Pharmaceutical care

Pharmaceutical Care given by Clinical Pharmaist (Based on the syllabus of 4th yr PHARMD Clinical Pharmacy).

1. PHARMACEUTICAL CARE PREPARED BY SMITHA SARAH THAMBI ASSISTANT PROFESSOR

2. WHAT IS PHARMACEUTICAL CARE? It is defined as the responsible provision of drug therapy for the purpose of achieving definite therapeutic outcomes that improve the patient’s quality of life. These outcomes are: Cure of the disease Elimination or reduction of patient’s symptomology Arresting or slowing of a disease process Preventing a disease or symptoms

3. Pharmaceutical care involves the process through which a pharmacist cooperates with a patient and other professionals in designing, implementing and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patients.

4. FOCUSED AREA OF PRACTICE The focused area of practice where in the pharmacist is engaged DRUG MONITORING DISEASE MONITORING DISEASE/ DRUG MANAGEMENT

5. MAJOR FUNCTIONS Identifying potential and actual drug related problems Resolving actual drug related problems Preventing potential drug related problems

6. CRITERIA The pharmacist should pass these five criterias to provide pharmaceutical care: Possess knowledge and skill in pharmaceutics and clinical pharmacology. Able to mobilize the drug distribution system by which drug use decisions are implemented. Able to develop relationship with patients and other healthcare professionals needed to provide pharmaceutical care. Available in the society/community for patients in time, Should have commitment to quality improvement and assessment procedure.

7. FUNCTIONS COLLECTION OF PATIENT DATA IDENTIFICATION OF PROBLEMS ESTABLISHING OUTCOME GOALS THROUGH A GOOD THERAPEUTIC PLAN EVALUATING TREATMENT ALTERNATIVES , BY MONITORING AND MODIFYING THERAPEUTIC PLAN INDIVIDUALISING DRUG REGIMENS MONITORING OUTCOMES

8. COLLECTION OF PATIENT DATA Patient Demographics: Age, race, sex Pertinent medical information Current and past medical history Family history Medication history Dietary history Social habits Physical findings Laboratory Findings Patient complaints: Signs and symptoms

9. IDENTIFICATION OF PROBLEMS It is drug related problems The goal is to identify actual or potential problem ACTUAL: A condition that requires the initiation of a new or additional drug. POTENTIAL: The patient may be at risk to develop a new medical problem. These problems may be related to the patient’s current drug therapy, drug administration, drug compliance, drug toxicity, ADR’s and a failure to achieve desired outcomes by the treatment. It is used to identify the PRIME pharmacotherapeutic problems.

10. PRIME P – Pharmaceutical based problems Patient not receiving a prescribed drug, device or intervention. R – Risks to patients Adverse drug reaction/drug allergy Potential for overlap of adverse effects I – Interactions Drug-drug , drug-disease, drug-lab interactions

11. PRIME ( contd ) M – Mismatch between medications and conditions or patients needs No indication for current drug, device or intervention Indication present but no drug, device or intervention prescribed E- Efficacy issues Too much of correct drug Too little of correct drug Wrong drug, device, intervention or regimen prescribed or more efficacious choice possible

12. ESTABLISHING OUTCOME GOALS Drug therapy can produce positive outcome: Cure of the disease Elimination or reduction of patient’s symptomology Arresting or slowing of a disease process Preventing a disease or symptoms It may also produce negative result, i.e. resulting in disease morbidity and sometimes mortality.

13. EVALUATING TREATMENT ALTERNATIVES BY MONITORING AND MODIFYING THERAPEUTIC PLAN Efficacy, safety, availability and cost of treatment and suitability of the treatment to the patient should be considered while evaluating. The risk-benefit ratio factors should also be considered: seriousness of the disease, complications if untreated, efficacy of drug, ADR’s.

14. INDIVIDUALISING DRUG REGIMENS When more than one therapeutic alternatives exist, the following factors to be considered: Patient factors:- diagnosis, treatment goals, past medical and medication history, contraindication, allergies, compliance, etc. Drug factors:- efficacy, adverse effects, dosage form, cost, drug-drug interactions, pharmacokinetic and pharmacodynamics, etc.

15. MONITORING OUTCOMES The goals of any therapeutic treatment are: Cure of the disease Elimination or reduction of patient’s symptoms Arresting or slowing of a disease process Preventing a disease or symptoms. Suboptimal outcomes include: I nappropriate prescribing Unnecessary drug regimen Dispensing error Non-compliance Patient idiosyncracy

16. To ensure good monitoring outcomes: Regularly reviews subjective and objective monitoring parameters and checks whether satisfactory progression is made or not according to the therapeutic plan. To determine whether original plan should continue or any treatment modifications has to be made or not. Reviews ongoing progress in achieving desire outcomes and provides report to the patient and other healthcare providers. Provides follow up with the patient Should regularly update patient’s medical/pharmacy records with information concerning patient’s progress.

