Clinical Pharmacy Practice: Prepared By: Cedrix Cuaderno RPH, Bs Ind Pharm. Adamson University College of Pharmacy

Clinical Pharmacy Practice
Prepared by:
Cedrix Cuaderno RPh, BS Ind Pharm.
Adamson University
College of Pharmacy
Patient Profile
Patient Demographics
• The individual characteristics of each patient

create the context for all of your clinical
activities.
• Patient demographic information is needed to
see each patient as a unique individual.
• The purpose of the patient demographic
portion of your assessment is to determine who
your patient is and to provide a description of
him or her at the time of the assessment.
• Your goal is to observe and elicit information

describing the personal characteristics of the
patient that are relevant to making drug
therapy decisions.
Age of the Patient

• Age is a vital statistic when providing
pharmaceutical care as it is often applied to both
the discovery of the indication for drug therapy as
well as the appropriate choice of pharmacotherapy
to manage the disease or illness.
• The patient's age is also required for selecting
appropriate products and dosage forms suitable for
his or her age group, and for dosing guidelines
(pediatric, geriatric).
Age of the Patient

• Age is best identified and documented as birth
date, so that age can be continuously updated
as you provide care year after year.
Height and Weight

• Each patient's height and weight should be
documented so it can be used for dosage
individualization.
• In many situations observational estimates of
body weight are sufficient, but for extremely
obese patients, or infants and children, and
when using medications that require precise
dose to body weight determinations, the exact
weight of your patient must be known.
Height and Weight

Estimates for Adult Body Weight, Mass, and Surface Area
Ideal body weight males (kg) = 50 kg + [2.3 x inches > 5'0"]
Ideal body weight females (kg) = 45 kg + [2.3 x inches > 5'0"]
Body mass index (kg/m2) = (weight in kg)/(height in meters)2
Body surface area (m2) = ((height in cm) x (weight in kg/3600))1/2

SOAP NOTES
• Subjective
• Objective
• Assessment
• Plan
SOAP NOTES
SUBJECTIVE
• Information that explains or delineates the
reason for the encounter.
• Information that the patient reports concerning
symptoms, previous treatments, medications
used, and adverse effects encountered.
• These are considered nonreproducible data
because the information is based on the
patient's interpretation and recall of past events.
SOAP NOTES
SUBJECTIVE
• Chief complaint
• Medical History
• Review of Systems (ROS) / Physical
Examination (PE)
• Social History
SOAP NOTES
OBJECTIVE
• Information from physical examination,
laboratory results, diagnostic tests, pill counts,
and pharmacy patient profile information.
• Objective data are measurable and
reproducible.
SOAP NOTES
ASSESSMENT
• A brief but complete description of the
problem, including a conclusion or diagnosis
that is supported logically by the above
subjective and objective data.
• The assessment should not include a
problem/diagnosis that is not defined above.
SOAP NOTES
PLAN
• A detailed description of recommended or
intended further workup (laboratory
radiology, consultation), treatment (e.g.,
continued observation: physiotherapy, diet,
medications, surgery), patient education (self-
care, goals of therapy, medication use and
monitoring), monitoring, and follow-up
relative to the above assessment.
Drug Therapy Timeline
Shows the time when the drugs are

administered
Drug Therapy Assessment Worksheet
The DTAW will serve as a guide to identify any

drug-related problems that your patient may
have.
Drug Related Problems

1. Correlation between drug therapy and medical problems
2. Appropriate drug selection
3. Drug regimen
4. Therapeutic duplication
5. Drug allergy or intolerance
6. Adverse drug events
7. Interactions: drug–drug, drug–disease, drug–nutrient, and drug-
laboratory test
8. Social or recreational drug use
9. Failure to receive therapy
10. Financial impact
11. Patient knowledge of drug therapy

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Drug Therapy Problem List (DPTL)
• Drug therapy problems are the clinical domain of

the pharmaceutical care practitioner.
• The purpose of identifying drug therapy
problems is to help patients achieve their goals
of therapy and realize the best possible
outcomes from drug therapy.
• Drug therapy problems are a consequence of
drug-related needs that have gone unmet. They
are central to pharmaceutical care practice.
Definition A drug therapy problem is any

undesirable event experienced by a patient
which involves, or is suspected to involve,
drug therapy, and that interferes with
achieving the desired goals of therapy.
Components of a Drug Therapy Problem

1. An undesirable event or risk of an event
experienced by the patient.
The problem can take the form of a medical
complaint, sign, symptom, diagnosis, disease,
illness, impairment, disability, abnormal laboratory
value, or syndrome. The event can be the result of
physiological, psychological, sociocultural, or
economic conditions. ,
Components of a Drug Therapy Problem

2. The drug therapy (products and/or dosage regimen)
involved.
3. The relationship that exists (or is suspected to exist)
between the undesirable patient event and drug
therapy. This relationship can be
(a) the consequence of drug therapy, suggesting a direct
association or even a cause and effect relationship, or
(b) to require the addition or modification of drug
therapy for its resolution or prevention.
Examples:
• "Mr. M.'s elbow pain is not being effectively
controlled because the dosage of ketoprofen he
has been taking for the past three days is too low
to provide relief."
• "Mrs. W. requires additional calcium
supplements in order to prevent osteoporosis."
Example:
Interventions /
Date Actual Problem Actions to be
taken
1/11 The 29-year-old patient is This drug therapy problem
having continued requires an increase in the
breakthrough seizures due patient's phenytoin dosage
to subtherapeutic
phenytoin concentrations.
Pharmacist’s Care Plan
• After the problem list is generated, subjective

and objective data are reviewed, and the
severity and acuity of the problems are assessed
and prioritized, the next step in the problem-
oriented (i.e., SOAP) approach is to create a plan
• The purpose of the care plan is to determine,
with the patient, how to manage his or her
medical conditions or illnesses successfully with
pharmacotherapy and includes all the work that
is necessary to accomplish this.
Pharmacist’s Care Plan
Patient’s Health Care Pharmacotherapeutic Recommendations / Monitoring Required

Need Goals Measures

Clinical Pharmacy Practice: Prepared By: Cedrix Cuaderno RPH, Bs Ind Pharm. Adamson University College of Pharmacy

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Clinical Pharmacy Practice

• The individual characteristics of each patient

• Your goal is to observe and elicit information

Age of the Patient

Age of the Patient

Height and Weight

Height and Weight

Body mass index (kg/m2) = (weight in kg)/(height in meters)2

Body surface area (m2) = ((height in cm) x (weight in kg/3600))1/2

Shows the time when the drugs are

The DTAW will serve as a guide to identify any

Drug Related Problems

The DTAW will serve as a guide to identify any

The DTAW will serve as a guide to identify any

The DTAW will serve as a guide to identify any

The DTAW will serve as a guide to identify any

The DTAW will serve as a guide to identify any

• Drug therapy problems are the clinical domain of

Definition A drug therapy problem is any

Components of a Drug Therapy Problem

Components of a Drug Therapy Problem

• After the problem list is generated, subjective

Patient’s Health Care Pharmacotherapeutic Recommendations / Monitoring Required

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