Written By: Abier Hamami. RPH.CPHQ
IntroductionCompetence Assessment Program
I. Introduction
Competence is a characteristic of a person related to effective or superior performance. The Joint Commission JCAHO defines a competent person as one who has the essential knowledge and skills necessary to perform a job and actually performs the job according to defined expectations. Also the joint commission management of human resources standards requires hospitals to assess employees' competence and qualification initially and then periodically to assure continuing abilities to perform.
Professional competence comprises three elements:
Skills: psychomotor or intellectual problem-solving.
Example: Sterile product preparation and calibration of equipment used in TPN preparation employ psychomotor skills. Determining the need to modify a dose of medication for a renal patient requires intellectual problem-solving.
· Professional socialization. These are the attitudes and values of the profession.
Example: the appropriate relationship with patients and other employees, the acceptance of responsibility, and ethics.
· Judgment is the capacity to successfully apply knowledge and experience to come up with the best clinical decision.
Applying these competence elements into practice, one can define a competent pharmacist as a pharmacist who is able to:
Prepare medications accurately.
Counsel patients and their families about medications effectively.
Understand the unique needs of various patient types and age groups.
Operate equipment properly.
Handle hazardous materials safely.
Minimize opportunities for contamination and transfer of infection.
Respond properly to medical emergencies and disasters.
Monitor drug therapy for inappropriate prescribing, allergies, interactions, and contraindications and, when necessary, act accordingly.
II. Competence Assessment Program
Competence assessment can assure the delivery of appropriate, effective, and safe patient care, therefore; pharmacy directors beside the regular employee performance evaluation or appraisal should design and manage a competence assessment program that can assure initial competence assessment at the hiring time during orientation, and regular then after (e.g., annually or every 2 years) as deemed applicable to the organization, to assure that the employee¢s competence is maintained. Also the program should assure competence assessment whenever a new service, equipment, or procedure is introduced. Assessment results could be tracked and used in directing special educational and developmental programs.
Assessment Methods
The program should include a variety of assessment methods considering their different weaknesses and strengths. In general an effective method must be both valid and reliable. Valid means that it actually measures what is needed to be measured, and reliable that gives the same result if repeated. Also an effective measure should accurately measure the quality of performance, indicate how well the person can perform similar tasks, and reflect what the person will do in general practice.
There are three methods for assessing competence:
Cognitive Written Tests :Include multiple choice, true or false tests.
Strengths are accuracy of measurement, and generalization to similar tasks.
Weaknesses are that these tests can not predict what the person will do in real practice, and they test only understanding of concepts and rules.
Simulations: take the form of a real patient case.
Strength is indication of how a pharmacist would handle similar cases.
Weaknesses are lack of accuracy of measurement, and incomplete cases as real practice.
Direct observation involves evaluating the process (patient counseling) or product (documentation of a care plan or a patient cassette) in real practice against a set of objective criteria.
Strength is reflection of real practice.
Weaknesses are inaccurate measurement, generalization to other practices is poor, and is time and labor consuming.
Combining two or three methods is the optimal way in assessing competence, and this can maximize the strengths and minimize the weaknesses.
Documentation
Competence assessments of employees must be documented at the beginning during orientation, and then regularly after.
Documentation should include:
Name/Job Title/Date
Reason for assessment
Methods of assessment
Outcome or results of assessment
Recommendations based on assessment
Date of re-evaluation.
Documentation of all employees' assessments could be kept in a special, readily available, and confidential file, or each employee assessment could be kept in his personal file. A master record with all required competencies and employees names could help in monitoring and maintaining control of the program.
Competence Assessment Modules
Selection of competence assessment modules depends on the type and scope of services provided by pharmacists, and on the population and demographics of patients served.
Assessment modules could address the following:
Aseptic Technique and infection control.
Patient education and counseling.
Age specific competencies(neonates, pediatrics, geriatrics).
Disease specific competencies(Oncology, Renal, Psychiatric, Cardiac Patients).
Confidentiality and Patient Rights.
Safety and Security.
Hazardous Materials.
Disaster and emergency plan.
Medication Safety and Adverse Drug Reaction.
References:
Competence Assessment Tools for Health-System Pharmacies. Lee B.Murdaugh. 1998
Competency Assessment Tool for Home Care Practitioners.http://www.ashp.org/homecare/competencyassess/directions.cfm Accessed Feb 2006
