CONCEPTS OF PHARMACOTHERAPHY CARE PLANNING

Clinical Pharmacy

A practice in which the pharmacist utilizes his professional judgment in the application of pharmaceutical sciences to foster the safe and appropriate use of drugs, in or by patients, while working with members of the health care team (Francke 1969)

Clinical Pharmacy

An individual practice, where we make specific recomendation and assessment in an individual

Interact with the health care team

Interview and assess patients

Make therapeutic recommendations

Monitor patient response to drug therapy

Provide drug informatio

Role of Clinical Pharmacists

Knowledge and Skills

WHAT ARE REQUIRED IN CLINICAL PHARMACY?

diseases, drug therapy, non-drug therapy, laboratory and diagnostic testing

Knowledge required for CP

Communication, patient monitoring, physical assessment, drug information provision, therapeutic planning

Skills required to CP

Providing drug information to physicians & other health professionals

Medication history taking

Medication profile preparation

Drug therapy monitoring

Patient education and medication

Counseling

Disease screening, monitoring and maintenance care for patients with chronic diseases

Participation in the management of emergency medical care

Health Information Source For The Public

Drug Use Review And Patient Care Audits

In-service Education For Physicians, Nurses And Other Health Professionals

Specialized Functions And Services (Ashp 1983)

GENERAL CLINICAL PHARMACIST FUNCTIONS

Patient Counseling

provision of oral or written information about drugs & other health-related information to a patient or his / her representative during the dispensing process or stay in hospital

Generic name, trade name

Techniques for self-monitoring

Use, action & onset

Potential drug interaction

Route, dosage form & storage

Contraindications

Directions for use

Relationship with lab or X-ray procedure

Action in case of missed dose

Disposal of drugs & devices

Precautions

Any other relevant health information unique to an individual patient

Side & adverse effects

Scope of counseling

• Drug-drug interaction

• Drug-disease interaction

• Drug-laboratory test interation

Types of Drug interaction

Methyldopa

Cooms test (false positive to hemolytic anemia)

Pregnant patient taking ___ will cause false positive to?

Side effect: Not observe as a pharmacological effect and it doesn’t meant BAD

Adverse effect: Bad effect

DIfference between Side and adverse effect

Stop talking

Get rid of distractions

React to the ideas, NOT to the person

Read non-verbal messages

Listen to how something is said

Provide feedback to clarify any message

Attending and active listening skills (enumerate)

Reflecting

Paraphrasing

Focusing

Empathic Responding Skills (Enumerate)

Reflecting

concentrating on the emotional meaning

Paraphrasing

conveying the essence of what was said

Focusing

getting back to the topic of conversation

1. Ask open questions

2. Ask closed questions

3. Check if the patient has understood or requires more information

4. Avoid suggesting during datagathering phase

5. Provide a balance of questions

6. Do not jump into conclusion

7. Keep goals of the conversation in mind

8. Avoid shifting from one topic to another until one is finished

9. Maintain objectivity

Give an interviewing skills

1. Give relevant advice

2. Make good suggestions

3. Share correct information

4. Summarize main points of information given

5. Emphasize key points with “This is important…”

6. Supplement spoken word with written instruction

7. Give reasons for key advice

8. Check for accuracy of patient’s understanding

9. Give definite, concrete, explicit instruction

Influencing Skills (Enumerate)

1. Collect

2. Assess

3. Plan

4. Implement

5. Follow-up: monitor and evaluate

Patient care process

Facilitates the selection of appropriate drug and nondrug interventions for specific patient problems

Provides a framework for monitoring a patient’s response to the drug and nondrug interventions

It incorporates a well-thought-out alternative regimens

Why is therapeutic planning necessary?

1.) Problem identification

2.) Problem prioritization

3.) Selection of patient-specific drug and non-drug interventions

4.) Development of an integrated monitoring plan

The PLANNING Process

Triage

Prioritizing the most necessary illness that needs the most prioritization when ranking them

STEP 1: Obtain patient data

Step 2: Group related data

Step 3: Determine each problem

Step 4: Assess each Problem

Enumerate the steps in Problem Idetification

Step 1: Identify the active problems

Step 2: Identify the inactive problems

Step 3: Rank the problems

Enumerate the steps in Problem prioritization

Step 1—Determine short-term and long-term goals of therapy

Step 2—Create a list of options

Step 3—Eliminate options based on patient-specific and external factors

Step 4—Select appropriate drug and nondrug interventions

Step 5—Identify alternative interventions

Enumerate the steps in Selection of patient-specific drug and nondrug interventions

Patient-specific factor

External factors

Factors to consider when selecting a specific therapeutic regimen

Step 1—Determine specific monitoring parameters

Step 2—Integrate the monitoring plan

Step 3—Obtain data

Step 4—Assess the response to therapy

Enumerate the steps in Develop a monitoring plan

STEP 1: Obtain patient data (Problem Identification)

This includes the

• History of the patient

• Physical examination findings

• Results of laboratory and diagnostic tests

• Medication history

• Relevant data resources: data from the current patient chart and past chart, data obtained from patient interview or interviews with relatives or significant others

SUBJECTIVE DATA

these are describable but cannot be precisely measured or quantified.

