SingHealth GLF Handbook 1st Edition Feb2011

A Competency Framework for
SingHealth Pharmacists to provide
Minimum Standard of General
Pharmacy Practice:
The General Level Framework
Handbook
First Edition
February 2011
Adapted with permission from the Safe Medication Practice Unit,

Queensland Health and the NHS London and South East - Competency
Development and Evaluation Group.
Contents
Acknowledgements……………………………………………………………………………………. Page 2
Background……………………………………………………………………………………………... Page 3
Introduction……………………………………………………………………………………………... Page 4
Assessment Rating…………………………………………………………………………………….. Page 5
Assessment Tools…………………………………………………………………………………….. Page 6
Mini-Clinical Evaluation Exercise (Mini-CEX)……………………………………………………….. Page 7
Case based Discussions (CbD)………………………………………………………………………. Page 8
Medication Review & Dispensing Observations……………………………………………………. Page 10
1. Delivery of Patient Care Competencies………………………………………………………….. Page 13
2. Problem Solving Competencies………………………………………………………………...... Page 33
3. Professional Competencies……………………………………………………………………….. Page 41
At The End of The Assessment Period……………………………………………………………… Page 48
Appendix 1: The General Level Framework
Appendix 2: GLF Mapping
Appendix 3: Mini-Clinical Evaluation Exercise (Mini-CEX) Form
Appendix 4: Case based Discussion (CbD) Form
Appendix 5A: Medication Review / Dispensing Observation for GLF Pharmacist
Appendix 5B: Dispensing Observation for GLF Pharmacist
Appendix 6: GLF Assessment Summary

Acknowledgements
The following people are acknowledged for their contributions and efforts towards the
production of this handbook:
- Angelina Tan Hui Min, Pharmacy, Singapore General Hospital
- Camilla Wong Ming Lee, Allied Health Division, Singapore General Hospital
- Jacqueline Ong Kia Geok, Allied Health Division, Singapore General Hospital
- Lim Kiat Wee, Pharmacy, Singapore General Hospital
- Lim Paik Shia, Pharmacy, Singapore General Hospital
- Yee Mei Ling, Pharmacy, Singapore General Hospital
- Patricia Ng Lai Lin, SingHealth Academy (Editorial Support)
- Anita Binte Mohamed Sani, Pharmacy, Singapore General Hospital (Cover Page Design)
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Background
The scope of pharmacy practice in Singapore has increased tremendously in recent

years. It is crucial that pharmacists have adequate postgraduate education, training
and guidance to enable them to perform competently so as to ensure safe and
effective patient care.
In 2007 the Singapore General Hospital (SGH), a member of the Singapore Health
Services (Singhealth) group, started collaborations with the UK Competency
Development and Evaluation Group (CoDEG) to adapt their General Level
Framework (GLF) for use in SGH. The GLF is an assessment and developmental
tool that encompasses the holistic scope of pharmacy practice, namely knowledge,
skills and attitudes. Ultimately, the aim is to develop competent pharmacists who will
provide safe and effective healthcare to the nation.
In May 2009, an adapted version of the GLF was initiated within the Department of
Pharmacy. In December of the same year, experts from CoDEG visited Singapore
and a Memorandum of Understanding was exchanged between CoDEG and
Singhealth, a milestone in the continued collaboration between the two parties. In
addition, the experts conducted a GLF training programme that included a ‘train the
trainers’ session in which Singhealth pharmacists were educated and trained on the
framework’s concepts and processes, and who then took the lead in the training of
other GLF assessors within their own institutions. In 2010, all of the Singhealth
pharmacy leaders agreed to adopt a unified ‘SingHealth’ GLF. This was a major
breakthrough.
Recent developments have also seen the Singapore Ministry of Health (MOH)
endorse the use of such competency frameworks as part of the new national career
pathway for pharmacists. This is an exciting development, which has put
Singhealth’s competency training initiatives at the forefront of the profession’s
development in Singapore.
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Introduction
The purpose of this document is to provide guidance on the Singhealth General

Level Competency Framework. (Refer to Appendix 1)
A competency framework is a collection of competencies that are thought to be

central to effective performance. Competency frameworks can be used to support a
range of different things. Typically, they are used to help with:
 Training and development;
 Performance review.
It is envisaged that this framework will be used to help with pharmacist training and
developmental activities. However, as the pharmacist develops, the framework also
has the potential to be used as a tool to help in appraisal and to track performance.

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Assessment Rating
The assessment rating is on a 4-point scale i.e. “Rarely”, “Sometimes”, “Usually” and
“Consistently” (see Table 1). An ‘Unable to Assess’ option is available for occasions
when a competency cannot be observed or is not appropriate.
Assessment should be referenced to the standard expected at a particular level of
practice. This may vary between levels of practitioners (for example, that expected of
a newly registered pharmacist will differ from that expected of a more experienced
pharmacist). Please refer to Appendix 2 for the current Singhealth mapping
reference.
Table 1: Frequency Ranges for Assessment Ratings

Rating Definition Percentage
Expression
Consistently Consistently demonstrates the expected standard 85–100%
practice, with very rare lapses.
Usually Demonstrates expected standard practice with 51–84%

occasional lapses.
Sometimes Demonstrates expected standard practice in less than 25–50%

half the time observed. Much more haphazard than
“usually”.
Rarely Very rarely meets the standard expected. No logical 0–24%

thought process appears to apply.
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Assessment Tools
As a result of ongoing implementation of the framework, various other assessment

tools have been developed. These tools provide formative assessments which are
designed to complement the GLF and help to identify areas for development and
monitor performance. They have been adapted from similar tools developed by
CoDEG and include:
 Mini-Clinical Evaluation Exercise (Mini-CEX) — Refer to Appendix 3;
 Case-based Discussions (CbD) — Refer to Appendix 4;
 Medication Review and Dispensing Observations - Refer to Appendices 5A

and 5B.
A portfolio (based on this framework) and the associated assessment tools can be
used to demonstrate a pharmacist’s ability to work at a general level. This provides a
platform for further development to a higher practice level.

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Mini-Clinical Evaluation Exercise (Mini-CEX)
Purpose: The Mini-CEX is designed to assess the skills essential to the provision of
pharmaceutical care.
Competencies assessed: The pharmacist will be assessed on the competencies of

gathering and analysing information, evaluating appropriateness of drug selection
and providing the necessary patient education. Communication skills with the other
healthcare providers, patients and caregivers will also reflect the pharmacist’s
problem-solving skills and professionalism.
Setting: It is preferable to discuss cases that are currently under the pharmacist’s
care i.e. inpatients or outpatients.
Feedback: Timely feedback should be provided after each encounter by the

assessor. In keeping with the quality improvement assessment model, strengths and
areas for development will be identified following each Mini-CEX.
The documentation (or a copy) of a Mini-CEX should be retained by the pharmacist

in his / her career portfolio. The assessment should end with formulating at least one
learning objective for the next encounter with the assessor.
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Case-based Discussions (CbD)
Purpose: CbD is designed to assess analytical skills and decision making, as well as
the clinical application of pharmaceutical knowledge in the care of the pharmacist’s
own patients. It also enables the discussion of professionalism and the ethical
aspects of practice, and in all instances, allows pharmacists to discuss why they
acted as they did.
Competencies assessed: The pharmacist’s ability to identify drug-related problems,

analysis and treatment recommendations, follow-up and monitoring, communication
with other healthcare professionals, consideration of patient concordance,
professionalism and overall clinical judgement will be assessed. Refer to Table 2 for
the relevant descriptors.
Setting: It is preferable that each CbD focus on a clinical area which the pharmacist
has been involved in. The case discussion could be conducted retrospectively, i.e.
after counselling or patient discharge. A variety of areas should be covered through
a number of CbDs.

areas for development will be identified following each CbD.
The documentation (or a copy) of a CbD should be retained by the pharmacist in his
/ her career portfolio. The assessment should end with formulating at least one
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Table 2: Competency Areas and Relevant Descriptors
Competency Areas Descriptor
Identification of Able to correctly identify and prioritise DRPs.
drug-related
problems (DRP)
Analysis and Able to discuss treatment of the main medical problems
treatment including drug therapy (mechanism of action of drugs, dosage
recommendations range, key pharmacokinetic consideration, cautions,
contraindications, common side effects, major drug / food
interactions, patient counselling points), utilising evidence-
based treatment guidelines where appropriate.
Follow-up and Able to discuss the rationale for pharmaceutical care.
monitoring Able to demonstrate appropriate monitoring of therapy
(including renal function test, full blood count, drug levels etc)
Professionalism Able to prioritise activities and demonstrate timeliness.
Is ethical and aware of any relevant legal frameworks.
Has insight into own limitations.
Overall clinical care Able to demonstrate sound judgement in the provision of

patient care.

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Medication Review and Dispensing Observations
Purpose: The Medication Review / Dispensing Observations tool document findings

during medication review and dispensing for pharmacists.
Competencies assessed: The pharmacist will be assessed on the ability to manage

the patients assigned, prioritising the tasks and handling urgent and important
interventions appropriately as well as showing effective communication skills.
Setting: Inpatient - During medication review round, and / or bedside / counter

dispensing. Outpatient - During medication review at ambulatory clinics and / or
counter dispensing.

areas for development will be identified following each observation.
The documentation (or a copy) of the findings should be retained by the pharmacist
in his / her career portfolio. The assessment should end with formulating at least one
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The General Level Framework
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Section One
Delivery of Patient Care Competencies
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1. Delivery of Patient Care Competencies
PATIENT CONSULTATION
This competency incorporates the structure and processes needed to obtain and
document information relating to the patient’s visit / admission, which will provide a
baseline for ongoing pharmaceutical care. The personal skills needed for effective
communication in this process are described in the professional competencies.
1.1 Opening the Consultation
A pharmacist should always provide clear introduction to the consultation and agree
on an agenda with the patient. After determining the ability of the patient to
communicate, confirming the time is convenient to the patient and adopting a
suitable position to enable the consultation to take place comfortably, the pharmacist
should:
 greet the patient or caregiver and establish his / her identity;
 introduce himself / herself and other colleagues if present;
 explain what the pharmacist is hoping to achieve, e.g. taking medication

history, drug specific counselling or a medication chart review;
 respect the patient’s right to decline an interview or consultation, or choose a

more appropriate time for the interview.
1.2 Questioning
Pharmacists must determine the specific goals of the interview and tailor the
questions and discussion to obtain the necessary data. The pharmacist must talk at
a level which enables the patient to hear, but does not compromise patient
confidentiality. Appropriate language must be used i.e. non judgemental, non
alarmist, reassuring, and using terminology that the patient will understand.
Questions must be relevant and succinct, as exhaustive interviews may be counter-

productive. Appropriate questioning makes it easier to obtain relevant information
from the patient. For example, begin the medication history interview with open-
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ended questions to encourage the patient to explain and elaborate, then move to
close-ended questions to systematically minimise omissions. Leading questions
should be avoided as they can result in false information.
GATHERING INFORMATION
1.3 Allergies
To document an accurate and comprehensive allergy / adverse drug reaction (ADR)

history, the pharmacist should:
 confirm with the patient any history of drug allergies or previous adverse
reactions to any agents;
 document the drug, reaction and date of reaction (if known) on the
prescription;
 document as “NKDA” (No Known Drug Allergy) on the prescription if the

patient reports no history of ADR or allergy;
 notify the doctor-in-charge of the drug allergy and reactions reported by the
patient and document as appropriate in the medication records and / or case
notes, and / or prescriptions, in a timely manner.
It is important to follow institutional policy regarding documentation of allergy / ADR

