48 Resolving a Medication Related Problem
Outcome:
To ensure the optimisation of a patient’s therapeutic regimen, improving efficacy, safety and adherence to achieve the desired health outcomes.
Potential Risks:
Unresolved medication related problems could lead to potential risk of the patient experiencing adverse effects, therapeutic failure or worsening of their condition.
Course
This EPA is undertaken in PHRM4071, PHRM4072 or PHRM4062.
Entrustment level
The anticipated entrustment level for PHRM4071, PHRM4072 or PHRM4062 is 2-3.
EPA Template:
Note: Printable EPA templates are available on course sites.
| Element | Performance Criteria Description |
|---|---|
| Review and Interpretation of Patient-Specific Data | - Where available, clinical data (e.g. laboratory investigations, clinical observations (temperature, pulse, blood pressure, bowel function, pain scores, mobility)) and progress notes are reviewed in the context of the patient’s admission - Clinical data is accurately interpreted with respect to diagnosis and current clinical state, past medical history and pathophysiology of disease(s), specifics of medications (e.g. time to effect) and desired outcome and potential for medicine to be causing adverse effects - Effectiveness of treatment and potential adverse effects are monitored - Missing data is identified and requested if required (e.g. patient on anti-hyperglycaemic medication and no BSLs have been recorded) |
| Understanding and recognition of the medication-related problem | - Identification of the type, nature and severity of the medication related problem in the context of individual patient factors: -> Prescription legality, clarity and legibility -> Medication choice, availability, dose, formulation, frequency and route of administration -> Missing therapy (e.g. VTE prophylaxis) or duplication in therapy -> Monitoring parameters, laboratory values and patient vital signs -> Patient adherence and/or education -> Therapeutic drug monitoring for medications with a narrow therapeutic index or variable pharmacokinetics -> Special populations including the unique needs of paediatric, geriatric, obese, pregnant/lactating patients -> Drug-drug, drug-disease/drug-patient, drug-nutrient interactions - Understand the potential clinical impact of the medication-related problem in the context of the patient’s presentation |
| Consideration of Appropriate Solutions in the Context of the Patient’s Admission | - Appropriate and relevant resources are consulted if required to determine possible solution(s) - Judicious clinical judgement is applied in the context of the medication-related problem and the patient’s current condition - Ability to determine the clinical urgency of the medication-related problem and decide on an appropriate escalation pathway |
| Communication with Relevant Stakeholders for Problem Resolution | - The prescriber is contacted for any urgent medication-related problems in a timely manner - Professional and appropriate language/manner is used to communicate with the prescriber - Confirm correct patient identity with the prescriber - Provides a clear and succinct description of the medication-related problem - If asked, is prepared with appropriate pathway(s) for the resolution of the medication-related problem - Confirms with the prescriber the preferred method of resolution |
| Clear Documentation of Confirmed Resolution or Appropriate Handover | - Confirmed resolution is clearly and appropriately documented in the patient records/chart/progress notes - Changes are communicated to relevant stakeholders involved (e.g. nursing staff) - If resolution is unable to be achieved, appropriate clinical handover is given to next pharmacist on duty - Appropriate follow-up is achieved in relevant timeframe |
| Incident Reporting | - Collate relevant documentation and evidence of medication-related problem - Report medication-related problem via workplace incident-reporting platform or escalate to manager (or delegate) if required |
| Consideration of Appropriate Education to Relevant Stakeholders | - Reflect on the nature of the medication-related problem and consider ways in which the problem could be mitigated in future - Consider education and/or discussion with relevant stakeholders involved to reduce future incidences |
| Collaboration and Agency | - Clarification is sought for any concerns identified and escalated to an appropriate stakeholder - Identify and acknowledge any professional or personal limitations and seek support where necessary - All communication is conducted in a professional, efficient and respectful manner |
