PHAR 442

1

Self Care Formulary 1:45-2:00SOAP Notes 2:00-2:50

Poster & Presentation Teamwork 2:50-3:00

Prepared by Paul J. Oesterman, Pharm.D. Introductory Experience Coordinator

and Associate Professor of Pharmacy PracticeModified and Presented by Andrew M. Draper, Pharm.D., MSA

Assistant Professor of Pharmacy Practice

November 21, 2011

LEARNING OUTCOMES

November 21, 20112

Describe the components of a formulary.Prepare an OTC Formulary for use at IPPE site

visits. List the components of a SOAP note.Identify and recognize where different information

is placed in a SOAP note.Individually prepare a sample SOAP note for a

simple case.As a team prepare a SOAP note for a complex case.When presented with the first two parts of a SOAP

note, complete the latter two parts.

Self Care Formulary

November 21, 20113

Formulary= List of productsRationale= Develop confidence in making self care recommendations

Table with 2 or 3 products per condition

Plan on laminating and keeping in labcoat pocket—handy reference guide when patients ask questions

Self Care Formulary

November 21, 20114

Headings for each medical condition selectedBrand/Generic Names/Active Ingredient(s)Dose/Directions for use (Adult & Pediatric)

List age-specific limitationsList OTC dosage-specific limitations

Adverse EffectsAlso identify how medications can affect other

patient medical conditionsContraindications/Warnings

Include pregnancy risk factor, special info for diabetic or hypertensive patients

Approximate Cost of TreatmentFor brand and generic for qty or usual duration of Tx

Self Care Formulary

November 21, 20115

6 Required Classes/Conditions Select one specific condition from each class

Fever/Pain/HeadacheCough/Cold/AllergyAcid-Peptic DisordersConstipation/DiarrheaOphthalmic/Otic ProductsDermatologic ProductsAnti-infective Agents

2 Selective Product Classes/ConditionsDiabetic DevicesSleep DisordersYour choice

A second condition within one of the required Classes/Conditions

8 TOTAL CLASSES/CONDITIONS REQUIRED

Self Care Formulary

November 21, 20116

4 Required Patient Categories1. Otherwise Healthy Adult2. Patient with Diabetes or

Hypertension3. Pregnant Patient4. Otherwise Healthy Pediatric

patient 1. Be sure to note age-specific

limitations

Sample Self Care Table

7

Brand/Generic Names

Usual Dose Adverse effects

Contraindications/Warnings

Pregnancy/Diabetes/HypertensionConsiderations

Cost/7 days

TylenolAcetaminophen

325-650mg po qid prn A

≥2 yo: 10-15mg/kg po q4h prn (max 5x/day)

Liver toxicity

NMT 3-4 g/24 hrs; EtOH use

Pregnancy Risk B $4.00 B$2.00 G

AdvilIbuprofen

200mg po qid prn A≥6 mo: 5-10 mg/kg

po qid prn

GI upset NMT 1.2 g/24 hrs OTC

Concurrent Rx NSAID use, Ulcer

Pregnancy Risk C/DMay cause ↑ in BP

$4.00 B$1.00 G

Bayer ASAAspirin

325mg po tid prn A81mg po qd

GI upset NMT 4 g/24 hrsHx of ulcer , FUO in

Peds, EtOH use

Pregnancy Risk C/DMay alter blood sugar

$1.75 B$1.00 G

Tylenol-PMAcetaminophenWith Diphenhy-

dramine

500mg APAP &25mg Diphenhy-

dramine≥ 12 yo: 2 po hs

prn

DrowsinessLiver

toxicity

May cause drowsinessContraindicated in

Peds < 12

Pregnancy Risk B $8.00 B

OTC TABLE FOR THERAPEUTIC CATEGORYExample- Pain

SOAP NOTE- Background

November 21, 20118

Most of the work we do in clinical medicine is problem based.

POMR- Problem Oriented Medical RecordAbout 40 years ago a Dr. Lawrence Weed

developed a system of “Problem oriented medical record.” 1

The SOAP note is a fundamental element.SOAP notes provide improved communication

between multiple providers and for multiple visits.1. Weed LL. Medical records, medical education, and patient care: the Problem-Oriented Medical

Record as a basic tool. Cleveland (OH): Press of Case Western Reserve University; 1970.

