Chapter 4: Implementing the Pharmacists’ Patient Care Process

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INTRODUCTION

Historically, the profession has referred to pharmacist patient care services by a variety of titles, such as pharmaceutical care, medication therapy management (MTM), comprehensive medication management (CMM), and individualized medication assessment and planning. While a pharmacist’s activities generally focus on (1) identifying, resolving, and preventing drug therapy problems, (2) improving medication use, and (3) optimizing a patient’s pharmacotherapeutic outcomes,¹ terminology tends to be inconsistent among practice settings, making it difficult to communicate the role of a pharmacist clearly with other healthcare providers. Without a clear, consistent patient care process, we cannot demonstrate to patients, caregivers, or other healthcare professionals our contributions to improved medication-related outcomes. The Pharmacists’ Patient Care Process (PPCP), as published by the Joint Commission of Pharmacy Practitioners (JCPP), provides a standardized process applicable to a wide variety of patient care services and highlights a pharmacist’s medication expertise.² While a consistent process of care applied to every patient is a foundational principle of most healthcare professions, the PPCP differs from processes in other professions because of a pharmacist’s unique approach to assessing a patient’s medication regimen to ensure that medications are appropriately indicated, effective, safe, and able to be taken by the patient as intended. The JCPP states that the goals of the PPCP are to (1) promote consistency across the profession, (2) provide a framework for delivering patient care in any practice setting, (3) be a contemporary and comprehensive approach to patient-centered care delivered in collaboration with other members of the healthcare team, and (4) be applicable to a variety of patient care services delivered by pharmacists, including medication management.³ Pharmacists in different practice settings have varying levels of intensity in implementing the PPCP. In some situations, pharmacists may not be responsible for all steps in the process or share responsibility with other pharmacists, yet all pharmacists will follow these basic steps to some degree. This chapter summarizes the steps in the PPCP and application of those steps to various patient care situations.

DRUG THERAPY PROBLEMS

The primary role of pharmacists when participating in the patient care process is to identify, resolve, and prevent drug therapy problems.⁴ A drug therapy problem is defined as “any undesirable event experienced by a patient which involves, or is suspected to involve, drug therapy and that interferes with achieving the desired goals of therapy and requires professional judgment to resolve.”⁴ Pharmacists must assess patient factors, drug therapy, and information on the patient’s medical conditions to thoroughly assess the appropriateness of medication regimens and identify potential drug therapy problems. This process involves a logical sequence of steps. It begins with evaluating each medication regimen for appropriateness of indication, then optimizing the drug and dosage regimen to ensure maximum effectiveness, and finally, individualizing drug therapy to make it as ...