Clinical Pharmacist Competencies
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Clinical Pharmacist Competencies
American College of Clinical Pharmacy
John M. Burke, Pharm.D., FCCP, William A. Miller, Pharm.D., FCCP, Anne P. Spencer, Pharm.D.,
Christopher W. Crank, Pharm.D., Laura Adkins, Pharm.D., Karen E. Bertch, Pharm.D., FCCP,
Dominic P. Ragucci, Pharm.D., William E. Smith, Pharm.D., Ph.D., and Amy W. Valley, Pharm.D.
Key Words: American College of Clinical Pharmacy, ACCP, clinical pharmacist,
competencies.
(Pharmacotherapy 2008;28(6):806–815)
The American College of Clinical Pharmacy Advancement of Pharmaceutical Education
(ACCP) strategic plan summarizes its core (CAPE) Education Outcomes, the American
ideology, envisioned future, core purpose and Society of Health-System Pharmacists (ASHP)
mission, and critical issues for the organization and ACCP joint statement on learning objectives
and the profession.1 A longstanding critical issue for residency training in pharmacotherapy, and
of the college’s plan is how ACCP can contribute the Board of Pharmaceutical Specialties content
to ensuring an appropriately educated and skilled outline for the Pharmacotherapy Specialty
clinical pharmacy workforce. Toward that end, Certification examination. 3–10 Consensus
the college sought to publish a definition of competencies of a clinical pharmacist were
clinical pharmacy and establish the competencies identified. Draft competencies and associated
of a clinical pharmacist. Coincident with the content knowledge components were then
development of its definition of clinical prepared for review by the ACCP Board of Regents.
pharmacy,2 the ACCP Board of Regents charged a After extensive deliberations, the authors
task force to develop a complete set of competency identified key differences between the competencies
statements for the clinical pharmacist. These of a clinical pharmacist and today’s pharmacy
statements were to be assessable and able to serve generalist.
as a foundation for the development of future
clinical pharmacist assessment tools. Background
In developing the competency statements for
this paper, the authors reviewed a number of The ACCP’s vision for the profession is that
documents that addressed competencies within “pharmacists will be recognized and valued as
the profession of pharmacy, including the the preeminent health care professionals
Accreditation Council for Pharmacy Education responsible for the use of medicines in the
(ACPE) Accreditation Standards for the Doctor of prevention and treatment of disease.” 1 The
Pharmacy degree, the American Association of vision articulated by the Joint Commission of
Colleges of Pharmacy (AACP) Center for the Pharmacy Practitioners also calls for future
This document was written by the ACCP Task Force on pharmacists to be responsible for rational
Clinical Pharmacist Competencies: John M. Burke, medication use.11, 12 Today, few pharmacists are
Pharm.D., FCCP, BCPS, Chair; William A. Miller, Pharm.D., viewed by the public, government, payers of
FCCP; Anne P. Spencer, Pharm.D., BCPS; Christopher W. health care, physicians, nurses and other health
Crank, Pharm.D., BCPS; Laura Adkins, Pharm.D., BCPS;
Karen E. Bertch, Pharm.D., FCCP; Dominic P. Ragucci, professionals, or patients as the preeminent
Pharm.D., BCPS; William E. Smith, Pharm.D.; and Amy W. health care professionals responsible for the use
Valley, Pharm.D., BCOP. Approved by the American College of medicines in the prevention and treatment of
of Clinical Pharmacy Board of Regents on January 25, 2006. disease or rational medication use. However, the
Address reprint requests to the American College of
Clinical Pharmacy, 13000 West 87th Street Parkway, Suite
profession has reason for optimism because a
100, Lenexa, KS 66215-4530; e-mail: accp@accp.com, or growing number of clinical pharmacists and
download from http://www.accp.com. clinical pharmacy specialists practicing in aCLINICAL PHARMACIST COMPETENCIES ACCP 807 variety of institutional and ambulatory care competencies of today’s pharmacy graduates settings are viewed by other health professionals upon entry into the profession, the authors as essential to ensuring rational medication use. reached the following conclusions: To achieve the ACCP’s vision, the profession 1. Competency lists and statements by each must ensure that there will be an adequate supply organization are similar. All of the statements are of appropriately educated and skilled clinical aimed at producing graduates of Pharm.D. or pharmacists practicing as both clinical pharmacy residency programs who can independently generalists and specialists. 