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Implementing the Pharmacists’ Patient Care Process: Lessons Learned from Nursing Education
Stephanie Forbes, PharmDThe Medication Management Center, The University of Arizona College of Pharmacy
Stephanie Dawson, MSN, BSN RNThe Martha Mann Smith School of Nursing, Wake Tech Community College
DisclosureIn accordance with the ACPE’s and ACCME’s Standards for Commercial Support, anyone in a position to control the content of an educational activity is required to disclose their relevant financial relationships. In accordance with these Standards, ASHP is required to resolve potential conflicts of interest and disclose relevant financial relationships of presenters.
• In this session:
All planners, presenters, reviewers, and ASHP staff report nofinancial relationships relevant to this activity.
The genesis of our collaboration
2018 National Pharmacy Preceptors ConferenceImplementing the Pharmacists’ Patient Care Process: Lessons Learned from Nursing Education
Is the PPCP applicable in professional practice for expert pharmacists? Or Do you see the PPCP as more of a tool to be used only the educational setting?
Discussion:
The Whys for Pharmacy Practice
Consistent expectations helps everyone Establishes patient‐pharmacist relationship Improves communication Promotes collaboration Explicit ways to teach learners to think like a pharmacist Aid in targeted development Advance the profession
2018 National Pharmacy Preceptors Conference
Implementing the Pharmacists’ Patient Care Process: Lessons Learned from Nursing Education
What did nursing learn from the implementation of their own thinking process?
Benefits of Implementation of ADPIE
Defines our practice and specialty Creates patient‐centered approach to care Unified nursing language Enhanced independent practice Systematized practice EMR integration Applicable to any setting (research, education, and practice) Highlighted on NCLEX
Pitfalls to Implementation of ADPIE Does it really capture all that nurses do? Can create excessive documentation Tends to "label" patients Varying interpretations: static vs. linear or dynamic vs. problem‐based Belief that it is only to be used as "training wheels" to new nurses Nursing diagnosis is the weak link Lack of definitional clarity Contemporary nursing philosophies not integrated Resistance when using a top down approach
2018 National Pharmacy Preceptors Conference
Implementing the Pharmacists’ Patient Care Process: Lessons Learned from Nursing Education
How does nursing teach their thinking process? Why do seasoned nurses continue ADPIE in
their daily practice?
Practical Approaches
Audience Polling: 1. Which step of the nursing
process do you think is most beneficial to patient care?
2. Which step, if left out, would be the most detrimental to patient care?
Assessment Crucial step in making patient specific intervention Carried on through all phases of nursing process Socratic questioning What specific data do I need to collect based on the
medical diagnosis, chief complaint, and chronic conditions?
Subjective vs. objective Assess before implement
2018 National Pharmacy Preceptors Conference
Implementing the Pharmacists’ Patient Care Process: Lessons Learned from Nursing Education
You are receiving handoff report for a patient who is 1 day post surgical. The patient has no history of medical problems and has a IV order that states:
D5LR at 125ml/hr; d/c IV when tolerating PO fluids,Ancef 1 g IVPB q 6 h x 3 doses.
You check on him and notice there is only 50 ml of fluid left in his primary IV bag. What should you do? 1. Hang another bag2. Slow the IV down to a 15ml/hr rate3. Saline lock the IV4. Discontinue the IV by removing the IV catheter
Nursing Diagnosis(The single step that does not correlate with the PPCP)
Definition: a clinical judgement about the client’s response to actual or potential health conditions or needs (ANA, 1998)
Not a medical diagnosis! Actual vs. potential problems (preventative) Can be independent, collaborative, or both Interventions then are often centered on nursing diagnosis Great way to teach prioritization What is your patient’s plan of care for the day? Nursing Diagnosis (pocket handbooks or apps)
Commonly Used Nursing Diagnoses Fluid volume deficit At risk for impaired skin integrity Risk for injury Anxiety Acute pain related to . . . Body image disturbance Ineffective airway clearance And so much more . . 235 in total!
