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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. Disclaimer Neither the PSA, nor any person associated with the preparation of this document, accepts liability for any loss which a user of this document may suffer as a result of reliance on the document and, in particular, for: use of the Guidelines for a purpose for which they were not intended any errors or omissions in the Guidelines any inaccuracy in the information or data on which the Guidelines are based or which is contained in them any interpretations or opinions stated in, or which may be inferred from, the Guidelines. Notification of any inaccuracy or ambiguity found in this document should be made without delay in order that the issue may be investigated and appropriate action taken. Please forward your notification to: Program Delivery Unit, Pharmaceutical Society of Australia, PO Box 42, Deakin West, ACT 2600. 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 22 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. 33 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. 44 Guidelines for pharmacists performing clinical interventions I © Pharmaceutical Society of Australia Ltd.
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