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PRINCIPLES OF PRACTICE
AND STANDARDS OF CARE
FOR PHARMACEUTICAL CARE

Eva M A Ombaka
 This session…
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 Identify gaps in present pharmacy practice

 State the APhA PC principles and how they are
applied
 Describe the standards of care and how each is
implemented.
 Ref books
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 1. Pharmaceutical care practice: The clinician’s

guide 2nd ed, R. Cipolle, L Strand, P Morley.
 2. Pharmaceutical care practice, R. Cipolle, L
Strand, P Morley.
 3. A practical guide to Pharmaceutical care: A
clinical skills primer. 3nd ed;. J.Rovers and
Currie
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 Reports on visits to the pharmacies in town

 REFLECTION….1
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 Review of your visit to the pharmacies in town:

 Do patients have all their medication –related health
care needs addressed?
 Are the pharmacists actively seeking out patients’
drug therapy problems?
 What opportunities to deliver improved care are left
unmet?
 Introduction to the principles
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 American Pharmacists Association (APhA) stated

principles.
 Philosophies- a prerequisite to delivering and
patient care services.
 Adopt philosophy- commit resources and effort-
quality of care.
 Opposite is unorganized, sporadic delivery of
isolated services to customers who are not engaged
with their pharmacists
 Principles of Practice.
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 A. A professional relationship must be

established and maintained.
 relationship based upon caring, trust, open
communication, cooperation, and mutual decision
making is established and maintained.
 Where pharmacist uses all his/her professional
knowledge and skills on the patient's behalf
 Where the patient agrees to supply personal
information and preferences, and participate in the
therapeutic plan
 Therapeutic Relationship-Integral to
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PC
 Trusting collaborative relationship between
pharmacist and patient
 Pharmacist:
 Hold patient welfare paramount
 Maintain appropriate attitude of caring for pt’s welfare
 Use professional knowledge and skill on pt’s behalf
 Patient
 Supply personal information
 Express preferences
 Participate in development of plan
 Principles of Practice
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B. Patient-specific medical information must

be collected, organized, recorded, and
maintained….1
Pharmacists must collect and/or generate subjective and
objective information
Info on general health and activity status, past medical
history, medication history, social history, diet and
exercise history, history of present illness, and
economic situation
 Principles of Practice
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B. Patient-specific medical information ….2

Sources - the patient, medical charts and reports,

pharmacist-conducted health/physical assessment,
the patient's family or caregiver, insurer, and other
healthcare providers

Info must be timely, accurate, and complete, and it must

be organized and recorded, confidential
 Principles of Practice
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 C. Patient-specific medical information must

be evaluated and a drug therapy plan
developed mutually with the patient….1
-Based upon a thorough understanding of the patient, develop
an outcomes-oriented drug therapy plan
-plan may have various components which address each of
the patient's diseases or conditions.
-must carefully consider the psycho-social aspects of the
disease as well as the potential relationship between the cost
and/or complexity of therapy and patient adherence.
 Principles of Practice
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C. Patient-specific medical information …

evaluated …drug therapy ….1
-patient must be apprised of
1) various pros and cons (i.e., cost, side effects,
different monitoring aspects, etc.) of the options
relative to drug therapy and
2) instances where one option may be more beneficial
based on the pharmacist's professional judgment.
 Principles of Practice
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 C. Patient-specific medical information …

evaluated … drug therapy plan
-The essential elements of the plan, including the patient's
responsibilities, must be carefully and completely explained
to the patient.
-Information should be provided to the patient at a level the
patient will understand
-plan documented and communicated to the patient's other
healthcare providers
 Principles of Practice
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 D. The pharmacist assures that the patient

has all supplies, information and knowledge
necessary to carry out the drug therapy
plan.
 Pharmacist providing Pharmaceutical Care must assume
ultimate responsibility for success of the drug therapy plan
 patient obtains and appropriately use

 Understands the disease

 Understand therapy or medication in the plan

 Principles of Practice
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 E. The pharmacist reviews, monitors, and modifies

the therapeutic plan as necessary and appropriate,
in concert with the patient and healthcare team.
 monitoring the patient's progress in achieving the specific
outcomes
 coordinates changes in the plan with the patient and the patient's
other healthcare providers as necessary
 Patient progress is accurately documented
 assure continuity of care as the patient moves between the
community setting, the institutional setting, and the long-term
care setting.
 Principles Summary
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
1.
Data Collection (included developing
ther. relationship)
 2. Information Evaluation

