Intro Exam 1

A in SOAP? Define.

Assessment. Your professional diagnosis of medical/drug issues during this visit. (What you think is going on)

A in SBAR? Define.

Assessment: summarize facts and give your opinion of what is going on

When you see your niece at Thanksgiving, she appears to have lost a great deal of weight. She says she is working on a project for school and takes her plate of turkey and trimmings to her room. You go up to see her later and notice she has not touched her dinner. Do you: A) Compliment her on her self-control during such a high-calorie opportunity and tell her she looks great--encourage her to keep it up! B) Engage her in conversation maybe asking how school is going. Mention that you notice her weight loss, are concerned, and tell her you're there for her if there's every anything she wants to talk about. C) You know she is a 4.0 student, so it's okay to leave her alone to concentrate on her schoolwork.

B

You are concerned about a co-worker who has been difficult lately. His work is suffering and he has been missing deadlines. On a few occasions, over the past month, he has called in sick when he seemed okay the afternoon before. Last night at a happy hour, where he is usually the life of the party, he was quiet, and consumed drink after drink by himself. This morning, he calls in sick and tells your that he can't take the pressure and is considering resigning. Do you: A)Tell him you have noticed that his frequent absences and missed deadlines have been hard on his co-workers, and maybe this job is not a good fit. B) Tell him that you are concerned about him, and ask him if he can talk more about the pressure he is feeling. Try to make plans to meet him that day for lunch to continue the conversation in person. C) Tell him that based on what you have seen at happy hours, he has a problem and should quit drinking.

B

You're at home watching a favorite moving when your ex calls, sounding really upset and talking about wanting to kill him/herself. Do you: A) End the call quickly, this is not your problem. People, who threaten suicide, rarely go through with it. Your ex can take care of him/herself and you are no longer together. B) Ask your ex if he/she has a plan or has made any prior suicide attempts and consider if he/she has the resources to attempt suicide now. Discuss ways he/she can stay safe, such as calling a suicide hotline, a mental health crisis team, or 911. C) Ask how he/she intends to kill him/herself. If you ex doesn't have a plan, he/she's probably not serious and so you can go back to your movie without worry.

B

You're outside the pre-school waiting to collect your child when you noticed another adult behaving strangely. He's walking in circles and having a heated argument with someone who isn't there. Do you: A) Ignore him. He's not your problem as long as he doesn't come anywhere near your child. B) Assess the situation for risk of harm to yourself or others. If needed, encourage others not to be confrontational with him. If you feel safe and able to approach him non-confrontationally, ask if he's okay and what help he might need. Considering notifying school personnel. C) Approach him directly, standing squarely in front of him and making clear eye contact. Put your hand on his shoulder and be assertive, telling him that he needs to leave the area.

B

I in AIDET

Introduce

Barcode Med Administration

Involves scanning the medication before administration to assure: right pt right medication right time right dose right route

How is the error rated calculated?

Number of observed errors (significant and non-significant errors)/opportunities for errors (total potential doses that could be given) x 100

You get a list from medication admin record (MAR). Subjective or objective?

Objective

You get a list from the pharmacy database. Subjective or objective?

Objective

O in SOAP? Define.

Objective. Documents objective, repeatable, and traceable facts about pt's status. (What the exam tells you)

OLD CARTS meaning

Onset, Location, Duration, Character, Aggravating/Alleviating Factors, Radiation, Timing, and Severity

OPQRST meaning

Onset, Palliating/Provoking Factors, Quality, Radiation, Site, and Timing

1987 OBRA (LTC Consulting)

Pharmacists are the drug expert and can do counseling in long term care facilities

1975 Millis Report

Pharmacists of the future; pharmacists had to do research on drugs; shifted from the old days of compounding to clinical pharmacists; disease statement management

What is PPCP? How does it work?

Pharmacists' Patient Care Process. Collect. Assess. Plan. Implement. Follow-up: Monitor and Evaluate.

P in SOAP? Define.

Plan. Describes what you will do to treat the pt. (What you're going to do about it)

What is a side effect?

A side effect is a problem that occurs in addition to the desired therapeutic response or goes beyond the desired therapeutic response.

Examples of PPCP application

comprehensive medication review and follow-up; IV to oral anticoagulant dosing; medication reconciliation during a care transition; diabetes management; immunization

PPCP: Plan

develop an individualized pt-centered care plan, in collaboration with other health care professions and the pt or caregiver that is evidence-based and cost-effective

1910 Flexner Report

formalized medical training; physicians could not own a medical school; was really bad for pharmacists; claimed that "pharmacy was not a profession"

G in ALGEE

give reassurance and information

PPCP: Collect

the collection of necessary subjective and objective information about the pt in order to understand the relevant medical/medication hx and clinic status of pt

Define "informatics."

the science of processing data for storage and retrieval; information science

What is an adverse drug reaction?

