | Not discrete as likely to take multiple successive actions. To be discrete would need an explanation of ‘how’ this is being done and ‘what’ is being evaluated. Possibly observable but this is dependent on specific outcome or action. |
Assess | 1. To fix or determine the amount of (damages, a tax, a fine, etc.). 2. To measure or evaluate. | For all definitions: Not discrete as likely to take multiple successive actions. To be discrete would need an explanation of ‘how’ this is being done and ‘what’ is being assessed. Possibly observable but this is dependent on specific outcome or action. |
Accesses | 1. To gain admittance to: you can access the foyer through this door. | Discrete and observable as is a physical action. |
Encourages | 1. To inspire with courage, spirit, or confidence. 2. To stimulate by assistance, approval, etc. | For all definitions: Not discrete as likely to take multiple successive actions. To be discrete would need an explanation of ‘how’ this is being done. Possibly observable but this is dependent on specific outcome or action. |
Facilitates | 1. To make easier or less difficult; help forward (an action, a process, etc.). 2. To assist the progress of (a person): to facilitate the customer to find the right product. | For all definitions: Not discrete as likely to take multiple successive actions. To be discrete would need an explanation of ‘how’ this is being done. Possibly observable but this is dependent on specific outcome or action. |
Engage | 1. To occupy the attention or efforts of (a person, etc.): she engaged him in conversation. 2. To secure for aid, employment, use, etc.; hire: to engage a worker; to engage a room. 3. To attract and hold fast: to engage the attention; to engage someone’s interest. 4. To reserve or secure. 5. To attract or please: his good nature engages everybody he meets. 6. To bind as by pledge, promise, contract, or oath; make liable. 7. To occupy oneself; become involved: to engage in business; to engage in a strategy. | For all definitions: Not discrete as likely to take multiple successive actions. To be discrete would need an explanation of ‘how’ this is being done. Possibly observable but this is dependent on specific outcome or action. |
Confirm | 1. To make certain or sure; corroborate; verify: this confirmed my suspicions. 2. To make valid or binding by some formal or legal act; sanction; ratify: to confirm an agreement. 3. To reaffirm (a booking, ticket reservation, appointment, etc.) as by a notification to a person or organisation of one’s intention to carry out one’s original plans. 4. To strengthen (a person) in habit, resolution, opinion, etc. | For definitions 2 and 3: Discrete and observable if ‘what’ or ‘who’ and ‘how’ something is being confirmed is named, as likely to have a physical or verbal outcome. For definitions 1 and 4: Not discrete as likely to take multiple successive actions. These may be internal thought processes. To be discrete would need an explanation of ‘how’ this is being done. Possibly observable but this is dependent on specific outcome or action. |
Selects | 1. To choose in preference to another or others; pick out. | Possibly discrete but may involve internal decision-making processes. Likely observable if physically choosing between objects. |
Recommends | 1. To commend by favourable representations; present as worthy of confidence, acceptance, use, etc.: to recommend a book. 2. To represent or urge as advisable or expedient: to recommend caution. 3. To advise (a person, etc., to do something): I recommend you to wait. | Discrete and observable as likely to have a physical or verbal outcome. |
Application of codebook
Data analysis
Results
Number with behaviourally relevant content | Action statements with discrete observable actions | Action statements with more than one discrete observable actions | Action statements that’s ACTION referenced other documents | Action statements that’s reference to other documents explicitly named and said how to access the document | ||
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Standard | No. | Meets criteria No. (%) | No. (%) | No. (%) | Specified No. (%) | Partially specified No. (%) |
Standard 1: Fundamental Pharmacy Practice | 48 | 22 (46%) | 2 (4%) | 8 (17%) | 4 (50%) | 0 |
Standard 2: Leading and Managing Pharmacy Practice | 51 | 16 (31%) | 1(2%) | 11(22%) | 0 | 1 (9%) |
