Pharmcare Final Flashcards
Pharmaceutical Care Definition
“The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patients quality of life”
5 core elements of the MTM Service Model
Medication therapy review (MTR) Personal medication record (PMR) Medication related action plan (MAP) Intervention and/or referral Documentation and follow up
S in SOAP note
(SUBJECTIVE) chief complaint, past medical history, social history, home medications, allergies, review of system (obtain from patient or care giver)
O in SOAP note
(OBJECTIVE) vital signs, physical exam, lab or diagnostic results, other confirmed data from the medical record
A in SOAP note
(ASSESMENT) etiology, assessment if therapy is indicated, goals of therapy, assessment of current and/or new therapy (summarize S and O data to support diagnosis, give goals, and identify the problem that needs correcting)
P in SOAP note
(PLAN) therapeutic plan, therapeutic and toxicity monitoring parameters, patient education, future plans, dosing and starting medications
(drug, dose, route, frequency, duration/ patient counseling points)
Framework for pharmacist patient care process
Collect (subjective and objective information)
Assess (analyze information collected, identify the prioritized problems)
Plan ( patient centered care plan, evidence based and cost effective)
Implement ( collaborative with other healthcare professionals and patient/caregiver)
Follow up: Monitor and Evaluate (monitor and evaluate effectiveness, include other players)
What is the difference between a SOAP note and a Progress note?
a progress note is a mini version of a soap note, but with only one drug related problem
Hutchisons 8 step model
- need of a drug
- selection of drug product
- selection of drug regimen
- provision of drug product
- patient education
- consumption of administration
- monitoring effects of medication
- evaluation and follow up
Hepler and Strans major types of drug related problems
untreated indications
improper drug selection
sub therapeutic dosage
failure to receive/take medication
over dosage
adverse drug reactions
drug interactions
medication use without indications
ASHPs Drug Therapy Problem Types have 11 categories
o Relationship between medications and medical problems o Appropriate medication selection o Drug regimen o Therapeutic duplication o Drug/allergy intolerance o Adverse drug events o Drug interactions (of all types) o Social or recreational drug use o Failure to receive therapy o Economic impact o Patient knowledge of medications
ASHPs four step process for creating pharmacist care plans
o Step 1: identify and prioritize patient’s health problems (drug therapy assessment worksheet)
o Step 2: identify pharmacotherapy goals
o Step 3: recommendation for therapy
o Step 4: develop a monitoring parameter and endpoints
ASHPs “Statement of Pharmaceutical Care”
o Principle elements Medication related Care Outcomes (4 general) • Cure of a disease • Eliminate/reduce patient symptomatology • Arrest/slow of disease process • Prevent disease/symptomatology Quality of life Responsibility
ASHPs key aspects of 2015 initiative and PPMI
Goal 1: Increase the extent pharmacists help individual hospital inpatients achieve the best use of medication
Goal 2: Increase extent to which health-system pharmacists help individual nonhospital patients achieve the best use of medication
• 1 and 2 are just help all patients with medicine
Goal 3: Increase application of evidence-based methods to improve medication therapy
Goal 4: Increase the extent to which pharmacy departments in health systems have a significant role in improving the safety of medication use.
Goal 5: Improve the safety of medication use in health care systems through the application of technology
Goal 6: Increase pharmacy department engagement in public health initiatives on behalf of their communities
Hepler and Strand’s definition of Pharm Care (WORD FOR WORD)
“The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.”
Who is the “Father of American Pharmacy?”
William Proctor
Who is credited with proposing separation of the practice of medicine and pharmacy?
John Morgan
What are causes of suboptimal care?
+ Acts of Commission (medication errors)
+ Idiosyncratic causes (Unpredictable medication consequences)
+ Acts of omission (absence of individual/profession to assume responsibility for patient medication outcomes)
What is ‘Central fill’?
Retail chains aggregate prescriptions from multiple locations to one central location fulfillment center. Prescriptions then mailed back to individual pharmacies or directly to patient. (EX: Walgreens POWER)
Describe remote medication order processing
+ One hospital pharmacy contracts with another hospital to provide RMOP ex. Hospital does not have a 24-hour pharmacy services
+ On- call model, pharmacist helps manage workload from another location during peak workload times
What is a Collaborative practice agreement?
A collaboration between pharmacists and physicians. Physician responsible for diagnosis and initial treatment of patient.
Pharmacist authorized to: monitor patient condition, modify drug therapy as necessary, discontinue medications at the end of treatment.
Requires preapproved, written treatment protocols for each course of therapy.
What was the Asheville Project?
Community-based disease management that provided CV risk reduction education and face to face counseling by specially trained community and hospital pharmacists which resulted in significant improvements in clinical and financial outcomes.
Chronic medical condition where self-care knowledge and appropriate medication use are important for improving outcomes
What were the objectives of the Asheville Project?