An unexpected and potentially harmful response to a drug that is unrelated to its intended use.

What is an unnecessary drug in LTC?

Any medication that is prescribed in an excessive dose, for excessive duration without an adequate indication for use.

E's in ALGEE

1. encourage to get professional help if needed 2. encourage self-help and other support strategies

Pharmacist's role in documenting?

1. identify potential and actual drug-related issues 2. resolve actual drug-related issues 3. prevent potential drug-related issues

Under VA state law, how many CE hours must be completed for pharmacist license renewal?

15 CE hours must be completed by 12/31 of the year. Home study must be approved by the board, ACPE, or Category 1 CME.

What is the error rate established for long term care (LTC) by the federal government?

5%

A colleague seems to have lost all pride in his appearance and enthusiasm for life. His speech is sluggish, he's sad all the time and he's recently given away several favorite office possessions. Do you: A) Ask if there's anything he'd like to talk about and try to find out if he seems depressed or had any thoughts about ending his life. B) Keep the conversation light--avoiding any discussion of suicide or death--he is upset enough already and you wouldn't want to put the idea in his head. C) Take him out for a good drink and send him home in a cab. Alcohol is a stimulant and can help someone snap out of a funk.

A

You get along well with your neighbor but her mood swings and love of partying are wearing thin. She can go without sleep for days and expects everyone else to do the same, coming up with poorly thought out projects and becoming annoyed at anyone less than enthusiastic about them. On other days, she rarely leaves her house or says hello. Do you: A) Try to catch her in one of her quieter moments and share with her that you're concerned about her moods, encouraging her to see her physician and offer to go along if she wishes. B) Distance yourself from her. She might be a lot of fun at times, but you shouldn't invest time and energy in the relationship as her split personality is draining for both of you. C) Be direct with her about her unrealistic projects and lifestyle. You can only help her by forcing her to confront her obvious mental illness.

A

Your best friend was a victim of physical assault some years ago and has since been diagnosed with an anxiety disorder. You're with her when she breaks into a sweat, doubles over as if in pain and starts to hyperventilated. Do you: A) Move with your friend to a quiet place, reassure her, and help her to slow her breathing. B) Giver her some time alone because giving her attention during these episodes will only encourage similar future behavior. C) Take her somewhere quiet and help her calm down over a cup of coffee or tea. Gently point out that her attacker is long gone and her fears are unfounded.

A

Your close friend has used marijuana regularly since high school and drinks occasionally. Lately she has seemed preoccupied with both substances, as well as confused and anxious. In fact, she seems to have undergone a significant personality change. Do you: A) Tell her you're concerned about her and the changes in her behavior you've noticed. Ask her to talk with you about these changes. B) Tell her to quit drinking because alcohol dulls your thinking while marijuana is a natural substance that doesn't interfere with brain function. C) Tell her that she has a drug problem and you cannot see her again until she has gotten it under control.

A

What is GDR (Gradual Dose Reduction) in LTC?

A gradual dose reduction is a tapering down of the dose of the drug to possible discontinue the drug, if not contraindicated, or to get the drug to the lowest effective dose with the least possible side effects.

acronym for communicating with pts

AIDET

A in AIDET

Acknowledge

B in SBAR? Define.

Background: state pertinent hx

You notice that a family friend who is a college sophomore has been functioning less well as the school year progresses. At the beginning of the semester, she was vibrant and seemed to enjoy her classes. Now, she has clearly lost weight, seems depressed, has a hard time paying attention, expresses odd ideas sometimes when you talk with her, and seems to have lost her motivation. Do you? A) Tell her she needs substances abuse treatment and you are sorry she succumbed to the drinking and drugs that are all too common at most colleges. B) Suggest that she get academic counseling or tutoring to help her get back on track. C) Express your concern and offer to help her get an appointment at the college counseling center or other services.

C

You're at a party when one of the guests becomes violent. She has a knife and it's obvious that she's responding to voices only she can hear. Do you: A) Try to gain her trust by pretending you can hear the voices too. Agree with everything she says until you can get close enough to take the knife away from her. B) Take her down physically by whatever means possible and have someone call the police. C) Call 911. While you're waiting for the police and mental health crisis team to arrive, turn off the music and encourage people not to confront her or get too close; make sure your exit is not blocked. Perhaps speak calmly to her, but don't argue with her.

C

What are the theories of disease causation? Define them.

