PHARME and ASHP

Question 1

Organizing Patient Information

Why?

Answer 1

• Assists with the patient assessment
  - What are the drug-related problems?

Assists with making therapy recommendations
- What is the pharmacotherapeutic plan?

Structured approaches

Question 2

Various structured approaches

Answer 2

SOAP – widely used

-Physician –focus

PHARME
- Pharmacist-focus

ASHP
- Pharmacist-focus, designed for Clinical Skills Competition

Question 3

PHARME

Answer 3

P: Pharmacotherapy List
H: History of Present Drug Related Problems
A: Assessment
R: Recommendations
M: Monitoring
E: Education

Question 4

Pharmacotherapy List

Answer 4

Basic patient information
CC- If possible; or brief summary
Allergies
Current list of medications
- Dose
- Frequency
- Route
- When initiated
- Indication for each med

Question 5

History of Present
Drug Related Problems

Answer 5

Identify/describe new signs and symptoms- Include physical and laboratory findings
Compare to subjective & objective sections

• of SOAP note
• S = subjective
• O = objective
• A = assessment
• P = plan

Question 6

Assessment

Answer 6

• Define and prioritize drug related problems
  (DRPs)
  1. Unnecessary drug therapy
  2. Drug selection not optimal
  3. Clinically significant drug interaction
  4. Medication dosing regimen not optimal
  5. Adverse drug reaction
  6. Needs additional drug therapy
  7. Failure to receive drug therapy appropriately
  8. Needs additional follow-up

Question 7

Recommendations

Answer 7

Patient-specific recommendations for changes
in drug therapy

- Include specific medication, dose, frequency, route
 and duration (Consider patient characteristics such as renal function

• Include brief rationale for recommendations

Question 8

Monitoring

Answer 8

Monitoring parameters:

• For the recommended regimen
• How often?
• For how long?

Include therapeutic ranges
: For the recommended regimen
: What is the target range for THIS patient?

Question 9

References

Answer 9

If new or controversial meds in
recommendation

Question 10

Pharmacist’s Care Plan:
ASHP Method

Answer 10

Alternative to organize patient data

• More detailed
• Includes all patient problems

Used in ASHP Clinical Skills Competition
Used on 3rd year advanced rotations

Question 11

Pharmacist’s Care Plan:
ASHP Method 2

Answer 11

Document on data collection form: Pharmacist’s
Patient Data Base Form
- Demographics
- CC/HPI
- PMH
- FH
- Vaccination history
- Allergies
- Current drug therapy: Drug name, dose, route, schedule: Start and stop dates
- Medication history
- PE/Labs

Question 12

Pharmacist’s Care Plan:
ASHP Method

Answer 12

Pharmacist’s Care Plan
- Identify all drug related problems

• Develop effective care plan
  :- Treatment of all acute and chronic medical problems
  :- Identify any other health care services needed

Question 13

Pharmacist’s Care Plan:
ASHP Method 4

Pharmacist’s Care Plan: also include:

Answer 13

• Potential medical problems
• Disease prevention
• Disease screening activities
• Very detailed

Question 14

Pharmacist’s Care Plan:
ASHP Method 5

All problems must be categorized

Answer 14

• 3 categories
• Most urgent
• Other problems needing to be addressed during this
  clinical encounter
• Problems that can be addressed later

Only 1 “Most Urgent” problem

Question 15

Pharmacist’s Care Plan
- Advantage

Answer 15

Easy to see if medications are missing/pharmacotherapy is not optimized

• Each medication should correspond to at least one
  problem!! (If not, this is a problem!)