Unplanned CPD record examples

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  • Community (RPS)
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    Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge or skills

    I attended a focal point learning programme on chronic obstructive pulmonary disease from the CPPE (centre for pharmacy postgraduate education). I already understood the link between COPD and smoking. However,  I learnt about the importance of ‘total exposure’ and the concept of ‘pack years’. For me, the most important aspect of learning was that, however bad your COPD, giving up smoking will change and better the rate of decline. This will help me with my stop smoking service.

    Give an example of how this learning benefited the people using your services.

    Whilst I already understood that people who smoke have a greater chance of developing COPD. This helped me to link support for stop smoking with COPD.

    Now, I will not only ask people generally whether they smoke (the quick intervention) but make a point to specifically ask people with COPD whether they smoke with a view to enrolling them in our stop smoking service.

  • Community (GPhC) #1
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    Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge or skills

    Whilst conducting a medicines usage review (MUR) the patient mentioned that he had recently been experiencing an increased incidence of palpitations and missed heart beats. The patient was a 49 year old male, did not smoke, took moderate exercise and was not overweight. He said he had no previous cardiac history. I checked his blood pressure and it was within the normal range. He explained that the problem came and went but had recently got worse and thought it might be linked to stress at work.

    We discussed his medication. He took amitriptyline daily for prophylactic management of migraine and cluster headaches and had recently increased the dose to manage the headaches. I recalled that amitriptyline might have cardiac side effects but wanted to check the details.

    BNF: Amitriptyline [unlicensed indication] – ‘arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side effects include postural hypotension, tachycardia and ECG changes’.

    Online literature search:

    • PJ 15th October 2014. Thomson, C and Wright, P. “Long QT syndrome”
    • BMJ 29 Jan 2013:346:F288. Castro, VM et al. “QT interval and antidepressant use: a cross-sectional study of electronic health records”

    The references confirmed that amitriptyline could cause long QT syndrome, primary symptoms may include palpitations and that symptoms were dose related. I concluded that his symptoms might be linked to either stress/dose-related side-effect of his amitriptyline, contacted the patient, informed him of my conclusions and suggested that he should be referred to his doctor for a more thorough assessment.

    Give an example of how has this learning benefited the people using your services.

    This CPD benefited the patient directly. He visited his GP and was referred to a cardiologist. He was found to have some abnormalities with his ECG and was diagnosed with ectopic heartbeats, which may not necessarily have been caused by the medication but could have been exacerbated. The patient is now under the care of the cardiologist and was grateful for the advice I provided.

    This example record is copyright to the General Pharmaceutical Council and reproduced with permission from “Example records - For revalidation for pharmacy professionals” 2017.

  • Community (GPhC) #2
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    Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge or skills

    As I work in community pharmacy, I received a letter addressed to the Pharmacist. The letter was from XX. The letter was highlighting the new safety information relating to the canagliflozin-containing medicines Invokana and Vokanamet. This immediately caught my attention as one of the GPs in the practice next door had phoned the previous week. As he was thinking of commencing a patient on it and he wanted to check its availability. The letter highlighted a two-fold higher incidence of lower limb amputation (primarily the toe) has been seen in a clinical trial with canagliflozin. The issue is currently under investigation.

    Dehydration and volume depletion may play a role in the development. Having read this I decided to look up canagliflozin in the BNF as I have not seen it in practice: NICE guidance - Canagliflozin in combination therapy for treating type 2 diabetes (June 2014). Canagliflozin in a dual therapy regimen in combination with metformin is recommended for the treatment of type 2 diabetes. Only if a sulfonylurea is contra-indicated or not tolerated or the patient has a significant risk of hypoglycaemia.

    Canagliflozin in a triple therapy regimen is an option for the treatment of type 2 diabetes in combination with metformin and a sulfonylurea or metformin and a thiazolidinedione. Canagliflozin in combination with insulin (alone or with other antidiabetic drugs) is an option for the treatment of type 2 diabetes.

    Patients currently receiving canagliflozin in a dual or triple therapy regimen that is not recommended according to the above criteria should have the option to continue treatment until they and their clinician consider it appropriate to stop (www.nice.org.uk/TA315). The Scottish Medicines Consortium has advised (May 2014) that canagliflozin (Invokana®) is accepted for restricted use within NHS Scotland for the treatment of type 2 diabetes in combination with metformin as dual therapy, or in combination with metformin and standard of care as triple therapy, or in combination with insulin and standard of care.

    Standard of care refers to any antidiabetic drugs that are indicated to be prescribed in combination with metformin or insulin for the treatment of type 2 diabetes.

