MEDICATION THERAPY MANAGEMENT

• It is the provision of integrated, accessible healthcare services by pharmacists who are accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community.

  Ambulatory care Pharmacy Practice
• Ambulatory care Pharmacy Practice Can accomplished through:

  Direct patient care

  Medication management for ambulatory patients Long – term relationships

  Coordination of care

  Patient advocacy

  Wellness and health promotion

  Triage and referral

  Patient education and self – management
• a distinct service or group of services provided by health care providers, including pharmacists, to ensure the best therapeutic outcomes for patients.

  Medication therapy managment
• CORE ELEMENTS OF MEDICATION THERAPY MANAGEMENT

  Medication review

  personal medication review

  intervention and referrals

  documentation and follow up
• especially effective for patients with multiple chronic conditions, complex medication therapies, high prescription costs, and multiple prescribers.

  Medication therapy management
• Patient brings in all medications (prescription and OTC) and pharmacist evaluates regimens for appropriate use.

  Medication review
• Patient receives a record of all current medications

  Personal medication review
• When drug related issues are identified, the pharmacist will intervene and collaborate with the physician to resolve existing medication related problems.

  Refferal
• Pharmacist will document and provide feedback to

  the physician of the findings and outcome.

  Documentation and follow up
• a patient-centered document which empowers the patient to take personal action and track their progress of self- management.

  Medication related action plan
• aka. medication related action plan

  therapeutic action plan
• Strong evidence exists that the use of MTM by pharmacists is effective. - strong internal and external validity.

  trials have been replicated in many different contexts with positive results.
• increasing patient knowledge; improving patient quality of life and medication adherence; and improving the safe and effective use of medications, including reducing therapeutic duplication, decreasing total medications prescribed, and increasing adherence for therapeutic care

  health impact
• increase access to health care for populations facing the most barriers to care

  Health disparity impact
• produce health care cost savings and a positive return on investment (ROI) for health care systems

  Economic impact
• any undesirable event experienced by a patient that involves, or is suspected to involve, drug therapy, and that interferes with achieving the desired goals of therapy and requires professional judgment to resolve

  Medication therapy problems
• medication therapy problems three primary components are:

  An undesirable event or risk of an event experienced by the patient.

  The drug therapy(products and/or dosage regimen)associated with the problem.

  The relationship that exists(or is suspected to exist)between the undesirable patient event and drug therapy.
• a known effect, other than that primarily intended relating to the pharmacological properties of a medication.

  side effect
• unexpected harm arising from a justified action where the correct process was followed for the context in which the event occurred

  adverse drug reaction
• This is the failure to carry out a planned action as intended or application of incorrect plan

  error
• Refers to an incident that result in harm to patient

  Adverse event
• RIGHT PATIENT

  1.Always check the patient id bracelet

  2. Ask the patient to state their name and birth date

  3. Verify patient’s allergy with chart and with patient
• RIGHT DRUG

  1.Perform a triple check of medication’s label.

  2. Always check the medication label with the physician’s order

  3. Never administer medication prepared by other person

  4. Never administered medication that is not labeled
• RIGHT DOSE

  1.Check label for medication concentration

  2. Compared prepared dose with medication order

  3. Verify that dosage is within the appropriate range for patient.
• RIGHT TIME

  1.Verify schedule of medication

  2. Check the last dose given to patient

  3. Administer medication within 30 mins of schedule.
• RIGHT ROUTE

  1.Verify the ROA with medication order.

  2. Medication may only be administered via route specified in the order
• any preventable event that may cause or lead to inappropriate medication use or medication is in the the health care professional, patient, or consumer.

  medication errors
• defined as freedom from preventable harm with medication use (ISMP Canada, 2007).

  medication safety
• refers to any error occurring at any dispensing stage in a hospital pharmacy, whether discovered in the pharmacy department or after the medication has left the department

  dispensing error
• primarily involves a patient error. From the patient's perspective, a medication error occurs when recovery is delayed because the patient took medication incorrectly, perhaps through misunderstanding what the prescriber and/or pharmacist said.

  compliance error
• are the most prevalent administration errors

  wrong time error
• the no administration of a medication needed for a patient, either because the treatment has not been prescribed, transcribed, dispensed or administrated”

  omission error
• are defined as a deviation from drug labels or approved off- label use in accordance with practice guidelines.

  prescribing error
• a lack of communication exists between the prescribing physician and other healthcare professionals.

  fragmented care error
• to review a prescribed dosage regimen for appropriateness and detection of problems, or failure to use appropriate clinical or laboratory data for adequate assessment of patient response to prescribe therapy.

  monitoring error
• 1.Can occur when additional dose is administered

  2. delay in documenting dose

  3. absence of documentation

  improper dose error
• 1. Doses administered as different form than ordered

  wrong dose error
• Reconstituting oral suspension with incorrect volume

  wrong drug preparation errors
• Drugs used past their expiration date may have lost potency,may be less effective or ineffective

  deteriorated drug error
• any deviation in transcribing medication order

  from previous steps( order on the order sheet, administrative nursing note, or documentation of the order in pharmacy database.

  transcription errors