Lecture 21: Monitoring Ongoing Therapy Flashcards Preview

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Flashcards in Lecture 21: Monitoring Ongoing Therapy Deck (18)
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What to do when accepting New Pt RX?

- Engage Patient
* Gather agenda
* Gather demo info
- Chat about Med
* Gather med/medical hx
* Explore understanding of purpose, directions, and monitoring


What to do at First Refill?

- Engage Patient
* Gather agenda
* Update demographic info
- Chat about Med
* Update med/medical hx
* Explore understanding/experience of purpose, directions, and monitoring
- Check Prescription
- Provide education as needed
* Personalized plan/info


What things to look for when reviewing Pt Profile?

- Refill Intervals
- Medical Hx
- Meds Hx
- Clinic Doc Note


What 4 questions ask during Pt Assessment refill?

1. PURPOSE: Just to check, are you using this for your
If indication is in doc note, you can verify instead of asking.
2. DIRECTIONS: How do you fit this into your workday?
3. MONITORING (+): How do you feel this medication is
working for you?
3. MONITORING (-)What is different since you started
this medication? OR What unwanted effect have you
noticed since starting this medication?


How can you visually confirm prescription with patients?

Verify patient's identity and remove medication and show to patient


Show & Tell Advantages:

1. Allows the final check for tablet accuracy
2. “My tablet looks different than last month’s fill”
3. Sets expectations with patients
4. Increases expectations within the pharmacy team
5. Promotes you and the profession
6. Allows you to control the pace and direction


Care Plan: Implementing

- Tailored information: For example, if the patient tells you that they remember the doses, you would not proceed to remind them
- Relating to the patient's experience: Use the same language and frame the care plan so that reflects the patient concerns. If the patient is concerned about walking around the block, you would not talk about training for a race.


What MIGHT you consider to use if appropriate in Care Plan: Education?

You MIGHT consider the following if appropriate:
1. Language included no jargon
2. Use visual methods of conveying info
3. Provide opportunities and encourages
4. Pick up and responds to verbal and nonverbal
5. Elicit patient's beliefs, reactions, and feelings


Care Plan: Education

- Check for understanding: If the patient was able to answer the 3PQs, not needed. If provided substantial additional education, then you may consider a teach back.
- Invite follow-up: "If you have any stomach upset, please give me a call. If not, we will check in with you at your next refill."


What 2 Evidences can you use to assess Med Taking?

1. Objective through records (can be misleading too)
* Late doses from samples?
* Probe very respectfully
2. Subjective through asking patient (can be misleading too)
* Social desirability effects
* Your rapport & how you ask is key


What are the 3 steps in Medication Taking Assessment to ensure adherence?

1. Ask about Med Taking in a Non-Threatening Manner
2. Assess for Barriers
3. Make a Plan to Address Barriers


Which way would you ask patient about med taking: Accusatory or Supportive?



What are some signs signalling barriers in med taking?

- In response questions about medication taking?
* Hesitates
* Avoids question
* Changes topic
- Doubts efficacy
- Drug Aversion Common


What are some Care Plan Ideas for Unintentional Nonadherence cases?

- First reduce the number of daily doses, number of medications and routes of administration (easier to change the med than patient behaviour)
- Pill organizers or pill boxes
- Blister packaging
- Reminder charts
- Reminder services


What are some Care Plan Ideas for Intentional Nonadherence cases?

- Build a relationship with a patient so there is a willingness to share and discuss decisions.
- Elicit questions from the patient.
- Specifically, elicit patients’ commonsense beliefs about the pros and cons of the med.
- Provided information tailored to the patient problem


What are other tips for med taking adherence?

- Solicit Pt Q’s /concerns & work with them!
- Focus on patient goals, symptoms, safety issues.
- Talk about each medication separately
- Do not argue if patient insists that he/she has been adherent. Focus on barriers


1. Social & Economic
2. Health Care System
3. Condition-Related
4. Therapy-Related
5. Patient-Related
What are these?

The 5 Dimensions of Adherence


Slide 34 ???

Look at the flow chart!