Pharmaceutical Care Practice Quiz

Introduction to Pharmaceutical Care Practice

• Integrated Therapeutics I
• Hanan Muzeyin (B.Pharm., MSc)
• Department of Pharmacology & Clinical Pharmacy, Addis Ababa University
• Email addresses provided
• Learning Objectives:
  • Differentiate the pharmacist's role in clinical pharmacy services.
  • Understand the development of clinical pharmacy and pharmaceutical care in Ethiopia.
  • Identify pharmacist roles and responsibilities in patient care.

Do We Still Need Pharmacists?

• Purchase and handling of medicines
• Non-pharmacists
• Compounding role
• Pharmaceutical manufacturers
• Medicine availability
• Pharmacies vs. supermarkets and local markets
• Doctors' offices, clinic nurses

Case Study 1

• Nine-month-old baby died from a 10-fold morphine overdose due to a misplaced decimal in the prescription.
• Physician ordered 0.5 mg IV morphine, but the order was transcribed as 5 mg.
• An experienced nurse administered 5 mg and repeated the dose two hours later.
• The baby stopped breathing four hours later.
• Incident occurred in 2001.
• Source mentioned: Washington Post, April 20, 2001.

Case Study 2

• 39-year-old female treated for metastatic breast CA at Dana Farber Cancer Institute in 1995.
• The patient was prescribed 4 grams per meter squared of cyclophosphamide for days 1 through 4.
• Correct dosage was 1 gram/meter squared daily.
• The patient received the total dose each day.
• Massive overdose caused death from cardiotoxicity.
• Location: Dana Farber Cancer Institute, Boston, Mass.

What is Wrong with the 'Old Model'?

• "Physicians prescribe, and pharmacists dispense" model is inadequate.
• Poor accountability.
• High healthcare costs from medication errors.
• Hospitalizations, doctor visits, lab tests, and remedial therapy.
• Adverse drug reactions.
• Non-compliance with medication regimens.
• Drug resistance.

Clinical Pharmacy and Pharmaceutical Care

• The old "Physicians Prescribe and Pharmacists Dispense" model is no longer sufficient.
• Goals: reduce drug therapy problems, ensure safety and effectiveness, ensure adherence to drug therapy.
• Proposed solution: concept of clinical pharmacy and pharmaceutical care

Clinical Pharmacy

• Defined as the area of pharmacy concerned with the science and practice of rational drug use.
• Includes services performed by pharmacists in hospitals, community pharmacies, home-based care services, clinics and other settings where prescriptions/medication are prescribed and used.

Pharmaceutical Care

• Defined as a patient-centered practice in 1997 where a practitioner assumes responsibility for a patient's drug needs.
• Key responsibility to optimize all aspects of a patient's drug treatment irrespective of sources.
• Ensures better patient outcomes and improved quality of life.
• This involves collaboration with other healthcare providers.
• Goal is to identify, solve, and prevent drug therapy problems.

Aim of Pharmaceutical Care

• Cure disease.
• Eliminate/Reduce symptoms.
• Stop/slow disease process.
• Prevent disease/symptoms.
• Pharmacist Responsibilities:
  • Ensure access to advice.
  • Ensure quality drug products.
  • Ensure rational drug use.
  • Empower patients to manage their health and treatment.

Pharmaceutical Care: Practitioner Actions

• Applies expert pharmacotherapeutic knowledge in practice to benefit the patient.
• Takes responsibility for optimizing a patient's drug therapy regardless of its source to achieve better outcomes and improve patient's quality of life.
• Collaborative effort with other healthcare providers.
• Uses a rational decision-making process.

Pharmaceutical Care: Practitioner Actions (cont.)

• Makes assessments of a patient's drug-related needs to identify drug therapy problems.
• Develops care plans.
• Conducts follow-up evaluations to ensure effectiveness and safety of drug therapies.

Pharmaceutical Care: Patient-Related Needs

• All patients have drug-related needs.
• Assessment includes the patient, medical conditions, and drug therapies to see if needs are met.
• Drug-related needs: indication, effectiveness, safety, compliance

Pharmaceutical Care: Medication Appropriateness

• The medication is appropriate when there is a valid clinical indication.
• All the patient's medical conditions that can benefit from drug therapy have been identified.

Pharmaceutical Care: Medication Effectiveness

• The most effective drug product should be utilized.
• The dosage should be sufficient to achieve the therapy goals.

Pharmaceutical Care: Medication Safety

• There should be no adverse drug reactions.
• There should be no signs of toxicity.
• Patient is willing and able to take medications as intended.
• Missing these needs can cause drug therapy problems.

Pharmaceutical Care: Practitioner Responsibilities

• Prevent drug therapy problems.
• Resolve drug therapy problems with the patient.
• Ensure therapy goals are achieved.
• Develops care plans for each medical condition.

Pharmaceutical Care: Complementing Existing Practices

• The goal is to complement existing practices to optimize and improve drug therapy safety and effectiveness.
• The pharmaceutical care practitioner is not intended to replace any other healthcare professional, but a new element of care within the system.

Why Pharmaceutical Care Practitioners Are Needed

• Complexities in drug therapy.
• Multiple products used.
• Overwhelming drug information.
• Multiple practitioners prescribing for the same patient.
• Increased patient involvement in therapy selection.

New Roles and Skills Required for Pharmaceutical Care

• Medical terminology, clinical use of drugs in disease, and patients' management.
• Pathophysiology and therapeutics.
• Therapeutic problem-solving.
• Communication (verbal and written).
• Literature evaluation.

