Management of Care Process in Pharmacy


Question: Management of Care process in Pharmacy


Merck & Co. is an American Pharmaceutical organization. it is one of the largest pharmaceutical organizations in the world. Merck & Co. was formed in 1891 as the United States subsidiary of the German Company Merck which was established by the family of Merck in 1668. The organization is mainly established for providing optimal health services to their patients. For achieving this goal the organization performing high efforts so that they can satisfy a large number of patients. For achieving this goal, the organization is focusing on team-based patient-centered care which helps the organization in delivering high-quality, cost-effective and accessible healthcare services to their patients. In this report, we will study the patient care process followed by the organization for effective delivery of their services. The patient care process of the organization mentioned in this document developed by examining a large number of key source documents on medication therapy management and pharmaceutical care.

Patient Care Process

The pharmacists of the organization use a patient-centered approach with the collaboration of other members of the health care team to optimize medication outcomes and patient health. The first step is the formation of patient-pharmacist relationships (Grol,2013). It is a very important and essential step because it supports effective communication and engagement with patients, caregivers and families throughout the whole process. In addition to it, pharmacists also continually collaborate, communicate with physicians, health care professionals and other pharmacists in the provision of effective, safe and coordinated care. The process of patient care is also improved by the organization by using interoperable information technology systems that facilitate effective and efficient communication among all individuals who is involved in patient care (figure-1).
1.    Collect 
In order to understand the relevant medication/medical history and clinical status of the patient-pharmacist assure the collection of required objective and subjective information about the patient. Information regarding the patient collected by the pharmacist using different sources including the patient, health care professionals, and various existing patient records. In collecting the data about the patient we follow the following process:
?    Medication uses history and current medication list for nonprescription and prescription medications, dietary supplements and other herbal products.
?    Health data of the current scenario may include health and wellness information, medical history, physical assessment findings, and biometric test results.
?    Patient lifestyle habits, health and functional goals, preferences, and beliefs, and socioeconomic factors that affect access to access to medications and various other aspects of care (Bennett,2015).
2.    Assess
At this stage of the patient care process, all collected data are analyzed by the pharmacists to understand the clinical effects of the patient's therapy in the context of the patient's overall health goals in order to identify and understand prioritize problems and achieve optimal care. Through conducting the effective assessment the organization can easily point out the requirements of their patients and their expectations from the organization. Assessing process includes the following:
?    Each medication for effectiveness, safety, appropriateness, and patient adherence.
?    Health and functional status of health data, risk factors, health literacy, cultural factors, and access to medications and various aspects of care.
?    Need for preventive care and the immunization status and various other health care services, where appropriate.
3.    Plan 
The pharmacist of the organization formulates an individualized patient-centered care plan with the help of other health care team members of the organization and the patient or caregiver that is cost-effective and evidence-based. In this, a plan is formulated by the organization which indicated the following:
?    Identifying various medication-related problems and utilizing medication therapy in an efficient manner.
?    Sets different goals of therapy that help the organization in achieving clinical outcomes in the context of the patient's access to care and overall health care goals.
?    Engages the patient by the organization through empowerment, education, and self-management.
?    Supports care continuity, including the transition of care and follow-up as appropriate.
4.    Implement
At this stage of the patient care process, the pharmacist of the organization implements the care plan with the cooperation of other health care professionals, and the caregiver or patient. For implementing the patient care process the pharmacist of the organization follows the following steps:
?    Identify problems related to health and medication and enforce various prevent care strategies for resolving these problems such as vaccine administration.
?    Modifies discontinues, initiates or administers different medication therapy as authorized.
?    They provide education and self-management training to the caregiver and the patient.
?    They contribute to the coordination of care, including transition and referral of the patient to another health care professional.
?    Follow-up cares scheduled by the organization to achieve goals of therapy.
5.    Follow-up: Monitor and Evaluate
The pharmacist of the organization evaluates and monitor the effectiveness and efficiency of the care plan and modifies the existing plan with the collaboration of other health care professionals and the caregivers or patient as needed. Process of follow-up includes the continuous monitoring and evaluation of the following:
?    Clinical endpoints which contribute to the overall health of the patient's.
?    Medication effectiveness, appropriateness, and safety and patient adherence through available biometric test results, health data, and feedback from the patient.
?    Outcomes of the care, including progress towards the achievement of objectives of the therapy.

