Lecture one: Patient Assessment in Pharmacy Practice


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An Introduction to pharmaceutical care and the role of patient assessment in providing optimal pharmaceutical care to your patients.

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Lecture one: Patient Assessment in Pharmacy Practice

  1. 1. Patient Care in Pharmacy Practice Anas Bahnassi PhD
  2. 2. Anas Bahnassi PhD CDM CDE 2
  3. 3. Patient-Centered Care Care centered on patients’ needs and expectations 3Anas Bahnassi PhD CDM CDE
  4. 4. 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 4Anas Bahnassi PhD CDM CDE
  5. 5. The central component of Pharmaceutical Care is: CARING ABOUT THE PATIENT. 5Anas Bahnassi PhD CDM CDE
  6. 6. 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 6Anas Bahnassi PhD CDM CDE
  7. 7. 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 7Anas Bahnassi PhD CDM CDE
  8. 8. Pharmacist responsibility in Pharmaceutical 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. 8Anas Bahnassi PhD CDM CDE
  9. 9. Drug Related Problems DRPs – 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. 9Anas Bahnassi PhD CDM CDE
  10. 10. Common DRPs and Their causes DRP Type Possible Causes Unnecessary Drug Prescribed No Indication Duplicate Therapy Wrong Drug Contraindications present Drug not indicated for conditions More effective medic. available Drug interaction Indication refractory to drug Inappropriate dosage form Dose Too Low Wrong dose Inappropriate frequency Inappropriate duration Incorrect storage Incorrect administration Drug interaction 10Anas Bahnassi PhD CDM CDE
  11. 11. Common DRPs and Their causes DRP Type Possible Causes Dose Too High Wrong dose Inappropriate frequency Inappropriate duration Incorrect administration Drug interaction Adverse Drug Reactions Undesirable drug side effect Allergic reaction Drug interaction Incorrect administration Dose changed too quickly Unsafe drug for the patient 11Anas Bahnassi PhD CDM CDE
  12. 12. Common DRPs and Their causes DRP Type Possible Causes Noncompliance Cannot afford drug Doesn’t understand instructions on how to take the drug Cannot swallow/administer the drug Drug not available Additional drug therapy Untreated condition Prophylactic therapy Synergistic therapy 12Anas Bahnassi PhD CDM CDE
  13. 13. Pharmaceutical Care Process • 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) 13Anas Bahnassi PhD CDM CDE
  14. 14. Pharmaceutical Care Process • 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). 14Anas Bahnassi PhD CDM CDE
  15. 15. Pharmaceutical Care Process • 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. 15Anas Bahnassi PhD CDM CDE
  16. 16. For successfully incorporate Pharmaceutical Care into Practice, the Pharmacist must have knowledge and skills in Patient Assessment 16Anas Bahnassi PhD CDM CDE
  17. 17. 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.) 17Anas Bahnassi PhD CDM CDE
  18. 18. Patient Assessment Means: 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. 18Anas Bahnassi PhD CDM CDE
  19. 19. Purpose of Patient Assessment: A pharmacist cannot adequately provide pharmaceutical care without assessing patients. • To identify, • To resolve, and • To prevent drug related problems. 19Anas Bahnassi PhD CDM CDE
  20. 20. 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. 20Anas Bahnassi PhD CDM CDE
  21. 21. 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. 21Anas Bahnassi PhD CDM CDE
  22. 22. Characteristics of Useful 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
  23. 23. SOAP Note 23Anas Bahnassi PhD CDM CDE
  24. 24. SOAP Note: Subjective: Includes information that is given by the patient, family members, significant others, or care givers. • Complaint/symptoms in his/her own words • Recent history that pertains ti those 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: 24Anas Bahnassi PhD CDM CDE
  25. 25. 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: 25Anas Bahnassi PhD CDM CDE
  26. 26. 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: 26Anas Bahnassi PhD CDM CDE
  27. 27. 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: 27Anas Bahnassi PhD CDM CDE
  28. 28. 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: 28Anas Bahnassi PhD CDM CDE
  29. 29. Pharmaceutical Care Plan: Name: M.H Gender: F Date: 9/2/2014 Complaint: 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: 29Anas Bahnassi PhD CDM CDE
  30. 30. Pharmaceutical Care Plan: Name: M.H Gender: F Date: 9/2/2014 Complaint: HTN. Drugs Used: Atenolol 25mg QD. Captopril 12.5mg BID • The patient was staggering at the pharmacy counter. • Pulse is: 48 bpm. • Blood pressure is: 114/72 mm Hg 112/70 mm Hg Objective: 30Anas Bahnassi PhD CDM CDE
  31. 31. Pharmaceutical Care Plan: Name: M.H Gender: F Date: 9/2/2014 Complaint: HTN. Drugs Used: Atenolol 25mg QD. Captopril 12.5mg BID • Bradycardia and hypotension- new-onset may be due noncompliance with atenolol dosing. Assessment: 31Anas Bahnassi PhD CDM CDE
  32. 32. Pharmaceutical Care Plan: Name: M.H Gender: F Date: 9/2/2014 Complaint: HTN. Drugs Used: Atenolol 25mg QD. Captopril 12.5mg BID • 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: 32Anas Bahnassi PhD CDM CDE
  33. 33. Clinical Pharmacy VI: First Aid Anas Bahnassi PhD CDM CDE abahnassi@gmail.com http://www.twitter.com/abpharm http://www.facebook.com/pharmaprof http://www.linkedin.com/in/abahnassi