13 Among the provide patient care and manage pharmacotherapy. strategies that will help address this issue is to 2. There are different competence levels that clearly define and promote the core competencies reflect the amount of experience that a of a clinical pharmacy practitioner. Hence, the pharmacy graduate has obtained in a doctor of ACCP sought to publish a definition of clinical pharmacy degree program or from completion pharmacy and the core competencies of a clinical of a PGY1 or PGY2 residency program. The pharmacist. PGY1 residency programs are, in most cases, The ACCP definition of clinical pharmacy aimed at producing pharmacy generalists. The states that “clinical pharmacy is that area of PGY2 programs are aimed at producing pharmacy concerned with the science and pharmacy specialists or pharmacists who practice of rational medication use.”2 The AACP, practice in well-differentiated areas of clinical through CAPE, has published educational pharmacy practice. outcomes to serve as a “target towards which the 3. A key factor in developing competence is the evolving pharmacy curriculum should be continual learning of new knowledge and the aimed.” 4 The ACPE doctor of pharmacy enhancement of critical thinking and problem- accreditation curricular standards state that solving skills through practice. Repetition is “graduates must possess the basic knowledge, essential in the development of practice skills, skills and abilities to practice pharmacy, and thus the average levels of performance of independently, at the time of graduation.”3 This doctor of pharmacy and residency program implies that pharmacy graduates upon entry to outcomes vary depending upon the amount of the profession are capable of independently patient care practice included in the program. providing pharmacotherapy to patients. The Upon entry into the profession, pharmacy ASHP postgraduate year one (PGY1) residency graduates are novices at managing pharmaco- standard states that a “first-year residency therapy. Entry-level pharmacy graduates program enhances general competencies in usually gain some clinical pharmacy practice managing medication-use systems and supports experience during their educational programs. optimal medication therapy outcomes for This experience prepares them for entry into patients with a broad range of disease states.”14 the profession, but not as fully competent The standard goes on to state that the purpose of clinical pharmacists.14, 15 Pharmacy graduates PGY1 residencies is to provide residents with are often able to competently perform basic “the opportunity to accelerate their growth clinical activities such as routine patient beyond entry-level professional competence in counseling, provision of drug information, and patient-centered care and in pharmacy opera- targeted drug monitoring, but are not competent tional services and to further the development of at providing more complex clinical services. leadership skills…PGY1 residents acquire Graduates of PGY1 residency programs are substantial knowledge required for skillful minimally competent to provide general problem solving, refine their problem-solving clinical services (e.g., patient counseling, strategies, strengthen their professional values routine drug monitoring) but often are not and attitudes, and advance the growth of their prepared to independently assume responsi- clinical judgment.” The postgraduate year two bility for the more complex decision making (PGY2) standard states that PGY2 programs involved in drug therapy selection and drug “increase the resident’s depth of knowledge, therapy management. The PGY2 programs skills, attitudes, and abilities to raise the allow residents to develop more in-depth resident’s level of expertise in medication therapy knowledge and skills by working in specialized management and clinical leadership” in a specific or differentiated areas of practice.15 Focusing and focused area of practice.15 After review of the on specific patient care populations (e.g., AACP, ACPE, and ASHP papers related to critical care, oncology, and pediatrics) allows pharmacy education and training, and the graduates of PGY2 programs to enter practice
808 PHARMACOTHERAPY Volume 28, Number 6, 2008
as entry-level clinical pharmacists. Through use. Although many pharmacists possess
continued clinical and additional learning some clinical knowledge or skills and
opportunities they become proficient clinicians perform some clinical functions or tasks,
and eventually experts in a field of practice. In they must demonstrate comprehensive
summary, clinical pharmacists develop clinical competence in order to be clinical
proficiency through formal training and pharmacists.
