1. The document discusses pharmaceutical care and developing a patient care plan. It defines pharmaceutical care and its basic elements which include being patient-oriented and focusing on prevention of drug-related problems. 2. Developing a care plan involves establishing goals of therapy for each medical condition, determining interventions to resolve issues and achieve goals, and scheduling follow-up evaluations. Goals should be measurable and include timeframes. 3. The care plan documentation includes the patient's medical conditions, drug therapy problems, goals of therapy, interventions, and follow-up dates. This ensures a systematic approach to managing a patient's pharmacotherapy needs.

1. PATIENT DATA EVALUATION
PATIENT CARE PLAN
DEVELOPMENT
DR. (MRS) S.F. USIFOH
BPharm, PharmD, MHPM, PhD.

2. Pharmaceutical care
• The pharmaceutical care is defined as “The responsible
provision of drug therapy for the purpose of achieving
definite therapeutic outcomes that improve the patients
quality of life”
• These outcomes are :
• Cure of the disease
• Elimination or reduction of patient`s symptomology
• Arresting or slowing of a disease process
• Preventing a disease or symptoms

3. Basic Elements of Pharmaceutical Care
• Patient oriented
• Both acute and chronic problems addressed
• Stress on prevention of drug related problems
• Documented system on patients record need and care.
• Offering continuous care in systematic way.
• Taking help of other health care providers in integrating the
care provided.
• Highly accountable and responsible
• Emphasis on optimizing patients health quality of life.

4. Basic Elements of Pharmaceutical Care(conti..)
• Emphasis on patient`s health education and health
promotion.
• 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 patients.
• Three major functions

5. Conti…
• 1-Identifying potential and actual drug-related
problems.
• 2-Resolving actual drug-related problems and
• 3-Preventing potential drug-related problems.
• The pharmacist ,who is the central figure of
pharmaceutical care, then he has the following
functions to perform

6. Function of Pharmacist To Perform
• 1-Collection of patient data.
• 2-Identification of problems.
• 3-Establishing outcome goals through a good therapeutic plan
• 4-Evaluating treatment alternatives, by monitoring and modifying
therapeutic plan.
• 5-Individualising drug regimens.
• 6-Monitoring outcomes.

7. Types of Pharmaceutical Care plan documentation
• Various documentation styles have been used
• “SOAP” (Subjective, Objective, Assessment and Plan);
• “FARM” (Findings, Assessment, Recommendations, Monitoring);
• “DRP” (Drug-Related Problem, Rationale Plan),
• “DAP” (Data Assessment Plan);
• DDAP (Drug-Related Problem, Data, Assessment Plan).
• PRIME(Pharmaceutical based, risk, interactions, mismatch and efficacy)
• CORE (Condition, Outcome, regimen and evaluation)
These styles offer the advantage of encouraging completeness of data,
consistency and improves organization of pharmacist thoughts.

8. PRIME Pharmacotherapy Plan
• PRIME Pharmacotherapy plan
• P-Pharmaceutical based problems’
• 1-pt not receiving a prescribed drug
• 2-routine monitoring ( lab data)
• R-risks ,to patients- ADR
• I-Interactions -Drug-drug interaction, food drug interaction
• M-Mismatch between medication and condition or pt needs.
• E-Efficacy, efficacy issues
• Too much of the correct drug
• Too little of the correct drug
• Wrong drug, device, intervention, or regimen prescribed ; more efficacious
choice possible)

9. CORE
• C=Condition or patient need, it may include
nonmedical conditions or need and is thus not a
reiteration of the current medical problem.
• O=outcome, desired for the condition or needs.
1. Patient outcomes (POEMS: patient-oriented
evidence that matters)

10. Core
There are generally five category of patient
outcome:
1. Mortality
2. Morbidity
a)-related to disease process,
b)-related to medication/ treatment plan
3. Behavior
4. Economic
5. Quality of life

11. • Therapeutic end point (surrogate markers; DOES:
disease oriented evidence)
• A) a therapeutic end point represents the
pharmacological or therapeutic effects that is
expected, ultimately, to achieve the desired outcome.
• B)more than one end point is usually needed to
achieve an outcome-for example, both near normal
glycemic control and normalization of blood pressure
are necessary to significant reduce the risk of end-
stage renal disease.

