Pharmaceutical Care Planning Vocational Training Scheme: Level = Stage 2

1. Pharmaceutical Care PlanningVocational Training Scheme:Level = Stage 2 Arlene Shaw Specialist Clinical Pharmacist, NHS Tayside

2. Aim and Objectives 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

3. Introduction 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

4. Evidence • 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.

5. Cover Page 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

6. Care Plan Page 1 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

7. Care Plan Page 2 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

8. Care Plan Page 2 cont. 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

9. Care Plan Page 2 cont. Current Medication • List everything the patient was taking on admission • Record allergies or NKA

10. Care Plan Page 3 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

11. Care Plan Page 3 cont. • 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

12. Care Plan Page 3 cont. 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

13. Care Plan Page 3 cont. 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

14. Care Plan Page 3 cont. 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.

15. Care Plan Page 3 cont. 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

16. Care Plan Page 3 cont. 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

17. Care Plan Page 4 Review Dates Investigations • Relate to care issues • TDM

18. Final Points.... • Complete all sections of care plan • Choose simple cases • Remember training is progressive!

19. Questions Any questions? Email: arlene.shaw@nhs.net