Reflect, Then Act: Implementing New Practices Requires Critical Self-Reflection

Note: The College thanks the Alberta College of Pharmacy for permission to adapt their Critical Reflective Pathway series for this article.

Pharmacy professionals who are considering undertaking new activities, services or areas of expertise within their scope of practice should complete critical self-reflection before deciding how to proceed. This reflection includes identifying their motivations, deciding whether they need additional information, skills or expertise, planning for next steps, and considering risks related to the situation. It’s important to note that just because a pharmacy professional has the legal authority to perform an act (i.e. it is within the pharmacy professional’s scope of practice as defined by the Pharmacy Act), doesn’t mean that they necessarily have the knowledge, skills, ability or environment to facilitate the safe provision of this care.

Ultimately, appropriate reflection supports care that is in the best interest of patients and aligned with the Code of Ethics, Standards of Practice and other expectations established in policies and guidelines.

For example, if a pharmacist wanted to begin providing specialized care at the pharmacy, such as opioid agonist treatment, or a pharmacy technician wanted to engage in non-sterile compounding, they would need to reflect both on whether they should commence the activity, and, if so, how they can ensure the safety of their patients by thinking through the self-reflection points below. Other examples may include providing injection services, travel clinics or point of care testing. Situations may also present themselves where a current patient requires specialized care, complex medication regimes, or treatments unfamiliar to the pharmacist.

What Does Self-Reflection Look Like?

Self-reflection could include questions like the following, considering them in the context of your professional judgment, knowledge and skills:

• Why do I want to do this? Is it in the best interest of my patient(s)?
• Does this activity fit within my scope of practice? What about the Code of Ethics? Is this activity supported in my practice setting?
• Am I the healthcare professional best suited for this role or activity? If I am referring to another healthcare provider, how do I ensure continuity of care?
• Do I have the necessary knowledge, skills and attitudes/aptitudes to implement it into practice?
• What learning sources do I need? How can I make sure they are the right ones?
• Who can I learn from? Do I have colleagues I could ask or collaborate with a mentor? Who can assess my competency/skills?
• What kind of risks could there be for my patients, colleagues or myself?
• What will I do if something goes wrong?
• Can I meet all of the requirements required for this action (i.e. safety, privacy, documentation, and training)?

Designated Managers and owners would have additional considerations, including the skills and knowledge of staff at the pharmacy, requirements for additional staff training, the policies and procedures that may need to be implemented as well as the physical facilities and equipment that may be required to optimally support their regulated pharmacy staff in undertaking the proposed pharmacy services. Training of unregulated pharmacy staff may also be required to support the work of the regulated pharmacy staff.

Once self-reflection has been completed, the planning of next steps can proceed. This could include reviewing clinical guidelines or journal articles, verifying policies or regulations, speaking with colleagues, practicing skills, attending courses or webinars or notifying the relevant organizations/individuals. If the situation in question involves a specific patient (vs. starting a new practice altogether at the pharmacy), then ongoing communication with the patient may be necessary, including gathering any additional information that is needed.

Ongoing evaluation is also important. As the pharmacy professional is engaging in this new idea, skill or service, they can be reflecting on how they are doing, considering whether they need additional collaboration or connection with other healthcare professionals, exploring additional areas of growth and continuing to find learning sources to support the evolution of their knowledge and skills.

As always, pharmacy professionals need to ensure that their actions and decisions are in alignment with the Code of Ethics and Standards of Practice.