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The Pharmacy Care Plan

Preceptor Development: Patient Care Process

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Outline

  • Setting the stage for precepting the pharmacy care plan
  • Elements of the pharmacy care plan
  • Feedback and evaluation of your student
  • Overview of the preceptor role
  • An example: my practice

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Setting the Stage

  1. Evaluate and identify how you create and implement a pharmacy care plan

Discuss your role as a pharmacist with the various aspects of the care plan.

          • What is the flow of patient care like at your work site?
          • Do you work independently or collaboratively?
          • What is your scope of practice?
          • How do you implement your care plans?
          • Do you have prescribing authority? Are you able to order labs?
          • Who typically provides monitoring and follow-up?
          • How do seamless care and communication occur with other health care givers?

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Setting the Stage

      • Get to know your student
          • How much experience have they had in creating care plans?
          • Implementing care plans?

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3. Share your approach and expectations for developing and implementing a pharmacy care plan

          • What are the student’s responsibilities?
          • How independently can the student work initially and as the clinical placement progresses?

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MEDICAL CONDITIONS AND/OR DRPs

GOALS OF THERAPY

ALTERNATIVES

RECOMMENDATIONS/

PLAN

MONITORING PARAMETERS

FOLLOW-UP

List and prioritize each medical condition first, followed by any DRPs identified for a given condition. Although some medical conditions may not have a DRP, a care plan is still necessary for ongoing patient monitoring.

DRP Categories: unnecessary drug● additional drug required● ineffective drug● dose too low● adverse drug reaction/interaction ●dose too high ●nonadherence

For each medical condition and/or DRP state desired goals of therapy/timeframe.

Goals: cure, prevent, slow/stop progression, reduce/eliminate symptoms, normalize a lab value.

Consider realistic goals determined through patient discussion. Goals of therapy are measurable or observable parameters that are used to evaluate the efficacy and safety of therapy.

Compare relevant drug and non-drug therapies that will produce desired goals. List the pros and cons of each therapy.

Consider:

Indication

Efficacy

Adherence

Safety

Cost/coverage

In collaboration with the patient and other health care providers, select the best alternative and implement the plan. Provide a rationale for the chosen plan.

Consider:

Drugs: correct drug, formulation, route, dose, frequency, schedule, duration, medication management.

Non-drug: non-drug measures, education, patient referral.

Determine the parameters for monitoring efficacy and safety for each therapy.

Consider:

Clinical & laboratory parameters

The degree of change

The time frame

Determine who, how and when follow-up will occur.

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Adapted with permission from the Division of Pharmacy Practice, Leslie Dan Faculty of Pharmacy, University of Toronto, 2011.

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PHARMACY CARE PLAN WORKSHEET

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Elements of the Pharmacy Care Plan Worksheet

  • Medical conditions and/or DRPs
          • Although some medical conditions may not have a DRP, a care plan is still necessary for ongoing patient monitoring.
  • Goals of therapy
          • Realistic and patient-centered
  • Alternatives
          • Compare realistic & relevant drug & non-drug therapies; list pros/cons.
  • Recommendations/Plans
          • Provide rationale for chosen plan. Be proactive! Have a few back-up plans.
  • Monitoring Parameters
          • Include parameters for efficacy and safety for each therapy.
  • Follow-up
          • Who, how and when will follow-up occur?

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The Care Plan Worksheet

  • A consistent and comprehensive approach on how to manage drug-related issues once an assessment is complete
  • The worksheet is:
        • a tool for students to write down their thoughts in a systematic way (in point form) WHICH
        • Facilitates discussion with you, the preceptor, AND
        • Allows for evaluation of their plan

PRECEPTING

TIP:

The worksheet is NOT a documentation form.

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Documentation should flow from this worksheet.

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Feedback and Evaluation

  • Provide feedback to your student on each component of the care plan:
          • Assess for completeness
          • Is the suggested plan reasonable and acceptable?
          • Which aspect is unacceptable?
          • What improvements need to be made?
  • Evaluate your student:
        • Use the checklist provided to review

their written care plan and provide written

feedback as required by the course.

PRECEPTING

TIP:

Ensure the student is developing specific monitoring and follow-up plans that the pharmacist will conduct.

Note: If student is unable to appropriately create a pharmacy care plan despite feedback and sufficient practice, please contact the course coordinator.

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Checklist for Evaluating Care Plans

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Overview of Preceptor Role

Before the clinical placement

    • Be familiar with the pharmacy care plan process student’s are taught
    • Know the number and variety of care plans required by the Faculty

Early in the clinical placement

    • Provide plenty of guidance on implementing care plans
    • Get to know your students strengths and areas for improvement. Discuss your expectations for creating and implementing each element in a pharmacy care plan
    • Discuss when you will provide routine feedback and evaluation on your student’s patient care activities

Later in the clinical placement

    • Challenge the student with more complex patients

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Precepting the care plan in my practice

HIV Ambulatory Practice- Northern Alberta Program, RAH site

My role and responsibilities

How data is collected and assessed

Developing a care plan

How the plan is implemented

How documentation occurs

Tips for the student as they go through the process