PPCP:JustAnotherAcronym?

CrystalDeas,Pharm.D.,BCPSAssistantProfessor,McWhorterSchoolofPharmacyAffiliateClinicalPharmacist,CooperGreenMercy HealthServices

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

NeedforPPCP

Otherhealthprofessionsconfusedon

roleofpharmacists

Widevariationinpatientcareprocesses

Inconsistentuseof

terminology

What have others done? Nursing

What have others done? Physicians Diagnostic Process

Monitoring&FollowupTreatment

DifferentialDiagnosisDataAnalysis

PhysicalExamination

MedicalHistory

ChiefComplaint

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

Thepharmacistcollectsnecessarysubjectiveandobjectiveinformationaboutthepatient.

Whatdoyouknoworneedtoknow??? Examples:

Medicationlistandmedicationusehistory Relevanthealthdata:medicalhistory,healthandwellnessinformation,biometrictestresults,andphysicalassessmentfindings

Patientlifestylehabits,preferencesandbeliefs,healthandfunctionalgoals,andsocioeconomicfactors

Assess

Thepharmacistassessestheinformationcollectedandanalyzestheclinicaleffectsofthepatientstherapyinthecontextofthepatientsoverallhealthgoals.

Whatsgoingon?? Assess:

eachmedicationforappropriateness,effectiveness,safety,andpatientadherence healthandfunctionalstatus,riskfactors,healthdata,culturalfactors,healthliteracy,andaccesstomedicationsorotheraspectsofcare

immunizationstatusandtheneedforpreventivecareandotherhealthcareservices,whereappropriate

Plan

Thepharmacistdevelopsanindividualizedpatientcenteredcareplan,incollaborationwithotherhealthcareprofessionalsandthepatientorcaregiver.

Whatareyougoingtodoaboutit?? Addressmedicationrelatedproblemsandoptimizemedicationtherapy Setgoalsoftherapyforachievingclinicaloutcomes Engagethepatientthrougheducation,empowerment,andselfmanagement

Supportcarecontinuity

ImplementThepharmacistimplementsthecareplanincollaborationwithotherhealthcareprofessionalsandthepatientorcaregiver.

Doit!! Addressmedication andhealthrelatedproblems,andengageinpreventivecarestrategies,includingvaccineadministration

Provideeducationandselfmanagementtrainingtothepatientorcaregiver

Contributetocoordinationofcare Schedulefollowupcareasneeded

Follow-up: Monitor and Evaluate

Thepharmacistmonitorsandevaluatestheeffectivenessofthecareplanandmodifiestheplanasneeded.

Howdiditgo??Anyideastoimprove?? Evaluate:

Medicationappropriateness,effectiveness,andsafety Clinicalendpointsthatcontributetothepatientsoverallhealth Outcomesofcare,includingprogresstowardortheachievementofgoalsoftherapy

Assessment Questions:

ThePharmacistsPatientCareProcess(PPCP)wasadoptedbythe____,withagoaltohelppharmacistsunderstandthecomponentsofthestandardpatientcareprocessandapplyinallpharmacysettings.

A. JointCommissionofPharmacyPractitioners(JCPP)B. AmericanAcademyofCollegesofPharmacy(AACP)C. NationalAssociationofBoardsofPharmacy(NABP)

Assessment Questions:

ThefoundationofthePharmacistsPatientCareProcess(PPCP)centersaroundeffective___. Selectallthatapply.

A. CommunicationB. CollaborationC. DocumentationD. Delegation

Steps to Applying and Implementing PPCP

1. Learntoapplytheprocess.2. Evaluateexistingservicesanddevelopstrategiesfor

implementationandqualityimprovement.3. Promotetheprocess.4. Continuousqualityimprovement.

BennettMS,KliethermesMA,editors.HowtoImplementthePharmacistsPatientCareProcess.Washington,DC:AmericanPharmacistsAssociation;2015.

CaseExampleofPPCPAdapted from Bennett MS, Klithermes MA, editors. How to Implement

the Pharmacists Patient Care Process. Washington, DC. American Pharmacists Association; 2015.

Collect

SamMcWhorterisa64y/omalewhopresentsforfollowuptoclinicforthemanagementofhisdiabetes.Thepatientwasdiagnosedwithtype2DM10yearsago.Althoughhehasbeentoleratingmedicationswell,hecannotcontrolhisglucose.Lately,hehasbeenunderstressfromworkandhasbeenworkinglonghoursandeatingfastfoodmoreoften.SMwaslastseeninDMclinic1monthago.YouareapharmacistintheDMclinic,withascheduledappointmentwithMr.McWhortertoday.

PMH:Type2DM,HTN,dyslipidemia

Whatnecessarysubjectiveandobjectiveinformationwouldyouneedtocollect?

