Emtenan AlHarbi , MSc.

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Pharmaceutical Care Introduction to Concepts
pharmacist role
PHCL 313

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

Fall 2011
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Objectives

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

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Objectives

• Recognize patient drug related needs
• Be familiar with the main categories of drug
  related problems
• Understand practice standards and ethical
  considerations

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From products to patients Evolution of Pharmacy
Practice
1900-1960
1850-1900
Late 1960s-1980s
1990- present
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Pharmaceutical Care

• The responsible provision of drug therapy for
  the purpose of achieving definite outcomes that
  improve a patients quality of life

Helper Strand 1990
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Pharmaceutical Care
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Philosophy of Pharmaceutical Care

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

Pharmacists work with and for the patient to
optimize the outcomes of medication therapy.
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The need for Pharmaceutical Care?
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Patient-Centered Practice

• A cornerstone of the philosophy of pharmaceutical
  care practice
• Care 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
  

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Meeting the health care needs of a patient
Patient
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Patients Drug Related Needs

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

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Patients Drug Related Needs

• The medication is safe
• There are no adverse drug reactions being
  experienced.
• There are no signs of toxicity.
•  
• The patient is compliant
• The patient is willing and able to take the
  medications as intended.

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Patients Drug Related Needs

1. Patients have all drug therapies necessary to
   resolve any untreated indications

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Unmet patient needs lead to drug related problems
(DRPs)

• Appropriate indication for each medication
• An effective drug product
• A safe drug product
• Be able to use and comply with the drug regimen
• Need drug therapy for untreated conditions

• Unnecessary drug therapy

• Inappropriate drug, low dose

• ADR or high dose

• Inappropriate compliance the drug regimen

• Need additional drug therapy

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Categories of drug therapy problems

• INDICATION
• Unnecessary drug therapy
• Needs additional drug therapy
• EFFECTIVENESS
• Ineffective drug
• Dosage too low

• SAFETY
• Adverse drug reaction
• Dosage too high
• CONVENIENCE of Therapy
• Noncompliance/
• nonadherence

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Requirements to be a Pharmaceutical Care
Practitioner
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What are the requirements to be a Pharmaceutical
Care Practitioner?

• Develop a therapeutic relationship with each
  patient
• Understand ones responsibilities
• identify and respond to any DRP for every
  patient.
• Learn the patient care process
• Use a systematic approach to make rational drug
  therapy decisions Pharmacotherapy Workup

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What are the requirements to be a Pharmaceutical
Care Practitioner?

1. Have an appropriate knowledge base and clinical
   skills
2. Understanding of practice standards and ethical
   considerations.
3. Documentation of all care provided

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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.

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Why is therapeutic relationship is important?

• Facilitate retrieval of information
• Patient as the Primary Source of Information
• positively influence the patient's decisions
• Patient as Decision Maker
• learn from the patient the actual impact of the
  drug therapy
• Use patient as Teacher

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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 problems
• organizes the interventions that need to be made
  on the patient's behalf
• establishes appropriate parameters to evaluate at
  follow-up

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Focus of Pharmacotherapy Workup

• Is the patient's problem caused by drug therapy?
  
• Can the patient's problem be treated with drug
  therapy?

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Patient Care Process
Initiate relationship with the patient or
caregiver
Gather patient information(subjective and
objective)
Assess information(patient assessment)
Develop patient care plan
Complete the intervention
Implement follow-up
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Patient Care Process

• describes the interaction between the patient and
  the practitioner
• Involves 3 steps

Continuous
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• Pharmacotherapy Workup
• is 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

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Documentation

• critical and essential step
• if you didnt document it, you didnt do it.
• Systematic documentation styles, different
  format
• SOAP (subjective, objective, assessment, plan),
• Places importance on intervention
• most common, universally recognized
• TITRS (title, introduction, text, recommendation,
  signature)
• an assessment approach
• FARM (findings, assessment, recommendations,
  management)
• places importance on monitoring.

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information that is given by the patient, family
members, significant others, or care-givers.
data that are obtained from the patient and that
can be measured objectively.
Summarizes pharmacist critical thinking and
analysis of the patient needs and DRP
Document 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
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Why Documentation is Important?

• Provides a permanent record of patient
  information
• Provides evidence of patient care activities by
  the pharmacist
• Communicates essential information to other
  pharmacists and healthcare professionals
• Serves as a legal record of patient care that was
  provided

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Oath of Pharmacists

• I will consider the welfare of humanity and
  relief of human suffering my primary concerns

King Saud University Pharmacy Code of Ethics/oath
of pharmacist Adopted by the membership of the
American Pharmacists Association October 27,
1994.
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Beneficence

• Doing what is best for the patient
• Involves decisions related to medical indications
  
• Base decision on risk-benefit assessment
• Negotiate with the patient the decision
• Example
• A patient with asthma and diabetes needs a course
  of steroids for worsening asthma, but the
  steroids will make diabetes control more
  difficult.

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Nonmaleficence

• Do no harm
• linked to the principle of beneficence
• Benefit risk assessment
• Any risk gtgtgt potential harm
• Example
• Forcing a treatment on a patient, regardless of
  any justification

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Veracity ?????

• Telling the truth about during all aspects of
  patient care
• Basis of therapeutic relationship
• Pharmacists should demonstrate sensitivity and
  thoughtful communication skills.
• Example
• Withholding information about treatment
• Being vague, or mumble information

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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..etc
• Deciding if a drug to be added/deleted from the
  formulary

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Fidelity ???????

• relates "to the concept of faithfulness and the
  practice of keeping promises
• Example
• upholding the profession's code of ethics

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Autonomy ????? ??????

• Autonomy
• patient having the freedom to make choices for
  him or herself
• conditions
• Patient clearly informed about care plan
• Cognitively competent
• Example
• Surgery vs. pharmacotherapy

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Autonomy

• Paternalism
• overriding or ignoring preferences of patients to
  benefit them or enhance their welfare. It
  represents the judgment that beneficence takes
  priority over autonomy
• Paternalism is not an option unless in certain
  circumstances
• patient is incompetent, child

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Confidentiality

• The act to protect patient medical and personal
  information
• Example
• 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

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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..
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Standards of Professional Performance for
Pharmaceutical Care Practitioners

• Pharmaceutical Care practitioner is accountable
  to maintain his professional practice through
• Self regulation
• Self evaluation

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Standards of Professional Performance for
Pharmaceutical Care Practitioners

• Quality of care
• Ethics
• Collegiality
• Collaboration
• Education
• Research
• Resource Allocation

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Standard I Quality of Care

• The practitioner evaluates his/her own practice
  in relation to professional practice standards
  and relevant statutes and regulations

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Standard II Ethics

• The practitioner's decisions and actions on
  behalf of patients are determined in an ethical
  manner

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Standard III Collegiality

• The pharmaceutical care practitioner contributes
  to the professional development of peers,
  colleagues, and others.

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Standard IV Collaboration

• The practitioner collaborates with the patient,
  significant others, and health care providers in
  providing patient care.

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Standard V Education

• The practitioner acquires and maintains current
  knowledge in pharmacology, pharmacotherapy, and
  pharmaceutical care practice.

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Standard VI Research

• The practitioner routinely uses research findings
  in practice and contributes to research findings
  when appropriate.

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Standard VII Resource Allocation

• The practitioner considers factors related to
  effectiveness, safety, and cost in planning and
  delivering patient care.