Download The Practitioner`s Responsibilities lecture 3

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The pharmaceutical care practitioner provides
direct patient care.
 the first responsibility is to the patient.
 a commitment to meet the patient's drugrelated needs whenever and wherever they
might arise.
 accountable to patients first and colleagues
second.
 patients' needs before personal needs and
all other obligations
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Provide comprehensive care of the same
quality to all patients.
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the practitioner will always perform the same set of
core functions.
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All of the following responsibilities must be
met for each patient, and they are considered
nonnegotiable with respect to providing
pharmaceutical care.
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become familiar with, and knowledgeable
about the whole patient and create a
pharmacologically relevant description of this
individual because many patient parameters
influence decisions regarding drug therapy.
accomplished when we understand the
patient's medication experience.
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for Appropriate Indication, Effectiveness,
Safety, and the Patient's Compliance
clinical questions about a patient's
pharmacotherapy must be asked: e.g
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Is the medication necessary?
Is it the best product?
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The answers to these questions will guide
practitioners in making decisions in a logical
manner using the Pharmacotherapy Workup.
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when positive outcomes occur, clinicians can
understand why these transpired, and learn from the
experience
when the patient experiences a negative outcome, it
is essential to take corrective action, and learn from
this experience.
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Pharmaceutical care practitioners will identify
these problems because no other practitioner
evaluates the patient's medications for drug
therapy problems
Drug therapy problems are costly to the patient
in terms of pain and suffering.
Treatment failures are also costly in terms of
hospitalizations, additional clinic visits, and
lost days at work or school.
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These goals of therapy guide the selection of
drug products and determine the acceptable
risk in selecting each dosage regimen.
Establishing achievable goals of therapy
requires an understanding of the patient's
preferences because goals represent a
negotiation between practitioner and patient.
Goals of therapy establish the criteria upon
which the outcomes of all pharmacotherapy are
evaluated, both positive and negative.
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Resolving drug therapy problems benefits the
patient directly.
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Practitioners intervene to resolve drug therapy
problems by taking actions
preventing drug therapy problems.
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When a specific patient is at an unacceptably high
risk of developing a side effect, toxicity, or
experiencing a treatment failure, the practitioner
identifies these individual risks and takes action to
prevent the problems from occurring.
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The responsibility to follow-up with the patient is
absolute.
if there is no follow-up
the patient may interpret this to mean that no one cares
about him/her.
 you will not know if the drug therapy was effective or if
it caused harm.
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It is unacceptable to make recommendations and
intervene with drug therapies in a patient's life
without determining the outcome of actions.
The follow-up evaluation works to strengthen the
therapeutic relationship.
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Once responsibility is taken for a patient's
medications, it is necessary to follow-up until a
successful outcome has been achieved.
It shows a lack of professional responsibility to
assume that someone else will accept the
responsibility or that patients will manage on
their own.
Continuous, excellent care is necessary for
patients to benefit optimally from their
medications.
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knowledge and skills are not enough to
guarantee success in practice.
A philosophy of practice is required to explain
how these responsibilities should be
conducted.
All practitioners within a profession adhere to
the same philosophy of practice thus creating
uniform behavior and standards.
Definition
 A philosophy of practice is a set of values that
guides the behavior of a professional.
 It helps the practitioner determine what is
important, how to set priorities, and how to
make clinical decisions and judgments.
 The philosophy of practice prescribes how a
practitioner should practice on a daily basis.
 It is a set of rules the practitioner must
follow to meet the standards of practice
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Two aspects of care
 Technical
 Demonstrating concern and
commitment to well-being of another
person.
In order to balance the aspects, the
practice of pharmaceutical care was
designed to be patient-centered.
When thinking and acting in a caring manner
with the patient at the center of the practice,
practitioners will
place the patients' needs, wants, and preferences before their own;
serve as advocates and do what is best for the patient, regardless of what it requires
on their part;
treat patients as individuals—be sensitive to cultures and belief systems, without
being patronizing or condescending;
respect patients' time and priorities by committing full attention to them;
remain conscious of patients' value system, and be prepared to identify and resolve
ethical dilemmas in an honest and straightforward manner.
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Pharmaceutical care practice is inherently
value-laden
Separate personal values from the professional
values that are required to provide care to
others.
in order to separate one set of values from
another, one must be conscious of what one's
personal values are.
To become conscious of these values, it is
necessary to engage in critical thinking in an
area usually referred to as values clarification.
