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Drug Therapy Assessment

Preceptor Development: Patient Care Process

•  Se#ng  the  stage  for  precep0ng  drug  therapy  assessment  

•  Elements  of  drug  therapy  assessment  •  Hierarchy  •  Flow  chart  

•  Student  use  of  flow  chart  •  Reviewing  the  Student’s  Assessment  

•  Feedback  and  evalua0on  of  your  student  •  Overview  of  preceptor  role  •  An  example:  my  prac0ce  

Outline

1.   Iden0fy  and  evaluate  how  you  assess  drug  therapy  in  your  prac0ce  

•  What  is  your  prac3ce  environment?  •  Who  are  your  team  members,  if  any?  •  What  role  do  other  pa3ent  care  providers  have  with  

respect  to  assessing  drug  therapy?      

2.   Get  to  know  your  student;  specifically,  their  comfort  and  experience  with  drug  therapy  assessments  

•  How  many  drug  therapy  assessments  have  been  learned  and  prac3ced?    

•  What  specific  drug  therapy  assessments  have  been  learned  and  prac3ced?    

 

 

Setting the Stage

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3.   Share  your  approach  with  your  student  •  What  types  of  drug  therapy  assessments  do  

you  rou3nely  conduct?  

•  Where  is  informa3on  documented  and  stored  which  supports  your  assessment?      

For  example:  ·  Past  Medical  History  (PMH)  ·  Netcare  data  ·  Refill  records    

 

 

 

Setting the Stage

 

1.  Indica3on  

2.  Efficacy  

3.  Adherence  

4.  Safety    

 

Hierarchy of Drug Therapy Problems (DTPs)

PRECEPTING    TIP:    

                                 

ARer  your  student  has  gathered  a  pa0ent  database,  have  him  present  to  you  the  INDICATION  for  each  drug.    This  would  also  apply  for:  

•  EFFICACY  •  ADHERENCE  •  SAFETY  

Is  drug  therapy  effec3ve  for  each  indica3on?

(Goals/Efficacy  Monitoring  Parameters)

Why?    Addi3onal  therapy  required  ●  Non-­‐adherence  ●  Low  dose/dosing  frequency/dose  3tra3on  ●  Interac3on  ●  Onset  of  ac3on  ●  Malabsorp3on  ●  Formula3on  ●  Expired  drug Move  on  to  Adherence  and  Safety  Evalua0on

Is  the  pa3ent  able  to  take  drug  therapy  as  prescribed?

Why?    Adverse  Effect  ●  Incorrect  dosage  form/frequency  ●  Direc3ons  not  understood  (consider  culture,  language,  educa3on/health  literacy)  ●  Cost/Drug  access  ●  Pa3ent  preference,  beliefs,  mo3vators  ●  Pa3ent  ability  to  self-­‐administer  drugs  (age,  dexterity,  vision,  swallowing,  memory)                       Move  on  to  Safety  Evalua0on

Is  the  pa3ent  at  risk  of  or  experiencing  any  significant  drug-­‐drug,  drug-­‐food,  drug-­‐disease,  or  drug-­‐laboratory  test  interac3ons?

Con3nue  therapy,  it  appears  appropriate  for  this  pa3ent. Can  the  interac3on  be  managed?  Is  a  change  in  therapy  indicated?

Is  the  pa3ent  at  risk  of  or  experiencing  any  adverse  effects?

(Safety  Monitoring  Parameters)

Is  the  dose  appropriate?  (Consider  weight,  organ  func3on,  age)  Is  the  pa3ent  being  monitored  appropriately?

Is  the  dose  too  high?  (Consider  weight,  organ  func3on,  age)  Can  the  adverse  effect  be  managed?    Is  a  change  in  therapy  indicated?

Developed  by:  Deon  Druteika,  PharmD,  Pharmacy  Services  AHS    Adapted  by:  Pa<ent  Care  Working  Group,  Faculty  of  Pharmacy,  UofA  2011  

Copyright  ©  2011,  Faculty  of  Pharmacy  &  Pharmaceu<cal  Sciences,  University  of  Alberta  

Is  drug  therapy  op3mal  (first-­‐line)  for  that  specific  condi3on?

