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Chapter Nine
Risk management
Darren M. Ashcroft
9
STUDY POINTS
*
The use of human error models to understand the
causes of patient safety incidents
*
Risk management techniques that can be used to
understand the ‘root causes’ of an incident
*
Some of the common risks in the pharmacy setting
*
The National Patient Safety Agency’s ‘Seven
Steps to Patient Safety’
*
A structured approach to undertaking risk
assessment in the pharmacy
Introduction
Risk – the probability thatan adverseevent willoccur –
is a normal part of daily life. We all continuously face
risks and make decisions about them. Each day we
decide when it is safe to cross the road and when it is
more sensible to wait; we may choose to travel by car
rather than walk. In these everyday choices, we assess
the potential risks and benefits, and select a plan of
action. Risk management is all about this process of
anticipating potential hazards and reducing the likelihood of a problem occurring. However, before thinking about how to minimize or eliminate the possibility
of errors, it is important to first consider how errors
occur.
errors of individuals, blaming them for forgetfulness,
inattention, carelessness, negligence or recklessness.
It has been widely acknowledged that blaming individuals does not encourage reporting and learning
from errors, and the development of an effective
risk management culture within healthcare settings
depends critically on establishing an open reporting
culture.
During the past decade, there has been increased
interest to understand how management practices
and other workplace factors impact on patient safety.
The systems approach acknowledges that humans are
imperfect and errors are to be expected, even in the
best organizations. Rather than focusing on the individual, the systems approach concentrates on the conditions under which individuals work, trying to build
defences to avoid errors or to mitigate their effects.
James Reason (2000) classified medical errors into
two types, active and latent failures, where active
failures are unsafe acts (for example dispensing the
wrong drug) committed by individuals who are at
the ‘sharp end’ of health care, while latent failures
are more distant from the actual incident and
reflect failures in management or other organizational
factors.
Active failures
Human error models
Human error can be considered in two ways: the
person approach and the systems approach. Traditionally, the person approach has been the dominant
approach used in health care. This focuses on the
Active failures take a variety of forms, such as slips,
lapses, mistakes and procedural violations, as shown in
Figure 9.1.
Slips occur when there has been a lack of attention,
despite the fact that the individual has all the necessary skills to complete the task successfully. Lapses
involve memory failures, such as forgetting your
SECTION TWO Governance and good professional pharmaceutical practice
Figure 9.1*Reason’s (2000) four-stage model of human error theory.
intentions or omitting planned actions. In contrast,
mistakes happen when we are in conscious control
of the situation, but successfully execute the wrong
plan of action. For instance, selecting the wrong plan
tive implementation with the provision of the necessary resources and support are all important in
promoting compliance and therefore avoiding pro-
cedural violations.
can come about because of an incorrect assessment of
the situation, such as arriving at the wrong diagnosis
for an individual asking for an effective treatment for
an ‘upset stomach’.
Violations, on the other hand, involve deliberate
deviations from the procedures or best way of performing a task, such as not following standard operating procedures (see Chs 7, 24 and 43) within the
pharmacy. Several types of violations have been described; these are outlined in Box 9.1.
Each of these error types (slips, lapses, mistakes,
violations) requires different strategies to be implemented to avoid similar events occurring in the
future. Better system defences, such as redesigning
the workplace, can help to minimize slips and
lapses. Improved training and rigorous checking
procedures can prevent some mistakes. Developing
Types of procedural violations
Optimizing violations occur when skill and
experience lead the individual to think that the rules
do not apply to them
Routine violations occur when it becomes accepted
practice to break a rule within the organization
Situational violations occur when the situation
necessitates rule breaking, for example there are
not enough staff or there is not enough time to carry
out all the required checks
Exceptional violations arise when the rules that are in
place are not able to deal with a novel situation
relevant procedures and protocols, ensuring effec-
Box 9.1
90
Risk management CHAPTER 9
Latent failures
Latentfailuresarethosewhoseadverseconsequences may lie dormant, only becoming evident
when they combine with other factors. These usually stem from poor decisions, made at a different
time and place, by more senior members of the
organization or people operating at a different level,
such as the headquarters of a pharmacy chain.
