DAY 1 AM Flashcards
Pharmaceutical care
The responsible provision of drug therapy to achieve definite outcomes that improves a patient’s quality of life. These outcomes include:
- Curing a disease
- Eliminating/reduce pt. symptoms
- Arresting or slowing the disease progress
- Preventing a disease or symptoms.
Five Key Elements of Pharm. Care
- Establish and maintain professional relationship
- Collect, organize, record and maintain pt. specific info.
- Evaluate info and develop drug therapy plan
- Assure patient has all the components to carry out the plan
- continually review, monitor, and modify as necessary in consultation with pt. and healthcare team.
Philosophy of Pharm. Care
- Social needs
- Responsibility
- Patient centered approach
- Caring about patients
What is a drug therapy problem?
An undesirable event experienced by pt. that involves drug therapy and that actually or potentially interferes with desired outcomes. This includes:
- Unnecessary drugs
- Wrong drugs
- ADR
- Non-adherence
- Additional drug therapy needed
Pharmacist Responsibility
ID, resolve, prevent drug therapy problems check to see if:
- Appropriate drug for indication
- Medication is safe and effective
- Pt. can comply with med or tx plan
- There aren’t any untreated indications that needs meds
The Patient Care Process Includes
- Initiate relationship with pt. and caregiver
- Gather pt info (Subjective and objective) (SO)
- Assess information (A)
- Develop care plan and complete intervention (P)
- Implement follow up
Subjective Data
Info provided by the pt or a caregiver that cannot be directly measured i.e pain. This segment includes chief complaint (CC), HPI, PMH, SH, FH, Review of symptoms.
Objective Data
Observable and can be measured. i.e Lab values, vital signs, physical examination findings, serum drug concentrations, diagnostic tests, computerized med profile with refill info.
What is patient Assessment
Process through Pharm.D evaluates pt. information that was gathered from pt. and other sources to make a decision regarding patient’s: health status, drug therapy needs and problems, interventions that will ID problems and prevent future ones, and follow up to ensure pt. outcomes are being met.
What does patient assessment involve?
- Information gathering
- Patient interviewing skills
- Physical assessment techniques
- Clinical reasoning
Patient Care Plan has to include
- ID drug therapy problem
- Prioritize and categorize the drug therapy problems
- Patient goals and outcomes determined
- Solutions/interventions identified
- Document (SOAP/Problem-oriented-note)
A Complete Health Assessment includes
- Patient interview and health history
- General survey and vital signs
- Physical examinations.
Patient Interviewing: Prepare Environment
- Gather pt info from medical record prior to interview
- 4-5 feet btwn pt and pharmD at equal status
- Take short/concise notes.
Patient Interviewing: Opening statements
- Call pt by surname (Mr. Mrs)
- Tell them how long this will take
- Introduce yourself and reason for this meeting
- Pt will ask questions and they will wonder why you are talking to them.
Patient Interviewing: Appropriate Questions
- Use open ended questions to hear the story.
- Use specific questions to get details about the symptoms.
- Use yes or no questions to asses pertinent negatives or positives information.
Patient Interviewing: Verify the informations by
- Clarification
- Reflection
- Silence
- Empathy
- Summary
- Facilitation
Patient Interviewing: Non verbal communication include
- Distance
- Body Posture
- Eye contact
- Facial expression
- Gestures
Patient Interviewing: During the Closing Statements
- Provide a brief summary
- Conclude with simple close ended questions ( like any???)
- Conclude with a sincere statement (like thanks 4 ur time)
Patient Interviewing: Common errors
- Changing the subject
- Giving advice
- False reassurance
- Asking leading or biased questions
- Using jargon
- Don’t get the pt. point of view.
Health History: Initial Information
- Date and time of history (document this)
- Identifying data (DOB, gender insurance)
- Source of History: (Pt., family member, med rec.)
- Reliability (note if pt was vague when describing symotoms)
Health History: Chief Complaint (CC)
- Why is this person here? give brief statement about their symptoms/concerns
- Record it in their own words
- Use open ended question to elicit this (why are you here today?)
- Write answer in quotation marks
Health History: History of present illness (HPI)
- Thorough expansion of CC, get enough details but dont be redundant.
