Post on 12-Feb-2019
PPCP: Just Another Acronym?
Crystal Deas, Pharm.D., BCPSAssistant Professor, McWhorter School of PharmacyAffiliate Clinical Pharmacist, Cooper Green Mercy Health Services
Conflict of Interest
Nothing to disclose.
Acknowledgements
Joint Commission of Pharmacy Practitioners
Objectives1. Identify the foundational elements of the Pharmacists’ Patient Care Process (PPCP).
2. Discuss the actions taken to complete each step of the Pharmacists’ Patient Care Process (PPCP).
3. Develop a plan for implementing the Pharmacists’ Patient Care Process (PPCP) in your specific practice area.
The “Why”
Need for PPCP
Other health professions confused on
role of pharmacists
Wide variation in patient care processes
Inconsistent use of
terminology
What have others done? Nursing
What have others done? Physician’s Diagnostic Process
Monitoring & Follow‐upTreatmentDifferential
DiagnosisData AnalysisPhysical Examination
Medical History
Chief Complaint
Joint Commission of Pharmacy Practitioners (JCPP) JCPP Vision:
• Patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers within patient-centered, team-based healthcare.
8
Pharmacists’ Patient Care Process
Collect
The pharmacist collects necessary subjective and objective information about the patient.
What do you know or need to know???• Examples:
• Medication list and medication use history • Relevant health data: medical history, health and wellness information, biometric test results, and physical assessment findings
• Patient lifestyle habits, preferences and beliefs, health and functional goals, and socioeconomic factors
Assess
The pharmacist assesses the information collected and analyzes the clinical effects of the patient’s therapy in the context of the patient’s overall health goals.
What’s going on??• Assess:
• each medication for appropriateness, effectiveness, safety, and patient adherence• health and functional status, risk factors, health data, cultural factors, health literacy, and access to medications or other aspects of care
• immunization status and the need for preventive care and other health care services, where appropriate
Plan
The pharmacist develops an individualized patient‐centered care plan, in collaboration with other health care professionals and the patient or caregiver.
What are you going to do about it??• Address medication‐related problems and optimize medication therapy • Set goals of therapy for achieving clinical outcomes • Engage the patient through education, empowerment, and self‐management
• Support care continuity
ImplementThe pharmacist implements the care plan in collaboration with other health care professionals and the patient or caregiver.
Do it!!• Address medication‐ and health‐related problems, and engage in preventive care strategies, including vaccine administration
• Provide education and self‐management training to the patient or caregiver
• Contribute to coordination of care• Schedule follow‐up care as needed
Follow-up: Monitor and Evaluate
The pharmacist monitors and evaluates the effectiveness of the care plan and modifies the plan as needed.
How did it go?? Any ideas to improve??• Evaluate:
• Medication appropriateness, effectiveness, and safety • Clinical endpoints that contribute to the patient’s overall health• Outcomes of care, including progress toward or the achievement of goals of therapy
Assessment Questions:
The Pharmacists’ Patient Care Process (PPCP) was adopted by the ____, with a goal to help pharmacists understand the components of the standard patient care process and apply in all pharmacy settings.
A. Joint Commission of Pharmacy Practitioners (JCPP)B. American Academy of Colleges of Pharmacy (AACP)C. National Association of Boards of Pharmacy (NABP)
Assessment Questions:
The foundation of the Pharmacists’ Patient Care Process (PPCP) centers around effective ___. Select all that apply.
A. CommunicationB. CollaborationC. DocumentationD. Delegation
Steps to Applying and Implementing PPCP
1. Learn to apply the process. 2. Evaluate existing services and develop strategies for
implementation and quality improvement.3. Promote the process.4. Continuous quality improvement.
Bennett MS, Kliethermes MA, editors. How to Implement the Pharmacists’ Patient Care Process. Washington, DC: American Pharmacists Association; 2015.
Case Example of PPCPAdapted from Bennett MS, Klithermes MA, editors. How to Implement
the Pharmacists’ Patient Care Process. Washington, DC. American Pharmacists Association; 2015.
Collect
Sam McWhorter is a 64 y/o male who presents for follow‐up to clinic for the management of his diabetes. The patient was diagnosed with type 2 DM 10 years ago. Although he has been tolerating medications well, he cannot control his glucose. Lately, he has been under stress from work and has been working long hours and eating fast food more often. SM was last seen in DM clinic 1 month ago. You are a pharmacist in the DM clinic, with a scheduled appointment with Mr. McWhorter today.
PMH: Type 2 DM, HTN, dyslipidemia
What necessary subjective and objective information would you need to collect?
