THE PRACTITIONER'S RESPONSIBILITIES 

Practice responsibilities

The pharmaceutical care practitioner provides direct patient care. the first responsibility is to the patient.

a commitment to meet the patient's drug-related needs whenever and wherever they might arise.

accountable to patients first and colleagues second.

patients' needs before personal needs and all other obligations

Practice responsibilities

Provide comprehensive care of the same quality to all patients. the practitioner will always perform the same

set of core functions.

Practice responsibilities

All of the following responsibilities must be met for each patient, and they are considered nonnegotiable with respect to providing pharmaceutical care.

Understand Who the Patient Is and What He Wants from the Practitioner

become familiar with, and knowledgeable about the whole patient and create a pharmacologically relevant description of this individual because many patient parameters influence decisions regarding drug therapy.

accomplished when we understand the patient's medication experience.

Assess Patient's Medical Conditions and Drug Therapies

for Appropriate Indication, Effectiveness, Safety, and the Patient's Compliance

clinical questions about a patient's pharmacotherapy must be asked: e.g Is the medication necessary? Is it the best product?

Assess Patient's Medical Conditions and Drug Therapies

The answers to these questions will guide practitioners in making decisions in a logical manner using the Pharmacotherapy Workup. when positive outcomes occur, clinicians can

understand why these transpired, and learn from the experience

when the patient experiences a negative outcome, it is essential to take corrective action, and learn from this experience.

Identify DTPs Because They Interfere with Achieving Goals of Therapy Pharmaceutical care practitioners will

identify these problems because no other practitioner evaluates the patient's medications for drug therapy problems

Drug therapy problems are costly to the patient in terms of pain and suffering.

Treatment failures are also costly in terms of hospitalizations, additional clinic visits, and lost days at work or school.

Develop a Plan that Establishes Goals of Therapy for Each Medical Condition These goals of therapy guide the selection of

drug products and determine the acceptable risk in selecting each dosage regimen.

Establishing achievable goals of therapy requires an understanding of the patient's preferences because goals represent a negotiation between practitioner and patient.

Goals of therapy establish the criteria upon which the outcomes of all pharmacotherapy are evaluated, both positive and negative.

Make Appropriate Interventions to Resolve/ Prevent DTps, Achieve Goals Resolving drug therapy problems benefits

the patient directly. Practitioners intervene to resolve drug therapy

problems by taking actions preventing drug therapy problems.

When a specific patient is at an unacceptably high risk of developing a side effect, toxicity, or experiencing a treatment failure, the practitioner identifies these individual risks and takes action to prevent the problems from occurring.

Follow-Up to Evaluate Results of Interventions The responsibility to follow-up with the patient

is absolute. if there is no follow-up

the patient may interpret this to mean that no one cares about him/her.

you will not know if the drug therapy was effective or if it caused harm.

It is unacceptable to make recommendations and intervene with drug therapies in a patient's life without determining the outcome of actions.

The follow-up evaluation works to strengthen the therapeutic relationship.

Continue to Manage Patient's Drug Therapy until the Goals of Therapy Are Achieved Once responsibility is taken for a patient's

medications, it is necessary to follow-up until a successful outcome has been achieved.

It shows a lack of professional responsibility to assume that someone else will accept the responsibility or that patients will manage on their own.

Continuous, excellent care is necessary for patients to benefit optimally from their medications.

THE PRACTITIONER'S PHILOSOPHY OF PRACTICE knowledge and skills are not enough to

guarantee success in practice. A philosophy of practice is required to

explain how these responsibilities should be conducted.

All practitioners within a profession adhere to the same philosophy of practice thus creating uniform behavior and standards.

THE PRACTITIONER'S PHILOSOPHY OF PRACTICEDefinition A philosophy of practice is a set of

values that guides the behavior of a professional.

It helps the practitioner determine what is important, how to set priorities, and how to make clinical decisions and judgments.

The philosophy of practice prescribes how a practitioner should practice on a daily basis.

It is a set of rules the practitioner must follow to meet the standards of practice

THE RESPONSIBILITY TO CARE

Two aspects of careTechnicalDemonstrating concern and

commitment to well-being of another person.

In order to balance the aspects, the practice of pharmaceutical care was designed to be patient-centered.

Patient-Centered Approach

When thinking and acting in a caring manner with the patient at the center of the practice, practitioners willplace the patients' needs, wants, and preferences before their own;

serve as advocates and do what is best for the patient, regardless of what it requires on their part;

treat patients as individuals—be sensitive to cultures and belief systems, without being patronizing or condescending;

respect patients' time and priorities by committing full attention to them;

remain conscious of patients' value system, and be prepared to identify and resolve ethical dilemmas in an honest and straightforward manner.

