Pharmacy Care Plans: Care Plan Tools

Pharmacy Care Plan Tools - Introduction

Pharmacy Practice has changed significantly over recent years and continues to evolve toward the provision of pharmaceutical care. Pharmaceutical care requires the effective use of care plans and documentation. This series of resource units describe a significant body of work undertaken by Canadian pharmacists, pharmacy regulators and pharmacy academics and highlights the many tools and resources developed by these groups as well as by their colleagues in the pharmaceutical industry.

Resources and tools included in this unit provide several approaches to effective pharmacy care planning, and delineate the necessary components of a plan. There is agreement that a documented plan is not needed for every patient, every time; sometimes a brief note in the computer profile will suffice. Many patients however, have drug-related problems that require the development, implementation and documentation of a care plan.

There are several approaches to care plans, and examples of each approach are found in the tools and resources in this unit. While the range and number of approaches may appear somewhat bewildering for practitioners who are just starting to provide pharmaceutical care, various examples included in this unit are intended to address the needs of all practitioners, including those with advanced practices and those who are at more developmental stages.

Standards of Practice

Practice Unit #2 supports in general Standard #1 of the "Model Standards of Practice for Canadian Pharmacists".

"The pharmacist, using unique knowledge and skills to meet a patient's drug related needs, practices/patient-focused care in partnership with patients and other health care providers to achieve positive health outcomes and/or to maintain or improve the quality of life for the patient."

Specifically, Practice Unit #2 supports four of Standard #1's Operational Components, #1.1, 1.2, 1.8, and 1.10.

Elements of Successful Care Plans

Graduating pharmacy students and practitioners, as well as the pharmacy literature, identified the following key elements for successful care plans:

• A relationship or partnership is established with the patient to ensure ongoing, active patient involvement
• There is effective, ongoing communication and coordination of the plan with the patient, physician, home care providers and other family members
• All medication use is incorporated into the plan, including prescription, non-prescription and complementary medications
• Realistic goals and clear objectives with options to meet the patient's objectives and expectations are set
• A computer program is used for plan documentation requirements, rather than paper
• Patient follow-up is integral to the plan
• The plan is easy to read and understand for the patient. It does not provide unrelated or unnecessary information which may confuse patients.
• A standardized form which is easy to use by the patient and the pharmacist works well, provided it can be customized; flow chart and checklist formats enable different pharmacists to participate in the care plan; facilitating continuity of care.
• The clinical and pharmacotherapeutic outcomes need to be clear, with endpoints well defined.
• Corporate support and cooperation is necessary for sufficient and appropriate staffing
• Some tailoring will be required for pharmacists who work in areas of specialization (e.g. renal, infectious disease, TPN pharmacists). Community pharmacists are much broader in their scope of practice, but nonetheless patients generally have one to two complaints (health problems) which require care/monitoring and as such can have specialized monitoring sheets.

Barriers to effective care plans as well as possible solutions are included in the first unit in this series, Pharmacy Care Plans: General Introduction and Getting Started.

Negotiating Goals of Therapy

This brief article by Janke (1997) provides questions and anticipated responses for an effective patient consultation. The questions are intended to assist in negotiating the goals of therapy with the patient and to look specifically for symptoms that are most relevant to the patient.

Pharmacy Care Plan in Family Practice

Bajcar and Vaillancourt (1996) describe a pharmacy care plan for an asthma patient, within the context of a pharmacy practice based in a family physician practice setting.

Pharmaceutical Care Research and Education Project, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta

This project has developed and published a care plan based on the Therapeutic Thought Process by Winslade et al., using the SOAP approach.

Saskatchewan Pharmaceutical Association (SPhA) Patient Care Plan

As a component of the trial prescription program, a Pharmacist/Patient Care plan has been developed.