12. • R=regimen to achieve desired outcome
1. Therapeutic regimens
Existing therapy
Initial therapy
2. Goal setting and behavior regimens
a. Identify the type of goal being set, such as the
following
Start a new positive action-exercise program
Increase the frequency or intensity of a positive
action- drink 2 more cup of water daily

13. CORE-Analysis
• Stop or decrease- stop smoking
• Continue an action that is perfect- continue to
exercise 30 min a day, every day.
b)State the behavior goal in terms that are clear,
specific and reasonable.
E=Evaluation parameter to assess outcome
achievement.
1. Efficacy parameters
2. Toxicity parameters- ADRs, allergic reactions, or
toxicity is not occuring.

14. FARM NOTE
• Formulate a FARM note or SOAP note to describe
and document the interventions intended or
provided by the pharmacist. Some healthcare facility
may specific one format over the other;
• F= findings
The patient-specific information that gives a basis for,
or leads to, the recognition of a pharmacotherapy
problem or indication for pharmacist intervention,
finding include subjective and objective information
about the patient.

15. • A=assessment
• a.) any additional information that is needed to best
access the problem to make recommendations
• b) the severity, priority or urgency of the problem
• c) the short-term and long term goals of the
problem
• Short term goals: eliminate symptoms, lower BP to
140/90 mm Hg within 6 weeks, manage acute
asthma flare-up without requiring hospitalization.

16. • R= resolution (including prevention)
The intervention plan includes actual or proposed
action by pharmacist
1. observing, reassessing
2. Counseling
3. Making recommendations to the patients
4. Informing the prescriber
5. Making recommendations to the prescriber
6. Withholding medication or advising against use

17. • M=monitoring and follow up.
1. The parameter to be followed (pain, depressed
mood, serum potassium level)
2. The intent of the monitoring (efficacy, toxicity,
adverse event)
3. How the parameter will be monitored (patient
interview, serum drug level, physical examination)
4. Frequency of monitoring (weekly, monthly)
5. Duration of monitoring (weekly, monthly)
6. Duration of monitoring (until resolved, while on
antibiotic, until resolved them monthly for 1 year)

18. Soap note
• Anticipated or desired finding (no pain,
euglycemia, healing of lesion)
• Decision point to alter therapy when or if
outcome is not achieved (pain still present after
3 days, mild hypoglycemia more than two times
a week)

19. Format of a SOAP note:
• The SOAP format is the one used most often by
medical practitioners; however, when used within
the pharmaceutical care context, the content of the
sections must be revised to match the pharmacist’s
legal scope of practice.
• S=subjective findings
Exp-chief complaints and duration or severity of
symptoms.

20. Soap note
• O=objective findings
Exp-laboratory data, weight, height, blood pressure,
and pulse.
A=assesment
Diagnosis or possible explanations for the patients
medical problems.
P=Plan
Drug regimen or surgical procedure

21. Care plan
• 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.

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

23. • 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.

24. 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.

25. CARE PLANNING ACTIVITIES AND
RESPONSIBILITIES
ACTIVITIES RESPONSIBILITIES
Establish goals of therapy Negotiate and agree upon endpoints and timeframe for
pharmacotherapies
Inform patients of their responsibilities to accomplish goals.
Determine appropriate interventions to:
-Resolve drug therapy problems
-Achieve goals of therapy
-Prevent new problems
Consider therapeutic alternatives and select patient specific
pharmacotherapy, patient education and other non drug
interventions
Schedule follow-up evaluation Establish a schedule for follow-up evaluation that is clinically
appropriate and convenient for the patient.

