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the use of traditional compounding techniques to manipulate chemical ingredients to produce appropriate dosage forms when no commercial medicine form is available

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Extemporaneous compounding

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PHARMCARE 3 - Details

Levels:

1) Extemporaneous compounding View
2) Medication Review View
3) Patient Medication Adherence.pptx View
4) PCP AND Medication or Drug Related Problem.pptx View
5) ADVERSE DRUG REACTION.pptx View
6) Incompatibilities View

Questions:

187 questions

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The use of traditional compounding techniques to manipulate chemical ingredients to produce appropriate dosage forms when no commercial medicine form is available

Extemporaneous compounding

Quality control FOR 1 Oral and topical liquids 2 Hard gelatin capsules

. 1 pH, sp. Gravity, assays, rheological properties, physical observation, physical stability 2 weight variation, dissolution and disintegration

Quality control FOR 1 Ointments, creams and Gels 2 Suppositories, Trouches

. 1 pH, sp. Gravity, assay, rheological properties 2 melting points, dissolution test, physical stability

Quality control FOR 1 Parenteral Preparation

. 1 pH, sp. Gravity, osmolality, color, clarity, particulate matter, sterility

Provide knowledge and skills in good extemporaneous practice, assessment of risk and medication error potential, formulation, quality assurance Demonstrate competency in the necessary extemporaneous preparation skills and pharmaceutical calculations and dilutions

Training and Experience

Clean, Neat, well-lit and quiet working area If aseptic compounding is considered , a clean air environment is needed Measures must be taken to avoid cross contamination Environmental conditions such as temperature, humidity and lighting to limit degradation of product

Environment

Should be developed or obtained Methods used, ingredients added and order of steps is documented.

Formulas

Proper dispensing container for the medications Pharmaceutical-grade chemical is necessary Pharmacist use different chemicals from reliable sources

Chemical and Supplies

It gives processing, packaging and release instructions. For products regularly prepared, master documents should be prepared and checked It should be clear and detailed Worksheets: name and formula of the product, source of formula, unique ID number, manufacturer, batch number of each starting material, date of preparation

Documentation

Risks associated with extemporaneous compounding:

1 Formulation Failure 2 Microbial contamination 3 Calculation errors 4 Starting materials 5 Patient Accessibility issues 6 Health and Safety Risk 7 Therapeutic risks and clinical consequences

1 is easier to learn and use and is more accurate than other types of balances. 2 should be used when picking up weights so that moisture and oils are not transferred to the weights 3 are used in compounding tasks such as preparing ointments and creams or loosening material from the surfaces of a mortar and pestle.

1 Balances 2 Forceps 3 Forceps

1 This is an ideal surface for mixing compounds because of its nonabsorbent surface. 2 The coarser the surface, the finer the triturating, or grinding, that can be done. 3 used for measuring liquids with a volume less than 1.5 mL

1 Compounding Slab 2 Mortar and Pestle 3 Graduates and Pipettes

Prepared by the pharmacist, this sheet indicates the amount of each ingredient needed, lists the procedures to follow, and provides the labeling instructions.

Master Formula Sheet

Is one of the most essential parts of the compounding process.

Weighing of the product

A way to combine drugs using a mortar and pestle.

Geometric Dilution Method

A structured evaluation of a patient‘s medicines with the aim of optimizing medicines use and improving health outcomes. This entails detecting drug related problems and recommending interventions A structured, critical examination of a patient’s medicines with the objective of reaching an agreement with the patient about treatment, optimising the impact of medicines, minimizing the number of medication-related problems and reducing waste.’

