Transcript PHCLLect#1 intro to

PHCL 313
Pharmaceutical Care: Introduction
to Concepts & pharmacist role
Emtenan AlHarbi , MSc.
Clinical Pharmacy Department
College of Pharmacy
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Fall 2011
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Objectives
 At the end of this lecture students should be able to:
 Understand the need for pharmaceutical care
 Define pharmaceutical care and its philosophy
 Describe the requirements for pharmaceutical
care
 Understand the patient care process and
therapeutic relationship.
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Objectives
 Recognize patient drug related needs
 Be familiar with the main categories of drug related
problems
 Understand practice standards and ethical
considerations
From products to patients: Evolution of Pharmacy Practice
1850-1900
Late 1960’s-1980’s
1900-1960
1990- present
Pharmaceutical Care
“The responsible provision of drug therapy for the
purpose of achieving definite outcomes that improve a
patient’s quality of life”
Helper & Strand 1990
Pharmaceutical Care
These outcomes are:
Curing of a disease
Eliminating or reducing of a patient’s symptoms
Arresting or slowing of a disease process
Preventing a disease or symptoms
Philosophy of Pharmaceutical Care
Societal need for pharmacists to address drug-related problems
2. A patient-centered approach to meet this need
3. A practice based on “caring” about and for patients
4. A responsibility for finding and responding to the patient’s
drug therapy problems.
1.
Pharmacists work with and for the patient to
optimize the outcomes of medication therapy.
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The need for Pharmaceutical Care?
Patients seek multiple practitioners
Presence of overwhelming amount of drug information accessible by patients
Patients playing a more active role in the selection and use of medications
Increased complexity of drug therapy
Increased use of self-care
The high level of drug-related morbidity and mortality resulting in significant human
and financial costs.
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Patient-Centered Practice
 A cornerstone of the philosophy of pharmaceutical
care practice
 Care that places the patient's needs as the focus of
the clinician's work
 Care that maintains the patient as a "holistic" being
and does not fragment the patient into disease
groups, organ systems, or drug categories
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Meeting the health care needs of a patient
Patient
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Patients Drug Related Needs
The medication is appropriate
 Legitimate clinical indication for each medication.
 All of the patient's medical conditions that can benefit
from drug therapy have been identified.
1.
2. The medication is effective
 The most effective drug product is being used.
 The dosage of the medication is sufficient to achieve
the goals of therapy.
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Patients Drug Related Needs
3. The medication is safe
 There are no adverse drug reactions being
experienced.
 There are no signs of toxicity.
4. The patient is compliant
 The patient is willing and able to take the medications
as intended.
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Patients Drug Related Needs
5. Patients have all drug therapies
necessary to resolve any untreated
indications
Unmet patient needs lead to drug related
problems (DRPs)
 Appropriate indication for each medication
 Unnecessary drug therapy
 An effective drug product
 Inappropriate drug, low dose
 A safe drug product
 ADR or high dose
 Be able to use and comply with the drug regimen
 Inappropriate compliance the drug regimen
 Need drug therapy for untreated conditions
 Need additional drug therapy
Categories of drug therapy problems
 INDICATION
Unnecessary drug
therapy
2. Needs additional
drug therapy
1.
 EFFECTIVENESS
3. Ineffective drug
4. Dosage too low
 SAFETY
5. Adverse drug
reaction
6. Dosage too high
 CONVENIENCE of
Therapy
7. Noncompliance/
nonadherence
Requirements to be a
Pharmaceutical Care Practitioner
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Knowledge
of drug
therapy
Knowledge
of disease
Therapeuti
c planning
skills
Knowledge
of nondrug
therapy
Knowledge of
laboratory &
diagnostic
testing
Patient
Care
Drug
informatio
n skills
Communic
ation Skills
Physical
Assessment
skills
Patient
Monitorin
g skills
What are the requirements to be a
Pharmaceutical Care Practitioner?
1.
Develop a therapeutic relationship with each patient
2.
Understand one’s responsibilities
3.

identify and respond to any DRP for every patient.

Learn the patient care process
Use a systematic approach to make rational drug therapy
decisions “Pharmacotherapy Workup “
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What are the requirements to be a
Pharmaceutical Care Practitioner?
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4. Have an appropriate knowledge base and
clinical skills
5. Understanding of practice standards and ethical
considerations.
6. Documentation of all care provided
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Therapeutic Relationship
 The therapeutic relationship is a partnership or
alliance between the practitioner and the patient
formed for the purpose of optimizing the
patient's medication experience.
Why is therapeutic relationship is
important?
 Facilitate retrieval of information
 Patient as the Primary Source of Information
 positively influence the patient's decisions

