Documentation: a value proposition for pharmacy education and the pharmacy profession.
We are what we repeatedly do. Excellence, then, is not an act, but a habit (or behavior). Aristotle Arguably one of the greatest challenges for pharmacy education today is the ability to identify, train, and retain quality/exemplary experiential education preceptors/sites of a diverse nature that meet the ACPE Standards 2007 for both introductory and advanced pharmacy practice experiences (IPPEs/APPEs) in a doctor of pharmacy curriculum. By a similar token, one of the challenges expressed in many contemporary pharmacy practice environments is demonstrating the ‘‘value’’ that pharmacists provide beyond pharmaceutical product procurement, preparation, distribution, and fulfillment responsibilities to patients. Presently there is no universal approach to document the overall use of medications (including vitamins/ supplements/ over-the-counter products), their intended therapeutic uses, the desired goals of therapy, the outcomes achieved (either positive or negative), and the follow up intended by either the prescriber or in some cases the dispensing pharmacist. Yet other healthcare providers routinely use documentation processes (ie, care plans) as it relates to their scope of professional practice. The medication use process has been described in several distinct stages: (1) ordering, (2) transcription and verification, (3) dispensing, and (4) medication administration or consumption. While pharmacy is typically involved in 2 of these stages, one critical element often neglected in describing the medication use process is the assessment of the patient’s response to therapy. Central to this argument is: who assesses the response to therapy, to whom is the response communicated, and how is the response documented and communicated? It is this feedback loop of the routine monitoring of patient response to therapy that is a critical missing element in assuring safe and optimal outcomes to medication therapies in all sectors of healthcare. Cleary various healthcare providers, including pharmacists should be involved in the assessment (at the point-of-care) and communication of outcomes related to medication therapies. Technological advancements such as electronic medical/health records (EMR/EHR), computerized physician/prescriber order entry (CPOE), bar code technology, radio frequency identification (RFID), and decision-support software will have a profound impact on all the stages of the medication use process in the next decade. Use of electronic patient profiles that include documentation of pharmacy generated patient-specific data (ie, history of medication usage—prescription, over-thecounter, and vitamins/supplements, history of refills, assessment of compliance) along with pharmacist intervention data (ie, recommendations for referrals, lab assessments, product discontinuations/changes) coupled with EMR/EHR technology can allow for overall improved communication, enhanced clinical decision-making, potential reduction of preventable adverse events, and the ability to follow up on outcomes associated with patient-specific care plans. The pharmacy profession must demonstrate to various stakeholders that pharmacists provide a vital component to the medication use process, ensuring safe medication use and documenting the associated outcomes of therapy on a consistent basis. Grainger-Rousseau and colleagues have proposed 8 essential elements that must be in place for medication therapy to be both safe and effective within a medication use system, of which the seventh element refers specifically to documentation and communication. When one or more of these 8 essential elements are missing in the care of a patient, the risk of experiencing a medicationrelated problem is increased. It is well understood that documentation is the accepted method by which health care providers communicate with one another with respect to patient care decision making and clinical outcomes. Documentation is also the primary method to demonstrate value within the health care system. Thus, if pharmacists in all practice settings are not communicating data/information routinely with other providers, they may not be considered an essential and integral part of the healthcare team. Beyond pharmaceutical product fulfillment responsibilities (and monitoring of therapeutic response), pharmacists are in an opportune position to refer patients back into the healthcare system for attention they may be in need of, as well as identifying laboratory data that American Journal of Pharmaceutical Education 2007; 71 (4) Article 73.