history in the patient’s case notes. As institutions move towards electronic
medication records, the above should be documented electronically.
1.4 Relevant Patient Background
Background information about the patient’s health and social status is important in
the provision of pharmaceutical care. Without this information it is difficult to establish
the existence of, or potential for, medication-related problems. Review of medication
charts and prescriptions without this information risks flawed judgements on the
appropriateness of therapy for that individual. The details required depend on the
circumstances. The data collected should be succinct and relevant. The key focus
should be on obtaining the most relevant data rather than collection of all
information.
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Details required may include:
 Age — the very young and the very old are most at risk of medication-related
problems. A patient’s age will indicate their likely ability to metabolise and
excrete medications and therefore has implications for appropriate selection
of drug dosage.
 Gender — may impact on the choice of therapy for certain conditions.
 Ethnic background / religion — pharmaceutical implications of this information

include racial pre-dispositions to intolerance or ineffectiveness of drug
classes, e.g. ACE-inhibitors in Afro-Caribbean individuals, or the unsuitability
of drug formulations, e.g. blood products in Jehovah’s Witness patients,
porcine-derived products for Jewish and Muslim patients.
 Social background — this may impact on their ability to manage their

medications and influence their pharmaceutical care needs e.g. what are their
home circumstances? Do they live in their own home or in residential
accommodation? Do they have a visiting nurse or caregivers? etc.
 Presenting condition — establish what symptoms the patient described and

the signs identified by the doctor on examination. Could these be adverse
effects related to prescribed or purchased medication? Could the lack of
symptom control indicate poor adherence, inadequate dose or inappropriate
agent?
 Working diagnosis of the medical team treating the patient — how would this
condition likely be managed? What drug therapy would be considered
appropriate and evidence-based? This will give an indication as to the classes
of medications that one should expect to see on the medication chart.
 Previous medical history — concurrent medical conditions may guide the

selection of appropriate therapy. Knowing the patient’s concurrent medical
conditions will help the pharmacist identify potential drug-disease
contraindications and ensure that management of the acute newly diagnosed
problem does not compromise a prior condition.
 Relevant laboratory or other findings (if available) — focus on findings that will
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 Renal Function
 Liver Function
 Full Blood Count
 Blood Pressure
 Cardiac Rhythm
 Heart Rate
 Temperature
 Pain Scores
Consider not only the impact that these findings could have on the ongoing
management of drug therapy e.g. the need for dose adjustments, but also whether
these results could have been caused by an unwanted drug effect.
Establishing this background information will allow you to make a more

accurate assessment of the appropriateness of therapy.
Sources of Patient Information
Obtaining relevant information will depend on your sector of practice. Sources of

patient information include medical, nursing and electronic records, as well as
directly from the patient or carer themselves. The most concise information source
should be used. Routine review of medical notes (if available) and all laboratory tests
may be time consuming, inappropriate and unnecessary for the retrieval of basic
information. Possible sources of information include:
 Nurses (including community nurses) – they are the frontline care providers for
the patients in a hospital and increasingly in primary care. Hence developing a
good working relationship with the nursing staff is a valuable exercise. In a
hospital, the nursing team may provide excellent information about the patient’s
current condition.
 Patients – they are often able to provide information, particularly in relation to
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 Case notes – these will provide the most detailed description of the patient’s care
to date, although they are often lengthy and repetitive and should therefore be
used to confirm findings, rather than as a first source of reference. Previous
hospital admissions and subsequent discharge summaries, or prescriptions are
often useful to clarify medication histories.
 Allied health professionals – these professionals e.g. physiotherapists, social

services care workers, occupational therapists etc. may be involved in the
patient’s medicine management e.g. assessing compliance and recommending
compliance aids.
 Laboratory results systems – if laboratory results are readily available,

pharmacists should ensure that they have personal access and have been
trained in retrieving correct patient information from the database.
As institutions move towards electronic medical records, the above could be

retrieved electronically. Finally, it should be remembered that all patient information
is CONFIDENTIAL and should not be discussed with anyone not involved in that
patient’s care.
1.5 Medication Reconciliation
An accurate medication history will assist in patient care and should include an
interview with the patient / carer. Taking accurate and complete drug histories has
been shown to have a positive effect on patient care. Pharmacists have
demonstrated an ability to accurately and reliably take medication histories. The
benefit of this to the patient lies in the fact that errors of omission or transcription
would be identified and corrected early, reducing the risk of harm and improving
care.
Queries regarding drug therapy should be clarified with the prescriber, or referred to
a more senior pharmacist. The core components of medication history taking are
listed in Tables 3 and 4.
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Table 3: Core Components of A Complete Medication History
1. Introduce yourself to the patient and explain the purpose of the visit /
consultation.
2. Identify and document any drug allergies or serious ADRs.
3. Determine the individual responsible for administration and management of
medication e.g. patient or carer.
4. Ascertain any information the patient is able to provide about their medication
from (in order of priority):
 their own knowledge, the patient’s own medication list, or other
concordance aids;
 the medication they brought to the hospital;
 the community pharmacy;
 repeat prescriptions;
 a GP referral letter;
 information available in medical notes;
 the GP.
5. Ensure the following are recorded:
 generic name of the medication (brand name to be recorded where
appropriate);
 route / dosage form;
 dose;
 frequency;
 duration of therapy if appropriate (e.g. antibiotics).
6. Document any recent changes to the medication regimen and reason(s) for
discontinuation or alteration of any medicines.
7. Ensure that items such as inhalers, eye drops and topical agents are included
and are used correctly, as patients often do not consider these to be
‘medication’;
8. Identify any self-medications that the patient may be using e.g. OTC, herbal,
homeopathic
(Source: Safe Medication Practice Unit, Queensland 2005)
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Table 4: Medication History Checklist
The patient should be specifically questioned regarding use of the

following items:
 Prescription medication
 Sleeping tablets
 Inhalers: puffers, sprays; sublingual tablets
 Oral contraceptives, HRT
 OTC, Analgesics esp. - NSAIDS, paracetamol +/- codeine
 Gastrointestinal drugs (for reflux, heartburn, constipation, diarrhoea)
 Complementary medicines (e.g. herbals, vitamins)
 Topical medicines (e.g. patches, creams, ointments)
 Inserted medication (e.g. nose/ eye/ ear drops, pessaries, suppositories)
 Injected medication (e.g. Insulin)
 Intermittent treatments (i.e. weekly, monthly)
 Recently completed courses of medicine/ other people’s medicine
 Social and recreational drugs;
 Any previous allergies or adverse reactions.
Medication History
Although a patient / carer interview should be the primary source of data, a

combination sources can be used to obtain the medication history. If the patient is
not responsible for medication administration or if a reliable medication history
cannot be obtained from the patient / carer, then alternative sources of patient
information must be accessed. The information sources may include:
 Medication dispensing history from previous hospital admissions and / or

community pharmacies;
 Administration records from nursing homes, community hospitals or other

care facilities;
 Other healthcare professionals i.e. GPs, community nurses;
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 Patient’s own medication or list of medications;
 Patient’s prescriptions (discharge and outpatient prescriptions).
The medication history obtained should be reconciled with that recorded in case
notes by medical staff and also with the inpatient medication record at the time of
admission. The pharmacist must be able to justify changes made to medications
taken prior to and on admission. If any changes of therapy were identified, check the
case notes and ascertain if these variances are intentional. The patient, nursing staff
and medical staff may also be contacted. Unintentional changes should be clarified
and communicated to the primary team medical officers or consultant and staff
nurses as appropriate.
If significant unresolved variances exist, and a medical officer and / or consultant

cannot be contacted, the issues should be documented as a pharmacy intervention
forms or case notes. Inform the nurse looking after the patient of any medication-
related problems. It is imperative that such problems are followed up at a later time
to ensure appropriate resolution.
As part of good pharmacy practice, all interventions (resolved or unresolved)

should be documented in the patient’s case notes.
Medications currently prescribed for the patient must also be reconciled with their
current problems and relevant patient background, for example with respect to
interactions as detailed in section 2.7
Discharge Prescription
Discharge prescription / medication must be checked against the patient’s current

medication record. Reconcile discharged medications prescribed against the current
inpatient active medications list. Ensure that all drugs are reflected accurately on
discharge prescriptions. When discrepancies are identified, ascertain if the difference
is an error or intentional, for example:
 “When required” medication used in hospital not required for discharge e.g.
analgesics, anti-emetics;
 Regular inpatient medication used in hospital not required for discharge e.g.
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 Completed courses of Antibiotics;
 Chemotherapy;
 Changes intended for discharge documented in case notes.
If discrepancies require clarification, the prescriber(s) should be contacted for

confirmation of drug orders.
Discharge prescription / medication should be checked against admission history.
Reconcile discharge medication against admission medication, thus ensuring:
 Ongoing medication is prescribed / supplied / documented as appropriate

according to hospital policy;
 Changes made during admission are identified so that details can be relayed
to the patient or community healthcare providers;
 Patients’ own medications are checked against discharge prescription if

appropriate;
 Patient’s own medication are checked with respect to dose, formulation,

strength, and quantity;
 Labels are checked to ensure that they reflect current dosage and frequency
instructions.
PROVISION OF MEDICATION
The pharmacist should ensure that the medication as prescribed can be supplied
and administered safely and effectively to the individual patient. Particular attention
should be paid to the monitoring of parenteral therapy, which carries the additional
risk of extravasation, infection and administration errors.
1.6 Prescription is Unambiguous
Ensure all aspects of the prescription — drug name, dose, administration routes and
times — are clear and legible, in accordance with the medication, drug dispensing
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and controlled drug policy of the respective institutions.
Ensure all medications are prescribed by generic names, except combination

products and some controlled drugs, according to MOH guidelines. To minimise
selection of the wrong drug, prescribing by brand name is sometimes preferred e.g.
in combination products and certain controlled drug formulations. Examples include:
 Fungizone® - Amphotericin B vs AmBisome® - Amphotericin (Liposomal) vs

Abelcet ® - Amphotericin (Phospholipid complex)
 OxyContin® – Controlled released oxycodone vs OxyNorm® – Immediate

released oxycodone
 Humalog Mix (Insulin Lispro / Protamine 30/70) which is not interchangeable with
NovoMix (Insulin Aspart / Protamine 30/70)
1.7 Prescription is Legal
Check that the patient identifiers are present and the prescription is legal:
 Drug, form, route, dose, frequency, date and prescriber’s signature;
 Quantity and strength are also legal requirements for discharge and
outpatient prescriptions including controlled drugs.
1.8 Labelling of the Medicine
Pharmacists should ensure that the label on the dispensed medicines follow legal
requirements and clearly state the required information, i.e.
 Patient name and identification number;
 Drug name and strength;
 Drug dosage form;
 Drug dose and frequency;
 Drug quantity
 Special administration instructions e.g. do not chew, swallow the whole

tablet;
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 Duration (if applicable);
 Date of dispensing;
 Pharmacy details.
1.9 Medication Supply
 The prescribed medication can be made available from the hospital’s

formulary.
 Consider whether the prescribed indication is within the drug’s licence

