Professional Issues Final Exam PDF

Professional Issues Final Exam Module 1: Profession, Professional, and Professionalism What makes a Profession, a Professional, and Professionalism? Profession: A profession is a disciplined group of individuals who adhere to ethical standards. This group positions itself as possessing special kno...

Professional Issues Final Exam Module 1: Profession, Professional, and Professionalism What makes a Profession, a Professional, and Professionalism? Profession: A profession is a disciplined group of individuals who adhere to ethical standards. This group positions itself as possessing special knowledge and skills in a widely recognized body of learning derived from research, education, and training at a high level. They are recognized by the public as such. A profession is also prepared to apply this knowledge and exercise these skills in the interest of others. Professional: A professional is a member of a profession. They are governed by a code of ethics and are accountable for their actions. Most professionals have a commitment to competence, integrity, morality, altruism, and the promotion of the public good. Professionalism: Professionalism is described as the behavior that a person exhibits during interactions with others. These behaviors are comprised of personally held beliefs about one’s conduct as a professional. Key characteristics include upholding principles, laws, ethics, and conventions of a profession as a way of practice. Bill 171 In 2007, the Health Systems Improvement Act (Bill 171) was passed by the Ontario Legislature. This act made amendments to the Regulated Health Professions Act, the Pharmacy Act, and the Drug and Pharmacies Regulation Act. The Pharmacy Act was enacted in 2010 and states that the Pharmacy Technician title is legally protected and can only be used by Pharmacy Technicians registered with the Ontario College of Pharmacists (OCP). These amendments also invoked the establishment of requirements for individuals who wished to be registered with OCP and become registered Pharmacy Technicians. This regulation in turn allowed OCP to define the scope of practice for Pharmacy Technicians. Having a scope of practice means that Regulated Pharmacy Technicians have the sole responsibility of the technical functions within their scope of practice. Module 2: Code of Ethics The Pharmacy Code of Ethics The Code of Ethics is a set of principles that form the basis of ethical conduct of Pharmacy Technicians and Pharmacists. It provides guidelines for professional judgment. The Code of Ethics applies to all current members of the Ontario College of Pharmacists (OCP). Practicing Ethically Ethical practice is essential to achieve the following: To gain the trust of the public To maintain the reputation of the profession To deliver excellent care To protect the public  To retain the ability to self-govern Principles that Guide Ethical Behaviors BENEFICENCE - to do or promote good CONFIDENTIALITY - protection of privileged information NON-MALEFICENCE - to do no harm JUSTICE - to promote fair treatment VERACITY - to be truthful FIDELITY - to be loyal to patients RESPECT FOR PERSONS - to be caring and compassionate to all patients PROTECTING THE VULNERABLE - to protect those susceptible to harm NAPRA Competencies for Entry to Practice The National Association of Pharmacy Regulatory Authorities (NAPRA) sets out the Professional Competencies for Pharmacy Technicians at Entry to Practice. These competencies provide us with information on the basic knowledge that every Pharmacy Technician who is licensed should possess. How do Competencies Relate to Professionalism and Ethics? The competencies set out by NAPRA help to guide our decision-making. NAPRA defines competencies as “significant job-related knowledge, skills, abilities, attitudes, and judgments required for competent performance by members of a profession”. The Competencies for Pharmacy Technicians were developed in consultation with the competences for Pharmacists. It is important that the competencies are complementary in order to achieve the best patient care. Overarching Competencies There are many overarching competencies that extend to both Pharmacy Technicians and Pharmacists: Use patient-centered care to focus on the patient’s needs, values, and safety to optimize patient outcomes. Practice in accordance with their jurisdiction’s legislation, professional standards, by-laws, guidelines, and/or policies. Are committed to life-long learning. Act as mentors to promote the growth and development of the profession. Collaborate with each other and members of the healthcare team and the broader circle of care. Use critical thinking, problem-solving, and decision-making skills appropriate to their role. Take responsibility for their decisions and provide leadership as appropriate. Possess pharmacy-specific knowledge, skills, abilities, and attitudes to support their scope of practice. Hold the patient’s health and safety as a priority at all times. Competency Categories The NAPRA competencies are categorized into categories and then subcategories. The main categories are: Ethical, Legal, and Professional Responsibilities Patient Care Product Distribution Practice Setting Health Promotion Knowledge and Research Application Communication and Education Intra and Inter-Professional Collaboration Quality and Safety Model Standards of Practice for Pharmacy Technicians NAPRA provides us with the Model Standards of Practice for Pharmacy Technicians. These Standards of Practice were developed after the Competencies for Entry to Practice. They serve to provide additional guidance on the activities that a Pharmacy Technician should be able to complete and they correlate to the competencies. Model Standard of Practice Domains Expertise in Drug Distribution Systems Collaboration Safety and Quality Professionalism and Ethics Accountability and Liability As regulated health professionals, Pharmacy Technicians are accountable and liable for activities within their scope of practice. This means