PHAR 442
1
Self Care Formulary 1:45-2:00SOAP Notes 2:00-2:50
Poster & Presentation Teamwork 2:50-3:00
Prepared by Paul J. Oesterman, Pharm.D. Introductory Experience Coordinator
and Associate Professor of Pharmacy PracticeModified and Presented by Andrew M. Draper, Pharm.D., MSA
Assistant Professor of Pharmacy Practice
November 21, 2011
LEARNING OUTCOMES
November 21, 20112
Describe the components of a formulary.Prepare an OTC Formulary for use at IPPE site
visits. List the components of a SOAP note.Identify and recognize where different information
is placed in a SOAP note.Individually prepare a sample SOAP note for a
simple case.As a team prepare a SOAP note for a complex case.When presented with the first two parts of a SOAP
note, complete the latter two parts.
Self Care Formulary
November 21, 20113
Formulary= List of productsRationale= Develop confidence in making self care recommendations
Table with 2 or 3 products per condition
Plan on laminating and keeping in labcoat pocket—handy reference guide when patients ask questions
Self Care Formulary
November 21, 20114
Headings for each medical condition selectedBrand/Generic Names/Active Ingredient(s)Dose/Directions for use (Adult & Pediatric)
List age-specific limitationsList OTC dosage-specific limitations
Adverse EffectsAlso identify how medications can affect other
patient medical conditionsContraindications/Warnings
Include pregnancy risk factor, special info for diabetic or hypertensive patients
Approximate Cost of TreatmentFor brand and generic for qty or usual duration of Tx
Self Care Formulary
November 21, 20115
6 Required Classes/Conditions Select one specific condition from each class
Fever/Pain/HeadacheCough/Cold/AllergyAcid-Peptic DisordersConstipation/DiarrheaOphthalmic/Otic ProductsDermatologic ProductsAnti-infective Agents
2 Selective Product Classes/ConditionsDiabetic DevicesSleep DisordersYour choice
A second condition within one of the required Classes/Conditions
8 TOTAL CLASSES/CONDITIONS REQUIRED
Self Care Formulary
November 21, 20116
4 Required Patient Categories1. Otherwise Healthy Adult2. Patient with Diabetes or
Hypertension3. Pregnant Patient4. Otherwise Healthy Pediatric
patient 1. Be sure to note age-specific
limitations
Sample Self Care Table
7
Brand/Generic Names
Usual Dose Adverse effects
Contraindications/Warnings
Pregnancy/Diabetes/HypertensionConsiderations
Cost/7 days
TylenolAcetaminophen
325-650mg po qid prn A
≥2 yo: 10-15mg/kg po q4h prn (max 5x/day)
Liver toxicity
NMT 3-4 g/24 hrs; EtOH use
Pregnancy Risk B $4.00 B$2.00 G
AdvilIbuprofen
200mg po qid prn A≥6 mo: 5-10 mg/kg
po qid prn
GI upset NMT 1.2 g/24 hrs OTC
Concurrent Rx NSAID use, Ulcer
Pregnancy Risk C/DMay cause ↑ in BP
$4.00 B$1.00 G
Bayer ASAAspirin
325mg po tid prn A81mg po qd
GI upset NMT 4 g/24 hrsHx of ulcer , FUO in
Peds, EtOH use
Pregnancy Risk C/DMay alter blood sugar
$1.75 B$1.00 G
Tylenol-PMAcetaminophenWith Diphenhy-
dramine
500mg APAP &25mg Diphenhy-
dramine≥ 12 yo: 2 po hs
prn
DrowsinessLiver
toxicity
May cause drowsinessContraindicated in
Peds < 12
Pregnancy Risk B $8.00 B
OTC TABLE FOR THERAPEUTIC CATEGORYExample- Pain
SOAP NOTE- Background
November 21, 20118
Most of the work we do in clinical medicine is problem based.
POMR- Problem Oriented Medical RecordAbout 40 years ago a Dr. Lawrence Weed
developed a system of “Problem oriented medical record.” 1
The SOAP note is a fundamental element.SOAP notes provide improved communication
between multiple providers and for multiple visits.1. Weed LL. Medical records, medical education, and patient care: the Problem-Oriented Medical
Record as a basic tool. Cleveland (OH): Press of Case Western Reserve University; 1970.
SOAP NOTES
November 21, 20119
Date and timeS = Subjective (Evaluative) Summary of relevant info given by the patient or
caregiversSummary of CC, HPI, PMH, Med Hx, ALL, SH, FH, and ROS
O = Objective (Measurable) Summary of quantifiable relevant data
Vital signs, lab results Imaging and pathology reports
A = AssessmentAn evaluation & interpretation of the subjective and
objective data in general termsP = Plan
Recommendation including goal and counseling
What does the “A” stand for in SOAP?