practice experience. • Clinical pharmacists spend the majority of
4. The term clinical pharmacist is used in many their time providing pharmacotherapy
different contexts. Some pharmacy leaders independently or in collaboration with other
view all of today’s pharmacists as clinical health care providers. Clinical pharmacists
pharmacists. Although this viewpoint is must be engaged in the provision of patient
consistent with the future vision for the care for a sustained period of time to
profession, we find this to be an unrealistic become fully competent and proficient.
assessment of today’s practitioners. Similarly, Although a number of pharmacists have
some educators maintain that all graduates of been educated and trained in some aspects
doctor of pharmacy programs are prepared to of clinical pharmacy, their current work
be clinical pharmacists. We feel that this is not responsibilities may not be characterized as
a realistic assessment of the outcomes of practicing clinical pharmacy because they
today’s doctor of pharmacy programs. In are not fully engaged in providing direct
addition, we agree with this future vision for patient care and do not provide complex, in-
the profession but feel that future manpower depth clinical services. Functions associated
needs will determine if today’s clinical with medication order fulfillment continue
pharmacists actually become the pharmacy to prevent pharmacists from becoming fully
generalists of the future.13 competent and proficient clinical pharmacists.
5. Reporting of the outcomes achieved by many There are a number of other barriers that
doctor of pharmacy and residency programs is continue to prevent pharmacists from
based predominantly on subjective data. practicing as clinical pharmacists, such as
Current pharmacy licensure board examinations inadequate leadership and management,
evaluate only minimal practice competency. failure to establish collaborative relation-
Advancement of pharmacy education and ships with physicians and nurses, lack of
residency training could be enhanced by reimbursement for clinical services, and
educational research that focuses on objective provider status. Time in practice beyond
measures of clinical performance. pharmacy education and training is required
6. A number of important qualities define the to allow one to gain experience with a wide
clinical pharmacist.2, 11 Although a majority of range of medical problems and therapies,
today’s pharmacists perform some clinical and to develop the necessary scope and
functions as part of their practice, they are not depth of knowledge and clinical skills
necessarily clinical pharmacists, just as all required to proficiently function as a clinical
physicians who perform heart auscultations to pharmacist.
assess cardiac disease are not cardiologists. • Clinical pharmacists have completed
The authors conclude that the following key postgraduate residency training. Although
qualities define the clinical pharmacist: there are excellent clinical pharmacists in
• Clinical pharmacists have a broad scope and practice today who have not completed
depth of pharmacotherapy knowledge and residency training, in most cases the pre-
clinical skills. Knowledge is obtained and ferred method for acquiring the competencies
clinical skills are developed through formal of a clinical pharmacist is through formal
education and training programs, including residency training. This will become
doctor of pharmacy degree and postgraduate increasingly important in the future.
residency programs, lifelong learning, and Individuals who satisfactorily complete
continuing professional development. PGY1 (and ideally PGY2) accredited
Clinical pharmacist competence is achieved residencies that focus on clinical practice
when one possesses the knowledge, skills, should have sufficient knowledge and
and attitudes required to provide direct care practice experience to be competent clinical
to patients and to ensure rational medication pharmacists with sound clinical judgment.CLINICAL PHARMACIST COMPETENCIES ACCP 809
Although experience may be obtained Clinical Pharmacist Competencies
outside of a structured residency program,
Specific clinical pharmacist competencies are
any experience deemed to be equivalent to
summarized in Appendix 1.6, 8–10 The following
residency training must allow for involve-
sections describe each major competency area
ment in the direct care of a sufficient
and its respective rationale. We acknowledge
number of patients over a period of time
that some clinical pharmacists may function
long enough to foster the development of
primarily as researchers or administrators and
clinical judgment. Without the necessary
that these responsibilities may require a different
level of judgment, practitioners are limited
set of competencies. However, this paper focuses
in their ability to make patient-specific
only on those competencies required for clinical
decisions and to know when a situation
practice.
extends beyond their limits of knowledge
and expertise.