Latent failures have two kinds of adverse effect:
they can lead to error and violation provoking conditions in the workplace (e.g. time pressures, understaffing, inadequate equipment, inexperience) or
they can create weaknesses in the defences (e.g.
unworkable procedures or design problems).
The investigation of many threats to patient safety
has shown that there are usually multiple causes
andtheytendtooccurwhenthereisanunfortunate combination of active and latent failures.
Reason (2000) proposed the ‘Swiss cheese model’
Figure 9.2*‘Swiss cheese’ model showing how failures in the
pharmacy can lead to patient harm.
to illus trate how accidents can occur within systems.
This analogy compares the defensive l ayers of the
system to layers of Swiss cheese, each having holes
that represent safety failures. The presence of holes
in one slice may not result in an accident because the
other slices act as safeguards. However, the holes in
the layers may temporarily line up, creating an opportunity for an accident. Figure 9.2 shows how
multiple failures in the pharmacy setting can result
in patient harm.
Risk management tools
There are a number of useful techniques that can be
used to help understand the underlying causes of
adverse events and help identify actions that can be
put in place to avoid similar events occurring in the
future. For instance, root cause analysis (RCA) provides a framework to reflect on an actual or potential
error, working back across the sequence of events.
RCA aims to uncover the underlying, contributory
and causal factors that resulted in an error, and also
understand better the protective factors that may
have prevented harm from occurring. It is important
to include all those involved in the incident in order
clearly to map out the chronology of events. The
analysis is then used to identify areas for change and
possible solutions, to help minimize the reoccurrence of the event in the future. Various methods
can be used for RCA including the use of a ‘fishbone
diagram’ in which each of the ‘bones’ reflect different system failures, or the use of timelines where a
chronological chain of events is mapped and tracked.
Failure modes and effects analysis (FMEA) is a
systematic tool for evaluating a process and identifying where and how it might fail. It also assesses the
relative impact of different types of failure and so
prioritizes which areas need attention first. In addition, it can be used to assess the likelihood of the event
reoccurring following changes to the system. The
FMEA process involves:
*
Mapping out the steps of the process through group
discussion
*
Identification of possible failure modes (what
could go wrong?) by brainstorming
*
For each error type or failure mode identified, a
cause (why should failure happen?) and effect
(what would be the consequences of each failure?)
are attributed, together with scores for likelihood
of occurrence, likelihood of detection and severity.
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SECTION TWO Governance and good professional pharmaceutical practice
Multiplication of these three scores generates a risk
priority number (RPN) which can be used to prioritize changes within the pharmacy.
Risk to patients in the pharmacy setting
It is increasingly recognized that risks within healthcare organizations, including pharmacies, are diverse
and complex, and not just confined to specific activities. An accurate estimate of the extent and causes of
adverse events that originate from the pharmacy is
difficult to obtain since different methods have been
used to collect the data.
Research has, however, suggested that in the UK,
for every 10 000 prescription items dispensed in community pharmacies, there are likely to be at least 26
dispensing incidents. Most threats do not result in
actual patient harm, but have the potential to do so.
The most common types of events include incorrect
product selection (60%) and labelling errors (33%).
Organizational factors are associated with the majority of these errors including issues concerning distractions while assembling and checking prescriptions,
poor communication, excessive workload and inadequate staffing.
Studies have also reported on practice variation in
the way in which non-prescription medicines are
sold and advice is communicated to patients in community pharmacies, suggesting that in s ome cases
pharmacy services may be deficient or sub-optimal.
Over the last decade, the Consumers’ Association in
the UK has repeatedly criticized deficiencies in the
level of advic e, questionin g and referral of consumers to other healthcare professionals from community pharmacies.
