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National Competency Framework for Pharmacists Working in Cancer Care
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Page 1: National Competency Framework for Pharmacists Working … · National Competency Framework for Pharmacists ... a National Competency Framework for pharmacists working in cancer ...

National Competency Framework for Pharmacists

Working in Cancer Care

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Table of Contents

Background 4

Method 4

Structure of Competency Framework 5

Domain 1: Professional Practice 6

Domain 2: Personal Skills 8

Domain 3: Supply of Medicines 10

Domain 4: Safe & Rational Use of Medicines 12

Domain 5: Public Health 16

Domain 6: Organisation & Management Skills 18

Glossary 21

Abbreviations 22

References 23

3

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BackgroundThe role of pharmacists in the delivery of cancer care has changed significantly in Irelandover recent years. These changes are largely due to increases in the use of chemotherapyas a result of the aging population, and supportive therapy for the management of sideeffects and co-morbidities. In addition, there has been a significant increase in the use of oral anticancer medicines (OAM) which are dispensed to patients in the community.Consequently, the skill and knowledge requirement of pharmacists involved in the deliveryof cancer care, in both hospitals and communities, has changed. This was recognised inthe NCCP Oncology Medication Safety Review (1) which recommended the developmentof: “National competencies for all disciplines in relation to acute oncology in collaborationwith the relevant colleges and professional bodies”.

Competence assessment has evolved and been influenced by the learning taxonomydevised by Bloom (2). Bates & Bruno (3) define competence as “the overarching capacityof a person to perform”. Competencies are the “functional”, the “what” that are attachedto competence and are defined as the knowledge, skills, attitudes and behaviours that anindividual develops through education, training, development and experience (3).

This National Competency Framework hopes to inform the development and provision oftraining for pharmacists working in cancer care. In addition, it will address the need tooptimise medicine use, to improve the quality of care and to improve outcomes for cancerpatients by illustrating the behaviours, skills and knowledge pharmacists require forworking in cancer care. This competency framework can be used at an individual level tomeasure performance and to help pharmacists working in cancer care, through reflection,to identify gaps in their continuing professional development needs (4). At a more strategiclevel, it can be used as a method to inform the development and provision of training andeducation for pharmacists working in cancer care (5,6).

The specific knowledge, skills and behaviour-related indicators identified in thiscompetency framework are intended to be useful to the wide spectrum of pharmacistsworking within cancer care, including hospital and community pharmacists. The indicatorsdescribed do not cover every aspect of practice and may overlap with a number ofspecialities. Users are encouraged to link the indicators, as detailed, to those in the PSICore Competency Framework for Pharmacists (4) and other related fields such as palliative care (7), aseptic compounding, and other critical adjacencies.

MethodA working group was convened by the NCCP in May 2015 to support, guide and overseethe development of this framework. The working group included representatives from theNCCP, the Irish Institute of Pharmacy, the Irish Pharmacy Union, hospital oncologypharmacy and community pharmacy. An initial objective of the group was to identifyexisting national and international competency documents for pharmacists and to highlightthose which could be used as reference documents. It was decided to use thePharmaceutical Society of Ireland Core Competency Framework for Pharmacists in Ireland(4), the British Oncology Pharmacy Association (BOPA) competency document (8) and theRoyal Pharmaceutical Society (RPS) Leadership competencies (9) as the key referencedocuments for this work.

Using the PSI framework as the foundation, this document maps the competenciesestablished by the BOPA (8) and the RPS Leadership competencies (9) with the PSIdomains (4) in order to develop a National Competency Framework for pharmacists working in cancer care. Some competencies may fit within more than one domain.

In August 2015, a draft document was circulated to key stakeholders and published on the NCCP website as part of a national consultation exercise. All feedback received was considered by the working group experts.

4

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Structure of Competency FrameworkSimilar to the PSI framework, this framework contains six domains: professionalpractice, personal skills, supply of medicines, safe and rational use of medicines,public health, organisation and management skills. Each of the six domains has anumber of competencies presented. Indicators pertaining to knowledge, skills andbehaviours have been assigned within each domain. The indicators are applicableirrespective of the care setting or the staff grade.

Three levels of practice have been adopted for pharmacists working in cancer care:Generalist, Specialist and Advanced Specialist. The three levels in the competencyframework are not necessarily discrete. Each level builds on the previous, creating awider viewpoint at each stage; thus there is a gradation in understanding at differentlevels. Pharmacists mapping their activities will find themselves operating acrossseveral levels. This facilitates the formulation of professional development plans (8).

