PGD outline framework (version for local adaptation)

By Deborah Evans,2015-01-15 21:06
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PGD outline framework (version for local adaptation)

Outline framework (version for local adaptation)

    The framework provides an excellent tool to help individuals, and organisations, assess prescribing practice. It might help when you are using the tool, to:

     Think of the framework as a way of guiding your reflections on your practice with PGDs ;

    ; Think about using it in a variety of settings to suit your needs, for example, it may be used alone, in

    a peer group or with your clinical lead

    ; The framework contains a lot of information. You might find it easier to work through it gradually,

    one section at a time

    ; This version of the framework can be downloaded, customised and adapted to suit your needs, with

    space for making notes against each competency


    (competency area)



Has up-to-date clinical and pharmaceutical knowledge relevant to the scope of the PGD.

    (overarching statement)

Behavioural indicator Notes

    Understands the medical conditions being

    treated, their natural progress and how to

    assess the severity of disease

Understands different non-pharmacological and

    pharmacological approaches to modifying disease and promoting health, desirable and undesirable outcomes and how to identify and assess them

    Understands the mode of action and

    pharmacokinetics of medicines and how these mechanisms may be altered (e.g. by age, renal impairment)

Understands the potential for unwanted effects

    (e.g. adverse drug reactions [ADRs], drug interactions, special precautions and contraindications) and how to avoid /minimise

    and manage them

    Maintains an up-to-date knowledge of products

    contained in the PGD

Understands how medicines are licensed,

    supplied and monitored (e.g. ADR reporting)

Applies the principles of evidence-based

    medicine, and clinical and cost-effectiveness

Understands the public health issues related to

    medicines use (e.g. antimicrobial drug resistance)

Appreciates the misuse potential of drugs


    (competency area)



    Makes and / or reviews diagnosis and generates treatment options for the patient,

    including follow-up within the PGD.

    (overarching statement)

Behavioural indicator Notes

    Takes a comprehensive medical history and

    undertakes an appropriate physical examination

Makes and / or reviews a working or final

    diagnosis by considering and systematically deciding between the various possibilities (differential diagnosis)

Requests and interprets relevant diagnostic


Views and assesses the patient’s needs

    holistically (psychosocial, physical)

Considers no treatment, non-drug and drug

    treatment options (including referral and preventative measures)

Assesses the effect of multiple pathologies,

    existing medication and contraindications on

    treatment options

Assesses the risks and benefits to the patient of

    taking / not taking a medicine (or using / not using a treatment)

Selects the most appropriate PGD for the

    individual patient

Selects the most appropriate drug, dose and

    formulation according to the PGD

Identifies ongoing treatment plan and referral

options for patient


    (competency area)


    (parents, carers and advocates where appropriate)


Establishes a relationship based on trust and mutual respect. Sees patients as partners in

    the consultation. Applies the principles of concordance.

    (overarching statement)

Behavioural indicator Notes

    Listens to and understands patients’ beliefs and


Understands the cultural, linguistic and religious

    implications of supplying and administering medicines

Deals sensitively with patients’ emotions and


Adapts the consultation to meet the needs of

    different patients (e.g. for age, level of


Creates a relationship which does not

    encourage the expectation that a medicine will be supplied and / or administered

Explains the nature of the patient’s condition

    and the rationale behind, and potential risks and benefits of treatment options

Helps patients to make informed choices about

    their options

Negotiates an outcome of the consultation that

    both patient and health care professional are satisfied with

    Encourages patients to take responsibility for their own health and self-manage their conditions

    Identifies opportunities to discuss health promotion with patients

    Gives clear instructions to the patient about their medication (e.g. what it is for, how to take it,

    possible side effects and expected outcomes)

    Checks patients’ understanding of, and commitment to, their treatment


    (competency area)



    Is aware of own limitations. Does not compromise patient safety.

    (overarching statement)

Behavioural indicator Notes

    Knows the limits of own knowledge and skill,

    and works within them

Knows when to refer to, or seek guidance from,

    another member of the team or a specialist

Supplies and administers a medicine only with

    adequate, up-to-date knowledge of its actions, indications, contraindications, cautions, dose and side-effects

Checks doses and calculations to ensure

    accuracy and safety

Knows about common types of medication

    errors and how to prevent them

Uses PGDs often enough to maintain

    confidence and competence

Understands the need for, and makes, accurate,

    clear and timely records and clinical notes


    (competency area)



    Works within professional and organisational standards.

    (overarching statement)

Behavioural indicator Notes

    Accepts personal responsibility for working

    within PGDs and understands the legal implications of doing so

Understands and works within the scope of the


Makes ethical and / or clinical decisions based

    on the needs of patients, not personal considerations

Understands current medicines legislation, the

    legal framework for working with PGDs and how they apply in practice

Applies current professional codes of practice to

    the use of PGDs

Keeps up-to-date with advances in practice and

    any emerging safety concerns related to medicines in the PGD

Understands how consent relates to PGDs

Knows how and when PGDs need to be

    changed, affects necessary changes


    (competency area)



Actively participates in the review and development of practice to improve patient care.

     (overarching statement)

Behavioural indicator Notes

    Reflects on own performance, learns and

    changes practice

Willing to share and debate own, and others’


Challenges inappropriate practice constructively

Develops own networks for support, reflection

    and learning

Develops and uses tools to review and improve

    PGDs and their use in practice (e.g. audit)

Reviews and reports incidents and near misses

    within a clinical governance context

Establishes professional links with practitioners

    working in the same specialist area


    (competency area)



    Knows how to access relevant information.

    Can critically appraise and apply information in practice.

     (overarching statement)

Behavioural indicator Notes

    Understands the advantages and limitations of

    different information sources

Uses relevant, up-to-date information; both

    written (paper / electronic) and verbal

Critically appraises the validity of information

    (e.g. promotional literature, research reports) when necessary

Applies information to the clinical context

    (linking theory to practice)

Uses relevant patient record systems,

    information systems, and decision support tools

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