26. • 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.
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.

27. • 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.

28. Common indications for pharmacotherapy
• Hypertension
• Hyperlipidemia
• Diabetes
• Osteoporosis prevention
• Vitamin/dietery supplements
• Hypothyrodisim
• Pain
• Depression
• Osteoarthrithis
• Ischemic heart disease etc.

29. Major questions to consider to construct 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?

30. Establish 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.

31. Goals of drug therapy are:
• 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

32. Examples of medical conditions for goals of therapy
Goals of therapy Medical conditions
Cure a disease Streptococcal pneumonia
Otitis media
diarrhea
Reduce /eliminate signs and/symptoms Major depression
Allergic rhinitis
Common cold
Slow or halt the progression of disease Diabetes
Congestive heart failure
Ischemic heart disease
Prevent a disease Osteoporosis
Myocardial infraction
Pneumococcal pneumonia
Normalize laboratory values Hypokalemia
Anemia
Assist in the diagnostic process Anxiety associated with MRI procedures
Intraocular pressure test for glaucoma

33. Goals of therapy have 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.

34. Goals of therapy
What are u trying
to accomplish with
pharmacotherapy
parameters
Improvement in clinical
signs & Symptoms
Changes in lab values as
evidence of improvement
(measured values)
How long it will
take
Time frame
When to expect
evidence of improvement
Time required to achieve
full therapeutic response

35. • 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.

36. CARE PLAN
Care plans contain interventions
designed to;
Resolve Drug Therapy Problems
Achieve the stated goals of therapy for
each active medical problem.
Prevent new Drug Therapy Problems
that has potential to develop.

37. Elements of a care plan include:
 Medical condition: List the disease state for
which patient has drug related needs
 Drug therapy problems: State drug therapy
by including the patient’s condition, drug
therapy involved and the association
between drug(s) and patient condition.
 Goals of therapy: State the goals in the
future tense. Goals should be realistic,
measurable/observable, specific and
associated within a definite time frame

38.  Intervention: in collaboration with the
patient, the pharmacist develops and
prioritizes a list of activities to address the
patient drug related needs. Patient input is
important. List of activities may be stated
in past present or future tense. It should
also include recommendations made to
patient , care giver on patient’s behalf or
prescriber to resolve or prevent drug
therapy problems
 Follow-up: determine when the patient
should return for follow up and what will
occur at that subsequent visit.

39. STATUS DEFINITION
Resolved Therapeutic goals achieve for the acute
condition, discontinue therapy.
Stable Therapeutic goal achieved, continue the same
therapy for chronic disease management.
Improved Progress is being made in achieving goals;
continue the same therapy because more time
is required to assess the full benefit of therapy.
Partially
improved
Progress is being made, but minor adjustment
in therapy are required to fully achieve the
therapeutic goals before the next assessment

40. Unimproved Little or no progress has been made but
continue the same therapy to allow
additional time for benefit to be observed.
Worsen A decline in health is observed despite an
adequate duration using the optimal drug:
modify drug therapy (e.g. increase the dose
of the current medication, add a second
agent with additive / synergistic effects.
Failure Therapeutic goal have not been achieved
despite an adequate dose and duration of
therapy; discontinue current medication(s)
and start new therapy.
Expired The patient died while receiving drug
therapy; document possible contributing
factors especially if they may be drug

41. PHARMACEUTICAL CARE PATIENT RECORD
Patient Name:
Address :
Telephone : Age:
Insurance:
Medical condition:
Tobacco / Alcohol / Substance abuse:
Gender:
Race /Tribe :
Actual weight:
Ideal weight:
Allergies:
Adverse reactions:
MEDICATION RECORDS
Start
Date
Stop
Date
Indication Drug Name Actual
Strength
Regimen Clinical Impression
ASSESSMENT, PLAN AND FOLLOW UP EVALUATION
Date Medical
Condition
Drug Therapy
Problem
Goal Current
Status
Intervention Follow up
PHARMACEUTICAL CARE PATIENT RECORD FOR CREATING A CARE PLAN (IN-PATIENT)