that if an error is made by a Pharmacy Technician, they will be held accountable for their actions. Mandated Professional Liability Insurance The OCP requires that all Pharmacy Technicians and Pharmacists in Ontario have Professional Liability Insurance (PLI). This insurance provides financial reimbursement if a lawsuit is brought against you once you are working as a licensed Pharmacy Technician. The Complaints Process The OCP handles all of the complaints that are received about any of its members or registrants. This means that once you become licensed as a Pharmacy Technician, that the Ontario College of Pharmacists will take steps to ensure that you are practicing appropriately. Module 3: Patient’s Rights Rights vs. Obligations As a pharmacy professional;, it is important that we understand the difference between rights and obligations. What are Rights? Rights are legal, social, or ethical principles of entitlement. They are rules about what is allowed of people or owed to people, according to some legal system, social convention, or ethical theory. What is an Obligation? An obligation is an act or a course of action to which a person is morally or legally bound. It is a duty or commitment. Patient’s Rights What are the Patient’s Rights? Within the Canadian Healthcare System, patients have certain rights. As healthcare professionals, it is important that we know what those rights are to ensure we deliver the best possible care to the patient. PATIENTS IN CANADA HAVE THE RIGHT TO: Receive appropriate care and timely care To be treated with dignity and respect To receive health services without discrimination To have their personal and health information protected from disclosure To have access to their health information unless, in the opinion of a relevant health professional, the disclosure could result in immediate and grave harm to the patient’s health and safety. To refuse consent to any proposed treatment To receive information relating to any proposed treatment and options To a second opinion To pain and symptom management PATIENTS IN ONTARIO HAVE THE RIGHT TO: Receive safe and proper care Have a medical professional clearly explain health problems and treatments to them Participate in healthcare decisions Ask questions and express concerns Request a second opinion; within reason Be assured that personal information is confidential Request to access their health information records Record Retention Privacy and record retention in the pharmacy are governed by multiple acts and regulations including the Persona Health Information Protection Act (PHIPA). All records are to be maintained in a manner that protects patient confidentiality and privacy through the use of physical, administrativem and technical safeguards. PHYSICAL SAFEGUARDS - keeping records on a shelf to protect from a flood. ADMINISTRATIVE SAFEGUARDS - polices and procedures, training staff on their obligations. TECHNICAL SAFEGUARDS - password protection, firewalls. Guiding Principles for Privacy and Record Retention Protected from theft, loss, and unauthorized use or disclosure. Authentic and reliable Timely, efficient, and accurate retrieval. Retained for the time periods set out in the law. Dispose of records securely. Circle of Care The circle of care is not a defined term in the Personal Health Information Protection Act (PHIPA). The Information and Privacy Commissioner of Ontario describes the Circle of Care as the ability of certain health information custodians to assume an individual’s consent to collect, use, or disclose personal health information for the purpose of providing healthcare, in circumstances defined in PHIPA. Kinds of Consent There are different kinds of consent that need to be understood so that healthcare professionals may use implied consent. Express Consent This is permission for something that is given specifically, either verbal or written. If the express consent is obtained from the patient verbally, then full documentation including the date and the time, as well as details surrounding the consent should be recorded. Implied Consent Implied consent is not expressly granted by a person, but rather implicitly granted by a person’s actions and the facts and circumstances of a particular situation. There is a specific criteria that forms implied consent that is provided by the Information and Privacy Commissioner of Ontario. Reporting a Privacy Breach In the event of a privacy breach, the responsible health information custodians (HIC) must notify the individual affected at the first reasonable opportunity. Inform the patient that they can make a complaint about the breach to the Information and Privacy Commissioner of Ontario. If any disciplinary action against a regulated healthcare professional relation to their unauthorized collection, use, disclosure, retention, or disposal of Personal Health Information must report that fact to their regulatory college. Autonomous Choice Autonomy is the capacity to make an informed, uncoerced decision with understanding. Faden and Beauchamp’s Theory of Autonomous Action describes conditions required to make an autonomous choice. The conditions are: Understand - the actions are based on understanding the situation and choices. Intentional - the actions are willed and performed according to one’s plan. Voluntary - their actions are free of external coercion and manipulation. Module 4: Communication and Conflict Management What is Communication? Communication is the process by which information is exchanged between individuals through a common system of symbols, signs, and/or behavior. The components that form communication are: Sender and Receiver Medium/channel Contextual factors Message itself Feedback Sender and Receiver The sender and receiver are different individuals who may have different beliefs, values, and personalities. Medium/Channel The medium or channel describes how the communication has taken place. It could be face-to-face, by email, over the phone, etc. The medium that we choose for communication should be based on the