It is also important to consider risks to pharmacy
staff and customers through failures to comply with
health and safety legislation. The Health and Safety at
Work Act 1974 is the guiding piece of legislation placing responsibilities on employers and employees to
carry out risk assessments. Pharmacies should have a
health and safety policy in place with responsibilities
allocated to specific members of staff. Key areas of
concern that are relevant to the pharmacy setting
include having an effective procedures manual dealing
with control of substances hazardous to health,
fire precautions, workplace equipment, the pharmacy
environment (such as unsafe furniture and fittings)
and first aid.
Developments in health policy
In 2000, the Chief Medical Officer (CMO) for
England published An Organisation With A Memory
(OWAM; Department of Health 2000). This was a
report of an expert group on learning from adverse
events in the NHS, drawing on insights from human
error and risk management as applied in other highrisk industries, such as aviation and nuclear power.
The report presented international evidence on the
scale and impact of adverse events and made reference to the lack of systems in the NHS that allowed
there to be learning from adverse events. The expert
group concluded that the NHS could benefit greatly
by applying these risk management principles to
health care.
The report also recommended as one of its four
key targets that there should be a 40% reduction in
the number of serious errors involving prescribed
drugs. In 2004, the Chief Pharmaceutical Officer for
England published Building a Safer NHS for Patients:
Improving Medication Safety (Department of Health
2004), which outlined strategies aimed at reducing the
occurrence of prescribing, dispensing and administration errors drawing on experience and models of good
practice within the NHS and worldwide.
More recent requirements, forming part of the
essential services of the contractual framework for
community pharmacy in England and Wales, has
meant that standard operating procedures (SOPs)
covering the dispensing process need to be in place
in pharmacies. In addition, all pharmacies should be
able to demonstrate evidence of recording, reporting, monitoring, analysing and learning from patient
safety incidents. Furthermore, pharmacists are now
expected to be competent in risk management, including the application of root cause analysis (RCA).
National Patient Safety Agency (NPSA)
Following the publication of the highly influential
OWAM report, the National Patient Safety Agency
(NPSA) was established in June 2001 to coordinate
efforts to report and learn from patient safety incidents. The NPSA has published guidance for NHS
organizations on the seven steps that they should take
in order to improve patient safety (as described in
Box 9.2). It is clear that risk management is firmly
incorporated into this guidance.
92
Risk management CHAPTER 9
Box 9.2
Seven steps to patient safety
Build a safety culture – create a culture that is open
and fair
Lead and support staff – establish a clear and strong
focus on patient safety throughout the organization
Integrate risk management activity – develop systems
and processes to manage the risks and identify and
assess things that could go wrong
Promote reporting – ensure that staff can easily report
incidents locally and nationally
Involve and communicate with patients and the public
– develop ways to communicate openly with and
listen to patients
Learn and share safety lessons – use root cause
analysis to learn how and why incidents happen
Implement solutions to prevent harm – embed
lessons through practices, processes or systems
Of particular interest, the NPSA has also published
recommendations on the labelling and presentation of
a dispensed medicine as well as suggestions on how to
promote the safe use of medicines. In addition, it has
also published recommendations on changes in the
general dispensing environment that can improve
patient safety (http://www.npsa.nhs.uk).
Box 9.3
Approaches that can be used to identify risks
Direct observation of working practices within the
pharmacy
Incident reports of adverse events and near misses
Interviews and questionnaires of patients and staff
Complaints from patients, or other healthcare
professionals
Litigation and compensation claims
an annual monitoring visit from representatives of
their primary care trust (PCT) to check compliance
with the community pharmacy controls assurance
framework.
Step 2: Identification of risk
It is important to take into account things that have
gone wrong in the past or near miss incidents that
have previously occurred. Box 9.3 lists a variety of
methods that c an be used to identify risks in the
pharmacy, and different approaches can be used in
combination. Each method will identify different
aspects about the frequency and nature of risks in
the pharmacy.
The risk management process
The risk management process is about the planning,
organization and development of a strategy that will
identify, assess and ultimately minimize risk. The process can be represented by a sequence of steps but
there is much overlap and often there is integration
between all the steps.
