Table 2 List of activities that clinical pharmacists will conduct in PharmaCAP intervention group
Activities that clinical pharmacists will carry out | Comment |
|---|---|
Medication review | • Assessing the appropriateness of each of the regular medications used for cancer pain management based on symptoms, laboratory findings, medication lists, consultation, and discharge notes, procedures • Test impetrations and therapeutic recommendations • Medication reconciliation and identification for appropriate monitoring |
Patient education and counselling | • Educate patients on drug therapy-related problems identified before the visit, reinforce clinical oncologists/radiation oncologists/physician's instructions • Providing instruction about why and how to take opioids, common adverse drug reactions due to opioids and how to deal with them • Education regarding drugs used in pain management and management of adverse drug reactions due to cancer pain management medications • Addressing concerns and general counselling on the condition of cancer patients • Providing further insight into an overall plan with patients and caretakers |
Recommendation | • Clinical pharmacist will give verbal recommendations for dose modification, drug modification, etc., to the medical oncologist. When medical oncologists are unavailable at the site, then written recommendations will be given to the medical oncologist |
Pain assessment | • Assessment of cancer patient’s pain by the clinical pharmacist |
Drug information | • Evidence-based answers to queries from multidisciplinary teams relating to medications • Liaising with cancer patients and their caregivers concerning medication alerts and related queries |
Adverse drug reaction | • Monitoring adverse drug reactions and informing the medical oncologist • Detection of adverse drug reactions |
Medication adherence | • Education to improve medication adherence among cancer patients • Encourage medication adherence using written patient educational leaflets • While the discharge of cancer patients providing pharmaceutical care services to reduce the medication discrepancies before and after discharge, and improve patient medication adherence and knowledge related to pain, pain medication and their adverse drug reaction |
Ward round | • Participation in inpatient ward round alone or with MDT |