2018 National Pharmacy Preceptors Conference
Implementing the Pharmacists’ Patient Care Process: Lessons Learned from Nursing Education
Nursing Problem Evidenced ByPROBLEM LIST‐ Based on the data collected; identify the potential and actual nursing problems for this patient and prioritize them (AT LEAST 3).Based on your number 1 priority nursing problem list interventions, and rationale, and evaluation of your short and long goals.
Short Term Goal Long Term Goal
Interventions Rationale
Evaluation of Short Term Goal Evaluation of Long Term Goal
Subjective:
Objective :
NANDA Nursing Diagnosis:
Teaching Preparation and Planning Common Phrase I use: “ADPIE it” What does this patient need? Teach how to write SMART goals How do you incorporate the patient’s readiness
to learn into your plan? Require students to write plan of care with
patient
2018 National Pharmacy Preceptors Conference
Implementing the Pharmacists’ Patient Care Process: Lessons Learned from Nursing Education
Avoid at all costs a top‐down approach Integration into EMR is crucial A standardized thinking process scaffolds learning from
novice to expert Must be reiterated in practice to maintain professionalism Central with interprofessional communication Basis of how nurses communicate with other
professionals (i.e. SBAR)
Implementing the PPCP
Within school's of pharmacy curriculum Within IPPE/APPE In current practice
2018 National Pharmacy Preceptors Conference
Implementing the Pharmacists’ Patient Care Process: Lessons Learned from Nursing Education
• PMH:• Non‐smoker, father died of MI at 64, NKA, prescription claims data available in EMR
which indicate good adherence, no ADRs reported• Vaccines/misc:
• Received all childhood vaccines • Tdap 2014• Zoster May 2018 • Current on flu vaccine• Dilated retinal eye exam 2015 • Comprehensive foot exam May 2018
Practical Use of the PPCP
Assess No clear indication for pantoprazole DM near goal, HTN at goal, HLD not ‘at
goal’ ASCVD 10 year risk ~28% Statin: currently low‐intensity, meets
criteria for high‐intensity Aspirin: meets criteria but not taking Vaccines: due for PPSV23 Screenings: due for retinal exam
2018 National Pharmacy Preceptors Conference
Implementing the Pharmacists’ Patient Care Process: Lessons Learned from Nursing Education
What are two ways you can implement the PPCP into your clinical practice education settings?
Think‐Pair‐Share:
Consistent and Habitual
References: Accreditation Council of Pharmacy Education. Accreditation standards and key elements for the professional program
leading to the doctor of pharmacy degree. https://www.acpe‐accredit.org/pdf/Standards2016FINAL.pdf Bennett MS. The Patient Care Process: A Framework for Change. Washington, DC. Joint Commission of Pharmacy
Practitioners. May 2017. Centers for Disease Control and Prevention. Using the Pharmacists’ Patient Care Process to Manage High Blood Pressure: A
Resource Guide for Pharmacists. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2016. https://www.cdc.gov/dhdsp/pubs/docs/pharmacist‐resource‐guide.pdf
Cooley J and Lee J. An Operationalization of the Pharmacists' Patient Care Process at one Public College of Pharmacy. The American Journal of Pharmaceutical Education. 2017
Joint Commission of Pharmacy Practitioners. Pharmacists' Patient Care Process. http://www.pharmacist.com/sites/default/files/files/PatientCareProcess.pdf
Joint Commission of Pharmacy Practitioners: Pharmacists' Patient Care Process Presentation. https://jcpp.net/resourcecat/patient‐care‐process/
Mason. M. C. and Attree M. (1997) The relationship between research and the nursing process in clinical practice. Journal of Advanced Nursing, 26: 1045‐1049.
Murray, M. E. and Atkinson, L. D. (2000). Understanding the Nursing Process In A Changing Care Environment. (6th Ed.). McGraw‐Hill Professional.
Pearson. (2019). Nursing, a concept based approach to learning. (3rd Edition). Boston, MA: Pearson Education, Inc. Varcoe, C. (1996). Disparagement of the nursing process: the new dogma?. Journal of Advanced Nursing 23:120‐125.
2018 National Pharmacy Preceptors Conference
Implementing the Pharmacists’ Patient Care Process: Lessons Learned from Nursing Education