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In this forum we explain and discuss various clinical pharmacy services and its practical approaches. Eg: Anticoagulant Management Therapy, Medical Reconciliation Service, Treatment Chart Review, Therapeutic Drug Monitoring, Patient Education and etc. NOTE: To read/reply any topics under this section members must spend 20 BB Points to get the access.
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TREATMENT CHART REVIEW

Introduction

Treatment Chart Review is a process where a pharmacist reviews the patient’s drug treatment during his hospital admission and involves evaluation of the therapeutic efficacy of each drug and the progress of the conditions being treated. It addresses issues such as adverse drug reactions, drug-drug interactions, and medication errors, lack of efficacy, suboptimal patient adherence, poor quality of life, economic consequences and patient experience as well as understanding of the condition.Recommendations from a pharmacist to a clinician and framing a good rapport between them are essential for rendering better clinical services to the patients.

Objectives

+To master the Clinical Pharmacy students to evaluate and interpret a medication chart.
+To make the students learn to set goals according to the patient’s medical condition and to intervene at the right time, if necessary.
+To train students in continuity of care through involvement in decision making about treatments, monitoring of patients, discharge medication and provision of medication information counseling.
+To train students in building a rapport with the clinical team members and creating an interpersonal relationship among them.

Procedure

The following points should be considered when performing Treatment Chart Review

• Evaluate whether all of the patient's medications are appropriately indicated, the most effective, the safest possible and affordable and if the patient is able and willing to take the medication as intended to rule out some medication problems.

• With other members of the health care team, assess the appropriateness of the current medications on the basis of health conditions, indications, and the therapeutic goals of each medication.

• Check whether the medicine order is comprehensive and unambiguous, that appropriate terminology is used, and that medicine names are not abbreviated.

• Make sure, if necessary medications are ordered and the patient has access to it, whether administration times are appropriate, e.g. with respect to food, other medicines,and procedures.

• Discuss patient-specific recommendations with the physician.

• Perform calculations form dosage adjustments, aid in the reconstitution for parenteral preparations,and follow-up on the stability after reconstitution

• Evaluate medication-taking behaviors and adherence to each medication.

• Detect actual and potential DTPs (drug related problems), record and document any identified DTPs on the Inpatient Medication Profile Form and report the identified adverse drug event (ADE) to the “yellow form” (Adverse Drug Event Reporting).

• Based on the agreed goals of therapy, prepare pharmaceutical care plan (PCP) based on patient progression that addresses the medicine therapy needs and prioritized DTPs, according to the patient’s disease condition, age, co-morbidity, renal and liver functions, pregnancy status,etc in collaboration with other health care professionals to optimize the patient’s health outcomes. The PCP should include follow up, monitoring, and evaluation components.

• Provide key medication care information to the nurses taking care of the patient, and encourage the nurses to report any ADEs identified.

• Review whether infusion solution is used with regard to concentrations, compatibilities, rate, and clinical targets, e.g. blood sugar levels, and blood pressure.

• Evaluate the patient's outcome, determine the patient's progress toward the achievement of the goals of therapy, determine whether any safety or adherence issues are present, and assess whether any new DTPs have developed.

• Follow up of the patient must be done on day to day basis.

• Check that the order is cancelled in all sections of the medication administration record when medicine therapy is intended to cease.

• The Treatment Chart Review Form is enclosed for your reference.

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