Acute care assessment tool (ACAT) example

Purpose

Evaluates the individual’s clinical assessment and management, decision making, team working, time management, record keeping prioritisation and handover over a continuous period of time across multiple patients. Can be used in all sectors.

Examples of when it can be used

Useful tool when a supervisor has organised a session to observe practice. Can be used in any setting when the individual reviews multiple people as part of their practice. Observation of a range (at least 5) of consultations in a single session (e.g. ward round, clinic, with people with a diverse range of complex needs)

Instructions

• A minimum of five cases need to be observed for an ACAT assessment in a continuous period of observation.
• This tool is designed to assess the pharmacist undertaking multiple patient interactions.
• The overall rating should reflect the expected level of an advanced pharmacist as defined in the curriculum.
• ‘Not applicable’ means that the pharmacist did not cover the identified area as it was not within the context of the procedure or case.
• ‘Below’ means that either the pharmacist did not cover the identified area to a competent level or it was not demonstrated at all, and should have been.

ACAT
Title*	Use of Independent Prescriber Skills in community pharmacy Common Clinical Conditions clinic.
Date of assessment*	24/10/2022

Collaborator details
Collaborator name *	Dr AZ
Collaborator email Only required for sending ticketed invitations	[email protected]
Collaborator position*	General Practitioner
Collaborator profession*	Medic
Collaborator declaration*	I can confirm I have read the RCPharm collaborator guidance and have the appropriate experience to complete this assessment. I confirm I have completed the assessment objectively and independently. Yes ☐

Details of Case
Summary of case(s)*	5 consecutive cases in a Common Clinical Conditions clinic in a community pharmacy using IP and examination skills: 1. UTI in an elderly female. 2. Conjunctivitis in a 7-year-old child. 3. 2-year-old breathless child (croup). 4. Ringworm in an adult male. 5. Gastroesophageal reflux disease (GORD) in an adult male.
Clinical setting(s)*	Community pharmacy
Level of complexity*	Low ☐     Medium ☐     High X

Collaborator Assessment
Professionalism
Is respectful, courteous and professional in their approach to patients and others. Is accountable and responsible for their own decisions. Works within ethical guidelines and legal frameworks. Actively practices honesty and integrity. Works safely within own level of competence, knows when to escalate or refer.*	Below ☐	Meets ☐	Exceeds X	Not applicable ☐
Comments: strengths and/or areas for development* Professional throughout, no concerns noted.
Communication and consultation skills
Communicates using clear patient friendly language, establishes rapport. Explores patient’s understanding of their clinical condition and beliefs including identifying and addressing patients’ ideas, concerns and expectations. The patient is appropriately involved throughout the consultation.*	Below ☐	Meets ☐	Exceeds X	Not applicable ☐
Comments: strengths and/or areas for development* Excellent patient-centered approach, able to tailor each consultation to the patient, including dealing with an elderly patient with hearing problems, and dealing with an unwell toddler and their worried parent. The pharmacist remained calm and professional throughout. The pharmacist was able to support the worried parent and confidently explain the diagnosis and next steps to the patient/guardian. The pharmacist also had to contact the Out-of-Hours GP, and was able to concisely discuss the history of the case.
Clinical reasoning
Takes a logical, appropriately thorough and focused history. Performs an appropriate physical and/or mental state examination, selecting and interpreting appropriate investigations. Makes an appropriate working diagnosis or decision.*	Below ☐	Meets ☐	Exceeds X	Not applicable ☐
Comments: strengths and/or areas for development* The three patients who presented with ringworm, conjunctivitis and GORD were standard cases and were all prescribed standard treatments after appropriate questioning and examination. In the fourth patient (an elderly female who presented with classic symptoms of a UTI), no urine sample was available as the patient was immunocompromised, but an appropriate treatment was prescribed. In the fifth patient (2-year-old child presented with a bark-like cough and slightly breathless at rest)– on initial examination, the pharmacist correctly identified continuous stridor and this was confirmed through chest auscultation. The pharmacist also correctly recognised that the child was breathing harder using accessory muscles. In addition, they were able to confirm a lack of severe symptoms (i.e. cyanosis, drowsiness, agitation, tachycardia, etc.). The pharmacist correctly diagnosed moderate croup. The pharmacist performed well in each case, and made appropriate decisions for each patient.
Clinical management
Applies clinical knowledge and skills to manage options and medicines appropriately and safely. Assesses and critically evaluates appropriate information to make evidence-based decisions. Makes appropriate use of referrals and prioritises care appropriately.*	Below ☐	Meets ☐	Exceeds X	Not applicable ☐
Comments: strengths and/or areas for development* The clinical management of the patients with ringworm, conjunctivitis and GORD required no deviation from recommended first line treatments, and these were prescribed. In the case of the elderly female with a UTI, nitrofurantoin was prescribed. The patient was taking methotrexate, so trimethoprim was not appropriate. There was no urine sample, but as the patient was immunocompromised, a decision was made to treat them which was appropriate in the circumstances. In the final case, once the diagnosis of moderate croup was reached, the pharmacist correctly identified that the child needed medical attention and immediately contacted the Out-of-Hours GP on the parents’ behalf. The case was discussed with the on-call medic, and an emergency face-to-face appointment was booked within an hour.
Organisation & efficiency
Effectively, efficiently and safely manages multiple priorities. Manages own time and workload calmly. Organises and delegates tasks appropriately to optimise effectiveness within the pharmacy and wider team, to enhance patient care.*	Below ☐	Meets X	Exceeds ☐	Not applicable ☐
Comments: strengths and/or areas for development* Stuck to time in all cases except in the case of the child with croup when they ran 10 minutes over the allocated time, but this was understandable given the presentation of severe symptoms.

Summary of Assessment
Overall rating* Based on your observation of this clinical episode, rate the overall level at which the pharmacist has shown that they are performing	Below the level expected of an advanced pharmacist	☐
	Working towards the level expected of an advanced pharmacist	☐
	Meets the level expected of an advanced pharmacist	x
Other relevant comments or feedback	The pharmacist was able to identify common conditions with ease, and this demonstrates their level of experience.
Agreed action(s)
Learner’s reflection Describe what you have learned. How will it change your practice in the future?	I am really pleased with how I’ve developed over the last year, and I have now grown in confidence to treat a variety of cases (e.g. different ages of patients and conditions).