Clinical Decision Making Flashcards
Clinical decision making
The use of logic, intuition, and critical
thinking based on history-taking and physical
examination skills in order to distinguish an
accurate diagnosis and plan of care for a
presenting health problem.
To determine and implement the most appropriate evidence-based drug treatment
for the individual patient/symptoms with the
fewest adverse effects
Clinical decision making considerations
◦ Patient factors
◦ Disease factors
◦ Drug factors
◦ Available evidence
One of the first steps in pharmacotherapy
medication reconciliation. What medications are they taking
two approaches to get an initial red rec
ask pt to bring in medications. contact the pharmacy
A MN meaningful measure
you have done a med rec everytime you see the patient.
examples of questions around prescription medication
taking, not taking dose frequency time taken duration
Verify that allergies are
up to date
Do not forget about
social drugs
example of social drugs
coffee, tea, cola, choclate, etoh, tobacco, pot, opioids
examples of PMH factors
Comorbidities
Baseline laboratory status
Allergies
examples of drug factor history
◦ Mechanism of action ◦ Efficacy ◦ Cost ◦ Naming ◦ Adverse effects ◦ Administration Frequency Ease Storage
Insurance considerations
look at formulary. Some drugs are covered differently. Tier 1, 2, 3 etc.
Evidence Based Medicine
Is an approach to practicing medicine in which the
clinician is aware of the evidence in support of
clinical practice, and the strength of that evidence
example of a tool to use to make a decision about prescribing
JNC 8
EBM are
guidelines. It is up to the provider to make decisions
Nursing Skills and Expertise (what will you use)
◦ Subjective data
◦ Objective data
◦ Intuition
◦ Previous clinical experience
