DSM Examination Standards and Objectives:

Diabetes

Patient Data Collection

  1. Conduct patient interviews pertinent to specific disease states.
    1. Assessment of patient knowledge of disease state
      1. Difference between Type 1 and Type 2
      2. Acute complications
      3. Chronic complications
      4. Awareness of tight glycemic control (DCCT)
      5. Sick day guidelines
      6. Travel
      7. Use of meters, strips, self care devices
      8. Interpretations of self care monitoring
      9. Foot care
      10. Eye care
      11. Diet
      12. Exercise
      13. Understanding of management plan
      14. Use and storage of medications
    2. Social history
      1. Tobacco, alcohol, other drug use
      2. Level of education
      3. Barriers
        1. Visual, dexterity, hearing
        2. Transportation
      4. Religious/cultural customs
    3. Family History
    4. Symptomatology
      1. Acute
        1. Hypoglycemic
        2. Hyperglycemic
      2. Chronic
      3. Recurrent infections
    5. Demographics
      1. Occupation
      2. Economic
      3. General
  2. Compile medical history information.
    1. Nutritional
    2. Previous/present therapy plans including concomitant needs
    3. Exercise therapy
    4. Complications
      1. Acute
      2. Chronic E. Concurrent disease states F. Risk factors - CHD
  3. Obtain accurate and relevant physical assessment and laboratory information.
    1. Height
    2. Weight
    3. Blood pressure
    4. Pulses (peripheral)
    5. Foot inspection
    6. Monofilament
    7. C-peptide
    8. Urine glucose
    9. Urine Keytones
    10. Glyco-hemo
    11. Fasting plasma
    12. SMBG results
    13. Lipids
    14. Microalbuminuria
    15. BUN
    16. Serum creatinine
    17. Monitor parameters specific to pharmacotherapy
    18. Injection site exam
  4. Collaborate with patient’s health care providers to secure pertinent information
    1. Additional labs
    2. Eye exam
    3. EKG
    4. Health care provider goals
    5. Clearance for exercise program
  5. Assess adherence to care (prescribed vs. reality).

Patient Assessment

  1. Review and interpret data.
    1. Subjective
    2. Objective
  2. Evaluate current therapy.
    1. Pharmacologic - Insulin, oral agents, therapy for diabetic complications, medications that alter glycemic control, all other medications, and alternative medications
      1. Indication
      2. Effectiveness
      3. Safety
      4. Convenience
    2. Non-pharmacologic - Diet, exercise (Type 1 vs. Type 2), stress management, smoking cessation
    3. Self-care - Self-monitoring devices, insulin administration devises, technique, pattern management, and acute care
  3. Develop a problem list.

Patient Care Plan

  1. Develop a pharmacist patient care plan.
    1. Goals
      1. Metabolic goals (consistent with standards of care and specific patient considerations)
      2. Patient education goals
      3. Dietary goals
      4. Exercise goals
    2. Recommend or implement pharmacologic, non-pharmacologic and/or self-care plans.
      1. Pharmacologic
      2. Non-pharmacologic
      3. Self-care
    3. Education
    4. Follow-up schedule
      1. Appropriate intervals to patient specific goals and standards of care

Patient Care Evaluation

  1. Assess established parameters at appropriate intervals.
  2. Assess the safety and effectiveness of the patient’s therapy.
  3. Assess patient compliance, noncompliance, and/or medication misuse or abuse.
  4. Assess adverse reactions, interactions, and/or contraindications.
  5. Assess alternative therapies and interventions in situations where the desired outcome is not being achieved.

Documentation

  1. Record and maintain data essential to continuity of care and consistent with applicable laws, regulations, and standards of practice.
  2. Transfer information consistent with federal and state laws.

 


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