Download Power point presentation - NHS Education for Scotland

Pharmacy
Pharmaceutical Care Planning
Vocational Training Scheme:
Level = Stage 2
Arlene Shaw
Specialist Clinical Pharmacist, NHS Tayside
Quality Education for a Healthier Scotland
Aim and Objectives
Pharmacy
AIM
To provide pharmacists with an overview of how to complete
pharmaceutical care plan as part of the Pharmacy Vocational
Training Scheme
OBJECTIVES
 to identify the key issues associated with a specific
pharmaceutical care plan
 to describe the care issues, actions and outputs associated with
a specific pharmaceutical care plan
 to record investigations as part of a pharmaceutical care plan
Quality Education for a Healthier Scotland
Introduction
Pharmacy
PHARMACY VOCATIONAL TRAINING SCHEME
 Competency based training scheme that enables pharmacists to
demonstrate competence through learning from experience in
the workplace.
PHARMACY VOCATIONAL TRAINING SCHEME
 Competency based training scheme that enables pharmacists to
demonstrate competence through learning from experience in
the workplace
Quality Education for a Healthier Scotland
Evidence
Pharmacy




Essential to demonstrate your personal involvement
Include a variety of clinical areas
Must reflect on each piece of evidence
No patient identifiable information
 Use Care Plan on NES Pharmacy Website
 Require 12 care plans, 4 of which should be
accompanied by a more detailed case study.
Quality Education for a Healthier Scotland
Cover Page
Pharmacy
Short summary (-200 words)
 Describe case
 Reasons for choosing case
Reflection
 Learning from developing the care plan
 Feedback from tutor
 Implications for future practice
Sign Off
 From the appropriate clinical specialist
Quality Education for a Healthier Scotland
Care Plan Page 1
Pharmacy
Patient Details
Patient Stay
 What brought the patient into hospital?
 Symptom / signs not diagnosis
Medical History / Drug History
 Try and match these sections up
Non-Drug Treatment
 E.g. physiotherapy, speech and language therapy etc
Continuity of Care
 Discharge details
Quality Education for a Healthier Scotland
Care Plan Page 2
Pharmacy
Factors affecting –
 Individual factors relevant to pharmacy practice
 Inform pharmaceutical issues






Absorption e.g. co-prescription of antacids
Distribution e.g. plasma protein binding
Metabolism e.g. age
Excretion e.g. renal failure
Ability to self medicate e.g. confusion
Route of Admin e.g. target site of action
Quality Education for a Healthier Scotland
Care Plan Page 2 cont.
Pharmacy
Clinical management
 Pharmaceutical need – requirement for pharmaceutical care
 Outcomes to consider:
 cure
 elimination or reduction in symptoms
 arresting or slowing disease progression
 prevention of disease / symptoms

 e.g. CAP – ensure appropriate antibiotics prescribed to
correctly treat infection, minimise risk of adverse drug
reactions
 e.g. hypertension – maintain blood pressure control in
order to reduce risk of future cardiovascular complications
 Include acute and chronic disease
Quality Education for a Healthier Scotland
Care Plan Page 2 cont.
Pharmacy
Current Medication
 List everything the patient was taking on admission
 Record allergies or NKA
Quality Education for a Healthier Scotland
Care Plan Page 3
Pharmacy
Pharmaceutical Care Plan
CARE ISSUE
• “An element of a pharmaceutical need which requires to be
addressed by a pharmacist”.
• What is the problem? Something which prompts a pharmacist to
“do” something.
 Take into account patient and medication risk
factors
 Consider each problem in turn
Quality Education for a Healthier Scotland
Care Plan Page 3 cont.
Pharmacy
 Categories to consider:
 Untreated indication
 Improper dug selection
 Sub-therapeutic dose
 Failure to receive medication
 Overdosage
 Adverse drug reactions
 Drug interactions
 Medication use without indication
Quality Education for a Healthier Scotland
Care Plan Page 3 cont.
Pharmacy
DESIRED OUTPUT
 Statement of what a pharmacist aims to achieve for a patient in
relation to a care issue
 What do you want to achieve as a pharmacist?
 SMART
 Specific
 Measurable
 Achievable
 Realistic
 Time-bound
Quality Education for a Healthier Scotland
Care Plan Page 3 cont.
Pharmacy
ACTION
 An action a pharmacist takes to address a care issue for a
patient
 What did you as a pharmacist do?
 Relate to evidence base / demonstrate knowledge of EBM
 Ideas to consider
 Recommending therapy
 Monitoring
 Patient counselling
 Confirm medication for discharge
Quality Education for a Healthier Scotland
Care Plan Page 3 cont.
Pharmacy
OUTPUT
 Response of the health team and /or patient to the pharmacists actions,
and/or the clinical outcome for the patient

What did you achieve as a result of your action?

Should be a direct result of your input.

Compare with desired output to evaluate
effectiveness of the action taken.
Quality Education for a Healthier Scotland
Care Plan Page 3 cont.
Pharmacy
Problem:
- Patient admitted is found to be
hyperkalaemic and is on an ACE inhibitor
which may be contributing to this condition.
Care issue:
- As above
Desired output:
- Avoid medicines which may contribute to
hyperkalaemia
- Potassium within reference range
- ? Appropriate treatment of hyperkalaemia
as per local guidelines
Quality Education for a Healthier Scotland
Care Plan Page 3 cont.
Pharmacy
Action:
- Review all medicines for potential
ADR
- Discuss potential ADR with the medical
team and suggest witholding / stopping
potential contributing agents
- Monitor Potassium
- ? Check local guielines to ensure
appropriate treatment of hyperkalaemia
Output
- ACEi witheld ?others
- Potassium within reference range
- ? Appropriate treatment
Quality Education for a Healthier Scotland
Care Plan Page 4
Pharmacy
Review Dates
Investigations
 Relate to care issues
 TDM
Quality Education for a Healthier Scotland
Final Points....
 Complete all sections of care plan
 Choose simple cases
 Remember training is progressive!
Quality Education for a Healthier Scotland
Pharmacy
Questions
Pharmacy
Any questions?
Email: [email protected]
Quality Education for a Healthier Scotland