November 21, 201110
1. Administration2. Approval3. Assessment4. Appropriate
SOAP NOTE LABS
November 21, 201111
Hgb
HCT
WBC PLT CLNa
K CO2
BUN
sCr
Glucose
Remember from last PHAR 442 lecture
CBC CHEM 7
SOAP NOTE- Subjective from Nov. 19
November 21, 201112
Jane Smith is a 27 year old healthy single pharmacy student complaining of left sided abdominal pain. She felt fine until about two days ago when she became nauseated and developed sharp abdominal pain in the RLQ. At that time she vomited. She used an over the counter “Emetrol” medication which provided her some relief but her nausea and vomiting persisted. She went to her PCP who admitted her to the hospital.
SH= No ETOH, occasional smoking
SOAP NOTE- Objective
November 21, 201113
General: Fatigued appearing young woman in apparent acute abdominal distress
Physical Exam: Rebound tenderness in the abdominal RLQEmesis basin containing bile colored material is present.
Head: No complaint of headacheNeck and Lungs: Clear, no bruits, no thyromegaly.
GI/GU: Normal appearing for age
SOAP NOTE – Objective from Nov. 19
November 21, 201114
Temperature 39oCBP 134/86, P 80, RR 18Weight 119, BMI 24Age 27yofCBC= H/H, RBC WNL; WBC 20,000 CHEM 7= all WNL
Your turnWhat is the “Assessment”?
Assessment can include more than one medical condition
Usually prioritized by urgency of problemWhat is the “Plan”?
Be sure to address all of the patient’s problemsAcuteChronic
November 21, 201115
SOAP NOTE- Assessment & Plan Nov. 19
November 21, 201116
AssessmentAcute Appendicitis
PlanTreat with IV Appendacillin 500mg four times
a day and IV Painaway 10mg q4 hrs prn. APAP 500mg po q6hrs prn fever > 38oC
Schedule for laparoscopic appendectomyCounsel regarding smoking cessation
SAMPLE POST-OP CHART SOAP NOTE
November 21, 201117
November 21, 2011 S: No Chest Pain or Abdominal pain. "Feeling
better today." Mild RLQ tenderness; Patient reports being hungry.
O: Afebrile, P 84, R 14, BP 125/82. No acute distress. Neck no JVD, Lungs bilateral clear ; Abd -Bowel sounds present. Wounds look clean. Ext without edema
A: Patient is a 27 year old female on post-operative day 2 for laparoscopic appendectomy, recently passed flatus.
P: Recovering well. Increase diet to solids. Continue to monitor labs. Prepare for discharge home tomorrow morning on po meds.
Which of the following is included under “Objective” information?
November 21, 201118
1. Blood pressure2. Social History3. Weight4. Two of the
above5. All of the above
Individual activityPrepare a SOAP note as directed in the
printed case.We will review the case as a class.
November 21, 201119
PHAR 442 Team Presentation Time
November 21, 201120
21
Disease state demographics & etiology
Signs & Symptoms
Acknowledgments
Initial Treatment Special Tips
Your name(s) hereUniversity of Southern Nevada, College of Pharmacy, Southern Nevada, UT - 84095
Literature cited
Figure 1. Photograph or drawing of disease, or whatever.
Figure 2. Graphical/pictorial representation
For further information
Abutting these last sections can save you a little space, and subtly indicates to viewers that the contents are not as important to read.
Abutting these last sections can save you a little space, and subtly indicates to viewers that the contents are not as important to read.
The first sentence of the first paragraph does not need to be indented.
The first sentence of the first paragraph does not need to be indented.
This is a header. If you make the font size large, and then add bolding, there is no need to also apply underlining or italicization or numbers. Adding multiple kinds of styles, needlessly, just marks you as a poster novice.
This is a header. If you make the font size large, and then add bolding, there is no need to also apply underlining or italicization or numbers. Adding multiple kinds of styles, needlessly, just marks you as a poster novice.
Format in “sentence case.” This means only the “t” in “title” gets capitalized.
Format in “sentence case.” This means only the “t” in “title” gets capitalized.
Make sure the edges of your columns are aligned with adjacent columns. Don’t trust your eyes: select the columns, then “Align” with the Align tool.
Make sure the edges of your columns are aligned with adjacent columns. Don’t trust your eyes: select the columns, then “Align” with the Align tool.
Maintain a good amount of space between your columns. Although you could squeeze them right up against each other, the poster’s aesthetics would suffer.
Maintain a good amount of space between your columns. Although you could squeeze them right up against each other, the poster’s aesthetics would suffer.
Title that hints at the underlying issue or question
Brand and generic names of common Rx products used for the condition
Mechanism of Action of the Product
Actual or Hypothesized
Drug Interactions
Contraindications
Adverse Drug Reactions
You are free to resize and move the boxes as you desire. Ensure that the layout of the poster is aesthetically appealing
You are free to resize and move the boxes as you desire. Ensure that the layout of the poster is aesthetically appealing
22 November 21, 2011
November 21, 201123
November 21, 201124
Team ActivityPrepare a SOAP note based on the printed
cases
November 21, 201125