Updatedmedicationlist Adherencetomedications(diabetesmedicationsinparticular) Symptomsofhyperglycemia,medicationtolerability Detailsofdietandexercise Anychangesinsocialhistory Labdatasincelastvisit(e.g.HbA1c,SMBGreadings) Vitals Preventivecarehistory

Collect

PMH:DM(type2),dyslipidemia,HTN

Medications:metforminER2000mgdaily,atorvastatin10mgdaily,lisinopril10mgdaily,centrumsilverMVIdaily

NKDASocialhistory:()EtOH/tobacco/illicitdruguse

PertinentpositivefromROS:(+)polyuria/polyphagia/polydipsia(+)tingling/numbnessintoes

Vitals:BP128/72;pulse:76bpm;weight 90kgSMBGreadings:206314mg/dL

Pertinentlabs:CMPisWNL,withexceptionofglucose 213InclinicPOCglucose 214HbA1c:10.4%Lipidpanel:TC:214;LDL:158,HDL:40;TG:186

SamMcWhorterisan64y/omalewhopresentsforfollowuptoclinicforthemanagementofhisdiabetes.Thepatientwasdiagnosedwithtype2DM10yearsago.Althoughhehasbeentoleratingmedicationswell,hecannotcontrolhisglucose.Lately,hehasbeenunderstressfromworkandhasbeenworkinglonghoursandeatingfastfoodmoreoften.SMwaslastseeninDMclinic1monthago.

Assess

Analyzetheinformationinthecontextofthepatientsoverallhealthgoals,andidentifyandprioritizetheproblems.

Patientsglucosecontrolissuboptimal

Preventivescreenings,immunizationsuptodate?

CalculateASCVDriskscoreandassessneedforstatin

Plan

Developanindividualizedpatientcenteredcareplan.

Recommendations: Additionofinsulin Pneumoccocalvaccination Increaseatorvastatinto20mgdaily Urinaryalbuminscreening Eyeexam

Educateondietandlifestylemodifications Establishfollowupandmonitoringplanbyphone Referrals

Implement

Howwouldyouexecutethecareplanincollaborationwithotherhealthcareprofessionals,thepatient,andcaregiver?

Adjustmedication(s)/orderlabspercollaborativepracticeagreement Patienteducation Administervaccination Schedulefollowupencounters Placereferrals

Follow-up/Monitoring

Listmonitoringandevaluationparameters.

HbA1cevery3months SMBGreadingsateachvisit Fastinglipidpanelannually BPcheckateachvisit Pertinentpatienteducation/reeducationasapplicable

Assessment Questions:

WhichofthefollowingisNOTacomponentofthePharmacistsPatientCareProcess(PPCP)?

A. CollectB. TriageC. FollowupD. PlanE. ImplementF. Assess

Steps to Applying and Implementing PPCP

1. Learntoapplytheprocess.2. Evaluateexistingservicesanddevelopstrategiesfor

implementationandqualityimprovement.3. Promotetheprocess.4. Continuousqualityimprovement.

BennettMS,KliethermesMA,editors.HowtoImplementthePharmacistsPatientCareProcess.Washington,DC:AmericanPharmacistsAssociation;2015.

Suggested Activities to Engage in PPCP

Medicationreconciliation Collaborativedrugtherapymanagement IVtoPOconversions PKmonitoringprograms Immunizations Healthscreenings TransitionsofCare SOAPnotes/MedicationActionPlans Casepresentations Patienteducationclasses(e.g.,diseasemanagement,deviceuse,etc.) Clinicaldocumentation

Resources for PPCP Implementation

Steps to Applying and Implementing PPCP

1. Learntoapplytheprocess.2. Evaluateexistingservicesanddevelopstrategiesfor

implementationandqualityimprovement.3. Promotetheprocess.4. Continuousqualityimprovement.

BennettMS,KliethermesMA,editors.HowtoImplementthePharmacistsPatientCareProcess.Washington,DC:AmericanPharmacistsAssociation;2015.

Preceptors, We Need Your Help!

GaugestudentsknowledgeandunderstandingofthePPCP

ModelappropriateuseofthePPCP MonitorstudentsuseofthePPCPandprovideformativefeedback

Looking for a consistent method to teach PPCP?Askquestions! Collect

Whatinformationdoyouneed? Whatarepotentialsourcesoftheinformation? Howwillyoucollecttheinformation?

Assess Arethereanydrugrelatedproblemspresent? Whatarethegoalsoftherapy? Whataretheprosandconstovarioustreatment

options? Plan

Howwillthepatientbeinvolvedinthedevelopmentofyourplan?

Howwillyouprioritizesuggestedinterventions? Howwillyoudocumentandcommunicateyour

plantopatientsandthehealthcareteam?

Implement Whatiswithinyourscopeofpracticeandwhat

needstobereferredtoothermembersofthehealthcareteam?

Whatifyourrecommendationisnotaccepted? Followup

Whatisyourrecommendedmonitoringplan? Whatisyourmethodofqualityassuranceto

reviewtheplanforsafetyandeffectiveness?

Steps to Applying and Implementing PPCP

1. Learntoapplytheprocess.2. Evaluateexistingservicesanddevelopstrategiesfor

implementationandqualityimprovement.3. Promotetheprocess.4. Continuousqualityimprovement.

BennettMS,KliethermesMA,editors.HowtoImplementthePharmacistsPatientCareProcess.Washington,DC:AmericanPharmacistsAssociation;2015.

References