The first level of practice is defined as Generalist and consists of specific behavioursessential for any pharmacist providing cancer care, including both hospitalpharmacists and community pharmacists. Pharmacists at this level will have a basiclevel of understanding of the principles involved in the prevention, diagnosis andtreatment of common cancers. In a hospital setting, these pharmacists would typicallybe working under the guidance of a more experienced oncology pharmacist and maynot necessarily wish to specialise further as oncology pharmacists themselves. Thesereflect the particular competences required at point of PSI registration or related tocurrent role. The goal is to define a minimum level of competence for any pharmacisthaving an oncology clinical input.

The second level of practice is defined as Specialist. This is aimed at pharmacists whodemonstrate a commitment to oncology practice. Any pharmacist described as anoncology pharmacist or equivalent should be at, or aiming for, this level of practice.Pharmacists practising at this level will have an in-depth knowledge of both thetreatment and support of patients with a wide range of cancers. This is the minimumdesirable level for a pharmacist practising in oncology without the lead of a moreexperienced pharmacist.

The third level of practice is defined as Advanced Specialist. Pharmacists operating atthis level will usually have a more strategic view of cancer services. They will haveconsiderable in-depth knowledge, skills and experience in oncology practice, and willbe able to demonstrate experience of caring for patients with complex co-morbiditiesor pharmaceutical care issues, or those with more specialist conditions within cancercare.

5

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Domain 1: Professional Practice�

n Practises ‘patient-centred’ care

n Practises professionally

n Practises legally

n Practises ethically

n Engages in appropriate continuing professional development

UNDERSTANDING CANCER

Generalist Specialist Advanced Specialist

6

n Understands the causes ofcancer and has an awarenessof the disease process.

n Knowledge of the key roles ofthe oncology, haematology andpalliative care teams.

n Understands the organisationalstructure of cancer services(surgery, radiation and medicaloncology) as set out by theNCCP, e.g. the relationshipbetween hospital networks1.

n Understands commonterminology used in cancer.

n Understands impact of canceron patients and families.

n Demonstrates a comprehensiveunderstanding of the patient’scancer journey.

n Understands likely diseaseprogression within their scopeof practice and impact onpatient’s cancer journey.

n Demonstrates a comprehensiveunderstanding of thetreatments, therapies and therole a higher level practitionerplays in the holistic care of thepatient.

n Knowledge to act as aspecialist resource for adviceand support to healthprofessionals, patients andcarers.

n Provides education andtraining to healthprofessionals, patients andcarers within own specialistarea.

n Knowledge of the NationalCancer Strategy.

n Assesses and advises on theimpact national initiatives willhave upon local cancerservices.

n Develops recommendations onthe delivery of innovativecancer practice.

n Actively participates in thedevelopment and configurationof cancer services within theirlocality.

n Personally contributes to andutilises evidence to inform ownpractice and that of others.

n Knowledge of specialistcentres for specific cancers.

1 Network is defined as a designated cancer centre (hub) and their affiliated hospital(s) (spoke) where medical consultants from the hubhospital have sessional commitments in spoke hospitals. In instances where there are no such affiliations between hospitals then the term“network” refers to an individual hospital.

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INFORMING, INVOLVING & SUPPORTING PATIENTS

Generalist Specialist Advanced Specialist

Within their scope of practice:

n Knowledge of information andneeds of patients and theirfamilies and the organisationsthat can provide informationand support.

n Monitors the medicines andother healthcare needs of thepatient on a regular basis andmakes recommendations forimprovement to the patientand other healthcareprofessionals as appropriate.

n Knowledge to impartinformation to patients andtheir carers in an appropriateformat/language on theirsystemic treatment andsupportive care medications(regimen schedule, possibleside effects and theirmanagement and prevention).

n Knowledge of educational andinformation leaflets whichpatients and carers shouldreceive for specificregimens/treatments.

n Awareness of the groups ofpatients and carers who havemore difficulty in accessinginformation and the toolsavailable to assist them.

n Knowledge of the main localand national support groupsand how to access them.

n Knowledge of pharmacyinvolvement in patienteducation on Systemic Anti-Cancer Therapy (SACT)programs, includingambulatory pump programs,oral assessment andeducation.

n Awareness of patient userinvolvement initiatives.

n Able to utilise all forms ofpatient information to enablethe patient to have a betterunderstanding of theirdiagnosis and treatment plan.This will include the use oftools for patient/carers fromthe minority groups.

n Recognises deficits inpatient’s information,developing and implementingnew materials.

n Ensures consistent informationacross the patient carepathway.

n Develops protocols andprocedures to ensure patientsreceive all relevantinformation.

n Develops links with patientsupport groups (community-based services/cancer carenurse education/ community-based nurse service) in orderto be able to signpost patientsappropriately.

n Utilises a range of techniquesto monitor patient/usersatisfaction with the service.

n Involvement in comprehensivepatient education programs.