• Updated medication list• Adherence to medications (diabetes medications in particular)• Symptoms of hyperglycemia, medication tolerability• Details of diet and exercise• Any changes in social history• Lab data since last visit (e.g. HbA1c, SMBG readings)• Vitals • Preventive care history
Collect
PMH: DM (type 2), dyslipidemia, HTN
Medications: metformin ER 2000mg daily, atorvastatin 10mg daily, lisinopril 10mg daily, centrum silver MVI daily
NKDASocial history: (‐) EtOH/tobacco/illicit drug use
Pertinent positive from ROS:(+) polyuria/polyphagia/polydipsia(+) tingling/numbness in toes
Vitals: BP ‐128/72; pulse: 76 bpm; weight‐ 90kgSMBG readings: 206‐314 mg/dL
Pertinent labs: CMP is WNL, with exception of glucose – 213In‐clinic POC glucose – 214HbA1c: 10.4%Lipid panel: TC: 214; LDL: 158, HDL: 40; TG: 186
Sam McWhorter is an 64 y/o male who presents for follow‐up to clinic for the management of his diabetes. The patient was diagnosed with type 2 DM 10 years ago. Although he has been tolerating medications well, he cannot control his glucose. Lately, he has been under stress from work and has been working long hours and eating fast food more often. SM was last seen in DM clinic 1 month ago.
Assess
Analyze the information in the context of the patient’s overall health goals, and identify and prioritize the problems.
• Patient’s glucose control is suboptimal
• Preventive screenings, immunizations up‐to‐date?
• Calculate ASCVD risk score and assess need for statin
Plan
Develop an individualized patient‐centered care plan.
• Recommendations:• Addition of insulin • Pneumoccocal vaccination• Increase atorvastatin to 20 mg daily• Urinary albumin screening• Eye exam
• Educate on diet and lifestyle modifications• Establish follow‐up and monitoring plan by phone• Referrals
Implement
How would you execute the care plan in collaboration with other health care professionals, the patient, and caregiver?
• Adjust medication(s)/order labs per collaborative practice agreement• Patient education• Administer vaccination• Schedule follow‐up encounters• Place referrals
Follow-up/Monitoring
List monitoring and evaluation parameters.
• HbA1c every 3 months• SMBG readings at each visit• Fasting lipid panel annually• BP check at each visit• Pertinent patient education/re‐education as applicable
Assessment Questions:
Which of the following is NOT a component of the Pharmacists’ Patient Care Process (PPCP)?
A. CollectB. TriageC. Follow‐upD. PlanE. ImplementF. Assess
Steps to Applying and Implementing PPCP
1. Learn to apply the process. 2. Evaluate existing services and develop strategies for
implementation and quality improvement.3. Promote the process.4. Continuous quality improvement.
Bennett MS, Kliethermes MA, editors. How to Implement the Pharmacists’ Patient Care Process. Washington, DC: American Pharmacists Association; 2015.
Suggested Activities to Engage in PPCP
• Medication reconciliation• Collaborative drug therapy management• IV to PO conversions• PK monitoring programs• Immunizations• Health screenings• Transitions of Care• SOAP notes/ Medication Action Plans• Case presentations• Patient education classes (e.g., disease management, device use, etc.)• Clinical documentation
Resources for PPCP Implementation
Steps to Applying and Implementing PPCP
1. Learn to apply the process. 2. Evaluate existing services and develop strategies for
implementation and quality improvement.3. Promote the process.4. Continuous quality improvement.
Bennett MS, Kliethermes MA, editors. How to Implement the Pharmacists’ Patient Care Process. Washington, DC: American Pharmacists Association; 2015.
Preceptors, We Need Your Help!
• Gauge students’ knowledge and understanding of the PPCP
• Model appropriate use of the PPCP• Monitor students’ use of the PPCP and provide formative feedback
Looking for a consistent method to teach PPCP?Ask questions!• Collect
• What information do you need?• What are potential sources of the information?• How will you collect the information?
• Assess• Are there any drug‐related problems present?• What are the goals of therapy?• What are the pros and cons to various treatment
options?• Plan
• How will the patient be involved in the development of your plan?
• How will you prioritize suggested interventions?• How will you document and communicate your
plan to patients and the healthcare team?
• Implement• What is within your scope of practice and what
needs to be referred to other members of the healthcare team?
• What if your recommendation is not accepted?• Follow‐up
• What is your recommended monitoring plan?• What is your method of quality assurance to
review the plan for safety and effectiveness?
Steps to Applying and Implementing PPCP
1. Learn to apply the process. 2. Evaluate existing services and develop strategies for
implementation and quality improvement.3. Promote the process.4. Continuous quality improvement.
Bennett MS, Kliethermes MA, editors. How to Implement the Pharmacists’ Patient Care Process. Washington, DC: American Pharmacists Association; 2015.
References
1. Bennett MS, Kliethermes MA, editors. How to Implement the Pharmacists’ Patient Care Process. Washington, DC: American Pharmacists Association; 2015.
2. Joint Commission of Pharmacy Practitioners. The pharmacists’ patient care process. https://jcpp.net/patient‐care‐process/ . Accessed Sept. 1, 2018.
3. Kolar C, Hager KD, Losinski V. Beyond the Pharmacists’ Patient Care Process: Cultivating Patient Care Practitioners by Utilizing the Pharmaceutical Care Framework. Inov Pharm. 2017;8(3): Article 7. http://pubs.lib.umn.edu/innovations/vol8/iss3/7 . Accessed Sept. 1, 2018.