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PROFESSIONAL JUDGEMENT Della Croteau Deputy Registrar/Director of Programs Greg Ujiye, B.Sc.Phm. Manager, Pharmacy Practice Programs The College continues to receive many phone calls from pharmacists seeking the College's opinion on situations they are facing in which there are no simple solutions and which in fact, require the pharmacist's professional judgement. The inquiring pharmacists often describe specific situations and request that the College provide an opinion on whether the pharmacist should or can take a certain action. We also receive calls from pharmacists that describe specific patient situations and are seeking OCP advice on what to do. It is important to know that professional judgement is a vital element in each and every practice. The prescribed laws 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, the laws and policies provide a detailed set of requirements, standards, and most importantly, intent for pharmacy practice. Seeking the College's opinion on a given topic is in fact asking a member of the College staff to interpret applicable professional standards on behalf of the inquiring pharmacist. The College staff member cannot do this for reasons of legal limitation, and most importantly, because the pharmacist is the person closest to and most aware of the patient situation under question. (Interpretations by anyone other than the attending pharmacist would therefore not reflect the judgement of the one person who is legally recognized to care for the patient.) 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. While professional judgement is the end result of several complex factors, we list below the key areas that you should consider whenever exercising professional judgement: 1. Actions that are in the best interest of the patient 2. Knowledge and expertise 3. A decision that your peers would consider reasonable given the circumstances 4. Documentation 1. Take actions that are in the best interest of your patient Upholding patient care is the over-riding principle that must be considered in all situations involving professional judgement. Your actions and decisions must always be made from the perspective of what is in the best interest of your patient. Your patient must have an active role in the decision-making process as well as understand all the options and choices that are available to them. Your role as pharmacist is to ensure the patient fully understands the situation and the reasons behind your recommendations. 2. Knowledge and expertise Your knowledge and expertise are the most vital and complex of the factors involved in all patient-care decisions in that you routinely draw upon the range of experiences that you have gained as a professional in clinical practice and from your everyday life experiences. Your ability to use the information at hand (e.g. patient history), to gather pertinent patient information through dialogue and communication skills, to observe and listen and to assess the benefits and risks to the patient, are all essential elements to being able to make professional judgements. (These are also key elements in the Standards of Practice.) 3. Make decisions that your peers would consider reasonable given the circumstances While you may sometimes have the luxury of additional time and the opportunity to discuss specific issues with your peers, you are typically constrained by pressures to make rapid and sound judgements for your patients that would also reflect what your peers, in such circumstances, would consider reasonable and acceptable. 4. Documentation While the over-riding principle in exercising professional judgement is to protect the interests of each patient, the key to making professional judgements is to maintain documentation. All relevant actions must be documented, otherwise they could easily be assumed to not have occurred. In each case you should: i) Ensure that you document what happened and why (i.e. the events leading up to the issue) ii) Document your course of action and reasoning for those particular actions iii) Ensure that you document the names of the professionals with whom you conferred and when vi) Document all outcomes. Documentation is essential to helping you recall or retrieve information on what has transpired and, more importantly, it serves as a valuable reference for others who may later be required to follow-up or review the particular case Indeed, we have, as professionals, the privilege of being able to apply our professional judgement as well as the responsibility of ensuring that we apply this judgement in a thorough way that allows both our patients and peers to understand our reasoning.