Theoretical knowledge of clinical pharmacy

1. Dr. L.T.M. Muungo
2011 - Date

2.  Pharmacists’ Patient Care Process
 Elements of Pharmaceutical Care Process
 Practice Principles of Pharmaceutical Care Process

4.  Review the development of the
Pharmacists’ Patient Care Process
 Describe the elements of the
Pharmacists’ Patient Care Process
 Discuss current strategies underway for
implementation
 Discuss case examples applying the
process
4

5.  JCPP Vision:
 Patients achieve optimal health and medication outcomes
with pharmacists as essential and accountable providers
within patient-centered, team-based healthcare.
5

6.  JCPP Strategic Plan: Consistent patient care
process identified as key driver for achieving
the JCPP vision
 Supports the profession’s provider status activities
 Needed to meet demands of evolving health care
system focused on triple aim
 Collaboration of national pharmacy
organizations working to develop a
standardized pharmacist patient care process
 Purpose: to stimulate consistency, predictability,
and measurability in pharmacists’ service delivery
6

7.  Activities: January 2012-May 2014
 Workgroup meetings
 Environmental scan
 Testing among clinicians
 Organizational feedback
7

8.  Review of key resources
 Pharmaceutical care – Strand & Cipolle
 Profession’s MTM definition and MTM Core Elements
 PCPCC Medication Management Resource Guide
 ACA language
 Nurse Practitioner’s Practice Standards
 Should apply to the wide variety of patient care
services provided by pharmacists AND the
pharmacist’s medication expertise
 Level of intensity varies depending on the service
 One pharmacist might be responsible for all the steps in
some settings where in others more than one pharmacist
may be involved at different stages of the process.
8

9.  Pharmacists’ Patient Care Process created to:
 Promote consistency across the profession.
 Provide a framework for delivering patient care in
any practice setting.
 Be a contemporary and comprehensive approach to
patient-centered care delivered in collaboration with
other members of the health care team.
 Be applicable to a variety of patient care services
delivered by pharmacists, including medication
management
9

10.  Foundational Components:
• Establishment of patient-pharmacist relationship
• Engagement and effective communication with
patient, family, caregivers
• Continually collaborate, document, and communicate
with physicians and other health care providers
• Process enhanced by interoperable information
technology systems that facilitate effective and
efficient communication
10

11.  Approved by JCPP
organizations in May
2014
 Supported by 13
national pharmacy
organizations
http://www.pharmacist.com/sites/default/files/JCPP_Pharmacists_Patient_Care_Process.pd
f
11

12. 12

13. The pharmacist assures the collection of necessary subjective
and objective information about the patient in order to
understand the relevant medical/medication history and
clinical status of the patient. Information may be gathered
and verified from multiple sources.
Collect:
 A current medication list and medication use history for
prescription and nonprescription medications, herbal
products, and other dietary supplements
 Relevant health data that may include medical history,
health and wellness information, biometric test results,
and physical assessment findings
 Patient lifestyle habits, preferences and beliefs, health
and functional goals, and socioeconomic factors that
impact access to medications and other aspects of care

14. The pharmacist assesses the information collected and
analyzes the clinical effects of the patient’s therapy in the
context of the patient’s overall health goals in order to
identify and prioritize problems and achieve optimal care.
Assess:
 Each medication for appropriateness, effectiveness,
safety, and patient adherence
 Health and functional status, risk factors, health data,
cultural factors, health literacy, and access to
medications or other aspects of care
 Immunization status and the need for preventive care
and other health care services, where appropriate

15. The pharmacist develops an individualized patient-centered
care plan, in collaboration with other health care
professionals and the patient or caregiver that is evidence-
based and cost-effective.
The plan:
 Addresses medication-related problems and optimizes
medication therapy
 Sets goals of therapy for achieving clinical outcomes in the
context of the patient’s overall health care goals and access
to care
 Engages the patient through education, empowerment,
and self-management
 Supports care continuity, including follow-up and

16. The pharmacist implements the care plan in collaboration with
other health care professionals and the patient or caregiver.
The pharmacist:
 Addresses medication- and health-related problems, and
engages in preventive care strategies, including vaccine
administration
 Initiates, modifies, discontinues, or administers medication
therapy as authorized
 Provides education and self-management training to the
patient or caregiver
 Contributes to coordination of care, including the referral or
transition of the patient to another health care professional
 Schedules follow-up care as needed to achieve goals of
therapy

17. The pharmacist monitors and evaluates the effectiveness of the
care plan and modifies the plan in collaboration with other
health care professionals and the patient or caregiver as needed.
Monitor and evaluate:
 Medication appropriateness, effectiveness, and safety and patient
adherence through available health data, biometric test results and
patient feedback
 Clinical endpoints that contribute to the patient’s overall health
 Outcomes of care, including progress toward or the achievement of
goals of therapy

