PHARMACEUTICAL CARE CONCEPT

How to implement in practice

Saepudin, M.Si., PhD., Apt.

Program Studi Profesi Apoteker
Universitas Islam Indonesia
Pharmaceutical care (PC)
 Pharmaceutical care (PC)
•  Defini'on (ASHP, 1993)
“ a direct, responsible provision of
medica'on-related care for the purpose of
achieving definite outcomes that improve a
pa'ent’s quality of life”
Pharmaceutical care (PC)
 Pharmaceutical care (PC)
•  Principal elements
–  Medica'on related
–  Care that is directly provided to the pa'ent
–  Definite outcomes
–  Quality of life
–  Responsibility
 Pharmaceutical care (PC)
•  Principal elements
–  Medica'on related
•  It involves not only medica'on therapy, but
also decision about medica'on use for
individual pa'ent
•  This includes decision NOT to use medica'on
therapy as well as judgments about medica'on
selec'on, dosage, routes, and medica'on
administra'on
 Pharmaceutical care (PC)
•  Principal elements
–  Care that is directly provided to the pa'ent
•  The central to the concept of PC is CARING à
personal concern for the well-being of another
person
•  Each health professional possess unique
exper'se and must cooperate in the pa'ent’s
overall care
•  The pharmacist contributes unique knowledge
and skills to ensure op'mal outcomes from the
use of medica'on
 Pharmaceutical care (PC)
•  Principal elements
–  Definite outcomes à medica'on-related
therapeu'c outcomes
•  Cure of pa'ent’s disease
•  Elimina'on or reduc'on symptoms
•  Arres'ng or slowing of a disease process
•  Preven'on of a disease or symptom
 Pharmaceutical care (PC)
•  Principal elements
–  Quality of life
•  A complete assessment of a pa'ent’s QoL
should include both objec've and subjec've
assessment
•  Pharmacist should be familiar with the
literature on assessing pa'ent’s QoL
•  Pa'ents should be involved in establishing QoL
goal for their therapies
 Pharmaceutical care (PC)
•  Principal elements
–  Responsibility
•  Involves both moral trust-worthiness and
accountability
•  Professional covenant in direct rela'onship
between pharmacist and pa'ent
•  As an accountable member of the health-care
team, the pharmacist MUST DOCUMENT the care
provided
•  The pharmacist is personally accountable for
pa'ent outcomes that ensue from the
pharmacist’s ac'on and decision
 Pharmaceutical Care (PC)
•  Three major func'ons of PC
– Iden'fying poten'al and actual medica'on-
related problems (MRPs)/drug-related
problems (DRPs)/drug therapy problems
(DTPs)
– Resolving actual MRPs/DRPs/DTPs
– Preven'ng poten'al MRPs/DRPs/DTPs
 MRPs
•  ASHP
–  An event or circumstance involving medica'on
therapy that actually or poten'ally interferes
with an op'mum outcome for a specific pa'ent
 MRPs
•  ASHP
–  Untreated indica'ons
–  Improper drug selec'on
–  Sub-therapeu'c dosage
–  Failure to receive medica'on
–  Over-dosage
–  Adverse drug reac'ons
–  Drug interac'ons
–  Medica'on use without indica'on
 DTPs
•  Cipolle/Morley/Strand classifica'on
–  Any undesirable event experienced by the pa'ent
that involves or is suspected to involve drug
therapy and that actually or poten'ally interferes
with a desired pa'ent outcome

 DTPs
•  Cipolle/Morley/Strand classifica'on
–  Need for addi'onal therapy
–  Unnecessary therapy
–  Wrong drug
–  Dosage is too low
–  Adverse drug reac'ons
–  Dosage is too high
–  Adherence problem
 DRPs
•  Pharmaceu'cal care network Europe (PCNE)
–  an event or circumstance involving drug therapy
that actually or poten'ally interferes with
desired health outcome
 DRPs
•  Pharmaceu'cal Care Network Europe (PCNE)
–  Adverse reac'ons
–  Drug choice problems
–  Dosing problems
–  Drug use/administra'on problems
–  Drug interac'ons
–  Other
Required Clinical Practice Skill for PC

§  Physical Assessment Skills

§  Clinical Assessment Skills
§  Drug Information & Evidence-Based Practice
skills
§  Communication Skills & Patient Counseling Skills
§  Caring Behaviour Skills
§  Professional Behaviour Skills
§  Proficient Documentation Skills
§  Learning to be reflective in practice
Documentation of PC
 Documentation

