Outline. Setting the Stage. Se#ng the stage for precep0ng drug therapy assessment Elements of drug therapy assessment Hierarchy Flow chart

Transcription

1 Preceptor Development: Patient Care Process Drug Therapy Assessment Outline Se#ng the stage for precep0ng drug therapy assessment Elements of drug therapy assessment Hierarchy Flow chart Student use of flow chart Reviewing the Student s Assessment Feedback and evalua0on of your student Overview of preceptor role An example: my prac0ce Setting the Stage 1. Iden0fy and evaluate how you assess drug therapy in your prac0ce What is your prac3ce environment? Who are your team members, if any? What role do other pa3ent care providers have with respect to assessing drug therapy? 2. Get to know your student; specifically, their comfort and experience with drug therapy assessments How many drug therapy assessments have been learned and prac3ced? What specific drug therapy assessments have been learned and prac3ced? 1

2 Setting the Stage 3. Share your approach with your student What types of drug therapy assessments do you rou3nely conduct? Where is informa3on documented and stored which supports your assessment? For example: Past Medical History (PMH) Netcare data Refill records Hierarchy of Drug Therapy Problems (DTPs) 1. Indica3on 2. Efficacy 3. Adherence 4. Safety ARer your student has gathered a pa0ent database, have him present to you the INDICATION for each drug. This would also apply for: EFFICACY ADHERENCE SAFETY Medical Condi3on/Problem Assessment of Drug Therapy Flow Chart Can therapy be discon3nued? Is therapy indicated? (Consider non- drug management and pa3ent preferences) Has drug therapy been ini3ated? Explore reasons for use of alternate drug therapy Consider switching to op3mal therapy if appropriate Is drug therapy op3mal (first- line) for that specific condi3on? Move on to Efficacy Evalua0on Is drug therapy effec3ve for each indica3on? (Goals/Efficacy Monitoring Parameters) Why? Addi3onal therapy required Non- adherence Low dose/dosing frequency/ dose 3tra3on Interac3on Onset of ac3on Malabsorp3on Formula3on Expired drug Move on to Adherence and Safety Evalua0on Is the pa3ent able to take drug therapy as prescribed? Why? Adverse Effect Incorrect dosage form/frequency Direc3ons not understood (consider culture, language, educa3on/health literacy) Cost/Drug access Pa3ent preference, beliefs, mo3vators Pa3ent ability to self- administer drugs (age, dexterity, vision, swallowing, memory) Move on to Safety Evalua0on Is the pa3ent at risk of or experiencing any adverse effects? (Safety Monitoring Parameters) Is the dose appropriate? (Consider weight, organ func3on, age) Is the pa3ent being monitored appropriately? Is the dose too high? (Consider weight, organ func3on, age) Can the adverse effect be managed? Is a change in therapy indicated? Is the pa3ent at risk of or experiencing any significant drug- drug, drug- food, drug- disease, or drug- laboratory test interac3ons? Con3nue therapy, it appears appropriate for this pa3ent. Can the interac3on be managed? Is a change in therapy indicated? Developed by: Deon Druteika, PharmD, Pharmacy Services AHS Adapted by: Pa<ent Care Working Group, Faculty of Pharmacy, UofA 2011 Copyright 2011, Faculty of Pharmacy & Pharmaceu<cal Sciences, University of Alberta 2

3 Student Use of Flow Chart Have your student use the flow chart as a guide when evalua3ng drug therapy Keep in mind that the flow chart is not all inclusive, but rather a systema3c process tool For more comprehensive informa0on about assessing drug therapy, refer your student to the full Pa0ent Care Process document for sugges0ons. Reviewing the Student s Assessment Is the student s assessment thorough, accurate and clinically relevant? Missing Informa0on What is needed, and how will it be gathered? Chart, pa3ent, Netcare, community pharmacy, MD, allied healthcare providers, other Assessment inaccurate or not clinically relevant How can you re- direct? Role model for your student how to think like a detec0ve when gathering and assessing informa0on. Feedback and Evaluation Provide feedback to your student on: Ability to ask the right ques3ons which in turn, forms the assessment of the pa3ent Ability to interpret, integrate and apply retrieved data Ability to priori3ze medical and drug therapy problems Evaluate your student on the following criteria: Ability to iden3fy clinically relevant DTPs Quality of DTP assessment Thorough Accurate Note: If student is unable to assess drug therapy despite feedback and sufficient prac3ce, please contact the course coordinator. 3

4 Before the clinical placement Be familiar with the drug therapy assessment process student s are taught Suggest medical condi3ons and therapeu3cs your student should review that are commonly assessed in your prac3ce Early in the clinical placement Discuss your expecta3ons for pa3ent assessments (on Day 1) Ensure your student can compile a thorough pa3ent database Assign some straighcorward, simple pa3ents with few co- morbidi3es Review thoroughly to ensure student has a good grasp on process and assessments are comprehensive. Later in the clinical placement Overview of Preceptor Role Assign more complex pa3ents, and increase pa3ent workload Precepting Drug Therapy Assessment in my practice Step 1 Have the student compile a list of current & previous medical problems from assigned pa3ent(condi3ons) Have the student priori3ze them (star3ng with the reason for admission/encounter/or consulta3on) Precepting Drug Therapy Assessment in my practice Step 2 Focus your student to start with highest priority medical problem and begin movement through the flow chart Your student should use one cycle of the flow chart per medica3on used for each medical condi3on and mul3ple cycles for condi3ons requiring mul3ple therapies Once all cycles complete for one medical condi0on, assess therapy for next problem in priori0zed list. Rinse, repeat. 4

5 Precepting Drug Therapy Assessment in my practice Step 3 As DTP s are iden3fied via the flow diagram, formulate a list of problems that can be resolved. Priori3ze solvable DTP s in terms of clinical relevance and 3meframe Move onto the next step in process of care.resolving DTPs. 5