• Clinical pharmacists maintain and further Clinical Problem Solving, Judgment, and
develop competence through practice and Decision Making
continued professional development. A combination of comprehensive therapeutic
Although many pharmacists assume some knowledge, experience, problem-solving skills,
direct patient-care responsibilities, they may and judgment is necessary in order to be a
not have received comprehensive, systematic competent clinical pharmacist. Clinical problem
clinical training. Achieving and maintaining solving and decision making are the processes by
clinical competence is a responsibility of all which patient-specific data are collected,
health care professionals. 16 Although interpreted, and analyzed; medical problems are
pharmacists have been required to obtain assessed; current drug therapy is evaluated; and
continuing education credit to maintain therapeutic plans are developed. These processes
their licensure, the value of this method of are critical to optimizing medication therapy.
education, which is often unfocused and Clinical pharmacists must be able to identify
noncurricular, has been questioned. 16, 17 patient problems, implement and manage patient
The specific needs of the clinical pharmacist pharmacotherapy, dispense and administer
are often not addressed through these non- medications as needed, educate patients, monitor
curricular programs. Hence, the profession drug therapy, and consult with other patient care
is evaluating alternate approaches of providers to improve patient outcomes.
continuing professional development to Although monitoring of therapy is often taught
meet these needs.17, 18 as the final step in the patient care process, it
If clinical pharmacists are to effectively must occur before, during, and after the start of
evaluate their own abilities to carry out clinical drug therapy. To effectively monitor therapy, the
responsibilities, they must have a defined list of clinical pharmacist must be able to collect and
competencies against which they can measure interpret patient data from a variety of sources.
performance. There are many competencies that Recognizing and identifying important
apply to all pharmacists. However, this document information, and then interpreting and analyzing
addresses those competencies that must be it in the context of complex clinical situations,
achieved by a clinical pharmacist. require practice and repetition. Only after
Establishing specific clinical pharmacist sufficient experience is acquired can a clinician
competencies is important. First, they describe know which situation demands urgent attention
the abilities necessary to practice as a clinical and which merely requires ongoing monitoring.
pharmacist. Second, they can be used by Although students often associate monitoring
practitioners to perform a self-assessment and with a list of specific parameters to follow in
thereby determine what areas need to be patients who have particular medical problems or
strengthened in order to enter clinical practice or who are receiving specific therapies, patient
maintain clinical competence. Although these monitoring is actually much more complex. It is
competencies will undoubtedly evolve over time, an active, ongoing process of patient assessment
this paper describes the competencies of today’s that promotes changes in therapy in order to
clinical pharmacist. Therefore, we provide below optimize therapeutic outcomes and avoid or
a set of clinical pharmacist competencies for correct drug-related problems. Only after a
contemporary clinical practice and a framework clinical pharmacist has cared for many patients in
in which to apply them. a variety of situations will he or she be able to810 PHARMACOTHERAPY Volume 28, Number 6, 2008
monitor patients efficiently and effectively. rejected when delivered by a pharmacy student
Similarly, assessing medical problems is an or resident may be accepted when delivered by
important clinical ability that must be developed an experienced clinician. Also, in communicating
and practiced. Although pharmacists are not with patients, a monologue of detailed infor-
responsible directly for establishing a patient’s mation can serve to confuse rather than educate.
medical diagnosis, it is essential that the Assessment of a patient’s level of understanding,
pharmacist be able to define patient-specific identification of issues important to the patient,
problems and effectively evaluate current therapy and delivery of information and advice in an
for those problems. Hence, clinical pharmacists understandable fashion are necessary.
cannot focus only on medications, but must take Written communication is also important. One
into account all patient-specific medical of the core tenets of clinical pharmacy is
problems as well. assuming responsibility for patient care.2, 11 Like
Designing and individualizing comprehensive other health care providers, it is the clinical
drug therapy regimens also requires clinical pharmacist’s responsibility to document
experience. Observing patient-specific responses medication reconciliation, clinical problem-
to medications is critical to anticipating potential solving activities, therapeutic interventions, and
outcomes of initiating and adjusting drug patient education activities in the medical record.