Medication Review

Principles of Medication Review

1. All patients should have a CHANCE TO RAISE QUESTIONS and highlight problems about their medicines. 2. Medication review SEEKS TO IMPROVE OR OPTIMIZE impact of TREATMENT for a patient 3. The review is undertaken in a SYSTEMATIC WAY, by a competent person 4. Any CHANGES resulting from the review are AGREED WITH THE PATIENT 5. The review is DOCUMENTED in the patient’s notes 6. The impact of any change is MONITORED

Provides the opportunity to discuss the patient’s values and beliefs, and how taking medicine fits in with the patient’s daily life. It provides an opportunity to assess patient’s knowledge of their medication.

Face-to-face review

Type of Medication review

Type 1: Prescription Review Type 2: Concordance and Compliance Review Type 3: Clinical Medication Review PCC

Primary purpose: Address practical medicine management issues that can improve clinical and cost-effectiveness of medicines and patient safety. It can take place without the presence of the patient. Any changes in the medication should be made with the consent of the patient/carer.

Type 1: Prescription Review

Review Process

1. Identify patients 2. Carry out the review 3. Record review outcomes / Feedback results 4. Audit / Quality assurance ICRA

Medication review may initially need to be prioritized to patients who are __

At risk of medicine related problems.

(Carrying out the review) Ten-point medication review

1 Why is this patient taking this drug? 2 Is the reason clear from the history summary? 3 Is the patient capable of taking this drug and is compliance satisfactory? 4 Are any tests required to monitor side-effects or dosage? 5 Are there any potential drug interactions and are they of significance? 6 What would happen if the drug was stopped? 7) Does the repeat need to be continued for the next 6 or 12 months? 8)Are any non-repeat items being prescribed regularly? 9 Should these be converted to formal repeats? 10 Set a date for the next review?

Recording the review outcomes

Level 1: REVIEW OF A LIST OF THE MEDICATION under the direction of doctor, nurse or pharmacist, but in the ABSENCE OF THE PATIENT Level 2: TREATMENT REVIEW UNDER THE direction of a doctor, nurse or pharmacist, in the ABSENCE OF THE PATIENT but with REFERENCE to the CODING ONLY PATIENT’S CLINICAL RECORD Level 3: CLINICAL MEDICATION REVIEW specifically undertaken by a doctor, nurse or pharmacist in the PRESENCE OF THE PATIENT with ACCESS to the PATIENT’S CLINICAL RECORD and LABORATORY TEST RESULTS as required

One method of assessing the quality of the review system is by evaluating the feedback from patients or their carers who have participated in the medication review process. This might include an evaluation of their experience of the review and the level of satisfaction with its outcome.

Quality Assurance

Medication review is an integral part of the repeat prescribing process and many practices undertake regular __of their repeat prescribing system. Implementing changes Documentation Communication of changes Follow up

Audit

Who does the Review?

In practice doctors, pharmacists and many nurses have the clinical skills and therapeutic knowledge to perform all aspects of medication review

(What should the review cover? ) For each drug: Check that:

1 The medication prescribed is APPROPRIATE for the patient’s needs 2 The medication is EFFECTIVE for the patient 3 The medication is a COST EFFECTIVE choice 4 Any required MONITORING has been done or arrangements are in place

The NO TEARS Mnemonic to Aid Medication Review in a 10 Minute Consultation 10

N Need and Indication O Open Questions T Tests and Monitoring E Evidence and Guidelines A Adverse Events R Risk reduction or prevention S Simplification and switches

Primary purpose: ADDRESS practical MEDICINE MANAGEMENT ISSUES that can improve clinical and cost-effectiveness of medicines and patient safety. It can take place WITHOUT THE PRESENCE OF THE PATIENT. Any changes in the medication should be made with the consent of the patient/carer. Other purpose: IDENTIFY RX ANOMALIES ex. Rx still prescribed which is intended for short term use only IDENTIFY UNMET and under met THERAPEUTIC NEED IDENTIFY MEDS that was PRESCRIBED BUT NOT DISPENSED

Type 1: Prescription Review

Type 3: Clinical Medication Review When to do it?