18.  Comprehensive
medication review and
follow-up
 IV to oral anticoagulant
dosing
 Medication
reconciliation during a
care transition
 Diabetes management
 Immunization
18

19. Current
strategies
underway:
Outreach: Press release, presentations
Communications plan, toolkit, practice-setting specific case examples, and other materials
under development through JCPP
ACPE has incorporated the patient care process in PharmD standards 2016.
Pharmacy HIT Collaborative is using the process as a framework to develop structured
patient care documents to be used electronically via the electronic health record (EHR).
The Pharmacy Quality Alliance (PQA) is considering the process in developing quality
measures.
Projects (example): Patient care process is being used in a national patient safety
organization project to identify gaps in care.
Training (examples): The Alliance for Integrated Medication Management (AIMM)
Collaborative, several Center for Medicare and Medicaid Innovation (CMMI) grantees,
CE providers incorporating the process into education and training.

20. 20

21. 21

22. ELEMENTS OF PHARMACEUTICAL CARE

23.  Pharmaceutical Care is a patient-centered, outcomes
oriented pharmacy practice that requires the
pharmacist to work in concert with the patient and
the patient's other healthcare providers to promote
health, to prevent disease, and to assess, monitor,
initiate, and modify medication use to assure that
drug therapy regimens are safe and effective.

24.  The goal of Pharmaceutical Care is to optimize the patient's health-
related quality of life, and achieve positive clinical outcomes.
 A structured approach to achieve thesegoals:
1) It requires an established patient-to pharmacist relationship.
2) It requires records of medication to be kept and, with the patient’s
informed consent, additional patient specific information to be
collected, organized, recorded, monitored and maintained.
3) It requires patient-specific medical information to be evaluated and,
in the case of prescribed medicines, a therapy plan to be developed
involving the patient and the prescriber.
4) It requires the pharmacist to ensure that the patient has all supplies,
information, and knowledge, necessary to carry out the drug
therapy plan.
5) It requires the pharmacist to review, monitor, and modify the
therapeutic plan in concert with the patient and healthcare team.

25.  Elements to provide quality pharmaceutical care are:
(1) Knowledge and skills of personnel,
(2) Systems for data collection, documentation, and
transfer of information,
(3) Efficient workflow processes,
(4) References, resources and equipment,
(5) Communication skills,
(6) Commitment to quality improvement and
assessment procedures.

26.  The implementation of pharmaceutical care is
supported by knowledge and skills in the area
of patient assessment, clinical information,
communication, adult teaching and learning
principles and psychosocial aspects of care.
 To use these skills, responsibilities must be
reassessed, and assigned to appropriate
personnel, including pharmacists, technicians,
automation, and technology. A mechanism of
certifying and credentialing will support the
implementation of pharmaceutical care.

27.  The implementation of pharmaceutical care is
supported
systems
by data collection and documentation
that accommodate patient care
communications (e.g. patient contact notes, medical
and medication
communications (e.g.
history),
physician
inter-professional
communication,
pharmacist-to-pharmacist communication), quality
assurance (e.g. patient outcomes assessment, patient
care protocols), and research (e.g. data for
pharmacoepidemiology, etc.). Documentation systems
are vital for reimbursement considerations.

28.  The implementation of pharmaceutical care is
supported by incorporating patient care into the
activities of the pharmacist and other personnel.

29.  The implementation of pharmaceutical care is
supported by tools, which facilitate patient care,
including equipment to assess medication therapy
adherence and effectiveness, clinical resource
materials, and patient education materials.
 Tools may include computer software support, drug
utilization evaluation (DUE) programs, disease
management protocols, etc.

30.  The implementation of pharmaceutical care is
supported by patient-centered communication.
Within this communication, the patient plays a key
role in the overall management of the therapy plan.

31.  The implementation and practice of pharmaceutical
care is supported and improved by measuring,
care
assessing, and improving pharmaceutical
activities utilizing the conceptual framework of
continuous quality improvement.

32.  Pharmaceutical care involves the process through
which a pharmacist cooperates with a patient and
other professionals in designing, implementing, and
monitoring a therapeutic plan that will produce
specific therapeutic outcomes for the patient.

33. I
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34.  The pharmacist conducts interviews with the
patient in a setting designed to ensure privacy.
The data obtained is accurate, appropriately
organized and kept current. Patient data is
confidential and is provided to others only
with informed consent of the patient or as
required by law.

