Patient care planning involves systematically
assessing a patient’s health problems and needs, setting objectives, performing
interventions, and evaluating results. Not all patients require a written PCP.
Pharmacists must assess their own patients and identify specific areas on which
to focus. For example, the pharmacist may want to identify patients with
specific diseases (e.g., asthma, hypertension, diabetes mellitus, or
hyper-cholesterolemia).
The development of a PCP can be summarized as a five
step process involving the SOAP format (Subjectivedata, Objective data.
Assessment, and Plan of care). Using the example in Figure 1 for an asthma
patient, the process can be described as follows.
Step 1. Gathering Information
The pharmacist should gather an accurate medication
history, including both prescription and non-prescription medications and the
reasons the medications were prescribed or taken. The pharmacist will likely
have to obtain some information from the physician, such as laboratory test
results and hospitalizations. If so, the pharmacist should get written permission
from the patient before soliciting this information. Once this information is
compiled, the preparation of a PCP can begin.
Step 2. Identifying Problems
From the patient’s medication profile in Figure I,
only one problem is evident: diagnosis of asthma. If applicable, other problem
should also be listed.
In Figure I, subjective and objective findings
correlated to the problem are listed. Subjective findings are those that the
patient describes (e.g., ’I feel tired all the time, “I feel bloated,” or “I
woke up coughing”). References 12, 13, and 14 describe methods to ascertain
this information. Objective findings are those that can be observed or measured
by the pharmacist (e.g., patient appears tired, blood pressure is 180/105,
pitting edema in ankles).
In the patient with asthma, the pharmacist would
have the patient use a peak expiratory flow meter and record the results.
Stop 3. Assessing Problems.
The pharmacist analyzes and integrates tile
information gathered in steps 1 and 2 and draws conclusions in preparation for
developing a patient-specific PCP, For example, in the asthma case (Figure 1),
the pharmacist may first investigate the etiology of the factors that
exacerbated the asthma. The pharmacist does not have to be involved in skin
testing, nor does the pharmacist have to conduct a detailed, extensive history
of all of the factors that may have precipitated the asthma. However, the
pharmacist should attempt to determine if drugs (e.g., aspirin, non-steroidal
anti-inflammatory agents, or beta-blockers) caused or exacerbated the asthma in
the patient. Thus, the importance of an accurate and complete drug history
becomes evident 12, 14
Next, the pharmacist assesses the severity of the
asthma. This could be accomplished (as shown in the plan) by determining the
PEFR, examining the patient’s daily symptom and peak flow diary, or determining
if the patient had been hospitalized and placed on steroids or a mechanical
ventilator.
Step 4. Developing the Plan
In step 4, the pharmacist establishes goals linked
to each of the patient’s problems and specifies a course of action aimed at
meeting each goal.
Each goal (i.e., desired improvement) should be
stated in terms of measurable outcomes that indicate the extent to which the
particular problem has been resolved. Often, the patient has several problems,
and the plan must be comprehensive enough to have a positive effect on the
overall health of the patient.
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