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  • Emtenan AlHarbi , MSc.Clinical Pharmacy Department College of Pharmacy

    *Pharmaceutical Care: Introduction to Concepts & pharmacist roleFall 2011PHCL 313

  • Objectives*At the end of this lecture students should be able to: Understand the need for pharmaceutical care Define pharmaceutical care and its philosophyDescribe the requirements for pharmaceutical care Understand the patient care process and therapeutic relationship.

  • Objectives*Recognize patient drug related needsBe familiar with the main categories of drug related problemsUnderstand practice standards and ethical considerations

  • 1850-19001900-1960Late 1960s-1980s1990- presentFrom products to patients: Evolution of Pharmacy Practice

  • Pharmaceutical CareThe responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patients quality of life Helper & Strand 1990

  • Pharmaceutical Care

  • Philosophy of Pharmaceutical Care Societal need for pharmacists to address drug-related problems A patient-centered approach to meet this needA practice based on caring about and for patientsA responsibility for finding and responding to the patients drug therapy problems.

  • The need for Pharmaceutical Care?*

  • Patient-Centered Practice*A cornerstone of the philosophy of pharmaceutical care practiceCare that places the patient's needs as the focus of the clinician's work Care that maintains the patient as a "holistic" being and does not fragment the patient into disease groups, organ systems, or drug categories

  • Meeting the health care needs of a patient*Patient

  • Patients Drug Related Needs*The medication is appropriateLegitimate clinical indication for each medication.All of the patient's medical conditions that can benefit from drug therapy have been identified.The medication is effectiveThe most effective drug product is being used.The dosage of the medication is sufficient to achieve the goals of therapy.

  • Patients Drug Related Needs*The medication is safeThere are no adverse drug reactions being experienced.There are no signs of toxicity.The patient is compliantThe patient is willing and able to take the medications as intended.

  • Patients Drug Related Needs*Patients have all drug therapies necessary to resolve any untreated indications

  • Unmet patient needs lead to drug related problems (DRPs)Appropriate indication for each medicationAn effective drug productA safe drug product Be able to use and comply with the drug regimenNeed drug therapy for untreated conditions

    Inappropriate drug, low dose Unnecessary drug therapyInappropriate compliance the drug regimenADR or high doseNeed additional drug therapy

  • Categories of drug therapy problemsINDICATIONUnnecessary drug therapy Needs additional drug therapyEFFECTIVENESSIneffective drugDosage too lowSAFETYAdverse drug reaction Dosage too highCONVENIENCE of TherapyNoncompliance/ nonadherence

  • *Requirements to be a Pharmaceutical Care Practitioner

  • What are the requirements to be a Pharmaceutical Care Practitioner?*Develop a therapeutic relationship with each patient Understand ones responsibilitiesidentify and respond to any DRP for every patient.Learn the patient care processUse a systematic approach to make rational drug therapy decisions Pharmacotherapy Workup

  • What are the requirements to be a Pharmaceutical Care Practitioner?*Have an appropriate knowledge base and clinical skillsUnderstanding of practice standards and ethical considerations. Documentation of all care provided

  • Therapeutic Relationship*The therapeutic relationship is a partnership or alliance between the practitioner and the patient formed for the purpose of optimizing the patient's medication experience.

  • Why is therapeutic relationship is important? *Facilitate retrieval of informationPatient as the Primary Source of Informationpositively influence the patient's decisions Patient as Decision Makerlearn from the patient the actual impact of the drug therapyUse patient as Teacher

  • Pharmacotherapy Workup*The logical, structured and rational thought process that guides work and decisions as the clinician:assesses the patient's drug-related needs and identifies drug therapy problemsorganizes the interventions that need to be made on the patient's behalfestablishes appropriate parameters to evaluate at follow-up

  • Focus of Pharmacotherapy Workup *

    Is the patient's problem caused by drug therapy?

    Can the patient's problem be treated with drug therapy?

