An introduction to

Pharmaceutical care
Abuzar abdulwahab, B.Sc, M.Sc
Pharmacy practice department
College of pharmacy
Qassim university
10 march 2010

level (3) - lecture (2)

Introduction :
why patientfocused?
multiple practitioners writing prescriptions for a single
o
o

o
o
o
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o

patient, often without coordination and communication.

the large number of medications and overwhelming
amount of drug information presently available to
patient.
patients playing a more active role in the selection and
use of medications.
an increase in the complexity of drug therapy;
an increase in self-care through alternative and
complementary medicine.
a high level of drug-related morbidity and mortality
which results in significant human and financial costs.
4 in 5 people over 75 y presciped 1 drug, with 36%
taking 4 medicines.
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Matern
al Care
Pediatric
Care

Eye
Care

Nursing
Care

Nutrition
al
Care
Geriatric
Pharmaceutical
Care

care

Patient

Surgical
care
Physiotherap
y
SelfCare
care

Pharmaceutica
l
services

Menta
l
Herbal
Healt
medicine h
Care
3

What is the
pharmaceutical
care ?

Pharmaceutical care :
The philosophy of pharmaceutical care is
centered on 4 primary element :
1. Social need to address DRPs
2. Patient-centered approach to meet
this need
3. Practice based on caring about and
for patients
4. Responsibility for finding and
responding to DRPs
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Pharmaceutical care :
pharmaceutical care is the responsible
provision of drug therapy for the
purpose of achieving definite
outcomes that improve a patients
quality of life

1.
2.

What is the key words in previous definition ?

.
.
Is it different to what pharmacist have been doing for years ?

Pharmaceutical care :

The basis of pharmaceutical care is

responsibility and accountability to patients
for the outcome of their drug therapy.
The overall goal of pharmaceutical care is to
maintain patients at the highest possible level
of functional and psychosocial well-being
through optimal management of drug therapy.
Pharmaceutical care requires continuity of
care between different practice settings.
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Pharmaceutical care :

What pharmacists often fail to do is to

accept responsibility (accountability)regardless of the source (prescription,
nonprescription, alternative, or traditional
medicines), for this care. Consequently
they may not adequately document,
monitor and review the care given.
Accepting such responsibility is essential
to the practice of pharmaceutical care.
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Pharmaceutical care :

In this practice, the pharmacist evaluates

a patients medicine-related needs, then
determines whether one or more drug
therapy problems exist, and, if so, works
with the patient and other health care
professionals to design, implement and
monitor pharmaceutical care plan.

This plan should be kept as simple as

possible
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Pharmaceutical care :

Ideally all patients who receive

pharmaceutical products or
services should also receive
pharmaceutical care

What the differences between pharmaceutical care ?

pharmaceutical product ?
pharmaceutical services ?

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What is the drug

therapy problems ?

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Drug therapy
problem :

An undesirable event, a patient

experience that involves, or is
suspected to involve drug
therapy, and that actually or
potentially, interferes with a
desired patient outcome

What is the difference between the medical problem and

drug therapy problem ?

13

Medication problem
check list :
The following list covers the range
of DRPs that could be
encountered by pharmacist
seeking to deliver pharmaceutical
care :

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DRPs :

Untreated indications. The patient has a

medical problem that requires drug therapy
but is not receiving a drug for that indication

Improper drug selection. The patient has

a drug indication but is taking the wrong
drug, or is taking a drug that is not the most
appropriate for the special needs of the
patient

Subtherapeutic dosage. The patient has a

medical problem that is being treated with
too little of the correct medication
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DRPs :

Failure to receive medication. The patient has a

medical problem that is the result of not receiving
a medication due to economic, psychological,
sociological, or pharmaceutical reasons.
Overdosage. The patient has a medical problem
that is being treated with too much of the correct
medication.
Adverse drug reactions. The patient has a
medical problem that is the result of an adverse
drug reaction or adverse effect.
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DRPs :

Drug interactions. The patient has a medical

problem that is the result of a drug-drug, drug-food,
or drug-laboratory test interaction.

Drug use without indication. The patient is taking

a medication for no medically valid indication.