Clinical Pharmacy Service in Ethiopia

• Pharmaceutical care is a primary role of a pharmacist or clinical pharmacist as a full-time career.
• Pharmacists are trained for 5 years, focusing on pharmacology, pharmacotherapy, and pharmaceutical care practices.
• Old curricula: focus on pharmacotherapy, clinical, and hospital pharmacy.
• New curricula introduced in 2008, nation wide.

Clinical Pharmacy Service in Ethiopia (cont.)

• Revised curricula (2008, 2015) are more patient-oriented, including pharmacy UG curriculum (4 years + 1-year internship).

Clinical Pharmacy Service in Ethiopia (cont.): FHRIG 2010

• Clinical pharmacists provide advice to doctors and nurses on the clinical use of medications, and economic drug utilization and safety.
• Direct patient care

Clinical Pharmacy Service in Ethiopia: FMHACA

• Pharmacists provide effective medication therapy management.
• Management of patient medication therapy.
• Education of clients on health-related issues.
• Participation in patient care regarding pharmacotherapy.
• Standard operating procedures related to providing clinical pharmacy services.

Pharmacotherapy Workup

• All patient care practitioners need a structured, rational thought process for making clinical decisions.
• The pharmacotherapy workup guides the decision-making process done by the clinician to assess patients' drug-related needs and identify drug therapy problems.

Pharmacotherapy Workup (cont.)

• Organizes interventions that need to be made on behalf of the patient.
• Establishes parameters to evaluate follow-up.
• Applies clinical knowledge and skills with a systematic thought process, for identification, stating the causes, prioritization, problem solving, and prevention of drug therapy issues.

Patient Care Process

• The patient care process describes the interaction between the patient and the practitioner.
• It is a guide, standard, descriptive method of the practitioner's work, and it allows for rational decisions.

Patient Care Process (cont.)

• A systematic approach involves four processes:
  • Assessing drug therapy needs and identifies DTPs
  • Developing a care plan
  • Implementing the care plan
  • Evaluating and reviewing the care plan.

Patient Care Process (cont.)

• Quality of assessment: depends on the relationship you establish.
• Success of the care plan is a result of the performed assessment.
• Outcomes the patient achieves are based on the decisions made.

Assessment

• A systematic review of a patient's drug-related needs.
• Understand the patient well enough to make rational drug decisions with and for them.
• Determine if the patient's drug therapy is appropriate, effective, and safe, and if the patient is compliant with his/her medications.

Assessment (cont.)

• Information required includes:
  • Patient data (demographics, medication experience)
  • Disease data (current conditions, history, review of systems, nutrition)
  • Drug data (current meds, past use, social drug use, immunizations, allergies)

Assessment Activities

• Elicit information from the patient.
• Make clinical decisions regarding medications and needs.
• Establish a therapeutic relationship.
  • Discuss the patient's medication experience.

Assessment (cont.)

• Medication experience: it includes the patient's approach to taking medication, beliefs, perceptions, attitudes, and behaviors towards drug therapy.
• Assessment involves effective communication with patients; caregivers or relatives; communicate with other health care team members; review/examination of patient records; consistently assess drug-related needs with the same systematic order

Case Studies

• Case Study 1: Patient with congestive heart failure developed bradycardia and a second-degree heart block due to unsafe drug therapy (high digoxin dose/drug interactions).
• Case Study 2: Patient with hypertension was found to be pregnant, and the therapy (ACE inhibitors) is undesirable during pregnancy.
• Case Study 3: Patient with TB was prescribed a drug therapy with a low dose.
• Case Study 4: Patient with asthma has good inhalation techniques.

Common Causes of Drug Therapy Problems (DTPs)

• Need for additional therapy.
• Indication, multiple drugs, nondrug methods, avoidable adverse reactions.
• Effectiveness: wrong drug, not effective for condition, inappropriate dosage form, inaccurate dose.
• Safety: undesirable reaction (not dose-related); safer drug needed because of risk factors; dosing regimen changed too rapidly.
• Compliance: misunderstand or unable to follow instructions.

Developing a Care Plan

• Purpose is to organize work to meet the goals.
• Organize care plans/medical conditions.
• Establish therapy goals.
  • Goals consist of a parameter, a value, and a timeframe.

Developing a Care Plan (cont.)

• Negotiate and agree upon endpoints and timeframe.

Developing a Care Plan (cont.)

• Select appropriate, individualized interventions to get desired results, and prevent new problems.

Follow-up Evaluation

• Evidence of actual patient outcomes and goals.
• Effectiveness.
• Safety (adverse drug reactions).
• Patient compliance.

Follow-up Evaluation (cont.)

• Document the clinical status and any changes.
• Assess for new DTPs (Drug Therapy Problems).
• Schedule the next follow-up evaluation.
• Clinical knowledge and experience.

Outcomes Status Terminologies

• Resolved: Goals achieved, therapy completed
• Stable: Goals achieved, continue therapy.
• Improved: Progress being made, continue same therapy.
• Partial Improvement: Progress made, minor adjustments required.
• Unimproved: No progress yet, continue same therapy.
• Worsened: Decline in health, adjust therapy.
• Failure: Goals not achieved, discontinue current therapy, initiate new therapy.
• Expired: Patient died while receiving the therapy.

Documentation

• Pharmaceutical care record/chart records information used, decisions made, and outcomes.
• Document all care, advice, services, and information given to the patient.

Reasons for Documentation

• High quality care; performance evaluation; justifies professional role; effectively manages large practices.
• Evaluate quantity and quality of care; evaluate economic impact; source of data in research/education.

Summary

• Lecture summary not provided in the given text, only the prompt.

Test your knowledge on the essentials of pharmaceutical care practice and the significant roles pharmacists play in patient care and clinical services. This quiz covers the evolution of clinical pharmacy in Ethiopia, the importance of proper medication management, and explores a critical case study in patient safety.