 The pharmaceutical care practitioner provides direct patient care.  the first responsibility is to the patient.  a commitment to meet the patient's drug- related needs whenever and wherever they might arise.  accountable to patients first and colleagues second.  patients' needs before personal needs and all other obligations

 Provide comprehensive care of the same quality to all patients.  the practitioner will always perform the same set of core functions.

 All of the following responsibilities must be met for each patient, and they are considered nonnegotiable with respect to providing pharmaceutical care.

 become familiar with, and knowledgeable about the whole patient and create a pharmacologically relevant description of this individual because many patient parameters influence decisions regarding drug therapy.  accomplished when we understand the patient's medication experience.

 for Appropriate Indication, Effectiveness, Safety, and the Patient's Compliance  clinical questions about a patient's pharmacotherapy must be asked: e.g  Is the medication necessary?  Is it the best product?

 The answers to these questions will guide practitioners in making decisions in a logical manner using the Pharmacotherapy Workup.  when positive outcomes occur, clinicians can understand why these transpired, and learn from the experience  when the patient experiences a negative outcome, it is essential to take corrective action, and learn from this experience.

 Pharmaceutical care practitioners will identify these problems because no other practitioner evaluates the patient's medications for drug therapy problems  Drug therapy problems are costly to the patient in terms of pain and suffering.  Treatment failures are also costly in terms of hospitalizations, additional clinic visits, and lost days at work or school.

 These goals of therapy guide the selection of drug products and determine the acceptable risk in selecting each dosage regimen.  Establishing achievable goals of therapy requires an understanding of the patient's preferences because goals represent a negotiation between practitioner and patient.  Goals of therapy establish the criteria upon which the outcomes of all pharmacotherapy are evaluated, both positive and negative.

 Resolving drug therapy problems benefits the patient directly.  Practitioners intervene to resolve drug therapy problems by taking actions  preventing drug therapy problems.  When a specific patient is at an unacceptably high risk of developing a side effect, toxicity, or experiencing a treatment failure, the practitioner identifies these individual risks and takes action to prevent the problems from occurring.

 The responsibility to follow-up with the patient is absolute.  if there is no follow-up  the patient may interpret this to mean that no one cares about him/her.  you will not know if the drug therapy was effective or if it caused harm.  It is unacceptable to make recommendations and intervene with drug therapies in a patient's life without determining the outcome of actions.  The follow-up evaluation works to strengthen the therapeutic relationship.

 Once responsibility is taken for a patient's medications, it is necessary to follow-up until a successful outcome has been achieved.  It shows a lack of professional responsibility to assume that someone else will accept the responsibility or that patients will manage on their own.  Continuous, excellent care is necessary for patients to benefit optimally from their medications.

 knowledge and skills are not enough to guarantee success in practice.  A philosophy of practice is required to explain how these responsibilities should be conducted.  All practitioners within a profession adhere to the same philosophy of practice thus creating uniform behavior and standards.

Definition  A philosophy of practice is a set of values that guides the behavior of a professional.  It helps the practitioner determine what is important, how to set priorities, and how to make clinical decisions and judgments.  The philosophy of practice prescribes how a practitioner should practice on a daily basis.  It is a set of rules the practitioner must follow to meet the standards of practice

 Two aspects of care  Technical  Demonstrating concern and commitment to well-being of another person.  In order to balance the aspects, the practice of pharmaceutical care was designed to be patient-centered.

When thinking and acting in a caring manner with the patient at the center of the practice, practitioners will

 Pharmaceutical care practice is inherently value-laden  Separate personal values from the professional values that are required to provide care to others.  in order to separate one set of values from another, one must be conscious of what one's personal values are.  To become conscious of these values, it is necessary to engage in critical thinking in an area usually referred to as values clarification.

 A personal set of values will include political views, religious beliefs, social norms, personal preferences, and influence from personal experiences.  Practitioners must become consciously aware of these personal values so that they know when they create conflict in the practice setting.

