Pharmacists’ patient care process gains traction
Global-level integration of process into programs, activities under way
In May 2014, the Joint Commission of Pharmacy Practitioners (JCPP) adopted the pharmacists’ patient care process—a consistent approach to patient-centered care that pharmacists are being urged to adopt. Today, the process is being recognized on a larger scale, and various pharmacy organizations have begun integrating it into their activities.
One major development is the inclusion of the process by the Accreditation Council for Pharmacy Education (ACPE) as a requirement for PharmD programs in colleges of pharmacy starting next year. ACPE is also working with accredited continuing education providers to incorporate the process into continuing education for pharmacists, and many national and state pharmacy associations are including it in their education training programs.
“We are starting to see a global-level integration of the process into the fabric of some key professional programs and activities,” said Anne Burns, BSPharm, APhA Vice President of Professional Affairs.
The American Society of Health-System Pharmacists has included the process in the updated postgraduate year 1 residency standards as well, and is working it into updates of other residency accreditation standards.
The profession’s evolution
The pharmacists’ patient care process supports the evolution of the pharmacy profession from primarily a medication-dispensing role to one of providing clinically oriented patient care services, said Burns.
Using principles of evidence-based practice and in collaboration with other health care providers, the process is outlined in five steps: collect, assess, plan, implement, and follow-up: monitor and evaluate (see figure).
The process is applicable to any practice setting where pharmacists provide patient care services and for all patient care services that pharmacists deliver. The level of intensity with each step may vary depending on the service, however.
For instance, although the process remains the same for administering immunizations and conducting a comprehensive medication review for a complex patient on multiple medications, the time spent on each step will be different.
Other key points for pharmacists to keep in mind about the process are that it’s patient centered, meaning the patient needs to be engaged and involved in their care; and that it’s a collaborative care model where pharmacists work with, and communicate with, other health care providers so that care is coordinated for the patient. Documentation is also a foundational component of the process.
Promoting the use of HIT
The process promotes the use of health information technology (HIT) to facilitate efficient and effective communication and exchange of information between practitioners, including pharmacists.
“Pharmacists need pertinent clinical information about their patients so they aren’t working in a silo, and they should be contributing information back to the team as well,” said Burns.
The Pharmacy HIT Collaborative is working to ensure that HIT supports pharmacists in health care delivery and that pharmacists are able to exchange information electronically. The HIT Collaborative has also incorporated the process into templates that can be used in health information exchanges.
All of this makes for a contemporary and comprehensive approach to patient-centered care that’s aligned with the broader direction of the health care system, according to Burns.
“As we continue to move to value-based payment models where health care providers are held accountable for the quality and outcomes of their care, we have to make sure care is consistent. Otherwise, it’s difficult to measure the impact pharmacists have in the health care system,” said Burns.
ACPE PharmD accreditation standards for 2016 were drafted knowing that the pharmacists’ patient care process was coming down the pike, according to Peter H. Vlasses, PharmD, DSc (Hon), BCPS, FCCP, Executive Director of ACPE.
In the standards themselves, key element 10.8 addresses the need to prepare students to provide patient-centered collaborative care, as described in the pharmacists’ patient care process endorsed by JCPP.
The PharmD standards for 2016 were released in January 2015 and become effective July 1, 2016.
“We are giving people 1.5 years to do curriculum reforms and other things that don’t happen overnight,” he said.
By the fall of 2016, Vlasses said ACPE will begin site visits to assess each program’s curriculum and begin asking questions about each program’s self-study reports on the pharmacists’ patient care process and how they are assessing students and their abilities to provide it in pharmacy activities.
Preceptors will also need to be up to speed with the pharmacists’ patient care process.
ACPE recently held a webinar to introduce the pharmacists’ patient care process to the continuing education provider community. More than 160 provider participants were in attendance.
“It should be incorporated into continuing education—we urge both practicing and student pharmacists to know this,” said Vlasses.
ACPE is also beginning to think about how to incorporate the process into other educational offerings.
“The profession has spoken,” he said. “Therefore, we have to move to get the accreditation standards lined up, and we need to teach continuing providers the importance of this—which we have started.”
Then and now
The concept for the pharmacists’ patient care process is not new. Its foundation is based on the pharmaceutical care practice model developed by Hepler and Strand in the 1990s.
The development of the pharmacists’ patient care process was spearheaded by a JCPP workgroup with valuable input from all sectors of the profession. There was an extensive evaluation of key pharmacy resource documents, as well as an examination of other health care practitioners’ patient care processes, said Burns.
Overall, Burns called it an exceptional collaboration among national pharmacy organizations to come together and articulate, and then approve, the process. So far, 13 national pharmacy organizations have signed on.
It’s now important to raise awareness and engage pharmacists to consistently implement the process across the pharmacy profession, said Burns.
In April 2015, APhA released a guidebook on implementing the pharmacists’ patient care process (available at www.pharmacist.com/shop), complete with sample case studies set in different patient care settings to help pharmacists understand how the process applies to them (see sidebars).
Case study: Community pharmacy
The pharmacists’ patient care process helped pharmacists at a Kroger pharmacy in Columbus, OH, care for an asthma patient—a common condition pharmacists there encounter, especially during allergy season.
“Being in a busy community pharmacy, it helped give us a standardized method to analyze the patient and to make sure we weren’t missing anything,” said Brigid Long, PharmD, MS, working as a Pharmacist Care Coordinator at Kroger Pharmacy, Columbus Division.
She said the process promoted efficiency and safety.
The pharmacists performed a comprehensive medication review on the patient, who also had a history of depression.
“This process allowed us to work in a step-by-step fashion and not miss any information,” said Cathy Kuhn, PharmD, Pharmacist Care Coordinator at the pharmacy.
In collecting information, they learned that the patient was a smoker and had no documented immunizations—both opportunities for pharmacists to have an immediate impact, either through counseling or referral. Upon assessing the patient, they identified several drug therapy problems, as well as the need for smoking cessation and recommended vaccines.
Their plan, which was developed with input from the patient, included educating the patient on appropriate inhaler technique, synchronizing medication refills to improve adherence, enrolling the patient in a smoking cessation program, and administering recommended vaccines. The pharmacists were able to implement some aspects of the plan during the comprehensive medication review and the rest over several follow-up visits.
Case study: Inpatient hospital
Pharmacists employed at community hospitals often work on interdisciplinary teams. This type of environment naturally lends itself to the pharmacists’ patient care process.
“They expect me to contribute,” said Tudy Hodgman, PharmD, FCCM, BCPS, Clinical Coordinator and Critical Care Specialist at Northwest Community Hospital in Illinois. “Due to staffing issues, sometimes the only member of the team who is consistent throughout the week is the pharmacist. That makes us the glue to hold all of it together.”
Using the pharmacists’ patient care process with a nursing home patient who presented with loose stools, poor appetite, and changes in mental status, Hodgman was able to first collect all relevant information, including current labs, the medication list from the nursing home, and prior hospital and discharge records—before moving on to the assessment and planning steps.
“The pharmacists’ patient care process is beneficial to the team in that we are able to plan goals for the day and work through the steps to re-evaluate what has been done during the day, and what needs to be changed or what needs further investigation or follow-up,” said Hodgman. “The circle is closed—but open, in that it continues until the patient has reached [his or her] goals.”
The team was able to implement certain testing—mainly an endoscopy to evaluate gastrointestinal bleeding—and medications before evaluating the patient and the interventions and completing the plan of care and other follow-up protocols to transfer the patient safely back to the nursing home.