Organizing Practices for Pharmaceutical

Care

Presenters:
Anish Ghale
Bhai Kaji Basnet
Rijju Maharjan
Subodh Chataut
Sunita Poudel
M.Pharm 1st semester
Introduction
• According to Strand, Cipolle and Morley, “for the profession of pharmacy to
accept the responsibility associated with the delivery of pharmaceutical care,
an evolutionary process needs to occur.”
• Patient need must be addressed first, and Pharmaceutical care services
should be imparted based on the requirements.
• The basic theme is to provide framework for incorporating the philosophy of
pharmaceutical care in improving the patient outcome.
• Prototypical models are used for implementing P. care.
• Process of redesigning the pharmacy:
Explore the needs of community that the practice serves
Mission statement development that encapsulates P. care philosophy
Short and Long term Goals based on the mission statement
Determining organizational structure and resources for supporting the mission
Developing minimum competencies and retraining the staffs to perform new roles
Develop procedures for implementing the plan
Use evaluation measures and techniques to determine if the plan is effective
Mission statement
• Should reflect the practice’s commitments to pharmaceutical care.
• According to Peter Drucker mission statement should answer the question
”what is our business and what it should be?”.
• The statement should be clear and explicit, based on which objectives and
goals can be set.
• Mission statement should emphasize on pharmacist’s responsibility towards
the patient regarding drug related problems and outcomes.
• Components needing inclusion in mission statement:
Customers, services, location, technology, concern for survival, philosophy,
self-concept, concern for public image, concern for associates.
4 words embrace our philosophy, 4-C’s:

CARE: We offer patient centric services by

FAMILY
fostering a caring, personal relationship PHARMACARE
with the patient

CONVENIENCE: Our policies and An independent

procedures are designed to minimize community pharmacy
unnecessary waiting, while ensuring
highest quality of care unlike any other
COST-EFFECTIVENESS: Obligation to Family Pharmacare centre, Inc
achieve the highest possible quality of 500 Sagamore Parkway, West Office
care at the lowest possible cost Suie

CONFIDENTIALITY: Safeguarding patient

information and to use it to fulfill the
patient responsibilities only
Your health is our business
What’s different about Family
Pharmacare?
Extended Consultation:
Private and personalized
counselling sessions
Medication Profile and Review:
Review of your current medications medicines for your symptoms
for possible interactions and
adverse effects. A summary of the
medication therapy is also made
Brown Bag Review:
This service allows you to bring in &
discuss every prescription & OTC
you are using currently
Compounding Laboratory:
For formulating medications tailor
made to match your needs
Self care advice:
Pharmacists will work to select the
best possible non prescription
Health Information Services:
Computerized Health Information
Services . Pharmacists at your
service are highly competent.
24-Emergency Services:
Providing care whenever you need
it
Patient Bill of Rights
To be treated with courtesy and
respect
To actively participate in your care
To speak to your pharmacist in
private when required
To complete confidentiality ofyour
medical information
To review your medications upon
request
To receive an explanation of the
charges of pharmacy services
Dennis J. McCallian
President
Goals
• Next step is to develop short term and long term organizational goals.
• Specific in nature compared to mission statement
• Examples of Goals:
1. Identifying drug related problems
2. Attaining an increase in patient compliance
• Goals set a benchmark for organization’s performance
• Progress can be tracked and necessary corrective actions undertaken
• Goals can be quantitative or qualitative
Quantitaive Qualitative
Numerical standards Subjective Judgement of attainment
of goal
Easily Verified Paient satisfaction with the
pharmacy services
Identification of 60 drug related
problems by the pharmacists
Linking Goals to plans
• Goals are desired end products, plans are a means of achieving it
• Plan describes what should be done and how, when, where and by whom in
order to achieve the goal
• Prototype pharmacies, the goals are presented in the form of standard of
practices
• These standard of practices demonstrate the knowledge required of a
pharmacist and the level to which the pharmacist must participate with other
health care professionals in order to provide the best care.
Standards of Practice from a prototype pharmacy United States Public
health services
• Std1. Assure appropriateness of drug therapy
• Std2.Verify that patient understand their medications and appropriate
outcomes of therapy
• Std3. Assure availability, preparation and control of medications
• Std4. Provide Drug Information, Drug therapy Consultation and staff
education relating to drug therapy
• Std5. Provide Health promotion and disease prevention activities relating
to drug use and prevention therapy
• Std6. Manage therapy for selected patients in whom drugs are the
primary method of treatment
Analysis of work
• Alice’s Adventures in wonderland, chesire cat explains about the importance of determining where is you want to go
before deciding how to get there.
• Any organizational design will do if it is not directed towards achieving any particular purpose. Therefore the
organization needs to determine the work to be performed before addressing the issue of design.
• The purpose of work analysis is expressed in the motto, “Work, smarter, not harder.”’
• Work analysis uses logic and knowledge of how the human body functions in performing physical tasks to devise
methods for task performance that are easier to learn, less fatiguing, quicker, safer, and more reliable than other
methods.
• The results of work analysis are often used to develop job descriptions, like statements of the duties, working
conditions, and other requirements associated with each job.
• Job descriptions are frequently combined with job specifications.
• A job specification is a statement of the ‘skills, abilities, education, and previous work experience that are required
to perform a particular job. Formats for job descriptions and job specifications tend to vary with the organization,
but the information is often used extensively for activities thatrequire a solid understanding of a job and the
qualifications necessary for performing it.
Example Standards of Practice from a Prototype Pharmacy,