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A personal set of values will include political
views, religious beliefs, social norms, personal
preferences, and influence from personal
experiences.
Practitioners must become consciously aware
of these personal values so that they know
when they create conflict in the practice setting.
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Every patient has a right to be treated
according to his/her unique character.
Every patient has a right to decide and act on
his/her own values to fulfill individual life
plans.
Every patient has a right to expect complete
objective information and the emotional
support necessary to act effectively on that
information.
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Every patient has the right, alone or through a
health care professional, to the control of
his/her time and effort.
Every patient has a right to expect whatever
benefit is possible in the health care setting and
to expect no avoidable harm.
Every patient has a right to expect that
agreements established with the health care
professionals will be kept.
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Every practitioner must be prepared to
recognize, and even prevent, situations with
moral and ethical implications.
This requires the practitioner has
 focused attention, and sensitivity to
recognize subtle clues that may indicate a
situation is laden with ethical components
 the knowledge and aptitude for making
logical, fair, and consistent decisions
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Basic professional behavior can help avoid
ethical dilemmas.
Each behavior is based on an ethical principle
Basic Professional Behaviors Expected in Practice
Professional behavior
Ethical principle
Do the very best you can for
every patient
Beneficence
In all cases, do no harm
Nonmaleficence
Tell the patient the truth
Veracity
Be fair
Justice
Be loyal
Fidelity
Allow the patient to be the
ultimate decision maker
Always protect your patient's
privacy
Autonomy/paternalism
Confidentiality
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The ethical practitioner will want to do what is
best for the patient.
negotiated between two parties rather than
imposed even if what is best for the patient
seems to be clinically obvious.
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the Hippocratic principle above all, do no harm.
At no time should the pharmaceutical care
practitioner aggressively force a treatment on a
patient.
the clinician who performs without due regard
for the patient's considerations acts
maleficently.
tell the truth at all times.
 Should we tell the truth at all times?
 Is it ever ethical not to tell the patient the truth?
 Can telling the truth harm people?
 If so, under what circumstances?
 Can we lie when we consider it in the best
interest of our patients?
 Does lying sometimes protect people?
 Why not deceive a patient if it promotes
his/her health and recovery?
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the truth will be told at all costs regardless of
the consequences.
Emotional strength, conscience, and often
clinical judgment can present barriers to truthtelling.
Truth-telling may be a skill that can be learned
with practice.
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Sensitivity and thoughtful communication
skills can be learned and polished with
experience.
Once initial formative trust is established and
a therapeutic relationship is developed,
honesty should be unconditional and
reciprocal.
Outline the expectation of truth, emphasize its
importance, and nurture its development.
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Justice is an ethical principle that relates to fair,
equitable, and appropriate treatment in the
light of what is due or owed to persons.
giving to some may deny receipt to others.
Not all patients can afford essential drugs
What are their responsibilities to the poor who
need assistance?
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the ethical pharmaceutical care practitioner to
make every effort to treat all patients equally
and assist those who are legitimately
disadvantaged by locating information and
programs that will meet their needs.
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Practitioners will be expected to adhere to the
principle of equality in so much as they care for
patients as equals regardless of ethnicity, class,
gender, or sexual preference.
Discrimination of any kind is unacceptable,
unethical, and intolerable
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relates to the concept of faithfulness and the
practice of keeping promises.
fidelity is related to trust as an essential part of any
meaningful therapeutic relationship.
Pharmaceutical care practitioners are expected to
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Be faithful to the society that grants the right to practice.
Keep the promise of upholding the profession's code of
ethics
to practice within the established scope of practice and
definition of (pharmaceutical care)
to remain competent in practice
to abide by the policies of employing institutions
to keep promises to individual patients.
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a patient having the freedom to make choices
for him or herself.
This does not mean that other individuals play
no role in influencing the choices people make
it means that individual choices are respected
and subsequent interventions are predicated on
respect.
Without it there can be no trust, no therapeutic
relationship, and no care.
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there are serious considerations to be taken into
account when formulating a care plan.
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Does the patient have a clear understanding of all
important facts and values?
How do I know if the patient is cognitively
competent and can make informed, autonomous
decisions?
Is the confused patient acting autonomously?
These questions may sound rhetorical, but they are
frequently asked, and uncertainty is common
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The trust that is built between practitioner and
patient is compromised without the assurance
of confidentiality.
you have a duty to protect a patient's personal
information from public view.
It is essential to further the free exchange of
information between patient and practitioner.