Standard 3: Dispensing and Other Supply Arrangements | 70 | 36 (51%) | 3 (4%) | 14 (20%) | 1 (7%) | 4 (29%) |
Standard 4: Provision of Non-prescription Medicines and Therapeutic Devices | 30 | 16 (53%) | 2 (7%) | 7 (23%) | 0 | 2 (29%) |
Standard 5: Compounding | 75 | 36 (48%) | 10 (13%) | 22 (29%) | 6 (27%) | 5 (23%) |
Standard 6: Medicines Information | 23 | 3 (13%) | 1 (33%) | 0 | 0 | 0 |
Standard 7: Health Promotion and Education | 21 | 6 (29%) | 0 | 1 (5%) | 0 | 0 |
Standard 8: Counselling | 36 | 14 (39%) | 1 (3%) | 4 (11%) | 0 | 0 |
Standard 9: Collaborative Care | 52 | 12 (23%) | 1 (2%) | 7 (13%) | 0 | 0 |
Standard 10: Screening and Risk Assessment | 36 | 10 (28%) | 0 | 10 (28%) | 2 (20%) | 2 (20%) |
Standard 11: Vaccination Service | 65 | 26 (40%) | 1 (2%) | 14 (22%) | 0 | 4 (29%) |
Standard 12: Minor Ailments Service | 39 | 13 (33%) | 0 | 9 (23%) | 1 (11%) | 1 (11%) |
Standard 13: Disease State Management | 47 | 16 (34%) | 1 (2%) | 10 (21%) | 2 (20%) | 3 (30%) |
Standard 14: Medication Review | 52 | 31 (60%) | 3 (6%) | 10 (19%) | 1 (10%) | 0 |
Standard 15: Dose Administration Aid Service | 73 | 21 (29%) | 0 | 10 (14%) | 2 (20% | 1 (10%) |
Standard 16: Harm Minimisation | 50 | 22 (44%) | 0 | 11 (22%) | 1 (9%) | 2 (18%) |
Total | 768 | 300 (39%) | 26 (3%) | 148 (19%) | 20 (14%)a | 25 (17%)a |
Actions with behaviourally relevant content | ACTOR(s) was specified | CONTEXT was specified | TARGET(s) was specified | TIME was specified | |||||
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Standard | No. | Meets criteria No. (%) | Meets criteria No. (%) | Partially meets criteria No. (%) | Meets criteria No. (%) | Partially meets criteria No. (%) | Not necessary No. (%) | Meets criteria No. (%) | Partially meets criteria No. (%) |
Standard 1: Fundamental Pharmacy Practice | 48 | 0 | 0 | 5 (10%) | 14 (29%) | 23 (48%) | 1 (2%) | 8 (17%) | 6 (13%) |
Standard 2: Leading and Managing Pharmacy Practice | 51 | 0 | 0 | 6 (12%) | 2 (4%) | 28 (55%) | 7 (14%) | 2 (4%) | 7 (14%) |
Standard 3: Dispensing and Other Supply Arrangements | 70 | 0 | 5 (7%) | 2 (3%) | 17 (24%) | 28 (40%) | 2 (3%) | 12 (17%) | 9 (13%) |
Standard 4: Provision of Non-prescription Medicines and Therapeutic Devices | 30 | 0 | 1 (3%) | 0 | 8 (27%) | 11 (37%) | 2 (7%) | 7 (23%) | 4 (13%) |
Standard 5: Compounding | 75 | 0 | 3 (4%) | 8 (11%) | 4 (5%) | 14 (19%) | 5 (7%) | 14 (19%) | 20 (27%) |
Standard 6: Medicines Information | 23 | 0 | 0 | 1 (4%) | 6 (26%) | 13 (57%) | 1 (4%) | 2 (9%) | 3 (13%) |
Standard 7: Health Promotion and Education | 21 | 0 | 1 (5%) | 0 | 1 (5%) | 14 (67%) | 1 (5%) | 2 (10%) | 1 (5%) |
Standard 8: Counselling | 36 | 0 | 2 (6%) | 0 | 11 (31%) | 10 (28%) | 0 | 3 (8%) | 3 (8%) |
Standard 9: Collaborative Care | 52 | 0 | 0 | 2 (4%) | 2 (4%) | 31(60%) | 2 (4%) | 1 (2%) | 4 (8%) |
Standard 10: Screening and Risk Assessment | 36 | 0 | 1 (3%) | 0 | 7 (19%) | 8 (22%) | 4 (11%) | 3 (8%) | 7 (19%) |
Standard 11: Vaccination Service | 65 | 0 | 0 | 4 (6%) | 12 (18%) | 29 (45%) | 2 (3%) | 8 (12%) | 12 (18%) |
Standard 12: Minor Ailments Service | 39 | 0 | 0 | 2 (5%) | 6 (15%) | 13 (33%) | 0 | 3 (8%) | 6 (15%) |
Standard 13: Disease State Management | 47 | 0 | 0 | 1 (2%) | 10 (21%) | 19 (40%) | 4 (9%) | 2 (4%) | 5 (11%) |
Standard 14: Medication Review | 52 | 0 | 1 (2%) | 3 (6%) | 11 (21%) | 25 (48%) | 0 | 4 (8%) | 7 (13%) |
Standard 15: Dose Administration Aid Service | 73 | 0 | 8 (11%) | 0 | 10 (14%) | 22 (30%) | 3 (4%) | 12 (16%) | 16 (22%) |
Standard 16: Harm Minimisation | 50 | 0 | 3 (6%) | 1 (2%) | 10 (20%) | 15 (30%) | 2 (4%) | 6 (12%) | 9 (18%) |
Total | 768 | 0 | 25 (3%) | 35 (5%) | 131(17%) | 303 (39%) | 36 (5%) | 88 (11%) | 120 (16%) |
Example number and problem type | Example action statement verbatim from the standards (4)(relevant section bolded) | Problem explained | Example of possible specification adjustment for the problem (relevant section bolded) a | Other issues with this criteria | Example of possible specification for entire action statement per AACTT (adjusted sections bolded) a | |