 3. Formulating a Plan

 4. Implementing the Plan

 5. Monitoring and Modifying the

Plan/Assuring Positive Outcomes

(includes documentation)
 The Patient care process
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 Privilege to care for others means you must develop a

discipline to meet the responsibility in consistent and
complete manner.
 The discipline (patient care process) requires use a
systematic, comprehensive, efficient process to:
 achieve goals of therapy (appropriate, effective, safe,
convenient)
 Identify, resolve and prevent DTP
 Assure positive patient outcomes
 Process involves 3 major steps: assessment, care plan
and evaluation (see Fig 4.1 pg 124 book red )
 The Patient care process
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 The Pharmacotherapy workup is a framework for

thinking about your patient-specific information, your
knowledge of patients, disease and drug therapy, and
the decisions you have to make.
 Indication Drug product dosage regimen
Outcomes (Effectiveness and Safety)
 The standards of care cover all the major activities
and are applicable to all practice sites, diseases,
patients and drug therapy categories.
 ASSESSMENT….Standard of care 1
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1. Collection of patient–specific information

Measurement criteria
1. Data collected using appropriate interview
techniques.
2. Involve patient, family, caregiver and health care
provider as appropriate
3. Medication experience elicited and incorporated
as context for decision making
4. Use data to develop pharmacologically relevant
description of patient and his drug related needs
 ASSESSMENT….Standard of care 1
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1. Collection of patient–specific information…cont

5. Relevance and significance of data determined by
patient’s present condition, illness, want and needs.
6. Medication history is complete and accurate
7. Current medication record complete and accurate
8. Data collection process is systematic and ongoing
9. Only data required and used is collected
10. Data documented in retrievable form

11. Process ensures patient confidentiality

 ASSESSMENT….Standard of care 2
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2. Assessment of drug related needs.

Pt’s specific data is assessed and used to decide if:
1. All patient’s medication are appropriately indicated
2. Patient needs additional medication not presently
taken
3. All patient’s medications are most effective products
available for condition
4. All medication are dosed appropriately to achieve
therapy goal
 ASSESSMENT….Standard of care 2
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2. Assessment of drug related needs cont.

Assess data and decide if:
5. Patient’s medication are causing adverse effects
6. Patient’s medication are dosed excessively and
causing toxicities
7. All his medications are being taken appropriately to
achieve goal of therapy (assessing patient’s
behaviour).
 ASSESSMENT….Standard of care 3
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3. Identification of drug therapy problems

1. DTP identified from the assessment findings
2. DTP validated with patient, family caregiver health
professional as necessary
3. DTP stated (medical condition, drug, relationship or
cause)
4. DTP prioritized and those to address first selected
5. DTP documented to facilitated goal of therapy
 CARE PLAN
DEVELOPMENT….Standard of care 4
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4. Development of goals of therapy

1. Goal of therapy (GOT) established for each indication
for drug therapy
2. GOT described in terms of observable or measurable
parameters to be used to evaluate effectiveness and
safely
3. GOT mutually negotiated with patient and health care
provider as appropriate
4. GOT realistic in relation to patient's present and
potential capabilities
5. GOT have timeframe for achievement
 CARE PLAN
DEVELOPMENT….Standard of care 5
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5. Statement of interventions
1. Intervention individualized to patient condition, drug
related needs, and DTP
2. Alternatives considered and best selected
3. Plan developed with patient, family/caregiver or
health care provider as appropriate
4. All interventions documented
5. Plan provides continuity of care by including a
schedule for continuous follow up evaluation
 CARE PLAN
DEVELOPMENT….Standard of care 6
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6. Establishing a schedule for follow up evaluations

1. Parameters (clinical and lab) for evaluating
effectiveness established and timeframe for
collecting info selected
2. Parameters (clinical and lab) for reflecting patient’s
safety selected and timeframe for collecting info
selected
3. Schedule for follow up evaluation established
4. Plan for follow up evaluation documented
 FOLLOW-UP EVALUATION Standard of
care 7
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7. Follow up evaluation
1. Patient’s outcomes from drug therapy and other
interventions documented
2. Effectiveness of drug therapy evaluated and pt’s
status determined by comparing outcomes within the
expected time frames to achieve goal of therapy
3. Safety of drug therapy evaluated
4. Patient compliance evaluated
5. The care plan is revised as needed.
 FOLLOW-UP EVALUATION Standard of
care 7
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Follow up evaluation cont

6. Revisions in the care plan are documented
7. Evaluation is systematic and ongoing until all goals
of therapy are achieved.
8. The patient, family/caregiver and health care
providers are involved in the evaluation process as
appropriate.
“No one cares how much you know until they know
how much you care”
Follow up help show you care!
 ACTIVITY
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 OPEN PAGES 126-127 ( book

Red) AND STUDY THE FLOW
DIAGRAM.
 RELATE TO THE FIVE

PRINCIPLES.