Patients must feel that anything they say, the
nature of their disease or illness, the
medications they take, or any other matter they
regard as private will be respected.
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practice responsibilities, the patient-centered
approach, and the ethical principles all lead to
a set of standards for professional performance.
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Caring for others is a privilege that is
reserved for those individuals who are
uniquely well prepared and who adhere
to standards for professional behavior.
The practitioner evaluates his/her own practice in
relation to professional practice standards and
relevant statutes and regulations.
 Measurement Criteria
1. The PCP uses evidence from the literature to
evaluate his/her performance in practice.
2. The PCP seeks peer review on a continual and
frequent basis.
3. The PCP utilizes data generated from his/her
practice to critically evaluate performance.
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self-regulating.
Colleagues hold other colleagues accountable
for the quality of the work that is performed.
starts with self-evaluation.
This helps each practitioner improve in
practice and contributes to maintaining high
standards of professional performance.
The practitioner's decisions and actions on behalf of
patients are determined in an ethical manner.
 Measurement Criteria
1.
The PCP maintains patient confidentiality.
2.
The PCP acts as a patient advocate.
3.
The PC P delivers care in a nonjudgmental and
nondiscriminatory manner that is sensitive to patient
diversity.
4.
The PCP delivers care in a manner that
preserves/protects patient autonomy, dignity, and
rights.
5.
The PCP seeks available resources to help formulate
ethical decisions.
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Second to providing high quality care is
providing care in an ethical manner.
The pharmaceutical care practitioner contributes
to the professional development of peers,
colleagues, and others.
 Measurement Criteria
1. The PCP offers professional assistance to other
practitioners whenever asked.
2. The PCP promotes relationships with patients,
physicians, nurses, and other health care
providers.
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impossible to become a great practitioner
without the support and assistance of
colleagues.
It is impossible to know everything,
experience everything and make the right
decision in all cases.
The practitioner collaborates with the patient,
significant others, and health care providers in
providing patient care.
 Measurement Criteria
1.
2.
The patient is seen as the ultimate decision maker,
and the practitioner collaborates accordingly.
The practitioner collaborates with the patient's
health care providers whenever it is in the best
interest of the patient.
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Patient care is collaborative.
The patient is complex.
Patient care is complex.
The health care system is complex.
Collaboration makes all of this manageable.
The practice of pharmaceutical care has been
developed to make collaboration relatively
easy and productive.
The practitioner acquires and maintains current
knowledge in pharmacology, pharmacotherapy,
and pharmaceutical care practice.
 Measurement Criteria
1.
The practitioner uses the skills of reflectivity to
identify areas where knowledge needs to be
supplemented.
2.
The practitioner continually updates knowledge
with journal subscriptions, current texts,
practitioner interactions, and continuing
education programs.
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closely associated with the first standard of
providing care.
It is impossible today to remain competent
without a rigorous schedule of continuing
education and collegial interaction.
invest both time and energy in remaining
current with your knowledge and competent in
your skills.
The volume and rate of knowledge expansion
makes this a necessity today
The practitioner routinely uses research findings in
practice and contributes to research findings when
appropriate.
 Measurement Criteria
1.
The practitioner uses research results as the basis
for practice.
2.
The pharmaceutical care practitioner
systematically reviews the literature to identify
knowledge, skills, techniques, and products that
are helpful in practice and implements them in a
timely manner.
3.
The practitioner approaches his/her practice with
a perspective to conduct applied research in
practice when appropriate.
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The expectation that research will serve as the
basis for decision making in practice is expressed
as evidence-based practice.
This is a requirement when a practitioner makes
decisions that will impact another person.
our knowledge is incomplete
clinicians make decisions in areas of uncertainty
on a daily basis.
The appropriate method for dealing with this is to
use our knowledge well, understand the limits of
the knowledge, and be able to recognize when
science is inconclusive on a topic.
The practitioner considers factors related to
effectiveness, safety, and cost in planning and
delivering patient care.
 Measurement Criteria
1.
The pharmaceutical care practitioner is sensitive
to the financial needs and resource limitations of
the patient, the health care providers, and the
institutions with which he/she interacts.
2.
Decisions are made by the pharmaceutical care
practitioner to conserve resources and maximize
the value of those resources consumed in practice
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All health care resources are limited whether it
be time, personnel, knowledge, or access to the
latest technology.
Decisions made by practitioners need to
recognize this, but always put the patient's best
interest first.