Dr. Yusi Anggriani, M.Kes, AptMita restinia, S.Farm., M.Farm, Apt

Contents

Definition1

Pharmaceutical Care Plan Process2

4

Pharmaceutical Care Plan

Pharmaceutical Care Plan is the process in which

pharmacist cooperates with the patient and health

care provider in:

Designing Implementing Monitoring

Pharmaceutical Care Plan

It describes specific services

activities through which an

individual pharmacist

cooperates with patients

and other health care

professionals in designing,

implementing & monitoring a

therapeutic plan that will

produce specific outcomes

for the patient

The Pharmaceutical Care Cycle

5

How will you know

you did it?

(monitor and follow-up)

Why do anything?

(identify the problem)

How will you do it?

(develop a care plan)

What do you want

to do?

(set goal)

Source: Rovers J. Des Moines, IA: Drake University College of Pharmacy.

How to implement Pharmaceutical Care

Plan?

Not all patients require a written PCP.

Pharmacists must assess their own patients and

identify specific areas on which to focus.

The pharmacist identify patients with specific diseases

(e.g., asthma, hypertension, diabetes mellitus, or

hypercholesterolemia).

The development of a PCP

Five step process involving the SOAP format (Subjective data, Objective data, Assessment, and Plan of care).

Developing Problem

Assesing Problem

Identifying Problem

Gathering Information

Step 4

Step 3

Step 2

Step 1

Evaluation the achievement

Step 5

Essential Components of Pharmaceutical Care Plan

1. Patient’s demographic date: age, sex, race etc. 2. Pertinent medical information 3. Medical history (current & past) 4. Family history 5. Dietary history 6. Medication history (prescription, OTC, social drugs,

allergies)7. Physical findings (weight, height, B.P)8. Lab results (serum drug levels, potassium levels,

serum creatinine levels relevant to drug therapy)9. Patient complaints, symptoms & signs

Step 1. Gathering Information

The pharmacist should gather an accurate:

• Medication history, both prescription and nonprescription medications

• The reasons the medications were prescribed or taken.

The pharmacist have to obtain some information from the physician, such as laboratory test results and hospitalizations.

The pharmacist should get written permission from the patient before soliciting this information.

Step 2. Identifying Problems

Example

From the patient's medication profile in, one

problem is evident: diagnosis of asthma.

Step 2. Identifying Problems

List subjective and objective findings correlated to the problem:

Subjective findings : those that the patient describes (e.g., 'I feel tired all the time, “I feel bloated,” or "I woke up coughing").

References describe methods to ascertain this information.

Objective findings are those that can be observed or measured by the pharmacist (e.g., patient appears tired, blood pressure is 180/105, pitting edema in ankles).

In the patient with asthma, the pharmacist would have the patient use a peak expiratory flow meter and record the results.

Step 3. Assessing Problems

The pharmacist analyzes and integrates the information gathered in steps 1 and 2 and draws conclusions in preparation for developing a patient-specific PCP

Step 3. Assessing Problems

For example, in the asthma case,

The pharmacist may first investigate the etiology of

the factors that exacerbated the asthma.

The pharmacist does not have to be involved in

skin testing, nor does the pharmacist have to conduct

a detailed, extensive history of all of the factors that

may have precipitated the asthma.

Step 3. Assessing Problems

The pharmacist should attempt to determine if drugs: (eg., aspirin, nonsteroidal anti-inflammatory agents, or beta-blockers) caused or exacerbated the asthma in the patient.

Next, the pharmacist assesses the severity of the asthma. This could be accomplished (as shown in the plan) by determining:

• the PEFR (Peak Expiratory Flow Meter).

• the patient's daily symptom

• peak flow diary, hospitalized

• placed on steroids or a mechanical ventilator.

Step 4. Developing the Plan

The pharmacist establishes:

1. goals linked to each of the patient's problems

2. specifies a course of action aimed at meeting

each goal.

Goal (i.e., desired improvement) should be stated in

terms of measurable outcomes that indicate

problem has been resolved.

Step 5. Evaluating the Achievement of

Outcomes

Outcomes that will be used to evaluate the success of the PCP.

Treatment plan must be meaningful, measurable, and manageable.

Outcomes are specific, measurable indicators for the goals of treatment.

Step 5. Evaluating the Achievement of

Outcomes

The outcomes listed for asthma, e.g:

Lower frequency and severity of acute exacerbations

Fewer physician office visits

Elimination of side effects

Fewer emergency department visits

Documentation

“if we didn’t document it, we didn’t do it”

Documenting the patient care provided during the

pharmaceutical care encounter is CRITICAL STEP in

Pharmaceutical care process

The Value of Documentation

Provided a permanent record of patient information that

the pharmacist has collected.

Efficiently communicates key information to colleagues at

the practice site or to other health care professional

Provides evidence of the pharmacist action and successes

in patient care

Serves as legal record of care provided

CONCLUSION: Requirements to conduct

pharmaceutical care

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Knowledge, skill, function of personnel

System for data collection and documentation

Efficient work flow processes

References, resources, and equipment

Communication skills

Quality assessment/improvement programs