THE VALUES INVOLVED IN CARING FOR PATIENTS Pharmaceutical care practice is inherently

value-laden Separate personal values from the

professional values that are required to provide care to others.

in order to separate one set of values from another, one must be conscious of what one's personal values are.

To become conscious of these values, it is necessary to engage in critical thinking in an area usually referred to as values clarification.

THE VALUES INVOLVED IN CARING FOR PATIENTS A personal set of values will include

political views, religious beliefs, social norms, personal preferences, and influence from personal experiences.

Practitioners must become consciously aware of these personal values so that they know when they create conflict in the practice setting.

From Values to Ethics Every patient has a right to be treated

according to his/her unique character. Every patient has a right to decide and

act on his/her own values to fulfill individual life plans.

Every patient has a right to expect complete objective information and the emotional support necessary to act effectively on that information.

From Values to Ethics Every patient has the right, alone or

through a health care professional, to the control of his/her time and effort.

Every patient has a right to expect whatever benefit is possible in the health care setting and to expect no avoidable harm.

Every patient has a right to expect that agreements established with the health care professionals will be kept.

Ethics in Practice Every practitioner must be prepared to

recognize, and even prevent, situations with moral and ethical implications.

This requires the practitioner has focused attention, and sensitivity to

recognize subtle clues that may indicate a situation is laden with ethical components

the knowledge and aptitude for making logical, fair, and consistent decisions

Ethics in Practice Basic professional behavior can help

avoid ethical dilemmas. Each behavior is based on an ethical

principle

Basic Professional Behaviors Expected in Practice

Professional behavior Ethical principle

Do the very best you can for every patient

Beneficence

In all cases, do no harm Nonmaleficence

Tell the patient the truth Veracity

Be fair Justice

Be loyal Fidelity

Allow the patient to be the ultimate decision maker

Autonomy/paternalism

Always protect your patient's privacy Confidentiality

Beneficence

The ethical practitioner will want to do what is best for the patient.

negotiated between two parties rather than imposed even if what is best for the patient seems to be clinically obvious.

Nonmaleficence

the Hippocratic principle above all, do no harm.

At no time should the pharmaceutical care practitioner aggressively force a treatment on a patient.

the clinician who performs without due regard for the patient's considerations acts maleficently.

Veracitytell the truth at all times. Should we tell the truth at all times? Is it ever ethical not to tell the patient the

truth? Can telling the truth harm people? If so, under what circumstances? Can we lie when we consider it in the best

interest of our patients? Does lying sometimes protect people? Why not deceive a patient if it promotes

his/her health and recovery?

Veracity the truth will be told at all costs

regardless of the consequences. Emotional strength, conscience, and

often clinical judgment can present barriers to truth-telling.

Truth-telling may be a skill that can be learned with practice.

Veracity Sensitivity and thoughtful communication

skills can be learned and polished with experience.

Once initial formative trust is established and a therapeutic relationship is developed, honesty should be unconditional and reciprocal.

Outline the expectation of truth, emphasize its importance, and nurture its development.

Justice Justice is an ethical principle that relates

to fair, equitable, and appropriate treatment in the light of what is due or owed to persons.

giving to some may deny receipt to others.

Not all patients can afford essential drugs What are their responsibilities to the poor

who need assistance?

Justice the ethical pharmaceutical care

practitioner to make every effort to treat all patients equally and assist those who are legitimately disadvantaged by locating information and programs that will meet their needs.

Justice Practitioners will be expected to adhere

to the principle of equality in so much as they care for patients as equals regardless of ethnicity, class, gender, or sexual preference.

Discrimination of any kind is unacceptable, unethical, and intolerable

Fidelity relates to the concept of faithfulness and the

practice of keeping promises. fidelity is related to trust as an essential part of

any meaningful therapeutic relationship. Pharmaceutical care practitioners are expected to

Be faithful to the society that grants the right to practice.

Keep the promise of upholding the profession's code of ethics

to practice within the established scope of practice and definition of (pharmaceutical care)

to remain competent in practice to abide by the policies of employing institutions to keep promises to individual patients.

Autonomy a patient having the freedom to make

choices for him or herself. This does not mean that other individuals

play no role in influencing the choices people make

it means that individual choices are respected and subsequent interventions are predicated on respect.

Without it there can be no trust, no therapeutic relationship, and no care.

Autonomy there are serious considerations to be

taken into account when formulating a care plan. Does the patient have a clear understanding

of all important facts and values? How do I know if the patient is cognitively

competent and can make informed, autonomous decisions?

Is the confused patient acting autonomously? These questions may sound rhetorical, but

they are frequently asked, and uncertainty is common

Confidentiality The trust that is built between practitioner

and patient is compromised without the assurance of confidentiality.

you have a duty to protect a patient's personal information from public view.

