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Table 6 Example action statements specification problems and possible adjustments

From: Do pharmacy practice standards effectively describe behaviour? Reviewing practice standards using a behavioural specificity framework

  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
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.
  1. aAssumptions made to interpret/make example adjustment