02-Pharmaceutical Care Process

8/4/2019 02-Pharmaceutical Care Process

1/42

PHARMACEUTICAL CARE

PROCESS

Pharmacy Practice , Pharm.D Balsam Al-

Hasan


2/42

THE PHARMACEUTICAL CARE PROCESS The delivery of effective pharmaceutical care

to patients requires pharmacists to practice

in a way that uses their time effectively and

reflects their responsibility and accountability.


3/42

Ideally all patients who receive

pharmaceutical products or servicesshould also receive pharmaceutical

care.


4/42

CARE PLAN STEPS:


5/42

PHARMACEUTICAL CARE Pharmacists should assume that all patients

require pharmaceutical care until they havebeen assessed to exclude drug therapy

problems (Step 1).

However, due to limited resources, this stepis not always possible and a systematic

approach (Figure Above) may need to beadopted to facilitate the targeting of care.


6/42


7/42

STEP 1:Assess the patients drug-therapy

needs and identify actual and potential

drug therapy problems:

Good communication needs to be established with the

patient, care giver and other members of the health

care team at the outset in order for pharmacists to

collect, synthesize and interpret the relevant

information.


8/42

STEP 1:When pharmacists assess patients, they

must take full account of all patient andmedication factors that may predispose

patients to the risk of drug therapy problems.The assessment process involves talking topatients, care givers or representatives and

consulting other members of the health careteam, as well as reviewing patient medicationand clinical records.


9/42

STEP 1: Although the focus is on drug therapy

problems, the process allows theidentification of disease-related problems as

the therapeutic approach is verified andvalidated. In addition, opportunities for healthpromotion and preventive health care are

identified and incorporated within the plan.


10/42

PHARMACEUTICAL

CASE STUDY


11/42

EXAMPLE: CASE STUDY 1: Mrs W, a 53-year-old woman has had

gastrointestinal acid-related disorders (GERD)diagnosed by endoscopy. Mrs W has a history

of asthma, hypertension and duodenal ulcer(DU). Her current drug therapy includes:

amlodipine (10mg in the morning),

salbutamol inhaler (two puffs as required),

beclometasone inhaler (200mcg twice daily),

and theophylline (300mg twice daily).


12/42


13/42

IDENTIFY LIFESTYLE, MEDICINE AND DISEASE

FACTORS FOR THE ABOVE PATIENT:1.

Lifestyle factors:

She is obese and should try to lose weight.

She is a smoker. Nicotine can cause reflux

by reducing lower oesophageal sphincter

tone.


14/42

Other factors may exist but are not apparent

from the history. For example, she does not

drink alcohol but may drink an excess of

coffee or other beverages such as colas or

tea, which would exacerbate GERD due to

their caffeine content.


15/42

2. DRUG FACTORSCalcium channel blockers reduce lower

oesophageal sphincter tone which can lead

to acid reflux. Perhaps the amlodipine could

be changed to another anti-hypertensive

such as bendroflumethiazide

(bendrofluazide).


16/42

Theophylline also reduces lower

oesophageal sphincter tone. Review asthma

management. If appropriate, could stop

theophylline without adding on therapy or

replace theophylline with another drug such

as salmeterol.


17/42

3. DISEASE FACTORSDiagnosis of GERD may have been masked

by long term treatment of DU which has

recently been healed by H. pylori eradication;

this is not uncommon.

Atypical presentations ofGERD include

asthma symptoms linked to acid reflux.


18/42

TYPES OF DRUG-RELATED

PROBLEMS


19/42

TYPES OF DRUG-RELATED PROBLEMSNeeding pharmacotherapy and not receiving

it (a drug indication).

Taking or receiving the wrong drug.

Taking or receiving too little of the correct

drug.


20/42

Taking or receiving too much of the correct drug.

Experiencing an adverse drug reaction.

Experiencing a drug-drug or drug-food

interaction.

Not taking or receiving the drug prescribed.

Taking or receiving a drug for no valid indication.