United States Public Health Services, Indian Health Service, Pharmacy Branch Standards of Practice

• Standard 1. Assure appropriateness of drug therapy

• Standard 2. Verify that patients understand their medications and appropriate outcomes of their -
• Standard 3. Assure availability, preparation, and control of medications.
• Standard 4. Provide drug information, drug therapy consultation, and staff education relating to
drug therapy
• Standard 5. Provide health disease prevention activities relating to drug use and prevention
therapy.
• Standard 6. Manage therapy for selected patients in whom drugs are the primary method of
treatment.
Department of Pharmacy. University of California San Diego (UCSD)Medical
Center Standards of Practice :
Standard l. Review of patient medication history, or establishment of a patient
medication history if none exists.
Standard 2. Identification of drug-related problems (potential and actual
problems) that the patient presents with.
Standard 3. Prevention or resolution of drug-related problems. '
Standard 4. Decision about which problems (from the patient's health
problem list) are treatable with drugs.
Standard 5. Establishment or clarification of goals and Objectives of therapy
(desired outcomes) in collaboration with physician or other primary provider,
for each problem being treated.
Standard 6. Establishment of individualized treatment plan with alternatives.
Standard 7. Facilitation of the implementation of the treatment plan.
Standard 8. Patient education and counseling, to assist the patient in making
best use of his or her medication.
Standard 9. Monitoring of the patient’s response to the treatment plan using
appropriate clinical indicators.
Standard 1o. Provision of a summary note for the benefit of the next
pharmacist who cares for the patient.
Standard ll. Projecting an appropriate professional image to the public, to
individual patients and to health care associates.
How to conduct work analysis:

• Work analysis is the systematic collection and recording of information

concerning the purpose of a job, its major duties, the conditions under which it
is performed, the contacts with others that performance of the job requires,
and the knowledge skills, and abilities needed for performing the job effectively.
• Work analysis information can be collected by observing individuals doing the
job, conducting interviews with individuals and their supervisors, having
individuals keep diaries of job related activities, and distributing questionnaires
to be completed by job incumbents and their supervisors (Milkovich and
Boudreau 1988).
Analyzing work consists of answering four separate but related questions
1. What are the component parts of work and the characteristics and
requirements of each pan?
2. How do the component parts fit together?
3. What resources are needed to do the work?
4. What controls are needed to determine and evaluate the direction,
quantity, and quality of work?
1. The Parts of Work:
what are the things that need to be done?
A guideline to identifying boundaries of components of work is to look for differences along the
following three general dimensions: time, technology, and territory (Charns and Schaefer 1983).
Along the dimension of time, the important question is whether work is done at distinctly different
points in time. For example, the components of nursing care, medical care, or other health care may
be performed for a patient during different visits to a clinic or office setting, or perhaps on different
days while the person is hospitalized.
Technology should be considered broadly to! include not only hardware but also skills and training,
personality characteristics and interpersonal orientations, and different practices associated with
performing different work.
Regarding territory, different elements of work can often be recognized by their performance in
different places. For example, in a multiple clinic system, each clinic site forms a natural boundary
around many .types 'of work.
2. Interconnectedness
The second activity in work analysis is determining how the pieces fit together
to form a coherent whole. To accomplish this, a manager should examine each
work element to each other element to see if the pieces of work can be
performed independently of each other or if their dependence upon each other
requires that they be performed sequentially or simultaneously. For example,
diagnosis of an illness is interconnected with treatment. Treatment plans follow
directly from diagnosis; alterations in diagnosis result in changes in treatment;
and errors in diagnosis directly affect the success of treatment. This example
demonstrates the need to realize the interconnectedness of the physician and
the pharmacist in establishing an appropriate therapeutic regimen.
3. Resource Requirements:
Next, the manager needs to estimate What the total task requires in terms of
staff , money, space, equipment, supplies; and information. Analysis of staff
requirements consists of assessing the numbers and types of personnel,
together with their skill requirements, and then determining what
competencies and behaviors are required murder for tasks to be performed.
4. Control Requirement: .
To determine how well work is being performed, the quantity, quality and
timeliness of output and also to assess resource utilization, managers need
information. In order to make decisions about what measures to use and
when to use them, the costs and other effects of the measures on the
practice need to be determined
Eg. Of Pharmacist Job Functions Before and After Implementing plutrmaceutical Care
Before Pharmaceutical Care
Fill prescriptions in compliance with
federal and -state regulations in an
accurate, timely, and courteous
manner; and provide drug
information and counselling to
patient.
Adhere to departmental patient
service standards.
After Pharmaceutical Care:
Interview patients to obtain information regarding medication use,
medication allergies and sensitivities; document the information in the
patient’s medical record or pharmacy information system when
appropriate; advise patients
of directions for use. medication storage requirements, importance of
compliance, precautions
and warnings for medication therapy: advise the patient on the use of
related devices and the coordination of medication therapy with diet,
according to established polices and procedures.
Evaluate and resolve, using professional judgement and established
policies and procedures, potential medication therapy problems
identified through any and all available sources, including
the patient and pharmacy information system
Consult with health care professionals. Confer with medical personnel concerning
pharmaceutical care and treatment of patients,
related clinical diagnosis, drug combinations and
dosage forms, and other factors that might influence
the course of treatment and the activity
of the medications; suggest changes in medication
therapy and/or use as appropriate to assure
optimum therapeutic results.

Maintain a professional image Exemplify pharmacy’s mission and organization’s

vision by contributing to the health and satisfaction of
patients by providing appropriate medications,
information, and professional services in a helpful,
caring, courteous, and efficient manner.
• Training And Development process is a planned effort
that faciliate employees learning of job-related
behaviours in order to improve their performance
By Hall and Goodale(1986)
• Redefine the role of employees
Why do it is needed?
To accomplish organizational objectives:
-More efficient identification of drug related problems
-Improve quality of health care
-Reduce health care cost
 To make staff,techinicians and pharmacist professionally
more competent and personally more committed to
providing consistantly high quality pharmaceutical care.
Methods Of Training

1.Information Presentation Method

This methods entails teaching facts,skills,attitudes or concepts
to the trainees.Examples:lectures,reading lists,videotapes.
2.Simulation training methods
It provides artificial situations that offer trainees a means of
practicing their learning during the training.Examples:case analysis,role
playing
3.On-the-job training methods
It focuses on having the trainee learn while actually
performing a job,usually with the help of a mentor or
preceptor.Examples:job rotation,vestibule training
 Information presentation
method

Simulation
method

On-the job
Phases Of Training(Cascio 1989)
Training efforts generally encompass three main phases:
- Assessment phase
-Training design and implimentation phase
-Evaluation phase
1.Assessment phase
This phase involves in identifying training needs,setting training objectives and
developing criteria to conduct the training.Within assessment phase,training
requirements are determined by conducting need analysis.
Need Analysis:
A need analysis is an assessment of an organizations
training needs that consider overall organizational
requirements,tasks associated with job for which
training is needed, and the degree to which
individuals are able to perfoem those tasks effectively.
(Wexley and latham-1981)
Setting Training Objectives:

After training needs have been determined, objectives must be

established for meeting these needs.
The objectives should demonstrate what the trainee must be taught
in order to do the job
efficiently,safely,economically,and intelligently.
Types Of Objectives(Byars and Rue-1991)

a) Instructional objectives:What principles,facts and concepts are to be

learned ?Who is to be taught?
b) Practice objectives:What impact will the training have on practice
outcomes,such as improved patient quality of life?
c) Individual performance and growth objectives:
What impact will the training have on behavioral and attitudinal outcomes and
personal growth of pharmacist or techinician.
2.Training design and implimentation phase:
This phase invovlves determining training methods,developing
training materials,and actually conducting the training.
3.Evaluation phase:
It is third phase of the training process and entails assessing the
result of training against the criteria developed during
assessment phase.
Result of training can be evaluated by :
-measuring participants reaction
-Assessing actual learning (through test before and after training)
-Determining the extent of behavioral change.
-Measuring actual result on the job.(such as increased output)
Eample: Stansy conducted community pharmacy training seminar for technician

Phase1:Need analysis:community pharmacy training seminar for technician.

(if they take false ,assumed or incorrect data,a pharmacist can not complete a proper drug regimen)

(patient management will be hindered)

Setting objectives:-to be able to interview patient without creating barriers or making assumptions.
-to understand the importance of communication with patients
-to allow the technician to truly understand the new dual purpose of pharmacy and their role in that purpose.
Phase2:Design and implimentaion:
-Designated as nine hour training conference
-Implimented by using following training methods
Lectures,reading lists,videotapes,on-the-job training
Phase3:Evaluation:measure job outcomes result,technician bihavioral change,change in communication skills.
Implementation:
• Implementation is the process that turns plans into actions in order to accomplish
objectives and goals of the program.
• An effectively managed implementation plan is equally important as an effective
program design for the overall success of the program.
• The implementation phase requires more precise supervision than the design
phase.
• When errors are committed during the implementation phase, the damage caused
by those errors must be corrected before that portion of the implementation is
revised.
• The implementation phase actually has two steps:
-planning the implementation of the program
-executing the implementation plan

• O’Donnell (1987) suggests using the following questions as a guide to planning

the implementation:
1) What are the components that need to be implemented?
2) What are the steps required to implement each component?
3) What are the major milestones and the timetable for each of the steps, and how
do they relate to other components being developed?
4) What resources, including funding, space, technological assistance, and people,
are required for each step?
5) What are the progress monitors and measures of success?
• The components that make the program successful include:
-strong support from top management
-involvement of staff in developing the program
-competence of the staff

• The steps required to achieve each of the elements necessary for a successful
program will be different in each case. For example; top management support will
be achieved through a completely different sets of steps than bringing the staff
knowledge level to minimal competencies.
• Execution of the implementation plan should be carried out keeping the plan on
track.
• This is done by monitoring the progress of the effort through predetermined
mechanisms and measuring successes against previously established standards.
• Progress can be monitored by a weekly comparison of tasks completed to tasks
planned.
• Specific assignment of this responsibility will facilitate these progress reports.
• Periodic reviews are important to ensure that plans are implemented as expected
and that goals will ultimately be met.

• Such reviews provide a good opportunity for checking performance to date,

identifying and removing obstacles, solving problems, and altering action plans
that are not achieving the expected results.

• Reviews also make it possible to assess the continuing appropriateness of the

goals, to change the goals if necessary, or to add new goals if required by
changing conditions.
Evaluation of The New Practice
“Evaluation may be defined as a systemic process of
determining the extent to which educational objectives are
achieved by pupil”- Dandekar.
To determine the extent to which program objectives are
being met.
A compilation of information which results in decision,
that must be interpreted and acted by appropriate
member of the pharmacy organizations.
Evaluation is a set of procedures used to appraise a
program’s merit and to provide information about its
goals, activities. Outcomes, impact and costs.