Patient as Decision Maker
 learn from the patient the actual impact of the drug therapy
 Use patient as Teacher
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Pharmacotherapy Workup…
 The logical, structured and rational thought
process that guides work and decisions as the
clinician:
 assesses the patient's drug-related needs and
 identifies drug therapy problems
 organizes the interventions that need to be made
on the patient's behalf
 establishes appropriate parameters to evaluate at
follow-up
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Focus of Pharmacotherapy Workup…
 Is the patient's problem caused by drug
therapy?
 Can the patient's problem be treated with
drug therapy?
Patient Care Process
Initiate relationship with the patient or caregiver
Gather patient information(subjective and objective)
Assess information(patient assessment)
Develop patient care plan
Complete the intervention
Implement follow-up
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Patient Care Process
 describes the interaction between the
Continuous
patient and the practitioner
 Involves 3 steps:
• Assessment
• Care Plan Development
• Follow-Up Evaluation
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 Pharmacotherapy Workup
 is the cognitive work occurring in the mind of the
practitioner while caring for the patient.
 The mental part of pharmaceutical care
 Patient Care Process
 is what the patient experiences when he/she receives
pharmaceutical care.
 The physical work of pharmaceutical care
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Documentation
 critical and essential step
 “if you didn’t document it, you didn’t do it.”
 Systematic documentation styles, different format:
 SOAP (subjective, objective, assessment, plan),
 Places importance on intervention
 most common, universally recognized
 TITRS (title, introduction, text, recommendation, signature)
 an assessment approach
 FARM (findings, assessment, recommendations, management)
 places importance on monitoring.
information that is given by
the patient, family members,
significant others, or caregivers.
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Summarizes pharmacist
critical thinking and analysis
of the patient needs and DRP
Document actions that were
or need to be taken to resolve
any problems that have been
identified. Sufficient detail
needs to be included without
being too lengthy,. Include FU
and Monitoring
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Why Documentation is Important?
 Provides a permanent record of patient information
 Provides evidence of patient care activities by the pharmacist
 Communicates essential information to other pharmacists
and healthcare professionals
 Serves as a legal record of patient care that was provided
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Oath of Pharmacists
 I will consider the welfare of humanity and relief of human
suffering my primary concerns
King Saud University Pharmacy Code of Ethics/oath of pharmacist
Adopted by the membership of the American Pharmacists Association October 27, 1994.
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Beneficence
 Doing what is best for the patient
 Involves decisions related to medical
indications
 Base decision on risk-benefit assessment
 Negotiate with the patient the decision
 Example:
 A patient with asthma and diabetes needs a
course of steroids for worsening asthma, but
the steroids will make diabetes control more
difficult.
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Nonmaleficence
 Do no harm
 linked to the principle of beneficence
 Benefit: risk assessment
 Any risk >>> potential harm
 Example:
 Forcing a treatment on a patient, regardless of any
justification
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Veracity ‫الصدق‬
 Telling the truth about during all aspects of
patient care
 Basis of therapeutic relationship
 Pharmacists should demonstrate sensitivity and
thoughtful communication skills.
 Example:
 Withholding information about treatment
 Being vague, or mumble information
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Justice ‫العدل‬
 Relates to fair, equitable, and appropriate
treatment in the light of what is due or owed to
persons
 Example:
 Discrimination because of political status, religion,
gender, financial status..etc
 Deciding if a drug to be added/deleted from the
formulary
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Fidelity ‫االخالص‬
 relates "to the concept of faithfulness and
the practice of keeping promises”
 Example:
 upholding the profession's code of ethics
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Autonomy ‫الحكم الذاتي‬
 Autonomy:
 patient having the freedom to make
choices for him or herself
 conditions:
 Patient clearly informed about care plan
 Cognitively competent
Example:
 Surgery vs. pharmacotherapy
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Autonomy
 Paternalism
 overriding or ignoring preferences of
patients to benefit them or enhance their
welfare. It represents the judgment that
beneficence takes priority over autonomy
 Paternalism is not an option unless in certain
circumstances:
• patient is incompetent, child
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Confidentiality
 The act to protect patient medical and personal
information
 Example:
 disclose personal health-related information about
your patient with one of your friends or family
members who is not a health care provider and who is
not involved in the care of that patient.
 Designing a consultation room with opaque glass
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Caring for others is a privilege that is
reserved for those individuals who
are uniquely well prepared and who
adhere to standards for professional
behavior..
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Standards of Professional Performance
for Pharmaceutical Care Practitioners
 Pharmaceutical Care practitioner is
accountable to maintain his professional
practice through
 Self regulation
 Self evaluation
Standards of Professional Performance
for Pharmaceutical Care Practitioners
 Quality of care
 Ethics
 Collegiality
 Collaboration
 Education
 Research
 Resource Allocation
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Standard I: Quality of Care
 The practitioner evaluates his/her own practice in
relation to professional practice standards and
relevant statutes and regulations
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Standard II: Ethics
 The practitioner's decisions and actions on behalf
of patients are determined in an ethical manner
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Standard III: Collegiality
 The pharmaceutical care practitioner contributes
to the professional development of peers,
colleagues, and others.
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Standard IV: Collaboration
 The practitioner collaborates with the patient,
significant others, and health care providers in
providing patient care.
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Standard V: Education
 The practitioner acquires and maintains current
knowledge in pharmacology, pharmacotherapy,
and pharmaceutical care practice.
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Standard VI: Research
 The practitioner routinely uses research findings
in practice and contributes to research findings
when appropriate.
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Standard VII: Resource Allocation
 The practitioner considers factors related to
effectiveness, safety, and cost in planning and
delivering patient care.