Megan Griffey; UMKC PharmD Candidate, Class of 2018,
Diane McClaskey, RPh, BCPS: Assistant Director of Experiential Learning-UMKC at MSU,
Valerie Ruehter, PharmD, BCPP; Director of Experiential Learning-UMKC
The role of a pharmacist in the health care system continues to evolve at a rapid pace. Pharmacists are becoming more involved in every aspect of patient care. While, many pharmacists across the nation may be utilizing the similar guidelines, dosing protocols, and thought processes, until 2014 there was not an agreed upon consistent patient care process. The vision of the Joint Commission of Pharmacy Practitioners (JCPP) is to see patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers within patient-centered, team-based healthcare. The JCPP, seeing a need for consistency in the profession, developed the standardized Pharmacists’ Patient Care Process (PPCP).
The PPCP was developed to be a contemporary and comprehensive approach to promote consistency across the profession and encourage collaboration with other members of the health-care team. The PPCP is applicable to a variety of patient care services and provides a framework for delivering patient care in any setting. An active patient-pharmacist relationship and open effective communication with patients, family and caregivers are vital components to patient-centered care. Pharmacists must continuously collaborate and communicate with other health care providers and provide thorough documentation to ensure patients receive optimal care. The patient care process can be further improved by efficient interoperable information technology systems.
The Pharmacists’ Patient Care Process
Collect: The pharmacist assures the collection of necessary subjective and objective information about the patient in order to understand the relevant medical/medication history and clinical status of the patient.
Assess: The pharmacist assesses the information collected and analyzes the clinical effects of the patient’s therapy in the context of the patient’s overall health goals in order to identify and prioritize problems and achieve optimal care.
Plan: The pharmacist develops an individualized patient-centered care plan, in collaboration with other health care professionals and the patient or caregiver that is evidence-based and cost-effective.
Implement: The pharmacist implements the care plan in collaboration with other healthcare professionals and the patient or caregiver.
Follow-up (Monitor and Evaluate): The pharmacist monitors and evaluates the effectiveness of the care plan and modifies the plan in collaboration with other health care professionals and the patient or caregiver as needed.
The Pharmacists’ Patient Care Process can be applied to countless services pharmacists practice on a daily basis. One example includes during a comprehensive medication review you must collect a medication history, assess the information collected and identify drug-related problems. You then develop a Medication-Related Action Plan, communicate and collaborate with the patient’s prescriber, then follow-up with the patient to monitor and evaluate any changes. IV to PO medication conversions require pharmacists to investigate and assess the appropriateness of a particular dosage form, make changes when necessary and properly communicate those changes with all health care professionals involved as well as the patient. Pharmacists collect demographic and disease state information from patients and assess whether they are in need of immunizations or other preventative care services. Chronic disease state management should involve this process at every patient encounter. Identifying drug related problems at the counseling window of a community pharmacy employs the PPCP and provides a process for effective interventions to be made. Even a medication reconciliation at any transition of care utilizes the Pharmacists’ Patient Care Process. Many pharmacists may be utilizing components of this process already, but strategically applying the PPCP to the services offered will ensure consistency and logical flow to patient-centered care.
As a quality improvement exercise, you may evaluate your existing patient care services to ensure all aspects of the PPCP are being met. To begin, select an existing patient care service and rate how it aligns with the components of the PPCP. Rate items with low alignment as level 1. Rate items with high alignment as level 3. For any rating less than 3, develop strategies for improvement and an implementation timeline.
Once you recognize how the PPCP can be applied to the services you provide patients, you can begin incorporating pharmacy student-interns and residents into this process. Early in the pharmacy school curriculum students learn the basics of patient health and medication assessment as well as identifying potential drug related problems and barriers to adherence. Involve students in the Collect and Assess stages of the PPCP through direct instruction and modeling to help them develop good professional communication skills and organization. As students progress through the curriculum mentor them through the critical assessment, plan, implement and follow-up stages. Emphasize the importance of evidence-based recommendations and detailed documentation and follow-up. After gaining an understanding of the baseline knowledge and experience of an APPE student, allow them to work independently through each of the PPCP stages providing coaching and facilitating when appropriate. High level learners, like pharmacy residents, can help teach and precept younger learners.
The Pharmacists’ Patient Care Process provides a standardized approach to patient care promoting consistency across the profession. Learning to implement the Pharmacists’ Patient Care Process in a variety of different pharmacy services will help achieve optimal team-based patient-centered care. Developing learners’ ability to understand and effectively use the PPCP will ensure pharmacists remain an essential member of the health care team.