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Lee Et Al-2017-Pharmacotherapy FINAL
Lee Et Al-2017-Pharmacotherapy FINAL
ACCP is committed to ensuring that clinical pharmacists possess the competencies necessary to deliver
comprehensive medication management in team-based, direct patient care environments. These compe-
tencies are divided into six essential domains: direct patient care, pharmacotherapy knowledge, sys-
tems-based care and population health, communication, professionalism, and continuing professional
development. The 2016 ACCP Clinical Practice Affairs Committee has developed an evaluation tool
that includes the assessable tasks of today’s clinical pharmacists that fall within each domain. This
instrument can be used by institutions, organizations, and others responsible for clinical pharmacist
performance evaluation and professional development.
KEY WORDS clinical pharmacy, evaluation tool, template, pharmacotherapy specialist, essential tasks.
(Pharmacotherapy 2017;37(5):e21--e29) doi: 10.1002/phar.1927
In August 2015, the American College of the essential tasks of today’s clinical pharmacists
Clinical Pharmacy (ACCP) Clinical Practice and that could be used by employers or supervi-
Affairs Committee was charged with updating sors for performance assessment.
the “Template for the Evaluation of a Clinical The original “Template for the Evaluation of a
Pharmacist.” The updated template was to Clinical Pharmacist,” published in 1993, was
consider today’s broader spectrum of clinical based on the ACCP practice guidelines for phar-
pharmacist practice, relevant standards and guide- macotherapy specialists, the drug use process,
lines, and work of the 2016 ACCP Certification and an American Society of Health-System Phar-
Affairs Committee, which had been charged macists (ASHP) paper on clinical practice in
simultaneously to update the 2008 ACCP paper pharmacy.1 Feedback from users suggested that
on clinical pharmacist competencies. Thus, the data from completed templates could be used to
goal of the 2016 ACCP Clinical Practice Affairs justify additional clinical pharmacy services,
Committee was to prepare a tool that included standardize services offered by clinical pharma-
cists, and replace several evaluation instruments
used in hospital pharmacy departments world-
This document was written by the 2016 ACCP Clinical
Practice Affairs Committee: Mary Lee, Pharm.D., FCCP, wide. However, because the template was over 2
BCPS (Chair); Melissa E. Badowski, Pharm.D., BCPS, decades old, it required updating.
AAHIVP (Vice Chair); Nicole M. Acquisto, Pharm.D.; Dou-
glas F. Covey, Pharm.D., MHA, FCCP, CDE; Brian D. Fox,
Pharm.D., BCPS; Sarah M. Gaffney, Pharm.D., BCPS; Stuart Process
T. Haines, Pharm.D., FCCP; Michelle L. Hilaire, Pharm.D., The 2016 ACCP Clinical Practice Affairs Com-
FCCP, BCPS, BCACP; Alexandre Raymond, Pharm.D.; Mar-
issa C. Salvo, Pharm.D., BCACP; and Kyle Turner, mittee reviewed the published literature related
Pharm.D. to clinical pharmacist practice. The committee
Approved by the American College of Clinical Pharmacy also assessed the websites of ACCP, the Ameri-
Board of Regents on July 18, 2016. can Association of Colleges of Pharmacy, the
Address reprint requests to the American College of Accreditation Council for Pharmacy Education,
Clinical Pharmacy, 13000 W. 87th St. Parkway, Suite 100,
Lenexa, KS 66215; e-mail: accp@accp.com; or download ASHP, the Board of Pharmacy Specialties (BPS),
from www.accp.com. and other nonpharmacy professional practice
Ó 2017 Pharmacotherapy Publications, Inc. organizations (e.g., Accreditation Council for
e22 PHARMACOTHERAPY Volume 37, Number 5, 2017
Graduate Medical Education [ACGME]) for rele- quality health care. The resulting six domains
vant guidelines, policy statements, and white are consistent with the core clinical pharmacist
papers. Moreover, the committee evaluated other competencies articulated by the ACCP Certifica-
health professional websites to identify current tion Affairs Committee: direct patient care, phar-
literature on the roles, responsibilities, and macotherapy knowledge, systems-based care and
expected competencies of clinical pharmacists. population health, communication, professional-
In addition, committee members provided sam- ism, and continuing professional development.5
ple evaluation forms used by their institutions or The committee then worked in two teams to
other large health care systems to evaluate clini- identify data that could be used to evaluate a
cal pharmacists. clinical pharmacist’s performance in each com-
After reviewing the literature and other infor- petency domain and define the potential criteria
mation collected, the committee decided to use for success. After receiving the Board of Regents’
the BPS Pharmacotherapy Specialist Certification comments on the draft template, the committee
Content Outline,2 which is employed in the test- clarified, condensed, and simplified the final ver-
ing and credentialing of Board Certified Pharma- sion of the template.