New Horizons: Partners in Aging - Community based geriatric pharmaceutical care: From theory to practice

This collaborative project, involving The Manitoba Pharmaceutical Association, The Manitoba Society of Pharmacists, Manitoba Health, Apotex Canada Inc., and the Faculty of Pharmacy, University of Manitoba, has been a working model of the pharmaceutical care process since May 1, 1998. Fourteen pharmacists have been able to provide comprehensive pharmacy services to clients in an ambulatory setting and obtain remuneration for their cognitive services. During the past eight months, these pharmacists have been responsible for the following:

• recruitment of clients who may benefit from individualized pharmacy services;

• obtaining a medical history from each client during a private consultation;

• identifying and prioritizing actual or potential drug-related issues;

• follow-up intervention with a client, physician, and/or other care-provider in order to achieve resolution of a drug-related issue; and

• documentation of these activities for the purpose of remuneration.

To date, the majority of pharmacists and patients have been enthusiastic about the Patient Care Fund Project. A satisfaction survey conducted in October revealed that most patients accepted the pharmacist in this non-traditional role, and were pleased with the service they received. Overall, pharmacists were comfortable providing continuous care when removed from their drug-distribution functions. Continuing education, problem solving skills, and pharmacist-physician interaction have been the main concerns of pharmacists involved in this project. The confidence of pharmacists regarding these obstacles has improved during the first few months of the project. Continued enthusiasm and commitment exist for all those involved in the project.

For further information contact: Jenny Sekyere, Patient Care Coordinator
or Susan Lessard-Friesen, Pharmaceutical Care Coordinator
Manitoba Pharmaceutical Association
187 St. Mary's Road Winnipeg, MB R2H 1J2
Phone: (204) 233-1411Fax: (204) 237-3468
e-mail: info@mpha.mb.ca

Pharmacist's Management of Drug Related Problems (PMDRP)

The original multi-step approach to the provision of pharmaceutical care, developed by Winslade et al at the faculty of Pharmacy, University of Toronto, this tool is helpful in learning the steps to the provision of pharmaceutical care, as well as a detailed care planning process.

Pharmacy care plans from Hospital Practice

In 1997, the Canadian Society of Hospital Pharmacists (CSHP) published a five module Direct Patient Care Curriculum for Learning, in which Module 3 Doucette, 1997) addresses Care Plans. The modules are intended to assist pharmacists in developing a more consistent approach to providing direct patient care, and while they target hospital practice, the many tools found in this resource have application in community practice as well. It is recommended that all five modules be worked through in order, but for purposes of this unit, the module which addresses patient care plans (Module 3) is highlighted here.

Care Plans are described in the context of the pharmaceutical care process. The module is designed for three major purposes:

• To encourage pharmacists to use a Pharmacy Care plan as a tool for the monitoring and follow-up of patient care
• To provide educational learning experiences supporting the development and implementation of individualized care plans
• To promote application of a structured approach to the consistent delivery of pharmaceutical care.

Tools supported by the module include:

• A monitoring plan
• Sample Pharmacy Care Plans from across the country - referenced to each organization

Please contact CSHP at www.cshp.ca to order the Pharmaceutical Care Education Modules

Developing A Pharmaceutical Care Plan

McDonough (1996) describes the steps in developing a care plan, within the context of the pharmaceutical care practice model in the Journal of the American Pharmaceutical Association.

Software Support

Several companies have developed software to support Care Plans including Health Outcomes Pharmacies, Simplicity and DKK Health Systems. Sample screens and information are attached.

1. Janke KK. Tobin C. Negotiating Goals of therapy with patients. Can Pharm J 1997 May;130(4):24-7.
2. Bajcar J, Vaillancourt R. Integrated Delivery of Pharmaceutical Care in Family Practice. Pharmacy Connection Sep/Oct 1996 :26-33.
3. Modified Version of Pharmacist's Management of Drug Related Problems. Pharmaceutical Care Research and Education Project. University of Alberta 1996.
4. Patient Care Plan, Saskatchewan Pharmaceutical Association.
5. Vercaigne LM, Grymonpre R. The Manitoba Pharmaceutical Care Project: Implementation and Evaluation. University of Manitoba 1998.
6. Winslade N, Bajcar J. Pharmacist's Management of Drug Related Problems (PMDRP). Faculty of Pharmacy, University of Toronto. 1994.
7. Doucette D. Direct Patient Care Curriculum - Module 3: Pharmacy Care Plan. CSHP; 1997.