Patient’s with long-term conditions Patient with recently diagnose long-term conditions Patient experienced an adverse event associated with medicine-taking Patient/Carer requests a review or reports they have stopped taking prescribed medicine.

Takes place IN PARTNERSHIP WITH THE PATIENT/CARER ENABLES patient and practitioner to EXPLORE PATIENT’S MEDICINES-TAKING, including the patient’s actual PATTERN OF MEDICINE-TAKING and patient’s belief about medicine. Purpose: Opportunity for the patient to ASK QUESTIONS Offer and SHARE INFORMATION about the medicines WITH THE PATIENT Establish whether the patient and health professional have SIMILAR OR DIFFERENT VIEWS about medicines CHECKS THE PATIENT’S READINESS, ability and intent in taking the medicines Ensure that patients know if SYMPTOMS CHANGE or problem persists

Type 2: Concordance and Compliance Review

Takes place with the patient and ACCESS TO PATIENT’S MEDICAL NOTES and relevant LABORATORY RESULTS Also takes place in the context of RECENT INDICATOR’S of the patient’s UNDERLYING CONDITIONS and with the patient’s self report of their current symptom experience or a report made by health or social care professional Focus on TREATMENT OF SPECIFIC CONDITION Purpose: A PERIODIC REVIEW of the patient’s medical CONDITION and treatment to ensure that conditions are managed optimally. OBTAIN FEEDBACK in response for treatment for symptomatic condition Review medical and self management of LONG-TERM CONDITIONS PROVIDE FULL AND ACCURATE INFO about pros and cons of treatment

Type 3: Clinical Medication Review

Type 1: Prescription Review When to do it?

1 Patient’s with long-term conditions 2 Patient with recently diagnose long-term conditions 3 Patient experienced an adverse event associated with medicine-taking 4 Patient/Carer requests a review or reports they have stopped taking prescribed medicine.

Type 1: Prescription Review When to do it?

1 Patient is IN THE HOSPITAL or TRANSFERRED BETWEEN CARE SETTINGS 2 REVIEWING PRACTICE for a class of medicine

Type 2: Concordance and Compliance Review When to do it?

1 PATIENT IS DISCHARGED from the hospital 2 Patient has NEW MEDICINE 3 Patients with LONG TERM CONDITIONS WITH MULTIPLE MEDICATIONS 4 Clinician IDENTIFIED a MEDICATION RELATED PROBLEM

Type 3: Clinical Medication Review When to do it?

1 Patient’s with LONG-TERM CONDITIONS 2 Patient with RECENTLY DIAGNOSE LONG-TERM CONDITIONS 3 Patient experienced an ADVERSE EVENT ASSOCIATED WITH MEDICINE-TAKING 4 Patient/Carer REQUESTS A REVIEW OR REPORTS they have STOPPED TAKING PRESCRIBED MEDICINE.

The extent to a persons behavior taking medication corresponds with AGREED RECOMMENDATIONS from a health care provider Emphasizes the ACTIVE PARTNERSHIP between the healthcare professional and the patients. seeks the patient’s consent to the proposed treatment

Adherence

Is the ONE OF THE MOST IMPORTANT FACTORS that determines the therapeutic out comes, especially in a patient suffering from chronic illness/diseases.

Medication adherence

“The degree to which the patient follows the treatment instructions given by the healthcare provider” Without active collaboration in decision-making of the treatment process

COMPLIANCE

1 The term __ has come into disfavor because it suggests that a person is PASSIVELY following a doctor's orders, rather than actively collaborating in the treatment process. 2 __, on the other hand, requires the person's agreement to the recommendations for therapy.

1 COMPLIANCE 2 Adherence

Defined as the ABILITY of a person to CONTINUE TAKING MEDICATIONS for the intended course of therapy. In the case of chronic diseases, the appropriate course of therapy may be months, years, or even the person's lifetime. Discussing the intended course of therapy when medications are first started has been shown to be an important factor in keeping people's __ with a medication regimen.

