This document outlines the key components of developing a pharmaceutical care plan. It discusses establishing goals of therapy for each medical condition in measurable terms. Interventions should resolve any drug therapy problems, achieve the goals of therapy, and prevent future problems. Therapeutic alternatives should be considered and the preferred option discussed with the patient. A follow-up plan is made to evaluate the effectiveness of the care plan. The overall goal is to optimize patient health through individualized pharmacotherapy and monitoring.

1. PHARMACEUTICAL CARE PLAN
Dr. L.T.M. Muungo
2011 - Date

2. Topical Subjects
⚫ Pharmaceutical Care
⚫ Principles of Pharmaceutical Care Practice
⚫ Pharmaceutical Care Plan

3. Pharmaceutical Care

4. Pharmaceutical Care
⚫ Pharmaceutical Care is a patient-centered,
outcomes oriented pharmacy practice that
requires the pharmacist to work in concert with
the patient and the patient's other healthcare
providers to promote health, to prevent
disease, and to assess, monitor, initiate, and
modify medication use to assure that drug
therapy regimens are safe and effective.

5. ITS GOALS
➢ The goal of Pharmaceutical Care is to optimize the patient's health-related
quality of life, and achieve positive clinical outcomes.
➢ A structured approach to achieve these goals:
1) It requires an established patient-to pharmacist relationship.
2) It requires records of medication to be kept and, with the patient’s
informed consent, additional patient specific information to be collected,
organized, recorded, monitored and maintained.
3) It requires patient-specific medical information to be evaluated and, in the
case of prescribed medicines, a therapy plan to be developed involving
the patient and the prescriber.
4) It requires the pharmacist to ensure that the patient has all supplies,
information, and knowledge, necessary to carry out the drug therapy plan.
5) It requires the pharmacist to review, monitor, and modify the therapeutic
plan in concert with the patient and healthcare team.

6. ITS ELEMENTS
➢ Elements to provide quality pharmaceutical care
are:
(1)Knowledge and skills of personnel,
(2)Systems for data collection, documentation, and
transfer of information,
(3)Efficient workflow processes,
(4)References, resources and equipment,
(5)Communication skills,
(6) Commitment to quality improvement and
assessment procedures.

7. 1) Knowledge and skills of
personnel
⚫ The implementation of pharmaceutical care is
supported by knowledge and skills in the area of
patient assessment, clinical information,
communication, adult teaching and learning
principles and psychosocial aspects of care.
⚫ To use these skills, responsibilities must be
reassessed, and assigned to appropriate
personnel, including pharmacists, technicians,
automation, and technology. A mechanism of
certifying and credentialing will support the
implementation of pharmaceutical care.

8. 2) Systems for data collection and
documentation
⚫ The implementation of pharmaceutical care is supported
by data collection and documentation systems that
accommodate patient care communications (e.g. patient
contact notes, medical and medication history), inter-
professional communications (e.g. physician
communication, pharmacist-to-pharmacist
communication), quality assurance (e.g. patient
outcomes assessment, patient care protocols), and
research (e.g. data for pharmacoepidemiology, etc.).
Documentation systems are vital for reimbursement
considerations.

9. 3) Efficient workflow processes
⚫ The implementation of pharmaceutical care is
supported by incorporating patient care into
the activities of the pharmacist and other
personnel.

10. 4) References, resources, and
equipment
⚫ The implementation of pharmaceutical care is
supported by tools, which facilitate patient
care, including equipment to assess medication
therapy adherence and effectiveness, clinical
resource materials, and patient education
materials.
⚫ Tools may include computer software support,
drug utilization evaluation (DUE) programs,
disease management protocols, etc.

11. 5) Communication Skills
⚫ The implementation of pharmaceutical care is
supported by patient-centered communication.
Within this communication, the patient plays a
key role in the overall management of the
therapy plan.

12. 6) Quality Assessment/ Improvement
Programs
⚫ The implementation and practice of
pharmaceutical care is supported and improved
by measuring, assessing, and improving
pharmaceutical care activities utilizing the
conceptual framework of continuous quality
improvement.

13. Principles of Pharmaceutical
Care Practice

14. PRINCIPLES OF PHARMACEUTICAL
CARE PRACTICE
⚫ Pharmaceutical care involves the process
through which a pharmacist cooperates with a
patient and other professionals in designing,
implementing, and monitoring a therapeutic
plan that will produce specific therapeutic
outcomes for the patient.

