DOCUMENTATION OF PHARMACOTHERAPHY INTERVENTION

Documentation

required to record pertinent facts, findings, and observations about a patient’s health history, including past and present illnesses, examinations, tests, treatments, and outcomes.

To evaluate and plan the patient’s immediate treatment and monitor his/her health care over time;

Communication and continuity of care among providers involved in the patient’s care;

Accurate and timely claims review and payment;

Appropriate utilization review and quality of care evaluations;

Collection of data that may be useful for research and education; and

Appropriate coding for use on health insurance claim forms should be supported by documentation in the patient record.

Purpose of documenting

A complete and legible record;

Documentation for each encounter with a rationale for the encounter, physical findings, prior test results, assessment, clinical impression/ diagnosis and plan for care;

Identified health risk factors, and an easily inferred rationale for ordering diagnostic tests or ancillary services; and

The patient’s progress, response to and changes in treatment, and revision of the original diagnosis/assessment.

Components of documentation:

Responsible provision of drug therapy for the purpose of achieving definite outcomes that improves a patient’s quality of life

Meaning of Pharmaceutical care by Helper and Strand in 1990

A patient-centered practice in which the practitioner assumes responsibility for a patient’s drug-related needs and is held accountable for this commitment

Meaning of Pharmaceutical care by Cipolle in 1998

Identifying potential and actual drug-related problems

Resolving actual drug-related problems

Preventing potential drug-related problems

Major Functions of Pharmaceutical Care

1. Cure of disease

2. Elimination or reduction of symptoms

3. Arrest or slowing down of a disease process

4. Prevention of disease or symptoms

Expected Outcomes of Pharmaceutical Care

1. Assessment

2. Plan

3. Monitoring

PHARMACEUTICAL CARE PLAN

Assessment

a review of the medical conditions and symptoms to determine the need for drug therapy

Plan

a decision of an appropriate drug therapy based on the assessment of the patient

Monitoring

a review of the outcomes of drug therapy (goals and endpoints) to determine if the patient is obtaining the desired outcomes

Medication Therapy Management

A distinct service or group of services that optimize therapeutic outcomes for individual patients.

Medication Therapy Management

Patient centered assessment and evaluation of the patient’s full medication regimen and not only individual medications.

Medication Therapy Management

Performing or obtaining necessary assessments of the patient’s health status

Medication Therapy Management

Formulating a medication treatment plan

Medication Therapy Management

Selecting, initiating, modifying, or administering medication therapy

Medication Therapy Management

Monitoring and evaluating the patient’s response to therapy, including safety and effectiveness.

Medication Therapy Management

Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events.

Medication Therapy Management

Documenting the care delivered and communicating essential information to the patient’s other primary care providers.

Medication Therapy Management

Providing verbal education and training designed to enhance patient understanding and appropriate use of his/her medications.

Medication Therapy Management

Providing information, support services, and resources designed to enhance patient adherence with his/her therapeutic regimens.

Medication Therapy Management

Coordinating and integrating medication therapy management services within the broader healthcare management services being provided to the patient.

Optimize medication use

Improve collaboration

Enhance communication

Empower patients

Goals of MTM

Patients who is:

• Experienced transition of care

• With more than one prescriber

• Taking 5 or more medications

• At least one chronic disease or chronic health condition

• Laboratory values outside the normal range that could be cause or improved by a medication

• Demonstrated non-adherence

• Limited health literacy or cultural differences

• Wants or needs to reduce out of pocket medication cost

• Experience a loss of significant change in health plan or insurance coverage

• Experienced an adverse event

• Taking high risk medicataions

• Self-identifies and presents with perceived need for MTM services

Who May Benefit From MTM Services?

1. Pharmacists

2. Registered Nurses

3. Physicians

4. Non-physician providers

Who can provide MTM services?

Medication theraphy review

Personal medication record

Medication-related action plan

Documentation and Follow up

Core Elements of an MTM Service

Medication Therapy Review:

A systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them.

Personal Medication Record

A comprehensive record of the patient’s medications (prescription and non-prescription medications, herbal products, and other dietary supplements).

Medication-Related Action Plan

A patient-centric document containing a list of actions for the patient to use in tracking progress for self-management.

Documentation and Follow-up:

an essential element of the MTM service model.

Documentation and Follow-up:

The pharmacist documents services and intervention(s) performed in a manner appropriate for evaluating patient progress and sufficient for billing purposes.

