Writing effective reflective account records
In this article we have brought together some tips to help you write effective reflective account records, and included a couple of example reflective account records with the feedback they received from our reviewers.
The reflective account was first introduced as part of revalidation in 2019 and one of its main aims is to encourage you to think about how you are meeting the standards for pharmacy professionals.
If you have a registration renewal deadline on or before 30 April 2021, you will only need to submit a reflective account when you renew your registration. You will need to make the required declarations and pay the fee; but you will not need to submit a peer discussion record or any planned or unplanned CPD records.
Writing the reflective account will increase your awareness and understanding of the standards and help you to reflect on how your practice affects the people using your services.
Your reflective account should cover:
- which of the three standards you have selected
- at least one clear example of how you have met one or more of the three relevant standards
- your main roles and responsibilities
- the setting and scope of your practice
- your typical service users
Tips on how to write an effective reflective account record
Which standards should I reflect on?
You should reflect on one or more of the following standards:
standard 3 - pharmacy professionals must communicate effectively
standard 6 - pharmacy professionals must behave professionally
- standard 9 - pharmacy professionals must demonstrate leadership
You can include reflections on any of the other standards, but you must select at least one standard from the above list. We would encourage you to consider your experiences during the COVID-19 pandemic when completing your reflective account, although this is not essential.
- Your reflective account can cover any area of your practice
- Try and strike a balance between a very brief description, which may lack important detail, and a very thorough account which may provide too much, possibly unnecessary, information
- Provide at least one real and specific example to support your account, so that we can see how you have reflected on your chosen standard(s). The standards for pharmacy professionals are all inter-related, so you will find that you can show how you have met more than one of them using just one example.
- Do not use examples which are vague or too broad; they will not be marked well by reviewers
- The example you choose should be relevant to your practice as a pharmacy professional and should focus on how you, personally, are meeting the standard(s), rather than your team as a whole
- Do not disclose names or confidential information about patients when writing your record
- On a practical note, make sure you initially spell out or explain any acronyms you use, as others who do not work in your area of practice may not be familiar with them
Example of a reflective account from a hospital setting
I am a ward-based pharmacist working in a hospital setting. My main role is to ensure that medicines are prescribed safely and appropriately, that nurses know how to administer them and when to monitor for side effects and that patients are kept informed and counselled. I am also responsible for ordering medications for patients on the ward.
My other duties involve accurate drug history taking, recording of allergies, checking the reason for admission and rationale for medication changes, that prescribing follows hospital guidelines, that medicines are clearly prescribed and making interventions where necessary.
Typical users of my services are patients, doctors, nurses, other healthcare professionals.
We do not have electronic prescribing at the hospital - all medications are entered on the computer system manually and make up the list of medication that the patient is on. It is therefore very important that the computer records are accurate, maintained and checked at point of discharge.
As part of the discharge process I counsel patients on any changes made to their medications and advise them that their discharge letter will be their written record of any medicines stopped, started or changed as a result of their hospital stay. This year we had an intake of new doctors. Several patients were being discharged and the doctors attempted to use the system to make changes to their medication. I found numerous errors had been made. Rather than just correcting the errors myself I spent time with the new doctors to increase their understanding of the system and improve patient safety. I introduced myself to the doctors; explained my role, showed them how the system works and how to prepare the drug list. The doctors said that they had a better understanding of the system now.
New doctors are now assigned pharmacist 'buddies' who they can contact for help and advice if needed.
I put this forward as an example of behaving professionally and communicating effectively in the interests of patient safety.
Reflective account feedback
This reflection covers all the criteria perfectly. You have set the scene of your role and scope of practice and detailed the users of your practice as patients and the wider multi-disciplinary team. Your example directly shows great evidence of meeting the professional standards. It is thorough and well written. In addition, the example of the new doctors demonstrates how your initiative has set up a scheme that is ongoing and hugely beneficial.
Example of a reflective account from a community setting
I work as a part-time locum community pharmacist, currently in two different pharmacy settings that provide a range of services to patients and public. One location is a 100 hour pharmacy in an edge-of-town supermarket and includes some out-of-hours work. The other pharmacy is in a small market town, open daytime hours only and serving a largely rural population.
In both pharmacies I consult with patients and customers about their self-care needs and communicate with them about accessing medical care as appropriate. This summer a new Minor Ailment Service (MAS) specification and guidance was launched. This was in line with national guidance from NHS England encouraging people to self-care for minor illnesses, using over-the-counter (OTC) medicines as appropriate, rather than routinely seeking prescribed medicines. Self-care posters and patient leaflets promoted the service and a self-care referral form was introduced for pharmacists to use when referring a patient to a GP. Examples of referrals include patients with a chronic or complex condition, a condition that falls outside the product license for an OTC treatment or with ‘red flag’ symptoms suggesting the condition is not minor and/or may require prescription only medicines.
In the market town pharmacy, there is already a strong self-care mindset among local residents. Here I use my communication skills to discuss their symptoms with them, offering them options and advice about OTC treatment as appropriate, ‘safety-netting’ i.e. explaining what to do if symptoms do not resolve or the condition worsens, or referring on for medical care. This has always been verbal communication although I do recommend that customers consult the NHS Choices website for further details or as a reminder of advice given.
After the introduction of the referral form in August I considered its use. I would give further clarity to the GP practice about the reason for referral. Also, after reflection on the initial referrals that had been done, it became clear that the GP practice also sought a recommendation on how soon a patient may need to be seen to guide their receptionists in scheduling an appropriate appointment. This has now been incorporated into practice at this pharmacy.
For example, when recommending same day medical care, an example being a patient with probable cellulitis following an insect sting, I would seek the patient’s agreement and contact details then telephone the GP practice for referral directly into their telephone triage service. I would then communicate back to the patient to expect a same day phone call, usually from a nurse practitioner, followed by treatment or onward referral to a GP appointment as necessary. I would issue them with a completed referral form.
In the supermarket pharmacy I have not yet used the self-care referral form and have always communicated advice and recommendations to the patient verbally. Since much of my work is in the out-of-hours period, I communicate options to the patient depending on the severity of their condition. Typically, this includes advising them about the extended hours access centre, phoning 111 or advising them to phone their GP practice as soon as it opens in the morning. I frequently explain that they need to ask for a same day appointment for an acute condition and to advise them that they have already consulted a pharmacist. I find that patients often need this extra advice in helping them navigate through our healthcare systems.
Reflecting on my communication skills in these scenarios I have identified ways in which I can enhance the patient experience when seeking self-care advice; signposting them to useful health advice resources and by optimising the support I give in obtaining timely medical care. I have also recently worked through the toolkit for the new Community Pharmacy Consultation Service, I note that these features have all been incorporated into the service.
Reflective account feedback
Your description of the two very different pharmacies in which you work and the different patients and situations you encounter sets the context for this reflective account very well. We enjoyed the level of detail. You have focused on GPhC standard 3 about communication, and have reflected on your consultation skills, discussed the services you are providing with a colleague and clearly described how the way in which you communicate with patients in two different sessions to demonstrate that you are meeting the requirements of Standard 3.