Pharmacist's Guide to Drug Therapy Problems and Patient Care Process

Drug Therapy Problem (DTP)

An undesirable event involving drug therapy that interferes with achieving desired health outcomes.

Four categories of DTPs

1. Indication (unnecessary drug, needs additional drug) 2. Effectiveness (ineffective drug, dose too low) 3. Safety (adverse reaction, dose too high) 4. Adherence (not taking correctly)

Drug-Related Morbidity (DRM)

When a DTP leads to morbidity (e.g., hospitalization, ER visit, permanent injury, death).

Preventable DRM (PDRM)

A DRM that could have been avoided if proper care was given.

Hepler & Segal's four preventability criteria

1. Foreseeable 2. Identifiable 3. Preventive action available 4. Patient would accept intervention

Case of Katherine LaStima

Chain of causality leading to preventable death from asthma due to poor monitoring and communication.

Patient-centered care

Care that is respectful, responsive, and aligned with patient's needs, values, and preferences.

Elements of professional practice

1. Philosophy of practice (commitment to patient needs) 2. Practice management system (tools, workflow, policies) 3. Pharmacist's Patient Care Process (PPCP)

Five steps of the PPCP

1. Collect 2. Assess 3. Plan 4. Implement 5. Follow-up: Monitor & Evaluate

Goal of the 'Collect' step

Gather subjective (patient-reported) and objective (labs, vitals) data to create the full patient story.

Goal of the 'Assess' step

Identify and prioritize DTPs (indication, effectiveness, safety, adherence).

Goal of the 'Plan' step

Develop individualized care plan with goals of therapy, interventions, monitoring, follow-up.

What happens in the 'Implement' step?

Carry out the plan: start/change meds, counsel, collaborate, arrange follow-up.

What happens in 'Follow-up: Monitor & Evaluate'?

Track progress, safety, effectiveness, adherence, and adjust therapy as needed.

Why do pharmacists document?

To communicate with providers, provide legal record, enable reimbursement, and support quality improvement.

Subjective information

Patient-reported data such as symptoms, history, lifestyle, adherence barriers.

Objective information

Measurable/verifiable data: vitals, labs, med list, physical exam results.

Assessment

Pharmacist's evaluation for each condition: medication-related needs, DTPs, prioritization.

Plan

Recommendations: therapy changes, monitoring, education, follow-up for each condition.

Best practices in documentation

Clear, concise, complete, organized by problem, and shows evidence-based reasoning.