Assess clinical and economic outcomes of a community-based, long-term MTM program for HTN/dyslipidemia in 12 community and hospital pharmacy clinics
Who were the participants in the Asheville Project?
Patients, Educators at Mission Hospital, 18 Certified-trained pharmacists
What were the interventions of the Asheville Project?
CV risk education; Regular and long-term follow up by pharmacists (Scheduled consultations, monitoring, recommendations to physicians)
What were the results of the Asheville Project?
CV health improved, BP at goal, Dyslipidemia improved, Decreased costs
List key elements of pharmaceutical care.
\+ Rational decision-making process, \+ ID, resolve, prevent DRP; assuming therapy is safe, \+ Establish goals of therapy, \+ Select interventions, \+ Evaluate outcomes
What interventions were used in the Tampa, FL example?
Interviewed patient, Evaluated adherence via refill history, Measuring BP, Implementing a therapeutic plan - educate patient, monitoring, Contact MD as needed, Document
Was the Tampa, FL example successful?
Not as successful as Asheville Project; Pharmacist didn’t have as much of a role in changes in meds.
ASHP definition of Pharmaceutical Care.
Direct, responsible, provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life.
What are the goals of ASHP initiatives?
- More involved pharmacist interaction with hospital patients
- More involved pharmacist interaction with non-hospital patients
- Apply evidence-based methods
- Pharmacy departments have a significant role in improving safety of medication use
- Health systems technology to improve safety of medication use
- Pharmacy departments engage in public health initiatives on behalf of their communities.
What does PPMI Stand for?
Pharmacy Practice Model initiative
What is the goal of PPMI?
A “Futuristic practice model” of pharmacy to respond to the changes in healthcare brought on by healthcare reform.
What were the objectives of PPMI?
a. Create a framework for a pharmacy practice model that ensures provision of safe, effective, efficient, accountable, and evidence-based care for all hospital/health system patients
b. Determine patient care-related services that should be consistently provided by departments of pharmacy in hospitals and health systems and increase demand for pharmacy services by patient/caregivers, healthcare professionals, healthcare executives, and payers
c. Identify the available technologies to support implementation of the practice model, and identify emerging technologies that could impact the practice model
d. Support the optimal utilization and deployment of hospital and health-system pharmacy resources through development of a template for a practice model which is operational, practical, and measurable
e. Identify specific actions pharmacy leaders and staff should take to implement practice model change including determination of the necessary staff, skills, and competencies required to implement this model
What does PAI Stand for?
Practice Advancement Initiative
What was the goal of PAI?
“aspires to transform how pharmacists care for patients by empowering the pharmacy team to take responsibility for medication-use outcomes.”
PPCP stands for?
Pharmacists’ Patient Care Process
What are the steps for PPCP?
Collect, Assess, Plan, Implement, Follow-up
What is the Collect step for PPCP?
Collection of necessary subjective and objective information about the patient from multiple sources including patient records, the patient, and other health care professionals.
Ex: Current medication list, Relevant health data, Patient habits/etc
What is the Assess step for PPCP?
assesses the information collected and analyzes the clinical effects of the patient’s therapy in the context of the patient’s overall health goals in order to identify and prioritize problems and achieve optimal care.
Ex: medication appropriateness and adherence, immunization status
What is the Plan step for PPCP?
Develops an individualized patient-centered care plan, in collaboration with other health care professionals and the patient or caregiver that is evidence-based and cost-effective.
Ex: Address medication-related problems, Set goals of therapy, Engage patients with education, Supports continued care
What is the Implement step for PPCP?
Implement the care plan in collaboration with other health care professionals and the patient or caregiver.
What is the Follow-up step for PPCP?
The pharmacist monitors and evaluates the effectiveness of the care plan and modifies the plan.
What does SOAP stand for?
S Subjective
O Objective
A Assessment
P Plan
What does in the Subjective portion of a SOAP note?
Information from the patient, in the patients words.
Chief Complaint, HPI, PMH, FH, SH, MH, Allergies, Review of Symptoms
What does in the Objective portion of a SOAP note?
Data that can be measured or verified
Vital Signs, Physical Assessment, Lab/Diagnostic Test Results.
What does in the Assesment portion of a SOAP note?
Subjective and Objective Data are used while determining potential courses of action.
- Etiology: what caused the problem
- If therapy is indicated: state problem and necessary treatment
- Current/New Therapy: clinician determines the best patient-specific therapy
- Goals
What does in the Plan portion of a SOAP note?