Donabedian Model

Donabedian model is referred to a conceptual model that provides a framework for examining different health services and evaluating quality of health care. Through using Donabedian Model, we are able to analyze the effectiveness and suitability of the patient care process of the organization. This helps us in identifying the possible problems which can arise in the implementation of the patient care process (Azami-Aghdash,2014). By using this model, the organization can collect information about the quality of care delivered by the organization to their patient in three categories: "structure", "process", and "outcomes". The following figure shows the components of the Structure
The structural component of the Donabedian model includes all the factors that affect the context in which the care is delivered by the organization to its patients. These factors control how patients and the providers in a healthcare system act and also measures the average quality of care provided by the organization within a facility or system. All the above factors such as human dignity, Equipment, Staff training and, Privacy and Confidentiality affects the level of services provided by the organization to their patients. The overall performance of the organization depends on managing these factors. These factors are very easy to observe and can measure easily, and they may be the upstream cause of problems identified in the process.
1.    Process
The process is known as the sum of all the actions that make up healthcare. The above-mentioned components are included in the process. These mentioned components describe the action of the organization towards delivering efficient services to the patient. These commonly include the level of services offered, Technical Quality, Counselling Quality, Interpersonal Relations, Access, Safety, and Promotion of continuity of care. Processes of the organization can also be classified as technical processes that show how care is delivered by the organization (Rais,2013). Generally, it is considered that the measurement of the process is equally important such as measurement of quality of care because the process contains all acts which are followed in the healthcare delivery. Information regarding the process can be calculated by using medical records, patient feedback, interview with practitioners and patients, or direct observations of healthcare visits. 
2.    Outcome
The outcome includes all the effects of healthcare on population or patients, including Patient Satisfaction, More Wellness: More Prevention, Patient Care and Patient Feedback, and Improved quality of care. Most of the time outcomes are considered as the most important indicators of quality because improving the health of the patient is the primary goal of the organization. It is difficult for an organization to measure the outcomes of the organization in an efficient manner, it requires huge efforts from the pharmacist to measure the outcomes in an efficient way. Factors of the outcome can be determined by the organization by conducting the household survey. 
Donabedian Framework of Structure, Process, and Outcome demonstrate that evaluation is very valuable for the organization to measure the safety and quality of service. Furthermore, in this study, specific elements related to the Structure, Process, and Outcomes were shown to influence the quality service processes and also detecting interdependence of Structure, Process, and Outcome components.
The possibility of patient harm always exists when the organization is delivering its services to their patients. It may be possible that patients may receive substandard care or a paucity of care from an impaired provider. Tempering can be identified by the organization through regular physical counts of controlled substance stock (Baum,2015). This helps the organization in quickly detect tampering. There are various tampering that was identified in the patient process of the organization. The tempering is the following: 
•    Missed opportunities
•    Poor Accessibility in Slum Areas
•    Low Knowledge about immunization among mothers and providers.


Improving the quality of patient care is necessary for Merck & Co. this will enable the organization in achieving a high degree of patient satisfaction. As the awareness among the public is enhancing, demand for better healthcare regulation and keener competition is increasing. The quality of patient care is effectively determined by the quality of training, Quality of infrastructure, the efficiency of the operational system, and the competence of personnel. There are the following opportunities available for the organization through which the organization can deliver better patient care services: 
?    Access
Availability and Accessibility of both the physician and hospital should be assured by the organization to all those patients who require health care. Through doing this Merck & Co. can effectively demonstrate itself in the market (Brown,2012).
?    Waiting
The organization can easily image itself in the eyes of patients by reducing its waiting time for all its services.
?    Ancillary services
Other services like food, communication, etc. should be accessible to the organization both to attending families and patients.
Reasons for Defect Deviation
?    Insufficient information for patient-centric clinical care, and effectively delivering high-quality services to their patients.
?    Insufficient information through which the process of care can be improved and understand.
?    Limited Cost measures and quality to support reporting of public on value and quality.
?    Insufficient information for conducting patient-based outcomes research.
Accidental Processes:
Now most of the pharmacy organizations conduct an annual hazard vulnerability analysis and finds various accidental emergencies. It is necessary for the organization to enforce a successful procedure for handling all accidental situations (d'Errico,2015). The accidental process is a combination of the following elements:


From studying all this, it can be concluded that the organization should perform a lot of efforts for delivering better services to their patients. The environment of today is dynamic in nature due to which the profession of pharmacy has undergone significant evolution and change over the past 40 years, shifting pharmacists from primarily dispensing medication to providing effective patient care. With this proves of evolutionary, various models were emerged by the pharmacists such as medication therapy management service model or spanning clinical pharmacy model to the pharmaceutical process. For the successful implementation of the patient care process, it requires unique training resources and also requires the participant to actively apply skills, abilities, and knowledge related to the patient care process. By utilizing their full potential pharmacist can effectively implement strategies for applying the patient care process to existing services of patient care within a practice. Through the comprehension. Knowledge, application and utilize the pharmacist-patient care process, future and practicing pharmacists will contribute more towards the achievement of the application of the patient care process. Through this organization can efficiently measure the quality of care. So, it can be said that it is necessary for the organization to satisfy its patients in an effective manner which helps in survive the organization for a long time. 


Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: the implementation of change in health care. John Wiley & Sons.
Bennett, M., & Kliethermes, M. A. (Eds.). (2015). How to Implement the Pharmacists' Patient Care Process: A Systematic Approach.
Bennett, M. S., Kliethermes, M. A., Derr, S., & Irwin, A. (2015). APhA academies reflect on the pharmacists’ patient care process of the Joint Commission of Pharmacy Practitioners. Journal of the American Pharmacists Association, 55(3), 230-236.
Rais, N. (2013). Quality of care between the Donabedian model and ISO9001V2008.
Azami-Aghdash, S., Ghojazadeh, M., Fardid, M., Aghaei, M. H., Nikanfar, R., & Mohseni, M. (2014). A Systematic Review and Content-Analysis of Service Quality Indicators Provided to Patients with Cardiovascular Disease using the Donabedian Model. Journal of Cardiology and Therapy, 1(9), 228-242.
Waller, D., Ash, J., Paulson, A., & Sonnier, G. (2015). Tempering threats to temperate forests. Science, 350(6262), 747-748.
Baum, N., Shalit, H., Kum, Y., & Tal, M. (2015). Social workers' role in tempering inequality in healthcare in hospitals and clinics: a study in Israel.Health & social care in the community.
Brown, B., Williams, R., Ainsworth, J., & Buchan, I. (2012). Missed opportunities mapping: computable healthcare quality improvement. Studies in health technology and informatics, 192, 387-391.
d'Errico, F., Vanhaeren, M., Van Niekerk, K., Henshilwood, C. S., & Erasmus, R. M. (2015). Assessing the accidental versus deliberate colour modification of shell beads: a case study on perforated Nassarius kraussianus from Blombos Cave Middle Stone Age levels. Archaeometry,57(1), 51-76.

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