7

Domain 1: Professional Practice

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Domain 2: Personal Skills�

n Leadership skills

n Decision-making skills

n Team working skills

n Communication skills

INTERPROFESSIONAL COLLABORATION

Generalist Specialist Advanced Specialist

n Knowledge of the carepathway foroncology/haematologypatients within theirscope of practice.

n Knowledge of how toaccess healthcareprofessionals fromacross the cancer carepathway.

n Ability to work withnurses, local physiciansand allied healthprofessionals to providecare – as part of amultidisciplinary team.

n Able to demonstrate an in-depth knowledge of theintegrated care pathway forareas within their hospital.

n Communicates effectivelywithin multi-professionalteam meetings.

n Knowledge to initiate andparticipate in caseconferences with allprofessionals involved in thedelivery of patient care.

n Team development of localoncology programmeprofessionals to solveproblems.

n Knowledge of how to accessthe local palliative careteam and to be able toadvise on drug-relatedmatters.

n Knowledge base to allowworking with a range ofdifferent specialists,including medical andradiation oncologists,surgeons, haematologists,etc.

n Encourages and supports colleagues to become actively involved in thenetworking process.

n Provides encouragement andopportunity for people to engage indecision making and to challengeconstructively.

n Respects, values and acknowledges the roles, contributions and expertiseof others.

n Evaluates and establishes inter-professional and inter-agencyprotocols/guidelines/patient carepathways.

n Participates in inter-professional/ inter-agency evaluation and audit.

n Develops network links with all keystakeholders at a local, regional and national level.

n Able to work with academic andresearch teams.

n Adopts a team approach,acknowledging and appreciatingefforts, contributions andcompromises.

n Recognises the common purpose of theteam and respects team decisions.

n Employs strategies to manage conflictsof interest and differences of opinion.

n Is willing to lead a team, involving theright people at the right time.

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Domain 2: Personal Skills

9

COMMUNICATION WITH CAREGIVERS IN THE HOME, IN OTHER INSTITUTIONS AND IN THE COMMUNITY

Generalist Specialist Advanced Specialist

Knowledge of communicationchannels within scope of practicewith:

n Patient’s family members andclose friends from thecommunity.

n Home care nursing and othercaregivers in the home.

n Other caregivers, includingthose from referral sites.

n Awareness ofconfidentiality/sensitivityissues in cancer care.

n Ability to build positiverelationships with patients,carers, colleagues and otherhealthcare professionals.

Knowledge of communicationchannels within network including:

n Cancer treatment specialistsfrom whom referrals arereceived.

n Family physiciancommunications.

n Other local specialists for related care.

n Local cancer societyrepresentatives.

n Home care agencies forconsultative advice.

Knowledge of communicationchannels outside networkincluding:

n Specialists for consultation oradvice.

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Domain 3: Supply of Medicines�

n Manufactures and compounds medicines

n Manages the medicines supply chain

n Reviews and dispenses medicines accurately

REGIMENS

Generalist Specialist Advanced Specialist

n Knowledge of first line and relapseregimens used within scope ofpractice.

n Demonstrates ability to accuratelyverify SACT prescriptions withinscope of practice.

n Applies pharmaceutical knowledgeto select appropriate ingredientsand excipients of the requiredquality standard for themanufacture and compounding ofmedicines.

n Knowledge and understanding ofCompassionate Use Medicines.

n Ability to advise on and queryappropriateness of prescribedregimens.

n Ability to assess compliance andability to manage oral SACT.

n Ability to demonstrate anappropriate treatment schedulefor a SACT regimen withsupportive treatment.

Knowledge of:

n First line and relapse regimens forcancers treated within Network.

n Current treatment guidelines, e.g.NCCP, NCCN, NICE, SIGN, etc.

n Develops protocols forNetwork, combiningdrug regimen andsupportive treatment,monitoring and dosageadjustment criteria.

n Implements newtreatment protocols andguidelines.

CALCULATION OF SACT DOSES, INCLUDING BSA DETERMINATION

Generalist Specialist Advanced Specialist

n Demonstrates the ability toperform pharmaceuticalcalculations accurately, e.g.m weight or BSAm use locally agreed BSA formula

(adult and paediatric)m carboplatin doses using Calvert

equation or 24 hour urinecollection

n Knowledge of issues surroundingobesity, renal and hepatic functionand low albumins, etc. on dosing.

n Awareness of dose banding,capping and rounding.

n Able to calculate lean bodyweight and ideal BSA.

n Able to advise on dosemodifications regarding issuessurrounding obesity, renal andhepatic function and lowalbumins, etc.

n Able to perform dosingcalculations for SACT inpaediatric populations.

n Awareness of differentmathematical modelsfor dose calculation.

