Pharmaceutical Care -Definition and Principles (1).ppt

Pharmaceutical care

1. Pharmaceutical Care

2. Introduction
•The term Pharmaceutical Care was first used by Mikeal et. al. in 1975.
•Information and advice is given to encourage safe and effective use of
medication.
•The principles of pharmaceutical Care are embedded in concept of good
pharmacy practice.
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3. Introduction
Definition:
•“Pharmaceutical care is the care of a patient by pharmacist, which is required to assure
safe rational drug use.”
Or
•Pharmaceuticalcareistheresponsibleprovisionofdrugtherapyforthepurposeof
achievingdefiniteoutcomesthatimproveapatient'squalityoflife.
•These outcomes are
–(1) Cure of a disease
–(2) Elimination or reduction of a patient's symptoms.
–(3) Arresting or slowing of a disease process……..
–(4) Preventing a disease or symptomatology.
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4. Introduction
•The community pharmacist are engaging in pharmaceutical care activities as:
1.Patient education programs
2.Immunization
3.Health screening
4.Nutrition services
5.AIDS specialty services.
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5. The scope of pharmaceutical care
•The three important key phrases are:
1.The responsible provision of drug therapy
2.Definite (Patient) Outcomes:
3.Quality of life:
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6. Introduction
•Pharmaceuticalcareinvolvestheprocessthroughwhichapharmacistcooperateswith
apatientandotherprofessionalsindesigning,implementing,andmonitoringa
therapeuticplanthatwillproducespecifictherapeuticoutcomesforthepatient.
•Thisinturninvolvesthreemajorfunctions:
(1)identifyingpotentialandactualdrugrelatedproblems,
(2)resolvingactualdrug-relatedproblems,and
(3)preventingpotentialdrug-relatedproblems.
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7. •Pharmaceuticalcareisanecessaryelementofhealthcare,andshouldbeintegratedwith
otherelements.
•Pharmaceuticalcareis,however,providedforthedirectbenefitofthepatient,andthe
pharmacistisresponsibledirectlytothepatientforthequalityofthatcare.
•Thefundamentalrelationshipinpharmaceuticalcareisamutuallybeneficialexchangein
whichthepatientgrantsauthoritytotheproviderandtheprovidergivescompetenceand
commitment(acceptsresponsibility)tothepatient.
•Thefundamentalgoals,processes,andrelationshipsofpharmaceuticalcareexist
regardlessofpracticesetting.
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Introduction

8. Principles of Practice for Pharmaceutical Care
•PharmaceuticalCareisapatient-centered,outcomesorientedpharmacypracticethat
requiresthepharmacisttoworkinconcertwiththepatientandthepatient'sother
healthcareproviderstopromotehealth,topreventdisease,andtoassess,monitor,
initiate,andmodifymedicationusetoassurethatdrugtherapyregimensaresafeand
effective.
•ThegoalofPharmaceuticalCareistooptimizethepatient'shealth-relatedqualityof
life,andachievepositiveclinicaloutcomes,withinrealisticeconomicexpenditures.
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9. How to achieve this goal?
A.Aprofessionalrelationshipmustbeestablishedandmaintained.
B.Patient-specificmedicalinformationmustbecollected,organized,recorded,and
maintained.
C.Patient-specificmedicalinformationmustbeevaluatedandadrugtherapyplan
developedmutuallywiththepatient.
D.Thepharmacistassuresthatthepatienthasallsupplies,informationandknowledge
necessarytocarryoutthedrugtherapyplan.
E.Thepharmacistreviews,monitors,andmodifiesthetherapeuticplanasnecessaryand
appropriate,inconcertwiththepatientandhealthcareteam.
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10. Develop Professional Relationship?
A. A professional relationship must be established and maintained.
•Interactionbetweenthepharmacistandthepatientmustoccurtoassurethatarelationship
baseduponcaring,trust,opencommunication,cooperation,andmutualdecisionmakingis
establishedandmaintained.
•Inthisrelationship,thepharmacistholdsthepatient'swelfareparamount,maintainsan
appropriateattitudeofcaringforthepatient'swelfare,andusesallhis/herprofessional
knowledgeandskillsonthepatient'sbehalf.
•Inexchange,thepatientagreestosupplypersonalinformationandpreferences,and
participateinthetherapeuticplan.
•Thepharmacistdevelopsmechanismstoassurethepatienthasaccesstopharmaceutical
careatalltimes. 10

11. Collect patient specific medical information?
B.Patient-specificmedicalinformationmustbecollected,organized,recorded,and
maintained.
•Pharmacistsmustcollectand/orgeneratesubjectiveandobjectiveinformationregardingthepatient'sgeneral
healthandactivitystatus,pastmedicalhistory,medicationhistory,socialhistory,dietandexercisehistory,
historyofpresentillness,andeconomicsituation(financialandinsuredstatus).