cotherapy Specialists, as the basis for an initial
skeleton outline to identify the essential tasks of
Guide for Using the Template
a contemporary pharmacotherapy specialist. The
BPS Pharmacotherapy Specialist Certification The template serves as a tool to measure, eval-
Content Outline identifies three domains, or uate, and document a clinical pharmacist’s per-
major responsibilities, and 17 tasks or activities. formance in any practice setting (Table 1). The
Although the committee considered the subspe- tool highlights the six core competency domains
cialty criteria for other BPS specialties, it focused that should be part of every clinical pharmacist’s
on the content outline for pharmacotherapy spe- job description: direct patient care, pharma-
cialists, which encompasses the principle of cotherapy knowledge, systems-based care and
ensuring “the safe, appropriate and economical population health, communication, professional-
use of medications as part of interprofessional ism, and continuing professional development.5
treatment teams in a variety of settings . . . to For each domain, the committee has listed sev-
optimize medication use, improve patient out- eral tasks. For each task, committee members
comes, and serve as an objective, evidence-based have suggested examples of performance mea-
source for therapeutic information and recom- sures, including observations or reviews of clini-
mendations.”3 cal decisions or documentation based on
The committee then modified items in the encounters with patients, caregivers, families,
BPS outline, adding or deleting tasks and replac- laypersons, or other health professionals. For
ing them with more descriptive items gathered some tasks, a wide variety of assessments can be
from committee members’ reviews of published used to evaluate performance.
literature, websites, or existing evaluation tools. Those responsible for evaluating clinical phar-
The committee completed a multistep, iterative macists are encouraged to modify the template
review process to consolidate items so that the and choose the type of assessment that best fits
template had a manageable number of criteria their institution and department. Clinical phar-
for assessment and would be practical and not macists may be evaluated by their supervisor,
excessively time-consuming for a supervisor to their peers, or other members of the health care
complete. Committee members preferentially team (e.g., physicians). Depending on the insti-
included items that could be assessed objectively tution, the clinical pharmacist’s peers may be
or measured. Finally, to be consistent with the appointed to a best practices, continuous quality
recommendations of the Board of Regents and improvement, or peer review committee.19 The
the 2016 ACCP Certification Affairs Committee, committee recognizes that each institution or
which was updating the ACCP guideline on clin- organization will set its own criteria for success
ical pharmacist competencies, the committee according to the clinical pharmacist’s experience
aligned the core domains of the template with level, how long he or she has practiced within
the six general competency domains of the the department, and other factors. For this rea-
ACGME Outcome Project.4, 5 Committee mem- son, the column labeled “Criteria to Define Suc-
bers deemed this appropriate, given that the cess” should be completed by a direct
overarching task domains of both pharmacother- supervisor. Finally, cut-points, as well as actions
apy specialists and physicians are to provide to take if the clinical pharmacist fails to meet
TEMPLATE FOR EVALUATING A CLINICAL PHARMACIST Lee et al e23
Table 1. Template for Evaluating a Clinical Pharmacist
Criteria to
Task Suggested Examples of Performance Evaluation Define Successa
Competency domain 1: direct patient care
Conducts interviews to obtain relevant Direct observation of patient (or caregiver)
subjective information as well as medication interviews
use history Feedback from other health care team members
about the clinical pharmacist’s interviewing
skills
Documents an accurate and complete list of Pharmacy progress notes and/or patient records—
medications, discrepancies between Review and evaluate for compliance with