- Get specific characteristics of all symptoms
- Include important +/- informations
Health History: Characteristics of HPI
- Timing (onset and duration)
- Location
- Quality (character)
- Quantity or severity
- Setting
- Alleviating/aggravating factors
- Associated symptoms
PQRST
- Palliating and exacerbating factors
- Quality
- Region
- Severity
- Timing
Health History: Past Medical History (PMH)
CASH IT IS
- Childhood illness
- Adult illness
- Surgeries
- Hospitalizations
- Injuries
- Trauma
- Immunizations
- Screening Tests/Exams
Health History: Family History (FH)
- Age and health/cause of death of 1st degree relatives
- Present chronic disease
- History of cancer
- Genetically transmitted diseases
Health History: Social History (SH)
- Alcohol/tabacco/recreational drugs
- Nutrition/exercise/sleep
- Sexual history/source of support
- Education/Occupation/Religious beliefs
Tabacco
- Type, number of years, number of packs per day (PPD)
- Pack year= number of years x #PPD
Alcohol and Drugs
-Type, amount, pattern, duration of use
CAGE Questionare
- Ever felt the need to cut down?
- Ever felt annoyed by criticism regarding drinking habits?
- Ever felt guilty for drinking?
- Ever took a drink in the AM to steady nerve or get rid of hangover?
- Blackouts, seizures, accident, job problems?
Diet and Exercise
- How many meals or snacks per day?
- Type of food and how much?
- % red meat, fat, fiber, salt
- What type of exercise, frequency and duration?
Health History: Review of Symptoms (ROS)
- General description of pt. symptom per body system to reveal any additional symptoms or problems, help guide examination.
- Typically close ended questions
- Head to toe format
- Note both absence and presence of symptoms.
Health History: ROS Areas
- General health
- Skin/Hair/Nails
- Eyes/Ears/Nose/Throat/Head/Neck
- Respiratory
- Cardiovascular
- Peripheral vascular
- GI
- Hepatic
- Renal
- Female/male reproduction
- Endocrine system
- Nervous system
- Mental status
- SK
Medication History: Current meds
- Name
- Dose and form
- Route
- Indication
- Duration of therapy
- Dosing schedule (prescribed vs actual vs PRN’s)
Medication History: Past meds
- Why was it stopped?
- What was the initial dose?
- What were the outcomes of using it?
Medication History: Meds adherence
- Review refill history
- Fill counts
- How often missed?
- Walk through daily routine
- Ask pt. to demonstrate
- Non adherence likely if pt is on equal/more than 5 meds or have greater than 3 disease states.
Allergies
- Medication, food and env.
- Ask what type of reaction and when/ how it was stopped.
- Side effects are usually thought to be allergies
- Does Pt experience outcome with members of similar drug class?
ADR
Unwanted pharmacologic effects associated with a medication.
Adapting to Specific Situations
-Don’t judge, explain why you need to know.
-Ask questions matter of factly and use anatomical terms
-
Silent Patient
- Silence can be good
- Pt. needs time o digest the info and collect their thoughts
- Pay attention to non-verbal cues
The patient with altered CApacity
- Determine if Pt has ‘decision making capacity’
- Talk to pt’s surrogate with the consent of the patient. and asses their relationship
The confused patient
- Consider psychosocial assessment to get mental status, orientation, memory and capacity to understand.
- Don’t spend too much time trying to understand use the MAR to fill in gaps.
The talkative patient
- Give them 5-10 min of free talk and assess them (obssessed with details? disorganized thoughts? anxious?)
- Set limits and ask focused questions
The non english speakeer
- Use an interpreter not family members
- Use short, clear, and simple Q’s
The patient with low health literacy
- Find out reason why they have low literacy (education? language barrier?)
- Test their skills in a nice way.
The crying patient
- Pause and respond with empathy
- Give time to recover
Angry or disruptive patient
- Stay calm, accept their anger and avoid confrontation
- Alert security
- Be collected and non threatening
Hearing impaired Patient
- May use handwritten questions and instructions
- Reduce background noise and talk into their good ear
- Don’r raise your voice
Patient with impaired vision
- Handshake
- Orient patient to room
- Report if anyone else is present