SOAP NOTES

November 21, 20119

Date and timeS = Subjective (Evaluative) Summary of relevant info given by the patient or

caregiversSummary of CC, HPI, PMH, Med Hx, ALL, SH, FH, and ROS

O = Objective (Measurable) Summary of quantifiable relevant data

Vital signs, lab results Imaging and pathology reports

A = AssessmentAn evaluation & interpretation of the subjective and

objective data in general termsP = Plan

Recommendation including goal and counseling

What does the “A” stand for in SOAP?

November 21, 201110

1. Administration2. Approval3. Assessment4. Appropriate

SOAP NOTE LABS

November 21, 201111

Hgb

HCT

WBC PLT CLNa

K CO2

BUN

sCr

Glucose

Remember from last PHAR 442 lecture

CBC CHEM 7

SOAP NOTE- Subjective from Nov. 19

November 21, 201112

Jane Smith is a 27 year old healthy single pharmacy student complaining of left sided abdominal pain. She felt fine until about two days ago when she became nauseated and developed sharp abdominal pain in the RLQ. At that time she vomited. She used an over the counter “Emetrol” medication which provided her some relief but her nausea and vomiting persisted. She went to her PCP who admitted her to the hospital.

SH= No ETOH, occasional smoking

SOAP NOTE- Objective

November 21, 201113

General: Fatigued appearing young woman in apparent acute abdominal distress

Physical Exam: Rebound tenderness in the abdominal RLQEmesis basin containing bile colored material is present.

Head: No complaint of headacheNeck and Lungs: Clear, no bruits, no thyromegaly.

GI/GU: Normal appearing for age

SOAP NOTE – Objective from Nov. 19

November 21, 201114

Temperature 39oCBP 134/86, P 80, RR 18Weight 119, BMI 24Age 27yofCBC= H/H, RBC WNL; WBC 20,000 CHEM 7= all WNL

Your turnWhat is the “Assessment”?

Assessment can include more than one medical condition

Usually prioritized by urgency of problemWhat is the “Plan”?

Be sure to address all of the patient’s problemsAcuteChronic

November 21, 201115

SOAP NOTE- Assessment & Plan Nov. 19

November 21, 201116

AssessmentAcute Appendicitis

PlanTreat with IV Appendacillin 500mg four times

a day and IV Painaway 10mg q4 hrs prn. APAP 500mg po q6hrs prn fever > 38oC

Schedule for laparoscopic appendectomyCounsel regarding smoking cessation

SAMPLE POST-OP CHART SOAP NOTE

November 21, 201117

November 21, 2011 S: No Chest Pain or Abdominal pain. "Feeling

better today." Mild RLQ tenderness; Patient reports being hungry.

O: Afebrile, P 84, R 14, BP 125/82. No acute distress. Neck no JVD, Lungs bilateral clear ; Abd -Bowel sounds present. Wounds look clean. Ext without edema

A: Patient is a 27 year old female on post-operative day 2 for laparoscopic appendectomy, recently passed flatus.

P: Recovering well. Increase diet to solids. Continue to monitor labs. Prepare for discharge home tomorrow morning on po meds.

Which of the following is included under “Objective” information?

November 21, 201118

1. Blood pressure2. Social History3. Weight4. Two of the

above5. All of the above

Individual activityPrepare a SOAP note as directed in the

printed case.We will review the case as a class.

November 21, 201119

PHAR 442 Team Presentation Time

November 21, 201120

21

Disease state demographics & etiology

Signs & Symptoms

Acknowledgments

Initial Treatment Special Tips

Your name(s) hereUniversity of Southern Nevada, College of Pharmacy, Southern Nevada, UT - 84095

Literature cited

Figure 1. Photograph or drawing of disease, or whatever.

Figure 2. Graphical/pictorial representation

For further information

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Title that hints at the underlying issue or question

Brand and generic names of common Rx products used for the condition

Mechanism of Action of the Product

Actual or Hypothesized

Drug Interactions

Contraindications

Adverse Drug Reactions

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22 November 21, 2011

November 21, 201123

November 21, 201124

Team ActivityPrepare a SOAP note based on the printed

cases

November 21, 201125