15. PRACTICE PRINCIPLES OF
PHARMACEUTICAL CARE

16. Data collection
⚫ The pharmacist conducts interviews with
the patient in a setting designed to ensure
privacy. The data obtained is accurate,
appropriately organized and kept current.
Patient data is confidential and is provided
to others only with informed consent of
the patient or as required by law.

17. Evaluation of Information and
Formulating a Plan
⚫ The pharmacist, collaborating with other
healthcare providers and the patient, identifies
and evaluates the most appropriate action to
ensure the safety and effectiveness (including
cost effectiveness) of current or planned
pharmacotherapy and to minimize current or
potential future health-related problems.
⚫ The pharmacist documents, in the patient’s
record, the plan and desirable outcomes for
each problem identified.

18. Implementing the Plan
⚫ The pharmacist works with the patient to
maximize patient understanding and
commitment to the pharmaceutical care
therapy plan.
⚫ The pharmacist ensures that the patient
knows how to use all necessary
medication and any equipment associated
with monitoring or administration
properly.

19. Monitoring and Modifying the Plan to
Ensure Positive Outcomes
⚫ The pharmacist regularly reviews the patient
progress towards achieving the desired outcomes
and provides a report to the patient’s other
healthcare providers as appropriate.
⚫ As progress is achieved, the patient should receive
positive reinforcement to encourage continuing co-
operation.
⚫ If the expected progress is not being achieved,
then the plan should be modified, applying the
principles used in formulating the original plan.

20. Follow up
⚫ When the desired outcomes have been
achieved, a follow up procedure should be
established to ensure the continued
wellbeing of the patient.

21. CONCLUSION
⚫ Pharmaceutical care reflects a systematic
approach in making sure that the patient
gets the right medicines, in the right dose,
at the right time and for the right reasons.

22. Any Questions

23. Pharmaceutical Care Plan

24. Key Concepts of pharm. care
plan
⚫ 1. A care plan is developed for each of the patient's
medical conditions being managed with
pharmacotherapy.
⚫ 2. A goal of therapy is the desired response or endpoint
that you and your patient want to achieve from
pharmacotherapy.
⚫ 3. The key to a successful care plan is clear, measurable
goals of therapy which include a parameter, desired
value(s), and a timeframe for achieving them.

25.  4. The care plan includes interventions to
resolve the drug therapy problems,
interventions to achieve goals of therapy,
and any necessary interventions to prevent
drug therapy problems.
 5. Pharmacotherapy interventions include
initiating new drug therapy, discontinuing
drug therapy, or changing the product
and/or dosage regimen.

26. ⚫ 6. Additional interventions to achieve the
goals of therapy can include patient
education, medication compliance
reminders/devices, referrals to other
health care providers, or
equipment to measure
monitoring
outcome
parameters.

27.  7. The last activity in the care plan is
scheduling a follow-up evaluation with the
patient to determine the outcomes of
pharmacotherapy at a clinically appropriate
time.
 8. Documentation of the care plan
establishes the relationships between the
goals of therapy, and interventions designed
to achieve the goals.

28. purpose of the care plan
⚫ The purpose of the care plan is to
determine how to manage patient medical
conditions or illness successfully.
⚫ It includes all the work that is necessary
to accomplish this.

30. Development of Goals of Therapy
(Identify goals of therapy for each patient)
 1. Goals of therapy are established for each indication for drug
therapy.
 2. Desired goals of therapy are described in terms of the
observable or measurable clinical and/or laboratory parameters to
be used to evaluate effectiveness and safety of drug therapy.
 3. Goals of therapy are mutually negotiated with the patient and
health care providers when appropriate.
 4. Goals of therapy are realistic in relation to the patient's present
and potential capabilities.
 5. Goals of therapy include a timeframe for achievement.

31. The care plan
⚫ allows you to work with patient, who may
have different expectations or
understanding of his or her medication.
⚫ It serves as a negotiated agreement.
⚫ It includes several individuals such as
patients, family members, physicians, and
pharmacists.

32. ⚫ In pharmaceutical care, care plans are
organized by indications for drug therapy.
⚫ Patients often have multiple medical
conditions.
⚫ Some conditions are acute and many are
chronic requiring long-term treatment.
⚫ Multiple drug therapies for the same
indication are grouped together with the
same care plan.