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1. | Not a discrete or observable action | 3.8.8 Creates awareness about the availability and appropriateness of brand substitution, and the contribution it makes to the sustainable use of health resources. | Creating awareness is difficult to observe and would likely require numerous discrete actions. This term needs to be replaced with something that is discrete and observable e.g. Educates. | Educates on the availability and appropriateness of brand substitution, and the contribution it makes to the sustainable use of health resources. | Actor, context, target and time are all not specified. Assume actor is pharmacist, patient is target, context is in the pharmacy and time could be when they are dispensing medicines for them. | The pharmacist educates patients presenting to the pharmacy on the availability and appropriateness of brand substitution, and the contribution it makes to the sustainable use of health resources when the patient presents for a medication. |
2. | Not an observable action | 3.8.7 Ensures that any substitution is directly, clearly and appropriately discussed and/or demonstrated with the patient in the counselling process. | We can’t observe someone ensuring something. We can observe them discussing substitution with the patient. Suggest remove ‘ensures’ and focus on discussing as the action. | Discusses and/or demonstrates substitution directly, clearly and appropriately with the patient in the counselling process. | Actor and context are not specified, assume pharmacist and in the pharmacy (doesn’t necessarily have to be though). Time is during the counselling process but how often should this occur, assume always when substitution has been made. Should name what is being substituted e.g. medication. | The dispensing pharmacist discusses and/or demonstrates medication substitution directly, clearly and appropriately with the patient in the counselling process whenever brand substitution is made. |
3. | How the action should be performed needs clarification | 15.7.5 Maintains accurate and clear records of all medications packed into DAAs (e.g. date, quantity, instances where brand substitution occurred, packed by [signature], checked by [signature]). | What is required to maintain these clear records? Assume need to document each of those things into a record every time they are packed into a DAA for a patient. | Documents (in an ongoing record) all medications packed into DAAs (e.g. date, quantity, instances where brand substitution occurred, packed by [signature], checked by [signature]). | Actor is not specified, assume pharmacist. Target and time are not specified, assume patient and every time it is packed. | The pharmacist documents (in an ongoing record) all medications packed into the DAA for the patient, every time (e.g. date, quantity, instances where brand substitution occurred, packed by [signature], checked by [signature]). |
4. | Nonspecific language used, how to perform action not specified | 14.8.2 Confirms that the patient, or carer or authorised representative, understands the process, requirements, benefits and limitations of the service. | How should they confirm this, could specify verbally? The service could also be further specified, in this standard it is talking about medicine review services. | Verbally confirms that the patient, or carer or authorised representative, understands the process, requirements, benefits and limitations of the medicines review service. | Actor, context and time are missing. Assume accredited pharmacist is the actor, context would be specific to the type of medicines review and this should all be confirmed prior to initiating the service. | The accredited pharmacist verbally confirms that the patient, or carer or authorised representative, understands the process, requirements, benefits and limitations of the medicines review service prior to conducting the medicine review. |
5. | Reference to document with necessary information missing | 14.3.1 Ensures that all medication review services are consistent with relevant clinical guidelines and comply with program guidelines. | Reference to clinical and program guidelines, but not specified exactly what they are or where they can be found. Suggest naming the relevant documents and supplying a link to where they can be found. | Ensures that all medication review services are consistent with relevant clinical guidelines and comply with program guidelines for medicine review services. These guidelines can be accessed at www.findthedocumenthere.com | Ensures isn’t discrete or observable, suggest changing to provides all medication review services that are… Actor isn’t specified, should be an accredited pharmacist. Target isn’t specified but assume is a patient. Context isn’t specified but would be dependent on the type of service being provided. | The accredited pharmacist always provides medication review services to patients that are consistent with relevant clinical guidelines and comply with program guidelines for medicine review services. These guidelines can be accessed at www.findthedocumenthere.com |
