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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