PERSISTENCE

A person is classified as __ if he or she never fills a prescription or stops taking a prescription prematurely.

Non-persistent

Medication Non-adherence percentages 1 Pain medications never filled 2 enter nursing homes because they can't self medicate on their own 3 Prescriptions for Chronic Conditions 4 Missed or Overdoses of medication (Hospital admissions for seniors)

. 1) 65% 2) 40% 3) 31% 4) 30%

Types of Non-adherence

1 Non-fulfillment 2 Non-persistence 3 Non-conforming

Non-fulfillment give examples

1 Prescription is never filled

Non-persistence give examples

- Px stopped taking the medication after taking it rarely intentional (due to miscommunication, reduced capacity, etc)

Non-conforming give examples

1 Medication is not taken as prescribed 2 Missed doses, Incorrect doses, Dose taken at the wrong time

“poor medication taking behavior due to circumstances BEYOND THE PATIENT’S CONTROL, such as socioeconomic issues, carelessness, forgetfulness and cognitive impairment”

Unintentional Nonadherence

Intentional Medication Nonadherence

Adherence is a multidimensional phenomenon determined by the interplay of FIVE SETS OF FACTORS, termed "DIMENSIONS" by the World Health Organization: In simple terms: GIVE FIVE SET OF FACTORS OF ADHERENCE

1. Social/economic factors 2. Provider-patient/health care system factors 3. Condition-related factors 4. Therapy-related factors 5. Patient-related factors SP CTP

1. SOCIAL AND ECONOMIC DIMENSION give examples

1 limited english proficiency 2 low health literacy 3 lack of family and social support network 4 unstable living conditions 5 burdensome schedule 6 limited access to healthcare facilities 7 lack of health care insurance 8 inability/difficulty accessing pharmacy 9 medication cost 10 cultural and lay beliefs 11 elder abuse

THERE ARE SEVERAL WAYS TO MEASURE MEDICATION ADHERENCE.

1. Medication Event Monitoring Systems (MEMS) - the most accurate 2. Patient self-reports - easiest method 3 Pill Counts 4 Pharmacy databases or Refill rates 5 Blood levels 6 Morisky's Medication Adherence Scale (MMAS) 2M3PB

HEALTH CARE SYSTEM DIMENSION give examples

1 provider-patient relationship 2 provider communication skills 3 disparity between the health beliefs of the health care provider and those of the patient 4 lack of positive reinforcement from healthcare provider 5 weak capacity of the system to educate px and follow up 6 lack of knowledge on adherence and of effective interventions for improving it 7 px information materials written at high literacy level 8 restricted formularies; changing meds covered on formularies 9 high drug cost 10 poor access or missed appointments 11 long wait times 12 lack of continuity of care

These are the MOST ACCURATE method of measuring adherence because they record the date and time the medication bottle was OPENED THROUGH MICROPROCESSOR technology embedded in the cap. (GIVE THE disadvantages of this)

Medication Event Monitoring Systems (MEMS) Disadvantages: 1 erroneous/not faith/falls., because pt may remove more than one dose 2 Very expensive & different devices are needed for each medication 3 Therefore it is an impractical way to determine adherence in clinical practice.

1 chronic 2 lack of symptoms 3 severity of symptoms 4 depression 5 psychotic disorders 6 mental retardation/ developmental disability

Is EASIEST METHOD when adherence is being assessed, OPEN-ENDED QUESTIONS should be asked. Instead of asking, “Are you taking your medications?” the HCP should phrase the question along the lines of, “How many times in the past week (month) have you skipped your medications?”