therapy. Sound clinical judgment should be Although this may appear to be a relatively easy
based on a combination of in-depth knowledge of task, experience is required to know what
diseases, expertise in drug therapy, and practical information to include and how to communicate
experience involving patients’ use of medications. it in a manner appropriate for the patient medical
Collaborating with patients, caregivers, and record. As with verbal communication, practice
other health professionals is another essential is required to become proficient at writing notes
ability that deserves attention. Clinical in the medical record.
pharmacists must be able to work with patients
and other health care professionals to determine Medical Information Evaluation and
which treatments will best meet the patient’s Management
therapeutic needs. They must understand their
roles, and the roles of collaborators, in the Providing quality patient care requires a
clinical problem-solving process. knowledge base that is continuously expanding
and being updated. A clinical pharmacist must
be able to identify situations beyond his or her
Communication and Education
own expertise or that require new information to
The ability to effectively communicate with reach a decision. This necessitates carefully
and educate patients and health care profes- defining the question and using a variety of
sionals is integral to ensuring optimal patient information sources to derive the answer. New
outcomes. As with other abilities, communi- information is then incorporated into one’s
cation is developed and refined throughout a existing knowledge base and integrated with
pharmacist’s career. Communicating with prior clinical experiences to help develop sound
patients and other health professionals about a clinical judgment.
particular issue at the appropriate level of Of course, young clinicians, students, and
complexity can be challenging, and pharmacists residents can sometimes become discouraged
must be aware of barriers to effective communi- when they realize how much they do not know.
cation. Because effective communication and However, recognizing the limits of one’s
education are so fundamental to the provision of knowledge base is an important step in the
patient care, it is imperative that these abilities be development of a mature clinician. Experience
well developed. with a wide variety of information resources is
The clinical pharmacist must identify those essential. The new clinician may rely heavily on
issues that are particularly pertinent for patients a limited number of resources rather than
and physicians to help optimize drug therapy. identifying the best sources of information for a
Providing accurate information alone is not given question. Fortunately, this skill is readily
sufficient. As with clinical problem solving, developed over time.
experience and judgment are required to The clinical pharmacist must keep abreast of
advocate for a needed intervention or change in current medical and therapeutic information. A
therapy. The same recommendation that was strong foundational knowledge base must first beCLINICAL PHARMACIST COMPETENCIES ACCP 811
developed so that new information can be readily those acquired in a doctor of pharmacy program
combined with prior knowledge. Students and and require development during postgraduate
trainees often lack the clinical experience training and practice.
necessary to recognize new information that
should be incorporated into their knowledge Therapeutic Knowledge
base. Skills in interpreting and evaluating
biomedical literature assist the clinical pharmacist Clinical pharmacists must possess a therapeutic
in effectively integrating new information with knowledge base of sufficient breadth and depth
prior knowledge. These skills, which are often to effectively promote rational medication use.
discounted as unimportant by students and Appendix 1 includes a list of diseases and
trainees, provide the basis not only for keeping pharmacotherapeutic principles intended to serve
up with the literature but also for making as a guideline for the identification, assessment,
evidence-based decisions. and development of clinical pharmacist compe-
tencies. In general, to be considered a clinical
pharmacist, one must be sufficiently knowl-
Management of Patient Populations
edgeable about the diseases and principles in this
Many clinical pharmacists not only are list to effectively assess and treat these problems
involved in providing care to individual patients, in the patient population one serves. It is
but work within a health system or other important to emphasize that a clinical pharmacist
organization to develop protocols and critical must be competent in the therapeutic manage-
pathways that optimize the care of patient ment of the many disease states that may affect a
populations. These efforts may include analyzing given patient, not simply those currently
drug utilization evaluations, composing protocols identified as active problems. To optimize a
for disease state management, and developing patient’s therapy, the clinical pharmacist must be
organizational policies and procedures that able to identify and solve new problems as they
improve patient care and resource utilization.9, 10 arise.