prescribed and actual use of medications, accepted standards and practice- or institution-
allergies, and prior adverse drug reactions in specific policies
accordance with institution-specific
medication reconciliation processes6
Establishes and documents patient-specific Progress notes and other documentation by the
and measurable outcomes; states the time clinical pharmacist
interval for the monitoring and follow-up of
each identified drug therapy problem8
Coordinates the timing and collection of drug Orders, progress notes, or other documentation
concentration samples, interprets results, by the clinical pharmacist
adjusts medication dosages or makes
recommendations regarding adjustments,
and monitors responses to treatment10
Advocates for the rational and cost-effective Orders, progress notes, or other documentation
use of tests (e.g., laboratory tests, cultures by the clinical pharmacist
and sensitivities, pharmacogenomic testing)
to guide patient care decisions11
(continued)
e24 PHARMACOTHERAPY Volume 37, Number 5, 2017
Table 1. (continued)
Criteria to
Task Suggested Examples of Performance Evaluation Define Successa
Monitors patients for adverse drug reactions Documentation in orders and progress notes of
and drug interactions (e.g., drug-drug, drug- adverse drug reactions
food, drug-disease, drug-lab, or drug-device) Frequency and accuracy of adverse drug reaction
reporting are consistent with institution-specific
policies
Direct observation of the clinical pharmacist
during team interactions (e.g., on patient care
rounds)
Performs basic life support and participates in Active life support certification (e.g., AHA BLS,
drug treatment management during medical ACLS, PALS, ATLS, ENLS), if required
emergencies10 Competency certifications, if available, for stroke
response, sepsis alerts, and/or trauma response
Advocates for patient access to medications Working relationships with case manager, social
by facilitating the use of preferred worker, and insurance or pharmaceutical
medications on prescription drug plans and company representatives
patient assistance programs12 Letters of appreciation of the clinical pharmacist’s
services submitted by patients
Scores on patient satisfaction surveys
Support for the institution’s medication assistance
program
(continued)
TEMPLATE FOR EVALUATING A CLINICAL PHARMACIST Lee et al e25
Table 1. (continued)
Criteria to
Task Suggested Examples of Performance Evaluation Define Successa
Participates in institutional processes to Guidelines for cost-effective practice in which the
increase patients’ access to medications clinical pharmacist has participated (including
guideline preparation)
Development, promotion, and/or implementation
of pharmacy-wide cost-saving initiatives
(continued)
e26 PHARMACOTHERAPY Volume 37, Number 5, 2017
Table 1. (continued)
Criteria to
Task Suggested Examples of Performance Evaluation Define Successa
Documents patient care activities Documentation of patient care activities
appropriately, consistent with the Documentation of the clinical pharmacist’s
institution’s policies and procedures communications with other members of the
team during handoffs between shifts or during
transitions of care: Ensure that the follow-up
and future encounters are aligned with the
patient’s medical and medication-related needs8
Optional task: educate health care professionals to ensure the safe and effective use of medications in systems and/or
populations
Serves as an effective clinical educator. Student or resident evaluations of the clinical
Engages learners at all levels of pharmacist as a preceptor
development, including students and Adjunct faculty member appointments at colleges
trainees; demonstrates commitment to of pharmacy, colleges of medicine, or other
helping learners succeed regardless of health professional programs
professional background; regularly Formal recognition of teaching excellence
participates in interprofessional activities17 Appointment as a residency or fellowship
program director
Appointment as a training program preceptor
(continued)
TEMPLATE FOR EVALUATING A CLINICAL PHARMACIST Lee et al e27
Table 1. (continued)
Criteria to
Task Suggested Examples of Performance Evaluation Define Successa
Seeks and provides constructive feedback; can Completion of self-assessments at appropriate