Statement that encompasses a comprehensive plan
- Therapeutic Plan: RAID
- Monitoring parameters
- Patient education
- Future plans
Discuss the basic parts of a progress note
Subject (S): obtained from patient or caregiver. Information cannot usually be measured. Objective (O): usually measured information (labs, vita signs, diagnostic tests). Assessment (A): Should explain WHY the identified problem needs to be corrected (shows thought process that lead to conclusion patient needs intervention). Summarizes S and O data to support diagnosis. Refers to guidelines or primary literature to make drug related decisions, with recommendations of primary drug for use. Gives goal for patient. If written optimally, reader of progress note will know what is going to be recommended and why. Plan (P) or Recommendation (R): Drug, dose, route, frequency, and duration. What will be measured to determine if effective? Who will measure? How often to measure? What will be measured to assess toxicity from drug (if applicable)? Include patient counseling points and when to follow up.
Identify differences in a SOAP note and a progress note
Progress notes are mini SOAP notes and focus on ONE key DRUG RELATED issue or problem.
Identify errors or omissions on sample progress notes
Errors include: excluding important information, including extraneous information, identifying disease related problem rather than drug related problem, lack of reasoning to explain assessment or recommendation, and inaccurate or incomplete assessment or recommendation.
Discuss the methods of collection necessary when creating a patient database
When collecting data you must consider the reliability of data and the efficiency of using sources of information.
Identify where common types of patient information are frequently located
Common types of patient information are located in the patient medical chart. Other sources include the patient, caregivers, and healthcare providers.
Provide examples of common types of patient information
Demographic information: name, address, date of birth, gender, religious affiliation, drug allergies, and occupation. Administrative information: Physician, pharmacy, consent forms, patient ID number. Medical Information: medical problems, current symptoms, vital signs, allergies/adverse drug reactions, past medical history, laboratory data, and diagnostic/surgical procedures. Drug therapy information: generic and brand name of drug, strength, dosage form and route of administration, frequency of use (actual use too), indication for use, duration of use, evaluation of efficacy, possible side effects, potential tolerance or dependence. Behavioral/Lifestyle Information: diet, exercise, substance abuse, sexual history, daily activities, how patient normally takes their meds. Social/Economic information: living arrangements, ethnic background, and financial/insurance.
List several of ASHP’s drug therapy problem categories and give examples of several of ASHP’s drug therapy categories
Relationship between medications and medical problems: medications without an identifiable medical indication or untreated medical conditions. Appropriate medication selection: pharmacist must consider comparative efficacy, comparative safety, and patient-related factors. Drug Regimen: pharmacist must examine if each medication is prescribed in to correct does, frequency, route, and dosage form in a patient specific manner. Therapeutic Duplication: can occur if two or more drugs contain the same medication or have the same pharmacologic effects. Drug Allergy/Intolerance: patient may not be able to take a medication due to allergy or intolerance. Adverse drug events: importance of pharmacist characterizing reaction in order to determine appropriate action in the presence of an ADR. Drug Interactions: pharmacist must consider drug interactions of all types. Social or recreational drug use: Assessment of patient’s use of caffeine, tobacco, alcohol, and illegal substances. Failure to receive therapy: is patient taking medication as prescribed or at all? Why or why not? Economic impact: economics from a payer perspective or a patient perspective. Patient knowledge of medications: is the patient properly educated on their medications?
Summarize select aspects of Medicare, focusing on Part D
Outpatient prescription drug coverage, voluntary program that covers all Medicare-eligible patients, private entities such as pharmacy benefit managers negotiate with pharmacy manufacturers (not the government).
Describe medication therapy management (MTM) as defined by Medicare and pharmacy organizations
service or distinct group of services that optimize therapeutic outcomes for individual patients.
Describe the core elements of MTM
The core elements are: medication therapy review, personal medication record, medication action plan, intervention/referral, and documentation and Follow-up.
Compare and contrast MTM, patient counseling, and pharmaceutical care
MTM differs from patient counseling in that it is associated with educating a patient about a dispensed medication or management of a related disease. It is also an expected, non-reimbursable service. MTM differs from pharmaceutical care in that it is a patient-centered practice in which the practitioner assumes responsibility for a patient’s drug related need and is held accountable for this commitment. It also differs in that it is provides responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.
Discuss implications of MTM on pharmacy practice
focuses on the individual patient and their entire drug regimen. Develops a strategy, including payment for services rendered to incorporate the philosophy of pharmaceutical care into everyday practice for a defined population.
Describe common barriers to providing MTM
Pharmacists providing MTM and getting paid: lack of sufficient compensation, lack of ability to obtain compensation, and lack of recognition as a provider. Pharmacists providing MTM without getting paid: compensation. Pharmacists wanting to provide MTM: lack of adequate staffing, lack of collaborative practice agreement
Outline a pharmacy intervention that would be reimbursable under MTM guidelines.
The pharmacist provides consultative services and intervenes to address medication-related problems; when necessary, the pharmacist refers the patient to a physician or other healthcare professional.