6. | Actor not specified | 2.3.2 Works with a mentor for peer review of practice or to assist in meeting professional development goals. | Who works with a mentor? The actor is not specified. | All pharmacists should work with a mentor for peer review of practice or to assist in meeting professional development goals. | Action is ‘works’ and ‘peer review of practice’ could both be further specified. Context and Time are also not specified at all. | All pharmacists should meet with a mentor in their own workplace, at least once a year so that the mentor can peer review their daily practice or assist the pharmacist to meet their professional development goals. |
7. | Assuming actor is a pharmacist but which pharmacist | 11.3.5 Confirms that the authorised immuniser has professional indemnity insurance and that the delivery site has insurance policies appropriate for the delivery of a vaccination service. | Whose job is it to do this? Is it the pharmacy owner, the pharmacist manager, the pharmacist on duty or someone else? | The pharmacy owner confirms that the authorised immuniser has professional indemnity insurance and that the delivery site has insurance policies appropriate for the delivery of a vaccination service. | Time is not specified at all. Context is delivery site but could be further specified. Confirms could also be further specified- how should they confirm? For example, verbally, via citation of appropriate documentation. | Before providing an immunisation service from the pharmacy the pharmacy owner confirms through citation of appropriate documentation that the authorised immuniser has professional indemnity insurance and that the delivery site has insurance policies appropriate for the delivery of a vaccination service. |
8. | No context specified but action may be in a fixed location | 16.6.9 Adapts workflow to facilitate the delivery of harm minimisation services. | Workflow and the delivery of the harm minimisation service where? | Adapts workflow of the dispensary and front of shop to facilitate the delivery of harm minimisation services in the community pharmacy. | Adapting is not a discrete behaviour as it would require multiple actions to achieve or would depend on need. Target is not specified and, in this case, could be for the patient and with the pharmacy owner and staff. Time is not specified, but likely should be prior to providing the service. Actor is also not specified and could be the pharmacy owner, manager, and/or dispensing pharmacist. | Prior to providing harm minimisation services to patients, the dispensing pharmacist and pharmacy assistants adapts the workflow of the dispensary and front of shop to facilitate the delivery of harm minimisation services in the community pharmacy. |
9. | Non-specific reference to a physical location/context | 12.11.4 Regularly assesses the suitability of the surfaces, furnishings and equipment in the service environment, and responds appropriately. | Service environment is non-specific? Standard 12 refers to Disease State Management services that would like to occur in a community pharmacy and preferably in a private consultation room within that pharmacy. | Regularly assesses the suitability of the surfaces, furnishings and equipment in the consultation room where disease state management services are provided and responds appropriately. OR Regularly assesses the suitability of the surfaces, furnishings and equipment in the consultation room of the pharmacy and responds appropriately. | Assess and responds appropriately are not necessarily observable or discrete as actions. Actor is missing, assume it should be pharmacist. Target is not specified, assume this is done for the patient. Time is specified as, regularly but this is not specific and could be further specified eg. Weekly or prior to providing the service. | Prior to providing a service the pharmacist assesses the suitability of the surfaces, furnishings and equipment in the consultation room where disease state management services are provided to patients… |