 Every patient has a right to be treated according to his/her unique character.  Every patient has a right to decide and act on his/her own values to fulfill individual life plans.  Every patient has a right to expect complete objective information and the emotional support necessary to act effectively on that information.

 Every patient has the right, alone or through a health care professional, to the control of his/her time and effort.  Every patient has a right to expect whatever benefit is possible in the health care setting and to expect no avoidable harm.  Every patient has a right to expect that agreements established with the health care professionals will be kept.

 Every practitioner must be prepared to recognize, and even prevent, situations with moral and ethical implications.  This requires the practitioner has  focused attention, and sensitivity to recognize subtle clues that may indicate a situation is laden with ethical components  the knowledge and aptitude for making logical, fair, and consistent decisions

 Basic professional behavior can help avoid ethical dilemmas.  Each behavior is based on an ethical principle

Basic Professional Behaviors Expected in Practice Professional behaviorEthical principle Do the very best you can for every patient Beneficence In all cases, do no harmNonmaleficence Tell the patient the truthVeracity Be fairJustice Be loyalFidelity Allow the patient to be the ultimate decision maker Autonomy/paternalism Always protect your patient's privacy Confidentiality

 The ethical practitioner will want to do what is best for the patient.  negotiated between two parties rather than imposed even if what is best for the patient seems to be clinically obvious.

 the Hippocratic principle above all, do no harm.  At no time should the pharmaceutical care practitioner aggressively force a treatment on a patient.  the clinician who performs without due regard for the patient's considerations acts maleficently.

tell the truth at all times.  Should we tell the truth at all times?  Is it ever ethical not to tell the patient the truth?  Can telling the truth harm people?  If so, under what circumstances?  Can we lie when we consider it in the best interest of our patients?  Does lying sometimes protect people?  Why not deceive a patient if it promotes his/her health and recovery?

 the truth will be told at all costs regardless of the consequences.  Emotional strength, conscience, and often clinical judgment can present barriers to truth- telling.  Truth-telling may be a skill that can be learned with practice.

 Sensitivity and thoughtful communication skills can be learned and polished with experience.  Once initial formative trust is established and a therapeutic relationship is developed, honesty should be unconditional and reciprocal.  Outline the expectation of truth, emphasize its importance, and nurture its development.

 Justice is an ethical principle that relates to fair, equitable, and appropriate treatment in the light of what is due or owed to persons.  giving to some may deny receipt to others.  Not all patients can afford essential drugs  What are their responsibilities to the poor who need assistance?

 the ethical pharmaceutical care practitioner to make every effort to treat all patients equally and assist those who are legitimately disadvantaged by locating information and programs that will meet their needs.

 Practitioners will be expected to adhere to the principle of equality in so much as they care for patients as equals regardless of ethnicity, class, gender, or sexual preference.  Discrimination of any kind is unacceptable, unethical, and intolerable

 relates to the concept of faithfulness and the practice of keeping promises.  fidelity is related to trust as an essential part of any meaningful therapeutic relationship.  Pharmaceutical care practitioners are expected to  Be faithful to the society that grants the right to practice.  Keep the promise of upholding the profession's code of ethics  to practice within the established scope of practice and definition of (pharmaceutical care)  to remain competent in practice  to abide by the policies of employing institutions  to keep promises to individual patients.

 a patient having the freedom to make choices for him or herself.  This does not mean that other individuals play no role in influencing the choices people make  it means that individual choices are respected and subsequent interventions are predicated on respect.  Without it there can be no trust, no therapeutic relationship, and no care.

 there are serious considerations to be taken into account when formulating a care plan.  Does the patient have a clear understanding of all important facts and values?  How do I know if the patient is cognitively competent and can make informed, autonomous decisions?  Is the confused patient acting autonomously?  These questions may sound rhetorical, but they are frequently asked, and uncertainty is common

 The trust that is built between practitioner and patient is compromised without the assurance of confidentiality.  you have a duty to protect a patient's personal information from public view.  It is essential to further the free exchange of information between patient and practitioner.  Patients must feel that anything they say, the nature of their disease or illness, the medications they take, or any other matter they regard as private will be respected.

 practice responsibilities, the patient-centered approach, and the ethical principles all lead to a set of standards for professional performance.

