Steps In Providing Pharmaceutical Care (PC) To Patients

A stepwise approach would ensure consistency and make it easy to adopt pharmaceutical care in a practice setting. Cipolle et al. (1998) have defined pharmaceutical care as a nine-step process. Strand identified the three basic components as: assessment of patient needs; development of a care plan; and follow up evaluation. This post, although portraying a similar process, delineates six steps in the overall process.

Steps in pharmaceutical care

Practice Principles Of Pharmaceutical Care

Steps In Pharmaceutical Care Process

1. Data Collection

1.1 The pharmacist conducts an initial interview with the patient for the purposes of establishing a professional working relationship and initiating the patient's pharmacy record. In some situations (e.g. pediatrics, geriatrics, critical care, language barriers) the opportunity to develop a professional relationship with and collect information directly from the patient may not exist. Under these circumstances, the pharmacist should work directly with the patient's parent, guardian, and/or principal caregiver.

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1.2 The interview is organized, professional, and meets the patient's need for confidentiality and privacy. Adequate time is devoted to assure that questions and answers can be fully developed without either party feeling uncomfortable or hurried. The interview is used to systematically collect patient-specific subjective information and to initiate a pharmacy record which includes information and data regarding the patient's general health and activity status, past medical history, medication history, social history (including economic situation), family history, and history of present illness. The record should also include information regarding the patient's thoughts or feelings and perceptions of his/her condition or disease.

1.3 The pharmacist uses health/physical assessment techniques (blood-pressure monitoring, etc.) appropriately and as necessary to acquire necessary patient-specific objective information.

1.4 The pharmacist uses appropriate secondary sources to supplement the information obtained through the initial patient interview and health/physical assessment. Sources may include, but are not limited to, the patient's medical record or medical reports, the patient's family, and the patient's other healthcare providers.

1.5 The pharmacist creates a pharmacy record for the patient and accurately records the information collected. The pharmacist assures that the patient's record is appropriately organized, kept current, and accurately reflects all pharmacist-patient encounters. The confidentiality of the information in the record is carefully guarded and appropriate systems are in place to assure security. Patient-identifiable information contained in the record is provided to others only upon the authorization of the patient or as required by law.

2. Information Evaluation

2.1 The pharmacist evaluates the subjective and objective information collected from the patient and other sources then forms conclusions regarding: (1) opportunities to improve and/or assure the safety, effectiveness, and/or economy of current or planned drug therapy; (2) opportunities to minimize current or potential future drug or health-related problems; and (3) the timing of any necessary future pharmacist consultation.

2.2 The pharmacist records the conclusions of the evaluation in the medical and/or pharmacy record.

2.3 The pharmacist discusses the conclusions with the patient, as necessary and appropriate, and assures an appropriate understanding of the nature of the condition or illness and what might be expected with respect to its management.

3. Formulating A Plan

3.1 The pharmacist, in concert with other healthcare providers, identifies, evaluates and then chooses the most appropriate action(s) to: (1) improve and/or assure the safety, effectiveness, and/or cost-effectiveness of current or planned drug therapy; and/or, (2) minimize current or potential future health-related problems.

3.2 The pharmacist formulates plans to effect the desired outcome. The plans may include, but are not limited to, work with the patient as well as with other health providers to develop a patient-specific drug therapy protocol or to modify prescribed drug therapy, develop and/or implement drug therapy monitoring mechanisms, recommend nutritional or dietary modifications, add non-prescription medications or non-drug treatments, refer the patient to an appropriate source of care, or institute an existing drug therapy protocol.

3.3 For each problem identified, the pharmacist actively considers the patient's needs and determines the desirable and mutually agreed upon outcome and incorporates these into the plan. The plan may include specific disease state and drug therapy endpoints and monitoring endpoints.

3.4 The pharmacist reviews the plan and desirable outcomes with the patient and with the patient's other healthcare provider(s) as appropriate.

3.5 The pharmacist documents the plan and desirable outcomes in the patient's medical and/or pharmacy record.

4. Implementing The Plan

4.1 The pharmacist and the patient take the steps necessary to implement the plan. These steps may include, but are not limited to, contacting other health providers to clarify or modify prescriptions, initiating drug therapy, educating the patient and/or caregiver(s), coordinating the acquisition of medications and/or related supplies, which might include helping the patient overcome financial barriers or lifestyle barriers that might otherwise interfere with the therapy plan, or coordinating appointments with other healthcare providers to whom the patient is being referred.

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4.2 The pharmacist works with the patient to maximize patient understanding and involvement in the therapy plan, assures that arrangements for drug therapy monitoring (e.g. laboratory evaluation, blood pressure monitoring, home blood glucose testing, etc.) are made and understood by the patient, and that the patient receives and knows how to properly use all necessary medications and related equipment. Explanations are tailored to the patient's level of comprehension and teaching and adherence aids are employed as indicated.

4.3 The pharmacist assures that appropriate mechanisms are in place to ensure that the proper medications, equipment, and supplies are received by the patient in a timely fashion.

4.4 The pharmacist documents in the medical and/or pharmacy record the steps taken to implement the plan including the appropriate baseline monitoring parameters, and any barriers which will need to be overcome.

4.5 The pharmacist communicates the elements of the plan to the patient and/or the patient's other healthcare provider(s). The pharmacist shares information with other healthcare providers as the setting for care changes, in order to help maintain continuity of care as the patient moves between the ambulatory, inpatient or long-term care environment.

5. Monitoring And Modifying The Plan/Assuring Positive Outcomes

5.1 The pharmacist regularly reviews subjective and objective monitoring parameters in order to determine if satisfactory progress is being made toward achieving desired outcomes as outlined in the drug therapy plan.

5.2 The pharmacist and patient determine if the original plan should continue to be followed or if modifications are needed. If changes are necessary, the pharmacist works with the patient/caregiver and his/her other healthcare providers to modify and implement the revised plan as described in "Formulating the Plan" and "Implementing the Plans" above.

5.3 The pharmacist reviews ongoing progress in achieving desired outcomes with the patient and provides a report to the patient's other healthcare providers as appropriate. As progress towards outcomes is achieved, the pharmacist should provide positive reinforcement.

5.4 A mechanism is established for follow-up with patients. The pharmacist uses appropriate professional judgement in determining the need to notify the patient's other healthcare providers of the patient's level of adherence with the plan.

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5.5 The pharmacist updates the patient's medical and/or pharmacy record with information concerning patient progress, noting the subjective and objective information which has been considered, his/her assessment of the patient's current progress, the patient's assessment of his/her current progress, and any modifications that are being made to the plan. Communications with other healthcare providers should also be noted.

6. Document Activities

Pharmaceutical care activities must be documented in the appropriate data forms. This step runs throughout the entire pharmaceutical care process. Documentation provides evidence for what was done, audit trail, and continuity of care when another pharmacist is on duty. Furthermore, it accumulates data for practice research. Product oriented pharmacists keep records about their drugs while patient oriented pharmacists maintain patient records. Cipolle et. al. have noted that documentation generates three types of records namely:

1. pharmaceutical care patient chart, created primarily for the practitioner's use;

2. patient's personalized pharmaceutical care plan, generated for the patient's use;

3. and practice management report that is used to manage the practice.

These records can be maintained manually, electronically or a combination of both.