For instance, the Institute of Medicine has Doctor of pharmacy degree programs provide
highlighted the importance of identifying broad but relatively superficial coverage of
processes within health systems that can disease states, pharmacotherapy, and general
predispose to medication errors. 19, 20 Clinical therapeutic principles. The PGY1 residencies are
pharmacists can apply their therapeutic structured to deepen one’s knowledge of many
knowledge and clinical experience to identify disease states, provide a supervised environment
and correct problems that contribute to adverse for the application of this knowledge, and
events in patients. This may involve the promote the development of patient care skills
collection and evaluation of information regarding and clinical judgment. Although preferred, a
how a particular medication or class of medica- PGY1 residency is not the only way to develop
tions is being used such that changes can be the required skills and knowledge to be a clinical
implemented to improve care. Drug therapy pharmacist. However, the content and structure
protocols can be developed to ensure the proper of a residency should serve as a model for
use and monitoring of medications. A clinical individuals seeking to become clinical pharmacists
pharmacist must possess sufficient experience but who are unable to pursue formal residency
and clinical judgment in the care of individual training.
patients to effectively contribute to this process. Although some clinical pharmacists may
Clinical pharmacists routinely contribute to distinguish themselves by developing a
the development and implementation of critical subspecialty area of expertise (e.g., cardiology,
pathways. 9, 10 Because critical pathways are infectious diseases), the maintenance of a sound
evidence based, the clinical pharmacist must be foundation of therapeutic knowledge over a wide
able to recognize and interpret relevant range of topics is necessary to meet their profes-
biomedical literature to formulate and justify sional demands. Other clinical pharmacists may
valid drug therapy recommendations. Educating have a practice that focuses on a specific patient
others about a critical pathway requires an in- population (e.g., pediatrics). A list of therapeutic
depth understanding of the pathway, the knowledge areas with similar breadth and depth
evidence on which it is based, and the clinical to that described in Appendix 1 could be
implications for both health care professionals identified for those clinical pharmacists.
and patients. These skills are clearly beyond Recognizing that such knowledge will grow and812 PHARMACOTHERAPY Volume 28, Number 6, 2008
evolve with changes in medicine, the guiding outcomes 2004. Available from http://aacp.org/Docs/Main
Navigation/Resources/6075_CAPE2004.pdf. Accessed October
principle is that a clinical pharmacist who 10, 2007.
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standard and learning objectives for residency training in
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characterize the breadth of knowledge minimally evaluation of a clinical pharmacist. Pharmacotherapy
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Advancement of Pharmaceutical Education: educational National Academy Press, 2000.CLINICAL PHARMACIST COMPETENCIES ACCP 813
Appendix 1. Clinical Pharmacist Competencies Appendix 1. (continued)
I. Clinical problem solving, judgment, and decision making II. Communication and education
A. Monitor patients in the health care setting. A. Educate patients.
1. Collect patient-specific data to identify problems 1. Identify appropriate patient educational needs.
and individualize care. 2. Recognize patient education barriers.
2. Perform relevant physical assessment. 3. Use appropriate educational methods to educate
3. Interview patient, family, and other health care patients regarding drug therapy.
professionals to complement patient’s medical 4. Use language appropriate for the patient.
history, medication therapy history, and review of 5. Assess patient’s level of knowledge and skill
systems. acquisition.
4. Identify additional data needed. B. Educate other health care professionals.
5. Identify patient specific goals of therapy. 1. Identify the educational needs of health care
6. Prospectively develop a plan for ongoing evaluation professionals.
of progression of disease, development of disease- 2. Establish rapport with other health care
related complications, efficacy of drug therapy, and professionals.
development of drug-related adverse effects. 3. Communicate recommendations or relevant
B. Assess patient-specific medical problems. information to health care professionals in a
1. Organize, interpret, and analyze patient-specific data. manner appropriate to their training, skills, and
2. Synthesize patient data to form an assessment. needs.
3. Develop a comprehensive medical problem list. 4. Provide background information and primary
4. Assess the status, etiology, risk factors, and literature to health care professionals as needed.
complications of the patient’s medical problems. C. Communicate effectively.