Patient demographics

Basic information: address, phone, e-mail, gender, age, ethnicity, education status, patient’s special needs, health plan benefit/insurance coverage

Subjective observations

Pertinent patient-reported information: previous medical history, family history, social history, chief complaints, allergies, previous adverse drug reactions

Objective observations

Laboratory results, vital signs, diagnostic signs, physical exam results, review of systems

Assessment

Problem list, assessment of medication-related problems

Plan

The healthcare professional’s course of action for helping a patient achieve specific health goals

Education

Goal setting and instruction provided to the patient with verification of understanding

Collaboration

Communication with other healthcare professionals: recommendations, referrals, and correspondence with other professionals (cover letter, SOAP note)

PMR (Personal Medication Record)

A record of all medications, including prescription and nonprescription medications, herbal products, and other dietary supplements

MAP (Medication-related action plan)

Patient-centric document containing a list of actions to use in tracking progress for self-management

Follow-up

Transition plan or scheduling of next follow-up visit

Billing

Amount of time spent on patient care, level of complexity, amount charged

Prescriber refers patient to pharmacy for pharmacotheraphy → Pharmacist reviews medical chart → Pharmacist assess patient-specific information → Pharmacist determines best therapeutic options → Pharmacist provide written/oral communication

MTM Flowchart explain

SOAP

MTM documentation includes creating and maintaining an ongoing patient-specific record that contains____

Subjective

Objective

Assessment

Plan

SOAP what?

Subjective

Chief complaint; history of present illness; why the patient is being seen;

What SOAP is this?

Objective

Evaluation of the patient,laboratory and diagnostic tests

What SOAP is this?

Assessment

Analysis or conclusion about the patient’s current status/behavior, evidence of progress, response to intervention or medication, and change in functional status;

What SOAP is this?

Plan

Interventions or actions taken in response to assessment, collaboration with others, plan for the next session, change in diagnosis, and documentation that the patient was informed of changes in interventions or medications.

What SOAP is this?

FARM note

is an alternative approach to documenting drug-related problems and plan which is a pharmacist equivalent of a physician progress note in a systematized approach.

Physician progress note

FARM note is a pharmacist equivalent of?

FARM note

It actually includes provisions for identification and assessment of actual or potential medication related problems, description of a therapeutic plan and appropriate follow-up monitoring of problems.

Findings

Assessment

Resolution

Monitoring

Enumerate the meaning of FARM note

Findings

patient specific information

What FARM is this?

Assessment

evaluation of findings (e.g) severity duration

What FARM is this?

Resolution

rationale for the intervention should be mentioned

What FARM is this?

Monitoring

assess efficacy, safety and outcome of the intervention

What FARM is this?

Assessment

It contains pharmacist evaluation of the present situation.

What FARM is this?

Assessment

It should delineate the thought process that led to the conclusion on problem whether it did or did not exist and active intervention either was or was not necessary.

What FARM is this?

Assessment

The severity or urgency of the problem should be indicated by stating whether the interventions should be made immediately or within one day, one week or longer.

What FARM is this?

Assessment

Therapeutic endpoint or outcome stated may be short term goals or long term goals.

What FARM is this?

Resolution

It highlights the actions proposed to resolve drug related problem based upon preceding analysis.

What FARM is this?

Resolution

Common recommendations include non-pharmacologic therapy like dietary modifications or assisting devices.

What FARM is this?

Resolution

Rationale for selecting a particular therapy should be clearly depicted. Alternative therapy in case of emergency switching-off of drugs must be enlightened.

What FARM is this?

Resolution

Patient counseling provided must be elaborated.

What FARM is this?

Monitoring

A plan for follow-up monitoring of the patient must be documented and adequately implemented

What FARM is this?

questioning the patient

gathering laboratory data

performing ongoing physical assessments necessary to determine effect of the plan.

Monitoring should include?

P - Pharmaceutical based problems

R - Risks to the patient

I - Interactions

M - Mismatch between medication and condition or patient needs

E - Efficacy issues

Meaning of PRIME

Dose

Route

Duration

Form

Timing

Frequency

Pharmaceutical based problems

Assess for incorrect:

1. Known contraindications

2. Patient medication allergy

3. Drug induced problems

4. Improper utilization

5. Common serious adverse effects

6. Medication error considerations

Risks to the patient

Assess for the following:

1. drug-drug interactions

2. Drug-food interactions

3. Drug-disease interactions

4. Drug-laboratory interactions

Interactions

Assess for:

Mismatch between medication and condition or patient needs

Assess for:

1. Medications used without indication

Mismatch between medication and condition or patient needs

Assess for:

1. Condition or complaint untreated

Mismatch between medication and condition or patient needs

Assess for:

1. Actual barriers for the implementation of medication or behavior regimens

Efficacy issues

Assess for:

1. Suboptimal selection of pharmacotherapy for indication

Efficacy issues

Assess for:

1. Minimal or no evidence of therapeutic effectiveness

Efficacy issues

Assess for:

1. Suboptimal utilization of pharmacotherapy

Efficacy issues

Assess for:

1. Patient preference considerations (ex. Undesirable experiences with the medication)

Efficacy issues

Assess for:

1. Medication availability considerations

Efficacy issues

Assess for:

1. Compliance or administration considerations

C - Condition of the patient

O - Outcomes desired in the specific patient

R - Regimen selected

E - Evaluation parameters

CORE meaning