effectively self-assess strengths, deficiencies, intervals
and limits of knowledge and expertise15 Participation in department’s peer evaluation
programs
Direct observation
Serves as a role model for others within the Demonstrable leadership skills at departmental
organization by taking initiative to meet meetings or on projects
department/team objectives7, 15 Initiatives to make positive changes in practice,
influence others to adopt change, articulate a
clear vision of what’s important and why change
is needed17
Formal recognition (e.g., appointments to
leadership positions, appointment as committee
chair) by the institution or other organizations
Regularly shares knowledge and expertise In-services given to other health professionals
with other health professionals Presentations at institutional seminars or grand
rounds
Invitations for presentations from other
departments or professional entities outside the
institution/organization
Appropriately assesses patient data Documentation of applicable and Appropriate assessments of patients’
(e.g., physical assessment, medical complete patient assessment and medication-related problems are
history, overall health status, treatment plans developed by the documented in ≥ 90% of the cases
quality of life, cultural issues, clinical pharmacist reviewed
educational level, language barriers, Documentation of accurate and OR
literacy level, current symptoms, complete medication therapy Complete medication therapy problem lists
laboratory or imaging study problem lists are documented in ≥ 90% of the cases
results) to identify medication- reviewed
related problems7 OR
The clinical pharmacist’s notes are peer-
reviewed. Peer reviewers use standardized
criteria, checking each note for specific
areas/items that should be included. Peer
reviewers also assign one of the following
scores to each note: A – most peers would
do the same; B – some peers would do
the same; C – no one would treat the
patient the same. The goal for each
clinical pharmacist is to receive no more
than two B scores in a year, and all
numeric scores should be within 1 SD of
the mean for the group
the criteria for success, should be determined. pharmacists, other items (“Optional Task(s)”)
Table 2 provides several examples of the “Crite- have been added to the appropriate domains of
ria to Define Success” for two of the tasks in the updated template. Finally, the individuals
competency domain 1: direct patient care. being evaluated should have the opportunity to
Although the committee highlights best prac- review the template before its use so that they
tices for clinical pharmacists in this template, are aware of specific performance expectations.
each institution or organization should select the
evaluable items within the domains that apply to
Conclusion
the clinician’s practice setting and the tasks most
appropriate for the scope of clinical services pro- The ACCP Template for Evaluating a Clinical
vided. Similarly, the committee recognizes that Pharmacist, as developed by the 2016 ACCP
some clinical pharmacists may also be responsi- Clinical Practice Affairs Committee, is a useful
ble for conducting research, leading/managing assessment tool for determining whether clinical
others, or teaching. For these clinical pharmacists meet predefined performance
TEMPLATE FOR EVALUATING A CLINICAL PHARMACIST Lee et al e29
criteria. The template is flexible enough to be 9. American College of Clinical Pharmacy (ACCP). Standards of
practice for clinical pharmacists. Pharmacotherapy 2014;
used in its entirety, or, if appropriate, sections 34:794–7.
of the template may be added to an existing 10. American College of Clinical Pharmacy Clinical Practice
institution-specific tool. Affairs Committee, Subcommittee B, 1998–1999. Practice
guidelines for pharmacotherapy specialists. Pharmacotherapy
2000;20:487–90.
Acknowledgment 11. Anonymous. ASHP statement on the pharmacist’s role in clini-
cal pharmacogenomics. Am J Health Syst Pharm 2015;72:579–
The 2016 ACCP Clinical Practice Affairs Commit- 81.
tee is grateful for the guidance and contributions 12. Board of Pharmacy Specialties (BPS). Ambulatory care
from Eric J. MacLaughlin, ACCP regent. pharmacy certification content outline/classification system.