42. PHARMACEUTICAL CARE PATIENT RECORD
Patient Name: Donald Osagie
Address : 32 Urubi Street , Benin
Telephone : 08056226668 Age:54
Insurance: NHIS
Medical condition: Osteoarthritis left knee (stable)
Tobacco / Alcohol / Substance abuse: Occasional cigar 3x/wk; EtOH3x/wk; no
caffein
Gender: M
Race /Tribe : Edo
Actual weight: 80kg
Ideal weight: 75.3kg
Allergies: Penicillin --- hives
Adverse reactions: Ibuprofen ----dyspepsia
MEDICATION RECORDS
Start
Date
Stop Date Indication Drug Name Actual
Strength
Regimen Clinical Impression
12/04/11 Osteoarthritis Piroxicam 20mg 1 capsule
once daily
Tolerating well minor
knee pain
05/07/12 29/07/12 HTN Hydrochlrothiazide
(HCT)
25mg 1 tab po
once daily
29/07/12 d/c;
due to hypokalemia
31/07/12 HTN Triameterene/HCT
(Dyazide)
37.25
/25mg
1tab. po daily 31/5/12; k+ WNL; HTN
partially improved
ASSESSMENT, PLAN AND FOLLOW UP EVALUATION
Date Medical
Condition
Drug Therapy
Problem
Goal Current
Status
Intervention Follow up
05/07/12 HTN Untreated HTN Lower BP to
110-138/70-88
within 4wks
Untreated
(BP 160/104)
Start HCT
25mgpo once
daily x4wks
Return for BP check &
serum K+ in 2 wks
31/07/12 HTN Hypokalemia
secondary to HCT
K+ 3.5-5.0
mEq/L
Untreated
K+3.2mEq/L
Discontinue
HCT start
dyazide
Recheck K+ in 2wks
14/08/12 HTN HTN inadequately BP10-138/70-88 Partial Change to Return in 2wks for bp

43. Pharmaceutical Care Sheet (OUT- PATIENT)
Pt. Name: ………………… Date ………………… Unit ………………… Weight …………..
Sex: ………………….. Age: ………………… Occupation……………………. Allergies: …………………
Medical Problems Medications:
……………………………………………. …………………………………………….
……………………………………………. …………………………………………….
……………………………………………. …………………………………………….
……………………………………………. …………………………………………….
……………………………………………. …………………………………………….
Drug Therapy Problems with descriptions:
……………………………………………. …………………………………………….
……………………………………………. …………………………………………….
……………………………………………. …………………………………………….
Notes:
……………………...…………………………………………….………………………………………………...……………………………
……………….………………………………………………...…………………………………………….……………………………………
…………...…………………………………………….………………………………………………...………………………………………
…….………………………………………………...…………………………………………….……………………………………………….
Follow-up:…………….
…………………………………. Pharmacist:…………………………..
Signature & Date:……………………..

44. FOLLOW –UP EVALUATION
The purpose of follow-up evaluation is to
determine the actual outcomes of drug therapy for the
patient,
compare these results with the intended goals of
therapy
determine the effectiveness and safety of
pharmacotherapy,
evaluate patient adherence
establish the current status of the patient.

45. In follow up the practitioner evaluates
the patient response to drug
therapies in terms of
 Effectiveness,
Safety
Compliance/Adherence
 Determines if any new problems
have developed

46. Activities performed in follow-up
Observe/measure the positive result the patient has
experienced from drug therapy. [effectiveness]
Observe/ measure any undesirable effects that were
cause by drug therapy (safety)
Determine the actual dosage of medication the patient is
taking that is producing the result observed (compliance)
Make clinical judgement of the status of patient’s medical
condition/ illness being managed by drug therapy.
(outcome) At each evaluation patient status can be
resolved. This status states patient present condition and
what was done to drug therapy in response to patient
condition.
Reassess the patient to determine if he/she developed
any new drug therapy problem.