5. Prioritize medical problems based on urgency and 1. Effectively communicate at a level appropriate to
severity. the audience.
6. Identify preventive and health maintenance issues. 2. Interpret verbal and nonverbal cues.
7. Persuasively communicate a justification for one’s 3. Use specific, clear, and appropriate terminology.
assessment. 4. Maintain appropriate eye contact.
C. Evaluate patient-specific drug therapy and therapeutic 5. Communicate in an organized, logical, and concise
problems. manner.
1. Evaluate the appropriateness of drug therapy, 6. Display an appropriate level of confidence.
including the choice of drug, and the dose, route, 7. Demonstrate tact.
frequency, and duration of therapy. 8. Answer questions clearly and completely.
2. Evaluate the efficacy of current drug therapy. D. Document interventions in the patient medical record.
3. Identify potential or actual drug-induced adverse 1. Clearly document drug therapy reconciliation and
effects. other patient-related interventions.
4. Identify potential or actual drug interactions. 2. Effectively communicate assessment, including
5. Identify contraindications to therapy. supporting subjective and objective data.
6. Identify untreated problems. 3. Effectively communicate the therapeutic plan.
7. Assess patient compliance and factors that may III.Medical information evaluation and management
influence compliance. A. Demonstrate the motivation and commitment to
D. Design a comprehensive drug therapy plan for patient- become a lifelong learner.
specific problems. 1. Effectively self-assess knowledge and limitations.
1. Select nonpharmacologic therapeutic measures. 2. Define the question to be answered or problem to
2. Select optimal drug, dose, route, frequency, and be solved.
duration of therapy. 3. Demonstrate habits of self-learning.
3. Select strategies for prevention of disease. B. Retrieve biomedical literature using appropriate search
4. Incorporate the significance of potential drug strategies.
interactions and adverse effects into the C. Interpret biomedical literature with regard to study
recommended plan. design, methodology, statistical analysis, significance
5. Persuasively justify recommendations based on of reported data, and conclusions.
patient-specific pharmacologic, pharmacokinetic, D. Integrate data obtained from multiple sources to derive
pharmacodynamic, pharmacogenomic, an overall conclusion or answer.
pharmacoeconomic, ethical, legal, and evidence-
based information.
E. Collaborate with patients, caregivers, and other health
care professionals.
1. Take responsibility for patient care duties.
2. Reliably complete tasks and assignments.
3. Manage time appropriately to be well prepared for
clinical activities.814 PHARMACOTHERAPY Volume 28, Number 6, 2008
Appendix 1. (continued) Appendix 1. (continued)
IV.Management of patient populations 3. Dermatologic
A. Patient safety and drug therapy evaluation6, 8 a. Acne
1. Collect data to characterize or identify health b. Urticaria
system–related problems in providing optimal c. Psoriasis
health care. d. Eczema
2. Interpret data to characterize health system–related 4. Endocrine
problems. a. Diabetes mellitus
3. Design a plan to improve the delivery and quality of b. Hypothyroidism, hyperthyroidism
pharmacotherapy. c. Adrenal disorders
4. Develop a justification for and garner support for d. Hormonal contraception
implementation of the plan. 5. Gastrointestinal
5. Design measures to monitor the success of the plan a. Gastroesophageal reflux disease
during and following implementation. b. Nausea and vomiting
6. Collaborate to implement the plan. c. Stress ulcer disease
7. Monitor the plan and implement appropriate d. Peptic ulcer disease
modifications. e. Upper gastrointestinal hemorrhage
8. Educate appropriate audiences on results of health f. Hepatitis
system–related pharmacotherapy problem g. Cirrhosis
assessment and recommended solutions. h. Pancreatitis
B. Critical pathways9, 10 i. Inflammatory bowel disease