(exemption drugs procedure).
 Follow local guidelines and hospital policies to obtain exemption and non-
formulary drugs and ensure that the appropriate documentation is
completed.
 Communicate clearly with the relevant people to ensure the efficient and
safe supply of medication.
 Ensure continuity of supply for outpatient use, inpatient use and at

discharge that will be sufficient till the next scheduled appointment or date
of expected completion of therapy.
 The prescribed medication is supplied accurately and legally
 Correct drug, form, strength, quantity, packaging and patient name.
 The prescribed medication is labelled accurately and appropriately
 As listed in 1.8.
 Instructions, as necessary, are provided. Inpatient items often do not

require dosing instructions. Exceptions to this may be items that may
be self administered by the patient and may subsequently be used for
discharge supply for example metered dose aerosols, eye drops, and
topical preparations. All discharge medication supplies must be
labelled with clear dosage instructions and, where appropriate,
ancillary labels.
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 Ensure medications are labelled appropriately for the patient e.g. the
visually impaired, non-English speaking patients.
 The prescribed medication is provided for the patient in a timely manner
 Medication should be made available in the ward for administration at

the prescribed times.
 Supply of newly prescribed medication may be prioritised depending

on medical condition of the patient e.g. IV antibiotics for the critically ill.
 Document the supply of the drug in the medication record
 The pharmacy column in the IMR is annotated in accordance with

hospital medication policy on review and supply workflow, inclusive of
date and amount supplied.
 For electronic medication administration records, dispensing system

must be able to record all the relevant information mentioned.
DRUG SPECIFIC ISSUES
1.10 Drug Selection
This relates to the principles of evidence-based medicine, clinical and cost-

effectiveness in the selection of the most appropriate drug, dose and formulation for
an individual patient, with the consideration of medical condition, co-morbidities,
financial and social issues. Pharmacists are not expected to know the full breadth of
clinical evidence for all conditions, but should have a clear understanding of, and be
able to access, local and other established prescribing guidelines. They should also
familiarise themselves with, and be able to demonstrate appreciation of, key
literature relevant to their current field of practice, for example they should be aware
of the established therapeutic services / departments. Pharmacists should also be
aware of the hospital Formulary Drug List. Postgraduate education and continuing
professional development should be guided by learning needs identified in practice.
1.11 Selection of Formulation, Concentration, Rate and Diluent
Pharmacists should check and be familiar with the following:
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 Is the medication available in a suitable form for administration via the prescribed
route?
 Is the route / formulation prescribed suitable for the patient e.g. oral liquid or
tablets for paediatric patients or patients fed via the nasogastric tube?
 Do the nurses or doctors require any specific information in order to administer

the medication safely (e.g. appropriateness of crushing tablets, dilution
requirements for parenteral medication, rate of administration, IV compatibilities
including syringe drivers)?
 Are aids required to ensure safe and effective administration (e.g. volumatic
spacers for inhalers)?
1.12 Checking of Dose, Frequency, Timing, Route and Duration
The pharmacist should assess the prescription to ensure that the dose is
appropriate. This includes adjustments for:
 Patient weight;
 Patient age;
 Disease states e.g. renal / hepatic impairment;
 Route and formulation prescribed e.g. IV versus oral metronidazole, IM versus

oral anti-psychotics, liquid versus solid dosage forms;
 Concurrent medications e.g. reduction of digoxin dose if used with amiodarone.
The pharmacist should assess the prescription to ensure the prescribed route is
available (e.g. is the patient nil by mouth? Is he / she able to take medicines orally?)
and appropriate (e.g. unnecessary prescription of IV medication when the patient
can swallow, or a solid dosage form when the patient has dysphagia) for that patient.
The pharmacist should assess whether the timing of the dose:
 is appropriate with respect to food e.g. before food, after food;
 is away from enteral, nasogastric or percutaneous endoscopic gastrostomy

(PEG) feeds where appropriate e.g. phenytoin;
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 correlates with medication administration rounds;
 help to minimise the side effects, e.g. frusemide in the morning.
The pharmacist should
 check the administration records of the medication and ensure that administration
has occurred and has been documented;
 check with patients and / or their caregivers to ensure that patients have been
compliant with their medications at home;
 identify occasions where drugs have not been administered and, if it was due to
unavailability of drug, ensure initiation of drug supply, or if it was due to non-
compliance, address the issues causing this.
PATIENT EDUCATION
It is expected that the pharmacist will provide medication and health information and
advice to patients, carers and medical staff where appropriate, e.g. in response to
information requested by an individual. In addition, the pharmacist should actively
seek opportunities to provide this aspect of the pharmacy service.
When consulting with patients and carers, the pharmacist should demonstrate a
structured, patient-centred process. The following information should be provided
where appropriate:
 Information on why a particular course of action is being suggested and how to

achieve the intended outcomes;
 Information on the condition as assessed during the consultation and any

changes that need to be monitored;
 Information on the medication / treatment recommended and how to use it;
 Advice on when it would be appropriate to seek further advice from either the
pharmacist or someone else if the condition does not improve;
 A combination of any of the above.
The pharmacist must take into account the patient’s cultural and social background
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when assessing his / her health needs. This will influence the patient’s health beliefs
and may affect the style of communication adopted. Interpreter services should be
used when needed.
1.13 Patient is Counselled on Medication
In most situations, the pharmacist should personally provide information in order to

facilitate patient compliance. Information can be provided verbally or in writing and
should be provided in a way that is appropriate to the patient’s needs. For example,
information should be provided:
 To the appropriate person i.e. patient and / or carer
 In a manner that overcomes any potential barriers to successful information

exchange e.g. non-English speaking, cognitive impairment, deafness, visual
impairment, illiteracy
 Using a format that can be comprehended e.g. non-medical jargon, appropriate

language (using an interpreter, if required), enlarged font for visually impaired
patients / carers;
 Using written information to back up verbal counselling;
 To demonstrate devices e.g. inhalers, insulin pens.
The following information should be provided:
 Generic and brand names of the drug;
 Purpose and action;
 Dose, route and administration schedule;
 What to do if a dose is missed;
 Special directions or precautions;
 Common adverse effects, ways in which to minimise them and action required if
they occur;
 Details of medications ceased;
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 Details of new medications or medication regimens;
 Techniques for self monitoring of therapy;
 Storage requirements;
 Safe ways to dispose of medication;
 Relevant drug-drug, drug-food, drug-alcohol and drug-procedure interactions;
 Number of days of treatment supplied and the duration of treatment;
 How to obtain further supplies;
 Patient information leaflet as appropriate;
 Relevant contact details of healthcare professionals and health services for any
follow-up information.
The pharmacist should discuss non-drug alternatives (when appropriate) as part of

their information provision, for example:
 Anti-embolic stockings for prevention of venous thromboembolism, or for

treatment of deep vein thrombosis and prevention of post-thrombotic syndrome;
 Heat packs (usually available from physiotherapy department);
 Mobilisation;
 Physiotherapy;
 Relaxation techniques.
The patient’s comprehension of the information provided should be assessed. The

pharmacist should assess the patient’s understanding of the information provided by:
 Asking the patient to describe how they are going to take the medication;
 Asking the patient to demonstrate use of a device such as an inhaler.
Gauging the patient’s perception of their illness allows you to understand their
healthcare needs and may be related to their current illness or past medical
conditions. This knowledge will allow the pharmacist to accurately review current
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therapy and provide appropriate medicine information to the patient and / or carer.
Open ended questions such as ‘What has brought you into hospital?’ will often illicit
a patient’s perception of what has happened. This may impact on how the patient
deals with healthcare professionals and the way they use medication. A poor
understanding of their illness may need to be addressed before the patient can fully
understand what treatment is necessary and the rationale for treatment.
Assess the patient’s experience of medication use, specifically regarding:
 Perceived effectiveness of medication;
 Control of symptoms;
 Perceived problems with this or other medication used;
 Why the patient stopped / started / changed the medication.
Assess the patient’s understanding and attitude to their therapy and seek specific
information on the following:
 Patient’s understanding of rationale for treatment;
 Patient’s perception of the purpose of the medication;
 Patient’s perception of potential adverse effects.
These perceptions may impact on the patient’s adherence to prescribed treatment.
Pharmacists should actively explore the patient’s need for lifestyle advice e.g. diet,
smoking and exercise. An awareness of local services and initiatives and the referral
process in primary care or discharge planning is essential e.g. Health Promotion
Board (HPB) Quitline, smoking cessation services at the respective hospitals or
community pharmacies.
1.14 Compliance Assessment
Non-adherence may be due to perceived adverse effects, and could be contributing

to the present condition. Use a non-judgemental, empathetic approach and open-
ended questions. Assess the patient’s adherence by normalising poor compliance for
example asking:
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 “People often have difficulty taking their medication… Do you have any difficulty
taking your medication?”
 “About how often would you say you miss taking your medication?”
 How are you taking the medicine? You have the supply at home?” for the
medicines that are always not collected from hospital/ polyclinic pharmacy.
Inform the medical staff if significant areas of poor compliance are identified.
Strategies to address poor compliance include use of dose administration aids, e.g.
education of carers, discharge medication records, a reduction in the number of
medications or simplification of the drug regimen, and / or changing to cheaper
alternatives where appropriate.
Knowing how medicines were managed prior to the patient’s hospital admission
allows therapy to be appropriately tailored to the patient and additional supports to
be initiated if needed. Factors such as cognition, alertness, mental acuity, literacy,
vision impairment and physical disabilities may impact the patient’s ability to manage
his / her medication.
For example:
 Patients with impaired cognition or alertness may require medication compliance

aids, dosette boxes or additional supports, such as, community nurse visits or
assistance of family members in medication administration.
 Patients with vision impairment, especially common in diabetic patients, may

require large-print labels and written information.
1.15 Need for Information Identified
Individuals have differing information needs. Pharmacists should be cautious about

providing information to patients in a ‘blanket’ format, and should tailor their provision
of information to individual circumstances. For example, general drug-specific
counselling advice may not be appropriate for patients who have been on a
medication long term. These patients will more likely require specific information
relevant to their situation. This will not be established unless the pharmacist allows
the patient an opportunity to ask questions early in the consultation.
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The pharmacist must retrieve information specific to a patient’s needs. Patients
commencing a medication are likely to require general information on indication,
administration, side effects and supply. Patients with ongoing supply may request
specific information regarding side effects they have experienced or use in
circumstances such as pregnancy and lactation.
The information must be accurate and retrieved from a reliable source such as
Lexicomp, SGH ePharmacopoeia, MIMS, product inserts, published literature or
medical databases such as Micromedex®.
RISK MANAGEMENT & SERVICE IMPROVEMENT
1.16 Risk Management
The pharmacist should be aware of and keep updated on the established policies
and procedures with respect to medication error prevention and reporting.
Pharmacist active participation is essential for ongoing analysis and monitoring of
medication errors. Suggestions to initiate safety measures should be discussed and
actively implemented and lessons learned should be disseminated in department
meetings.
In the medication review process and multidisciplinary ward rounds, pharmacists

should actively take the initiative to monitor, report and prevent medication errors
and adverse drug reactions.
1.17 Service Improvement
The pharmacist should routinely participate in quality improvement activities related

to the distribution, administration and use of medications particularly at ward level
and at the department level in general. In delivering patient care, the pharmacist
should proactively identify issues, discuss and ensure compliance to medication-
related policies and procedures. In providing service to patients, the pharmacist
should constantly seek quality improvement when applicable and should integrate
the practice standards with the hospital policies and procedures.
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Constructive feedback to the relevant individuals / pharmacists about the quality
achieved should be encouraged. It will not only help the pharmacist but the rest of
the team to strive towards a higher standard of service to patients.
Reflection and evaluation of practice is essential if an individual pharmacist is going