following factors: Importance of the message Practicality Sender and receiver’s preferences Receiver’s communication style Need for feedback Contextual Factors Contextual factors may include: Verbal vs. non-verbal communication (tone of voice, volume, rate of speech, body language) Timing Environment Type of language that is used for the message Assumptions that could be made The willingness of the receiver to engage in the dialog Message The object of the communication of the thing that is being communicated. The message could be spoken, written, visual, and/or physical signals. Feedback Feedback allows one-way communication to turn into two-way communication. There is a positive and negative feedback. Positive feedback indicates that the receiver has received the message and understood the message. Negative feedback indicates that the receiver either has not received the message or has not understood its content. Conflict Management Conflict is a mental struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands. Conflict can arise when two or more individuals view issues from differing perspectives. In general, conflict is perceived as negatice yet it can be healthy. If a conflict is left unmanaged, it can hinder care and lead to abuse and bullying. Conflict of Interest A conflict of interest is defined as a conflict between the private interests and the official responsibilities of a person in a position of trust. There is an actual conflict of interest and a perceived conflict of interest. Module 5: Cultural Diversity Culture Culture is present in all patients and care providers. Culture plays a role in the interactions among patients, their families, healthcare providers, and systems. In Canada, patients and healthcare professionals come from many different cultures. The Canadian Charter of Rights and Freedoms guarantees individual rights and freedomes to all Canadians and stipulates that those rights must be interpreted in the context of cultural diversity. Culture can Influence: Health and the management of illness. Patient’s approach to attending medical appointments in a timely manner. Some patients prefer not being informed of a terminal illness or the implications of not following through with adherence. Eating and fasting rituals, even when nourishment is vital to recovery and overall function. Level of family influence on patient care decisions. Gender differences in a given culture may also affect health and patient outcomes. As well, there may be differences among men and women seeking treatment for mental health problems. Module 6: Medical Assistance in Dying (MAiD) Medical Assistance in Dying (MAiD) MAiD includes circumstances where a medical practitioner or nurse practitioner at an individual’s request: Administers a substance that causes an individual’s death; OR Prescribes a substance for an individual to self-administer to cause their own death. In February 2015, the Supreme Court of Canada ruled that all provinces and territories in Canada must permit some form of physician-assisted death. In June 2016, the federal government enacted amendments to the Criminal Code of Canada to include circumstances under which medical assistance in dying is permitted. Pharmacists and Pharmacy Technicians are now exempt from criminal liability when dispensing a medication that is written by a medical or nurse practitioner in providing medical assistance in dying in accordance with applicable federal legislation, provincial or territorial legislation, standards, policies, or guidelines, is protected from criminal liability. What if I do not agree with MAiD? Conscientious objection is the refusal to perform a legal role or responsibility because of personal beliefs. There are several activities that conscientious objection applies to in pharmacy. These include terminating a pregnancy, MAiD, contraceptives, and blood transfusions. A healthcare professional can limit the health services he or she provides for reasons of conscience or religion BUT cannot impede, either directly or indirectly, access to those services for existing patients, or those seeking to become patients. OCP provides guidelines to members that they must, in circumstances where they are unwilling to provide a product or service to a patient on the basis of moral or religious grounds, ensure the following: That the member does not directly convey their conscientious objection to the patient. That the member participates in a system designed to respect the patient’s right to receive products and services requested. Treating Family, Friends, and Yourself Treating Family, Friends, and Yourself is generally considered to be inappropriate and a conflict of interest. It can potentially compromise objective and unbiased professional judgment. There is a balance of power in this kind of situation. Family and friends may also be hesitant to provide a complete medical history. Transfer of Care Transfer of care can occur in many different situations that include: When the patients acuity changes. If the pharmacy is unable to provide services that the patient needs. If the patient moves to a different city or pharmacy. If the pharmacy terminates the patient-pharmacists relationship (this is rare and requires additional steps). Transfer of Care Process To ensure that the transfer of care process is completed properly, the pharmacist may decide to complete one of the following: MedsCheck During the MedsCheck, a one-on-one interview between the pharmacist and the patient occurs to review the patient’s prescription and non-prescription medications. Through this process, patients are encouraged to better understand their medication therapy. It also helps to ensure that patients are taking their medications as prescribed and that they are receiving the most benefit from their medications. Medication Reconciliation This is a process of creating the most accurate list possible of all medications a patient is taking and comparing that list against the physician’s admission, transfer, and/or discharge orders, with the goal