It is essential to further the free exchange of information between patient and practitioner.

Patients must feel that anything they say, the nature of their disease or illness, the medications they take, or any other matter they regard as private will be respected.

standards for professional performance

standards for professional performance practice responsibilities, the patient-

centered approach, and the ethical principles all lead to a set of standards for professional performance.

The standards for professional behavior

Caring for others is a privilege that is reserved for those individuals who are uniquely well prepared and who adhere to standards for professional behavior.

Standard I: Quality of Care

The practitioner evaluates his/her own practice in relation to professional practice standards and relevant statutes and regulations.

Measurement Criteria1. The PCP uses evidence from the literature

to evaluate his/her performance in practice. 2. The PCP seeks peer review on a continual

and frequent basis. 3. The PCP utilizes data generated from

his/her practice to critically evaluate performance.

Standard I: Quality of Care

self-regulating. Colleagues hold other colleagues

accountable for the quality of the work that is performed.

starts with self-evaluation. This helps each practitioner improve in

practice and contributes to maintaining high standards of professional performance.

Standard II: Ethics

The practitioner's decisions and actions on behalf of patients are determined in an ethical manner.

Measurement Criteria1. The PCP maintains patient confidentiality. 2. The PCP acts as a patient advocate. 3. The PC P delivers care in a nonjudgmental and

nondiscriminatory manner that is sensitive to patient diversity.

4. The PCP delivers care in a manner that preserves/protects patient autonomy, dignity, and rights.

5. The PCP seeks available resources to help formulate ethical decisions.

Standard II: Ethics

Second to providing high quality care is providing care in an ethical manner.

Standard III: Collegiality

The pharmaceutical care practitioner contributes to the professional development of peers, colleagues, and others.

Measurement Criteria1. The PCP offers professional assistance to

other practitioners whenever asked. 2. The PCP promotes relationships with

patients, physicians, nurses, and other health care providers.

Standard III: Collegiality

impossible to become a great practitioner without the support and assistance of colleagues.

It is impossible to know everything, experience everything and make the right decision in all cases.

Standard IV: Collaboration

The practitioner collaborates with the patient, significant others, and health care providers in providing patient care.

Measurement Criteria1. The patient is seen as the ultimate decision

maker, and the practitioner collaborates accordingly.

2. The practitioner collaborates with the patient's health care providers whenever it is in the best interest of the patient.

Standard IV: Collaboration

Patient care is collaborative. The patient is complex. Patient care is complex. The health care system is complex. Collaboration makes all of this

manageable. The practice of pharmaceutical care has been developed to make collaboration relatively easy and productive.

Standard V: Education

The practitioner acquires and maintains current knowledge in pharmacology, pharmacotherapy, and pharmaceutical care practice.

Measurement Criteria1. The practitioner uses the skills of reflectivity

to identify areas where knowledge needs to be supplemented.

2. The practitioner continually updates knowledge with journal subscriptions, current texts, practitioner interactions, and continuing education programs.

Standard V: Education

closely associated with the first standard of providing care.

It is impossible today to remain competent without a rigorous schedule of continuing education and collegial interaction.

invest both time and energy in remaining current with your knowledge and competent in your skills.

The volume and rate of knowledge expansion makes this a necessity today

Standard VI: Research

The practitioner routinely uses research findings in practice and contributes to research findings when appropriate.

Measurement Criteria1. The practitioner uses research results as the basis

for practice. 2. The pharmaceutical care practitioner systematically

reviews the literature to identify knowledge, skills, techniques, and products that are helpful in practice and implements them in a timely manner.

3. The practitioner approaches his/her practice with a perspective to conduct applied research in practice when appropriate.

Standard VI: Research

The expectation that research will serve as the basis for decision making in practice is expressed as evidence-based practice.

This is a requirement when a practitioner makes decisions that will impact another person.

our knowledge is incomplete clinicians make decisions in areas of

uncertainty on a daily basis. The appropriate method for dealing with this is

to use our knowledge well, understand the limits of the knowledge, and be able to recognize when science is inconclusive on a topic.

Standard VII: Resource AllocationThe practitioner considers factors related to

effectiveness, safety, and cost in planning and delivering patient care.

Measurement Criteria1. The pharmaceutical care practitioner is sensitive

to the financial needs and resource limitations of the patient, the health care providers, and the institutions with which he/she interacts.

2. Decisions are made by the pharmaceutical care practitioner to conserve resources and maximize the value of those resources consumed in practice

Standard VII: Resource Allocation All health care resources are limited

whether it be time, personnel, knowledge, or access to the latest technology.

Decisions made by practitioners need to recognize this, but always put the patient's best interest first.