Contagion Theory: asphidity bags; purpose is for people to stay away from you because the bag stank Divine: theory/thought that if you were sick, God didn't like something that you did. Sect responsible: group of people who ate healthy food, dieted, and exercised/did physical activity; stayed away from others who did not live by a healthy lifestyle Miasma Theory: the idea that bad smells cause diseases so they wanted to keep everything clean and sanitized to prevent sickness

1929 Baylor Hospital Blue Cross Program

Developed Blue Cross Blue Shield

What is DRR?

Drug Regimen Review is a critical fxn of the consultant pharmacist and is required for nursing home residents.

How have services expanded with providing information to pts?

Drug information activities are provided outside of a formalized center.

D in AIDET

Duration

What are extrapyramidal side effects (EPS)?

EPS are physical sx including tremor, slurred speech, akathesia, dystonia, paranoia, and bradphenia.

Why have drug info centers developed? Define.

Easier for all health care professionals; condensed info source (books, journals, computer systems, etc.) for physicians, dentists, and nurses. a physical location where pharmacists have the resources to provide drug information

E in AIDET

Explanation

Define "drug information."

Facts or advice on drugs regarding a specific pt or a group of pts

Only young people self-harm. T/F?

False

A person who attempts suicide will always be "suicidal." T/F?

False.

If you ask a person about his or her suicidal intentions, you will encourage the person to kill themselves. T/F?

False.

Improvement following a suicidal crisis means that the risk of suicide is over. T/F?

False.

Once a person is seriously considering suicide, there is nothing you can do. T/F?

False.

Self-harm is a failed suicide attempt. T/F?

False.

Suicide happens without warning. T/F?

False.

1906 Pure Food and Drug Act

First legislation requiring all ingredients to be listed.

R in SBAR? Define.

Recommendation: clearly state what you are asking or recommending with the next step to resolve the issue

S in SBAR? Define.

Situation: provide a brief, but clear description of the situation

People who self-harm are attention seekers. T/F?

Somewhere in between.

You get a list from the pt. Subjective or objective?

Subjective

S in SOAP? Define.

Subjective. Describes the pt's current condition, in narrative form. (What the pt tells you)

SCHOLAR meaning

Sx, Characteristics, Hx, Onset, Location, Aggravating Factors, Remitting Factors

T in AIDET

Thank you

What is an anticholinergic effect?

These effects are caused by drugs that block the action of a neurotransmitter called "acetylcholine."

How are errors classified based on severity?

They can be classified significant or non-significant based on the criteria established by Medicare, as well as the professional judgment of the pharmacist.

Self-harm can be a good thing. T/F?

True.

Self-harm is more than just cutting, burning, and things we can see. T/F?

True.

Suicide occurs across all classes of people. T/F?

True.

Define "drug monograph."

a collection of key fields of information specific to a particular medication

Define "compendia."

a collection of things that have been gathered together and presented as a group especially in the form of a book

Define RAP (Resident Assessment Protocol).

address and assess the issues found in the MDS and RAI, specifically for MDS

Hill Burton Act of 1946

allowed for the constructing, financing, and building of hospitals; changed the face of all hospitals; changed all medical practices

What medications have an anticholinergic effect?

antihistamines, antidepressants, and antipsychotics

Define "medication error."

any PREVENTABLE event that may cause or lead to inappropriate medication use or harm the pt while medication is in control of healthcare provider, pt, or consumer

A in ALGEE

assess for risk of suicide or harm

PPCP: Assess

assess the information collected and analyzes the clinical effects of the pt's therapy

Define "comorbidity."

having multiple mental disorders at once

PPCP: Implement

implements the care plan in collaboration with other health care professionals and the pt or caregiver

Define "Beers Criteria."

list of medications that are not appropriate for use in the elderly due to the risk benefit ratio; direct increased risk of harm or an indirect risk by the increased number of falls and complications that occur in pts on these medications

L in ALGEE

listen non-judgmentally

Define "utilization guidelines."

make sure doses are taken as prescribed and indicated

PPCP: Follow-up: Monitor and Evaluate

monitors and evaluates the effectiveness of the care plan and modifies the plan in collaboration with other health care professionals and the pt or caregiver PRN

Define RAI (Resident Assessment Instrument).

needs to be done every 90 days; collection form to assess what is going on with the pt

Define MDS (Minimum Data Set).

pt weight intake

Public Health VS Health Practitioners

public health focuses on entire populations rather than on individuals

What kind of physicians were there in the early 19th century?

sectarian: "irregular physicians"; practiced a lot of natural medicine; plant-based orthodox: "regular" physicians; considered mainstream medicine back then; practiced leeches and bleeding