OBJECTIVE DATA

data that can be precisely measure or quantified.

Objective data

The signs are what type of data?

Subjective data

The symptoms are what type of data?

Step 2: Group related data (Problem Identification)

Evaluate the list of objective and subjective data for possible relationships among the data.

Step 2: Group related data (Problem Identification)

This step requires comprehensive knowledge of the signs and symptoms of disease and pharmacotherapy

Step 3: Determine each problem (Problem Identification)

Evaluate each group of related subjective and objective data items to determine the specific patient problem or issue

Step 3: Determine each problem (Problem Identification)

The problem is not always a specific diagnosis but may be a preliminary identification of the issue pending acquisition of additional data (e.g., acute diarrhea, not shigellosis)

Acuity (acute or chronic)

Severity (mild, moderate, or severe)

Symptom level (symptomatic or asymptomatic)

Treatment status (treated or untreated)

Degree of control (controlled or uncontrolled)

Classification (staging of disease)

Step 4: Assess each Problem terms of eachof the following characteristics (Problem Identification)

Step 1: Identify the active problems (Problem prioritization)

Are problems that require some kind of drug or nondrug intervention to resolve or manage the problem

pneumonia, asthma, congestive heart failure, dyslipidemia, osteoporosis, diabetes mellitus

Examples of active problems

Step 2: Identify the inactive problems (Problem prioritization)

are problems that do not require any kind of drug or nondrug intervention and are of historical interest only

history of an appendectomy at age 12, a

history of pneumonia 2 years ago, and a history of smoking two packs of cigarettes

per day until quitting 10 years ago.

examples of inactive problems

Step 3: Rank the problems (Problem prioritization)

Rank-order the active patient problems. One approach is to identify the problem that needs the most immediate attention and then rank the remaining active problems in order of need for intervention.The number one problem is the problem that if left untreated will cause the most harm to the patient in the shortest amount of time.

Known problems and medications

• Social habits and cultural beliefs

• Willingness to commit to a course therapy

Example of Patient-specific factor

Insurance coverage

Cost of proposed therapy

State-of-the-art therapeutics

Example of External factors

Step 1: Determine short-term and long-term goals of therapy (Selection of patient-specific drug and nondrug interventions)

All drug and nondrug interventions should be in the context of the specific short-term and long-term goals of therapy, which may or may not be the same depending on the specific patient problem.

Step 2: Create a list of options (Selection of patient-specific drug and nondrug interventions)

Identify all classes of drugs and possible therapeutic approaches for each problem; do not eliminate any option at this stage of planning.

Step 2: Create a list of options (Selection of patient-specific drug and nondrug interventions)

As the member of the health care team with the most knowledge of pharmacotherapy, it is the pharmacist’s responsibility to identify all possible

Step 2: Create a list of options (Selection of patient-specific drug and nondrug interventions)

drug therapy options. This step becomes easier and more time efficient with practice and experience.

• comparative effectiveness of the drugs

• the suitability of the drug for the patient given the other patient medical conditions and drug therapies

• the ability of the patient to adhere to the proposed regimen

• other factors such as the effectiveness of previous treatment regimens and cost

(Selection of patient-specific drug and nondrug interventions):

Step 3: Eliminate options based on patient specific and external factors, Give the eliminate options

Step 4: Select appropriate drug and nondrug interventions (Selection of patient-specific drug and nondrug interventions)

Determine the best drug and nondrug regimen, including each specific drug to be used, dosage, route, duration of therapy, and rationale for the selection of each drug and nondrug component of the regimen.

Step 5: Identify alternative interventions (Selection of patient-specific drug and nondrug interventions)

An important part of the planning process is anticipation of potential patient problems with the prescribed and/or recommended drug and nondrug interventions.

Step 1—Determine specific monitoring parameters (Develop a monitoring plan)

Select specific target outcomes

Select monitoring intervals for each parameter