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Domain 3: Supply of Medicines

11

USE OF SPECIALITY DEVICES FOR DRUG ADMINISTRATION, INCLUDING INFUSION PUMPS

Generalist Specialist Advanced Specialist

n Demonstrates awareness of use ofSACT delivery devices such aspumps and syringe drivers.

n Able to describe drugs used,within scope of practice, whichrequire filters, specific lines, etc.

n Awareness of stability of SACT.

n Awareness of the safe acquisition,storage and distribution/supply ofSACT.

n Knowledge of use andadvantages/disadvantages ofdifferent types of administrationdevices used within local areafor SACT and symptom control.

n Awareness of stability andcompatibility required for SACTdrugs.

n Awareness of newinfusion devices andtechnological advancesrelevant to SACTadministration.

n Knowledge ofalternative approachesto therapy, circadianrhythm infusions,pulsed therapy,intraoperativechemotherapy.

ROUTES OF ADMINISTRATION OF COMMONLY USED SYSTEMIC AGENTS

Generalist Specialist Advanced Specialist

n Awareness of routes by whichdrugs used within scope ofpractice can be given.

n Awareness of national and localintrathecal policy and practicalimplications.

n Awareness of routes by whichdrugs used within institutioncan be given.

n Awareness of differences informulations required fordifferent routes.

n Awareness of clinical relevanceof infusion rate for differentSACT drugs.

n Awareness of rationale behindorder in which SACT drugs aregiven and their timing.

n Awareness of policy for homeadministration of SACT relevantto scope of practice.

n Awareness of routes bywhich drugs within theinstitution can begiven.

n Involved in thedevelopment of localpolicies in accordancewith nationalguidelines.

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Domain 4: Safe and Rational Use of Medicines�

n Patient consultation skills

n Patient counselling skills

n Reviews and manages patient medicines

n Identifies and manages medication safety issues

n Provides medicines information and education

GENERAL THERAPEUTICS & TREATMENT GOALS

Generalist Specialist Advanced Specialist

n Awareness of curative, adjuvant, neo-adjuvant and palliative goals, when theseapply and their clinical implications.

n Supports patient adherence to medicationregimens.

n Addresses patient expectations of treatment within scope of practice.

n Awareness of the use of combinedmodality treatment, e.g. chemoradiation.

n Awareness of the use of systemic therapy,radiotherapy, surgical oncology and supportive care to achieve goals.

n Identification, monitoring and appropriatereporting of adverse drug events.

n Use of advancedtherapeutics (e.g. bonemarrow/stem celltransplant) to achievegoals.

Knowledge of:

n Locally used staging andits role in treatmentdecisions.

n Staging systems and theirrole in treatmentdecisions.

Understanding of:

n Psychosocial goalsassociated withsystemic therapy.

n Patient decision-making processes.

PRINCIPLES OF SACT

Generalist Specialist Advanced Specialist

Knowledge of:

n Classification and mechanism of actionof SACT and hormonal agents.

n Cell cycle and cell kill hypothesis.

n Scheduling and basic principles ofcombination SACT.

n Ways of monitoring tumour responsesand disease progression.

Knowledge of:

n Classification andmechanism of action ofother cancer treatmentdrugs.

n Differentiation betweendrugs from same class.

n Modulation of SACT drugsby non-SACT agents.

n Pharmacokinetics andpharmacodynamics ofSACT and other cancertreatment drugs.

n Measurement of response,survival and other tumouroutcomes for cancerswithin scope of practice.

Knowledge of:

n Pharmacogenetics ofSACT drugs.

n Principles of newanticancer drugdevelopment.

n Principles of genetherapy.

n Principles of drugresistance.

n Differentiation of survivaloutcomes (overall,progression free, relapsefree, etc.); meaning ofcomplete, partialresponses, stabledisease, etc.

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Domain 4: Safe and Rational Use of Medicines

13

MONITORING & MANAGEMENT OF COMMON TOXICITIES OF CANCER TREATMENT

Generalist Specialist Advanced Specialist

Knowledge of:

n Monitoring and managementof regimen toxicities(including those that are doselimiting) used within scope ofpractice.

n Monitoring blood counts withSACT.

n Treatment and prevention ofcommon toxicities.

n Dose reductions or delays forneutropenia and othertoxicities for regimens usedwithin scope of practice.

n Dose reductions in renal andhepatic impairment.

n Documentation of toxicities.

n Monitoring organ functiontests with drugs that maycause organ toxicities.

Knowledge of:

n Monitoring and management of toxicitiesof regimens used within treating hospital.

n Monitoring effectiveness of antiemetictherapy.

n Dose modification strategies.

n Identification of patients at increased riskof toxicity due to additional risk factors.

n Distinction between early and late onsettoxicities, accumulation effect (incl.paediatric and young patients).

n Toxicity grading scales.

n Evaluation, development andimplementation of policies and guidelinesto minimise toxicities.

n Policies to reduce occurrence or treattoxicities relevant to diseases treatedwithin hospital, e.g. use of irradiated bloodproducts with fludarabine or managementof GVHD.