Patient Self-reports

A method FAR MORE FEASIBLE OPTION for CLINICAL PRACTICE employed in RESEARCH

Blood Levels

Method DESIGNED TO DISTINGUISH POORLY ADHERENT PATIENTS from those with MEDIUM TO HIGH ADHERENCE to their ANTIHYPERTENSIVE REGIMEN consists of QUESTIONS ADDRESSING MULTIPLE REASONS FOR NON ADHERENCE The SCALE CONTAINS A QUESTION assessing whether the PATIENT FEELS HASSLED ABOUT THE REGIMEN Questions are PHRASED to avoid BIAS Question MEASURES MEDICATION TAKING BEHAVIOR rather than adherence/ compliance behavior

Morisky's Medication Adherence Scale (MMAS)

Methods that can improve Medication Adherence by Pharmacists iisa ang method

1 Improve PHARMACY WORKFLOW 2 SIMPLIFY Patient’s Medications 3 IDENTIFY REASONS for Medication Non-adherence 4 ASK PATIENTS SPECIFIC QUESTIONS about their Medication IISA

ROLE of Pharmacists in ADHERENCE

1 PX education 2 Dosing simplification & minimization of A/E 3 Preparing a dosing card PDP

Contains ONLY THE MOST ESSENTIAL ELEMENTS of a PATIENT'S MEDICATIONs; highly beneficial HELPFUL FOR patients who take medications or who have COGNITIVE BARRIERS

Dosing Card

1. SOCIAL AND ECONOMIC DIMENSION give examples

1 LIMITED ENGLISH PROFICIENCY 2 LOW HEALTH LITERACY 3 LACK OF FAMILY AND SOCIAL SUPPORT NETWORK 4 UNSTABLE LIVING CONDITIONS 5 burdensome schedule 6 LIMITED ACCESS to healthcare facilities 7 lack of health care insurance 8 inability/DIFFICULTY ACCESSING PHARMACY 9 MEDICATION COST 10 cultural and lay beliefs 11 elder abuse

HEALTH CARE SYSTEM DIMENSION give examples

1 PROVIDER-PATIENT RELATIONSHIP 2 PROVIDER COMMUNICATION SKILLS 3 disparity between the health beliefs of the health care provider and those of the patient 4 LACK OF POSITIVE REINFORCEMENT from healthcare provider 5 WEAK CAPACITY of the system TO EDUCATE PX AND FOLLOW UP 6 LACK OF KNOWLEDGE ON ADHERENCE and of effective interventions for improving it 7 px information materials written at HIGH LITERACY LEVEL 8 restricted formularies; changing meds covered on formularies 9 HIGH DRUG COST 10 POOR ACCESS OR MISSED APPOINTMENTS 11 LONG WAIT TIMES 12 LACK OF CONTINUITY OF CARE

1 chronic 2 lack of symptoms 3 severity of symptoms 4 depression 5 psychotic disorders 6 mental retardation/ developmental disability

THERAPY-RELATED DIMENSION give examples

1 COMPLEX MEDICATION REGIMEN 2 TREATMENT REQUIRES MASTERY of certain techniques 3 DURATION OF THERAPY 4 FREQUENT CHANGES IN MED REGIMEN 5 LACK OF IMMEDIATE BENEFIT OF THERAPY 6 medications with SOCIAL STIGMA attached use 7 ACTUAL OR PERCEIVED UNPLEASANT SIDE EFFECTS 8 TREATMENT INTERFERES WITH LIFESTYLE or requires significant behavioral changes

PATIENT-RELATED DIMENSION give examples

PHYSICAL FACTORS - visual, hearing, cognitive, mobility impairment - swallowing problems PSYCHOLOGICAL/BEHAVIORAL FACTORS - knowledge about dx - perceived risk - understanding reason meds is needed - attitude toward treatment - confidence in ability to follow treatment regimen - motivation - fear of possible a/e - fear of dependence - feeling stigmatized by the dx - frustration w/ health care providers - stress, anxiety - alcohol or susbtance use

Defined as "the responsible provision of drug therapy for the purpose of achieving definite therapeutic outcomes that improve the patients quality of life" Used for many years and gained widespread acceptance to describe the Pharmacist’s professional aspiration describes ‘what the patient is intended to receive”

Pharmaceutical Care

Places due emphasis on prevention, on preventing deterioration by maintenance of control of a condition rather than on responding to a crisis -provides a concise definition of what pharmacists are doing- i.e using their close patient contact to monitor the effects of medication and to provide safeguards to help doctors and patients obtain best possible results form drug therapy.