First, Proceed throughout Extend well beyond

identification of the planning and the length of the
the need for new implementing phase program itself.
program
 Of developing a new Results from systemic
program planning

Evaluation is a
vital part:
Serves as a mechanism for
Involves a regular and improving present and
comprehensive review of all future programs and
phases of the program. participants.
Types of Evaluation
A.) Formative Evaluation:

Focus on findings: Purpose:

• What goes on within a To determine how the program
program? can be upgraded and refined.
• How well the program
has been implemented?
• How well the program is
achieving its goal? In community pharmacy:

To develop curriculum package.

Conducted
during planning To train new pharmacist about
pharmaceutical care technique that
and operational involve patient assessment.
phase of
program.
Each step would provide immediate feedback, and use such information to make
necessary revision.
B.) Summative Evaluation:

Determine the effectiveness of and provide information about all potential participants and
all comparable program.

Purpose:
To evalute a program’s
overall impact and to
determine the consistency
with which it produce certain
outcomes.

Findings Example: In pharmaceutical care,

indicate that curriculum was developed, how
whether it is effective the program was in
necessary to identifying, resolving and
continue, revise
preventing patient drug-related
or terminate
problems, using a broad sample of
the particular
program. patient in the practice for which it
was developed.
 Steps in the evaluation process
Five steps involved in conducting a comprehensive evaluation:

Step-1:-
Evaluation is most relevant when it
builds upon and involved the people To determine who is to be
directly and indirectly affected by its involved in the evaluation
results.

To built in mechanism for

assuring that input will be
obtained from all who will be Otherwise
Involvement in affected by the decisions made on evaluation
decision making of the basis of the evaluation process
people who collect findings. limited in
and analyze scope and
evaluation thus
information. unsuccessful.
 This step determine the
type of evaluation that
needs to be completed
Purpose for conducting (i.e, formative or,
the evaluation are made summative)
explicit (clearly
defined), which involve
Step-2: stating the rational for
the evaluation as well
as specifying the
potential audiences for
the evaluation results.

Evaluation should focus on

securing answer to
To identified about the
specific questions
Step-3: program inputs,
regarding program
operations and outputs.
efficacy and participants
effectiveness.
 Step-4:

Evaluation methodology is
determined.

• Answering the evaluation questions posed by planners,

Identification of evaluation
participants, clients and public.
activities that will create a • Provide evidence regarding the successful accomplishment of
description of the program- program objectives.

Information collected for decision

making will be based on
specification otherwise useless of
program.
The collected information that
will be deemed acceptable by the
various audiences regarding
program input, operation and
outputs for the results.
Instruments employed for the collection of data should have following characteristics:
a) Reliability
b) Validity and specificity
c) Practical design
d) Utility in diagnosing strengths and weakness.
e) Inclusions of factors crucial to making distinctions between individuals possessing differing amount
of the characteristic being measured.
To determine when To access the
evaluation will accomplishment of Participants
occur and the points program
in the program objectives,
progress
where it is most participants should evaluated
advantageous to be evaluated prior through-
evaluate to, during and • Progression in
performance. immediately after learning from
the program and at simple to
later intervals. complex.
• Progression in
learning from one
stage to the next.

Step-5:

Inherent in each steps are procedure and technique.

 Internal Evaluation External Evaluation

Evaluation conducted by someone within the

pharmacy in which program is based.
Internal evaluators-regular staff member who take
responsibility for evaluation.
Advantages of internal evaluator in conducting
evaluation-
 Evaluation conducted by someone outside it.
 External evaluators are outside consultants.
 Advantages of external evaluator:
• Being objective than internal.
• Having a fresh perspectives.
 Disadvantage:

• Closer to program and its staff • Their image as a outsider-critics.

• Physical isolation from the program.
• Less obtrusive (noticable).

• They are personally involved in program and their

In summative evaluation, however
job depend upon it-so are less likely to be
objective than outside evaluator. use an external evaluator-

Disadvantages??  To be an objective
 To have an independent
In formative evaluation, it is possible to use either an
perspective
internal or, external evaluator, since the evaluation is
 Evaluation findings are more
likely to require close contact with the project and
likely to be accepted.
staff.
THANK YOU