•Sourcesofinformationmayinclude,butarenotlimitedto,thepatient,medicalchartsandreports,pharmacist-
conductedhealth/physicalassessment,thepatient'sfamilyorcaregiver,insurer,andotherhealthcareproviders
includingphysicians,nurses,mid-levelpractitionersandotherpharmacists.
•Sincethisinformationwillformthebasisfordecisionsregardingthedevelopmentandsubsequent
modificationofthedrugtherapyplan,itmustbetimely,accurate,andcomplete,anditmustbeorganizedand
recordedtoassurethatitisreadilyretrievableandupdatedasnecessaryandappropriate.
•Patientinformationmustbemaintainedinaconfidentialmanner.
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12. Evaluatepatient specific medical information?
C.Patient-specificmedicalinformationmustbeevaluatedandadrugtherapyplan
developedmutuallywiththepatient.
•Baseduponathoroughunderstandingofthepatientandhis/herconditionordiseaseanditstreatment,
thepharmacistmust,withthepatientandwiththepatient'sotherhealthcareprovidersasnecessary,
developanoutcomes-orienteddrugtherapyplan.
•Theplanmayhavevariouscomponentswhichaddresseachofthepatient'sdiseasesorconditions.
•Indesigningtheplan,thepharmacistmustcarefullyconsiderthepsycho-socialaspectsofthedisease
aswellasthepotentialrelationshipbetweenthecostand/orcomplexityoftherapyandpatient
adherence.
•Asoneofthepatient'sadvocates,thepharmacistassuresthecoordinationofdrugtherapywiththe
patient'sotherhealthcareprovidersandthepatient.
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13. •Inaddition,thepatientmustbeappraisedof
(1)variousprosandcons(i.e.,cost,sideeffects,differentmonitoringaspects,etc.)ofthe
optionsrelativetodrugtherapyand
(2)instanceswhereoneoptionmaybemorebeneficialbasedonthepharmacist's
professionaljudgment.
•Theessentialelementsoftheplan,includingthepatient'sresponsibilities,mustbe
carefullyandcompletelyexplainedtothepatient.
•Informationshouldbeprovidedtothepatientatalevelthepatientwillunderstand.
•Thedrugtherapyplanmustbedocumentedinthepatient'spharmacyrecordand
communicatedtothepatient'sotherhealthcareprovidersasnecessary.
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14. Pharmacist assurance?
D.Thepharmacistassuresthatthepatienthasallsupplies,informationandknowledge
necessarytocarryoutthedrugtherapyplan.
•ThepharmacistprovidingPharmaceuticalCaremustassumeultimateresponsibilityfor
assuringthathis/herpatienthasbeenabletoobtain,andisappropriatelyusing,anydrugs
andrelatedproductsorequipmentcalledforinthedrugtherapyplan.Thepharmacistmust
alsoassurethatthepatienthasathoroughunderstandingofthediseaseandthe
therapy/medicationsprescribedintheplan.
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15. Pharmacist Review?
E.The pharmacist reviews, monitors, and modifies the therapeutic plan as necessary
and appropriate, in concert with the patient and healthcare team.
•Thepharmacistisresponsibleformonitoringthepatient'sprogressinachievingthe
specificoutcomesaccordingtostrategydevelopedinthedrugtherapyplan.
•Thepharmacistcoordinateschangesintheplanwiththepatientandthepatient'sother
healthcareprovidersasnecessaryandappropriateinordertomaintainorenhancethe
safetyand/oreffectivenessofdrugtherapyandtohelpminimizeoverallhealthcarecosts.
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16. •Patientprogressisaccuratelydocumentedinthepharmacyrecordandcommunicated
tothepatientandtothepatient'sotherhealthcareprovidersasappropriate.
•Thepharmacistsharesinformationwithotherhealthcareprovidersasthesettingfor
carechangesthushelpingassurecontinuityofcareasthepatientmovesbetweenthe
communitysetting,theinstitutionalsetting,andthelong-termcaresetting.
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17. FUNCTION
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18. Practice Principles
•Pharmaceuticalcareishoweverprovidedforthedirectbenefitofthepatient,andthe
pharmacistisresponsibledirectlytothepatientforthequalityofthatcare.
•Thefundamentalrelationshipinpharmaceuticalcareisamutuallybeneficialexchange
inwhichthepatientsgrants(entrust)theauthoritytotheprovideri.e.Pharmacist;and
theprovider(Pharmacist)givescompetenceandcommitment(responsibility)tothe
patients.