Step 1: Establish the context
It is essential to identify all the legal and professional
requirements for the pharmacy and to respond appropriately, since most of these will be needed for
accreditation purposes or to satisfy a risk insurer or
commissioner of pharmaceutical services. In the UK,
pharmacies are routinely inspected by the Royal
Pharmaceutical Society. Community pharmacies in
England and Wales are also required to take part in
Step 3: Analysis of risk
Once a risk has been identified, it should be analysed
to determine what action needs to be taken. Ideally,
the risk should be eliminated, but often this may not
be possible and efforts need to be taken to minimize
its potential impact. The use of rigorous risk management techniques such as RCA and FMEA can play an
important role at this stage.
The following factors should be considered:
*
The likelihood that an adverse event will occur
*
Its potential impact (seriousness)
*
The availability of methods to reduce the chance of
the event happening
*
The costs (financial and other) of solutions to
minimize the occurrence of similar events in the
future.
This will involve making decisions about risks that are
rare but potentially very serious compared with risks
93
SECTION TWO Governance and good professional pharmaceutical practice
that are very common but have a low probability of
causing harm.
Step 4: Manage the risk
A range of choices is often available to manage the
identified risks. The decision is largely determined
by the financial cost of implementation balanced
against the potential benefits (such as the cost of
compensation if an adverse event occurred). The cost
of preventing one major, but very rare, adverse event
may be very great when compared with preventing
hundreds of more minor adverse events.
Risk control
It may not be possible to eliminate all the identified
risks, but preventative steps can be introduced that
minimize the likelihood of an adverse event occurring.
Risk acceptance
This involves the recognition that the risk cannot be
entirely removed, but at least it can be known and
anticipated.
Risk avoidance
It may be possible to avoid the risk by understanding
the causes of the risk and taking appropriate actions.
An example is the recognition that company branding
may result in different medications, such as digoxin
tablets (see Fig. 9.2), being packaged in similar ways.
This risk can be reduced by using different manufacturers so that different medications are clearly distinguishable.
Step 5: Auditing and reviewing
performance
Finally, the effectiveness of the approaches used to
identify, analyse and treat risks should be reviewed.
The role of audit is essential, in which risk management standards are set and monitored to see if the
standards have been met. Following audit, the cycle of
organizing, planning, measurement and review should
reoccur to support continuous improvement within
the pharmacy.
Conclusion
Risk management is an essential role for pharmacists
to protect patients from harm. An understanding of
human error models and risk management techniques can be used to analyse the possible risks in a
working pharmacy environment and thus manage
the risks.
KEY POINTS
*
Risk is a normal part of daily life, but risk
management attempts to minimize or
eliminate risk
*
Errors can be classified as active or latent
*
Active failures are things like slips, lapses, mistakes
and procedural violations by a pharmacist
*
Latent failures often arise as a result of poor
decisions by other, more senior people
*
Techniques such as root cause analysis (RCA) are
useful risk management tools
*
A systematic tool such as failure modes and
effects analysis (FMEA) has three main steps –
mapping, identification and specifying cause and
effect. Together they produce a risk priority
number ( RPN)
*
Adoption of standard operating procedures (SOPs)
is a contractual requirement for community
pharmacies
*
The National Patient Safety Agency (NPSA)
coordinates efforts to learn from incidents
*
Risk management processes have five essential
stages: establish a context; identify the risks;
analyse the risks; manage the risks; audit and
review performance
94
Chapter Ten
Continuing professional development
and fitness to practise
Raminder Sihota
10
STUDY POINTS
*
Continuing professional development (CPD) and
why it concerns pharmacists
*
The CPD cycle
*
Recording evidence of CPD
*
Fitness to practise and its regulation
Introduction
The term continuing professional development
(CPD) is familiar to most people and yet is frequently
misunderstood. This chapter is designed to develop an
understanding of CPD and to consider the importance to pharmacists of individual active engagement
in an ongoing programme of CPD.