21/42

COMMUNITY PHARMACY: Self-care (where patients purchase

medicines over the counter) is an important

component of all health care systems.

Unfortunately it may be the only form of

access to medicines in countries unable to

sustain a publicly-funded health service.


22/42


23/42

STEP 2:Develop a care plan to resolve and/or

prevent drug therapy problems:

Not all patients may progress to Step 2. For

example, no problems may have been identified at

Step 1 or you may not be able to meet the needs ofa particular patient due to severe resource

limitations.


24/42

STEP 2: If the latter is the reason the drug therapy

problems identified should be documented and

brought to the attention of the patient and the

health care team and advice provided for

reasons of ethical, clinical and professionalresponsibility, even if the patient cannot be

followed up.


25/42

PRIORITIZE DRUG THERAPY PROBLEMS:

Once identified (Step 1), drug therapy

problems should be prioritized within the

context of the overall clinical management of

the patient.


26/42

IDENTIFY DESIRED THERAPEUTIC

OBJECTIVES AND PROPOSED ACTIONS A statement should be made of what the

pharmacist intends to achieve for a patient in

relation to each drug therapy problem. Thestatements should be agreed with the patientand the health care team.


27/42

These therapeutic objectives should be

expressed as measurable outcomes to be

achieved within a defined time scale. In

deciding on the most appropriate actions it is

vital that the pharmacist confirms the

acceptability of these actions with the patient.


28/42

If a number of options exist, the patient must

be given sufficient information to select the

most appropriate option.


29/42


30/42

DOCUMENT THE CARE PLAN : The pharmacists record of drug therapy

problems and therapeutic objectives,

together with the proposed actions, form a

documented pharmaceutical care plan. Good

documentation facilitates continuity of care

and clinical audit.


31/42

CASE STUDY EXAMPLE 2:Mr D, aged 52 years, has been diagnosed

with hyperlipidaemia and advised on diet andlifestyle measures for the past year. His

medical history includes hypertension andatrial fibrillation (AF). His blood pressure wasrecently measured as 140/85 mm Hg, pulse

40 beats per minute and a lipid screenshowed total cholesterol of 8.4 mmol/L.


32/42

On interview the patient complains of tirednessand weight gain.

Current drug therapy is as follows:

amiodarone 200 mcg in the morning

bendroflumethiazide 10 mg in the morning


33/42


34/42

STEP 3:Implement the care plan:

The pharmaceutical care plan is

implemented with the agreement of the

patient and, where possible, within the

context of the overall care of the patient, in

cooperation with other members of the health

care team.


35/42

CASE STUDY EXAMPLE 3: Mrs J, aged 45 years, has recently been

diagnosed with asthma, following reversibilitytesting with a short-acting bronchodilator.

Her relevant medical history includesosteoarthritis and hypertension. Her bloodpressure was recently measured as 170/ 110

mmHg. Mrs J smokes 30 cigarettes a day, is a

moderate to heavy drinker and does no physicalexercise.


36/42

Previous drug therapy of bendroflumethiazide 2.5 mgin the morning was ineffective for hypertension.

Her current drug therapy is as follows:

Paracetamol 500 mg 2 as required up to 8 in 24hours

Propranolol 40 mg three times daily

Salbutamol metered dose inhaler (MDI) 2 puffs as

required Budesonide turbo (dry powder inhaler) 200 mcg twice

daily


37/42


38/42

STEP 4:Evaluate and review the care

plan:

Actual outcomes are evaluated in relation tothe therapeutic objectives to determine

whether drug therapy problems have beenresolved. If outcomes are not achieved, thecare plan should be reviewed.


39/42

The actual outcomes may then be accepted

as being the best achievable for the patient,

or an alternative plan may be necessary. The

plan should develop as original drug therapy

problems resolve and new drug therapy

problems appear, which require resolution.


40/42

CASE STUDY EXAMPLE 4:

For the same earlier patient


41/42


42/42

QUESTIONS??

Documents

02-Pharmaceutical Care Process