to undertake effective work-based learning. Contributions to care should be recorded
and followed up where possible to establish the outcomes of individual actions. It
may not be appropriate or possible for a pharmacist to follow the care of an
individual patient in every case, but effective communication with colleagues will
often establish outcomes. Pharmacists can assure evaluation of contribution by
reflecting on service delivery or patient encounter and identifying a resultant service
improvement or learning need.
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2. Problem Solving Competencies
PROBLEM IDENTIFICATION
2.1 Identification of Drug-related Problems
The pharmacist should be able to identify high risk medications and patients for
whom ongoing monitoring of therapy is required. The pharmacist should monitor for
effectiveness of treatment and potential adverse effects, and also establish and
maintain a plan for reviewing the therapeutic objective / end point of treatment.
High Risk Medications
 Anticoagulants (warfarin, heparin, enoxaparin)
 Drugs with narrow therapeutic range (e.g. digoxin, lithium, theophylline, immuno-
suppressants)
 NSAID or opiate analgesic
 IV antibiotics (e.g. gentamicin, vancomycin)
 Chemotherapy
 Electrolyte supplementation (IV potassium, IV magnesium)
 Drugs requiring TDM + interpretation
 Anti-epileptics (phenytoin, valproic acid, carbamazepine)
 Insulin
High Risk Patient Groups
 Renal impairment
 Cardiac
 Liver disease
 Transplantation
 Mental health
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 Cancer
 Paediatrics
 Elderly
 Unstable clinical condition
The pharmacist should be able to prioritise the medication management problems of

both individual patients and the group of patients for whom they are responsible.
2.2 Prioritisation
Once a problem has been identified, the pharmacist must be able to identify the
urgency of resolution and appropriately prioritise their actions. Factors that may be
considered include:
 Is the patient likely to be harmed?
 When is the next dose due?
 Can the dose be withheld until the problem is resolved?
 What do I need to do to resolve this problem?
 Who do I need to inform regarding this problem e.g. nurse, doctor, patient?
Having identified and prioritised drug-related problems, the pharmacist should

ensure that an appropriate course of action is identified and implemented. If actions
by multiple healthcare professionals are required for resolution of the problems, the
pharmacist should accurately communicate to the relevant personnel the action
required and the urgency of that action. At all times, the pharmacist must ensure that
no harm comes to the patient.
2.3 Consultation or Referral
The pharmacist should be aware of his / her own limitations and always consult a
more senior colleague if necessary or refer the patient appropriately to another
healthcare professional. Referral can occur at different points during an episode of
care, for example:
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 On the first review, when there is inappropriateness of medication management;
 At the end of the consultation with the patient, when drug-related problems have
been identified and referral is needed to medical staff and community health
support.
The referral and consultation process should form part of continuing professional
development and it is expected that during the course of an individual’s work,
repeated exposure to similar pharmaceutical problems will result in development of
the pharmacist’s experience and competence.
KNOWLEDGE
2.4 Pathophysiology
An understanding of normal organ function and the effect of disease state on this is
relevant to the effects of, and the effects on, drug therapy. The pharmacist should be
able to clearly describe the pathophysiology relevant to the therapeutic areas in
which they are currently working and apply this knowledge when reviewing the
therapeutic use of drugs.
2.5 Pharmacology
The pharmacist should be able to clearly discuss the mode of action of medications
that they routinely review in the course of their daily practice. An appreciation of the
absorption, distribution, metabolism and elimination of these medications and the
influence of disease states (e.g. renal failure) and patient factors (e.g. age) should
also be demonstrated.
2.6 Side Effects and Monitoring
Knowledge of the common and major side effect profile of routinely used
medications must be demonstrated. The pharmacist should be able to both discuss
the potential for these with patients and recognise and describe any appropriate
monitoring parameters.
2.7 Interactions (Drug / Disease / Special Patient Groups)
The pharmacist should be able to describe the different mechanisms of drug
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interactions and be able to identify which type of interaction applies.
With the appropriate use of reference material, pharmacists are expected to:
 Identify common, well-documented, clinically significant drug interactions

(including complementary medication);
 Identify the mechanism by which the interaction occurs;
 Be able to recognise medications with increased risk of potential interactions, e.g.

those with narrow therapeutic indices, those metabolised by the CYP450 system
and those which are inducers or inhibitors of the CYP450 system;
 Assess the actual or potential interaction for clinical significance and

management options, prioritise the problem and refer as appropriate, using Table
4 as a guide
With regards to individual, patient-specific interactions and contra indications /

cautions to medication in certain patient groups, a pharmacist should:
 Understand the potential for unwanted effects of medications, e.g. allergies and
other adverse drug reactions (ADRs);
 Ensure that any allergy or ADR is identified and documented;
 Review the prescription to ensure that no medications likely to cause harm have
been prescribed;
 Assess actual or potential interaction for clinical significance and management

options, prioritise the problem and refer as appropriate using Table 4 as a guide.
With regards to contraindications / cautions that should be applied to the use of

individual drugs in a range of pathophysiological conditions, a pharmacist should be
able to:
 Understand the mode of action and pharmacokinetics of the medications;
 Understand how these mechanisms may be altered by the disease (e.g. renal
impairment);
 Assess the actual or potential interaction for clinical significance and
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Table 5: Prioritising Action (Risk Rating based on Harm)
Extreme Consequence major or extreme OR probability Act Now

of occurrence likely or almost certain OR time
frame to harm is < 1 hour
Very High Consequence moderate OR possibly will Act < 4 hours

occur OR time frame to harm is < 4 hours
High / Medium Consequence minor OR unlikely to occur OR Before leaving

time frame to harm is today work
Low Consequence negligible OR harm rare OR not Tomorrow

likely to impact on patient outcome today
ANALYSIS AND RECOMMENDATIONS
2.8 Use of Guidelines and Evidence
A pharmacist should be able to demonstrate an awareness of guidelines available

for the clinical field in which they are practising. Pharmacists should also know the
practical implications of these guidelines. Guidelines may be local policies or national
guidelines from established groups (e.g. MOH Clinical Practice Guidelines,
AHA/ACC guidelines). The pharmacist should be able to utilise guidelines and be
aware of both the advantages and disadvantages of their use, and show regard for
individual patient need when using guidelines.
Following review of the guidelines, the pharmacist should demonstrate the ability to
summarise the information and extract the key points that influence drug therapy.
The pharmacist should demonstrate the ability to effectively evaluate information

they have retrieved. This could be for a variety of purposes including designing a
patient information leaflet or critically appraising information about new products. The
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pharmacist should be able to assess information for the following aspects:
 Reliability of source — depending on the nature of information retrieved, the

pharmacist should be able to evaluate the likely accuracy of information and any
likelihood of bias (e.g. pharmaceutical company sponsored information).
 Relevance to patient care — the impact or potential impact that the information
has on the pharmaceutical care of the individual patient or group of patients.
 Required response — the pharmacist should demonstrate the ability to identify an

appropriate response, both in the nature of the action required and the priority
that it should be assigned.
The pharmacist should demonstrate that they have considered the various options
available to them to resolve a problem. They should consider the possible outcomes
of any action and recognise the pros and cons of the various options. In order to
achieve this, the pharmacist should determine the goal of treatment. This might be
one of the following:
 Curing a disease or disorder;
 Reducing or eliminating a symptom;
 Arresting or slowing disease progression;
 Preventing a disease;
 A combination of any of the above.
Having appraised a selection of options, the pharmacist should be able to identify the
most appropriate solution and be able to justify the decision taken. However,
pharmacists should recognise their personal limitations and seek advice from
another colleague wherever necessary.
2.9 Information Provision to Other Healthcare Professionals
Whenever medication-related information is requested, or a need for information is

identified, it is the pharmacist’s responsibility to ensure that the response they give is
accurate. Information should be assessed from reliable sources and, if necessary,
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reference should be made to appropriate literature or to colleagues.
The content and style of presentation should be appropriate to the recipient’s needs.
Establishing the reason for the request and appreciating what action will be taken on
receipt of the information should be a first priority. The pharmacist should
demonstrate that they have considered these aspects and respond appropriately by
tailoring the information that they provide.
When information is requested, or the need for information is identified, the

pharmacist should provide it in a timely manner. It may be that the information is
immediately required for patient care and it will take priority over other activities e.g.
management of drug alerts in the critically ill.
FOLLOW-UP
2.10 Documentation of Drug-related Problems
It is necessary to document medication-related problems so there is a record of

pharmaceutical input to the patient’s care. This facilitates follow-up by other
healthcare professionals, ensures resolution of medication-related problems and
ensures documentation of ongoing monitoring requirements. Documentation can be
made in pharmaceutical care plans, in pharmacy intervention forms, in patients’
medical record or on locally accepted tools, e.g. clinical pathways. Include all
relevant information pertaining to pharmaceutical care for example:
 Relevant background information;
 Problems identified and resolution gained;
 Results of relevant laboratory tests / investigations;
 Ongoing monitoring requirements;
 Education needs;
 Compliance issues / aids.
Intervention should be documented in accordance with the hospital pharmacy

department policy.
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2.11 Monitoring and Problem Resolution
Once a medication has been appropriately selected for a patient, supplied and
administered, ongoing use of the drug should be assessed, both for the desired
therapeutic effect and the appearance of adverse reactions. Therapeutic drug
monitoring (TDM) is an essential duty for hospital pharmacists. Assessment involves
the following steps:
1. Identify patients at high risk of drug-related problems;
2. Identify monitoring parameters for ongoing disease management, e.g. BP,

cholesterol, etc.;
3. Evaluate the patient against these parameters;
4. Recommend appropriate monitoring to medical staff;
5. Discuss with a colleague if necessary;
6. Review ALL current inpatient medication records (including IV fluids, heparin,

insulin, eye drops and PCA charts etc.) and if needed, patient clinical charts/
flowsheets;
7. Discuss changes to medication with medical staff if required.
If a problem is identified by or reported to a pharmacist, it is his / her responsibility to

ensure that it is appropriately resolved. This may not require his / her direct action,
but he / she must ensure that the appropriate person is alerted to the situation and
that accurate information is given to the other party. As a minimum, the pharmacist
must ensure that no harm comes to the patient.
For development purposes, the pharmacist should seek to follow up on problems,

both those that they had dealt with directly and those that were referred to another
party, and reflect on the outcomes.
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3. Professional Competencies
ORGANISATION
3.1 Prioritisation
The pharmacist should be able to prioritise his / her own work and adjust priorities in
response to changing circumstances; for example, knowing which patients / tasks
should take priority. Prioritisation of clinical workload may include:
 Identifying all new patient admissions;
 Obtaining and recording a complete medication history for new patients;
 Identifying patients approaching discharge and establishing their need for

discharge medications and information;
 Ensuring that all medications are appropriate and that the patient is informed
about their medications;
 Ensuring newly prescribed medications are safe for the patients and sufficient
supplies are available;
 Monitoring narrow therapeutic index drugs and other identified monitoring

parameters;
 Monitoring parenteral therapy;
 Evaluating current medication for safety and effectiveness.
3.2 Punctuality
The pharmacist should ensure he / she attends appointments and meetings on time,
and is there to provide cover at previously agreed times, e.g. back from lunch or the
ward as rostered.
3.3 Time Management
The pharmacist should organise his /her time effectively, assigning appropriate
amounts of time to different tasks with regular review and revision of time frames and
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deadlines. For example, a pharmacist may be allocated a morning to cover a ward.
He / she may spend his / her time seeing new patients, reviewing existing patients,
providing counselling and organising discharges. If any of these time lines slip, the
others have to be adjusted to allow the work on the ward to be completed in the
allocated time.
Pharmacists should be able to use their time productively with minimum waste. For
example, only review the renal function of patients taking medications that may
require dose adjustment, rather than routinely check and record the renal function of
the all patients regardless of medical conditions.
The pharmacist should be able to complete tasks within a previously agreed time
frame. This time frame may be set by a pharmacy manager, supervisor, or someone
outside the pharmacy department (e.g. consultant or nurse manager). For example,
reviewing and conducting medication reconciliation for new cases of the allocated
ward on a daily basis; or having discharge medication ready prior to the patient
leaving by ambulance.
3.4 Initiative
The pharmacist should demonstrate initiative in solving a problem or taking on a new

opportunity / task without the prompting from others, and demonstrate the ability to
work independently within their limitations.
PROFESSIONALISM
3.5 Professional Code of Ethics
The pharmacist must behave in an ethical manner in accordance with professional

codes such as:
 Singapore Pharmacy Council (SPC) Code of Ethics
 Singapore Pharmacy Competency Standards (MOH/SPC)
3.6 Confidentiality
As it is with all healthcare professionals, pharmacists must respect individuals’ right

to privacy, maintain confidentiality and understand the circumstances when
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information about the patient’s condition can be shared with colleagues. This
includes an awareness of hospital policies and relevant legislation, e.g. Code of
Ethics.
3.7 Confidence
All pharmacists must be confident of their own abilities and portray an image of
confidence to patients and other healthcare professionals.
3.8 Responsibility
Professional responsibility may be defined as the ability to provide an account of

professional judgements, acts and omissions in relation to a professional’s role. This
therefore requires accountability for professional practice.
In professional ethics, accountability is of paramount importance. The SPC Code of

