PHARMACY CONNECTION ARTICLE

Professional Judgment

Published on: November 1, 2012

The new regulation permitting an expanded scope of practice requires that, more than ever, pharmacists use professional judgment to assess their patient’s health status and make appropriate decisions regarding their medication management. A key principle of practice when pharmacists exercise expanded scope activities is that they do so only for the benefit of the patient based on the individual nature of the patient’s need/history.

The Royal Pharmaceutical Society of Great Britain provides the following advice in their Code of Ethics on the exercise of professional judgment:

The exercise of professional judgement requires identification and evaluation of the risks and benefits associated with possible courses of action. On occasion there may not be a right or wrong answer. Different people may reach different decisions on a single set of circumstances and each may be justifiable.

A decision arrived at through the use of professional judgment is rooted in the problem to be solved and the individual pharmacists’ education, training and experience. Pharmacists already make professional judgment decisions daily, for example, determining whether to:

• Dispense or not dispense a medication for a patient; or
• Acting on or over-riding a drug interaction warning.

When several courses of action are available, the pharmacist applies their expertise and chooses the one that is most appropriate based on an assessment of the patient, the medication-related issue, and the patient’s best interests, documents his or her actions and rationale and if appropriate notifies the primary health care provider.

The Standards of Practice and Code of Ethics are the two most important tools for a pharmacist when faced with using their professional judgment. The key factors that apply to the exercise of professional judgment are:

1. The best interest of the patient;
2. The pharmacist’s knowledge and expertise;
3. Whether the decision is both reasonable and acceptable; and
4. Documenting the rationale and actions.

1. Taking Actions in the Patient’s Best Interest:

Actions and decisions must always be made from the perspective of what is in the best interest of the patient. The patient, or his or her agent, are partners in the decision-making process and must be provided with enough information to understand the options and choices that are available to them in order to provide an informed consent. The role of the pharmacist is to ensure that the patient, and his or her agent, fully understands the situation and the rationale for the recommendations that are being offered.

2. Applying Knowledge and Expertise:

The pharmacist’s knowledge and expertise is the most complex of the factors involved in patient care decisions because they are based on the range of experience gained through clinical practice in general and through involvement in similar circumstances, if any. The other factors that go into decision-making are based on the pharmacist’s assessment of the patient, including utilizing the information in the patient record, if any, and dialogue with the patient in order to assess the benefits and risks of a proposed approach to therapy.

3. Reasonable and Acceptable:

At times, there may be an opportunity to discuss specific issues with a colleague; however, generally decisions must be made immediately, based on the information at hand. When a decision must be made immediately, it may be helpful to objectively consider whether a peer would make a similar decision, given the circumstances, or whether the rationale that supports the decision would be understood and accepted in a similar practice.

4. Documenting the Rationale and Actions:

Documentation is a key element of every health profession’s standard of practice and one of the most basic professional responsibilities. The pharmacist demonstrates accountability and responsibility for their actions, and evidence of the application of their medication and medication therapy management expertise, through documentation. Documentation should be organized in such a manner that all professional actions on behalf of a patient are accurately described. The College’s Documentation Guideline (which can be found on the College’s website, www.ocpinfo.com) provides guidance in this area.

Summary

Professional judgment is a vital element in everyday practice. The prescribed laws, protocols and policies of our profession can never, nor do they attempt, to provide detailed solutions for every possible situation that a pharmacist might encounter. Rather, they provide a comprehensive set of requirements, standards, and most importantly, intent for pharmacy practice.

Members sometimes seek the College’s “opinion” on a specific situation by asking College staff to interpret applicable professional standards, but the pharmacist is the individual closest to and most aware of the patient’s situation. Interpretations by anyone other than the attending pharmacist would therefore not reflect the judgement of the one person who is responsible and accountable for the decision.

Interpreting the intent and spirit of our profession’s standards can certainly pose difficulties for resolving practice issues, but this ability to interpret is also one of the most valuable contributions that a pharmacist can bring to patient care and practice.