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collect
obtain and/or gather information
subjective
descriptive and generally cannot be confirmed by diagnostic tests or procedures
objective
physical examinations, and comparing to laboratory values from other diagnostic tests
assess
REQUIRES: CRITICAL THINKING,,,checks each medication for appropriateness, effectiveness, safety, and patient adherence
drug therapy problems
any undesirable event experienced by a patient that involves, or is suspected to involve, drug therapy and that interferes with achieving the desired goals of therapy and requires professional judgement to resolve
DTP- indication
unnecessary drug therapy, needs additional drug therapy
DTP- effectiveness
ineffective drug, dosage too low, needs additional monitoring
DTP-safety
dosage too high, adverse drug effect, drug interaction, needs additional monitoring
DTP- adherence
ease of administration, access, patient preference/beliefs
plan
addresses medication-related problems and optimizes medication therapy
implement
address medication and health-related problems and engages in preventive care strategies, including vaccine administration
initiates, modifies, discontinues, or administers medication therapy as authorized
monitor and evaluate
medication appropriateness, effectiveness, and safety and patient adherence through available health data, biometric test results, and patient feedback
S.O.A.P.
subjective, objective, assess, plan
what are the three skills of patient centered care?
collaboration, communication, document