A search of the World Wide Web for the phrase
‘continuing professional development’ recently
returned more than 30 million hits. The web search
showed the phrase is not specific to pharmacy and
pharmacists. The results included reference to CPD
for teachers, psychotherapists, lawyers, architects,
healthcare professionals and many more. Thus, a wide
range of people in varying professions all over the
world are involved in CPD. These professionals all
recognize the value of planned CPD. In most professions CPD is not optional but mandatory. In the UK
and many other countries (see Ch. 2) CPD is mandatory for pharmacists. It is relevant to all practising
pharmacists, whether experienced and full time or
newly qualified and just starting their career. CPD
for pharmacists is part of being a professional with
an obligation on all to continue to enhance their
own knowledge and skills throughout their career
and working life.
CPD is related to, and indeed part of, clinical
governance (see Ch. 8). Clinical governance is about
both continuous quality improvement and being
accountable for quality improvement. As such,
CPD is an integral part of clinical governance and
it involves all healthcare professionals. Those
healthcare professionals working in the UK NHS
will find there are specific requirements for clinical
governance and CPD which are mandatory. The
Community Pharmacy Contract (England and
Wales) with the NHS states a clear need for community pharmacists to be undertaking and maintaining CPD records within the clinical governance
requirements (essential service number eight). In
addition to this, the Code of Ethics of the Royal
Pharmaceutical Society of Great Britain (RPSGB)
places further obligations on pharmacists. Before
any service is offered, whether to prescribers,
patients or others, a pharmacist must ensure that
whoever is delivering the service has a relevant level
of com petence, skill or knowledge in that area. CPD
allows the pharmacist to provide evidence and demonstrate competence.
What is continuing professional development?
CPD means many things to many people. The NHS
defines it as ‘a process of lifelong learning for all individuals and teams which meets the needs of patients
and delivers the health outcomes and healthcare priorities of the NHS and which enables professionals to
expand and fulfill their potential’ (Department of
Health 1998). While this definition is accurate, it is
SECTION TWO Governance and good professional pharmaceutical practice
somewhat lengthy. An easier option is to consider the
three words individually:
*
Continuing – this is about lifelong learning, an
ongoing (or continuing) process regardless of age of
the pharmacist or the stage of their career
*
Professional – this is focused on individual
competence in a professional role, i.e. it is to do
with the work of the pharmacist
*
Development – this is about identifying and
undertaking learning that improves the personal
skills of the pharmacist to enhance patient care and
career development, i.e. it changes for the better
the work of the pharmacist.
CPD can be defined as the process of reflection, planning, action and evaluation through which pharmacists continuously develop their knowledge, skills,
attitudes and behaviours throughout their professional careers. CPD in the UK applies to both pharmacists
and registered pharmacy technicians.
The RPSGB began introducing a framework for
CPD for pharmacists in 2002. CPD was developed
in pharmacy as a response to the profession’s wishes,
expressed in a consultation exercise for the Pharmacy
in a New Age (PIANA) project in the 1990s, and in
response to the requirements of the Health Act 1999.
Today, the concept of CPD remains a relatively
new idea and process for pharmacists. Prior to the
introduction of the CPD framework, pharmacists
had to engage in 30 hours of continuing education
each year in line with the professional obligation stated in their code of ethics. This requirement has been
replaced with a formal need for CPD records to be
completed and retained for the duration of a pharmacist’s career in order to demonstrate the pharmacist is
competent to be undertaking the role they are working in at the time.
CPD gives a pharmacist the opportunity to demonstrate to their employer, the NHS, and to patients
that they are maintaining and building their own professional capabilities.
of changing techniques, knowledge, methods and processes, etc. The report made recommendations for ongoing professional development and suggested CPD
should not focus solely on clinical skills but should
encompass both attitudes and communication skills.
