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ASHP Guidelines on a Standardized Method for Pharmaceutical Care

Need for a Standardized Method

The purpose of this document is to provide pharmacists with a standardized method for the provision of pharmaceutical care in component settings of organized health systems. Since the introduction of the pharmaceutical care concept¹ and the development of the ASHP Statement on Pharmaceutical Care,² considerable variation in pharmacists’ provision of pharmaceutical care has been noted. ASHP believes pharmacists need a standardized method for providing pharmaceutical care.

This document describes a standardized method based on functions that all pharmacists should perform for individual patients in organized health systems. The use of this method would foster consistency in the provision of pharmaceutical care in all practice settings. It would support continuity of care both within a practice setting (e.g., among pharmacists on different work shifts caring for an acutely ill inpatient) and when a patient moves among practice settings (e.g., when an inpatient is discharged to home or ambulatory care). Further, a standardized method would establish consistent documentation so that patient-specific and medication-related information could be shared from pharmacist to pharmacist and among health professionals.

The need to identify the functions involved in pharmaceutical care and the critical skills necessary to provide it was discussed at the San Antonio consensus conference in 1993.³ Functions for the provision of pharmaceutical care were identified by the practitioner task force of the Scope of Pharmacy Practice Project.⁴ Those functions have been defined in more detail in the pharmacotherapy series of the ASHP Clinical Skills Program.^5–9

These Guidelines are not specific to any practice setting. ASHP believes this standardized method can be used in acute care (hospitals), ambulatory care, home care, long-term care, and other practice settings. Functions can be tailored as appropriate for a given practice setting. It is recognized that the degree of standardization and tailoring appropriate for a given work site will depend on the practice environment, the organization of services (e.g., patient-focused or department-focused), working relationships with other health professionals, the health system’s and patient’s financial arrangements, and the health system’s policies and procedures. ASHP believes the use of the systematic approaches encouraged by these guidelines will assist pharmacists in implementing and providing pharmaceutical care in their work sites.

Functions of Pharmaceutical Care

ASHP believes that a standardized method for the provision of pharmaceutical care should include the following:

• Collecting and organizing patient-specific information,
  
• Determining the presence of medication-therapy problems,
  
• Summarizing patients’ health care needs,
  
• Specifying pharmacotherapeutic goals,
  
• Designing a pharmacotherapeutic regimen,
  
• Designing a monitoring plan,
  
• Developing a pharmacotherapeutic regimen and corresponding monitoring plan in collaboration with the patient and other health professionals,
  
• Initiating the pharmacotherapeutic regimen,
  
• Monitoring the effects of the pharmacotherapeutic regimen, and
  
• Redesigning the pharmacotherapeutic regimen and monitoring plan.

These major functions have been adapted, in part, from the pharmacotherapy series of the ASHP Clinical Skills Program and the final report of the ASHP Model for Pharmacy Practice Residency Learning Demonstration Project.

Collecting and Organizing Pertinent Patient-Specific Information. Information should be collected and used as a patient-specific database to prevent, detect, and resolve the patient’s medication-related problems and to make appropriate medication-therapy recommendations. The database should include the following sections, each containing specific types of information to the extent that it is relevant to medication therapy:

Demographic

• Name
  
• Address
  
• Date of birth
  
• Sex
  
• Religion and religious affiliation
  
• Occupation

Administrative

• Physicians and prescribers
  
• Pharmacy
  
• Room/bed numbers
  
• Consent forms
  
• Patient identification number

Medical

• Weight and height
  
• Acute and chronic medical problems
  
• Current symptoms
  
• Vital signs and other monitoring information
  
• Allergies and intolerances
  
• Past medical history
  
• Laboratory information
  
• Diagnostic and surgical procedures

Medication therapy

• Prescribed medications
  
• Nonprescription medications
  
• Medications used prior to admission
  
• Home remedies and other types of health products used
  
• Medication regimen
  
• Compliance with therapy
  
• Medication allergies and intolerances
  
• Concerns or questions about therapy
  
• Assessment of understanding of therapy
  
• Pertinent health beliefs

Behavioral/lifestyle

• Diet
  
• Exercise/recreation
  
• Tobacco/alcohol/caffeine/other substance use or abuse
  
• Sexual history
  
• Personality type
  
• Daily activities

Social/economic

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