Lecture one: Patient Assessment in Pharmacy Practice

Patient Care in Pharmacy
Practice
Anas Bahnassi PhD

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 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.

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.

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

Common DRPs
and Their causes
Dose Too High Wrong dose
Inappropriate frequency
Inappropriate duration
Drug interaction
Adverse Drug Reactions Undesirable drug side effect
Allergic reaction
Drug interaction
Dose changed too quickly
Unsafe drug for the patient

Common DRPs
and Their 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

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)

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).

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.

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 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.

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 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.

SOAP Note

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:

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:

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:

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:

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:

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:

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

Lecture one: Patient Assessment in Pharmacy Practice

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Lecture one: Patient Assessment in Pharmacy Practice