●  Explore  reasons  for  use  of  alternate  drug  therapy

●  Consider  switching  to  op3mal  therapy  if  appropriate

Move  on  to  Efficacy  Evalua0on

Medical  Condi3on/Problem

Is  therapy  indicated?  (Consider  non-­‐drug  management  and  pa3ent  preferences) Has  drug  therapy  

been  ini3ated?

Can  therapy  be  discon3nued?

Assessment  of  Drug  Therapy  Flow  Chart

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•  Have  your  student  use  the  flow  chart  as  a  guide  when  evalua3ng  drug  therapy  

•  Keep  in  mind  that  the  flow  chart  is  not  all  inclusive,  but  rather  a  systema3c  process  tool  

Student Use of Flow Chart

PRECEPTING    TIP:    

For  more  comprehensive  informa0on  about  assessing  drug  therapy,  refer  your  student  to  the  full  Pa0ent  Care  Process  document  for  sugges0ons.  

• Missing  Informa0on  

• What  is  needed,  and  how  will  it  be  gathered?  •  Chart,  pa3ent,  Netcare,  community  pharmacy,  MD,  allied  healthcare  providers,  other  

• Assessment  inaccurate  or  not    

clinically  relevant  

•  How  can  you  re-­‐direct?  

Reviewing the Student’s Assessment

PRECEPTING    TIP:    

Role  model  for  your  student  how  to  think  like  a  detec0ve  when  gathering  and  assessing  informa0on.  

Is  the  student’s  assessment  thorough,  accurate  and  clinically  relevant?        

•  Provide  feedback  to  your  student  on:  •  Ability  to  ask  the  right  ques3ons  which  in  turn,  forms  

the  assessment  of  the  pa3ent  •  Ability  to  interpret,  integrate  and  apply  retrieved  data  •  Ability  to  priori3ze  medical  and  drug  therapy  

problems  

•  Evaluate  your  student  on  the  following  criteria:  

•  Ability  to  iden3fy  clinically  relevant  DTPs  •  Quality  of  DTP  assessment    ·  Thorough  ·  Accurate  

Feedback and Evaluation

Note:  If  student  is  unable  to  assess  drug  therapy  despite  feedback  and  sufficient  prac3ce,  please  contact  the  course  coordinator.  

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Before  the  clinical  placement  •  Be  familiar  with  the  drug  therapy  assessment  process  student’s  are  

taught  •  Suggest  medical  condi3ons  and  therapeu3cs  your  student  should  

review  that  are  commonly  assessed  in  your  prac3ce  

Early  in  the  clinical  placement  •  Discuss  your  expecta3ons  for  pa3ent  assessments  (on  Day  1)  •  Ensure  your  student  can  compile  a  thorough  pa3ent  database  •  Assign  some  straighcorward,  simple  pa3ents  with  few  co-­‐morbidi3es  •  Review  thoroughly  to  ensure  student  has  a  good  grasp  on  process  and  

assessments  are  comprehensive.  

Later  in  the  clinical  placement  •  Assign  more  complex  pa3ents,  and  increase  pa3ent  workload  

Overview of Preceptor Role

Have  the  student  compile  a  list  of  current  &  previous  medical  problems  from  assigned  pa3ent(condi3ons)  

Have  the  student  priori3ze  them  (star3ng  with  the  reason  for  admission/encounter/or  consulta3on)    

Precepting Drug Therapy Assessment in my practice – Step 1

Focus  your  student  to  start  with  highest  priority  medical  problem  and  begin  movement  through  the  flow  chart  

Your  student  should  use  one  cycle  of  the  flow  chart  per  medica3on  used  for  each  medical  condi3on  and  mul3ple  cycles  for  condi3ons  requiring  mul3ple  therapies    

Precepting Drug Therapy Assessment in my practice – Step 2

Once  all  cycles  complete  for  one  medical  condi0on,  assess  therapy  for  next  problem  in  priori0zed  list.  Rinse,  repeat.  

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As  DTP’s  are  iden3fied  via  the  flow  diagram,  formulate  a  list  of  problems  that  can  be  resolved.  

 

Priori3ze  solvable  DTP’s  in  terms  of  clinical  relevance  and  3meframe  

 

Move  onto  the  next  step  in  process  of  care….resolving  DTPs.  

Precepting Drug Therapy Assessment in my practice – Step 3