Knowledge of:

n Monitoring otherobjective andsubjective toxicities,including pain.

n Evaluation of canceroutcome tests.

n Unusual drugtoxicities.

n Advantages anddisadvantages ofassessment tools formeasuring specifictoxicities.

n Systems in place tocommunicatepotential side effectsand management ofthem to primary andother secondaryhealth workers.

PROCEDURES FOR SAFE HANDLING OF SACT

Generalist Specialist Advanced Specialist

n Knowledge of basic safehandling proceduresincluding spillage anddisposal ofchemotherapeutic waste.

n Knowledge of extravasationrisks.

n Demonstrates basicunderstanding ofoccupational hazards ofexposure to SACT drugs andwaste.

n Understands causes ofexposure to SACT.

n Able to describe precautionswhen extemporaneouslypreparing oral formulationsof SACT (e.g. for paediatricsor clinical trial materials).

n Ensures measures are in place tominimise risks when patients are havingSACT at home (oral and IV).

n Able to provide advice for patients inrelation to handling SACT at home (spills,handling of contaminated linen, etc).

n Knowledge of practical and administrativeaspects of legislative requirements forsafe handling/waste management.

n Able to write, implement and evaluateprocedures for safe handling of SACT.

n Able to provide advice for patients andcarers on how to handle potentiallycontaminated waste at home.

n Able to provide advice for pregnant andbreastfeeding staff in relation to handlingSACT and contaminated waste.

n Knowledge of personnel monitoring.

n Documents extravasation, managesextravasation kits, reports within hospitalreporting system and/or to HealthProducts Regulatory Authority (HPRA).

n Assessesadministrationdevices and newtherapies to ensureoccupational andpatient exposure isminimised.

n Understandsimplications ofdevelopingtechnologies, e.g.gene therapyproducts andmonoclonalantibodies.

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Domain 4: Safe and Rational Use of Medicines

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COMMON SYMPTOMS OF DISEASE AND TREATMENT

Generalist Specialist Advanced Specialist

n Awareness of symptoms andmanagement of side effects andadverse effects such as:

m Mucositis

m Neutropenia

m Pain

m Extravasation

m Hypercalcaemia

m Diarrhoea

m Nausea and vomiting

m Constipation

m Palmar-plantarerythrodysesthesia

m Hypersensitivity reactions

m Tumour lysis syndrome

n Common symptom control drugsincluding analgesics.

n Antibiotic regimens and growthfactors for febrile neutropenia.

n Use of mesna.

n Use of folinic acid rescue.

n Understands and makesrecommendations for themanagement of symptoms, suchas:

m Electrolyte disturbances

m Infections

m Dyspnoea

m Bleeding

m Obstruction

m Ifosfamide encephalopathy

m Alkalinisation of urine

m Hydration regimes andmanagement of fluid balance

n Understands and makesrecommendations for themanagement of oncologicalemergencies:

m Superior vena cava obstruction

m Spinal cord compression

m Hypersensitivity reactions

m Anaemia and the role ofepoetin/blood

n Develops and evaluates local drugrelated policies.

n Develops networktreatment protocolsfor management ofsymptoms ofdisease ortreatment.

n Disseminatesevaluated researchon SACT drugs,advises onformulary changes,and informspolicies.

n Acts as expertadvisor/stakeholderfor nationalpolicies andguidelines.

USE OF SUPPORTIVE CARE AND SYMPTOM MANAGEMENT TREATMENTS

Generalist Specialist Advanced Specialist

Knowledge of:

n Use of analgesics and adjuvanttherapy for pain management.

n Management and treatmentprotocols forcancer/haematologicalsymptoms (e.g. constipation,diarrhoea, dyspnoea, cough,etc.) seen within scope ofpractice.

Knowledge of:

n Role of pharmacologic and non-pharmacologic pain management.

n Application of pharmaceuticalcare for symptom control

n Evaluation of symptom controlprotocols and practices withinnetwork.

n Use of radiotherapy and SACT forsupportive care and painmanagement within scope ofpractice.

Knowledge of:

n Integration ofpharmacologicinterventions withother treatments.

n Use of radiotherapyand SACT forsupportive careand painmanagementwithin network.

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Domain 4: Safe and Rational Use of Medicines

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DOCUMENTATION2 OF SYSTEMIC TREATMENT ORDERS & ADMINISTRATION

Generalist Specialist Advanced Specialist

n Documentation ofpharmaceutical careactivities and outcomesincluding those specificto oncology.

n Documentation of treatmentsoutcomes, pharmaceuticalinterventions and advice related toSACT on health records.

n Knowledge andevaluation ofdifferent prescribingsystems/prescriptionformats (includingcomputerised).