Ethics states that, ‘A pharmacist shall take responsibility for all work done personally
and ensure that those under his direct supervision are able to carry out their duty
competently.’
The pharmacist should adopt a non-discriminatory attitude to all patients and

recognise their needs as individuals. As part of their responsibility, pharmacists
should recognise when to ask for advice and be willing to consult others. They
should act upon actual or potential errors and ensure resolution of identified issues.
The pharmacist should understand the need and take personal responsibility for
Continuing Professional Development. This involves:
 Reflecting on his / her own practice, e.g. using critical incident review;
 Maintaining current awareness of professional, pharmaceutical and clinical

issues (e.g. attend in-house pharmacy presentations, continuing professional
education and professional conferences as appropriate);
 Maintaining a broad background clinical knowledge;
 Recognising and using relevant learning opportunities;
 Evaluating learning;
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 Being self-motivated and eager to learn;
 Showing willingness to learn from others;
 Being willing to accept criticism for the benefit of his / her own development;
3.9 Organisational
The pharmacist is able to describe the structure and appreciate value of the
employing organisation. Pharmacists should take responsibility to keep themselves
updated with departmental goals and how they are aligned with institutional strategic
goals. This will provide direction to pharmacists during planning and implementation
of department work plans.
Pharmacists must develop a logical approach to their work. The competency

framework is intended to guide the activities that should be undertaken for each
patient or task, to ensure that points are not overlooked. Pharmacists should be able
to demonstrate that they use relevant and up-to-date procedure and a logical
process when delivering the assigned tasks or reviewing a prescription. This process
identifies the key action points that need to be addressed for that patient. It is
recognised, however, that individuals can use different approaches to problem
solving and still achieve the required outcome.
COMMUNICATION SKILLS
Good communication is an essential component of pharmaceutical care. It involves

communicating effectively in verbal, electronic and written form, using the language
appropriate to the recipient; for example, use of open questions initially followed by
appropriate closed questions, and supporting any recommendations with evidence.
3.10 Communication
Effective communication encompasses the following skills:
 Questioning;
 Explaining;
 Listening — active listening demonstrates genuine respect and concern for the
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 Feedback — to ensure that the message is understood. It can take the form of
appropriate questions and asking the individual to demonstrate that they have
understood or can now do what you have explained;
 Empathy — seeking to understand where other people are coming from and what
their wants and needs are;
 Non-verbal communication;
 Overcoming physical and emotional barriers to effective communication, e.g.

speech difficulties, fear and aggression;
 Negotiating;
 Influencing.
The desired outcome of using effective communication skills should be a concordant

relationship. There are three aspects of concordance with medicines:
1. Patients as partners: the patient and the healthcare team participate as

partners to reach an agreement on the illness and its treatment;
2. Patients’ beliefs: the agreement on treatment draws on the experiences,

beliefs and wishes of the patient to decide when, how and why to use
medicines;
3. Professional partnerships: healthcare staff treat one another as partners and

recognise each other’s skills to improve the patient’s participation.
The ‘patient’ in this context means any person the pharmacist provides any
pharmaceutical service to. The ‘carer’ may be a relative or friend of the patient as
well as a social services or private agency care worker.
Healthcare professionals include doctors, nurses, and the other Allied Health
professionals (e.g. dietitians, medical social workers, physiotherapists, occupational
therapists, podiatrists, speech therapists, etc) as well as ward clerks, cleaners, GP
receptionists and medical secretaries.
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The pharmacist must take into account the patient’s cultural and social background
when assessing his / her needs and understanding. This will influence his / her
interpretation and may affect the style of communication adopted. Interpreter service
should be used when needed.
3.11 Staff Development
The pharmacist must interact with colleagues both within the pharmacy department
and outside to convey information gained both within the hospital and externally. For
example, the pharmacist must:
 Relay information learnt at continuing education sessions, training sessions,

conferences, etc.;
 Contribute to departmental training sessions, journal clubs, etc.;
 Relay patient safety issues;
 Contribute to staff meetings;
 Share with colleagues new information / journal articles if relevant.
TEAMWORK
It is important for the pharmacist to be a team player. This includes:
 Understanding the roles and responsibilities of team members and how the team
works;
 Respecting the skills and contributions of colleagues and directly managed staff;
 Recognising one’s own limitations within the team.
3.12 Pharmacy Team
Within the pharmacy team, the pharmacist should be expected to:
 Be a committed member of the team;
 Understand the roles of all other team members;
 Understand individuals’ strengths and weaknesses;
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 Identify when team members need support and provide it;
 Establish good working relationships with all colleagues;
 Accept responsibility for own work (and for those in training where appropriate);
 Give and receive constructive criticism;
 Work efficiently in the team;
 Know when to ask for help;
 Share and / or hand over information to avoid duplication of work by team

members.
3.13 Multidisciplinary Team
The pharmacist should recognise the roles and skills of other healthcare
professionals and seek to establish cooperative working relationships with
colleagues, based on an understanding of and respect for each other’s roles.
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AT THE END OF THE ASSESSMENT PERIOD
At the end of the GLF assessment period, a summary sheet (Appendix 6) should be
completed to highlight the pharmacist’s strengths, areas for development and the
objectives to be achieved for the next assessment.
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Appendix 1 – The General Level Framework
A Competency Framework for Pharmacy Practitioners
General Level Pharmacist Name: ___________________
Date of assessment: Baseline/end of 1st rotation/ end of 2nd rotation/ end of 3rd rotation/end of 4th rotation
a = baseline facilitated assessment b = 4 month facilitated assessment c = 8 month facilitated assessment d = 12 month facilitated assessment
1.1 Opening the CONSISTENTLY provides a b USUALLY provides clear a b SOMETIMES provides clear a b RARELY provides clear a b
consultation clear introduction to the introduction to the introduction to the introduction to the
c d c d c d c d
consultation consultation consultation consultation
Comments
1.2 Questioning CONSISTENTLY uses a b USUALLY uses appropriate a b SOMETIMES uses a b RARELY use appropriate a b
appropriate questioning to questioning to obtain relevant appropriate questioning to questioning to obtain relevant
obtain relevant information c d information from patient c d obtain relevant information c d information from patient c d
from patient from patient
Comments
1.3 Allergies CONSISTENTLY confirms or a b USUALLY confirms or a b SOMETIMES confirms or a b RARELY confirms or a b
documents accurate and documents accurate and documents accurate and documents accurate and
comprehensive allergy and/or c d comprehensive allergy and/or c d comprehensive allergy and/or c d comprehensive allergy and/or c d
adverse drug reaction history adverse drug reaction history adverse drug reaction history adverse drug reaction history
Comments
1.4 Relevant CONSISTENTLY retrieves all a b USUALLY retrieves all a b SOMETIMES retrieves all a b RARELY retrieve all relevant a b
patient relevant medical information relevant medical information relevant medical information medical information from
background from medical, nursing and c d from medical, nursing and c d from medical, nursing and c d medical, nursing and c d
electronic records electronic records electronic records electronic records
Comments
2
UNABLE TO CONSISTENTLY (100 - 85%) USUALLY (84 - 51%) SOMETIMES (50 - 21%) RARELY (<20%)
ASSESS ( UA)
Record as UA under Demonstrates the expected standard of Implies standard practice with occasional Much more haphazard than ‘usually’ Very rarely meets the standard expected.
comments practice with very rare lapses lapses No logical thought process appears to apply
© 2004 CoDEG
General Level Framework (GLF) used with permission from the Competency Development and Evaluation Group (CoDEG), South East England, UK, and the Medicines Safety Unit, Queensland, Australia.
Adapted for use in Singapore General Hospital by Victoria Coleman and Camilla Wong, April 2009. Updated in Jan 2010.

1.5 Medication CONSISTENTLY takes or a b USUALLY takes or checks for a b SOMETIMES takes or checks a b RARELY takes or checks for a b
reconciliation checks for an accurate and an accurate and for an accurate and an accurate and
comprehensive medication c d comprehensive medication c d comprehensive medication c d comprehensive medication c d
history where appropriate history where appropriate history where appropriate history where appropriate
CONSISTENTLY reconciles a b USUALLY reconciles a b SOMETIMES reconciles a b RARELY reconciles a b
medication history with medication history with current medication history with medication history with current
current medication prescribed, medication prescribed, current medication prescribed, medication prescribed,
medical history and current medical history and current medical history and current medical history and current
c d c d c d c d
condition where appropriate condition where appropriate condition where appropriate condition where appropriate
(including reconciling (including reconciling (including reconciling (including reconciling
transcribed IMRs and transcribed IMRs and transcribed IMRs and transcribed IMRs and
discharge prescriptions) discharge prescriptions) discharge prescriptions) discharge prescriptions)
CONSISTENTLY consults a b USUALLY consults a b SOMETIMES consults a b RARELY consults a b
appropriately on any appropriately on any appropriately on any appropriately on any
c d c d c d c d
inconsistencies inconsistencies inconsistencies inconsistencies
Comments
1.6 Prescription is CONSISTENTLY ensures a b USUALLY ensures clarity of a b SOMETIMES ensures clarity a b RARELY ensures clarity of a b
unambiguous clarity of the prescription the prescription of the prescription the prescription
c d c d c d c d
Comments
1.7 Prescription is CONSISTENTLY ensures a b USUALLY ensures legality of a b SOMETIMES ensures legality a b RARELY ensures legality of a b
legal legality of prescription c d prescription c d of prescription c d prescription c d
Comments
1.8 Labeling of The label on the dispensed a b The label on the dispensed a b The label on the dispensed a b The label on the dispensed a b
the medicine medicine CONSISTENTLY medicine USUALLY includes medicine SOMETIMES medicine RARELY includes
c d c d c d c d
includes required information required information includes required information required information
Comments
3
ASSESS ( UA)
© 2004 CoDEG
1.9 Medication CONSISTENTLY ensures a b USUALLY ensures availability a b SOMETIMES ensures a b RARELY ensures availability a b
supply availability of medication of medication availability of medication of medication
(Example: procedure to c d (Example: procedure to obtain c d (Example: procedure to obtain c d (Example: procedure to c d
obtain exemption drugs) exemption drugs) exemption drugs) obtain exemption drugs)
CONSISTENTLY ensures that a b USUALLY ensures that the a b SOMETIMES ensures that the a b RARELY ensures that the a b
the right medication is right medication is supplied to right medication is supplied to right medication is supplied to
supplied to the right patient c d the right patient with the right c d the right patient with the right c d the right patient with the right c d
with the right labeling labeling labeling labeling
CONSISTENTLY ensures the a b USUALLY ensures the supply a b SOMETIMES ensures the a b RARELY ensures the supply a b
supply of the drug is of the drug is documented supply of the drug is of the drug is documented
c d c d c d c d
documented documented
Comments
DRUG SPECIFIC ISSUES Check for the 8 ‘Rs’ : Right patient, medication, dose, route, time and frequency, duration, diluent, rate of infusion
1.10 Drug CONSISTENTLY ensures a b USUALLY ensures need for a b SOMETIMES ensures need a b RARELY ensures need for a b
selection need for the drug c d the drug c d for the drug c d the drug c d
CONSISTENTLY ensures a b USUALLY ensures cost- a b SOMETIMES ensures cost- a b RARELY ensures cost- a b
cost-effectiveness of c d effectiveness of medication c d effectiveness of medication c d effectiveness of medication c d
medication use use use use
Comments
1.11 Selection of CONSISTENTLY ensures a b USUALLY ensures a b SOMETIMES ensures a b RARELY ensures appropriate a b
formulation, appropriate formulation and appropriate formulation and appropriate formulation and formulation and dose
concentration, dose equivalents taken into dose equivalents taken into dose equivalents taken into equivalents taken into
rate and diluent account. Appropriate c d account. Appropriate c d account. Appropriate c d account. Appropriate c d
information given for information given for information given for information given for
concentration/rate/diluent of concentration/rate/diluent of concentration/rate/diluent of concentration/rate/diluent of
parenteral drugs parenteral drugs parenteral drugs parenteral drugs
Comments
4
ASSESS ( UA)
© 2004 CoDEG