    Give an example of how this learning benefited your patients or service users

    This learning benefited my patients as I am now more informed about the drug canagliflozin. I decided to phone the GP that had queried the availability of canagliflozin and highlight this new alert that had come through regarding higher incidence of limb-amputation. He was extremely thankful for the phone call as he was closely monitoring this patient and as the patient was suffering from neuropathy he felt it was best to continue with current therapy. I felt that my learning not only improved my knowledge base but also supported another healthcare professional.

  • Hospital (GPhC)
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    Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge or skills

    Whilst on my clinical area, I came across a drug on a patients medication chart, that I was unfamiliar with. The drug was Entresto. Prior to ordering the drug for this patient, I advised the ward Pharmacist that we did not stock this drug, and I would enquire how long it would take us to get this drug in for the patient. I learnt this drug was for the treatment of Heart Failure, the drug was available in three different strengths, I learnt the dosing regimens for this drug and also the vast amount of contraindications that go with this drug. It was important that the patient received this drug as soon as we could possibly get it from the wholesalers.

    Give an example of how this learning benefited your patients or service users

    This learning alerted me to a new drug which had been prescribed within my own clinical area, the importance in the patient in receiving their medicines at the appropriate time, with minimum delay. It was stocked at our wholesalers, so were able to obtain this medication on next day delivery. After discussions with the Cardiology pharmacist and the Senior Charge Nurse we decided to add one box of each strength of Entresto to the ward stock list. This will stop delay for future patients if they are prescribed this drug.

    I also met with the other clinical pharmacy technicians within my team and I delivered a mini training session on this drug and advised it had now been added to the ward stock lists. So, overall, this was very beneficial to the service user and the clinical pharmacy technicians working in Cardiology.

  • Hospital (RPS)
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    Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge or skills

    I attended a literature searching course provided by the local acute trust medical librarian to learn about healthcare databases which could be accessible via NHS Athens. I learnt how to structure basic and advanced literature searches and manage the results of searches. I also learnt how to setup automatic searches and receive automatic alerts of relevant articles.

    Give an example of how this learning benefited the people using your services.

    This has been helpful in my work in updating a monograph on topical antiseptics. I structured three searches on individual antiseptics and setup an automatic notification via email. So that I will be alerted whenever new information on these are cited. The skills learnt have enabled me to structure more specific and efficient searches, and I have also been able to show some of my colleagues how to setup automatic searches for their speciality.

  • Academia (RPS)
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    Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge or skills

    I attended a course run by the Wellcome trust clinical research foundation education programme which provided an introduction to qualitative methods for health professionals.

    I subsequently read papers issued during the course and talked to a colleague who is experienced in qualitative research methods.

    Give an example of how this learning benefited the people using your services.

    I now have a much better basic understanding of qualitative research methods and have a good starting point to advance my learning through further reading and training in order to be able to use these methods.

  • Hospital (GPhC)
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    Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge or skills

    I attended a recent in-house hospital clinical meeting on paediatric nutrition.

    I learnt about different milk products and allergies and when you would use regular formula, hydrolysed proteins and amino acids. I also learnt about products included in our hospital paediatric formulary and when they should be used.

    Give an example of how this learning benefited the people using your services.

    We sometimes receive enquiries from nursing staff and parents about paediatric nutrition.

    My confidence and understanding of the issues faced by parents of babies with intolerances and allergies has improved. When I receive a prescription I can now safely validate it and supply the appropriate product for the patient.

    Last week, for example, I received a prescription for a particular milk product for a nine month baby. I checked the paediatric formulary and confirmed that the product was appropriate for the child and the dosage correct.

    I am interested in finding out more about paediatric medicines and plan to attend other clinical meetings related to paediatrics.

    This example record is copyright to the General Pharmaceutical Council and reproduced with permission from “Example records - For revalidation for pharmacy professionals” 2017.

  • Academia (GPhC)
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    Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge or skills

    I was asked to provide an internal review for the e-assessment questions linked to the new CPPE learning programme on Summary Care Records (SCR).

    Although mainly reviewing for educational robustness, I completed the associated learning programme to ensure the answers to the questions were correct and could be answered by completing the learning programme.

    This provided me with knowledge about SCR and how they can be accessed and used in community pharmacy. Including what information they contain, when they can be accessed and governance requirements around their use.

    Give an example of how this learning benefited the people using your services.

    This learning has allowed me to ensure that the learners who access this programme and the linked assessment are provided with accurate knowledge and testing. So that they can be confident that they are acting within the law when accessing records in community pharmacy. Ultimately this will have a direct impact on patients who will be able to access improved care from the pharmacy when they need it.

