In fall 2011, I charged the 2012 Public and Professional Relations Committee with a daunting task: to develop a series of commentaries to address the question, “Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that could apply to any clinical practice setting?” WHAT was I thinking? It sounds easy, but it is more complicated than you might think. As most of you are aware, ACCP has published a definition of clinical pharmacy (please see http://www.accp.com/docs/positions/commentaries/Clinpharmdefnfinal.pdf). We have also developed a comprehensive list of Clinical Pharmacy Competencies (please see http://www.accp.com/docs/positions/whitePapers/CliniPharmCompTFfinalDraft.pdf). Isn’t that enough? Well, not exactly…
What remains is for our discipline to describe, beyond a reasonable doubt, “The WHAT.” That is, our discipline needs to define, articulate with clarity, and demonstrate consistently WHAT clinical pharmacists do to improve patients’ drug therapy outcomes. Let me explain. Individually, we all employ a method to address a new or returning patient in our own clinical practices. We have developed our own approaches to conducting an interview, performing a detailed assessment, and formulating plans for drug therapy management and monitoring. However, there is a significant degree of variability in how we all do this. Should we not invest the time and effort to determine whether there is a single, consistent approach to direct patient care that results in reproducible, optimal patient outcomes? In addition, when we are asked by patients, other health professionals, and payers to demonstrate that we can consistently deliver better patient-specific outcomes, shouldn’t we be well positioned to do so? We can debate the merits of precise patient care rubrics and even discuss which organ system is most important, but it seems to me that embracing a consistent, reproducible approach to direct patient care would position clinical pharmacists to maximally leverage their activities to the benefit of patients.
To be honest, a “cowboy” mentality remains within sectors of our discipline that has existed since I was a student. Many of you have seen this, right? It’s sometimes manifested by an attitude of fierce independence (“You can’t tell me how to practice!”) and dogged autonomy (“I’ll do whatever I want to do”). Indeed, when I’ve encountered external evaluators responsible for assessing clinical pharmacy practices in various patient care settings, these evaluators have said to me, “If you’ve seen one (clinical pharmacist’s practice), you’ve seen one.”
Is it unreasonable or unrealistic to expect that the clinical pharmacy discipline could embrace a consistent process of direct patient care? Such a process is already in place in many disciplines, and we should be able to develop a defined process and procedure for clinical pharmacy practice so that other health care professionals know WHAT we do and WHAT kind of outcomes can be expected from our direct patient care activities. Remember the last time you visited your dentist? Okay, I loathe going to the dentist, too. However, I recognize that the care I receive from my dentist is consistent and reproducible—dentists employ the same procedure every time. They start their examination with tooth No. 1 and proceed through tooth No. 32; they evaluate the gums and tongue; they inquire about the patient’s general health status. And every dentist does it the same way. Hence, I know exactly what process to expect when I visit my dentist. Some of you are aware of my humble beginnings in health care as a nursing assistant. At that time, I observed a nursing process that is still in practice today: assessment, nursing diagnosis, outcome planning, implementation, and evaluation—a five-step process that is repeated with every patient and on every nursing unit regardless of the acuity of care. During the physician’s routine physical examination, a review of systems approach is used to be certain one evaluates and considers the “whole patient” in the same manner every time; shortcuts can lead to missed signs/symptoms that can result in diagnostic misadventures.
In my view, clinical pharmacists need to adopt a similarly consistent practice. Such a “consensus practice model” should involve an approach that every clinical pharmacist can embrace and that can be validated and promoted to all stakeholders. So, I hope that you’ll read with interest part I of the Public and Professional Affairs Committee commentary, which is featured as the lead story on page 1 of this issue of the ACCP Report. For the next 4 months, the committee will help guide us down the road toward considering the question regarding the need for a consistent clinical pharmacy practice approach. Through this series of commentaries, readers will become familiar with the major issues surrounding this controversial question. The commentary series will also set the stage for an unprecedented Keynote Session and expert panel discussion at the 2012 ACCP Annual Meeting in Hollywood, Florida, on October 21. Later that afternoon, Annual Meeting attendees will have the opportunity to participate in a special Town Hall Meeting and provide “in-the-trenches” grassroots input into this discipline-wide discussion.
As always, all ACCP members are invited to provide the Board of Regents and me with input on this issue. E-mail me at firstname.lastname@example.org or log-in to the ACCP Feedback site at http://www.accp.com/feedback/index.aspx and express your opinions there. Remember, the Board of Regents receives all of these comments on at least a quarterly basis; hence, your voice will be heard. Stay tuned for more perspectives on this subject in my upcoming July and September president’s columns. And yes, I’ll still be asking in those columns “WHAT was I thinking?!”