47. Example:
Patrick Murphy is a 73yr old man, who underwent
coronary artery bypass grafting 2months ago and was
started on Simvastatin 10mg by mouth (po) once daily
6wks ago for dyslipidemia. The results of this week’s
fasting lipid profile revealed total cholesterol 230mg/dl
low density lipoprotein (LDL) 141mg/dl HDL 45mg/dl and
Triglycerides 220 mg/dl, he continues to smoke 1.5packs
of cigarette per day.

48. Care Plan:
 Medical condition: Dyslipidemia.
 Drug Therapy Problem’s: dyslipidemia treated with
inadequate dose of lipid-lowering agent.
 Goals of therapy: The patient’s LDL cholesterol will be
lowered to <100mg/dl within 6 wks. (Note: Because the
patient has known coronary artery disease, his goal of
LDL is <100mg/dl).
 Interventions: The max dose of Simvastatin is 80mg, so
the dose should be increased in an attempt to achieve
the target LDL level. Increased Simvastatin to 20mg po
once daily. (30 tabs dispensed). Reviewed possible side
effects of Simvastatin with patient.(i.e. constipation rare
muscle weakness

49. Care plan …..
and monitored for liver injury(serum alanine amino
transferase measurements). Recommended that the
patient consider stopping smoking, advised to keep a log
of smoking habits , including number of cigarette, time of
day and trigger events.
• Follow up plan: Patient will return to clinic in 6 weeks for
a repeat testing lipid profile, questioning about potential
adverse effects and discussion of plan for smoking
cessation.
• If Patient P.M returns 6wks with a repeat testing LDL
cholesterol of 120mg/dl without complaints of side
effects, then the outcome status of this patient would be
partial improvement. Another adjustment in therapy is
indicated to further reduce his LDL cholesterol. E.g.
Simvastatin dose to 40mg per daily

50. Exercise
• J.R is a 55 year old female with HTN, and ESRD. She is currently receiving
hemodialysis 3 times a week (MWF). She presents today to the ER with
complaints of general muscle weakness and a mild fever. She also admits to
palpitation and feelings of “a racing heart” prior to hospital presentation. JR
missed her dialysis appointment because she felt tired, experienced flank pain,
and painful urination on Friday.
• PMH: HTN for 10 years – poorly controlled IDDM for 15 years, ESRD for 5 years,
and a history of chronic urinary tract infection.
• FH: Father died from a stroke 2 years ago, mother living with HTN and CHF,
grandmother with Diabetes and Asthma.
• SH: Smoker for 10 year (stopped 3 years ago), drinks alcohol occasionally.
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51. Exercise…
• Allergies: Sulfa
PE:
GA: Alert and oriented, but in mild to
moderate distress,
VS: BP 155/89, HR 74, RR 18, T 37.2
• HEENT: WNL
• NECK: No JVD or swollen nodes
• LUNGS: Clear to auscultation
• CV: Peaked T waves and ST segment
depression
• ABD: Soft and non-tender, N & V
• GU: WNL
Laboratory tests today show:
• WBC = 10,500 mm3
• Cl = 108 mEq/L
• Glucose = 160 mg/dL
• Na = 136 mEq/L
• CO2 =24 mMol/L
• Ca = 6.6 mEq/L
• SCr =6 mg/dL
• K = 6.7 mEq/L
• BUN = 25 mg/dL
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52. Exercise…
Current Medications:
• Captopril 25 mg PO TID
• HCT/triamterene 1 capsule daily
• Human NPH Insulin 30 units SQ AM
Questions
• What subjective and objective data can you get from this patient’s case.
• Make your assessment of the condition and
• formulate pharmaceutical care plan for the patient.
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53. THANK YOU
FOR LISTENING