    This learning will also benefit the users of any learning I develop in the future. As I will be able to incorporate this knowledge into programmes to allow them to think how access to SCR can have a positive impact on patient care.

    This example record is copyright to the General Pharmaceutical Council and reproduced with permission from “Example records - For revalidation for pharmacy professionals” 2017.

  • Industry (GPhC)
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    Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge or skills

    I am a pharmacist and work for a pharmaceutical company. We have a standard operating procedure (SOP) for Product Recalls that need, in line with good working practices, to be tested on an annual basis. A recall might occur for example when a company has to remove a product because of design or production defects that may compromise safety, efficacy and purity of the product or because of government regulation.

    Our company performs ‘mock product recalls’ to check that the various steps in the SOP work and that a product can be recalled in a timely manner, fully reconciled and accounted for, should this be required. We recently instigated a mock recall that highlighted some potential business risks.

    The following learning points were identified:

    • When conducting a mock recall, careful consideration needs to be given to who to contact and when. In this particular study there are over 150 active sites. Our Recall Committee deliberated on who to contact and eventually decided to contact a sample of ten sites. This decision making took valuable time and resource and delayed the notification to sites.
    • Although the Packing Organisation who prepared the supplies, the Clinical Contract Research Organisation who monitor the study and the targeted sites all responded, the mock recall was a notification exercise only. No reconciliation was performed.
    • The Packing Organisation provided a stock inventory, but did not perform a physical stock count. Similarly, the target sites did not do a physical count to ensure they could locate the affected kits provided on the shelves in their clinics.

    From the mock we identified areas for improvement within our Product Recall SOP.

    Give an example of how this learning benefited the people using your services.

    The Product Recall SOP has been updated to reflect these key learnings. We have also introduced standard letter templates into the Product Recall SOP (in line with the MHRA Guidelines). This will simplify and speed up the process of contacting the Packing Organisation who prepares the supplies. The Clinical Contract Research Organisation (CRO), who monitor the study and the clinical sites that run the study and dose the patients.

    My colleagues at work have benefited because they have a better understanding of what is required of them. Patients will also benefit if a genuine product recall was ever to take place.

    For future mock recalls, the recall committee will also be more specific in terms of its requirements, to ensure the information can be obtained in a more time efficient manner.

    This example record is copyright to the General Pharmaceutical Council and reproduced with permission from “Example records - For revalidation for pharmacy professionals” 2017.

  • Advisory/Regulatory/Government (GPhC)
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    Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge and skills

    In my role as a primary care pharmacy technician with the ministry of defence, I received an email regarding a change of policy with antimalarial prophylaxis prescribing. This mainly concerned the recent discovery of the serious adverse effects of malarone and the steps that were to be taken following this new procedure.

    It was important to note that the procedure was required in all cases where an antimalarial drug was prescribed. This involved the patient having a face-to-face consultation with a prescriber and specific questions being answered using an antimalarial protocol on the EMIS system.

    As I was not familiar with the use of these computer system protocols, I was not sure of how I would be able to see if a patient had been prescribed the medication in the correct manner. - I therefore spoke with a prescriber who explained the procedure to me and the different stages that were involved in the process. Because of this discussion and knowledge gained, it was then possible for me to look at a patient’s record and see if the antimalarial protocol had been completed as per the policy before dispensing the prescription.

    Give an example of how this learning benefited the people using your services

    This change in my practice when dispensing prescriptions for antimalarial drugs has benefited every patient I have handed them to since the introduction of the new protocol-based system. It ensures that all patients have received a face-to-face consultation with a prescriber to discuss the appropriateness of the medication chosen, its efficacy and potential risks and side effects.

    On one occasion before dispensing atovaquone/proguanil, I noticed that there was no protocol documented in the patient's record. Before dispensing the prescription, I queried this inconsistency with the prescriber to ensure that the face-to-face consultation and counselling took place before the prescription was dispensed. Even though the prescription was urgent, the procedure still needed to be followed correctly. I received praise from the regional pharmacist for the action taken.

  • Education and Training (GPhC)
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    Describe unplanned event or activity that enabled you to learn something new or refresh your knowledge and skills

    I was asked to provide an internal review of a learning package on summary care records. To do this I went through the learning package myself to ensure that that it achieved its educational objectives. As a result, I have gained knowledge about summary care records, such as how they can be accessed and used in community pharmacy, including what information they contain, when they can be accessed and governance requirements around their use.

