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Clinical Thinking
Jacqueline Cleary, PharmD, BCACP
Assistant Professor Pharmacy Practice
Jacqueline.cleary@acphs.edu
OB210D
Objectives
List and explain the components of the JCPP
Pharmacists Patient Care Process
Identify examples of components of the JCPP
Pharmacists Patient Care Process
Understand the role of clinical thinking in
pharmaceutical care
Patient Care
WHO
WHAT
WHERE
WHEN
WHY
Adherence
Immunizations
Scheduled patient follow-up
Preventative Health Screenings
Medical History
Medications
Allergies
ALL OF THE ABOVE
Introduction to the
Patient Case
Get familiar with it
Patient Case
Example:
R.R. is a 55 yo M. PMH: diabetes (DM), hypertension (HTN), peripheral
neuropathy, anxiety and insomnia
SH: smoking (-), alcohol (occasionally)
FH (family history): mother- alive with diabetes; father- deceased (MI- 2008)
Allergies: penicillin's (rash)
Immunizations: UTD (up to date)
Medications: metformin 1000mg PO BID, lisinopril 20mg PO daily,
gabapentin 900mg PO TID, trazodone 100mg PO QHS, furosemide 20mg PO
daily
Labs:.
Patient Case
Example:
CC (chief complaint): patient presents today because his
provider told him to take OTC aspirin and he wants to know
which one to take
Patient Case
Treatment of a chief complaint
Disease state management
Provider question
Patient counseling
Drug-information question
Etc.
YOU HAVE TO EXTRACT INFORMATION
Collect
What questions do you want to ask T.C.?
He has not tried anything yet
He has no allergies
He has no significant past medical history
He does not take any medications regularly
He is up to date on his immunizations
He states he recently spent the weekend in Lake George and
thinks he has water trapped in his ear
No labs are available to you
Assess
What would you assess?
He has no other symptoms (ie: fever, cough)
You peer into his ear and it appears red and inflamed
Plan
You make a plan to recommend
Ibuprofen 400mg PO q6 PRN for inflammation and ear pain
AND
Carbamide paroxide 6.5% 5-10 drops BID for up to 4 days for
ear wax removal
Implement
What would you tell the patient?
What the medication is for:
How to take:
What to monitor for:
3 Prime Questions!
Follow Up
When should the patient come back?
Recommend patient see a provider if the symptoms do not
resolve in 48 hours OR
Immediately if he has an adverse reaction to therapy
Points to Remember
Gather ALL pertinent health information
Why is the patient REALLY here
Give clear recommendations and instructions
3 PRIME QUESTIONS: (1) what are you taking it for (2)
how are you taking it (3) what can you expect
Realistic and clear follow up
Collect
What questions do you want to ask A.L?
Has she tried anything for him yet yet
Does her son have any allergies
Does her son have any significant past medical history
Does he take any medications regularly
Is he up to date on his immunizations
No labs are available to you
Collect
A.L. states he only takes Claritin during the spring and
fall for allergies to pollen
She also states he has no other allergies, significant
PMH and is up to date on all of his immunizations
She is concerned he got it while outside playing at a
friends house and does not want to spread the rash to
her other children
Assess
What would you assess?
Her son has no other symptoms
You can visibly see a red raised rash on both of the child's
forearms
He reports it is very itchy
Plan
You make a plan to recommend
Calamine lotion 8% apply to affected area externally as often
as is needed
Diphenhydramine 25mg PO at bedtime if needed
Wash the area with mild soap and warm water as well as
continue to keep the area clean and dry to avoid infection
Implement
What would you tell the patient?
What the medication is for:
How to take:
What to monitor for:
3 Prime Questions!
Follow Up
When should the patient come back?
Recommend to A.L. see a provider if rash continues to spread,
reaches his eyes, or any other symptoms develop
Immediately if he has an adverse reaction to therapy
Points to Remember
Non pharmacologic counseling points are often JUST AS
important as pharmacologic counseling
Clearly communicate your recommendation to the
patient (ie: verbal, written, etc.)
Collaborate with other providers if necessary
Clinical Thinking
Definition
ACCPs definition of clinical pharmacy:
Clinical pharmacy is that area of pharmacy concerned with
the science and practice of rational medication use
http://www.accp.com/docs/positions/whitePapers/CliniPharmCompTFfinalDraft.pdf
http://www.accp.com/docs/positions/whitePapers/CliniPharmCompTFfinalDraft.pdf
Monitoring Therapy
Before
During
After
Take 3 minutes
In pairs: come up with 5 questions you would want to ask
Example Questions
Age
Comorbidities
PMH (past medical
history)
SH (social history)
Medications
Allergies
Conclusion
Collect -> Assess -> Plan -> Implement -> Follow Up:
Monitor/Evaluate
Document ALL activities
Collaborate and communicate with other members of
the healthcare team
3 prime questions
Be comfortable with reading a patient case..
Questions?
Jacqueline Cleary, PharmD, BCACP
Assistant Professor Pharmacy Practice
Jacqueline.cleary@acphs.edu
OB210D