Pharmacy Competency Assessments: Improving Practice and Training

Competency assessments have become increasingly common over the years, including in the pharmacy environment. In health care, competencies began to evolve following a groundbreaking 2003 Institute of Medicine (IOM) publication addressing gaps in health system design. The IOM identified five core competencies at the time which would be the root of further attempts to develop more specific competency assessments for health care professionals.

These core competencies – patient-centered care, interdisciplinary work, evidence-based practice, quality improvement, and informatics – are the basis of current competency assessments in a wide range of health professions including pharmacy. It is important to recognize competency assessments as the tool they are and to communicate the importance of competency assessments in pharmacy practice.

What Is A Competency Assessment And Why Are They Important?

Competency assessments are often performed initially at time of hire and then are required components of annual reviews and are mandated by some human resources departments. For this reason, it can be tempting for some workers and even managers to consider them as just another box to check off during the annual review process.

However, competency assessments play a much bigger role. The goal of a competency assessment is multi-fold, measuring the behaviors an employee displays when completing a task or skill. The employee’s competency level can then be compared not only with their own previous scores, but also with the scores of their colleagues. The goal of this should not be punitive, but rather should be identifying opportunities for systemic improvements in training.

Competency assessments will generally assess skills across a number of domains. These domains, of course, may vary as applicable to the specific employee role.

From there, competency assessments can diverge wildly. Some competency assessments are pass/fail and are completely based on management observation and sign-off. Other types of competency assessments are more nuanced and based on a knowledge-skills-and-attitudes (KSA) model. In this latter type of assessment, each domain includes multiple competency statements. The employee then self-evaluates about the level at which they are performing the skill in the competency statement. The employee can then rate their proficiency level on each statement as follows:

• I am unaware or have very little knowledge of the skill (no current skill)

• I have heard of, but have limited knowledge or ability to apply the skill (aware)

• I am comfortable with my knowledge or ability to apply the skill (knowledgeable)

• I am very comfortable, am an expert, or could teach this skill to others (proficient)

Management can then also complete the competency assessment, scoring the employee on the proficiency levels observed for each competency statement in each domain. By combining both the management and employee competency assessments during the review process, management can identify knowledge gaps and opportunities for additional employee training.

Competency Assessments Throughout the Various Levels of Pharmacy Practice

Every level of pharmacy practice can benefit from competency assessments. However, it is important to remember that because different pharmacy roles have different functions, that their competency assessments should likewise vary, reflecting the differences in their roles.

Some examples of different kinds of pharmacy assessments include:

• Pharmacy Technician competencies: These may include assessments on aseptic technique, glove-fingertip testing, media fill testing, and disinfection.

• Inpatient/Outpatient Pharmacist competencies: These may include assessments on infection control, quality improvement, and medication safety.

• Clinical pharmacist competencies: These may include assessments on medication management, conducting research, precepting students, and managing clinic operations.

• Pharmacy management competencies: These may include assessments on developing and managing programs, supervising staff, recruiting employees, managing projects, and staying on budget

• Pharmacy leadership competencies: These may include assessments on overseeing, setting organizational strategies, setting the tone for workplace culture, advocating for resources, and partnering with community leaders.

Sample Pharmacist Competencies

Below is a sample inpatient clinical pharmacist competency assessment for IV cleanroom technique related to cleaning tools. This particular sample competency assessment is pass/fail and relies entirely on management observation. The management observation is documented and can be based on employee demonstration, direct observation, or verbal discussion:

1. Employee has reviewed and can verbalize and demonstrate understanding of and compliance to specific policies and procedures regarding cleaning tools.

2. Employee uses only approved cleaning and sanitizing agents
   1. Employee consideration of cleaning and sanitizing agent compatibilities, effectiveness, and residues.

   2. Employee ensures that cleaning and sanitizing agent schedules of use and methods of application are done according to written procedures.

3. Employee uses only low-level-particulate generating cleaning tools.
   1. Employee ensures cleaning tools dedicated to use in the anteroom shall not be removed from these areas except for disposal.

   2. Employee ensures that disposable wipes are discarded after one use.

   3. Employee ensure that reusable cleaning tools maintain cleanliness by thorough rinsing and sanitization and by storing in a clean environment between uses.

   4. Employee maintains cleaning tools in a dedicated clean room area.

However, remember that other models for competency assessments are available. For example, a sample clinical pharmacist competency assessment for patient care based on a KSA model is as follows. The competency statements below all fall under the domain of medication management. The pharmacist should respond to each competency statement with their level of knowledge of the skill in question, ranging from being unaware of the skin to being an expert in the skill.

1. I am able to effectively interact with medical teams to collaboratively manage patients’ medication needs.

2. I am able to effectively interact with patients, family members, and caregivers.

3. I am able to successfully collect relevant patient information to ensure safe and effective medication management.

4. I am able to successfully analyze and assess relevant information to ensure safe and effective medication management.

5. I am able to design or redesign safe and effective patient-centered medication and monitoring plans.

6. I am able to take appropriate follow-up measures to ensure the successful implementation of medication plans.

7. I am able to appropriately document patient care activities.

The employee and manager both complete this assessment of the employee. Both assessments can then be placed in the employee’s file.

Developing Competency Assessments For Pharmacy Personnel

Many different resources are available on how to develop and optimize your existing competency assessments for your staff. Some organizations, like the American Society of Health-System Pharmacists, offer fully outsourced pharmacy competency assessments for various levels of staff. These assessments are online and are fully customizable.

Other resources are available if you prefer to design in-house competency assessments. These include publications such as Competence Assessment Tools for Health-System Pharmacists and papers like ACCP Clinical Pharmacist Competencies.  StaffReady offers a fully-customizable solution for competency assessments in the pharmacy and othe departments.  

By continuing to improve and evolve competency assessments to match health care system needs, we can continue to improve patient care.

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Sources:

Public Health Foundation. “Competency Assessments for Public Health Professionals.” Retrieved from: http://www.phf.org/resourcestools/pages/competency_assessments_for_public_health_professionals.aspx

Institute of Medicine. “Health Professions Education: A Bridge to Quality: Chapter 3, The Core Competencies Needed for Health Care Professionals.” 2003. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK221519/