    Give an example of how this learning benefited the people using your services

    This learning has allowed me to ensure that the learners who access this programme and the linked assessment are provided with accurate knowledge and testing so that they can be confident that they are acting within the law when accessing records in community pharmacy. I have also used this knowledge to explain how accessing summary care records can have positive benefits for patients.

  • Industry (GPhC)
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    Describe unplanned event or activity that enabled you to learn something new or refresh your knowledge and skills

    We recently instigated a mock recall that highlighted some potential business risks. The following learning point was identified: When conducting a mock recall, careful consideration needs to be given to who to contact and when. Decision making took valuable time and resource and delayed the notification to sites. From the mock we identified areas for improvement within our Product Recall SOP.

    Give an example of how this learning benefited the people using your services

    The product recall SOP has been updated to reflect these key learnings. I have also introduced standard letter templates into the product recall SOP (in line with the MHRA Guidelines). This will simplify and speed up the process of contacting the Packing Organisation who prepares the supplies, the clinical contract research organisation who monitor the study and the clinical sites that run the study and dose the patients. My colleagues at work have benefited because they have a better understanding of what is required of them. Patients will also benefit if a genuine product recall was ever to take place. For future mock recalls, the recall committee will also be more specific in terms of its requirements, to ensure the information can be obtained in a more time-efficient manner.

  • Locum (GPhC)
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    Describe unplanned event or activity that enabled you to learn something new or refresh your knowledge and skills

    I attended an in-house hospital lunchtime training session on dressings. The pharmacist covered different types of dressings and had people try them on to see how they worked. This included dressings ranging from simple bandages to more specialist dressings containing iodine and silver. I learnt which brands are used as absorbent layers, have antimicrobial action, or used as a top covering to hold everything in.

    Give an example of how this learning benefited the people using your services

    Since this training, I had a patient come to the community pharmacy where I locum asking for a dressing to cover a small burn on his hand. It had not blistered, had scabbed over and not infected. He requested one of the specialist iodine dressings as he had used these in the past for another skin condition.

    From my learning, I knew that the ones we had in stock did not have an adhesive around the edge and required a second dressing to cover it and hold in place. I also did not think this was needed for the patient as there was no sign of infection. On further questioning, I found out the patient only required a dressing so that he would not knock the scab off or damage it further.

    I recommended a simple dressing, which is non-adherent, had an adhesive edge and can easier fit to the shape of a hand. This would provide a simple covering and help to keep the wound clean.

  • Management and Leadership (GPhC)
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    Describe unplanned event or activity that enabled you to learn something new or refresh your knowledge and skills

    A colleague is undertaking a pharmacy management qualification and had been asked to complete an essay on how her role fits into, and how her department are working to further the aims of a national strategy for pharmacy. She sent me a copy of her first draft essay for review and comment. As it had been some time since I had read the strategy I decided to reread it prior to commenting on the draft essay.

    As well as refreshing my memory, I spent time reflecting on the aims of the strategy in relation to my department, my role and how I could personally contribute to its application. Having updated my knowledge, I provided comment to my colleague to help improve her draft essay, making it more relevant to the topic in question. I also encouraged her to read the document more fully and reflect on it in relation to her individual role.

    Give an example of how this learning benefited the people using your services

    My colleague has indicated that she: a) has a better understanding of the strategy and the vision for pharmacy and, b) is more aware of how the strategy is being implemented in her department and, c) is reflecting on how she can personally work towards the aims.

    My own refresher has reminded me of the aims of the vision for pharmacy and that I should be using that mindset when planning my workload (e.g. in terms of communicating with others and providing resources to support work that staff and General Practices are asked to do). This will benefit service users (both in terms of interaction with myself and my colleague) in that we will both be trying to work in a more inclusive, patient centered manner, putting the patient at the heart of what we do (and encouraging others to do so too).

  • Mental Health (GPhC)
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    Describe unplanned event or activity that enabled you to learn something new or refresh your knowledge and skills

    I work at a mental health unit and had a query from the consultant psychiatrist, asking how we could provide pharmaceutical provision for a patient to leave the unit for one month. This was complicated because he was a Clozapine patient who needed to have bloods monitored and medication released only following blood results.

    The medication cannot be supplied where he was going because a different brand of clozapine and monitoring service was in use. I firstly had to think through the process and the issues involved in this medicine supply. I wrote a plan and list of issues to be resolved. My plan was approved by the Superintendents’ office and we had key responsibilities outlined for all involved. This was then applied through a trial period.

    Give an example of how this learning benefited the people using your services

    This was a successful trial period for the patient and a team effort through effective communication between all healthcare professionals involved. The lead pharmacist on where the patient was located commented on how well I had organised it and kept everyone informed.