“care”

Why is Pharmaceutical Care Important?

1 MULTIPLE PRESCRIBERS 2 EXPLOSION DRUG PRODUCTS AND DRUG INFORMATION 3 Increase COMPLEXITY OF DRUG THERAPY 4 Significant level of DRUG-RELATED MORBIDITY AND MORTALITY 5 HIGH FINANCIAL COST of drug misadventure 6 Social NEED TO ADDRESS DRUG-RELATED PROBLEMS (DRP) MEI SHS

Primary Responsibilities of Pharmacist

A. To ensure patient’s drug therapy is safe, effective and efficient b. To identify, resolve, and prevent any DRPs c. To ensure that the patient’s therapeutic goals are met and optimal health-related outcomes are attained

Responsible Provision 1 complex outcomes involving atleast three parties 2 For higher __ in individual patients, there is a need to clarify the respective responsibilities of these parties 3 A __ then becomes more amenable to control.

. 1 drug treatment 2 levels of care 3 complex process

> DRUG TREATMENT- complex outcomes involving atleast three parties > For higher LEVELS OF CARE in individual patients, there is a need to clarify the respective responsibilities of these parties > A COMPLEX PROCESS then becomes more amenable to control.

Responsible Provision

Definite Outcomes 1 requires an assessment of what has been achieved against what was expected 2 Outcomes of drug tx must be assessed against __ 3 there is an ↑ striving for better ways of measuring and __

. 1 careful optimization of drug therapy 2 definite goals 3 recording clinical outcomes

Responsible Provision 1 complex outcomes INVOLVING AT LEAST THREE PARTIES For HIGHER LEVELS OF CARE in individual patients, there is a need to clarify the respective responsibilities of these parties

. 1 drug treatment

> CAREFUL OPTIMIZATION OF DRUG THERAPY requires an assessment of what has been achieved against what was expected > Outcomes of drug tx must be ASSESSED AGAINST DEFINITE GOALS > there is an ↑ striving for better ways of measuring and RECORDING CLINICAL OUTCOMES

Definite Outcomes

Definite Outcomes 1 __ requires an assessment of what has been ACHIEVED against what was EXPECTED

. 1 careful optimization of drug therapy

> Patient EXPECTS AN IMPROVEMENT in the way they are able to conduct their lives > While it is subjective, it is a potentially important PARAMETER FOR MONITORING in the individual patient > Using Validated questionnaires, it can become a MEASURABLE ENDPOINT OF DRUG TREATMENT > Effective clinical practitioners instinctively SEEK OUT EVIDENCE OF THE IMPACT OF THEIR CARE TO THEIR PATIENTS

Quality of Life

Drug Therapy 1 process of securing __ from drug therapy is becoming increasingly complex- patients may receive medication unnecessarily 2 __ are made under circumstances in which patients are not fully informed or involved-> patient should be part of that decision if they do require medication

. 1 best results 2 decisions to start, to continue, to change or discontinue a drug

Drug Therapy 1 concept of MEETING INDIVIDUAL PATIENT’S PARTICULAR NEEDS 2 Securing __ in decision making and in monitoring patient’s progress are important objectives in pharmaceutical care.