17. DOCUMENTATION Documentation provides a record of care provided and history of the decisions made for a specific patient. Documentation of pharmaceutical care formulate a FARM note or SOAP note to describe and document the intervention intended or provided by the pharmacist.

18. FARM NOTE F – FINDINGS The patient-specific information. Findings include subjective and objective information of the patient A – ASSESSMENT Any additional information that is needed to bets assess the problem. The severity, priority or urgency of the problem .

19. FARM NOTE ( contd ) R – RESOLUTION (Including Prevention) The intervention plan includes actual or proposed actions by the pharmacist or recommendations to other health care professionals. The rationale for choosing specific intervention should be stated as: Counselling or educating the patient or care giver Making recommendations to patient or care giver Informing the prescriber Making recommendations to the prescriber

20. FARM NOTE ( contd ) M – MONITORING AND FOLLOW UP The parameter to be followed (e.g. Pain, depressed mood, serum potassium). The intent of monitoring (e.g. efficacy, toxicity, adverse event) How the parameters will be monitored (e.g. patient interview, physical examination) Frequency of monitoring (e.g. weekly, monthly) Duration of monitoring (e.g. until resolved, while on antibiotic, until resolved, monthly for 1 year)

21. SOAP NOTE S – SUBJECTIVE These are non-quantifiable data on how the patient feels and any subjective observation made by the pharmacist that cannot be confirmed by diagnostic procedure. O – OBJECTIVE These are facts that are verifiable which includes the measurements made by testing and other items such as medications and other notes provided by other healthcare professionals.

22. SOAP NOTE ( contd ) A – ASSESSMENT This section would include the pharmaceutical evaluation of the subjective and objective findings and the method by which the pharmacist derives the recommendations and form a plan. P – PLAN The plan is the action, intervention or recommendation made by the pharmacist. This would also include any follow up measures if necessary.

23. PHARMACIST’S ROLE IN PHARMACEUTICAL CARE PATIENT ASSESSMENT Physical assessment Barriers to adherence Psychological issues PATIENT EDUCATION AND COUNSELLING Interview skills Communication skills Ability to motivate, inspire Identification & resolution of compliance barriers

24. PHARMACIST’S ROLE IN PHARMACEUTICAL CARE ( contd ) PATIENT – SPECIFIC PHARMACIST CARE PLANS Recognition, prevention & management of drug interactions. Pharmacology & therapeutics. Interpretation of laboratory tests. Knowledge of community resources. Professional referrals. DRUG TREATMENT PROTOCOLS Develop & maintain protocols Follow protocols as a pharmacist clinician

25. PHARMACIST’S ROLE IN PHARMACEUTICAL CARE ( contd ) DOSAGE ADJUSTMENT Apply pharmacokinetic principles to determine patient specific dosing. SELECTION OF THERAPEUTIC ALTERNATIVES Use drug information resources effectively Construct comparative analysis to support therapeutic decisions

26. PHARMACEUTICAL CARE IN HOSPITALS Prescription monitoring Prescribing advice to medical and nursing staff Medication errors and adverse reaction monitoring Medication history interview Patient education and counselling Pharmacokinetics and therapeutic drug monitoring Hospital formulary

27. PHARMACEUTICAL CARE FOR THE COMMUNITY Participate in health screening Participate in health promotion and education Serve as a source of drug and poison information Collaborate with other health care professionals to develop treatment guidelines Design and monitor procurement and drug distribution system including storage and disposal.

28. BARRIERS TO PHARMACEUTICAL CARE Pharmacist barrier Practice setting constraints System impediments Intra professional barrier

29. PHARMACEUTICAL CARE PLAN ESTABLISH PHARMACIST-PATIENT RELATIONSHIP COLLECT DATA INTERPRET DATA IDENTIFY DRUG RELATED PROBLEMS DETERMINE PRIORITY OF DRUG RELATED PROBLEM

30. PHARMACEUTICAL CARE PLAN ( contd ) DETERMINE DESIRED OUTCOMES DEVELOP THERAPEUTIC PLAN DEVELOP MONITORING PLAN IMPLEMENT AND FOLLOW UP PHARMACEUTICAL CARE PLAN

31. THANK YOU