INTERACTIONS BETWEEN CANCER TREATMENT/ SUPPORTIVE CARE DRUGS AND OTHER DRUGS/FOODS

Generalist Specialist Advanced Specialist

n Understands clinicalsignificance of drug-drugand drug-food interactionswith SACT drugs and drugsused to prevent andalleviate symptoms, withinarea of practice.

n Understands clinical significance ofdrug-drug and drug-food interactionswith SACT drugs, and drugs used toprevent and alleviate symptoms usedwithin Network.

n Knowledge of SACT drugs which aresensitised by radiotherapy.

n Reports any interactions to HRPA andwithin hospital.

n Able to assesspotential ofinteractions withinvestigational agents.

n Knowledge of clinicalsignificance of drug-drug and drug-foodinteractions toindividual patientcircumstances.

ADVICE ON COMPLEMENTARY AND ALTERNATIVE MEDICINE IN RELATION TO SACT

Generalist Specialist Advanced Specialist

n Knowledge of theeffectiveness, safety andpotential for interactionsof medicines withcomplementary andalternative medicinewithin scope of practice.

n Understands reasons why cancer andhaematology patients use alternativemedicines.

n Understands evidence of effectivenessand safety for complementary andalternative medications used withinscope of practice.

n Able to access information oncomplementary and alternate therapiesused within oncology/haematology.

n Able to advise on contra-indications toalternative therapies within scope ofpractice.

n Able to criticallyappraise evidencefor alternativemedicines andtherapies usedwithin network.

2 Documentation includes both paper and electronic systems where in place.

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16

Domain 5: Public Health�

n Population health

n Health promotion

n Research skills

EPIDEMIOLOGY OF CANCER

Generalist Specialist Advanced Specialist

n Incidence and prevalenceof common cancers(breast, lung andcolorectal) and thosewithin their scope ofpractice.

n Incidence and prevalence ofcancers treated within theirhospital.

n Knowledge of incidence andprevalence of cancers treatedwithin their Network.

n Knowledge of changing trendsin cancer epidemiology.

PATHOPHYSIOLOGY AND SYMPTOMS OF CANCER

Generalist Specialist Advanced Specialist

Knowledge of cancers withinscope of practice, including:

n Characteristics.

n Common metastaticpresentations.

n Associated symptoms.

n Knowledge of anatomic characteristics ofcancers and their metastatic presentationsencountered within their hospital.

n Symptoms associated with these cancers.

n Knowledge of relevant genes andawareness that they are not necessarilycancer specific, e.g. HER2.

n Characteristics of cancerstreated within theNetwork including raretumours and childhoodcancers, their metastaticpresentations, symptomsand relevant genes.

HEALTH PROMOTION & EDUCATION

Generalist Specialist Advanced Specialist

n Able to conduct brief interventions forsmoking cessation.

Demonstrates awareness of:

n The causes and prevention of cancer.

n Chemoprevention strategies for cancer.

n Health education and promotionissues.

n Resources available for healthpromotion.

n Knowledge of how to access referralcentres.

n Understands the principlesof health promotion andthe causes of cancer andhow to apply these withintheir practice.

n Actively participate inpromotion of healthylifestyles to foster cancerprevention.

n Understands theprinciples of healthpromotion in relationto cancers within theNetwork.

n Involved in theeducation andpromotion of healthylifestyles in cancerpatients, theirfamilies, staff and thegeneral public.

GOALS OF SUPPORTIVE AND PALLIATIVE CARE FOR CANCER PATIENTS

n Refer to HSE Palliative Care Competence Framework (10) for a more detailed outline of competencies forpharmacists specific to palliative care.

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Domain 5: Public Health

17

SCREENING

Generalist Specialist Advanced Specialist

n Awareness and promotionof the national cancerscreening programs.

n Knowledge of the referralpathways for other screeningservices, e.g. geneticscreening.

n Demonstrates an understandingof the impact screeningprograms may have on servicedelivery and cancer patients andtheir families.

CLINICAL TRIALS

Generalist Specialist Advanced Specialist

Knowledge of:

n Purpose of clinical trials in oncology patients.

n Clinical trial endpoints in cancer trials.

n Documentationrequirements.

n The role of otherpractitioners involved inrunning clinical trials andhow to access them.

n The clinical trialssupported in Network.

n Principles of ICH-GCP and the EU Directive.

n The role of national and internationalorganisations such asMRC/CRC/EORTC/ICORG.

n Knowledge of basic researchdesign and application for oncology.

n Access to clinical trials inNetwork.

n Ethical considerations specific to oncology.

n Understands the role of national and internationalorganisations such asICORG/MRC/CRC/EORTC.

n Knowledge of how to set upclinical trials.

n Identifies areas where researchor audit could improve.

n Able to undertake and supervisedispensing of clinical trialswithin scope of practice.

n Understands clinical trial designand application at the local site and across the country(especially nationallyfunded/badged trials).

n Aware of most relevant clinicaltrials underway for patientpopulations served withinhospital/treatment centre(including ICORG and NCRNstudies and important trials with other groups).

n Aware of immediate and futurepotential impact on serviceresulting from the trialsparticipation (funding, staffingand training).

n Knowledge of practice whichallows ability to identify research questions and initiateresearch activity.

n Critically evaluates clinical trialsand audit and implications forfuture clinical practice.

n Advises on drug aspects ofclinical trial protocols.

n Assists with the preparation of patient information in line with local practice.