The Pharmacists and Pharmacy Technicians Order
2007 in the UK initiated the final steps for mandatory
CPD for practising pharmacists registered with the
RPSGB. This means that pharmacists must keep a
record of their development which shows they are
‘actively’ keeping up to date with the knowledge they
use day to day. By keeping up to date they are able to
demonstrate ongoing competence in their current
role, or roles that they wish to pursue in the future.
The RPSGB format for recording CPD involves
keeping a written record of an activity or event, demonstrating that the pharmacist has learned from a
situation relevant to their professional role.
Pharmacists gain from taking ownership of their
CPD, since CPD is a personal activity: it is specific
to each pharmacist. No two pharmacists will have the
same CPD records. CPD is designed to help pharmacists structure and plan ways to ensure that their skills
are constantly being updated and renewed. CPD puts
pharmacists in control of their learning.
CPD cycle
CPD is defined as a systematic, ongoing, cyclical process of self-directed learning. It should enable pharmacists to do their job more effectively and involves
employers as well as individuals.
CPD is a four-stage process which helps the pharmacist plan their learning and track, record and reflect
on learning and development. The learning may be
clinical or related to a skill, attitude or behaviour
Background to CPD
The requirement for formal CPD arose from an increasing pressure on the government to ensure healthcare professions operate in a ‘professional’ manner.
Professional accountability has been highlighted by
many well documented high-profile reports and incidents. For instance, the Kennedy Report, published in
2001, highlighted gaps in the way the medical profession and the professions allied to medicine kept abreast
96
Figure 10.1*The four stages of the CPD cycle.
Continuing professional development and fitness to practise CHAPTER 10
associated with the pharmacist’s role. The four stages
are often depicted as a cyclical process. The RPSGB
recording system is based on the four stages of the
CPD cycle.
The four stages of the cycle are shown in
Figure 10.1 and involve:
*
Reflection on practice
*
Planning
*
Action
*
Evaluation (reflection on learning).
Reflection on practice
Reflection involves the pharmacist spending time
reflecting on current performance and how work is
undertaken. The reflection time aids in the pharmacist identifying personal learning and development
needs. The pharmacist is the best person to identify
their own personal learning needs. Reflection involves
the pharmacist thinking about how daily tasks are
carried out, the areas in which the pharmacist feels
knowledge or skills are weak or events have happened
which indicate a pharmacist needs to improve knowledge or skills in that area.
Sometimes a particular situation or event will draw
the attention of the pharmacist to a weakness in
knowledge, ability or systems of work which, if not
addressed, could cause further problems. This is
called a critical incident (see Ch. 9).
When reflecting, there are several questions the
pharmacist may ask:
*
What knowledge gaps do I have when
undertaking my current role?
*
What areas do I need to develop to further
progress my career?
*
What have I done recently which I could
improve next time?
*
What do I want to be able to do?
*
What extra skills can I offer my patients that
would be of benefit to them?
*
What skills could I develop that would help
deliver my organization goals more effectively?
Other ways of identifying learning needs or knowledge, skill, attitude or behaviour gaps is for the pharmacist to consider the following activities:
*
Asking colleagues for feedback on one’s own
practice – how do they think you are doing? What
do they think you could do differently?
*
Participating in new activities
*
Formulating a development plan to structure
future development
*
Questions from customers
*
Learning from a past event, sometimes referred to
as critical incident analysis
*
Appraisals
*
Professional audit, measuring one’s own standard
against current competencies for the role of a
pharmacist in a similar role.
When identifying learning needs, the pharmacist
must remember to keep the learning need simple. A
learning need broken down into bite-size pieces is
easier to address. The process of reflecting on what
a pharmacist does not know or is unable to do results
in identification of training needs.
Planning
Having identified learning needs, the pharmacist next
needs to plan what can be done to meet these learning
needs and how it can be achieved. At this stage, if
several learning needs have been identified the pharmacist will have to prioritize learning. When prioritizing, the pharmacist needs to consider the impact of
the learning on one’s self, on colleagues, on the organization worked for and on the patient.
