Guidelines for pharmacists performing clinical interventions PSA Committed to better health © Pharmaceutical Society of Australia Ltd. 2018 This publication contains material that has been provided by the Pharmaceutical Society of Australia (PSA), and may contain material provided by the Commonwealth and third parties. Copyright in material provided by the Commonwealth or third parties belong to them. PSA owns the copyright in the publication as a whole and all material in the publication that has been developed by PSA. In relation to PSA owned material, no part may be reproduced by any process except in accordance with the provisions of the Copyright Act 1968 (Cwth), or the written permission of PSA. Requests and inquiries regarding permission to use PSA material should be addressed to: Pharmaceutical Society of Australia, PO Box 42, Deakin West ACT 2600. If you would like to use material that has been provided by the Commonwealth or third parties, contact them directly. 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ISBN: 978-0-908185-14-6 Title: Guidelines for pharmacists performing clinical interventions Date of Publication: December 2018 (updated January 2019) Date of Endorsement by PSA Board: December 2018 Publisher: Pharmaceutical Society of Australia 2 Guidelines for pharmacists performing clinical interventions I © Pharmaceutical Society of Australia Ltd. Contents Executive summary 4 Introduction 5 Scope 6 Terminology 7 Clinical interventions overview 8 Clinical interventions as part of medicines management 9 Relevance to funded programs 10 Performing clinical interventions 10 Patient privacy 10 Consent 10 Training 10 Policies and procedures 11 Documentation 11 Staff responsibilities 11 Identifying and addressing medication-related problems 11 Communicating and collaborating with other healthcare providers 12 Communicating with patients 13 Follow-up 13 Documentation 13 Methods of documentation 14 Patient history (clinical) notes 14 Recording medication-related problems 14 Recording recommendations 20 Monitoring and evaluation 23 Appendix 1 - PROMISe projects 24 Appendix 2 - Guide for documenting clinical notes (SOAP notes) 25 SOAP notes 25 Example 25 Appendix 3 - Referral letter template 26 Appendix 4 - Clinical intervention template 27 Appendix 5 - DOCUMENT MRP and recommendation classification codes 28 References 29 Guidelines for pharmacists performing clinical interventions I © Pharmaceutical Society of Australia Ltd. 3 Executive summary Although pharmacists routinely undertake clinical interventions This will help pharmacists to: as part of their professional duty of care, they may not • identify, classify and document medication-related problems consistently document these interventions, or document them at (MRPs) and clinical interventions in a professional manner all. In addition, some pharmacists may not always recognise that • ensure that all important information is recorded effectively their decisions and actions constitute clinical interventions. and systematically These guidelines provide information and guidance to assist • use documented clinical interventions to communicate with pharmacists to meet their professional responsibilities, exercise other healthcare providers and/or patients, where required. professional judgement and manage risks associated with The guidelines do not replace the need for pharmacists to performing clinical interventions. They provide information exercise professional discretion and judgement when performing and advice to pharmacists on professional issues related to these tasks in their own practice environment. The guidelines performing clinical interventions. do not include clinical information or detailed legislative requirements. Pharmacists must at all times comply with relevant Commonwealth, state and territory legislation, as well as relevant standards, codes and rules. 4 Guidelines for pharmacists performing clinical interventions I © Pharmaceutical Society of Australia Ltd. Introduction A clinical intervention may be defined as “any professional activity Performing, documenting and classifying MRPs and clinical by the pharmacist directed towards improving the quality use interventions are important for several reasons, including: of medicines and resulting in a recommendation for a change • facilitating better health outcomes for patients in the patient’s medication therapy, means of administration or • improving communication between pharmacists and other 1 medication-taking behaviour”. healthcare providers involved in the patient’s care, and the Pharmacists routinely provide clinical interventions to improve patient themselves the health outcomes of patients. Clinical interventions are • supporting a learning and quality improvement culture with provided to prevent or address MRPs related to both prescription evidence to support a professional practice portfolio and non-prescription medicines. • developing tools that encourage pharmacists to provide and record more clinical interventions An MRP is defined in the literature as “an event or circumstance • providing a basis for quality audits and peer review involving drug treatment that actually or potentially interferes with the patient experiencing an optimum outcome of medical • permitting analysis of the data for pharmacovigilance, care”. Terms used to describe an MRP or subtype include economic review or other purposes drug-related problem, medication error, adverse drug event, • adequately recording details for potentially litigious situations. 2–5 adherence issue and adverse drug reaction. Researchers involved in the series of Pharmacy Recording of MRPs are a major burden on the Australian healthcare system5,6: Medication Incidents and Services electronically (PROMISe) projects7 (see Appendix 1), conducted with funding provided • Of all hospital admissions, an estimated 2–3% are medication under the Fourth Community Pharmacy Agreement, developed related. Up to three-quarters of these are considered potentially preventable, equating to 230,000 hospital and refined a classification system, termed the DOCUMENT admissions with an annual cost of $1.2 billion. classification system, for MRPs. This system is used in pharmacies Medication-related hospital admissions are greater in across Australia. the population aged 65 years and over, at 20–30% of all It is important to review these guidelines in conjunction with admissions. relevant Professional Practice Standards,8 particularly: • Within residential aged care, the prevalence of potentially inappropriate medicine use in residents has been estimated • Standard 1—Fundamental Pharmacy Practice as 40–50%. Other studies have found that more than 90% of • Standard 3—Dispensing and Other Supply Arrangements residents had at least one MRP, with an average of three or four • Standard 8—Counselling. per person. Pharmacists should also be familiar with Australian Standard • In the community, studies have found that around 10% of AS85000:2017 (Quality Care Community Pharmacy Standard),9 patients seeing a general practitioner (GP) had had an adverse medication event in the previous 6 months. Of these, 11–12% specifically: were severe, and approximately 5% required hospitalisation. • 5.1—Compliance with Legal and Professional Obligations These studies have highlighted the need for improved detection • 5.2—Supply of Medicines, Medical Devices, and Poisons and prevention of MRPs within the community and aged care • 5.3—The Supply of Complex Compounded Products (if offered) facilities, before a GP visit, or hospital attendance or admission, is • 5.4—Delivery of Health Programs and Services. necessary. (These are equivalent to Elements 1, 2 and 3 of the Quality Care A clinical intervention is the process of a pharmacist identifying Pharmacy Program (QCPP) requirements.10) a potential MRP and making a recommendation in an attempt These guidelines provide pharmacies with a procedure to to prevent or resolve the MRP. It is intended that clinical appropriately adhere to requirement 5.2.8 of the Australian interventions will complement other professional services such Standard (“maintaining and following a system for the as in-pharmacy MedsCheck services, Staged Supply, Home identification, managing, recording, analysis and reporting of Medicines Reviews, Residential Medication Management (i) clinical interventions and (ii) adverse drug reactions”), which is Reviews, pharmacist vaccination services and the provision of equivalent to mandatory requirement 2.9 for accreditation under Dose Administration Aids. the QCPP.10 Guidelines for pharmacists performing clinical interventions I © Pharmaceutical Society of Australia Ltd. 5 Scope These guidelines focus on the best-practice process for Pharmacists