Treatment failures. The patient has a medical

problem that is being treated with a medication that
is generally considered appropriate for the
indication, but the desired therapeutic outcome is
not achieved.
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DRPs :

Therapeutic duplication
Allergic reaction to prescribed drug
Problem arising from the financial impact
of medication therapy on the patient
Lack of understanding of the medication
therapy by the patient
failure of the patient to adhere to the
medication therapy
Interference with medical therapy by
social recreational drug use
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DRPs :

Do not forget the word of the last

semester

PRIME
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Evaluate each drug :

Indications

NO

Discontinue and evaluate

Yes
Effective

NO

Increase dose
Initiate additional agent
Alternative agent

Yes
Adverse effect

Yes

Decrease dose
Less toxic alternative

NO
Is cost an issue

Yes

Use generic
Substitute with less costly
agent

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Evaluate entire regimen :

Yes
Duplicate therapy ?

Drug interaction ?

Can regimen be
Simplified ?

Discontinue and evaluate

Yes

Change drug
Dose
Schedule
Or preparation

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Evaluate adherence :

Can the patient

or Caregiver
administer
Medication as
Prescribed ??

NO

Provide verbal and written

instruction
Consider adherence aid
Other educational materia
(videos, books

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The major functions of pharmacist

in providing pharmaceutical care :

1
To insure that the patient drug therapy is
appropriately indicated, the most
effective available, the safest possible, the
most convenient to take, and the most
economical.
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The major functions of pharmacist

in providing pharmaceutical care :

2
Identify, resolve, and
prevent any drug
therapy problems
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The major functions of pharmacist

in providing pharmaceutical care :

3
Ensure that the patient
therapeutic goal are met
and that optimal healthrelated outcomes are
attained
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Clinical Pharmacy Role in Reducing Risks

Admission medication history
Formulary
Prescribing protocols
Allergy check
Prospective review
Administration instructions
Clinical pharmacy
Drug distribution system

Opportunity
For Error
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What if we are not there!

Admission medication history
Formulary
Prescribing protocols
Allergy check
Prospective review
Administration instructions
Clinical pharmacy
Drug distribution
system

Opportunity
For Error
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Adapted by P.Thornton from J. Reason, 9/01

How to practice
pharmaceutical
care ?
Practice principles

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Patients receiving or
requiring
a pharmaceutical
product or service

Initiate relationship
with patient
or care giver

Develop a care
plan and goals
Of therapy

Implement
Follow-up
evaluation

Identify and
Prioritize actual
or potential DRPs

Gather patient
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information
(Subjective and
Objective)

Patient assessment
(Assess information)
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Subjective data :

Subjective section include information that is

given by the patient, family, caregiver, it include
complain/symptom (chief complain)
History of present illness
Past medical history
Medication history
Allergies
Family history
Social history
Review of system
patient's thoughts or feelings and perceptions of
his/her condition or disease
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Objective data :

The objective section includes data

that obtained from the pt and that can
be measured objectively, it includes
Vital signs
Physical finding
Laboratory test result
Serum drug concentration
Diagnostic test
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Assessment :

A brief but complete description

of the problem, including
diagnose that supported logically
by the above subjective and
objective data

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Goals of therapy :

Clearly defined (measurable or observable).

established in collaboration with pt and other
member of health team provider
Should be realistic
With multiple medical problem, the practitioner
must consider the therapeutic objective for
each problem separately and in aggregate
Avoidance of ADRs
Convenience
Cost-effectiveness
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Goals of therapy :
Example of clinical out comes :
Curing a disease
Eliminate or reduce patient symptoms
Arresting or slowing the disease
process
Preventing an un wanted condition
(COC, immunization, prophylaxis)
Improving the quality of life
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Care Plan :
Detailed description of
Recommended further workup
(lab, radiology, consultation)
Treatment (diet, medication,
physiotherapy)
Patient education
Monitoring and follow up
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Documentation :

Documenting a patient care encounter is a

critical step in PC process, as it create a
valuable communication tool for future
encounter with that patient and with other
health care professionals
More than just filling out a form, it should
facilitate good patient care.
Evidence of PC activities
Accurate subjective & objective information
Focusing in DRPs
Plan to resolve any problem that were identified
Plan for future follow up.
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SOAP note :

Common and universally recognized

format for documentation pt information
in health care system is the SOAP note,
which is an acronomy that stand for
S subjective
O objective
A assessment
P ... plan
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The End
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