If the pharmacist has identified more than one
learning need then it may be that more than one
CPD cycle needs to be started. When planning actions
to meet learning objectives, the pharmacist needs to
consider:
*
What level of competence needs to be reached?
*
When does the learning objective need to be met
by?
*
What will be the impact of the learning on
customers, colleagues, the organization and the
pharmacist?
*
What activities can be undertaken to best meet
needs?
*
What activities lead to the best learning? (This will
differ for each pharmacist.)
Additionally, at this stage the pharmacist needs to
consider what the consequence of not undertaking
the learning would be. If the pharmacist realizes that
the learning need is no longer urgent or important,
then it is appropriate not to take it any further.
When considering how to meet learning needs,
there are a number of ways that learning can be undertaken. The RPSGB suggests pharmacists be creative and not limit themselves to formal or certificated
97
SECTION TWO Governance and good professional pharmaceutical practice
courses. Pharmacists may wish to consider the following methods (this list is not exhaustive):
*
Talking to a colleague
*
Attending a course
*
Reading a book, article or journal
*
Research
*
Work shadowing
*
Coaching another individual
*
Everyday experience (learning on the job)
*
Talking to patients
*
Computer assisted learning
*
Deputizing for someone
*
Audit.
It is important to recognize pharmacists all learn in
different ways and all have preferences. It may be
worthwhile considering options which may have not
been considered before.
Action
At this stage of the cycle, once the plan is complete for
what needs to happen, it is time for the pharmacist to
put the plan into action and commence learning. Action is simply carrying out the plan. While this sounds
simple, the time taken to undertake the learning
needs to be built into the plan and the timetable
adhered to.
While undertaking the actions, the pharmacist
should throughout be asking:
*
What have I gained from this action?
*
How might this action benefit my practice?
As these questions are answered, a record should be
made of what has been learned.
Evaluation (reflection on
learning)
As with all development, evaluating what learning has
been undertaken and how it has been undertaken is
important. During the evaluation process, pharmacists should consider a series of questions:
*
Has the activity achieved what the original
learning objective was?
*
Has any learning occurred?
*
Have any further learning needs been identified?
*
Has an opportunity to apply the learning occurred?
If so, was there any feedback?
In some cases pharmacists may find that what has
been learned is not what they set out to learn. In this
case the pharmacist needs to revisit the original learning need and consider if the requirement to undertake
further actions is still necessary for their practice. If
the pharmacist decides the learning need is still valid,
then this will lead the pharmacist into a new CPD
cycle or alternatively the pharmacist can go back a
couple of steps in the cycle and add in different
actions.
If the pharmacist does not have the learning need
any longer because it is no longer relevant or it has
been overtaken by other priorities or events, then the
pharmacist may exit the CPD cycle there.
Assessing whether the learning
undertaken has been effective
A further question that the pharmacist needs to ask is:
‘Can my practice now be shown to have improved as a
result of the learning experience or is further learning
required?’ Realistically, true evaluation may not occur
for some weeks or months, since an opportunity to
apply learning may not occur sooner.
Scheduled learning vs
unscheduled learning
The CPD cycle is a circle – each stage flows into the
next. There are three entry points into the cycle –
‘Reflection on practice’, ‘Planning’ and ‘Action’.
The exit (end point) is always ‘Evaluation’, when
the impact of the learning undertaken is reviewed.
Scheduled learning is another term given to CPD
which enters the process at ‘Reflection on practice’.
This is when someone or something leads the pharmacist to identify a learning need or knowledge gap
and plan ways that the pharmacist can meet this need
or gap. This can be as simple as someone asking the
pharmacist a question that the pharmacist does not
know the answer to.
Unscheduled learnin g i s learning that starts
from ‘Action’. This is l earning that happens unexpectedly through someone or something. It is learning that was not planned and has not happened
consciously.
All entry points into the CPD cycle are valid.
Ordinarily a pharmacist would have a mixture of
cycles, some starting at ‘Reflection’ or ‘Planning’,
which indicates the pharmacist is thinking about his
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