Preceptor Development: Patient Care Process
The Pharmacy Care Plan
Outline
• Setting the stage for precepting the
pharmacy care plan
• Elements of the pharmacy care plan
• Feedback and evaluation of your student
• Overview of the preceptor role
• An example: my practice
Setting the Stage
1. Evaluate and identify how you create and
implement a pharmacy care plan
Discuss your role as a pharmacist with the various aspects
of the care plan.
• What is the flow of patient care like at your work site?
• Do you work independently or collaboratively?
• What is your scope of practice?
• How do you implement your care plans?
• Do you have prescribing authority? Are you able to order labs?
• Who typically provides monitoring and follow-up?
• How do seamless care and communication occur with other
health care givers?
Setting the Stage
2. Get to know your student
• How much experience have they had in creating
care plans?
• Implementing care plans?
3. Share your approach and expectations for
developing and implementing a pharmacy
care plan
• What are the student’s responsibilities?
• How independently can the student work initially and
as the clinical placement progresses?
MEDICAL CONDITIONS GOALS OF THERAPY
PHARMACY CARE PLAN WORKSHEET
ALTERNATIVES RECOMMENDATIONS/ MONITORING FOLLOW-UP
AND/OR DRPs PLAN PARAMETERS
List and prioritize each For each medical Compare relevant drug and non- In collaboration with the Determine the parameters Determine who, how and
medical condition first, condition and/or DRP drug therapies that will produce patient and other health care for monitoring efficacy and when follow-up will
followed by any DRPs state desired goals of desired goals. List the pros and cons providers, select the best safety for each therapy. occur.
identified for a given therapy/timeframe. of each therapy. alternative and implement the Consider:
condition. Although some Goals: cure, prevent, Consider: plan. Provide a rationale for the Clinical & laboratory
medical conditions may slow/stop progression, Indication chosen plan. parameters
not have a DRP, a care reduce/eliminate Efficacy Consider: The degree of change
plan is still necessary for symptoms, normalize a Adherence Drugs: correct drug, The time frame
ongoing patient lab value. Safety formulation, route, dose,
monitoring. Consider realistic goals Cost/coverage frequency, schedule, duration,
DRP Categories: determined through medication management.
unnecessary drug● patient discussion. Goals Non-drug: non-drug measures,
additional drug of therapy are education, patient referral.
required● ineffective measurable or
drug● dose too low● observable parameters
adverse drug that are used to evaluate
reaction/interaction the efficacy and safety of
●dose too high therapy.
●nonadherence
Adapted with permission from the Division of Pharmacy Practice, Leslie
Dan Faculty of Pharmacy, University of Toronto, 2011.
Elements of the Pharmacy Care Plan Worksheet
•Medical conditions and/or DRPs
• Although some medical conditions may not have a DRP, a care plan is
still necessary for ongoing patient monitoring.
•Goals of therapy
• Realistic and patient-centered
•Alternatives
• Compare realistic & relevant drug & non-drug therapies; list pros/cons.
•Recommendations/Plans
• Provide rationale for chosen plan. Be proactive! Have a few back-up
plans.
•Monitoring Parameters
• Include parameters for efficacy and safety for each therapy.
•Follow-up
• Who, how and when will follow-up occur?
The Care Plan Worksheet
• A consistent and comprehensive
approach on how to manage drug-
related issues once an assessment is PRECEPTING
complete TIP:
The worksheet is NOT a
• The worksheet is: documentation form.
• a tool for students to write down their Documentation should flow
thoughts in a systematic way (in point from this worksheet.
form) WHICH
• Facilitates discussion with you, the
preceptor, AND
• Allows for evaluation of their plan
Feedback and Evaluation
• Provide feedback to your student on each
component of the care plan:
• Assess for completeness
• Is the suggested plan reasonable and acceptable?
• Which aspect is unacceptable?
• What improvements need to be made? PRECEPTING
TIP:
• Evaluate your student: Ensure the student is
developing specific
• Use the checklist provided to review monitoring and follow-
their written care plan and provide written up plans that the
pharmacist will conduct.
feedback as required by the course.
Note: If student is unable to appropriately create a pharmacy care plan despite
feedback and sufficient practice, please contact the course coordinator.
Checklist for Evaluating Care Plans
PHARMACY CARE PLAN WORKSHEET with CHECKLIST FOR ASSESSMENT
MEDICAL CONDITION GOALS OF ALTERNATIVES RECOMMENDATIONS/ MONITORING FOLLOW-UP
AND/OR DRPs THERAPY PLAN PARAMETERS
For each medical condition For each medical condition Compare relevant drug and non-drug In collaboration with the patient and Determine the Determine who, how and when
and/or DRP identified, create an and/or DRP state desired therapies that will produce desired goals. List other providers, select the best parameters for follow-up will occur.
integrated pharmacy care plan. goals of therapy. the pros and cons of each therapy. alternative and implement the plan. monitoring the efficacy
List and prioritize each medical Goals: cure, prevent, (Consider indication, efficacy, safety, Provide a rationale for the chosen and safety for each
condition first, followed by any slow/stop progression, adherence and cost/coverage). plan. therapy.
DRPs identified for a given reduce/eliminate Consider: (Consider clinical and
condition. Although some symptoms, normalize a lab Drugs: consider drug, formulation, laboratory parameters,
medical conditions may not have value. route, dose, frequency, schedule, the degree of change
a DRP, a care plan is still (Consider realistic goals duration, medication management. and the time frame).
necessary for ongoing patient determined through Non-drug: non-drug measures,
monitoring. patient discussion. Goals of education, patient referral.
DRP Categories: Indication: 1. therapy are measurable or
Unnecessary drug therapy, 2. observable parameters
Needs additional Drug Therapy, that are used to evaluate
Effectiveness: 3. Ineffective the efficacy and safety of
Drug, 4. Dosage too low, Safety: therapy).
5. Adverse Drug Reaction
(includes drug interactions), 6.
Dosage too high, Compliance:
7.Non-adherence/compliance.
Are all DRPs identified Therapeutic Is an assessment of each DRP Plan/recommendations are Monitoring plan Follow-up plan present
(based on 4 prime areas goal/outcome(s) provided (factors considered to outlined present
of indication, efficacy, stated? influence/determine a plan)? Includes:
safety, medication Patient goal Are alternatives (with rationale Includes: Includes: who
organization/adherence)? incorporated (if for each) provided? dosing safety how
If no, discuss with appropriate) considerations efficacy when
student and probe to see patient frequency
if those missing can be preferences duration (if includes outcome (if
determined. appropriate) possible)
ACTIONS TAKEN which healthcare
Are DRPs prioritized in Appropriate/acceptable provider will
an acceptable manner? action has been taken follow-up
Is rationale provided or
discussed for DRPs (based
on either patient or
provider data)?
Overview of Preceptor Role
Before the clinical placement
• Be familiar with the pharmacy care plan process student’s are taught
• Know the number and variety of care plans required by the Faculty
Early in the clinical placement
• Provide plenty of guidance on implementing care plans
• Get to know your students strengths and areas for improvement.
Discuss your expectations for creating and implementing each
element in a pharmacy care plan
• Discuss when you will provide routine feedback and evaluation on
your student’s patient care activities
Later in the clinical placement
• Challenge the student with more complex patients
Precepting the care plan in my practice
HIV Ambulatory Practice- Northern Alberta Program,
RAH site
My role and responsibilities
How data is collected and assessed
Developing a care plan
How the plan is implemented
How documentation occurs
Tips for the student as they go through the process