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WORKPLACE MANAGEMENT SKILLS

Generalist Specialist Advanced Specialist

n Identifies and discusseshow services are adverselyaffected by poorperformance.

n Participates in audit orassessment after criticalevent reviews.

n Examines the potentialimpact of their ownperformance onsustainability of newservices.

n Researches appropriatesources of information tosupport learning.

n Critically analysesappropriate information anddata to determine trends.

n Implements appropriaterecord-keeping and datasystems.

n Works effectively with thedocumented procedures and policies within theworkplace.

n Identifies pharmacyresource requirements andmanages those resourceseffectively, as appropriate to their level ofresponsibility.

n Investigates and identifiesproblems in small groupwork.

n Applies principles ofevidence-based practice.

n Reviews service targets anddelivery by themultidisciplinary team.

n Critiques departmentalperformance and systems ofmanagement.

n Promotes changes leading tosystems redesign.

n Takes part in discussions withhealth commissioners todevelop understanding offuture service plans.

n Uses and interpretsdepartmental performancedata and information todebate services withinmultidisciplinary teammeetings.

n Uses external references, e.g.IT based resources to supportanalysis.

n Synthesises information andprepares a business case.

n Supports plans for oncologyservices that are part of thestrategy for the wider healthservice.

n Uses management information to monitor and evaluate servicedelivery against national/localtargets and plans.

n Communicates progress againsttargets and plans and ensuresthat colleagues take personalresponsibility for outcomes.

n Informs the dialogue around theintroduction or amendment oflocally set performance targets.

n Uses audit outcomes to challenge current practice and develop consistent, reliable care.

n Delegates responsibility tocolleagues to act as service leads and supports them toinnovate.

n Changes service delivery inresponse to new evidence.

n Gathers feedback from patients,service users and colleagues tohelp develop plans.

n Develops creative solutions totransform services and care.

n Identifies areas for improvementfor oncology services and createssolutions through collaborativework.

n Educates and informs key people who influence and make decisions.

n Obtains and acts on patient, carer and service user feedbackand experiences.

Domain 6: Organisation and Management Skills�

n Self-management skills

n Workplace management skills

n Human resources management skills

n Financial management skills

n Quality assurance

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Domain 6: Organisation and Management Skills

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QUALITY ASSURANCE/PATIENT SAFETY

Generalist Specialist Advanced Specialist

n Participates in patientsafety, clinical audits, riskassessment or other safetyrelated activities.

n Critically analysessignificant events/criticalincidents to identify theeffect on patient outcomes.

n Ensures safe practice withinclinical guidelines.

n Takes part in clinical and/orother governance processesrelated to safety within theorganisation.

n Trains others in safe workpractices and a culture thatfacilitates safety throughconsultation with patients.

n Undertakes a risk assessmentof a clinical service area.

n Works to develop systems thatare safe and reliable, andprevent harm from occurring.

n Evaluates the outcome ofchanges following clinicalaudits or other audit activity.

n Works with managers tosupport servicechange/improvement.

n Develops systems to measure risk,and practises to diagnose andquantify risk.

n Contributes to the development ofclinical governance strategies andpractises, learning from relevantnational collaborative projects.

n Develops strategies to promote asafety culture within the serviceor organisation.

n Identifies and quantifies the riskto patients using information froma range of sources.

n Monitors the effects andoutcomes of change.

n Supports more junior colleaguesto lead a service improvementproject.

n Works with healthcare colleaguesand patients/service users andtheir representatives to establishthe most appropriate means ofcollecting and analysing patientand carer feedback.

n Supports colleagues to evaluateand audit the outcomes ofhealthcare improvement projects.

n Ensures that protocols andpolicies are established andfollowed consistently.

