Raising the standards

Pharmacy practice is rapidly evolving. Here’s how the drastically reimagined Professional Practice Standards can help the profession adapt.

Pharmacy practice is evolving rapidly, with recent years bringing a near-constant parade of changes. With the steady expansion to scope of practice, the industry is anything but static. Practice is more complex than ever. It is against this backdrop that the Pharmaceutical Society of Australia recently [late July] launched a massive shake-up of the Professional Practice Standards (PPS).

‘These standards are like nothing you’ve seen before,’ says Dr Fei Sim FPS, PSA National President. ‘At its core, the PPS are designed to define and articulate the minimum expected standards of professional behaviour in all aspects of pharmacy practice.’

The product of more than a year of development, this is the first rebuilding of the PPS since 2017. It reimagines the PPS into 17 standards conceptually based on the medicine management cycle (MMC).

Dr Sim notes, ‘Pharmacists should be everywhere that medicines are, at all stages of the MMC. That’s why we have totally rebuilt the standards around the MMC, so that no matter your individual scope of practice, the PPS are consistent foundations for all of us.’ By building standards around specific clinical functions, such as prescribing or medicine packing, rather than a new standard for each clinical service, the new PPS is much shorter.

The previous PPS had 774 actions and 167 criteria, which has been replaced with just 171 actions across the 17 standards. ‘Redesigning the standards to be easier to read and more definitive, while also flexible in practice, is really difficult,’ Dr Sim says.

‘Never before have we undertaken such an ambitious redesign of the Professional Practice Standards. These standards set our profession up for the future – for expanded scope of practice and beyond.’

What are Professional Practice Standards?

The Professional Practice Standards describe minimum performance expectations for pharmacists in both clinical and non-clinical roles. Adherence to the Professional Practice Standards is an expectation of the Pharmacy Board of Australia.¹

The new PPS has minimum standards which support pharmacists’ clinical roles at all stages of the medicine management cycle and will provide guidance as new roles develop and evolve. This is important for the profession’s growth, as standards provide confidence to stakeholders by defining quality and accountability.

‘The standards support us to be more flexible; to confidently expand our scope when things change; it offers clear and actionable direction; and, most importantly, it increases the safety and effectiveness of the services we provide,’ says Dr Sim.

As part of the Australian Government’s recognition that PSA is the custodian of standards and guidelines, the project has been funded by the Australian Government Department of Health and Aged Care.

What is different about these standards?

At their core, the standards set the minimum performance expectations for all pharmacists, regardless of practice settings. The project had several objectives, including being more specific, actionable and measurable – key recommendations of the Enhancing Quality in Pharmacy Practice (EQiPP) Project. These recommendations framed the development work.

‘It is critical that pharmacists have an up-to-date and evidence-based foundation to guide their professional practice, says Project Advisory Group Chair Deanna Mill MPS. ‘A key component of the support needed is clear and actionable Professional Practice Standards.’

PSA’s CPD Manager Jacob Warner MPS who led the project, notes: ‘Previously the standards used language like “consider” or “ensure” in the context of a service. The new standards are much more active. Actions better capture the clinical decisions pharmacists need to make with active words such as “determine”, “critically appraise” or “interpret and evaluate”.’

This supports greater autonomy, and empowers pharmacists, particularly in roles where this may not be recognised, he notes.

‘By clearly capturing the accountability to clinical decisions, the standards go further than ever before in empowering pharmacists to make independent, autonomous decisions in the care of patients.’

Pharmacists have to think about these standards differently

The reimagining of the standards to look at the different roles pharmacists play at each stage of the medicine management cycle means pharmacists will have to think differently when applying these standards.

Each service a pharmacist provides relates to more than one phase of the cycle, so there are now multiple standards that apply to each activity and service. Jacob Warner explains this using the example of Dose Administration Aids (DAAs).

‘We don’t have a standard just for DAAs anymore. Pharmacists will instead need to think about what they do in that activity for the minimum standards that apply,’ he says.

‘In the case of DAAs, that’s probably going to include service delivery, patient assessment, dispensing, medicine packing, safe and secure handling of therapeutic goods and providing health information. And the fundamental standards – person-centred care, responsibility and accountability, collaborative practice – always apply,’ he adds.

However, he maintains that while having multiple standards apply to each service may sound intimidating, it probably isn’t when you start to apply it to practice.

‘Each standard has a lot less actions than in the previous version. And we’ve removed the “criteria” level in the standards. So, what you’re left with is fewer, more definitive actions to work through. And there’s far less repetition.’

Which standards apply to me?

Every pharmacist needs to define their own personal scope of practice, mapping the activities and services they perform as a pharmacist. This is because every pharmacist has a different scope of practice, says Dr Sim. ‘For example, I have a number of different roles – as a community pharmacist, an academic pharmacist, and now as a leader, as National President at the PSA.

‘Not all of my roles directly involve medicines, such as my academic role,’ she points out. ‘However, I know there are standards that are fundamental and always apply to me.

‘The other standards may also apply indirectly. For example, if I am supervising students conducting research, we need to make sure the research intervention aligns with the requirements in the relevant standards.

‘In each of these roles there are multiple standards that apply to each aspect of the work I do. I need to consider and apply all of the relevant standards to ensure I meet the requirements of that work.’

Putting the standards to practice

Self-assessment helps put standards into practice in a structured way. The PSA’s digital self-assessment and implementation program helps pharmacists assess their performance against relevant standards.

The program takes you through the standards, provides guidance to undertake self-assessment and then produces a tailored action plan for adapting your practice where necessary to meet the standard. Successfully completing the program and following the guidance in the action plan also enables pharmacists to record Group 2 and self-record Group 3 CPD credits.

Team effort

‘I provide my sincere thanks and congratulations to the PSA’s project team, and to all the consumers and pharmacy organisations who worked so collegiately on this project to help the profession grow and thrive through these new Professional Practice Standards,’ says Dr Sim. ‘When you look at the endorsing organisations, you really see what a team effort this project has been.’ Deanna Mill MPS agrees. ‘We encourage all pharmacists to use the newly revised and updated Professional Practice Standards as a contemporary, evidence-based resource to guide their quality professional practice. ‘By incorporating these standards into daily practice, pharmacists will ensure safe, effective and person-centered care for all Australians.’

The core standards

Reference

1. Ministers. Department of Health. On-site pharmacists to improve medication management in RACFs. 2022. At: https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/on-site-pharmacists-to-improve-medication-management-in-racfs