Lecture one: Patient Assessment in Pharmacy Practice

Patient Care in Pharmacy Practice

Anas Bahnassi PhD

Anas Bahnassi PhD CDM CDE 2

Patient-Centered Care

Care centered on patients’ needs and expectations

3Anas Bahnassi PhD CDM CDE

Goals of Pharmaceutical Care

Cure of a disease

Elimination or reduction of a patient’s symptoms

Arresting or slowing of a disease process

Preventing a disease or symptomatology


The central component of Pharmaceutical Care is: CARING ABOUT THE PATIENT.


Pharmaceutical Care Process

Initiate relationship with

the patient or caregiver

Gather patient information

(subjective and objective) Assess info

(patient assessment)

Develop pharmaceutical

care plan

Complete InterventionImplement

follow-up


Primary Elements of Pharmaceutical Care

The need of the society to address Drug

Related Problems (DRPs) A patient-centered

approach to meet this need

A practice based on “caring”

about and for patients

Responsibility for finding and

responding to the patient’s DRPs


Pharmacist responsibility inPharmaceutical Care

To ensure that the patient’s drug therapy is appropriately indicated, the most effective available, the safest possible, the most convenient to take, and the most economical

To identify, resolve, and prevent any DRPs

To ensure that the patient’s therapeutic goals are met and that optimal health-related outcomes are attained.


Drug Related ProblemsDRPs

– To resolve identified DTPs and to prevent future problems, pharmacist must understand the causes of these problems.

– The pharmacist must use a consistent, systematic and comprehensive process Pharmaceutical Care process

DRP is any undesirable event experienced by the patient that involves drug therapy and that actually (or potentially) interferes with a desired patient outcome.


Common DRPs and Their causesDRP Type Possible CausesUnnecessary Drug Prescribed

No IndicationDuplicate Therapy

Wrong Drug Contraindications presentDrug not indicated for conditionsMore effective medic. availableDrug interactionIndication refractory to drugInappropriate dosage form

Dose Too Low Wrong doseInappropriate frequencyInappropriate durationIncorrect storageIncorrect administrationDrug interaction 10Anas Bahnassi PhD CDM CDE

Common DRPs and Their causesDRP Type Possible CausesDose Too High Wrong dose

Inappropriate frequencyInappropriate durationIncorrect administrationDrug interaction

Adverse Drug Reactions Undesirable drug side effectAllergic reactionDrug interactionIncorrect administrationDose changed too quicklyUnsafe drug for the patient


Common DRPs and Their causesDRP Type Possible CausesNoncompliance Cannot afford drug

Doesn’t understand instructions on how to take the drugCannot swallow/administer the drugDrug not available

Additional drug therapy Untreated conditionProphylactic therapySynergistic therapy


Pharmaceutical CareProcess• Initiating a relationship with the patient

– patient bringing a new prescription to the pharmacy or asking about a nonprescription drug

• Pharmacist gathers all the pertinent information to evaluate the patient’s health and drug therapy appropriately– subjective information (patient complaints and

symptoms)– objective information (medication profile, vital signs,

or physical assessment data)


Pharmaceutical CareProcess• Pharmacist assess the information and looks for

DRPs. • The DTPs are prioritized along with corresponding

goals and goal criteria, and documented in pharmaceutical care plan (PCP)

• Integral to the PCP, pharmacist develop the solutions to DRPs (= interventions).

• Develop the monitoring plan, which outlines factors that will determine attainment of the desired patient outcomes (BP measurement, lab data, talking with patient).


Pharmaceutical CareProcess• Implement follow-up, which includes

implementing the monitoring plan (ex. Contact the patient to evaluate drug therapy compliance or drug side effects). Other follow up may include measuring vital signs or checking other physical or lab data.

NOTE:• Ideally, the patient should be involved throughout the entire

pharmaceutical care process.• After that plan has been implemented, the PCP recycles once again. The

pharmacist gather more data, assess the Px progress, and adjust the plan.


For successfully incorporate Pharmaceutical Care into Practice, the Pharmacist

must have knowledge and skills in Patient

Assessment


Patient Assessment

Patient assessment is the process through which the pharmacist evaluate the patient information (both objective and subjective) that was gathered from the patient and other sources (e.g. drug therapy profile, medical record, etc.)


