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Pharmaceutical care

Pharmaceutical care: Definition, Principle and Procedure

HOSPITAL PHARMACY

Alok Bains

5/26/20235 min read

pharmaceutical care: Principles and Procedure.

Compiled by: Alok Bains

Pharmaceutical care: Definition, Principles and Procedure to provide Pharmaceutical care.

Definition

ASHP Definition: “Pharmaceutical care is the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life.”

There are three elements in the Pharmaceutical care definition. These are medication-related, care and outcome.

  1. Medication-Related: Pharmaceutical care is not only medication therapy medication selection, dosages, routes of administration, medication therapy monitoring, the provision of medication-related information and patient counselling.

  2. Care: Pharmacists have unique knowledge and skill to ensure the optimal outcome of the medication. Pharmacists’ one-to-one professional relationships provide direct care to the patients in their best interest. Pharmacists cooperate with other professionals to design, implement and monitor therapeutic planS for the best therapeutic outcome and to improve the quality of the life of patients.

  3. Outcomes: Outcomes are prevention of disease, arrest or slow down of the disease process, reduction in the symptoms, and cure of the disease.

Principles and Procedure to Provide Pharmaceutical Care.

Pharmacists are gatekeepers to check unintentional harm due to medication. They are accountable for patient outcomes. That should be ensured by the pharmacists’ actions and decisions. Pharmaceutical care is a matter of direct personal, professional and responsible relationship with a patient to ensure optimum medication. This must lead to improvements in the patient’s quality of life.

Goal: To improve an individual patient’s quality of life by achieving predefined medication-related therapeutic outcomes.

Principles to Provide Pharmaceutical Care

Following principles shall be followed to achieve the goal of Pharmaceutical care.

  1. Professional Relationship with Patients: The relationship between pharmacist and patient should be based upon caring, trust, open communication, cooperation and mutual decision. Pharmacists should use their caring attitude, knowledge and skills to protect patient welfare. Pharmacists should encourage patients to provide personal information and preferences and to participate in therapeutic plans willingly. There should be a mechanism round o clock access to pharmaceutical care.

  2. Patient-specific medication information: All subjective and objective information related to the patient's past and present medical history, social history, diet and exercise history, illness history, general health and activity status, financial status and insurance policy status should be collected/generated. These all must be accurate and complete because these are required for drug therapy plans. These all are confidential information and must be maintained properly.

  3. Availability of medicines and information: Pharmacists shall develop drug therapy plans depending upon the conditions or diseases of the patient. A drug therapy plan shall be developed considering the psycho-social aspect of the disease, the complexity of the disease, the cost of treatment and patient adherence. Pharmacists shall explain all the pros and cons of the therapy plan and the benefits of one therapy plan over another. Pharmacists shall assure that the patient has clearly understood the disease condition and therapy plan.

  4. Monitoring: The pharmacist shall be responsible to monitor the progress of the outcome of the therapy plan. Pharmacists shall coordinate with changes in the therapy plan to assure the safety and effectiveness of the therapy plan and to minimise overall healthcare costs. Progress of outcome shall be informed to the patient, caregiver of the patient and other healthcare providers.

  5. Documentation: All these shall be accurately documented and communicated to the patient, caregiver and other healthcare providers. This document shall also be helpful in the change of any healthcare provider. It helps in the continuity of a care for long duration.

Procedure to Provide Pharmaceutical Care

Pharmacists shall observe the following steps for effective pharmaceutical care.

  1. Data Collection: The pharmacist establishes a professional relationship with the patient. They conduct an interview with the patient to collect data and initiate a pharmacy record. Sometimes, it is not possible to collect data from the patient such as paediatric patients, geriatric patients and ICU patients, or due to language barriers. Under these conditions, the patient's guardian or caregiver is consulted to collect the data.

    The interview shall be conducted in a professional manner with maintaining the confidentiality and privacy of the patient. Question-answer sessions during the interview shall be carried out without any hurry or feeling of uncomforted. A systematic interview shall be preferred for subjective information and to initiate pharmacy records. Information such as the patient's general health, medical history, social history, family history, illness history, previous prescription of diseases, activity status, thoughts, feelings, etc shall be collected during a friendly interview.

    Necessary patient objective information shall be collected by using health assessment techniques such as blood pressure, body temperature, heartbeat rate, ECG, etc. These are the primary source of information.

    Secondary sources of the information are patients’ other health care providers, patients’ medical records, patients’ medical histories etc.

    Pharmacist accurately develops a pharmacy record of the patient. Pharmacists shall accurately organise the pharmacy record to assure entry of all conversations between pharmacist and patient. Pharmacy records shall not be disclosed to anyone without permission from the patient. It can be disclosed only by the order of the court of law.

  2. Information evaluation: Pharmacists shall evaluate all the subjective and objective information in the patient record. On the basis of this information pharmacists shall decide the followings:

    1. To improve the effectiveness, safety and economy of drug therapy

    2. To minimise drug and health-related problems

    3. Time to consult a pharmacist in future.

    The pharmacist shall record the conclusion of the evaluation and discuss it with the patient. The pharmacist shall assure that the patient has understood the nature of the illness and the outcome of drug therapy.

  3. Appropriate action plan: The pharmacist shall consult with other healthcare providers to select the most appropriate action

    1. To improve the effectiveness, safety and economy of drug therapy

    2. To minimise drug and health-related problems

    The pharmacist shall identify in consultation with other health care providers and patient identify the patient's need to determine the drug therapy outcome. They will formulate a plan to achieve desired drug therapy outcome. They will develop Patient-specific drug therapy or modify already prescribed drug therapy, implement a drug therapy monitoring mechanism, develop a dietary plan or modify an already prescribed dietary plan, add non-prescription medication and refer to another institute if required.

    From time to time, the pharmacist shall review the plan and desired outcome with the patient and other healthcare professionals. The pharmacist shall document all their actions in the pharmacy record

  4. Action plan implementation: The pharmacist involves the patient to implement an action plan. The implementation shall include clarification of prescription, modification of prescription, education of patient and caregivers to understand action plan and illness, coordination of medication supplies, initiation of drug therapy, coordination with healthcare providers to whom the patient is referred, action to overcome financial burden on the patient, action to overcome lifestyle barriers, etc.

    Pharmacists shall also assure the arrangement of drug therapy monitoring such as laboratory examination, blood pressure monitoring, blood glucose testing, etc. Pharmacists shall educate patients to understand the usefulness of these monitoring, the necessity of medication and the application of medical devices in the home. The pharmacist shall record the entire steps implemented in an action plan in the pharmacy record.

  5. Monitoring and modifying the action plan: The pharmacist shall regularly monitor the subjective and objective parameters of the patient to review them. The pharmacist and patient shall decide to continue or modify drug therapy depending outcome of the drug therapy. The pharmacist shall share the review report with the other healthcare professionals to decide the further line of action to achieve the desired result of drug therapy.

    The pharmacist shall establish a follow-up mechanism with the patient to monitor the drug therapy. The pharmacist shall always update the medical and pharmacy record of the patient with all information.