Pharmaceutical care

pharmaceutical care

• the pharmacist contribution in the care of individuals in order to optimise medicines and improve health outcomes

What does this mean

• work as part if MDT to empower patient through SDM to make the most of their medicines essential part of our job as pharmacist

PCP and EPA

• the concepts of pharmaceutical care planning align with the activites of the EPAs

Principle of pharmaceutical care

• the pharmacist will assess the pharmaceutical needs of patient and take responsibility for meeting those needs in collaboration with other health and social care professionals

• the assessment will identity any placemaceutical care issues with concordance and sets out to establish within the available info":

  • if the drug therapy and dose is appropriate for the condition in this patient

medicines optimisation

• medicines optimisation looks at how people use medicines and acknowledge that the way people use medicines over time may change. it may involve stopping some medicines as well as starting others and consider opportunities for lifestyle changes and non medical therapies to reduce the need for medicines

• ultimately, medicines optimisation can help encourage people to take ownership of their treatment

medicines reconciliation

• the process of identifying an accurate list of a patients current medications and comparing to the current list in use, recognising any changes

• should take place whenever patients are transferred from one care setting to another

• prevent medication errors

• provide a foundation for assessing the appropriateness of a patient current medicines and directing future treatment choices

• the process also allows the pharmaceutical issues such as poor adherence or non adherence to be identified

What do I need to consider

• patient characteristics

  • patient type

  • co- morbidities

  • patient allergies

• medication characteristics

  • indication

  • changes in regular treatment

  • duration

  • dose, frequency, strength

  • formulation

  • compatibility

• medication administration

  • route

  • need for aids

patient characteristics- co- morbidities

• renal impairement.

• hepatic impairment

• heart failure

• hypertension

  • respiratory disease

medication characteristic

• dose, frequency, strength

• duration

• compatibility

• monitoring

• formulation

• changes

• indication

medication review

• a critical examination of a persons medicines with the objective of reaching an agreement with the person about treatment, optimising the impact of medicines, minimising the number of medication related problems and reducing waste

conducting a medicines review- OSCE

• set the scene - who are you, confirm patient ID, that has brought about the review

• confirm exactly what patient is taking- name, dose, route, frequency

• check all meds are accounted for, POM, OTC, herbals

• check lifestyle

• specifically ask for any problems taking the medicines

• any counselling, information, problems, questions that the patient may have about their medicines

patient consultations

• all contact with a patient is a chance to improve the patients understanding of their health and medicines

• don’t forget power of verbal and non verbal communication

• this year and next year, will start to look at more advanced consideration, such as SDM, age appropriate consultation and psychology behind decision making

Documentation

• some places of work formally documents PCPs

• completing a formal PCP is helpful

essential information in a PCP

• drug specific information

  • what drugs are present on the drug chart

  • what is the therapeutic outcome of the drug

  • how do we know its achieving the desired outcomes

• problem identification and prioritisation

  • any actual or potential problems associated with the drug

  • any actual or potential problems associated with the PC

  • what action is needed and how urgently

• specifying the desired outcomes and monitoring these

  • what are you planning on doing and why

  • how will you know that your intervention has been successful

example of outcomes

• the solution to the problem should be influenced by guidelines, the patient best interest and your professional judgement

6 main medication related actions for us to follow

• initiate new medication

• increase dose

• decrease dose

• discontinue medication

• refer to another healthcare professional

• optimise medicines use for the patients conditions

what do we mean by monitoring

• context of PCP, monitoring can mean

  • checking on therapeutic drug level of narrow TI drugs

  • checking laboratory parameters, e.g blood results

  • checking patient parameters

  • ensuring that clinical conditions is improving

  • monitoring the frequency that a PRN drug is requested as a surrogate marker of a condition