of providing correct medications. In many hospitals, Pharmacy Technicians are responsible for completing medication reconciliations. Documentation for Transfer of Care Documentation occurs when there is a transfer of care in order to ensure continuity of care and collaboration. In order to enable effective communication, documentation must be clear and available. Effective documentation optimizes decision-making and helps to reduce duplication of services. There are two main kinds of documentation that can occur with a transfer of care: Transfer of Care Note Orders/Prescriptions Medication Safety All pharmacists and pharmacy technicians have the responsibility and obligation to manage medication incidents and address unsafe practice. Documenting and communicating all medication incidents and near misses with the entire pharmacy staff, and as appropriate to the patient and other healthcare providers. Communication with other healthcare providers will occur if the incident reaches the patient. Pharmacists and Pharmacy Technicians are required to record all medication incidents, near misses, and engage in continuous quality improvement planning and initiatives to improve system vulnerabilities. AIMS is a standardized medication safety program that will support continuous quality improvement and out in place a mandatory consistent standard for medication safety for all pharmacies in the province. The goal of the program is to reduce the risk of patient harm caused by medication in Ontario pharmacies. PharmaPod is an online platform use to record medication events as part of the AIMS program. The data entered by each pharmacy is anonymous. Module 7: Continuous Professional Development Continuous Professional Development Continuous professional development (CPD) is a post-graduate professional education, involving a cycle where individuals: Assess their learning needs. Create a personal learning plan. Implement the plan, and Evaluate the effectiveness of the education intervention as it applies to their pharmacy practice. CPD is Different In CPD, the approach or process is more important rather than the individual learning activity. With traditional continuing education, the focus is on structured, organized educational programs. CPD is different as it emphasizes the practitioner’s self-identified learning needs; it is linked to needs within the practitioner’s practice and it focuses on outcomes. Every 20% of pharmacists in Part of the Register and pharmacy technicians will be randomly selected to complete a self-assessment tool. This means that every pharmacist in Part A and every pharmacy technician will be selected to participate once in every five-year cycle. Why will this happen? A commitment to life-long learning is a fundamental requirement of all healthcare professionals. This requirement is mandatory by the OCP. Remember the code of ethics. Principle of non-maleficence and standard 2.2 which states that members ensure that they remain current with respect to professional knowledge and skills and are committed to continuous lifelong learning and professional involvement throughout their professional working life. Self-Assessment Tools Plan Create a plan to achieve a goal. Learning objectives are documented and resources/activities that will help achieve these goals are identified. Choose activities/targets that are the most meaningful to the individual. The final step is to set a target date to complete the objectives. Act Implement the plan Document Record education. Sometimes the documentation activity is pictured in the center of the learning cycle because all stages are recorded. Module 8: Pharmacy Gathering How to Answer a Question In the pharmacy environment, there are a variety of sources and information available to help inform your answer. Before answering a query it is important to ask yourself some key questions. You should ask yourself: 1. Am I answering the right question? **sometimes when someone asks you a question they are not clear on what they are asking. If you feel that you need clarification on the question being asked you need to be open and ask the patient so that you fully understand the question that they are asking. 2. Is there more than one possible answer? **sometimes the solutions to problems or questions in pharmacy have more than one answer. 3. Do I have all the information I need to answer the question? **in pharmacy we do not guess what the correct answer is. When presented with any uncertainty on the answer or solution a pharmacy professional will find the appropriate resource in order to provide the correct answer. A patient comes into the pharmacy and states her salbutamol is not working and asks if she can have a replacement bottle free of cost. Before you solve this problem, you should ask yourself what is the actual question? Are they asking about: Ineffective medication?  Ineffective technique? Expired medication? Ineffective delivery of the medication due to a problem with the device it is contained in? In this example, we see how broad of a question is actually posed by the patient. Before being able to answer the question the pharmacy technician should probe for additional information in order to figure out exactly what is wrong with the salbutamol inhaler. Steps to Respond to a Query 1. Secure the requestors demographics. It’s important to know your audience, as your response technique may differ depending on whether the question comes from a health care professional or a patient. 2. Obtain background information Determine whether it’s a general or patient-specific question, and then identify resources the requestor has already consulted to help facilitate the process. What does the requester already know? What more do you need to know? You need to be a detective! 