1.12 Checking of CONSISTENTLY checks that a b USUALLY checks that patient a b SOMETIMES checks that a b RARELY checks that patient a b
dose, frequency, patient has received the has received the correct dose patient has received the has received the correct dose
timing, route and correct dose and frequency, at and frequency, at the correct correct dose and frequency, and frequency, at the correct
duration the correct time via most c d time via most appropriate c d at the correct time via most c d time via most appropriate c d
appropriate route for the right route for the right duration appropriate route for the right route for the right duration
duration duration
Comments
PATIENT EDUCATION
1.13 Patient is CONSISTENTLY ensures a b USUALLY ensures a b SOMETIMES ensures a b RARELY ensures appropriate a b
counseled on appropriate oral/written appropriate oral/written appropriate oral/written oral/written information is
medication information is provided to c d information is provided to c d information is provided to c d provided to patient. c d
patient patient. patient.
CONSISTENTLY ensures a b USUALLY ensures advice a b SOMETIMES ensures advice a b RARELY ensures advice a b
advice given on non- given on non-pharmacological given on non-pharmacological given on non-pharmacological
pharmacological therapy c d therapy when appropriate c d therapy when appropriate c d therapy when appropriate c d
when appropriate
CONSISTENTLY assesses a b USUALLY assesses patient’s a b SOMETIMES assesses a b RARELY assesses patient’s a b
patient’s comprehension of comprehension of information patient’s comprehension of comprehension of information
c d c d c d c d
information information
Comments
1.14 Compliance CONSISTENTLY identifies a b USUALLY identifies patients a b SOMETIMES identifies a b RARELY identifies patients a b
assessment patients with compliance with compliance issues and patients with compliance with compliance issues and
issues and manages manages appropriately issues and manages manages appropriately.
appropriately c d (Example: literacy, visual c d appropriately c d (Example: literacy, visual c d
(Example: literacy, visual impairment, disability, (Example: literacy, visual impairment, disability,
impairment, disability, cognition/memory) impairment, disability, cognition/memory)
cognition/memory) cognition/memory)
Comments
5
ASSESS ( UA)
© 2004 CoDEG

1.15 Need for CONSISTENTLY identifies a b USUALLY identifies and a b SOMETIMES identifies and a b RARELY identifies and a b
information and responds appropriately to responds appropriately to responds appropriately to responds appropriately to
identified patient’s need for more c d patient’s need for more c d patient’s need for more c d patient’s need for more c d
information information information information
Comments
RISK MANAGEMENT & SERVICE IMPROVEMENT
1.16 Risk CONSISTENTLY documents a b USUALLY documents a b SOMETIMES documents a b RARELY documents a b
management medication errors c d medication errors c d medication errors c d medication errors c d
Comments
1.17 Service CONSISTENTLY looks to a b USUALLY looks to improve a b SOMETIMES looks to a b RARELY looks to improve a b
improvement improve quality of service quality of service improve quality of service quality of service
c d c d c d c d
Comments
6
ASSESS ( UA)
© 2004 CoDEG

2.1 Identification of CONSISTENTLY identifies a b USUALLY identifies drug- a b SOMETIMES identifies drug- a b RARELY identifies drug-drug a b
drug-related drug-drug interactions drug interactions (including drug interactions (including interactions (including
c d c d c d c d
problems (including complementary complementary medicines) complementary medicines) complementary medicines)
medicines)
CONSISTENTLY identifies a b USUALLY identifies drug- a b SOMETIMES identifies drug- a b RARELY identifies drug- a b
drug-related problems in related problems in special related problems in special related problems in special
special patient groups patient groups patient groups patient groups
(Example: Use of warfarin in (Example: Use of warfarin in (Example: Use of warfarin in (Example: Use of warfarin in
c d c d c d c d
an alcoholic creates an alcoholic creates an alcoholic creates an alcoholic creates
unwarranted level of risk, tube unwarranted level of risk, tube unwarranted level of risk, tube unwarranted level of risk, tube
feeding, paediatric/elderly, feeding, paediatric/elderly, feeding, paediatric/elderly, feeding, paediatric/elderly,
G6PD) G6PD) G6PD) G6PD)
CONSISTENTLY identifies a b USUALLY identifies drug- a b SOMETIMES identifies drug- a b RARELY identifies drug- a b
drug-disease interactions c d disease interactions c d disease interactions. c d disease interactions c d
(Example: NSAID in HF) (Example: NSAID in HF) (Example: NSAID in HF) (Example: NSAID in HF)
Comments
2.2 Prioritization CONSISTENTLY prioritizes a b USUALLY prioritizes drug- a b SOMETIMES prioritizes drug- a b RARELY prioritizes drug- a b
drug-related problems c d related problems appropriately c d related problems appropriately c d related problems appropriately c d
appropriately
Comments
2.3 Consultation or CONSISTENTLY a b USUALLY understands own a b SOMETIMES understands a b RARELY understands own a b
referral understands own limitations, limitations, considers most own limitations, considers limitations, considers most
considers most appropriate c d appropriate referral point, c d most appropriate referral point, c d appropriate referral point, c d
referral point, refers in a refers in a logical, clear and refers in a logical, clear and refers in a logical, clear and
logical, clear and concise concise manner concise manner concise manner
manner
Comments
7
ASSESS ( UA)
© 2004 CoDEG

KNOWLEDGE
2.4 CONSISTENTLY able to a b USUALLY able to discuss (or a b SOMETIMES able to discuss a b RARELY able to discuss (or a b
Pathophysiology discuss (or able to access able to access information (or able to access information able to access information and
information and use this to c d and use this to describe) the c d and use this to describe) the c d use this to describe) the c d
describe) the underlying underlying pathophysiology of underlying pathophysiology of underlying pathophysiology of
pathophysiology of disease disease disease disease
Comments
2.5 Pharmacology CONSISTENTLY able to a b USUALLY able to discuss (or a b SOMETIMES able to discuss a b RARELY able to discuss (or a b
discuss (or able to access able to access information (or able to access information able to access information and
information and use this to c d and use this to describe) how c d and use this to describe) how c d use this to describe) how c d
describe) how drugs work drugs work drugs work drugs work
Comments
2.6 Side-effects and CONSISTENTLY able to a b USUALLY able to describe a b SOMETIMES able to describe a b RARELY able to describe a b
monitoring describe major side-effects major side-effects and major side-effects and major side-effects and
c d c d c d c d
and monitoring parameters monitoring parameters monitoring parameters monitoring parameters
Comments
2.7 Interactions CONSISTENTLY able to a b USUALLY able to describe a b SOMETIMES able to describe a b RARELY able to describe a b
(drug/disease/ describe mechanisms of mechanisms of interactions mechanisms of interactions mechanisms of interactions
special patient interactions c d c d c d c d
groups)
Comments
8
ASSESS ( UA)
© 2004 CoDEG

a = baseline facilitated assessment b = 4/6 month facilitated assessment c = 8/12 month facilitated assessment d = 12/18 month facilitated assessment
ANALYSIS & RECOMENDATIONS
2.8 Use of CONSISTENTLY able to a b USUALLY able to access a b SOMETIMES able to access a b RARELY able to access a b
guidelines and access recent clinical recent clinical guidelines recent clinical guidelines recent clinical guidelines
evidence guidelines and/or relevant c d and/or relevant references c d and/or relevant references c d and/or relevant references c d
references
CONSISTENTLY able to a b USUALLY able to analyze a b SOMETIMES able to analyze a b RARELY able to analyze a b
analyze information and information and critically information and critically information and critically
critically appraise literature c d appraise literature c d appraise literature c d appraise literature c d
CONSISTENTLY able to a b USUALLY able to identify a b SOMETIMES able to identify a b RARELY able to identify a b
identify evidence gaps evidence gaps evidence gaps evidence gaps
c d c d c d c d
CONSISTENTLY a b USUALLY demonstrates a b SOMETIMES demonstrates a b RARELY demonstrates clear a b
demonstrates clear decision clear decision making clear decision making decision making
c d c d c d c d
making
Comments
2.9 Information CONSISTENTLY provides a b USUALLY provides accurate a b SOMETIMES provides a b RARELY provides accurate a b
provision to other accurate information c d information c d accurate information c d information c d
healthcare CONSISTENTLY provides a b USUALLY provides relevant a b SOMETIMES provides a b RARELY provides relevant a b
professionals relevant information c d information c d relevant information c d information c d
CONSISTENTLY provides a b USUALLY provides timely a b SOMETIMES provides timely a b RARELY provides timely a b
timely information c d information c d information c d information c d
Comments
9
ASSESS ( UA)
© 2004 CoDEG

