clinical pharmacy practice
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Clinical Pharmacy Practice
Prepared by:
Cedrix Cuaderno RPh, BS Ind Pharm.
Adamson University
College of Pharmacy
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Patient Profile
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Patient Demographics
The individual characteristics of each patientcreate the context for all of your clinicalactivities.
Patient demographic information is needed tosee each patient as a unique individual.
The purpose of the patient demographic
portion of your assessment is to determinewho your patient is and to provide adescription of him or her at the time of theassessment.
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Patient Demographics
Your goal is to observe and elicit information
describing the personal characteristics of the
patient that are relevant to making drug
therapy decisions.
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Patient Demographics
Age of the Patient
Age is a vital statistic when providingpharmaceutical care as it is often applied to both
the discovery of the indication for drug therapy aswell as the appropriate choice ofpharmacotherapy to manage the disease orillness.
The patient's age is also required for selectingappropriate products and dosage forms suitablefor his or her age group, and for dosing guidelines(pediatric, geriatric).
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Patient Demographics
Age of the Patient
Age is best identified and documented as birth
date, so that age can be continuously updatedas you provide care year after year.
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Patient Demographics
Height and Weight
Each patient's height and weight should bedocumented so it can be used for dosageindividualization.
In many situations observational estimates ofbody weight are sufficient, but for extremely
obese patients, or infants and children, andwhen using medications that require precisedose to body weight determinations, the exactweight of your patient must be known.
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Patient Demographics
Height and Weight
Estimates for Adult Body Weight, Mass, and Surface Area
Ideal body weight males (kg) = 50 kg + [2.3 x inches > 5'0"]
Ideal body weight females (kg) = 45 kg + [2.3 x inches > 5'0"]
Body mass index (kg/m2) = (weight in kg)/(height in meters)2
Body surface area (m2) = ((height in cm) x (weight in kg/3600))1/2
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SOAP NOTES
Subjective
Objective
Assessment
Plan
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SOAP NOTES
SUBJECTIVE
Information that explains or delineates the
reason for the encounter.
Information that the patient reports concerning
symptoms, previous treatments, medications
used, and adverse effects encountered.
These are considered nonreproducible databecause the information is based on the patient's
interpretation and recall of past events.
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SOAP NOTES
SUBJECTIVE
Chief complaint
Medical History
Review of Systems (ROS) / Physical
Examination (PE)
Social History
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SOAP NOTES
OBJECTIVE
Information from physical examination,
laboratory results, diagnostic tests, pill counts,and pharmacy patient profile information.
Objective data are measurable and
reproducible.
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SOAP NOTES
ASSESSMENT
A brief but complete description of the
problem, including a conclusion or diagnosisthat is supported logically by the above
subjective and objective data.
The assessment should not include a
problem/diagnosis that is not defined above.
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SOAP NOTES
PLAN
A detailed description of recommended or
intended further workup (laboratoryradiology, consultation), treatment (e.g.,
continued observation: physiotherapy, diet,
medications, surgery), patient education (self-
care, goals of therapy, medication use andmonitoring), monitoring, and follow-up
relative to the above assessment.
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Drug Therapy Timeline
Shows the time when the drugs are
administered
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Drug Therapy Assessment Worksheet
Drug Related Problems
1. Correlation between drug therapy and medical problems
2. Appropriate drug selection
3. Drug regimen
4. Therapeutic duplication
5. Drug allergy or intolerance
6. Adverse drug events
7. Interactions: drugdrug, drugdisease, drugnutrient, and
drug-laboratory test8. Social or recreational drug use
9. Failure to receive therapy
10. Financial impact
11. Patient knowledge of drug therapy
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Drug Therapy Assessment Worksheet
The DTAW will serve as a guide to identify any
drug-related problems that your patient may
have.
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Drug Therapy Assessment Worksheet
The DTAW will serve as a guide to identify any
drug-related problems that your patient may
have.
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Drug Therapy Assessment Worksheet
The DTAW will serve as a guide to identify any
drug-related problems that your patient may
have.
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Drug Therapy Assessment Worksheet
The DTAW will serve as a guide to identify any
drug-related problems that your patient may
have.
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Drug Therapy Assessment Worksheet
The DTAW will serve as a guide to identify any
drug-related problems that your patient may
have.
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Drug Therapy Problem List (DPTL)
Drug therapy problems are the clinical domain of
the pharmaceutical care practitioner.
The purpose of identifying drug therapyproblems is to help patients achieve their goals
of therapy and realize the best possible
outcomes from drug therapy.
Drug therapy problems are a consequence of
drug-related needs that have gone unmet. They
are central to pharmaceutical care practice.
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Drug Therapy Problem List (DPTL)
Definition A drug therapy problem is any
undesirable event experienced by a patient
which involves, or is suspected to involve,
drug therapy, and that interferes with
achieving the desired goals of therapy.
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Drug Therapy Problem List (DPTL)
Components of a Drug Therapy Problem
1. An undesirable event or risk of an event
experienced by the patient.The problem can take the form of a medical
complaint, sign, symptom, diagnosis, disease,
illness, impairment, disability, abnormal laboratory
value, or syndrome. The event can be the result of
physiological, psychological, sociocultural, or
economic conditions. ,
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Drug Therapy Problem List (DPTL)
Examples:
"Mr. M.'s elbow pain is not being effectively
controlled because the dosage of ketoprofen hehas been taking for the past three days is too low
to provide relief."
"Mrs. W. requires additional calcium
supplements in order to prevent osteoporosis."
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Pharmacists Care Plan
After the problem list is generated, subjective and
objective data are reviewed, and the severity and
acuity of the problems are assessed and
prioritized, the next step in the problem-oriented(i.e., SOAP) approach is to create a plan
The purpose of the care plan is to determine,
with the patient, how to manage his or hermedical conditions or illnesses successfully with
pharmacotherapy and includes all the work that
is necessary to accomplish this.
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Pharmacists Care Plan
Patients Health Care
Need
Pharmacotherapeutic
Goals
Recommendations /
Measures
Monitoring Required