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Domain 6: Organisation and Management Skills

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RESOURCE MANAGEMENT SKILLS

Generalist Specialist Advanced Specialist

n Identifies how changes inresources can affect patientsand their safety.

n Awareness of role/implicationsof advisory bodies, e.g.NCPE/NCCP.

n Understands the principles ofpharmacoeconomicassessment and medicinescost-benefit analysis.

n Awareness of role/implicationsof the funding pathways ofoncology drugs.

n Demonstrates awareness ofHSE reimbursement schemes.

n Participates in departmentaldiscussions about resourceallocation and serviceimprovement.

n Identifies the financialconstraints that affect theirservice.

n Highlights areas of potentialwaste to senior colleagueswithin the department.

n Questions and challenges theuse of resources.

n Seeks opportunities to learnabout HSE resource allocationprinciples and practices.

n Works closely with the businessmanager to manage the budgetfor the service.

n Forecasts for financialconstraints.

n Advises on the cost-effective useof SACT.

n Reviews current service delivery,identify opportunities forminimising waste and introducingchange for more efficient work.

n Ensures services are deliveredwithin allocated resources.

HUMAN RESOURCES MANAGEMENT SKILLS

Generalist Specialist Advanced Specialist

n Identifies and manageshuman resources andstaffing issues as requiredin their position ofresponsibility.

n Supports, motivates andmentors others withingroup learning.

n Contributes to peerassessment/review.

n Teaches and mentors otherstaff members with regardto other disciplines.

n Influences others to useknowledge and evidence toachieve best practice.

n Delegates work to staff.

n Assesses and appraisesstaff.

n Recruits and selects staff.

n Identifies policy andlegislation relevant topeople managementpractices.

n Interprets and implements HRprocesses for a service, e.g.recruitment and selection,appraisal, mentoring andcoaching.

n Undertakes appraisals of juniorclinical colleagues.

n Manages the performance of staffwithin an area of responsibility,undertakes challengingconversations with colleagueswhose actions have beenassociated with poor performanceand takes appropriate action,including disciplinary action,where necessary.

n Provides practice supervisionwhich may be across professionalboundaries.

n Develops workforce plans in linewith pharmacy servicereviews/requirements.

n Monitors staff capabilities,training plans and revalidation inline with organisationalgovernance requirements.

n Supports team members todevelop their roles andresponsibilities.

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�Glossary�

Competency - the knowledge, skills, attitudes and behaviours that an individual develops through education, training, development and experience

Consultant - consultant medical oncologist or haematologist

Prescriber - the person authorised to order or prescribe chemotherapy

Prescription - a written or printed prescription for dispensing in a retail pharmacy business

Systemic anti-cancer all chemotherapy, biological agents and vaccines deliveredtherapy - with the purpose of treating solid and non-solid

malignancies

Treatment order - a written, printed or electronic order for chemotherapy to be administered in a hospital

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Abbreviations�

BOPA British Oncology Pharmacy Association�

BSA Body Surface Area

CRC Clinical Research Centre

EORTC European Organisation for Research and Treatment of Cancer

GVHD Graft Versus Host Disease

HPRA Health Products Regulatory Authority

HER2 Human Epidermal Growth Factor Receptor 2

ICH-GCP International Conference on Harmonisation – Good Clinical Practice

ICORG All Ireland Cooperative Oncology Research Group

MRC Medical Research Council

NCCN National Comprehensive Cancer Network

NCCP National Cancer Control Programme

NCPE National Centre for Pharmacoeconomics

NCRN National Cancer Research Network

NICE National Institute of Clinical Excellence

OAM Oral Anticancer Medicines

PSI Pharmaceutical Society of Ireland

RPS Royal Pharmaceutical Society

SACT Systemic Anti-Cancer Therapy

SIGN Scottish Intercollegiate Guidelines Network

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References�

1. Heckmann P, McCarthy T, Walsh O, Hanan T. National Cancer Control ProgrammeOncology Medication Safety Review Report. NCCP; 2014.

2. Bloom B. Taxonomy of Educational Objectives Book 1: Cognitive Domain. 1984.

3. Bates I, Bruno A. Competence in the Global Pharmacy Workforce. Int Pharm J.2008;30.

4. PSI. PSI Core Competency Framework for Pharmacists. Pharmaceutical Society ofIreland; 2013.

5. Wilson K, Langley C. Pharmacy Education and Accreditation Reviews (PEARs) Project.Rep Comm Pharm Soc Irel. 2010.

6. Pharmaceutical Society of Ireland. Review of International CPD Models. PSI; 2010.

7. Becker R. The use of competencies in palliative care. Innov Cancer Palliat Care Educ. 2007;2:13.

8. Adams V, Blake D, Corlett S. BOPA Competency Framework for Specialist OncologyPharmacists. British Oncology Pharmacy Association Newsletter. 2004.

9. Royal Pharmaceutical Society. Leadership Competency Framework for PharmacyProfessionals. Royal Pharmaceutical Society; 2011.

10. Palliative Care Competence Framework Steering Group. Palliative Care CompetenceFramework. Dublin: Health Service Executive; 2014.

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http://cancercontrol.hse.ie


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