clinical pharmacy practice

8/7/2019 Clinical Pharmacy Practice

1/30

Clinical Pharmacy Practice

Prepared by:

Cedrix Cuaderno RPh, BS Ind Pharm.

Adamson University

College of Pharmacy


2/30

Patient Profile


3/30

Patient Demographics

The individual characteristics of each patientcreate the context for all of your clinicalactivities.

Patient demographic information is needed tosee each patient as a unique individual.

The purpose of the patient demographic

portion of your assessment is to determinewho your patient is and to provide adescription of him or her at the time of theassessment.


4/30


Your goal is to observe and elicit information

describing the personal characteristics of the

patient that are relevant to making drug

therapy decisions.


5/30


Age of the Patient

Age is a vital statistic when providingpharmaceutical care as it is often applied to both

the discovery of the indication for drug therapy aswell as the appropriate choice ofpharmacotherapy to manage the disease orillness.

The patient's age is also required for selectingappropriate products and dosage forms suitablefor his or her age group, and for dosing guidelines(pediatric, geriatric).


6/30


Age of the Patient

Age is best identified and documented as birth

date, so that age can be continuously updatedas you provide care year after year.


7/30


Height and Weight

Each patient's height and weight should bedocumented so it can be used for dosageindividualization.

In many situations observational estimates ofbody weight are sufficient, but for extremely

obese patients, or infants and children, andwhen using medications that require precisedose to body weight determinations, the exactweight of your patient must be known.


8/30


Height and Weight

Estimates for Adult Body Weight, Mass, and Surface Area

Ideal body weight males (kg) = 50 kg + [2.3 x inches > 5'0"]

Ideal body weight females (kg) = 45 kg + [2.3 x inches > 5'0"]

Body mass index (kg/m2) = (weight in kg)/(height in meters)2

Body surface area (m2) = ((height in cm) x (weight in kg/3600))1/2


9/30

SOAP NOTES

Subjective

Objective

Assessment

Plan


10/30

SOAP NOTES

SUBJECTIVE

Information that explains or delineates the

reason for the encounter.

Information that the patient reports concerning

symptoms, previous treatments, medications

used, and adverse effects encountered.

These are considered nonreproducible databecause the information is based on the patient's

interpretation and recall of past events.


11/30

SOAP NOTES

SUBJECTIVE

Chief complaint

Medical History

Review of Systems (ROS) / Physical

Examination (PE)

Social History


12/30

SOAP NOTES

OBJECTIVE

Information from physical examination,

laboratory results, diagnostic tests, pill counts,and pharmacy patient profile information.

Objective data are measurable and

reproducible.


13/30

SOAP NOTES

ASSESSMENT

A brief but complete description of the

problem, including a conclusion or diagnosisthat is supported logically by the above

subjective and objective data.

The assessment should not include a

problem/diagnosis that is not defined above.


14/30

SOAP NOTES

PLAN

A detailed description of recommended or

intended further workup (laboratoryradiology, consultation), treatment (e.g.,

continued observation: physiotherapy, diet,

medications, surgery), patient education (self-

care, goals of therapy, medication use andmonitoring), monitoring, and follow-up

relative to the above assessment.


15/30

Drug Therapy Timeline

Shows the time when the drugs are

administered


16/30


17/30

Drug Therapy Assessment Worksheet

Drug Related Problems

1. Correlation between drug therapy and medical problems

2. Appropriate drug selection

3. Drug regimen

4. Therapeutic duplication

5. Drug allergy or intolerance

6. Adverse drug events

7. Interactions: drugdrug, drugdisease, drugnutrient, and

drug-laboratory test8. Social or recreational drug use

9. Failure to receive therapy

10. Financial impact

11. Patient knowledge of drug therapy


18/30


The DTAW will serve as a guide to identify any

drug-related problems that your patient may

have.


19/30




have.


20/30




have.


21/30




have.


22/30




have.


23/30

Drug Therapy Problem List (DPTL)

Drug therapy problems are the clinical domain of

the pharmaceutical care practitioner.

The purpose of identifying drug therapyproblems is to help patients achieve their goals

of therapy and realize the best possible

outcomes from drug therapy.

Drug therapy problems are a consequence of

drug-related needs that have gone unmet. They

are central to pharmaceutical care practice.


24/30


Definition A drug therapy problem is any

undesirable event experienced by a patient

which involves, or is suspected to involve,

drug therapy, and that interferes with

achieving the desired goals of therapy.


25/30


Components of a Drug Therapy Problem

1. An undesirable event or risk of an event

experienced by the patient.The problem can take the form of a medical

complaint, sign, symptom, diagnosis, disease,

illness, impairment, disability, abnormal laboratory

value, or syndrome. The event can be the result of

physiological, psychological, sociocultural, or

economic conditions. ,


26/30


27/30


Examples:

"Mr. M.'s elbow pain is not being effectively

controlled because the dosage of ketoprofen hehas been taking for the past three days is too low

to provide relief."

"Mrs. W. requires additional calcium

supplements in order to prevent osteoporosis."


28/30


29/30

Pharmacists Care Plan

After the problem list is generated, subjective and

objective data are reviewed, and the severity and

acuity of the problems are assessed and

prioritized, the next step in the problem-oriented(i.e., SOAP) approach is to create a plan

The purpose of the care plan is to determine,

with the patient, how to manage his or hermedical conditions or illnesses successfully with

pharmacotherapy and includes all the work that

is necessary to accomplish this.


30/30

Pharmacists Care Plan

Patients Health Care

Need

Pharmacotherapeutic

Goals

Recommendations /

Measures

Monitoring Required

clinical pharmacy practice

Documents