1. Identify diagnoses, procedures, or drugs that j. Cholelithiasis
involve high risk, high patient volume, high process k. Diarrhea and constipation
variability, and/or high cost. 6. Genitourinary
2. Select a multidisciplinary health care team based on a. Prostate hypertrophy
likelihood of involvement in the pathway. b. Urinary incontinence
3. Identify appropriate outcome measures based on 7. Hematologic
review of the current medical literature and a. Anemias
assessment of current processes. b. Clotting factor deficiencies
4. Document processes and outcomes for current c. Sickle cell disease
practice and compare with current literature-based d. Disseminated intravascular coagulopathy
standards (benchmarking). e. Thrombocytopenias
5. Elucidate discrepancies between current literature- 8. Immunologic
based standards and current practice. a. Hypersensitivity reactions
6. Develop the pathway with clearly defined goals and b. Allergic rhinitis
outcomes, patient education criteria, patient safety c. Organ transplantation
documentation, and monitoring. d. Human immunodeficiency syndrome
V. Therapeutic knowledge areas6 9. Infectious diseases
A. Apply disease-oriented knowledge of the following a. Meningitis
areas. b. Endocarditis
1. Anatomy, physiology, and pathophysiology c. Fungal infections
2. Epidemiology, etiology, risk factors, and signs and d. Gastrointestinal infection
symptoms e. Intraabdominal infection
3. Natural course and prognosis f. Opportunistic infection
4. Laboratory and diagnostic test interpretation g. Osteomyelitis
B. Demonstrate competence in the pharmacotherapy of h. Otitis media
the following medical problems. i. Peritonitis
1. Bone and joint j. Pneumonia
a. Degenerative joint disease k. Prostatitis
b. Osteoporosis l. Septic arthritis
c. Gout m. Sexually transmitted diseases
2. Cardiovascular n. Sinusitis
a. Hypertension o. Skin and soft tissue infections
b. Heart failure p. Surgical prophylaxis
c. Coronary artery disease q. Tuberculosis
d. Acute coronary syndromes r. Upper respiratory tract infections
e. Atrial fibrillation s. Urinary tract infections
f. Thromboembolic disorders t. Viral infections
g. Dyslipidemias
h. Cardiopulmonary resuscitation
i. Peripheral arterial disease
j. Shock (hypovolemic, cardiogenic, and septic)
k. StrokeCLINICAL PHARMACIST COMPETENCIES ACCP 815
Appendix 1. (continued) Appendix 1. (continued)
10.Neurologic C. Apply the following principles in the setting of each
a. Epilepsy, status epilepticus disease state, patient population, and/or therapeutic
b. Pain management category.
c. Stroke 1. Pharmacokinetics
d. Headache, migraine 2. Pharmacodynamics
e. Peripheral neuropathy 3. Pharmacoeconomics
f. Parkinson’s disease 4. Pharmacogenomics
g. Dementia 5. Toxicology
h. Delirium 6. Empiric antibiotic therapy
11.Oncologic 7. Health screening
a. Melanoma 8. Health maintenance
b. Breast cancer 9. Drug interactions (drug-disease, drug-drug, drug-
c. Colorectal cancer laboratory, drug-nutrient)
d. Leukemia 10.Nondrug therapies and nonprescription remedies
e. Lung cancer 11.Herbal products
f. Lymphoma 12.Immunizations
g. Prostate cancer 13.Geriatric considerations
12.Psychiatric 14.Pediatric considerations
a. Drug and alcohol abuse 15.Nutrition (enteral and parenteral)
b. Anxiety disorders 16.Fluids, electrolytes, acid-base balance
c. Attention-deficit–hyperactivity disorder
d. Depressive disorders
e. Schizophrenia
f. Bipolar disorders
13.Pulmonary
a. Asthma
b. Chronic obstructive pulmonary disease
c. Respiratory distress syndrome
d. Respiratory failure
e. Cystic fibrosis
f. Pulmonary hypertension
14.Renal
a. Acute renal failure
b. Chronic renal failure
c. Renal replacement therapies (hemodialysis,
peritoneal dialysis, continuous renal
replacement)
d. Nephrolithiasis
e. Glomerulonephritis
f. Fluid and electrolyte disorders
15.Rheumatologic
a. Polymyositis
b. Scleroderma
c. Systemic lupus erythematosus
d. Sarcoidosis
e. Rheumatoid arthritisYou can also read