  • Patient Care ProcessInitiate relationship with the patient or caregiverGather patient information(subjective and objective)Assess information(patient assessment)Develop patient care planComplete the interventionImplement follow-up

  • Patient Care Process*describes the interaction between the patient and the practitionerInvolves 3 steps:

    Continuous

  • *Pharmacotherapy Workupis the cognitive work occurring in the mind of the practitioner while caring for the patient.The mental part of pharmaceutical care

    Patient Care Process is what the patient experiences when he/she receives pharmaceutical care.The physical work of pharmaceutical care

  • Documentation* critical and essential stepif you didnt document it, you didnt do it. Systematic documentation styles, different format: SOAP (subjective, objective, assessment, plan), Places importance on interventionmost common, universally recognizedTITRS (title, introduction, text, recommendation, signature)an assessment approachFARM (findings, assessment, recommendations, management)places importance on monitoring.

  • information that is given by the patient, family members, significant others, or care-givers. *Summarizes pharmacist critical thinking and analysis of the patient needs and DRPDocument actions that were or need to be taken to resolve any problems that have been identified. Sufficient detail needs to be included without being too lengthy,. Include FU and Monitoring

  • Why Documentation is Important?*Provides a permanent record of patient informationProvides evidence of patient care activities by the pharmacistCommunicates essential information to other pharmacists and healthcare professionalsServes as a legal record of patient care that was provided

  • Oath of Pharmacists*I will consider the welfare of humanity and relief of human suffering my primary concernsKing Saud University Pharmacy Code of Ethics/oath of pharmacistAdopted by the membership of the American Pharmacists Association October 27, 1994.

  • Beneficence*Doing what is best for the patientInvolves decisions related to medical indications Base decision on risk-benefit assessmentNegotiate with the patient the decisionExample: A patient with asthma and diabetes needs a course of steroids for worsening asthma, but the steroids will make diabetes control more difficult.

  • Nonmaleficence*Do no harmlinked to the principle of beneficenceBenefit: risk assessmentAny risk >>> potential harmExample: Forcing a treatment on a patient, regardless of any justification

  • Veracity *Telling the truth about during all aspects of patient careBasis of therapeutic relationshipPharmacists should demonstrate sensitivity and thoughtful communication skills.Example: Withholding information about treatment Being vague, or mumble information

  • Justice *Relates to fair, equitable, and appropriate treatment in the light of what is due or owed to persons

    Example: Discrimination because of political status, religion, gender, financial status..etcDeciding if a drug to be added/deleted from the formulary

  • Fidelity *relates "to the concept of faithfulness and the practice of keeping promises

    Example: upholding the profession's code of ethics

  • Autonomy *Autonomy: patient having the freedom to make choices for him or herselfconditions: Patient clearly informed about care planCognitively competentExample: Surgery vs. pharmacotherapy

  • Autonomy*

  • Confidentiality*The act to protect patient medical and personal informationExample: disclose personal health-related information about your patient with one of your friends or family members who is not a health care provider and who is not involved in the care of that patient.Designing a consultation room with opaque glass

  • Caring for others is a privilege that is reserved for those individuals who are uniquely well prepared and who adhere to standards for professional behavior..

    *

  • Standards of Professional Performance for Pharmaceutical Care Practitioners*Pharmaceutical Care practitioner is accountable to maintain his professional practice throughSelf regulationSelf evaluation

  • Standards of Professional Performance for Pharmaceutical Care Practitioners*Quality of careEthicsCollegialityCollaborationEducationResearchResource Allocation

  • Standard I: Quality of Care*The practitioner evaluates his/her own practice in relation to professional practice standards and relevant statutes and regulations

  • Standard II: Ethics*The practitioner's decisions and actions on behalf of patients are determined in an ethical manner

  • Standard III: Collegiality*The pharmaceutical care practitioner contributes to the professional development of peers, colleagues, and others.

  • Standard IV: Collaboration*The practitioner collaborates with the patient, significant others, and health care providers in providing patient care.

  • Standard V: Education*The practitioner acquires and maintains current know

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