Finalized October 2014. Available from www.bpsweb.org/
wp-content/uploads/2015/11/2015AmCareCoreClassification_For
Publication_20141015.pdf. Accessed March 1, 2017.
References 13. Green ML, Aagaard EM, Caverzagie KJ, et al. Charting the
road to competence: developmental milestones for internal
1. American College of Clinical Pharmacy (ACCP). Template for
medicine residency training. J Grad Med Educ 2009;1:5–20.
the evaluation of a clinical pharmacist. Pharmacotherapy
14. Anonymous. American Society of Health-System Pharmacists
1993;13:661–7.
statement on health-system pharmacist’s role in national
2. Board of Pharmacy Specialties (BPS). Pharmacotherapy specialist
health care quality initiatives. Am J Health Syst Pharm
certification content outline/classification system. Finalized Septem-
2010;67:578–9.
ber 2015/for use on fall 2016 examination and forward. Available
15. Kirwin J, Canales AE, Bentley ML, et al. Process indicators of
from www.bpsweb.org/wp-content/uploads/bps-specialties/pharmac
quality clinical pharmacy services during transitions of care.
otherapy/pharma_fall.pdf. Accessed March 4, 2016.
Pharmacotherapy 2012;32:e338–47.
3. Board of Pharmacy Specialties (BPS). Pharmacotherapy as a
16. Accreditation Council for Graduate Medical Education
BPS specialty. Available from www.bpsweb.org/bps-specialties/
(ACGME) and the American Board of Emergency Medicine
pharmacotherapy/. Accessed March 3, 2016.
(ABEM). Emergency medicine milestone project. July 2015.
4. Swing SR. The ACGME outcome project: retrospective and
Available from www.acgme.org/acgmeweb/portals/0/PDFs/mile
prospective. Med Teach 2008;29:648–54.
stones/emergencymedicinemilestones.pdf. Accessed March 4,
5. Saseen JJ, Ripley TL, Bondi D, et al. ACCP clinical pharmacist com-
2016.
petencies. Pharmacotherapy 2017;37, in press. Pre-publication draft
17. University of Maryland School of Pharmacy, Department of
available from www.accp.com/docs/positions/guidelines/Competenc
Pharmacy Practice and Science. Policies and procedures.
ies_Final_2.25.17.pdf. Accessed March 1, 2017.
Faculty practice evaluation – qualitative assessment. Adopted
6. Joint Commission of Pharmacy Practitioners (JCPP). Pharma-
March 7, 2012. Available from www.pharmacy.umaryland.ed
cists’ patient care process. May 29, 2014. Available from
u/media/SOP/wwwpharmacyumarylandedu/about/depts/pps/pdf/
https://www.pharmacist.com/sites/default/files/files/PatientCa
pps-faculty-practice-evaluation-qualitative-assessment-policy.pdf.
reProcess.pdfwww.pharmacist.com/sites/default/files/patientca
Accessed March 1, 2017.
reprocess/pdf. Accessed March 1, 2017.
18. Department of Veterans Affairs. VHA Handbook 1108.11.
7. Medina MS, Plaza CM, Stowe CD, et al. Center for the
Clinical pharmacy services. Available from www.va.gov/
Advancement of Pharmacy Education 2013 educational out-
vhapublications/ViewPublication.asp?pub_ID=3120. Accessed
comes. Am J Pharm Educ 2013;77:162.
March 5, 2017.
8. American Pharmacists Association (APhA). Pharmacist
19. Haines ST, Ammann RR, Beehrle-Hobbs D, Groppi JA.
clinical services performance evaluation. Available from www.
Protected professional practice evaluation: a continuous qual-
pharmacist.com/sites/default/files/files/mtm_pharmacist_clinical_
ity-improvement process. Am J Health Syst Pharm 2010;67:
services.pdf. Accessed March 4, 2016.
1933–40.