    This resulted in the patient being discharged back home following a four-week period back in the unit. I found this to be a safe and effective way to provide continuation of pharmaceutical care. In future, I would note that we need to allow plenty time for this to be arranged with all concerned and the process thought through very carefully on an individual basis. Using effective communication with the patient and team involved, we can use this protocol again alongside risk assessment and safer care considerations, for individual patients.

    If we have the same situation again I could readily organise medicines to be provided at a distance. Thereby benefiting the patient's continuation of care and integration back into their local community.

  • Military Pharmacy (GPhC)
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    Describe unplanned event or activity that enabled you to learn something new or refresh your knowledge and skills

    We had a recent change to policy where a new anti-malarial will be used in preference to another. We use malaria tablets a lot in the military but the expense of the medicine means we monitor its use closely. One of the prescribers asked why it is only used for a week instead of the normal four weeks. I thought it was something to do with the action of the drug but wasn't completely sure. I decided to look into it and report back. After checking the BNF, MIMMS and the eMC I still didn't have the answer. I decided to speak to the medicines information team at the supplier. They provided me with information of the efficacy with only seven days use after leaving a malarious area. It kills the parasites at stage one in the liver which lasts up to seven days. The blood stage lasts for up to 28 hence the difference in duration of treatment.

    Give an example of how this learning benefited the people using your services

    I will be able to explain to patients and prescribers the difference in duration of use and provide them assurance about the effectiveness of the medicine. When I explained to the prescriber's they thanked me for helping them keep their prescribing knowledge up to date – in fact it was something they realised they had temporarily forgotten in this instance.

    Primary Care example (GPhC)

    Describe unplanned event or activity that enabled you to learn something new or refresh your knowledge and skills

    I attended the prescribing sub-group meeting for my area. The medicines management team discussed ‘de-prescribing’ quinine for leg cramps. I learnt about how quinine is not to be used routinely for nocturnal leg cramps. (Ref:www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON085085). I also learnt that quinine should only be used when cramps regularly disrupt sleep, when other treatable causes of cramp have been excluded and when non-pharmacological treatments have not worked (e.g. passive stretching exercises). After a trial of at least four weeks, treatment should be stopped if there is no benefit. If treatment continues, the benefits should be assessed around every three months.

    Give an example of how this learning benefited the people using your services

    When I go and assess patients who are having difficulties taking their medications I try to de-prescribe medications with the GP which are no longer necessary for the patient. By learning about quinine, I am able to now look at these patients who are prescribed quinine to see if a trial discontinuation of quinine could be done for patients taking it long-term for nocturnal leg cramps.

    I assessed a patient after this learning occurred who was struggling to remember to take her night medication. When I asked her how long she had been taking this for she said that she had been on it for years. She told me that she doesn't get cramps at night anymore and said she forgets to take the quinine regularly. I was then able to speak to the patient's GP to suggest that he reviews whether he could de-prescribe the quinine. The GP reviewed the patient’s records and the quinine was de-prescribed. The patient was reviewed again by the GP six weeks later and she had not had any night cramps during this period. The patient was very happy that she no longer had to take night medications.

  • Primary Care (GPhC)
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    Describe unplanned event or activity that enabled you to learn something new or refresh your knowledge and skills

    I attended the prescribing sub-group meeting for my area. The medicines management team discussed ‘de-prescribing’ quinine for leg cramps. I learnt about how quinine is not to be used routinely for nocturnal leg cramps. (Ref:www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON085085). I also learnt that quinine should only be used when cramps regularly disrupt sleep, when other treatable causes of cramp have been excluded and when non-pharmacological treatments have not worked (e.g. passive stretching exercises). After a trial of at least four weeks, treatment should be stopped if there is no benefit. If treatment continues, the benefits should be assessed around every three months.

    Give an example of how this learning benefited the people using your services

    When I go and assess patients who are having difficulties taking their medications, I try to de-prescribe medications with the GP which are no longer necessary for the patient. By learning about quinine, I am able to now look at these patients who are prescribed quinine to see if a trial discontinuation of quinine could be done for patients taking it long-term for nocturnal leg cramps.

    I assessed a patient after this learning occurred who was struggling to remember to take her night medication. When I asked her how long she had been taking this for she said that she had been on it for years. She told me that she doesn't get cramps at night anymore and said she forgets to take the quinine regularly. I was then able to speak to the patient's GP to suggest that he reviews whether he could de-prescribe the quinine. The GP reviewed the patient’s records and the quinine was de-prescribed. The patient was reviewed again by the GP six weeks later and she had not had any night cramps during this period. The patient was very happy that she no longer had to take night medications.