•BeforeapharmacistacceptthisresponsibilitytoprovidepharmaceuticalcareHe/She
mustpassthroughthefollowingcriteria
•1)Mustpossesknowledgeandskillsinpharmaceuticalcaresuchasclinical
pharmacology…
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19. •2) Must be able to develop relationships with the patients and other health acre professionals
needed to provide pharmaceutical care.
•3) Must be available in society/community for patients in time
•4) Should have commitment to quality improvement and assessment procedure.
•5) Must be able to handle the prescription and medication
In addition to the above qualities of a pharmacist, the following institutional setup has to be in
place:
a)System of data collection, Documentation, and Transfer of information
b)Reference, resources and equipment.
c)Efficient workflow processes
Once the above parameters are in proper place, the pharmacist Who is the central figure for
pharmaceutical care. And then a pharmacist has the following function to perform
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20. Functions
1.Collection of patient data
2.Identification of problems
3.Establishing outcome goals through a good therapeutic plan
4.Evaluating treatment alternatives, by monitoring and modifying therapeutic plan
5.Individualizing drug regimens
6.Monitoring outcomes.
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21. Functions / Practice Principles
1.Data Collection
2.Information Evaluation
3.Formulating a Plan
4.Implementing the Plan
5.Monitoring and Modifying the Plan/Assuring Positive Outcomes
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22. Practice Principles
1.DataCollection
•1.1Thepharmacistconductsaninitialinterviewwiththepatientforthepurposesof
establishingaprofessionalworkingrelationshipandinitiatingthepatient'spharmacy
record.
•Insomesituations(e.g.pediatrics,geriatrics,criticalcare,languagebarriers)the
opportunitytodevelopaprofessionalrelationshipwithandcollectinformationdirectly
fromthepatientmaynotexist.
•Underthesecircumstances,thepharmacistshouldworkdirectlywiththepatient'sparent,
guardian,and/orprincipalcaregiver.
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23. •1.2Theinterviewisorganized,professional,andmeetsthepatient'sneedfor
confidentialityandprivacy.
•Adequatetimeisdevotedtoassurethatquestionsandanswerscanbefullydeveloped
withouteitherpartyfeelinguncomfortableorhurried.
•Theinterviewisusedtosystematicallycollectpatient-specificsubjectiveinformationand
toinitiateapharmacyrecordwhichincludesinformationanddataregardingthepatient's
generalhealthandactivitystatus,pastmedicalhistory,medicationhistory,socialhistory
(includingeconomicsituation),familyhistory,andhistoryofpresentillness.
•Therecordshouldalsoincludeinformationregardingthepatient'sthoughtsorfeelingsand
perceptionsofhis/herconditionordisease.
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24. •1.3Thepharmacistuseshealth/physicalassessmenttechniques(blood-pressuremonitoring,etc.)
appropriatelyandasnecessarytoacquirenecessarypatient-specificobjectiveinformation.
•1.4Thepharmacistusesappropriatesecondarysourcestosupplementtheinformationobtained
throughtheinitialpatientinterviewandhealth/physicalassessment.
•Sourcesmayinclude,butarenotlimitedto,thepatient'smedicalrecordormedicalreports,the
patient'sfamily,andthepatient'sotherhealthcareproviders.
•1.5Thepharmacistcreatesapharmacyrecordforthepatientandaccuratelyrecordsthe
informationcollected.Thepharmacistassuresthatthepatient'srecordisappropriatelyorganized,
keptcurrent,andaccuratelyreflectsallpharmacist-patientencounters.
•Theconfidentialityoftheinformationintherecordiscarefullyguardedandappropriatesystems
areinplacetoassuresecurity.
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25. Practice Principles
2. Information Evaluation
•2.1 The pharmacist evaluates the subjective and objective information collected from the patient and other
sources then forms conclusions regarding:
(1)opportunities to improve and/or assure the safety, effectiveness, and/or economy of current or planned drug
therapy;
(2) opportunities to minimize current or potential future drug or health-related problems; and
(3) the timing of any necessary future pharmacist consultation.
•2.2 The pharmacist records the conclusions of the evaluation in the medical and/or pharmacy record.
•2.3Thepharmacistdiscussestheconclusionswiththepatient,asnecessaryandappropriate,andassuresan
appropriateunderstandingofthenatureoftheconditionorillnessandwhatmightbeexpectedwithrespect
toitsmanagement.
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26. PracticePrinciples
3. Formulating a Plan
•3.1 The pharmacist, in concert with other healthcare providers, identifies, evaluates and then
chooses the most appropriate action(s) to: (1) improve and/or assure the safety, effectiveness, and/or
cost-effectiveness of current or planned drug therapy; and/or,
(2) minimize current or potential future health-related problems.
•3.2Thepharmacistformulatesplanstoeffectthedesiredoutcome.