2.10 CONSISTENTLY documents a b USUALLY documents drug- a b SOMETIMES documents a b RARELY documents drug- a b
Documentation of drug-related problems using related problems using drug-related problems using related problems using
drug-related appropriate styles and appropriate styles and appropriate styles and appropriate styles and
problems methods c d methods c d methods c d methods. c d
(Example: intervention forms, (Example: intervention forms, (Example: intervention forms, (Example: intervention forms,
case notes, prescriptions, case notes, prescriptions, case notes, prescriptions, case notes, prescriptions,
ADR reports) ADR reports) ADR reports) ADR reports)
Comments
FOLLOW UP
2.11 Monitoring & CONSISTENTLY L monitors a b USUALLY monitors drug a b SOMETIMES monitors drug a b RARELY monitors drug a b
problem resolution drug therapy appropriately. therapy appropriately. therapy appropriately. therapy appropriately.
(Example: TDM, high risk (Example: TDM, high risk (Example: TDM, high risk (Example: TDM, high risk
drugs/diseases/special patient c d drugs/diseases/special patient c d drugs/diseases/special patient c d drugs/diseases/special patient c d
groups) groups) groups) groups)
CONSISTENTLY ensures a b USUALLY ensures drug- a b SOMETIMES ensures drug- a b RARELY ensures drug- a b
drug-related problems are related problems are resolved related problems are resolved related problems are resolved
resolved (including following c d (including following up c d (including following up c d (including following up c d
up interventions) interventions) interventions) interventions)
Comments
10
ASSESS ( UA)
© 2004 CoDEG
ORGANIZATION
3.1 Prioritization CONSISTENTLY prioritizes a b USUALLY prioritizes work a b SOMETIMES prioritizes work a b RARELY prioritizes work well a b
work well c d well c d well c d c d
Comments
3.2 Punctuality CONSISTENTLY punctual a b USUALLY punctual a b SOMETIMES punctual a b RARELY punctual a b
c d c d c d c d
Comments
3.3 Time CONSISTENTLY uses time a b USUALLY uses time a b SOMETIMES uses time a b RARELY uses time efficiently a b
management efficiently resulting in tasks efficiently resulting in tasks efficiently resulting in tasks resulting in tasks being
being completed within c d being completed within c d being completed within agreed c d completed within agreed c d
agreed deadlines agreed deadlines deadlines deadlines
Comments
3.4 Initiative CONSISTENTLY a b USUALLY demonstrates a b SOMETIMES demonstrates a b RARELY demonstrates a b

demonstrates appropriate c d appropriate initiative when c d appropriate initiative when c d appropriate initiative when c d
initiative when required required required required
Comments
11
ASSESS ( UA)
© 2004 CoDEG
PROFESSIONALISM
3.5 Professional CONSISTENTLY practices a b USUALLY practices within a b SOMETIMES practices within a b RARELY practices within a b
code of ethics within Code of Ethics c d Code of Ethics c d Code of Ethics c d Code of Ethics c d
Comments
3.6 Confidentiality CONSISTENTLY maintains a b USUALLY maintains a b SOMETIMES maintains a b RARELY maintains a b
confidentiality c d confidentiality c d confidentiality c d confidentiality c d
Comments
3.7 Confidence CONSISTENTLY a b USUALLY demonstrates a b SOMETIMES demonstrates a b RARELY demonstrates a b

demonstrates confidence, confidence, inspires confidence, inspires confidence, inspires
c d c d c d c d
inspires confidence in others confidence in others confidence in others confidence in others
Comments
3.8 Responsibility CONSISTENTLY takes a b USUALLY takes responsibility a b SOMETIMES takes a b RARELY takes responsibility a b
responsibility for own actions for own actions and for patient responsibility for own actions for own actions and for patient
and for patient care c d care c d and for patient care c d care c d
Comments
3.9 Organizational Can CONSISTENTLY a b Can USUALLY describe the a b Can SOMETIMES describe a b Can RARELY describe the a b
describe the structure and structure and values of the structure and values of structure and values of
values of employing c d employing organization c d employing organization c d employing organization c d
organization
CONSISTENTLY uses a b USUALLY uses relevant and a b SOMETIMES uses relevant a b RARELY use relevant and up a b
relevant and up to date up to date procedures for and up to date procedures for to date procedures for practice
procedures for practice c d practice c d practice c d c d
Comments
12
ASSESS ( UA)
© 2004 CoDEG
3.10 CONSISTENTLY ensures a b USUALLY ensures a b SOMETIMES ensures a b RARELY ensures a b

Communication communication with patients communication with patients communication with patients communication with patients
is clear, precise and c d is clear, precise and c d is clear, precise and c d is clear, precise and c d
appropriate appropriate appropriate appropriate
CONSISTENTLY ensures a b USUALLY ensures a b SOMETIMES ensures a b RARELY ensures a b
communication with communication with communication with communication with
prescribers is clear, precise c d prescribers is clear, precise c d prescribers is clear, precise c d prescribers is clear, precise c d
and appropriate and appropriate and appropriate and appropriate
CONSISTENTLY ensures a b USUALLY ensures a b SOMETIMES ensures a b RARELY ensures a b
communication with nursing communication with nursing communication with nursing communication with nursing
staff and other members of c d staff and other members of c d staff and other members of c d staff and other members of c d
the health care team is clear, the health care team is clear, the health care team is clear, the health care team is clear,
precise and appropriate precise and appropriate precise and appropriate precise and appropriate
Comments
3.11 Staff CONSISTENTLY willing to a b USUALLY willing to share a b SOMETIMES willing to share a b RARELY willing to share a b
development share learning experiences learning experiences and give learning experiences and give learning experiences and give
and give feedback/guidance c d feedback/guidance to support c d feedback/guidance to support c d feedback/guidance to support c d
to support staff development staff development staff development staff development
CONSISTENTLY active in a b USUALLY active in educating a b SOMETIMES active in a b RARELY active in educating a b
educating and training and training healthcare educating and training and training healthcare
healthcare professionals c d professionals c d healthcare professionals c d professionals c d
Comments
13
ASSESS ( UA)
© 2004 CoDEG
TEAM WORK
3.12 Pharmacy CONSISTENTLY recognizes a b USUALLY recognizes the a b SOMETIMES recognizes the a b RARELY recognizes the a b
team the value of team members c d value of team members c d value of team members c d value of team members c d
CONSISTENTLY works a b USUALLY works effectively a b SOMETIMES works a b RARELY works effectively as a b
effectively as part of a team c d as part of a team c d effectively as part of a team c d part of a team c d
CONSISTENTLY passes on a b USUALLY passes on relevant a b SOMETIMES passes on a b RARELY passes on relevant a b
relevant information c d information c d relevant information c d information c d
Comments
3.13 CONSISTENTLY recognizes a b USUALLY recognizes value a b SOMETIMES recognizes a b RARELY recognizes value of a b
Multidisciplinary value of other team members c d of other team members c d value of other team members c d other team members c d
team CONSISTENTLY works a b USUALLY works effectively a b SOMETIMES works a b RARELY works effectively as a b
effectively as part of a team c d as part of a team c d effectively as part of a team c d part of a team c d
Comments
14
ASSESS ( UA)
© 2004 CoDEG
Appendix 2 – GLF Mapping
General Level Framework Mapping
1. DELIVERY OF PATIENT CARE COMPETENCIES
Assessment Phase Suggested Timeframe
End Yr1 End Yr2 End Yr3*

3a/Clinical Prerequisite
Gateway to Senior/
Research
Gateway
GLF Behaviour Descriptor Minimum Performance Level
1.1 Opening the Provides clear introduction to the consultation C C C
consultation
1.2 Questioning Uses appropriate questioning to obtain U C C
relevant information from patient
1.3 Allergies Confirms or documents accurate and C C C
comprehensive allergy and/or adverse drug
reaction history
1.4 Relevant patient Retrieves all relevant medical information from U C C
background medical, nursing and electronic records
1.5 Medication Takes or checks for an accurate and C C C
reconciliation comprehensive medication history where
appropriate
Reconciles medication history with current U C C
medication prescribed, medical history and
current condition where appropriate (including
reconciling transcribed IMRs and discharge
prescriptions)
Consults appropriately on any inconsistencies C C C
1.6 Prescription is Ensures the clarity of the prescription C C C
unambiguous
1.7 Prescription is Ensures legality of prescription C C C
legal
1.8 Labelling of the The label on the dispensed medicine includes C C C
medicine required information
1.9 Medication Ensures availability of medication (Example: C C C
supply procedure to obtain exemption drugs)
Ensures that the right medication is supplied C C C
to the right patient with the right labelling
The supply of the drug is documented C C C
DRUG SPECIFIC ISSUES
1.10 Drug selection Ensures need for the drug U C C
Ensures cost-effectiveness of medication use S U C
1.11 Selection of Ensures appropriate formulation and dose C C C
formulation, equivalents taken into account. Appropriate
concentration, rate information given for concentration/rate/diluent
and diluent of parenteral drugs
1.12 Checking of Checks that patient has received the correct C C C
dose, frequency, dose and frequency, at the correct time via
timing, route and most appropriate route for the right duration
duration
PATIENT EDUCATION
1.13 Patient is Ensures appropriate oral/written information is C C C
counselled on provided to patient
medication Ensures advice given on non-pharmacological S U C
therapy when appropriate
Assesses patient’s comprehension of U C C
information
1.14 Compliance Identifies patients with compliance issues and S U C
assessment manages appropriately. (Example: literacy,
visual impairment, disability,
cognition/memory).
1.15 Need for Identifies and responds appropriately to S U C
information patient’s need for more information
identified
RISK MANAGEMENT& SERVICE IMPROVEMENT
1.16 Risk Documents medication errors C C C
management
1.17 Service Looks to improve quality of service S U C
improvement
C R P
C=CONSISTENTLY; U=USUALLY; S=SOMETIMES; R=RARELY; = Clinical track; = Research track; =
Professional track 2
*Also to fulfil minimum criteria on ALF depending on the track to pursue – see point 4
2. PROBLEM SOLVING COMPETENCIES

3a/Clinical Prerequisite
Gateway to Senior/
Research
Gateway
2.1 Identification of Identifies drug-drug interactions (including U U/CC C
drug-related complementary medicines)
problems Identifies drug-related problems in special U U/CC C
patient groups. Example: Use of warfarin in an
alcoholic creates unwarranted level of risk,
tube feeding, paediatric/elderly, G6PD.
Identifies drug-disease interactions. Example: U U/CC C
NSAID in HF
2.2 Prioritization Prioritizes drug-related problems appropriately U U/CC C
2.3 Consultation or Understands own limitations, considers most U C C
referral appropriate referral point, refers in a logical,
clear and concise manner
KNOWLEDGE
2.4 Pathophysiology Able to discuss (or able to access information U U/CC C
and use this to describe) the underlying
pathophysiology of disease.
2.5 Pharmacology Able to discuss (or able to access information U U/CC C
and use this to describe) how drugs work
2.6 Side-effects and Able to describe major side-effects and U U/CC C

monitoring monitoring parameters
2.7 Interactions Able to describe mechanisms of interactions C
U U/C C
(drug/disease/
special patient
groups)
ANALYSIS & RECOMMENDATIONS

2.8 Use of Able to access recent clinical guidelines U U/CC C
guidelines and and/or relevant references
evidence Able to analyse information and critically C
U U/C C
appraise literature
Able to identify evidence gaps U U U/CR
Demonstrates clear decision making U U/CC C
2.9 Information Provides accurate information C C C
provision to other
healthcare
Provides relevant information U U/CC C
professionals Provides timely information U C C
2.10 Documentation Documents drug-related problems using C C C
of drug-related appropriate styles and methods. Example:
problems intervention forms, case notes, prescriptions,
ADR reports
FOLLOW UP
2.11 Monitoring & Monitors drug therapy appropriately. Example: U U/CC C
problem resolution TDM, high risk drugs/diseases/special patient
groups
Ensures drug-related problems are resolved C C C
(including following up interventions)
C R P
3. PROFESSIONAL COMPETENCIES

3a/Clinical Prerequisite to
Gateway Senior/
Research
Gateway
ORGANISATION
3.1 Prioritization Prioritizes work well S U C
3.2 Punctuality Punctual C C C
3.3 Time Uses time efficiently resulting in tasks being S U C
management completed within agreed deadlines
3.4 Initiative Demonstrates appropriate initiative when S U C
required
PROFESSIONALISM
3.5 Professional Practices within Code of Ethics C C C
code of ethics
3.6 Confidentiality Maintains confidentiality C C C
3.7 Confidence Demonstrates confidence, inspires confidence S U C
in others
3.8 Responsibility Takes responsibility for own actions and for C C C
patient care
3.9 Organizational Describe the structure and values of C C C
employing organization
Uses relevant and up to date procedures for C C C
practice
3.10 Communication Ensures communication with patients is clear, U C C
precise and appropriate
Ensures communication with prescribers is U C C
clear, precise and appropriate
Ensures communication with nursing staff and U C C
other members of the health care team is
clear, precise and appropriate
3.11 Staff Willing to share learning experiences and give U C C
development feedback/guidance to support staff
development
Active in educating and training healthcare S U C
professionals
TEAM WORK
3.12 Pharmacy Recognizes the value of team members U C C
team Works effectively as part of a team U C C
Passes on relevant information U C C
3.13 Recognizes value of other team members U C C
Multidisciplinary Works effectively as part of a team
team
S C C
4. Overlap of ALF Competencies

