Transcript Power point presentation - NHS Education for Scotland

Pharmacy
Pharmaceutical Care Planning
Vocational Training Scheme:
Level = Stage 2
Arlene Shaw
Specialist Clinical Pharmacist, NHS Tayside
Quality Education for a Healthier Scotland
Aim and Objectives
Pharmacy
AIM
To provide pharmacists with an overview of how to complete
pharmaceutical care plan as part of the Pharmacy Vocational
Training Scheme
OBJECTIVES
 to identify the key issues associated with a specific
pharmaceutical care plan
 to describe the care issues, actions and outputs associated with
a specific pharmaceutical care plan
 to record investigations as part of a pharmaceutical care plan
Quality Education for a Healthier Scotland
Introduction
Pharmacy
PHARMACY VOCATIONAL TRAINING SCHEME
 Competency based training scheme that enables pharmacists to
demonstrate competence through learning from experience in
the workplace.
PHARMACY VOCATIONAL TRAINING SCHEME
 Competency based training scheme that enables pharmacists to
demonstrate competence through learning from experience in
the workplace
Quality Education for a Healthier Scotland
Evidence
Pharmacy
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Essential to demonstrate your personal involvement
Include a variety of clinical areas
Must reflect on each piece of evidence
No patient identifiable information
 Use Care Plan on NES Pharmacy Website
 Require 12 care plans, 4 of which should be
accompanied by a more detailed case study.
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Cover Page
Pharmacy
Short summary (-200 words)
 Describe case
 Reasons for choosing case
Reflection
 Learning from developing the care plan
 Feedback from tutor
 Implications for future practice
Sign Off
 From the appropriate clinical specialist
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Care Plan Page 1
Pharmacy
Patient Details
Patient Stay
 What brought the patient into hospital?
 Symptom / signs not diagnosis
Medical History / Drug History
 Try and match these sections up
Non-Drug Treatment
 E.g. physiotherapy, speech and language therapy etc
Continuity of Care
 Discharge details
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Care Plan Page 2
Pharmacy
Factors affecting –
 Individual factors relevant to pharmacy practice
 Inform pharmaceutical issues
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Absorption e.g. co-prescription of antacids
Distribution e.g. plasma protein binding
Metabolism e.g. age
Excretion e.g. renal failure
Ability to self medicate e.g. confusion
Route of Admin e.g. target site of action
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Care Plan Page 2 cont.
Pharmacy
Clinical management
 Pharmaceutical need – requirement for pharmaceutical care
 Outcomes to consider:
 cure
 elimination or reduction in symptoms
 arresting or slowing disease progression
 prevention of disease / symptoms

 e.g. CAP – ensure appropriate antibiotics prescribed to
correctly treat infection, minimise risk of adverse drug
reactions
 e.g. hypertension – maintain blood pressure control in
order to reduce risk of future cardiovascular complications
 Include acute and chronic disease
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Care Plan Page 2 cont.
Pharmacy
Current Medication
 List everything the patient was taking on admission
 Record allergies or NKA
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Care Plan Page 3
Pharmacy
Pharmaceutical Care Plan
CARE ISSUE
• “An element of a pharmaceutical need which requires to be
addressed by a pharmacist”.
• What is the problem? Something which prompts a pharmacist to
“do” something.
 Take into account patient and medication risk
factors
 Consider each problem in turn
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Care Plan Page 3 cont.
Pharmacy
 Categories to consider:
 Untreated indication
 Improper dug selection
 Sub-therapeutic dose
 Failure to receive medication
 Overdosage
 Adverse drug reactions
 Drug interactions
 Medication use without indication
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Care Plan Page 3 cont.
Pharmacy
DESIRED OUTPUT
 Statement of what a pharmacist aims to achieve for a patient in
relation to a care issue
 What do you want to achieve as a pharmacist?
 SMART
 Specific
 Measurable
 Achievable
 Realistic
 Time-bound
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Care Plan Page 3 cont.
Pharmacy
ACTION
 An action a pharmacist takes to address a care issue for a
patient
 What did you as a pharmacist do?
 Relate to evidence base / demonstrate knowledge of EBM
 Ideas to consider
 Recommending therapy
 Monitoring
 Patient counselling
 Confirm medication for discharge
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Care Plan Page 3 cont.
Pharmacy
OUTPUT
 Response of the health team and /or patient to the pharmacists actions,
and/or the clinical outcome for the patient

What did you achieve as a result of your action?
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Should be a direct result of your input.
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Compare with desired output to evaluate
effectiveness of the action taken.
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Care Plan Page 3 cont.
Pharmacy
Problem:
- Patient admitted is found to be
hyperkalaemic and is on an ACE inhibitor
which may be contributing to this condition.
Care issue:
- As above
Desired output:
- Avoid medicines which may contribute to
hyperkalaemia
- Potassium within reference range
- ? Appropriate treatment of hyperkalaemia
as per local guidelines
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Care Plan Page 3 cont.
Pharmacy
Action:
- Review all medicines for potential
ADR
- Discuss potential ADR with the medical
team and suggest witholding / stopping
potential contributing agents
- Monitor Potassium
- ? Check local guielines to ensure
appropriate treatment of hyperkalaemia
Output
- ACEi witheld ?others
- Potassium within reference range
- ? Appropriate treatment
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Care Plan Page 4
Pharmacy
Review Dates
Investigations
 Relate to care issues
 TDM
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Final Points....
 Complete all sections of care plan
 Choose simple cases
 Remember training is progressive!
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Pharmacy
Questions
Pharmacy
Any questions?
Email: [email protected]
Quality Education for a Healthier Scotland