Pharmacists’ Patient Care Process

• The objectives are to list and explain the components of the JCPP Pharmacists' Patient Care Process, identify examples of these components, and understand the role of clinical thinking in pharmaceutical care.
• Pharmacists should employ the patient care process in settings such as CVS, anticoagulation clinics, and Albany medical center ICUs.
• Pharmacists are responsible for more than just managing a patient's medications.
• Patient care involves considering who, what, where, when, and why.
• The Joint Commission of Pharmacy Practitioners envisions patients achieving optimal health and medication outcomes with pharmacists deemed essential and accountable providers in patient-centered, team-based healthcare.

Pharmacist's Patient Care Process

• It is a process centered around patient care via collaboration and communication.
• It involves documentation at every stage.
• The processes include:
  • Collect
    • Assess
    • Plan
    • Implement
    • Follow-up: Monitor and Evaluate

Collect

• Relevant information to collect includes:
  • Chief complaint (CC)
  • History of Present Illness (HPI)
  • Past Medical History (PMH)
  • Personal and Social History (SH)
  • Family History (FH)
  • Lab results/physical exam findings, including review of systems (ROS)
  • Current medication list
    • This includes prescription and nonprescription medications, herbals and other dietary supplements, and medical history
  • Lifestyle habits
  • Patient preferences and beliefs
  • Health and functional goals
  • Socioeconomic factors
  • Health Maintenance and immunizations
  • Patient-centered factors which affect care
  • Interpersonal and communication skills
  • Social determinants of health/Self-Care
• One must maintain professionalism and interview proficiency when collecting data

Assess

• Each medication should be assessed for appropriateness, effectiveness, safety, patient adherence, dose, and tolerability.
• Assessment should include:
  • Health and functional status
  • Risk factors
  • Cultural factors
  • Health literacy
  • Access to medications and other needs
  • Need for preventative care or healthcare
  • Immunizations
• Assessment also determines candidacy for self-care.

Plan

• Develop an individualized, patient-centered plan with the patient and other healthcare professionals that is evidence-based and cost-effective.
• Address medication-related problems to optimize therapy.
• Set patient-specific goals
• Engage patients through education, empowerment, and self-management.
• Incorporate follow-up in plan. Options include:
  • Pharmacologic and non-pharmacologic options
  • Referral to another healthcare professional or an additional healthcare professional

Implement

• Implementation involves executing the developed plan addressing any identified problems including vaccinations, initiating, modifying, discontinuing, or administering medication therapy as authorized.
• Education and self-management training should also be given to the patient.
• Care should be coordinated with other healthcare professional with appropriate follow-up.
• Communication is key for implementation, need patient engagement (teach back method, open-ended questions)

Follow-up

• Monitor and evaluate the effectiveness of the care plan.
• Continuous laboratory monitoring and patient feedback should be implemented regarding:
  • Medication appropriateness/effectiveness/safety
  • Patient adherence.
  • Clinical endpoints contributing to overall health.
  • Outcomes of care.
  • Progress towards goals
• Bring it full circle!

Patient Centered Care

• This involves providing "care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions,"
• The values of the patient guide the clinical decisions.
• Collaborate, communicate, and document it all.
• Unique processes would be needed for children, pregnant/lactating women, and geriatric patients.

Patient Cases

• Patient cases include "alphabet soup" scenarios, like R.R., a 55-year-old male with past medical history including diabetes, hypertension, peripheral neuropathy, anxiety, and insomnia.
• Patient cases include a chief compliant (CC) of wanting to take OTC Aspirin.
• Patient cases might address:
  • Treatment of a chief complaint
  • Disease state management
  • A provider question
  • Patient counseling
  • Drug information
• Extract all possibly-relevant information out of the available patient cases
• The key differences in patient cases presented in relation to self-care is the use of a standardized IPS template.

Patient Case Examples

• Case: T.C., a 33-year-old male, complained of an ear ache.
  • Questions to ask: Determine if the patient has tried anything yet so far.
  • Check allergies, past medical history, medications, and immunization status.
  • Ask about recent potential causes like Lake George swimming
  • No labs are available to determine cause of the pain.

Assessment for T.C.

• Consider whether other symptoms such as fever or cough are present, and directly assess the ear area for any indications of redness or inflammation

Plan for T.C.

• Recommending ibuprofen 400mg PO q6 PRN for inflammation and pain plus carbamide peroxide 6.5% 5–10 drops BID for up to 4 days if ear wax removal is needed.

Implementation for T.C.

• What the medication is:
  • How to take:
  • Monitor what for:
  • Answer the 3 prime questions.

In follow-up for T.C.,

• Patient needs to sees a provider if the symptoms do not resolve in 48 hours or if he has an adverse reaction to therapy
• Gather pertinent health information, determine why they are really here, and provide clear recommendations and instructions.
• Engage the 3 Prime questions along with realistic follow-up

A.L. Example Patient

• Patient A.L. is a mother of 3 presenting because she thinks her son has poison ivy.
  • Ask questions like if she has tried anything for him yet, if her son has any allergies or significant past medical history, if he takes any medications regularly, and if is he up to date on his immunizations.
• In this case, the son only takes Claritin during pollen season with no other allergies or significant PMH and is up to date on all immunizations.
• Determine if spread is a risk with additional children from son at the friends house
• The son has red, raised, itchy rash of the forearms, but no other symptoms.
• Recommending calamine lotion 8% apply to affected area externally as often as needed plus diphenhydramine 25mg PO at bedtime PRN, and encourage washing the area with mild soap and warm water to avoid infection.
• Implement, use the 3 prime questions
• A.L. should see a provider if rash continues to spread, reaches his eyes, or any other symptoms develop or for an adverse reaction to therapy.

Points to Remember

• Non pharmacologic counseling points are often as important as pharmacologic counseling.
• Clearly communicate recommendation to patient.
• It is important to collaborate with other providers as necessary
• Conclusion: You must be comfortable with reading a patient case to effectively collect, assess, plan implement and follow up, while documenting all actions and collaborating with the healthcare team.

Clinical Thinking

• ACCP defines clinical pharmacy as "that area of pharmacy concerned with the science and practice of rational medication use."
• Clinical pharmacy includes:
  • Comprehensive therapeutic knowledge
  • Experience
  • Problem-solving skills
  • Judgement
• Pharmacists monitor drug therapy before, during, and after.

What Questions Would You Ask

• Example: Mrs. B has had a cough for 2 weeks and wants help at the Hometown Pharmacy.
  • Relevant factors include age, comorbidities, PMH, SH, medications and allergies.
  • Ask what she has tried, whether anything worsens or improves the cough, quality of the cough, and if it is dry or wet.

Questions covering key aspects of the Pharmacists’ Patient Care Process, including patient assessment, the pharmacist's role in healthcare teams, and data collection. Includes medication review and care planning.