Suggested Timeframe
End Yr1 End Yr2 End Yr3* End Yr4
3a/Clinical Prerequisite to Senior/ Research Gateway Senior/ Research
Gateway Gateway
N/A N/A FOUNDATION Level in
Minimum ALF Building Working Relationships See ALF
Competency plus FOUNDATION Level in ONE of:
to be  ManagementP
Mapping
Attained  Expert Professional PracticeC Document
 Research & EvaluationR
Depending on track to pursue
C R P
Appendix 3 –
Mini-Clinical Evaluation Exercise (mini-CEX) Form
Mini-clinical Evaluation Exercise (mini-CEX)
This tool is designed to be used on the ward/in the clinic, to assess the pharmacist’s provision of
pharmaceutical care to new patients. The purpose is to assess the thought process and overall
performance of the GLF pharmacist, not necessarily the depth of their clinical knowledge.
Minimum frequency requirement: ONE every 4 months

Estimated time required: 20 mins (15mins for assessment, 5 mins for feedback)
Pharmacist name:
Clinical Area:
Topic:
Date:
Please grade the Significantly Below Borderline Meets Above Significantly Not
below expectations above observed
following areas
using the scale
below:
Delivery of Patient Care
Patient
consultation
Retrieves relevant
medical/drug
information
(including allergies)
Evaluates the
appropriateness of
drug selection
Appropriate patient
education given
Professionalism
Problem Solving
Identifies drug-
related problems
Demonstrates
required drug-
related knowledge
Analyzes information
and makes
appropriate
recommendations
Overall clinical care
© 2007 CoDEG
Mini-CEX used with permission from the Competency Development and Evaluation Group (CoDEG), South East England, UK.
Adapted for use in Singapore by Victoria Coleman, Holly Lee Ho-Yan and Camilla Wong, April 2009.
Anything especially good? Suggestions for development
Agreed action Follow up

(Be specific and include time frame) (To be completed at a later date by next preceptor)
Action
completed?
Comments
(if any)
Name:
Reviewer
Signature:
Date:
Trainee satisfaction with performance: (please circle)
Not at all Highly

1 2 3 4 5
Assessor satisfaction with overall performance of trainee: (please circle)
Not at all Highly

1 2 3 4 5
Assessor name: ________________________________
Assessor signature: _____________________________
Date: ________
© 2007 CoDEG
Mini-CEX used with permission from the Competency Development and Evaluation Group (CoDEG), South East England, UK.
Appendix 4 - Case Based Discussion (CbD) Form
Case Based Discussion (CBD)
This tool is designed to assess clinical decision-making and the application or use of pharmaceutical
knowledge in a patient they have managed. It may be used during clinical rounds or formal case
presentations, where the pharmacist has had time to prepare and research the case.
Minimum frequency requirement: ONE every 4 months

Estimated time required: 20 mins (15mins for assessment, 5 mins for feedback)
Pharmacist name:
Clinical Area:
Topic:
Date:
Please grade the Significantly Below Borderline Meets Above Significantly Not observed
below expectations above
following areas
(please tick
using the scale if unable to
below: comment)
Identification of
drug-related
problems
Analysis and
recommendations
Follow up and
monitoring
Professionalism
Overall clinical
judgment
© 2007 CoDEG
CBD used with permission from the Competency Development and Evaluation Group (CoDEG), South East England, UK.
2
Anything especially good? Suggestions for development
Agreed action Follow up

(To be completed at a later date by next preceptor)
Action
completed?
Comments
(if any)
Name:
Reviewer
Signature:
Date:
Trainee satisfaction with performance: (please circle)
Not at all Highly

1 2 3 4 5
Assessor satisfaction with overall performance of trainee: (please circle)
Not at all Highly

1 2 3 4 5
Assessor name: ________________________________
Assessor signature: _____________________________
Date: ________
© 2007 CoDEG
CBD used with permission from the Competency Development and Evaluation Group (CoDEG), South East England, UK.
3
Appendix 5A: Medication Review/ Dispensing Observation
for GLF Pharmacist
Pharmacist: Ward covered:
Clinical Group (CG): Rotation period:
Date of Ward Visit: 1.__________________ Date of Ward Visit 2._________________

Note: if more ward observations performed, please record in another new document.
1. Medication Review
Activities during Comments / Remarks Suggestions for
Medication Review Round (Please specify the date) Development
 Retrieves relevant Visit 1 Visit 1

medical / drug
information (including
allergies)
 Demonstrates required
drug-related
knowledge
 Evaluates the
appropriateness of
drug selection
 Identifies drug-related
problems
 Analyses information
and makes appropriate
recommendations
 Able to prioritise tasks Visit 2 Visit 2
and handle urgent and
important intervention
appropriately
 Appropriate
administration
instruction given to
patient / SN / Doctor
 Communicate clearly
and effectively with
other healthcare
providers (doctors,
nurses etc
2. Dispensing (Bedside / Counter Dispensing)
Activities during Comments / Remarks Suggestions for Development
Prescriptions (Please specify the date)
Dispensing
 Patient Visit 1 Visit 1
consultation
 Retrieves
relevant
medical/drug
information
(including
allergies)
 Demonstrates
required drug-
related
knowledge Visit 2 Visit 2
 Evaluates the
appropriatenes
s of drug
selection
 Appropriate
patient
education
given
 Analyses
information and
makes
appropriate
recommendatio
ns
 Able to perform
intervention
with respective
doctors
appropriately
 Identifies
potential
compliance
issue
Summary
Aspects Observed/ Findings Feedback/ Suggested
Development
Clinical knowledge
Clinical skills
Decision making
(prioritisation,
counselling
arrangement,
handling enquiries
etc)
Communication
Confidence level
Overall
Documented by CG Leader: _____________ Signature: _____________

Date:_________
Appendix 5B: Dispensing Observation for GLF Pharmacist
Pharmacist: Date:
Clinical Group (CG): Rotation period:
Note: This assessment will be conducted for ALL pharmacists at the end of each
rotation. However, for new pharmacists joining the department, a baseline assessment
will be completed.
1. Dispensing (Counter Dispensing)

Activities during Comments / Remarks Suggestions for
Prescriptions (Please specify the date) Development
Dispensing
 Patient
consultation
 Retrieves relevant
medical/drug
information
(including
allergies)
 Demonstrates
required drug-
related knowledge
 Evaluates the
appropriateness of
drug selection
 Appropriate patient
education given
 Analyses
information and
makes appropriate
recommendations
 Able to perform
intervention with
respective doctors
appropriately
 Identifies potential
compliance issue
 Billing (optional)
Summary
Aspects Observed/ Findings Feedback/ Suggested
Development
Clinical knowledge
Clinical skills
Decision making
(prioritisation,
counselling
arrangement,
handling enquiries
etc)
Communication
Confidence level
Overall
Documented by CG Leader: _____________ Signature: _____________

Date:_________

Appendix 6 - GLF Assessment Summary
Pharmacist’s name:
Rotation/clinical area:
Dates that assessment covers:
Anything especially good? Suggestions for development?
Overall impression: (please circle)

Poor Borderline Satisfactory Good Very good
Assessor Name: Assessor Signature:
Pharmacist Signature: Date:
Clinical Objectives to be Achieved Action Completed

(Be specific e.g. case presentation on HF) Date Comment
(To be filled by next CG leaders)
Assessor Name: Assessor Signature:
Pharmacist Signature: Date:

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A Competency Framework for

Adapted with permission from the Safe Medication Practice Unit,

Assessment Rating…………………………………………………………………………………….. Page 5

Assessment Tools…………………………………………………………………………………….. Page 6

Mini-Clinical Evaluation Exercise (Mini-CEX)……………………………………………………….. Page 7

Case based Discussions (CbD)………………………………………………………………………. Page 8

Medication Review & Dispensing Observations……………………………………………………. Page 10

1. Delivery of Patient Care Competencies………………………………………………………….. Page 13

2. Problem Solving Competencies………………………………………………………………...... Page 33

3. Professional Competencies……………………………………………………………………….. Page 41

At The End of The Assessment Period……………………………………………………………… Page 48

Appendix 1: The General Level Framework

Appendix 2: GLF Mapping

Appendix 3: Mini-Clinical Evaluation Exercise (Mini-CEX) Form

Appendix 4: Case based Discussion (CbD) Form

Appendix 5A: Medication Review / Dispensing Observation for GLF Pharmacist

Appendix 5B: Dispensing Observation for GLF Pharmacist

Appendix 6: GLF Assessment Summary

production of this handbook:

- Angelina Tan Hui Min, Pharmacy, Singapore General Hospital

- Lim Kiat Wee, Pharmacy, Singapore General Hospital

- Lim Paik Shia, Pharmacy, Singapore General Hospital

- Yee Mei Ling, Pharmacy, Singapore General Hospital

- Patricia Ng Lai Lin, SingHealth Academy (Editorial Support)

The scope of pharmacy practice in Singapore has increased tremendously in recent

The purpose of this document is to provide guidance on the Singhealth General

A competency framework is a collection of competencies that are thought to be

Table 1: Frequency Ranges for Assessment Ratings

Usually Demonstrates expected standard practice with 51–84%

Sometimes Demonstrates expected standard practice in less than 25–50%

Rarely Very rarely meets the standard expected. No logical 0–24%

As a result of ongoing implementation of the framework, various other assessment

 Mini-Clinical Evaluation Exercise (Mini-CEX) — Refer to Appendix 3;

 Case-based Discussions (CbD) — Refer to Appendix 4;

 Medication Review and Dispensing Observations - Refer to Appendices 5A

Competencies assessed: The pharmacist will be assessed on the competencies of

Feedback: Timely feedback should be provided after each encounter by the

The documentation (or a copy) of a Mini-CEX should be retained by the pharmacist

Competencies assessed: The pharmacist’s ability to identify drug-related problems,

Feedback: Timely feedback should be provided after each encounter by the

Overall clinical care Able to demonstrate sound judgement in the provision of

Purpose: The Medication Review / Dispensing Observations tool document findings

Competencies assessed: The pharmacist will be assessed on the ability to manage

Setting: Inpatient - During medication review round, and / or bedside / counter

Feedback: Timely feedback should be provided after each encounter by the

Delivery of Patient Care Competencies

1.1 Opening the Consultation

 greet the patient or caregiver and establish his / her identity;

 introduce himself / herself and other colleagues if present;

 explain what the pharmacist is hoping to achieve, e.g. taking medication

 respect the patient’s right to decline an interview or consultation, or choose a

Questions must be relevant and succinct, as exhaustive interviews may be counter-

To document an accurate and comprehensive allergy / adverse drug reaction (ADR)

 document as “NKDA” (No Known Drug Allergy) on the prescription if the

It is important to follow institutional policy regarding documentation of allergy / ADR

1.4 Relevant Patient Background

 Gender — may impact on the choice of therapy for certain conditions.

 Ethnic background / religion — pharmaceutical implications of this information

 Social background — this may impact on their ability to manage their

 Presenting condition — establish what symptoms the patient described and

 Previous medical history — concurrent medical conditions may guide the

 Full Blood Count

Establishing this background information will allow you to make a more

Sources of Patient Information