•Theplansmayinclude,butarenotlimitedto,workwiththepatientaswellaswithotherhealth
providerstodevelopapatient-specificdrugtherapyprotocolortomodifyprescribeddrugtherapy,
developand/orimplementdrugtherapymonitoringmechanisms,recommendnutritionalordietary
modifications,addnon-prescriptionmedicationsornon-drugtreatments,referthepatienttoan
appropriatesourceofcare,orinstituteanexistingdrugtherapyprotocol.
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27. •3.3Foreachproblemidentified,thepharmacistactivelyconsidersthepatient'sneedsand
determinesthedesirableandmutuallyagreeduponoutcomeandincorporatestheseintothe
plan.
•Theplanmayincludespecificdiseasestateanddrugtherapyendpointsandmonitoring
endpoints.
•3.4Thepharmacistreviewstheplananddesirableoutcomeswiththepatientandwiththe
patient'sotherhealthcareprovider(s)asappropriate.
•3.5Thepharmacistdocumentstheplananddesirableoutcomesinthepatient'smedicaland/or
pharmacyrecord.
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28. Practice Principles
4. Implementing the Plan
•4.1Thepharmacistandthepatienttakethestepsnecessarytoimplementtheplan.
•Thesestepsmayinclude,butarenotlimitedto,
–contactingotherhealthproviderstoclarifyormodifyprescriptions,
–initiatingdrugtherapy,
–educatingthepatientand/orcaregiver(s),
–coordinatingtheacquisitionofmedicationsand/orrelatedsupplies,whichmightinclude
helpingthepatientovercomefinancialbarriersorlifestylebarriersthatmightotherwise
interferewiththetherapyplan,or
–coordinatingappointmentswithotherhealthcareproviderstowhomthepatientisbeing
referred. 28

29. •4.2Thepharmacistworkswiththepatienttomaximizepatientunderstandingandinvolvementin
thetherapyplan,assuresthatarrangementsfordrugtherapymonitoring(e.g.laboratoryevaluation,
bloodpressuremonitoring,homebloodglucosetesting,etc.)aremadeandunderstoodbythe
patient,andthatthepatientreceivesandknowshowtoproperlyuseallnecessarymedicationsand
relatedequipment.
•Explanationsaretailoredtothepatient'slevelofcomprehensionandteachingandadherenceaids
areemployedasindicated.
•4.3Thepharmacistassuresthatappropriatemechanismsareinplacetoensurethattheproper
medications,equipment,andsuppliesarereceivedbythepatientinatimelyfashion.
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30. •4.4Thepharmacistdocumentsinthemedicaland/orpharmacyrecordthestepstakento
implementtheplanincludingtheappropriatebaselinemonitoringparameters,andany
barrierswhichwillneedtobeovercome.
•4.5Thepharmacistcommunicatestheelementsoftheplantothepatientand/orthepatient's
otherhealthcareprovider(s).Thepharmacistsharesinformationwithotherhealthcare
providersasthesettingforcarechanges,inordertohelpmaintaincontinuityofcareasthe
patientmovesbetweentheambulatory,inpatientorlong-termcareenvironment.
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31. Practice Principles
5. Monitoring and Modifying the Plan/Assuring Positive Outcomes
•5.1Thepharmacistregularlyreviewssubjectiveandobjectivemonitoringparametersinorderto
determineifsatisfactoryprogressisbeingmadetowardachievingdesiredoutcomesasoutlinedin
thedrugtherapyplan.
•5.2Thepharmacistandpatientdetermineiftheoriginalplanshouldcontinuetobefollowedorif
modificationsareneeded.Ifchangesarenecessary,thepharmacistworkswiththepatient/caregiver
andhis/herotherhealthcareproviderstomodifyandimplementtherevisedplanasdescribedin
"FormulatingthePlan"and"ImplementingthePlans"above.
•5.3Thepharmacistreviewsongoingprogressinachievingdesiredoutcomeswiththepatientand
providesareporttothepatient'sotherhealthcareprovidersasappropriate.Asprogresstowards
outcomesisachieved,thepharmacistshouldprovidepositivereinforcement.
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32. •5.4Amechanismisestablishedforfollow-upwithpatients.
•Thepharmacistusesappropriateprofessionaljudgmentindeterminingtheneedtonotifythe
patient'sotherhealthcareprovidersofthepatient'slevelofadherencewiththeplan.
•5.5Thepharmacistupdatesthepatient'smedicaland/orpharmacyrecordwithinformation
concerningpatientprogress,notingthesubjectiveandobjectiveinformationwhichhasbeen
considered,his/herassessmentofthepatient'scurrentprogress,thepatient'sassessmentof
his/hercurrentprogress,andanymodificationsthatarebeingmadetotheplan.
Communicationswithotherhealthcareprovidersshouldalsobenoted.
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33. SOAP
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34. Thank You
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