10. | Non-specific term used for the target | 5.11.3 Educates other health professionals about appropriate preparation and administration of complex compounded preparations. | The target is health professionals, but this is a non-specific term and could be further specified as to who is most likely to need education on preparation and administration. This would most likely be nurses as they usually administer medications. | Educates nurses responsible for administration about appropriate preparation and administration of complex compounded preparations. | Actor is missing, assume pharmacists. Action is educating, could be further specified how they should educate. Context and time are also not specified, but context may not matter for education and time could be as requested or prior to them administering. | The pharmacist educates nurses responsible for administration of medications about appropriate preparation and administration of complex compounded preparations, when requested by the nurses to do so. |
11. | Missing information for target | 8.7.1 Checks the dispensing history and/or electronic healthcare record to determine the appropriateness of information being sought and provided. | Does not specify who is seeking the information and who it is being provided to. Assume target is a patient. | Checks the dispensing history and/or electronic healthcare record to determine the appropriateness of information being sought by and provided to a patient. | Actor is not specified, assume pharmacist. Action words are checks and determines, not necessarily observable and discrete. Context is not specified, assume in a pharmacy. Time is not specified assume, when it is requested. | Upon request, the pharmacist will check the dispensing history and/or electronic healthcare record of a patient presenting in a pharmacy, to determine the appropriateness of information being sought by and provided to them. |
12. | Assumption of when to do action is needed | 4.8.2 Provides advice to optimise use of non-prescription medicines and therapeutic devices. | It is not specified when this should be done. Assume this should be done every time either of these products is supplied or it is requested by the patient. | When asked by the patient provides advice to optimise use of non-prescription medicines and therapeutic devices. OR Provides advice to optimise use of non-prescription medicines and therapeutic devices every time one of these products is supplied. | Actor is not specified, assume pharmacist. Context is not specified, assume within the pharmacy or wherever selling/recommending these products. Target is not specified, assume a patient. | When asked by a patient the pharmacist provides advice to optimise use of non-prescription medicines and therapeutic devices sold in the pharmacy or elsewhere. |
13. | Non-specific language used for time | 5.5.6 Regularly conducts and documents environmental monitoring of the cleanroom and ancillary areas, and initiates corrective action, as required. | Nonspecific terms ‘regularly’ and ‘as required’ have been used to indicate when the action should be completed. These could be further specified by stating a length of time instead of regularly and a specified circumstance instead of as required. | Conducts and documents environmental monitoring of the cleanroom and ancillary areas every day, and initiates corrective action, when results differ from normal range. | Actor is not specified and, in this case, could be a pharmacist or assistant assigned by the pharmacist. Action words conducts, documents and initiates corrective action could possibly be further specified (e.g. how should it be conducted, what is corrective action). Context is specified as clean room and ancillary areas, but no context for where it should be documented has been provided. Target is not specified but this would depend if the pharmacist or an assistant was completing the action. | The pharmacist conducts and documents environmental monitoring of the cleanroom and ancillary areas in the monitoring log every day, and initiates corrective action, when results differ from normal range. |