Define and describe the medical home model
strives to provide all of a patient’s health care services that are structured, delivered, and coordinated around the specific needs of each patient. Personal physician provides comprehensive services, personal physician leads team of clinicians who collectively take responsibility for their patients, care is coordinated across the health system, quality and safety are hallmarks of care, and patient have increased access to care.
Discuss how pharmacists and MTM can fit into the medical home model
MTM for the entire patient that includes a patient plan and improvement in outcomes.
Discuss the relationship between comprehensive medication management and the medical home
Each patient’s medications (ALL) are individually assess to determine that each medication is: appropriate for the patient, effective for the medical condition, safe for the patient, and able to be taken by the patient.
Describe the framework of the pharmacists’ patient care process
Developed by the Joint Commission of Pharmacy Practitioners (JCPP), Goal of high quality, cost-effective and accessible health care for patients, pharmacists are essential members of the health care team, embedded within helper and strand’s pharmaceutical care model, PPCP consensus developed to promote consistency.
Define prescription order
a written, verbal or electronic order from an authorized person for a prescription drug, prescription device, or pharmaceutical service.
Describe the legal requirements regarding medication counseling and drug use review
medication counseling should include: Name, description, and purpose of medication, route, dosage, administration, and continuity of therapy, special directions, common side effects, interactions or therapeutic contraindications, techniques to self monitor therapy, proper storage, refill information, and action to be taken in the event of a missed one. Drug use review: once patient information is obtained, it is reviewed and updated by the pharmacist to screen for potential drug-related problems.
List several common drug-related problems and an example of each
Needing pharmacotherapy but not receiving it: not being able to afford med, see a doctor, no insurance. Missed a diagnosis. Negative patient attitudes or beliefs toward medications. Taking or receiving wrong drug: Self-explanatory. Taking or receiving too little or too much of correct drug: self-explanatory. Experiencing adverse drug reactions: medication allergies and common drug-related side effects. Experiencing a drug-drug, drug-food, or drug-laboratory interaction: Warfarin and Bactrim, Diltiazem and grapefruit juice. Not taking or receiving the drug prescribed: High rates of medication non-adherence with chronic medications. Taking or receiving a drug for which there is NO indication: use of antibiotics in viral infections, effect of direct-to-consumer advertising, and self-treatment with alternative agents.
Describe the relationship between drug-related problems, pharmaceutical care, and medication therapy management
the most common ways for pharmacists to address drug-related problems are prospective drug use reviews, patient counseling, and MTM interventions.
Explain the drug use process
An all-encompassing concept from drug procurement to completion of the drug’s effect in the patient’s body.
Define collaborative practice agreement
Are used to create formal relationships between pharmacists and physicians or other providers that allow for expanded services the pharmacist can provide to patients and the healthcare team.
Why is documentation important in the pharmacy profession?
To provide a record, Improve communication (to improve patient care, Demonstrate value, Reduce liability
Define the problem-oriented approach to patient care.
System that organizes all patient data into a prioritized problem list.
Problems include definite diagnoses and other issues that are pertinent but may not yet be attached to a diagnosis. Should be: complete, organized, up-to-date and dynamic.
Who is the father of pharmacy?
Select one:
a. Donald Brodie
b. John Morgan
c. William Procter
d. Charles Strand
c. William Procter
The prefix pan- means
Select one:
a. many
b. all
c. again
d. middle
b. all
The suffix -malacia means
Select one:
a. resembling
b. softening
c. incision
d. condition
b. softening
Which suffix does NOT mean small?
Select one:
a. -icle
b. -ary
c. -ule
d. -ole
b. -ary
Which term means clot?
Select one:
a. Thrombo
b. melan
c. Vaso
d. oma
a. Thrombo
Mary received some paperwork after completing an MTM session with her local pharmacist. The paperwork contained suggestions for Mary to help her achieve her specific health goals. What document did Mary receive?
Select one:
a. Medication therapy review
b. Documentation and follow up
c. Personal medication record
d. Medication-related action plan
e. Intervention and/or referral
d. Medication-related action plan
Ann, a community pharmacist, systematically reviews the prescriptions and OTC products that Mrs. G uses to identify any potential issues and subsequent resolutions. Which part of the Core Elements has Ann completed?
Select one:
a. Medication-related action plan
b. Medication therapy review
c. Intervention and/or referral
d. Personal medication record
e. Documentation and follow up
b. Medication therapy review
Bob, a pharmacist at an independent pharmacy, calls Mr. R two weeks after completing his comprehensive med review (CMR), where he recommended that Mr. R start taking his cholesterol medication at night. He wants to see how Mr. R is doing with the recommendation. Which Core Element is described here?
Select one:
a. Personal medication record
b. Documentation and follow up
c. Medication therapy review
d. Intervention and/or referral
e. Medication-related action plan
d. Intervention and/or referral