34. The major questions you must consider to
construct a successful care plan are:
⚫ 1. What goals of therapy are you and your patient trying to achieve
with pharmacotherapy?
⚫ 2. What are you going to do, or how are you going to intervene, to
resolve any drug therapy problems identified during the
assessment?
⚫ 3. What interventions (drug therapies, devices, patient education)
are you going to provide to ensure that your patient achieves the
desired goals of therapy?
⚫ 4. When are you going to follow-up with your patient to determine
the actual outcomes of drug therapies and other interventions?

35. Establishing Goals of Therapy
⚫ They are necessary in order to produce
and document positive outcomes.
⚫ You and the patient must agree upon
clear and concise goals of therapy.
⚫ It is essential to ensure that a patient will
maximally benefit from drug therapies.

36. The goals of drug therapy are to:
⚫ 1. Cure a disease
⚫ 2. Reduce or eliminate signs and/or symptoms
⚫ 3. Slow or halt the progression of a disease
⚫ 4. Prevent a disease
⚫ 5. Normalize laboratory values
⚫ 6. Assist in the diagnostic process

38. Goals of therapy have a specific structure and
always include:
⚫ 1. Clinical parameters (signs and
symptoms) and/or lab values which are
observable, measureable, and realistic;
⚫ 2. Desired value or observable change in
the parameters;
⚫ 3. Specific timeframe in which the goal is
to be met.

40. ⚫ Example For a patient who suffers from
allergic rhinitis and presents with nasal
congestion, runny nose, and eye itching,
but no cough or loss of taste, the patient-
specific goals of therapy might include the
relief of the patient's complaints of nasal
congestion, runny nose, and eye itching in
a timeframe of 48 hours.

41. Eliciting goals of therapy and obtaining agreement with the
patient can be facilitated with the following discussion
questions.
⚫ What would you like to achieve with your
medications?
⚫ What are your goals for this therapy?
⚫ How do you feel about trying to achieve .
. . with a new drug therapy?

44. Interventions
⚫ The Practitioner Develops a Care Plan that
Includes Interventions to:
⚫ Resolve Drug Therapy Problems,
⚫ Achieve Goals of Therapy, and
⚫ Prevent Drug Therapy Problems.

45. Measurement Criteria
⚫ 1. Each intervention is individualized to the
patient's conditions, drug related needs, and drug
therapy problems.
⚫ 2. All appropriate therapeutic alternatives to
resolve drug therapy problems are considered, and
the best are selected.
⚫ 3. The plan is developed in collaboration with the
patient, his/her family and/or care-givers, and
health care providers, when appropriate.
⚫ 4. All interventions are documented.
⚫ 5. The plan provides for continuity of care by
including a schedule for continuous follow-up
evaluation.

46. Interventions to Resolve Drug
Therapy Problems
⚫ It is given highest priority
⚫ They interfere with patients.
⚫ If your patient is not realizing the full
effectiveness form her prescribed
antihistamine to manage seasonal allergic
rhinitis because the dose is too low, the
dosage regime must be increased before
there is any realistic hope of achieving a
positive outcome.

47. ⚫ Similarly, if your patient is experiencing
dose-related side effects from her
antihistamine, the dosage regimen must
be modified in order for her to receive
appropriately indicated drug therapy that
is both effective and safe.

48. ⚫ Interventions might include:
⚫ 1. Initiating new drug therapy,
⚫ 2. Changing the drug product,
⚫ 3. Altering the dose and/or the dosing
interval, or
⚫ 4. Discontinuing drug therapy

49. It is important to include the patient at each step in your decision
making process. The following questions can facilitate this discussion:
⚫ How do you feel about making these adjustments
in your medications?
⚫ Is this a change that you think you can manage in
your daily use of this medication?
⚫ What do you think would be the best way to
improve your therapy?
⚫ Establish with your patient effectively and
efficiently all drug related needs.
⚫ The interventions you select are grounded in
patient preferences, selected according to patient
needs, and limited by patient tolerance.

50. Interventions to achieve the goals
of therapy can include
⚫ 1. Drug regimen(s) the patient should receive,
⚫ 2. Changes in drug therapy that are required,
⚫ 3. Patient-specific education or information,
⚫ 4. Referrals to specialists,
⚫ 5. Instructions on how to properly use
prescription drug products, Nonprescription drug
products, and How to use other remedies,
products, and devices.

