Pharmaceutical Care Skills II Lecture PDF

PHARMACEUTICAL CARE SKILLS II Dr. Wael Y Khawagi Dr. Abdullah A Alshehri Dr. Fahad A BaAli PharmD, MSc, PhD PharmD, MSc, PhD PharmD, MSc, PhD [email protected] [email protected] [email protected] No...

PHARMACEUTICAL CARE SKILLS II Dr. Wael Y Khawagi Dr. Abdullah A Alshehri Dr. Fahad A BaAli PharmD, MSc, PhD PharmD, MSc, PhD PharmD, MSc, PhD [email protected] [email protected] [email protected] No List of Topics 1 Introduction and Interviewing the patient and taking history 2 Collection of patient's data 3 Drug Therapy Problems 4 Patient-centered pharmaceutical care. Assessment 5 Patient-centered pharmaceutical care. Care Plan 6 Patient-centered pharmaceutical care. Follow-up Evaluation 7 Patient-centered pharmaceutical care. Documentation 8 Patient case presentation 9 Patient counselling process 10 Medication counseling workshop 1 11 Medication counseling workshop 2 12 Mock OSCE 13 OSCE 2 ASSESSMENT Percentage of Total # Assessment task Week Due Assessment Score 1 Assignments 4-5 10% 2 Midterm Exam 7-8 30% 3 OSCE 14-15 20% 4 Final Exam The end of term 40% Total 100% Interviewing the patient and taking history 4 Introduction Basic functions of a clinical pharmacist: Monitor prescriptions Optimisation of therapy Influence drug selection and use Implement policies Inform colleagues (liaison) Medication history and Medicines Reconciliation Education and counselling Clinical research Drug information 5 Interviewing the patient and taking history The patient interview is the primary way of obtaining comprehensive information about the patient in order to provide effective patient-centered care, and the medication history component is the pharmacist’s expertise A comprehensive patient interview includes inquiring about the patient's medical, medication, social, personal, and family history, as well as a thorough review of systems and possibly a physical examination 6 Interviewing the patient and taking history There are two distinctly different approaches to preparing for a patient interview. The first approach is to review all that is known about the patient’s medical condition and medications and then target the interview to specific issues identified during the review. This approach is commonly used when patients are admitted to acute care or long term care institutions where physicians and nurses have already documented at least some patient information. The advantages of this approach are that The pharmacist has some knowledge of the patient before the interview and can prepare to explore and address specific issues ; the pharmacist may feel more comfortable having this knowledge before interacting with the patient. The disadvantage of this approach is that Important information may be overlooked if the pharmacist becomes too focused or unduly influenced by previously obtained information. INTERVIEWING THE PATIENT AND TAKING HISTORY The second approach is to interview the patient before reviewing any previously documented patient information. Community-based pharmacists rarely have access to information about patients and must be able to conduct effective interviews without knowing the patients or their histories. The advantage of this approach is that The pharmacist is completely unbiased about each patient and the patient’s history, which allows the exploration of all aspects of the medication history with equal intensity. The disadvantage of this approach is that It can be an intimidating and time-consuming process for the inexperienced interviewer.  PATIENT-ORIENTED PROCESS SKILLS 1. Knock on the door and request permission to enter the room of the institutionalized patient. 2. Introduce yourself. 3. Try to achieve privacy. 4. Make sure the patient is comfortable. 5. Communicate at eye level or lower. 6. Remove distractions (loud television, radio, relatives, and friends). 7. Clarify the purpose of the interview. 8. Obtain the patient’s permission for the interview. 9. Verify the patient’s name and correct pronunciation. 10. Address the patient by the appropriate title. 11. Maintain eye contact with the patient. Communication Skills 1. Provide clear instructions regarding the structure of the 13. Give feedback to the patient. Ask, “Is this what you mean?” interview and expectations for the patient. 14. Obtain feedback from the patient. 2. Use a balance of open-ended and closed-ended questions. 15. Attend to patient cues (posture, tone of voice, affect). 3. Use vocabulary geared to the patient. 16. Invite the patient to ask questions. 4. Use nonbiased questions. 17. Answer patient questions. 5. Give the patient time to respond. 18. Use transitional statements and summarization. 6. Interrupt or redirect as necessary but do not interrupt when 19. Close the interview. the patient is on track. 7. Listen to the patient; do not cut off the patient. 8. Discuss one topic at a time. 9. Move from general to specific topics. 10. Pursue unclear answers to questions until they are clarified. 11. Ask simple questions. 12. Identify and recognize patient feelings. Verbally acknowledge 10 inappropriate or hostile feelings. Avoid Using technical language and medical jargon Frequently interrupting the patient Asking leading questions Allowing frequent interruptions (phone calls, beepers) Expressing bias and personal prejudices Maintaining a closed posture Reading notes and charts during the interview Adopting a superior or threatening posture Avoiding eye contact with the patient Engaging in sarcasm Making derogatory statements about other health care professionals Ignoring emotion displayed by the patient Speaking too quickly or too slowly or mumbling Asking multiple questions Asking rapid-fire questions SAMPLE OF INTERVIEW QUESTIONS GENERAL QUESTIONS Have you ever had trouble breathing or had a rash Do you take any prescription medications? after taking a medication? What prescription medications are you taking? Have you ever had any bad reactions to a medication? If so, can you describe what happened? Do you take any nonprescription medications (medications that you can buy without a prescription)? Can you describe your routine for taking your If so, what nonprescription medications are you taking? medications? Do you take any complementary and alternative medicines (for example, herbal supplements)? If so, what complementary and alternative medicines are you taking? Are you allergic to any medication? CONT. TARGETED QUESTIONS Have you ever taken any other prescription/nonprescription medications? Have you ever taken any other complementary and alternative medicines? When did you start/stop taking the medication? When did you find out you were allergic to the medication? What did you do when you had the allergic reaction to the medication? Did you take any medication to treat the allergic reaction? Do you ever miss any doses of your medications? Do you ever take more or less than the prescribed dose of your medications? Can you show me how you use your inhaler? When did you start smoking? How many packs per day do you smoke? Thank you 14