3. Determine and categorize the question For example - you may need to determine the drug coverage, device technique instruction, clinical information 4. Develop a strategy and conduct a search There are three types of literature -- Primary, Secondary, Tertiary literature. The format for the literature may be electronic or print. The information that you need may be presented as text, images, and/or videos. Demonstrations may be available to help the patient. In order to find the information you may need to conduct interviews or have discussions with others (for example, healthcare professionals, vendors, Ministry of Health staff members, etc.) 5. Perform evaluation, analysis, and synthesis. Objectively critique all of the information you retrieve from your comprehensive search. Also, consider the background information of your question. Consult with health care professionals with expertise in the specific topic. 6. Formulate and provide a response. If there is more than one possible answer, inform the requestor of that and indicate if one is more desirable (if applicable). Present competing viewpoints and considerations if appropriate. Also, describe your evaluation of the research. Written responses should always be concise and fully referenced.  7. Conduct follow-up and documentation as necessary. Following up is important for ensuring the information was received. Always document your drug information questions so you can refer back to them. Share with others in your team as appropriate. You’ll likely see the same question in the future, and this well help serve as a reference point. Different Kinds of Literature In the above steps we discussed different kinds of literature that are available during information findings. We will look at all three kinds - primary, secondary, and tertiary. Primary Literature These primary sources are original materials. It is authored by researchers, contains original research data, and is usually published in a peer-reviewed journal. Primary literature may also include conference papers, pre-prints, or preliminary reports. Secondary Literature Secondary literature consists of interpretations and evaluations that are derived from or refer to the primary source literature. Examples include review articles (specifically meta-analysis and systematic reviews) and reference works. Professionals within each discipline take the primary literature and synthesize, generalize, and integrate new research. Tertiary Literature Tertiary literature consists of a distillation and collection of primary and secondary sources such as textbooks, encyclopedia articles, and guidebooks or handbooks. The purpose of tertiary literature is to provide an overview of key research findings and an introduction to principles and practices within the discipline. Module 9: Professional Boundaries A boundary is an accepted social, physical, or psychological space between people. Boundaries create an appropriate therapeutic distance between healthcare professionals and patients and clarify their respective roles and expectations. Boundary violations are harmful and exploitative to the patient. Sexual contact with a patient is always considered a boundary violation. Sexual Abuse The sexual abuse of a patient by a member is defined as: Sexual intercourse or other forms of sexual relations between the member and the patient. Touching of a sexual nature, of the patient by the member. Behavior or remarks of a sexual nature, by the member towards the patient. A co-existing sexual and patient relationship is considered to be professional misconduct and an act of sexual abuse. Education Plan RHPA requires that Ontario’s regulated health professionals develop sexual abuse prevention programs. OCP has established a fund for therapy and counseling for persons who, as patients, were sexually abused by a member of the college. Preventing Sexual Abuse and Harassment Under the RHPA, any form of sexual relations between a member and a patient is considered to be sexual abuse. Per RHPA, if a member of a college is not exempt from spousal treatment, the member can provide care to a spouse in an emergency or incidental situation. The member must transfer care as soon as it is practical. OCP does not exempt the treatment of spouses from this rule, and as such, does not permit the provision of routine care to a spouse. Maintaining Appropriate Professional Boundaries Show sensitivity and respect for the patient’s privacy and comfort at all times. Outside of clinical necessity, avoid any physical contact with a patient that could be perceived as inappropriate. Avoid any behaviour or remarks that may be interpreted as sexual by the patient. Endeavor to be aware or mindful of a patient’s particular cultural or religious background. Do not make sexualized comments about a patient’s body or clothing. Do not criticize or comment unnecessarily on a patient’s sexual preference. Do not ask questions of sexual history or behavior unless related to the purpose of the consultation. Be cognizant of social interactions with patients that may lead to romantic involvement. Learn to control the consultation setting and to detect possible erosions in boundaries. Discrimination Discrimination is an action or a decision that results in the unfair treatment or negative treatment of person or group because of their race, age, religion, sex, etc. Some types of discrimination are illegal under federal and provincial human rights laws. Discrimination usually indicates the following elements: Not individually assessing the unique merits, capacities, and circumstances of a person. Making stereotypical assumptions basied oon a person’s presumed traits. Having the impact of excluding persons, denying benefits, or imposing burdens. Harassment This is a common discriminatory practice. It is defined as engaging in conduct that is known or ought reasonably to be known to be unwelcome. Harassment occurs when someone: Offends or humiliates you physically or verbally. Threatens or intimidates you. Makes unwelcome remarks or jokes about your race, religion, sex, age, diability, etc. Displaying or circulating offensive pictures or materials, or offensive or intimidating phone calls. Makes unnecessary physical contact with you, such as touching, patting, pinching, or punching. This can also be assault.