Pharmaceutical care planning

Pharmaceutical care planning is a formalization of the activities that clinical pharmacists have been performing for many years. It was originally framed by Dr. Linda M. Strand and her colleagues at the University of Minnesota in the early 1990's.

Pharmaceutical care planning is a systematic, comprehensive process with three primary functions:

1. Identify a patient's actual and potential drug-related problems.
2. Resolve the patient's actual drug-related problems.
3. Prevent the patient's potential drug-related problems.

Overview

The pharmaceutical care plan is a written, individualized, comprehensive medication therapy plan based on clearly defined therapeutic goals. The pharmaceutical care plan, which is available to all pharmacists caring for a patient, is updated with each major change in patient status. It is important that the physician be informed about the care plan to ensure common goals. Patients should also be informed about the general content of the care plan as means of gaining their agreement regarding drug therapy.

Create patient database

The first step in the care planning process is the creation of a comprehensive patient database, which includes at minimum, the following information:

1. Patient demographics
2. Diagnoses and past medical history
3. Present medications and medication history
4. Medication allergies/intolerances
5. Smoking/alcohol/caffeine/drug use history
6. Abnormal laboratory and physical exam results
7. Renal and liver function

Assess drug-related problems

Following the creation of a comprehensive patient database, the pharmacist should evaluate the patient's drug therapy:

1. Assess the patient for drug-related problems.
2. Determine whether drug-related problems are being treated.
3. Determine whether current drug therapy is appropriate.
4. Determine whether additional drug therapy is needed.
5. Determine if any of the drug-related problems may have been caused by medication.

An understanding of the types of drug-related problems that may occur facilitates the evaluation process. Most drug-related problems are the result of:

1. Not receiving an indicated drug
2. Receiving the wrong drug
3. Receiving too little of the drug
4. Receiving too much of the drug
5. Experiencing an adverse drug reaction
6. Experiencing a drug interaction
7. Not receiving the prescribed drug
8. Receiving a drug for which there is no valid medical indication

Establish therapeutic goals

Next, therapeutic goals must be established for each drug-related problem so that the pharmaceutical care planning process can be effective. Therapeutic goals should be definite, realistic and, if possible, measurable. Most therapeutic goals relate to:

1. Approach normal physiology (i.e., normalize blood pressure).
2. Slow progression of disease (i.e., slow progression of cancer).
3. Alleviate symptoms (i.e., optimize pain control).
4. Prevent adverse effects.
5. Control medication costs.
6. Educate the patient about his or her medication.

Specify monitoring parameters

Finally, monitoring parameters must be specified so that the patient's progress can be followed. Monitoring parameters must also include potential adverse effects. Determine desired end points for each parameter and the frequency of monitoring.

Document patient's progress

The pharmacist evaluates and documents the patient's progress in achieving the desired therapeutic goals and avoidance of potential adverse effects. The pharmaceutical care plan is updated with each major change in patient status.

Care plan summary

In summary, the general steps involved in creating a pharmaceutical care plan are:

1. Create comprehensive patient database.
2. Assess for actual and potential drug-related problems.
3. Establish therapeutic goals.
4. Specify monitoring parameters with end points and frequency.
5. Document the patient's progress towards therapeutic goals.

The care plan function in Kinetics© is basically just a skeleton that you can expand on because plans will differ depending on the practice setting in which the program is being used. Acute care, home care and long term care all have different monitoring parameters and schedules.

The default care plan for a drug can be changed on the Edit drug model function which is accessed via the drop down menu tree or by the keyboard shortcut Ctl+E. The care plan field is free form text entry, you can enter anything you like in this field.

References

1. Strand LM, Cipolle RJ, Morley PC. Pharmaceutical care: an introduction. 1992. Upjohn Co. pp 14-29.
2. Strand LM, Cipolle RJ, Morley PC. Drug-related problems; their structure and function. Ann Pharmacother 1990;24:1093-7.
3. Canady BR, Yarborough PC. Documenting pharmaceutical care: creating a standard. Ann Pharmacother 1994;28:1292-6.
4. Gold ML, Fedder DO. Developing a pharmaceutical care plan. US Pharmacist 1992; 17(10):53-60.
5. Chase PA, Bainbridge J. Care plan for documenting pharmacist actvities. Am J Hosp Pharm 1993; 50:1885-8.
6. Rich DS. Pharmaceutical care plans. Hosp Pharm 1994;29(2);176-8.
7. Brown S. Clinical monitoring of home care patients. US Pharmacist 1996; 21(Suppl);3-8.
8. Cameron KA. Preventing medication-related problems among older Americans. Man Care Int 1998;11(10);74-85.
9. Egging P. Implementing pharmaceutical care in the home setting. Pharmaguide 1995; 8(4);1-9.