Lecture 1: pharmaceutical care planning Flashcards
What are the two major classes of medication-related illness?
Adverse drug reactions
Non-compliance
What are adverse drug reactions?
harmful or unwanted consequences when using drugs at
normal therapeutic doses (e.g gastrointestinal
bleeds with NSAIDs)
What is non-compliance?
harmful effects of not using drugs as intended (e.g acute asthma attack due to not taking ‘relievers’)
What is pharmaceutical care?
Where the Pharmacist takes responsibility not only for drug distribution (dispensing etc.) but also for
ensuring the best outcomes of medication use
for patients
What is the pharmacist’s role in pharmaceutical care?
To ascertain all the medicines a patient is
taking, from whatever source,
To assesses them for reasonableness and effectiveness in light of the patients condition,
and to develop a care plan, and follow up on it on a regular basis
Which new pharmacy services have been developed overseas?
medication review, specialist services, supplementary and independent
prescribers etc.
Which new pharmacy services have been developed in NZ?
The Pharmacy Council together with other professional organisations and DHBs are currently defining a range of specialist and extended ‘medicines management’ pharmacy services (over and above the current Dispensing contracts)
What are these new services based on?
the ‘cognitive skills’ of pharmacists in improving
outcomes from the use of medicines (i.e.
‘Pharmaceutical care’)
Why are there drug related problems?
medicines intended to provide positive benefits to patients, However, there are often adverse effects
which occur either by taking medicines inappropriately,
or by not taking medicines where indicated
What are the 8 main types of drug related problems?
1) untreated indication
2) improper drug selection
3) subtherapeutic dose
4) failure to receive drugs
5) overdosage
6) adverse drug reactions
7) drug interactions
8) drug use without an indication
What is the pharmaceutical care plan?
the written document of the pharmacist’s assessment of the actual and potential drug-related problems (DRPs) for an individual patient.
It also includes goals, outcomes and monitoring associated with this assessment.
It is an element of the pharmacuetical care process
What kinds of outcomes is the PCP constructed around?
realistic, measureable outcomes which can be measures of biological and physiological function
e.g. PEFR, blood pressure, glycosylated haemoglobin
It can also be complex measures like patient functioning (improved mobility) or their satisfaction with care
Why are outcomes or goals important to the PCP?
Defining outcomes of drug use is absolutely
fundamental to safe and effective use of medicines
What are the processes involved with constructing a PCP?
1: Collection of Information and Patient Consultation 2: Pharmacist’s Assessment and Prioritisation of Problems 3: Development of a Pharmaceutical Care Plan 4: Patient Education, Recommendations and Referrals 5: Patient Monitoring (Evaluation) and Follow-up
How can information be gathered?
From:
- Prescription/OTC records
- Drug charts
- Medical notes/referral letters
- Laboratory tests/investigations
- Interview with patient/carers
Information can be Documented on a hard-copy form or electronic
database
How do you assess the information?
To thoroughly assess the patient’s entire drug therapy needs, you may need to
• Consider OTC and complementary medicines,
as well as prescribed medicines
• Analyse relevant patient, drug and disease
information
• Identify all current or potential drug-related
problems (DRPs)
• Document this information
How do you develop a plan?
• Prioritise actual and potential DRPs (tackle the
most urgent and important issues first)
• Develop realistic and specific goals for therapy
• Establish goal criteria
• Establish a monitoring or evaluation schedule, to check that goals are reached
How do you implement the PCP?
• Give actionable recommendations on drug, dose,
frequency, duration, and required monitoring
• This may include targeted patient education
(e.g. explain role of drugs in diabetes, demonstrate proper use of inhalers)
• May include recommendations on general
health (e.g. quit smoking)
• May also include referral back to prescriber
(usually the GP), or to another health
professional (eg podiatrist)
How do you monitor patient outcomes?
• Aim to monitor at planned intervals (eg visit to
pharmacy, telephone follow-up, home visit)
What happens if goals are not being met?
• The full PCP process will be repeated
Why must monitoring occur?
to ensure that: - Therapeutic goals are being met - Patient outcomes are evaluated and documented - To assure that new DRPs do not develop
Which three areas must you always cover in a PCP?
– Problems – with priority and goals
– Options – suitable for the patient
– Plans – recommendations and follow-up