51. Interventions to Prevent Problems
⚫ Each pharmaceutical care plan must
address the need to prevent the
development of new drug therapy
problems.
⚫ In clinical practice design drug therapies
and patient education to avoid
preventable side effects or risks known to
be associated with certain drug therapies
or diseases.

52. ⚫ Examples include
⚫ initiating antihypertensive therapy with a
minimal dosage to prevent orthostatic
hypotension or
⚫ warning patients about drowsiness associated
with some antihistamine products.
⚫ Practitioners also routinely recommend that
patients take certain medications with food to
avoid stomach upset.

53. ⚫ These types of interventions are due to
the pharmacological or chemical
properties of the drug and/or the disease
but are not unique to the patient.
⚫ These would be considered standard or
routine instructions and would be provided
for all patients taking those medications.

55. Therapeutic Alternatives
⚫ There is seldom only one best Intervention.
⚫ Decide what interventions you will select to
resolve drug therapy problem
⚫ Decide what interventions you will select to
achieve the goals of therapy.
⚫ Decide what other interventions in order to
prevent the development of drug therapy
problems.
⚫ Notice that for each set of clinical decisions you
are making you must consider all of the
reasonable alternatives available.

56. Learning tip
⚫ During the learning phase, it is useful to always identify at least
three different therapeutic alternatives for every drug therapy
decision you make with your patients.
⚫ This helps you to learn about drugs that you may not otherwise
encounter, and it helps you to learn to investigate, compare, and
contrast the evidence supporting efficacy and safety of drug
products used for similar indications.
⚫ When you make recommendations to prescribers for changes in
your patient's drug therapy, you will want to provide two
alternatives that you consider acceptable. Always indicate which of
the two is preferred and why.

57. Discussing options with your patient can be
facilitated with the following questions.
⚫ What is your preference given these
approaches for treating your illness
⚫ There are several medications available to
treat your illness, which would you prefer?
⚫ Which therapy do you feel will work best
for you?

58. Cost Considerations
⚫ Cost considerations should become
important only after you have generated
therapeutic alternatives based on
effectiveness and safety.
⚫ Any drug therapy that is ineffective for a
patient or results in toxicity is too
expensive.

59. ⚫ Too often, if the differences between the clinical
efficacies and/or safety of various drug therapy
alternatives have not been well documented, they are
considered to be the same.
⚫ This results in choosing the less expensive of the
alternatives.

60. ⚫ Note Considering drug product costs
before efficacy and safety considerations
is not rational and can often be harmful
and wasteful.
⚫ Cost is an important management issue,
but effectiveness and safety always take
precedence

61. ⚫ After you have considered the evidence of
efficacy and safety, then convenience and
cost considerations can be applied.
⚫ The least expensive drug therapy is the
one that is effective and does not cause
the patient harm.

62. Schedule and Plan for Follow-Up
Evaluations
⚫ The Practitioner Develops a Schedule to
Follow-Up and Evaluate the Effectiveness
of Drug Therapies and Assess Any Adverse
Events Experienced by the Patient.

63. Measurement Criteria
⚫ 1. The clinical and laboratory parameters to evaluate
effectiveness are established, and a timeframe for
collecting the relevant information is selected.
⚫ 2. The clinical and laboratory parameters that reflect the
safety of the patient's medications are selected, and a
timeframe for collecting the relevant information is
determined.
⚫ 3. A schedule for the follow-up evaluation is established
with the patient.
⚫ 4. The plan for follow-up evaluation is documented.

64. The plan for the follow-up evaluation addresses three
basic questions:
⚫ 1. When should the follow-up evaluation
be scheduled?
⚫ 2. How will you determine if positive
outcomes have occurred?
⚫ 3. How will you determine if negative
outcomes have occurred?

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indication and includes a brief summary of
the signs and symptoms.
⚫ Goals of therapy must be a prominent part
of every care plan.
⚫ One of the most valued additions that a
pharmaceutical care practitioner makes to
the patient's health records is explicitly
stated goals of therapy.