Patient AssessmentMeans:

Making decisions regarding:

1. The health status of the patient.

2. Drug therapy needs and problems.

3. Interventions that will resolve identified drug problems and future problems

4. Follow-up to ensure that patient outcomes are being met.


Purpose of Patient Assessment:

A pharmacist cannot adequately provide pharmaceutical care without assessing patients.

• To identify, • To resolve, and • To prevent drug

related problems.


Patient Assessment Should be done by:

• Asking a series of questions:• These questions will guide the pharmacist

through the assessment process.

• Assess the patient’s physical conditions:

• e g. skin abnormalities, obtainment of vital signs, peak flow readings, blood glucose levels, cholesterol values.


Documentation:

• Provides a permanent record of patient information.

• Provides a permanent record and evidence of pharmaceutical care activities by the pharmacist.

• Communicates essential information to other pharmacists and health care professionals.

• Serves as a legal record of patient care that was provided.

• Provides back-up for billing purposes.


Characteristics ofUseful Patient Records:• Information that is neat, organized, and able to be found

quickly.• Information that is easily understandable, so that any health

care professional can determine what the problems were, what actions were taken, and what follow-up is needed.

• Accurate subjective and objective information.• An assessment of the patient

information, focusing on DRPs.• A plan to resolve any problems that

were identified.• A plan for future follow-up to ensure that any problems are

resolved and that patient outcomes are met.22Anas Bahnassi PhD CDM CDE

SOAP Note


SOAP Note:

Subjective:Includes information that is given by the patient, family members, significant others, orcare givers.

• Complaint/symptoms in his/her own words

• Recent history that pertains tithose symptoms (history of present illness)

• Past medical history• Medication history, including

compliance & ADRs.• Allergies• Social and/or family history• Review of systems.

This type of information contains:


SOAP Note:

Objective:Includes data that are obtained from the patient and that can be measured objectively.

• Vital signs.• Physical findings or physical

examination (if possible).• Laboratory test results (if

available).• Serum drug concentrations (if

available).• Various diagnostic test results (if

available).• Computerized medication profile

with refill information (if available).

This type of information contains:


SOAP Note:

Assessment:

• Analyzes subjective and objective information.

• Determines the health status of the patient.• Is the patient experiencing a

DRP?• Have the patient’s outcomes

been met?• Provides the basis and rationale

for the plan.

The pharmacist:


SOAP Note:

Plan:• Actions that were—or need to be—

taken to resolve any problems that have been identified.

• Follow-up to ensure that problems are actually corrected and that future problems do not develop.• The follow-up should include

monitoring parameters that need to be assessed as well as the interval for the next assessments

It involves:


SOAP Note:

Plan:• Guidelines should be done with

the data at the time of the follow-up.

• Simplicity and reproducibility:• A colleague should be able to

read, interpret, and act on the plan if the pharmacist who documented the note is not available.

It involves:


PharmaceuticalCare Plan:

Name: M.HGender: FDate: 9/2/2014Complaint: HTN.Drugs Used:Atenolol 25mg QD.Captopril 12.5mg BID

• The patient is picking up her Atenolol Rx.

• She feels:• Head lightness.• Weakness.• Impaired balance for 2 weeks.

• She has been taking Atenolol BID instead of QD this week.

Subjective:




• The patient was staggering at the pharmacy counter.• Pulse is: 48 bpm.• Blood pressure is:

114/72 mm Hg112/70 mm Hg

Objective:




• Bradycardia and hypotension-new-onset may be due noncompliance with atenololdosing.

Assessment:




• Inform the patient to take atenolol once a day with breakfast and captopril 2 times daily as usual.

• For the follow-up a week later recheck pulse and blood pressure. • If still low, ask her to contact

her doctor and suggest lowering the dose atenolol.

Plan:


Clinical Pharmacy VI:First AidAnas Bahnassi PhD CDM CDE

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Lecture one: Patient Assessment in Pharmacy Practice

Education

Transcript of Lecture one: Patient Assessment in Pharmacy Practice