Beyond Standard Operating. Critical Thinking Skills to. Caryn Marie Dellamorte Bing, RPh, MS, FASHP

Transcription

1 Beyond Standard Operating Procedures: Applying Critical Thinking Skills to Your Practice Caryn Marie Dellamorte Bing, RPh, MS, FASHP Clinical Services/Residency Program Manager Critical Care Systems, Inc.

2 Top 5 Things to Know for CE: Make sure your BADGE IS SCANNED each time you enter a session, to record your attendance. Carry the Evaluation Packet you received on registration with you to EVERY session. If you re not applying for CE, we still want to hear from you! Your opinions about our conference are very valuable. Pharmacists, Pharmacy Technicians and Nurses need to track their hours on the Statement of Continuing Education Certificate form as they go. FOR CE: At your last session, total the hours and sign both pages of your Statement of Continuing Education Certificate form. Keep the PINK copies for your records. Place the YELLOW and WHITE copies in your Evaluation packet. Make sure an evaluation form from each session you attended is completed and in your Evaluation packet (forgot to pick up an evaluation form at a session? (Extras are available in an accordion file near the registration desk.) Put your name and unique member ID number (six digit number on the bottom of your badge) on the outside of the packet, seal it, and drop it in the drop boxes in the NHIA registration area at the convention center.

3 Disclosures Caryn Marie Dellamorte Bing declares no conflicts of interest or financial interest in any service or product mentioned in this program. Cli i l t i l d ff l b l ill t b Clinical trials and off-label uses will not be discussed during this presentation.

4 Program objectives Review the role and limitations of standard operating procedures in home infusion therapy (HIT) practice. Describe the core elements of critical thinking. Apply a critical thinking framework to case study scenarios.

5 Audience poll What sources do you rely on when your SOPs do not fully address a situation? a) Corporate management tells us what to do. b) We just do it if we think it will be okay. c) Process for researching and recommending an approach, getting approval d) Some combination of the above e) Other

6 Role and limitations it ti of SOPs in practice Why do we have policies, SOPs, and practice standards: Uniform delivery of care Education and training Compliance with law and regulation Risk management

7 Sources of uniformity Clinical guidelines Evidence-based practice standards Research Internal policies and standards Other?

8 Compliance Absolute requirements = absolute SOP s Federal law/regulation State t law/regulation l Accreditation standards Gray areas Absent, incomplete, or inapplicable requirements Professional (clinical) judgment

9 Deal with the 80:20 rule If SOPs address HIT patient needs 80% of the time, what about the other 20%? What is your approach? Inflexible: Say No, unless the situation is black and white. (Would we have a HIT service model today?) Just do it: Ask for forgiveness, not permission. Responsible: Apply critical thinking.

10 Application of critical thinking Many references in higher education literature (see bibliography) Today s focus on management and care process: When policies, standards, and established references are not specific Synthesis of multiple data sources Patient need, policy, orders, referral requests, logistics, capabilities, demand for resources, time constraints, conflicting goals, new information

11 Core elements of critical thinking Identify the problem. Gather pertinent information. Interpret data to appraise evidence and evaluate arguments. Recognize the existence (or nonexistence) of logical relationships between propositions. Draw warranted conclusions and generalizations. Put to test the conclusions and generalizations at which one arrives. Reconstruct one's patterns of beliefs on the basis of wider experience. Render accurate judgments.

12 Applying a decision model to new or unusual requests Adapted from Six-Step Decision Making Model for Determining Nursing Scope of Practice. Texas State Board of Nursing. Accessed February 9, 2011.

13 Is the activity consistent with law, position statements, or requirements documents? If YES, continue If NO, then stop

14 Is the activity authorized in a valid order/prescription? If YES, continue If NO, then stop* *May need to facilitate receipt of a valid order/rx

15 Is the activity addressed in established policies/ procedures/sop? If YES, continue If NO, then stop* *May work to obtain authorization and/or develop procedure/sop

16 Is the activity supported in external guidelines? If YES, continue If NO, then stop* *May require a comprehensive literature search

17 Do staff possess the knowledge/competency to safely execute the activity? it If YES, continue If NO, then stop * * May require staff development/training

18 Would a prudent pharmacist/clinician participate in this care? If YES, continue If NO, then stop

19 Will you assume professional accountability for the safe care and outcome of care? If YES, continue If NO, then stop ask not of others

20 Strategies t for managing risk in gray areas Interdisciplinary patient care plan Staff education and competency validation Clear, concise patient education materials Therapy-specific informed consent Clinical documentation (patient) Source documentation (references) Management documentation (approval)

21 Case examples Let s make a home infusion i time warp jump...back to the future?

22 Recap and discussion i Report back from groups

23 Bibliography Critical thinking in education: Karimi R, Arendt CS, Cawley P, Buhler AV, et.al. Learning bridge: curricular integration of didactic and experiential education. American Journal of Pharmaceutical Education Apr 12;74(3):48. Earl GL. Using cooperative learning for a drug information assignment. American Journal of Pharmaceutical Education Nov 12;73(7): Pai VB, Kelley KA, Bellebaum KL. A technology-enhanced patient case workshop. American Journal of Pharmaceutical Education Aug 28;73(5):86. Wallman A, Lindblad AK, Gustavsson M, et.al. Factors associated with reflection among students after an advanced pharmacy practice experience (APPE) in Sweden. American Journal of Pharmaceutical Education Oct 1;73(6): Popovich NG, Katz NL. A microteaching exercise to develop performance-based abilities in pharmacy students. American Journal of Pharmaceutical Education Jul 10;73(4):73. Cisneros RM Assessment of critical thinking in pharmacy students. American Journal of Pharmaceutical Education Jul 10;73(4):66. Clinical decisions: Six-Step Decision Making Model for Determining Nursing Scope of Practice. Texas State Board of Nursing. p p p Accessed February 9, 2011.