. 1 “optimization” 2 patient’s commitment and ensuring continuity

Drug Therapy 1 Objectives 2 Outcome

. 1 > Cure > Reduce or eliminate symptom > Slow down disease progression > Prevention 2 > ↑ pt. quality of life/wellbeing > ↑ work productivity > Save cost

Pharmaceutical Care Process

1 Collect 2 Assess 3 Plan 4 Implement 5 Monitor 6 Follow Up CAPtain IMF

Constructing PCP

1. IDENTIFY THE PHARMACEUTICAL CARE ISSUES >”medical-related problems” ex. Uncontrolled BP, irregular home glucose monitoring, non-compliance to diet 2. PRIORITIZE the care issues 3.Determine the ACTION to be taken 4. RECORD the action taken 5. Record the OUTCOME of the action taken IP DRR

> the process by which RPh EVALUATES PATIENT INFORMATION (subjective & objective) from pt. and medical records and makes decisions regarding: 1. health status of the pt. 2. Drug therapy needs & problems 3. Intervention (care plan) 4. Follow-up

Patient Assessment

> It includes IMPLEMENTATION OF THE MONITORING PLAN >e.g. a. contact pt. to evaluate compliance or side effects b. measuring vitals signs or checking other physical or lab data

Follow-up

> VALUABLE COMMUNICATION TOOL for FUTURE ENCOUNTERS with patients and other health care professionals > Provides PERMANENT RECORD of patient information >Provide EVIDENCE of pharm care activities > Serves as a LEGAL RECORD of patient care provided > “What is not written is not done”

Documentation

Various ways to document patient care & PCP

A. SOAP format b. FARM format c. “IAO” (care issues, action, outcome) format

Challenges in Pharmaceutical Care

1. Knowledge and skills update 2. Communication with patient 3. Communication with doctors 4. Time management KCC Ta

SOAP Format May include: > complaints (symptoms) > History of presenting illness > Past medical history > Medication history >Allergies > Social and Family hx

S= Subjective

SOAP Format Includes: > Vital signs > Physical findings (PE) > Lab test results > Serum drug concentrations > Various diagnostic results (ECG, X-ray, biopsy)

O= Objective

SOAP Format Includes: > Medical problems (diagnosis) > DRPs > Clinical progress ( ex. Gastritis- resolved)

A= Assessment

SOAP Format Includes: > Add/remove/ change drug > Dosage modification > Communication with pt & health care provider > Monitoring and Counselling

P= Plan

“IAO” Format

>I= care issues similar to A in the SOAP > A= action (“pharm care action”) similar to P in the SOAP > O= outcome To document the outcome of the action carried out

Are ONE OF THE MOST IMPORTANT HEALTH CARE TECHNOLOGIES for improving longevity and quality of life. > prescribed or selected FOR SELF-TREATMENT with the intent to cure, improve symptoms or prevent diseases. Unfortunately, is a DOUBLE-EDGED SWORD. can also result in problems such as side effects, drug interactions and other undesired outcomes.

Medications

A __ is anything involving drug therapy that interferes with (or has the potential to interfere with) the desired outcome for a patient. - PCNE

Medication-related problem

“ A __ is any undesirable event experienced by a patient which involves, or suspected to involve, drug therapy, and that interferes with achieving the desired goals of therapy” -ASHP

Drug therapy problem

TYPES OF MEDICATION RELATED PROBLEMS

1 Meds requires NEW or ADDITIONAL DRUG THERAPY that is NOT PRESCRIBED 2 Patient is taking UNNECESSARY DRUG 3 WRONG DRUG for patients condition or age 4 patient NOT TAKING DRUG CORRECTLY 5 CORRECT DRUG, DOSE TOO LOW 6 CORRECT DRUG, DOSE TOO HIGH 7 ADVERSE DRUG REACTION / DRUG INTERACTION

Aging or underlying health conditions

How to Prevent? MRPs

1 Communicate effectively with health care providers about medications. 2 Designate a medication manager. 3 Keep a medication list. 4 Consult with a doctor or pharmacist before taking over-the-counter medication, alcohol or herbal supplements along with prescription drugs. 5 Use common sense when using medications. 6 Obtain medication refills in a timely manner.

PHARMCARE 3