1. Quality Education for a Healthier Scotland Pharmacy Pharmaceutical Care Planning Vocational Training Scheme: Level = Stage 2 Arlene Shaw Specialist Clinical Pharmacist, NHS Tayside

2. Quality Education for a Healthier Scotland Pharmacy Aim and Objectives AIM To provide pharmacists with an overview of how to complete pharmaceutical care plan as part of the Pharmacy Vocational Training Scheme OBJECTIVES  to identify the key issues associated with a specific pharmaceutical care plan  to describe the care issues, actions and outputs associated with a specific pharmaceutical care plan  to record investigations as part of a pharmaceutical care plan

3. Quality Education for a Healthier Scotland Pharmacy Introduction PHARMACY VOCATIONAL TRAINING SCHEME  Competency based training scheme that enables pharmacists to demonstrate competence through learning from experience in the workplace. PHARMACY VOCATIONAL TRAINING SCHEME  Competency based training scheme that enables pharmacists to demonstrate competence through learning from experience in the workplace

4. Quality Education for a Healthier Scotland Pharmacy Evidence  Essential to demonstrate your personal involvement  Include a variety of clinical areas  Must reflect on each piece of evidence  No patient identifiable information  Use Care Plan on NES Pharmacy Website  Require 12 care plans, 4 of which should be accompanied by a more detailed case study.

5. Quality Education for a Healthier Scotland Pharmacy Cover Page Short summary (-200 words)  Describe case  Reasons for choosing case Reflection  Learning from developing the care plan  Feedback from tutor  Implications for future practice Sign Off  From the appropriate clinical specialist

6. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 1 Patient Details Patient Stay  What brought the patient into hospital?  Symptom / signs not diagnosis Medical History / Drug History  Try and match these sections up Non-Drug Treatment  E.g. physiotherapy, speech and language therapy etc Continuity of Care  Discharge details

7. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 2 Factors affecting –  Individual factors relevant to pharmacy practice  Inform pharmaceutical issues  Absorption e.g. co-prescription of antacids  Distribution e.g. plasma protein binding  Metabolism e.g. age  Excretion e.g. renal failure  Ability to self medicate e.g. confusion  Route of Admin e.g. target site of action

8. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 2 cont. Clinical management  Pharmaceutical need – requirement for pharmaceutical care  Outcomes to consider:  cure  elimination or reduction in symptoms  arresting or slowing disease progression  prevention of disease / symptoms   e.g. CAP – ensure appropriate antibiotics prescribed to correctly treat infection, minimise risk of adverse drug reactions  e.g. hypertension – maintain blood pressure control in order to reduce risk of future cardiovascular complications  Include acute and chronic disease

9. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 2 cont. Current Medication  List everything the patient was taking on admission  Record allergies or NKA

10. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 3 Pharmaceutical Care Plan CARE ISSUE “An element of a pharmaceutical need which requires to be addressed by a pharmacist”. What is the problem? Something which prompts a pharmacist to “do” something.  Take into account patient and medication risk factors  Consider each problem in turn

11. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 3 cont.  Categories to consider:  Untreated indication  Improper dug selection  Sub-therapeutic dose  Failure to receive medication  Overdosage  Adverse drug reactions  Drug interactions  Medication use without indication

12. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 3 cont. DESIRED OUTPUT  Statement of what a pharmacist aims to achieve for a patient in relation to a care issue  What do you want to achieve as a pharmacist?  SMART  Specific  Measurable  Achievable  Realistic  Time-bound

13. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 3 cont. ACTION  An action a pharmacist takes to address a care issue for a patient  What did you as a pharmacist do?  Relate to evidence base / demonstrate knowledge of EBM  Ideas to consider  Recommending therapy  Monitoring  Patient counselling  Confirm medication for discharge

14. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 3 cont. OUTPUT  Response of the health team and /or patient to the pharmacists actions, and/or the clinical outcome for the patient  What did you achieve as a result of your action?  Should be a direct result of your input.  Compare with desired output to evaluate effectiveness of the action taken.

15. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 3 cont. Problem: - Patient admitted is found to be hyperkalaemic and is on an ACE inhibitor which may be contributing to this condition. Care issue: - As above Desired output: - Avoid medicines which may contribute to hyperkalaemia - Potassium within reference range - ? Appropriate treatment of hyperkalaemia as per local guidelines

16. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 3 cont. Action: - Review all medicines for potential ADR - Discuss potential ADR with the medical team and suggest witholding / stopping potential contributing agents - Monitor Potassium - ? Check local guielines to ensure appropriate treatment of hyperkalaemia Output- ACEi witheld ?others - Potassium within reference range - ? Appropriate treatment

17. Quality Education for a Healthier Scotland Pharmacy Care Plan Page 4 Review Dates Investigations  Relate to care issues  TDM

18. Quality Education for a Healthier Scotland Pharmacy Final Points....  Complete all sections of care plan  Choose simple cases  Remember training is progressive!

19. Quality Education for a Healthier Scotland Pharmacy Questions Any questions? Email: arlene.shaw@nhs.net