y t ests
b o rator
L a
Pharmaceutical care plan

on
Medicati

en t Profile
Pati

Responsibility
 Benefit of Documenta'on
•  Efficient communica'on of recommenda'on
for improving individual pa'ent’s care
•  Demonstra'on of the role of pharmacist in
the pa'ent’s care
•  Peer review of the pharmacist’s ac'vi'es by
the health care team
•  Promo'on of con'nuity of care by other
health care workers
 What should be documented?
•  The documenta'on should be succinct and
deal only with aspect of drug therapy
•  The format of the documenta'on should be
consistent with policies, procedures, and
style of documenta'on of the ins'tu'on
•  Documenta'on should be completed
immediately a]er the ac'vity
Ac'vi'es involved in PC documenta'on
•  Assessment à taking medica'on history,
iden'fying actual and poten'al DRPs
•  PC plan development à making and
implemen'ng recommenda'on, monitoring
parameters to resolve or prevent DRPs
•  Evalua'on à following up to make sure
whether the desired outcomes have been
achieved
 Organiza'on of document
•  One commonly used method of documenta'on
is the problem-oriented medical record
(POMR) format à organized according to a list
of problems
•  It consists of four major components
–  a defined database
–  a problem list
–  an ini'al plan
–  a progress notes
 Organiza'on of document
•  Each component is to be filed according to the
source from which it comes à physician
orders, nursing notes, and laboratory and
diagnos'c results
•  The clinical notes for each medical problem
commonly are organized according to the
common format
 Common Documenta'on Format
•  SOAP
–  Subjec've
–  Objec'ves
–  Assessment
–  Plan
•  FARM
–  Finding
–  Assessment
–  Resolu'on
–  Monitoring
Contoh Kasus dan Dokumentasi
•  Ny. Eni Subroto, 62 th, salah satu pasien yang di-visite
oleh 'm visite terpadu pada tgl 25 Oktober 2017. Px
tsb masuk RS malam sebelumnya karena keluhan sesak
nafas, demam dan batuk produk'f dengan dahak
berwarna kehijauan. Px memiliki riwayat DM type 2,
CHF, dan MI
•  Px secara ru'n mengkonsumsi meeormin 500 mg 2x
sehari, glyburide 10 mg po 1x sehari, digoxin 0.125 mg
po 1x sehari, warfarin 5 mg po 1x sehari, aspirin 80 mg
po 1x sehari, furosemide 80 mg po 2x sehari, and
metoprolol XL 100 mg po 1x sehari
Contoh Kasus dan Dokumentasi
•  TTV
–  BP 168/88, HR 88x/mnt, RR 20x/menit dengan
nafas tampak berat, T 39.4oC
•  Jantung
–  S3 gallop, Post MI pada intercostal ruang keenam
3 cm distal dari garis midclavicular
•  Dada
–  Ronki basah, peningkatan tak'l fremitus pada
daerah bawah dan tengah area paru kiri
Contoh Kasus dan Dokumentasi
•  Ekstremitas
–  2+ pedal edema
•  Kepala, mata, THT, GI, GU, Kulit, Syaraf
–  Tidak ada kelainan yang berar'
•  Hasil pemeriksaan lab semua dalam batas normal
kecuali untuk beberapa parameter berikut:
–  INR 3,5
–  GDS 156 mg/dL
–  HbA1c 8,3%
–  WBC 16,0 × 103/mm3 dengan 12% bands and 0%
eosinophils
Contoh Kasus dan Dokumentasi
•  Hasil pemeriksaan sputum
–  Gram-posi've coccus berpasangan
•  Hasil Chest x-ray
–  Konsolidasi pada lobus paru kiri dengan beberapa
bercak pada lobus bawah dan tengah paru kiri.
Nampak adanya gambaran pembesaran jantung
Contoh Kasus dan Dokumentasi
•  Assessment
–  Susp. community-acquired pneumonia (CAP)
–  CHF
–  DM Type 2 belum terkontrol secara op'mal
Contoh Kasus dan Dokumentasi
•  Obat yang diberikan saat MRS
–  Parasetamol 500 mg po se'ap 6 jam PRN jika suhu >38oC
–  Ga'floxacin 500 mg po 1x sehari untuk CAP
–  Azithromycin 500 mg po1x sehari untuk CAP
–  Meeormin 500 mg po 2x sehari untuk DM 'pe 2
–  Glyburide 10 mg 1x sehari untuk DM 'pe 2
–  Digoxin 0,125 mg 1x sehari untuk CHF
–  Furosemide 80 mg po 2x sehari untuk CHF
–  Warfarin 5 mg po 1x sehari untuk post MI
–  Aspirin 80 mg 1x sehari untuk post MI
–  Metoprolol XL 100 mg po 1x sehari untuk post MI
–  Famo'dine 20 mg po 2x sehari untuk profilaksis pep'c ulcer
Contoh Kasus dan Dokumentasi
•  Buatlah care plan sesuai problem medik/
diagnosa yang ditetapkan!
 Asuhan Kefarmasian
•  CAP
–  Subyek'f:
–  Obyek'f:
–  Assessment:
–  Plan:
 Asuhan Kefarmasian
•  CHF
–  Subyek'f:
–  Obyek'f:
–  Assessment:
–  Plan:
 Asuhan Kefarmasian
•  DM 'dak terkontrol
–  Subyek'f:
–  Obyek'f:
–  Assessment:
–  Plan:
Contoh rekam catatan PC di RS