Clinical Interventions Flashcards
What is a clinical intervention? Why is it done?
Pharmacists routinely perform clinical interventions in order to improve health outcomes of consumers
> A clinical intervention = professional activity that is done by a registered pharmacist directed towards improving quality use of medicines –> resulting in a recommendation for a change in the patient’s medication therapy, means of administration, or medication-taking behavior.
What does a clinical intervention involve?
Pharmacist performs clinical interventions that involve the identification of actual or potential drug-related problems (DRPs) and the provision of recommendations to resolve or prevent them, and subsequently documents the clinical intervention, to improve health outcomes for consumers
What is a drug-related problem (DRP)? What are some other terms used to describe DRPs? What is done to prevent or resolve a DRP?
A DRP is defined as “an event or circumstance involving drug treatment that actually or potentially interferes with the patient experiencing an optimum outcome of medical care”
- Other terms to describe DRP include: “medication-related problem”, “medication error”, adverse drug reaction/event”, “adherence issues”
- A clinical intervention is used as an attempt to prevent or resolve a DRP by making a recommendation. the recommendation may or may not be accepted.
Why are clinical interventions significant?
- 2-4% of all hospital admissions are drug-related, and up to three-quarters of those admissions are potentially preventable
- Adverse drug events are responsible for up to 30% of hospital admissions in people >75 years
- 10% of patients visiting their GPs had experienced DRP within past 6 months
Therefore, studies highlight the need for improving detection and prevention of DRPs within the community before a GP visit or hospital admission is necessary
Why is documenting important when performing clinical interventions?
- Facilitates enhanced outcomes for consumers
- Improves communication between pharmacists and other health professionals involved in the consumer’s care
- Maintains EVIDENCE to support a professional practice portfolio
- Provides a basis for quality audits and peer review
- Permits analysis of data for pharmacovigilance, economic review etc
Clinical interventions may also provide a pathway into other professional services for pharmacists such as? How do these services and activities uphold the Quality use of Medicines principles?
- Dose Administration Aids (DAA) services
- Provision of Consumer Medicine Information (CMIs)
- Home Medicine Reviews (HMRs)
- Residential Medication Management Reviews (RMMRs)
- MedsCheck etc.
Uphold the Quality Use of Medicines (QUM) principles:
- Selecting management options wisely
- Choosing suitable medicines if a medicine is considered necessary; and
- Using medicines safely and effectively
What are some examples of when clinical interventions SHOULD BE recorded by pharmacists in practice?
- Pharmacist identifies potential over-use or duplication of medicines, or overtreatment of conditions
- Pharmacist identifies a medical condition which is poorly controlled which may require enhanced therapy or improved medication adherence
- Pharmacist identifies the need for preventative therapy, such as potassium supplementation
- Pharmacists uncovers a possible myopathy associated DRP in a patient on HMG CoA reductase inhibitor that comes in requesting OTC pain relief
- Consumer requests further information regarding a medication or disease management
What are some examples of situations that ARE NOT clinical interventions SHOULD NOT BE recorded by pharmacists in practice?
- routine consumer counselling and provision of CMI, such as when a consumer has been dispensed a new medicine
- substitution of medication brand – unless the recommended brand has a unique characteristic to assist in the resolution of a DRP (e.g. a calendar pack, braille markings, gluten-free)
- routine assessment or management of minor ailments, such as provision of symptom relief for cold and flu, or assessment and treatment of allergic rhinitis
- administrative events (e.g. medicine ordering, prescription processing, determining PBS eligibility)
What is the DOCUMENT classification system?
This system consists of 8 categories to classify DRPs –> has been developed to classify and document DRPs in practice.
D = Drug Selection
O = Over or Under Use
C = Compliance
U = Undertreated
M = Monitoring
E = Education
N = Not Classifiable
T = Toxicity or Adverse Reaction
What is SBAR? Provide an example
SBAR is an easy to remember acronym that can be used to frame conversations with prescribers or other health professionals concerning issues (interventions) that require their immediate attention and action such as DRPs. It enables you to clarify what information should be communicated.
Why are the steps for a medication reconciliation in a clinical intervention? Why must a medication reconciliation be done?
Any assessment of a patient should always start with medication reconciliation
- Obtaining the best possible medication history
- Confirming the accuracy of the history
- And reconciliation of the history with the patient’s prescribed medication
After medication reconciliation has been performed, how to check for clinical issues/therapeutic problems? (medication history, prescribed medication, laboratory reports or complaints)
- Identify the drugs contained in the prescribed medication and the patient’s current medication
- Identify the most likely indication for each of the medications. If unsure about any indication due to there being multiple indications check with the patient.
- Check the dose of each of the prescribed medication
- Check for any drug interaction between the prescribed medication and the patient’s current medications
- Check for any drug-disease interaction or precautions between the prescribed medication and the patient medical conditions
- Always consider the AGE and SEX of the patient
- Always consider other factors such as pregnant or breastfeeding
- Always check the drug interaction table at the back of the AMH and also READ each monograph of each drug and drug group description related to drug interactions, contraindications, warnings etc.
Process for practical examination
- CHECK each drug on the prescription for safety and appropriateness INDIVIDUALLY & against the patient’s OTHER MEDICATIONS
- COMPLETE an Intervention Sheet if necessary (if more than one problem include ALL issues on the one sheet
- CONSULT the prescriber/patient to correct the issue using the SBAR approach
- If new drug ordered, complete new Medication Management Worksheet (therefore research all the drugs for the patient BEFORE you commence writing on your worksheet!)
- DISPENSE prescription & label medications etc
- COUNSEL patient
