Clinical Pharmacy
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- Created by: LBCW0502
- Created on: 05-04-18 17:29
What are the three steps for 'bench to bedside'?
Hypothesis (test), evidence (account for patient specific factors) and bedside
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Describe features of a clinical decision (e.g. selecting a painkiller)
Understand condition (pain), know treatment options (e.g. NSAIDs), weigh up pros and cons, what happens if I do nothing?
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What is system 1 of the decision making process?
Fast intuitive decisions (based on pattern recognition) - autopilot
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What is system 2 of the decision making process?
Deliberate analytic approach, locate information not easily recalled
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Outline the dual processing theory
Pharmaceutical problem - pattern processor - if recognised (system 1/difficult/ambiguous) or if not recognised (system 2/logical/critical thinking/intellectual)
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What are the links between system 1 and system 2?
Repetition and pattern recognition (both systems required, not one or the other)
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What is the effect of NICE (evidence based) guidelines on therapeutic outcome?
Decrease in morality/morbidity, symptoms and improved quality of life
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Which factors influence system 2 decisions?
Patient specific factors and medication specific factors
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What are the patient characteristics?
Age/ethnicity/gender, height/weight/BMI, pregnancy/breast feeding, organ function
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Give examples of co-morbidities
Asthma/hypertension, arthritis/peptic ulcer disease, allergy status/infection, pain/renal disease
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What are the function and cognitive factors?
Mobility/balance/sight/swallowing/opening packaging, memory/comprehension
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What are the social and environmental factors?
Lifestyle/home environment/family support, support services available
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What is the other patient specific factor?
Patient's perception of drug therapy
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What are the toxicity factors?
Drug interactions/complementary medicines, allergy status/contraindications, adverse reactions (type A/predictable, type B/idiosyncratic)
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What are the drug disposition factors?
Renal/hepatic function, therapeutic index of medicine
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What are the other medication specific factors?
Drug administration, availability of medicine, response to current and previous drug therapy (did the treatment work/any problems?), efficacy of treatments used
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What are the five key domains when making clinical decisions in pharmacy (1)?
Why is this patient in front of you? What prompted them to seek healthcare? Is this their first presentation with this condition?
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What are the five key domains when making clinical decisions in pharmacy (2)?
What PMH does the patient have?
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What are the five key domains when making clinical decisions in pharmacy (3)?
What drug history does this patient have? If they've had this condition before, what medicine was used then? What was the patient's experience? Do the drug history and PMH match up?
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What are the five key domains when making clinical decisions in pharmacy (4)?
Are there patient factors present that could alter the clinical pharmacology of prescribed medicines?
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What are the five key domains when making clinical decisions in pharmacy (5)?
Are all medicines indicated, safe, effective and convenient?
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What can pharmacists add?
Identify actual problems caused by medicines, anticipate any potential problems medicines may cause (e.g. prophylaxis)
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Describe the features of presenting clinical material
Always maintain patient confidentiality (patient X), be concise, relevant (e.g allergies), logical structure, provide detail where appropriate e.g. medicines
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What is the structure of information?
Intro (age/gender/issue), C/O, HPC, PMH, O/E, FH, SH, DH, lab data, provisional diagnosis, action plan
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What does hyper mean?
High
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What does kal mean?
Potassium
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What does aemia mean?
Blood
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What are the worst possible outcomes of healthcare?
Death, disability, disease (progression/iatrogenic), discomfort, dissatisfaction
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What can affect outcome of healthcare?
Physiological reserve, patient behaviour, healthcare, social factors and environmental factors
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What is the model for medicines optimisation?
Aim to understand patient's experience, evidence based choice of medicines, ensure medicines are used as safe as possible, make medicines optimisation part of routine practice
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What are the eight steps of drug use process?
Need for drug, select drug, select regimen, provide drug, drug administration, monitor drug therapy, counsel patient, evaluate effectiveness
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What is an iatrogenic disease?
Adverse effect due to treatment (cascade effect)
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What is the role of pharmacists vs role of pharmacy?
Provision of medicines (technical, non-pharmacist), moving from a product (medicine) focus to patient focus - clinical activity (pharmacist)
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What is driving the change of pharmacy?
Realisation that medicines can cause unintended harm, need competent healthcare clinicians to minimise risk, change reimbursement of pharmacists, informed general public
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Describe features of the Francis report
Patient harm, deaths, poor care, low staff numbers - Feb 2013
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Describe features of the Berwick report
Culture change, learning, warning signals, identify system failures - Aug 2013
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Describe features of the Carter report
Productivity in the NHS, acute hospitals, practice, costs, motivation/morale
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What are STPs?
Sustainability and transformation plans, 5 year plans, build services around local populations, hospital specialised working in GP surgeries, improve quality/health/efficiency of services
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What are the major errors in the medication process?
Administration/supply of a medicine, wrong/unclear dose or strength
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What are the sources of error?
Prescribing error, supply error, administration error and lack of user education
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What are error provoking circumstances (HALT)?
Hungry, angry, late and tired
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What is pharmaceutical care?
A practice in which a practitioner takes for a patient's drug related needs and holds him or herself for meeting these needs
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What are the aims of pharmaceutical care?
Identify actual and potential drug related problems, resolve problems and prevent potential problems
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What are the three key elements of the pharmaceutical care process?
Assessment, care plan, evaluation
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What are the six categories of medication-related problems?
Untreated indication, medicine being used without an indication, inappropriate medicine selected for the condition, incorrect dose of medicine (too high/low), patient not using medicine, adverse drug reaction
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What are the four key outcomes of pharmaceutical care?
Effective drug therapy, safe drug therapy, economic drug therapy and improve quality of life
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What are the key points for the process of work in pharmaceutical care planning?
Collect relevant patient information, assess information, identify problems, state desired outcomes, prioritise problems, develop an action plan for each problem, determine is desired outcome was achieved
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What are the aspects of consultation skills?
Gathering data, interpreting data, problem solving, providing a solution, effect, monitoring outcomes - (patient consultation, pharmacist' assessments, creation of care plan, patient education, patient monitoring)
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Other cards in this set
Card 2
Front
Describe features of a clinical decision (e.g. selecting a painkiller)
Back
Understand condition (pain), know treatment options (e.g. NSAIDs), weigh up pros and cons, what happens if I do nothing?
Card 3
Front
What is system 1 of the decision making process?
Back
Card 4
Front
What is system 2 of the decision making process?
Back
Card 5
Front
Outline the dual processing theory
Back
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