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A detailed description of how to complete a structured assessment of a patien’s drug

theraphy can be found later in this chapter.

The care plan

The care plan is an outline of the practitioners and the patients responsibilities to meet
stated, mutually agreed upon goals and interventions. This is care plan represents a joint
venturebetween the patient and the practitioner. It represents a structure for two
individuals, the practioner and the patient, who may have different understanding, different
expectations, different concerns, and/or a different value system, to work together to
achieve common goals.

The care plan is constructed to define goals, determine appropriate interventions, and to
define responsibilities for three different purposes.

1. To resolve the drug theraphy problems present at this time, which were identified
during the assessment.
2. To meet the goals of theraphy for each of the patients medical conditions, thereby
achieving the outcomes desired by the patient.
3. To prevent future drug theraphy problems from developing.

The first and most important step of care planning is establishing goals for each of
the purposes just described. These goals need to be clearly stated, measurable, and
achievable by the patient. Also, a time frame needs to be associated with each goals
so that the patients expectations about meeting the goals can be realistic. Once the
goals have been established , the practitioner must consider the actions to take or
choices to be made to successfully meet the patients drug related needs. Based on
the patients drug related needs identified, the care plant will contain interventions
that are designed to resolve drug theraphy problem, achieve therapeutics goals for
medical conditions, and prevent new problems from developing. Interventions do
not stand by themselves and must be
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a follow up evalution is conducted for two different purposes :
1. To determine progress toward meeting the established goals of
theraphy for each of the patiens medical conditions by evaluating the
actual outcomes a patient experiences against these stated goals.
2. To assess whether any new drug therapy problems have developed or
whether any new drug theraphy problems need to be prevented in
the future.

The follow up evalutions process ensures continuity of care. In

practice, many patients have chronic disordes and require continous
care and serial follow up evalutions in order to compare previously
stateds goals with progress or status to date. Documented, serial
determinations of a patients progress serve practitioners to evaluate
therapeutic approaches designed to help patients make slow but
steady positive progress toward long-term goals.

When the practitioner accomplishes the second purpose for doing a

follow up evalutions (to asses whether any new drug therapy
problems have developed or any new ones need to be prevented),
the practitioner has come full circle in the patients care process, back
to the assessment process again. This is the only way we can know
that we have provided care to a patients, that we have been
complete in our care and that we are able to hold ourselves
accountable for our actions.

In summary, the patients care process allows the practitioner to put

the philosophy of practice into action for the patients benefit. It
consists of three inseparable steps : the assessment, the care plan,
and the follow up evalution. The steps of the pharmaceutical care
process are summarized in fig, 4-3
Although each step of the patients care process is a joint venture
between the patients and the practitioner, the amount and type of
work required at each step varies with the particular step and the
specific needs of a patient. For example, in practice, it appears that a
thorough assessment of a patients drug related needs requires the
majority of effort on the part of the practitioner. The care plan, in
comparison, requires a true fifty-fifty joint venture between the
practitioner and the patients. The care plan must represent a course
of action that has the acceptance and accountability of the patients.
Follow up evalutions of patient status and outcomes require
substantial patient input and effort if they are to truly represent and
describe the actual patients experience and outcome of drug
therapies. To ensure that follow up evalutions reflect actual patients
outcomes, the majority of the input must come from the patient.

Practitioners who provide pharmaceutical care impose on

themselves the self discipline required to make a comprehensive
assessment, individualize a care plan, and rigorously follow up to
evaluate the out comes of the care provided. These three
fundamental steps essential to the pharmaceutical care process must
be mastered by the practitioner. All three must always be completed,
and during each episode of care, order and fully documented. We
have developed a learning aid that will help the pharmacist to master
the cognitive processes involved in the patient care process. This aid
is called the pharmacist workup of drug theraphy and it is use to
illustrate how to the patients care process is internalized by the
practitioner and is executed in practice.
THE PHARMACIST WORKUP OF DRUG THERAPY
The pharmacist’s workup of drug therapy is a description of the
practitioner’s cognive thougth processes when he or she provides
pharmaceutical care for a patient. The pharmacist’t workup of drug
therapy also serve as the outline for what the practitioner must write
down, or document, in practice. Each section of the pharmacist’s
workup of drug therapy is discussed in detail below and a complete
copy is located at the end of the chapter.
The thought processes involved in the pharmacist’s workup of drug
therapy will eventually become internalized as “tacit” knowledge.
However, for this to happen, the practitioner must understand
exactly what these thought processes are and engage in extensive
practice with each process. This can take a practitioner already in
practice from 2 months to 2 years. It will take a student up to 4 years,
through the for mal educational process, to be come a pharmacist.
The exact time it take usually depends on the number of patients
taken care of by the practitioner. The more patients, the steeper the
learning curve and the shorter the time it takes to internalize the
pharmacist’s workup of Drug therapy and become highly proficient
at providing pharmaceutical care. (130)

136:
Disease, and drugh information. All three are necessary. Usually the
question that must first be asked for any patient with a new
prescription is : is this drug therapy appropriately indicated fpr this
person at this time ? Also, the practitioner must assess what the
patient understand about drug therapy and the disorder. The more
the patient understands, the less time and effort is required in
patient education or patient counseling. The less the patient
understand the more effort,time, and resources will be required to
ensure that he or she can and will comply with the medication
direction and instruction in the care plan being developed
The pharmacist’s workup of drug therapy isa fluid process and can be
expanded as necessary in practice, the collection of data is
cumulative. Moreover, experienced practioners become highly
efficient at gathering the information necessary to identify a patient’s
drug-related needs. On the other hand, inexperienced practitioner
are less certain and frequently less confident regarding the nature
and type of information that will actually assist them in their decision
making tasks. Thus, we find that inexperienced practitioners are less
certain and frequently less confident regarding the nature and type of
information that wiil actually assist them in their decision making
tasks. Thus, we find that inexperienced practitioners all too
frequently tend to develop a “shotgun” apporoach to information
gathering thereby producing quite discursive, and less than usuful
data. In either case, it is crucial that practitiobers internalize all the
components of the pharmacist’s workup of drug therapy in order to
collect and reassemble patient responses and medication narrativers
into a succinct effective document.
Data are never gathered as an end in themselves. Each item that is
gathered from the patient is collected for a purpose.Before any data
are collected, the practitioner must determine (1) that they are
necessary. (2) why are they necessary and (3) how will they be used.
Do not waste the patient’s time. When the information is collected, it
must be used immediately to determine if more information is
required and to make decisions about the patient’s drug therapy.
In summary, the assessment process represents a structured data
and information gathering dialogue between the patient and the
pharmacist and is designed to determine very specific, essential
information in order to allow a patient specific care plan to be
developed to respond to the patient’s unique needs, expectations
and concerns. What (concerns), and what the patient knows
(understanding) are the three essential topics that must drive the
assessment dialogue. Additionally, patient demographic information
is then used to modify and personalize the pharmacist’s response to
the patient’s drug related needs and drug therapy problems.
We are now ready to approach the detail of the pharmacist’s workup
of drug therapy.we will do this by discussing how the practitioner
works through each of the sections of the assessment.