35.  The pharmacist, collaborating with other
healthcare providers and the patient, identifies
and evaluates the most appropriate action to
ensure the safety and effectiveness (including
cost effectiveness) of current or planned
pharmacotherapy and to minimize current or
potential future health-related problems.
 The pharmacist documents, in the patient’s
record, the plan and desirable outcomes for
each problem identified.

36.  The pharmacist works with the patient to
maximize patient understanding and
commitment to the pharmaceutical care
therapy plan.
 The pharmacist ensures that the patient knows
how to use all necessary medication and any
equipment associated with monitoring or
administration properly.

37.  The pharmacist regularly reviews the patient
progress towards achieving the desired outcomes
and provides a report to the patient’s other
healthcare providers as appropriate.
 As progress is achieved, the patient should receive
positive reinforcement to encourage continuing
co-operation.
 If the expected progress is not being achieved,
then the plan should be modified, applying the
principles used in formulating the original plan.

38.  When the desired outcomes have been
achieved, a follow up procedure should be
established to ensure the continued wellbeing
of the patient.

39.  Pharmaceutical care reflects a systematic
approach in making sure that the patient gets
the right medicines, in the right dose, at the
right time and for the right reasons.

40. Any Questions or Additions

42. Reference:
1. Clinical Skills for Pharmacists, A Patient-Focused Approach, 3rd Ed, ISBN 978-0-
323-05485-0, by Karen J Tetze, 2012
2. Clinical Pharmacy & Therapeutics, 5th Ed, ISBN – 978-0-7020-4294-2, by Roger
Walker & Cate Whittlesea, 2012
3. Clinical Anatomy and Physiology of the visual Views, 3rd Ed, ISBN: 978-1-4377-
1926-0, by Butterworth-Heinemann, 2012.
4. Clinical Guidelines : Diagnosis and Treatment Manual, 7th Ed, ISBN: 2-906498-69-
6, By L.Blok (MD) et al.
5. Clinical Pharmacology, 9th Ed, ISBN 0443064814, by P.N. Bennett and M.J. Brown,
2003

43. Study Questions
 Define the following generic terms of pharmacy:
 [Clinical Pharmacy, Oedema, Hypothyroidism, Dosage, Medication, Compliance, Pharmaceutical Care,
Apothecary, Pharmaceutical compounding, Ayurvedic Pharmacy, Antiquity Pharmacy, Middle Ages Pharmacy,
Modern Pharmacy, Retail pharmacy, Alchemy, Remedy, Drug, Medicine, Cure, Care, Trephining, Millennium,
Symptoms, Renaissance, Disease, Illness, Microbes, Civilization, Herbal remedies, Usage, Side effects, Quantities,
Dosages, Storage, Pharmacopeia, Pharmacology, Pharmaceutics, Pharmacokinetics, Therapeutics, Pathophysiology,
Evolution, Patient counseling, Nutrition, Antibiotics, Chemotherapy, Pain management, Semiotician, Physician,
Pharmacist, Diagnosis, Mutual respect, Honesty/ Authenticity, Open Communication, Cooperation, Collaboration,
Empathy, Sensitivity, Promotion, Competence, Assurance, Confidence,etc]
 Respond to the following questions:
 In line with historical background of originality of pharmacy, How was disease thought of in early civilization
and how was it treated.
 What are some of the contributions to the practice of pharmacy from around the world regions such as Asia,
Greece, Roman Empire, Arabia,Europe.
 Why has there been a trend toward fewer independent pharmacies in some world
pharmaceutical established operations as compared to those of national institutes
 Historically, how has the role of the pharmacist evolved overtime to its present time nature
 Write on the ways the modern-day pharmacist has impacted patients’ health and safety
 State and explain the critical role of clinical pharmacy in a designed health sector
 Describe in details what is considered when demographic data is compiled
 State and explain the essential considerations in patient medication process
 Explain in details the process of Pharmaceutical care and it role and stages in the provision of patient care
 State and explain the critical components of patient counselling during medication process and how it can
effectively be provided.

44.  Group work discussional questions for Journal Club
Meetings:
 State and explain the critical role of clinical pharmacy in a designed
health sector
 Describe in details what is considered when demographic data is
compiled
 State and explain the essential considerations in patient medication
process
 Explain in details the process of Pharmaceutical care and its role and
stages in the provision of patient care
 State and explain the goals of Pharmaceutical Care plan as it is
designed for patient caring
 State and explain the effective elements of Pharmaceutical Care plan
as it is designed to provide desired and quality patient care
 State and explain the key concepts of Pharmaceutical Care plan as it is
considered to provide desired and quality patient care
 State and explain the critical components of patient counselling during
medication process and how it can effectively be provided.