Patient Assessment Tool Helps Identify Drug-Related Problems
This viewpoint offers commentary on important clinical research in the area of pharmacy.
Dersch D
Am J Health Syst Pharm. 2008;65:702-703
Today's pharmacy graduates are trained to carefully consider the patient's history, medication profile, laboratory data, physiologic parameters, and information gleaned from the patient interview. Pharmacists merge this patient-specific data with a thorough understanding of evidence-based pharmacotherapy. This article describes a tool that incorporates all that a pharmacist must consider in order to discover potential drug-related problems.
Components of this tool allow for gathering patient data, such as medical history, laboratory data, and physical exam findings, to identify any conditions not being addressed. The tool also prompts the pharmacist to determine whether any type of prophylaxis is needed (eg, vaccines or drugs to prevent deep vein thrombosis, stress ulcers, osteoporosis, etc).
Next, medications are matched to each medical problem so the pharmacist can determine whether any additional drugs are needed or if any therapies currently being administered are unnecessary. Prompts are listed in the tool to screen for inappropriate dosages, side effects, interactions, and allergies. Some of the more subtle pieces of patient history that students and inexperienced pharmacists may overlook are also listed. Finally, the pharmacist is prompted to consider any barriers to medication adherence that may exist, such as financial or formulary concerns, as well as problems associated with the actual dosage form.
Studies have demonstrated that pharmacists practicing in a variety of settings can identify and prevent clinically significant drug-related problems. Pharmacist trainees learn complex information about medications, diseases, intravenous solutions, drug information, dispensing, patient counseling, and research techniques, and they acquire skills needed to provide quality pharmaceutical care. However, most trainees and novice pharmacists often lack a systematic method of prospectively identifying drug-related problems, a skill that is second nature for experienced clinical pharmacists.
As a clinical faculty member, I have found that pharmacy students, residents, and newly licensed pharmacists often lack the ability to efficiently identify and manage important drug-related problems. I have also been frustrated in my attempts to condense these skills into a manageable "checklist" format. Fortunately, this useful patient assessment tool can be incorporated into the hectic pace that is familiar to pharmacists practicing in a variety of settings.
The assessment tool is very user-friendly and practical. One precaution: It is not a substitute for the actual gathering of clinical data, but rather it prompts the pharmacist or trainee to screen for potential or actual drug-related problems.
Equipped with this tool, senior pharmacy students, new pharmacy practitioners, and even more seasoned pharmacists will be able to more efficiently identify drug-related problems. Application of this tool may lead to improvement in the quality of patient care. Examples include the avoidance of drug toxicity, more economical prescribing, administration of appropriate vaccines, prescribing of more appropriate, patient-specific dosages, improved medication adherence, and the withdrawal of unnecessary medications in a systematic, informed manner. My belief is that this tool would also be useful in the hands of anyone licensed to prescribe, or those responsible for monitoring patients in acute-care settings, such as nurses and other providers.
Abstract
This viewpoint offers commentary on important clinical research in the area of pharmacy.
Dersch D
Am J Health Syst Pharm. 2008;65:702-703
Today's pharmacy graduates are trained to carefully consider the patient's history, medication profile, laboratory data, physiologic parameters, and information gleaned from the patient interview. Pharmacists merge this patient-specific data with a thorough understanding of evidence-based pharmacotherapy. This article describes a tool that incorporates all that a pharmacist must consider in order to discover potential drug-related problems.
Components of this tool allow for gathering patient data, such as medical history, laboratory data, and physical exam findings, to identify any conditions not being addressed. The tool also prompts the pharmacist to determine whether any type of prophylaxis is needed (eg, vaccines or drugs to prevent deep vein thrombosis, stress ulcers, osteoporosis, etc).
Next, medications are matched to each medical problem so the pharmacist can determine whether any additional drugs are needed or if any therapies currently being administered are unnecessary. Prompts are listed in the tool to screen for inappropriate dosages, side effects, interactions, and allergies. Some of the more subtle pieces of patient history that students and inexperienced pharmacists may overlook are also listed. Finally, the pharmacist is prompted to consider any barriers to medication adherence that may exist, such as financial or formulary concerns, as well as problems associated with the actual dosage form.
Studies have demonstrated that pharmacists practicing in a variety of settings can identify and prevent clinically significant drug-related problems. Pharmacist trainees learn complex information about medications, diseases, intravenous solutions, drug information, dispensing, patient counseling, and research techniques, and they acquire skills needed to provide quality pharmaceutical care. However, most trainees and novice pharmacists often lack a systematic method of prospectively identifying drug-related problems, a skill that is second nature for experienced clinical pharmacists.
As a clinical faculty member, I have found that pharmacy students, residents, and newly licensed pharmacists often lack the ability to efficiently identify and manage important drug-related problems. I have also been frustrated in my attempts to condense these skills into a manageable "checklist" format. Fortunately, this useful patient assessment tool can be incorporated into the hectic pace that is familiar to pharmacists practicing in a variety of settings.
The assessment tool is very user-friendly and practical. One precaution: It is not a substitute for the actual gathering of clinical data, but rather it prompts the pharmacist or trainee to screen for potential or actual drug-related problems.
Equipped with this tool, senior pharmacy students, new pharmacy practitioners, and even more seasoned pharmacists will be able to more efficiently identify drug-related problems. Application of this tool may lead to improvement in the quality of patient care. Examples include the avoidance of drug toxicity, more economical prescribing, administration of appropriate vaccines, prescribing of more appropriate, patient-specific dosages, improved medication adherence, and the withdrawal of unnecessary medications in a systematic, informed manner. My belief is that this tool would also be useful in the hands of anyone licensed to prescribe, or those responsible for monitoring patients in acute-care settings, such as nurses and other providers.
Abstract
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