66. ⚫ The care plan needs to be complete and
should follow the structure of drug
product(s) and dosage instructions
including dose, route, frequency, and
duration.
⚫ Any special dosing instructions that will
help the patient maximally benefit from
the drug therapy should be included in the
care plan

67. ⚫ If the drug therapy is a change from earlier
regimens, it should be noted and dated in the
care plan.
⚫ Multiple drug therapies for the same condition
are contained in the same care plan.
⚫ Any changes in drug products, dosage
regimens, or instructions should be recorded
so that the patient's care plan is continuously
current and includes all forms of
pharmacotherapy the patient is receiving.

68. ⚫ Other interventions to support the specific
pharmacotherapy should also be recorded.
⚫ These often include health advice,
exercise, dietary changes, or instructions
on the proper use of medication
administration devices or drug monitoring
devices.

69. ⚫ The care plan should include the schedule
for the next follow-up evaluation including
effectiveness and safety parameters to be
evaluated.

70. Any Questions or Additions

72. Reference:
1. Clinical Skills for Pharmacists, A Patient-Focused Approach, 3rd Ed, ISBN 978-0-
323-05485-0, by Karen J Tetze, 2012
2. Clinical Pharmacy & Therapeutics, 5th Ed, ISBN – 978-0-7020-4294-2, by Roger
Walker & Cate Whittlesea, 2012
3. Clinical Anatomy and Physiology of the visual Views, 3rd Ed, ISBN: 978-1-4377-
1926-0, by Butterworth-Heinemann, 2012.
4. Clinical Guidelines : Diagnosis and Treatment Manual, 7th Ed, ISBN: 2-906498-69-
6, By L.Blok (MD) et al.
5. Clinical Pharmacology, 9th Ed, ISBN 0443064814, by P.N. Bennett and M.J. Brown,
2003

73. Study Questions
⚫ Define the following generic terms of pharmacy:
➢ [Clinical Pharmacy, Oedema, Hypothyroidism, Dosage, Medication, Compliance, Pharmaceutical Care,
Apothecary, Pharmaceutical compounding, Ayurvedic Pharmacy, Antiquity Pharmacy, Middle Ages Pharmacy,
Modern Pharmacy, Retail pharmacy, Alchemy, Remedy, Drug, Medicine, Cure, Care, Trephining, Millennium,
Symptoms, Renaissance, Disease, Illness, Microbes, Civilization, Herbal remedies, Usage, Side effects, Quantities,
Dosages, Storage, Pharmacopeia, Pharmacology, Pharmaceutics, Pharmacokinetics, Therapeutics, Pathophysiology,
Evolution, Patient counseling, Nutrition, Antibiotics, Chemotherapy, Pain management, Semiotician, Physician,
Pharmacist, Diagnosis, Mutual respect, Honesty/ Authenticity, Open Communication, Cooperation, Collaboration,
Empathy, Sensitivity, Promotion, Competence, Assurance, Confidence,etc]
⚫ Respond to the following questions:
➢ In line with historical background of originality of pharmacy, How was disease thought of in early civilization
and how was it treated.
➢ What are some of the contributions to the practice of pharmacy from around the world regions such as Asia,
Greece, Roman Empire, Arabia,Europe.
➢ Why has there been a trend toward fewer independent pharmacies in some world
pharmaceutical established operations as compared to those of national institutes
➢ Historically, how has the role of the pharmacist evolved overtime to its present time nature
➢ Write on the ways the modern-day pharmacist has impacted patients’ health and safety
➢ State and explain the critical role of clinical pharmacy in a designed health sector
➢ Describe in details what is considered when demographic data is compiled
➢ State and explain the essential considerations in patient medication process
➢ Explain in details the process of Pharmaceutical care and it role and stages in the provision of patient care
➢ State and explain the critical components of patient counselling during medication process and how it can
effectively be provided.

74. ⚫ Group work discussional questions for Journal Club
Meetings:
➢ State and explain the critical role of clinical pharmacy in a designed
health sector
➢ Describe in details what is considered when demographic data is
compiled
➢ State and explain the essential considerations in patient medication
process
➢ Explain in details the process of Pharmaceutical care and its role and
stages in the provision of patient care
➢ State and explain the goals of Pharmaceutical Care plan as it is
designed for patient caring
➢ State and explain the effective elements of Pharmaceutical Care plan
as it is designed to provide desired and quality patient care
➢ State and explain the key concepts of Pharmaceutical Care plan as it is
considered to provide desired and quality patient care
➢ State and explain the critical components of patient counselling during
medication process and how it can effectively be provided.