 Caring for others is a privilege that is reserved for those individuals who are uniquely well prepared and who adhere to standards for professional behavior.

The practitioner evaluates his/her own practice in relation to professional practice standards and relevant statutes and regulations.  Measurement Criteria 1. The PCP uses evidence from the literature to evaluate his/her performance in practice. 2. The PCP seeks peer review on a continual and frequent basis. 3. The PCP utilizes data generated from his/her practice to critically evaluate performance.

 self-regulating.  Colleagues hold other colleagues accountable for the quality of the work that is performed.  starts with self-evaluation.  This helps each practitioner improve in practice and contributes to maintaining high standards of professional performance.

The practitioner's decisions and actions on behalf of patients are determined in an ethical manner.  Measurement Criteria 1. The PCP maintains patient confidentiality. 2. The PCP acts as a patient advocate. 3. The PC P delivers care in a nonjudgmental and nondiscriminatory manner that is sensitive to patient diversity. 4. The PCP delivers care in a manner that preserves/protects patient autonomy, dignity, and rights. 5. The PCP seeks available resources to help formulate ethical decisions.

 Second to providing high quality care is providing care in an ethical manner.

The pharmaceutical care practitioner contributes to the professional development of peers, colleagues, and others.  Measurement Criteria 1. The PCP offers professional assistance to other practitioners whenever asked. 2. The PCP promotes relationships with patients, physicians, nurses, and other health care providers.

 impossible to become a great practitioner without the support and assistance of colleagues.  It is impossible to know everything, experience everything and make the right decision in all cases.

The practitioner collaborates with the patient, significant others, and health care providers in providing patient care.  Measurement Criteria 1. The patient is seen as the ultimate decision maker, and the practitioner collaborates accordingly. 2. The practitioner collaborates with the patient's health care providers whenever it is in the best interest of the patient.

 Patient care is collaborative.  The patient is complex.  Patient care is complex.  The health care system is complex.  Collaboration makes all of this manageable. The practice of pharmaceutical care has been developed to make collaboration relatively easy and productive.

The practitioner acquires and maintains current knowledge in pharmacology, pharmacotherapy, and pharmaceutical care practice.  Measurement Criteria 1. The practitioner uses the skills of reflectivity to identify areas where knowledge needs to be supplemented. 2. The practitioner continually updates knowledge with journal subscriptions, current texts, practitioner interactions, and continuing education programs.

 closely associated with the first standard of providing care.  It is impossible today to remain competent without a rigorous schedule of continuing education and collegial interaction.  invest both time and energy in remaining current with your knowledge and competent in your skills.  The volume and rate of knowledge expansion makes this a necessity today

The practitioner routinely uses research findings in practice and contributes to research findings when appropriate.  Measurement Criteria 1. The practitioner uses research results as the basis for practice. 2. The pharmaceutical care practitioner systematically reviews the literature to identify knowledge, skills, techniques, and products that are helpful in practice and implements them in a timely manner. 3. The practitioner approaches his/her practice with a perspective to conduct applied research in practice when appropriate.

 The expectation that research will serve as the basis for decision making in practice is expressed as evidence-based practice.  This is a requirement when a practitioner makes decisions that will impact another person.  our knowledge is incomplete  clinicians make decisions in areas of uncertainty on a daily basis.  The appropriate method for dealing with this is to use our knowledge well, understand the limits of the knowledge, and be able to recognize when science is inconclusive on a topic.

The practitioner considers factors related to effectiveness, safety, and cost in planning and delivering patient care.  Measurement Criteria 1. The pharmaceutical care practitioner is sensitive to the financial needs and resource limitations of the patient, the health care providers, and the institutions with which he/she interacts. 2. Decisions are made by the pharmaceutical care practitioner to conserve resources and maximize the value of those resources consumed in practice

 All health care resources are limited whether it be time, personnel, knowledge, or access to the latest technology.  Decisions made by practitioners need to recognize this, but always put the patient's best interest first.