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The document is a pharmaceutical care plan template used by the Kwame Nkrumah University of Science and Technology for documenting patient profiles, including personal, medical, and medication histories. It outlines sections for patient information, investigations, current medications, medical problems, and pharmaceutical care issues. Additionally, it includes a SOAPO format for developing care plans and emphasizes the pharmacist's role in patient management.

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darlington D. y ayim
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12 views10 pages

Soapo Format Original

The document is a pharmaceutical care plan template used by the Kwame Nkrumah University of Science and Technology for documenting patient profiles, including personal, medical, and medication histories. It outlines sections for patient information, investigations, current medications, medical problems, and pharmaceutical care issues. Additionally, it includes a SOAPO format for developing care plans and emphasizes the pharmacist's role in patient management.

Uploaded by

darlington D. y ayim
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Kwame Nkrumah University of Science and Technology

Faculty of Pharmacy and Pharmaceutical Sciences


Department of Clinical & Social Pharmacy
[Pharmaceutical Care Plan Documentation]

ADVANCED PATIENT PROFILE

Personal Information

Patient Initials: A.C Age: ^1 Gender

Date Ethnic Origin Height


Weight
BMI:
Ward

Presenting complaint: History of Presenting Complaint:

Social History: Family History:


Kwame Nkrumah University of Science and Technology
Faculty of Pharmacy and Pharmaceutical Sciences
Department of Clinical & Social Pharmacy
[Pharmaceutical Care Plan Documentation]

Past Medical History: Relevant Signs:

Risk Factors

Differential diagnosis (if any)


Kwame Nkrumah University of Science and Technology
Faculty of Pharmacy and Pharmaceutical Sciences
Department of Clinical & Social Pharmacy
[Pharmaceutical Care Plan Documentation]

Medication History [past 6 months)


Medication Comment
name and Dose/Frequency Start End Reason for use
strength date date
Kwame Nkrumah University of Science and Technology
Faculty of Pharmacy and Pharmaceutical Sciences
Department of Clinical & Social Pharmacy
[Pharmaceutical Care Plan Documentation]

Allergies - Please specify what patient is allergic to and the nature of


reaction to the allergen

Lifestyle Information- please ask questions which are relevant and appropriate to
the patient
(e.g., exercise, use of: tobacco, alcohol, recreational drugs). Quantify information where
possible (e.g., units of alcohol, frequency of exercise).

Does pt self-monitor at home?


Blood  Yes Peak  Yes Blood  Yes
Pressure  No Flow  No Glucose  No

Immunisation Information- Has patient had relevant vaccinations and/or does


patient require any additional vaccinations based on disease history?
Kwame Nkrumah University of Science and Technology
Faculty of Pharmacy and Pharmaceutical Sciences
Department of Clinical & Social Pharmacy
[Pharmaceutical Care Plan Documentation]

Additional Information

Who organises the patient’s medications at home?


 Patient
 Carer
 Other: ________________________________________________________________________

Suspected adherence concerns? Please describe.

INVESTIGATIONS
Biochemistry
Parameter Reference Dates
Range
Total cholesterol 3.90-5.20
mmol/L
Triglycerides 0.50-2.26
mmol/L
HDL-cholesterol 1.15-2.20
mmol/L
LDL-cholesterol 0.00-3.80
mmol/L
VLDL-cholesterol 0.20-1.00
mmol/L
Coronary risk 4.2-7.1
AST 0.0-32.0
U/L
ALT 0.0-33.0
U/L
ALP 35.0-129.0
U/L
GGT 6.0-42.0
U/L
Total protein 66.0-87.0
g/L
Kwame Nkrumah University of Science and Technology
Faculty of Pharmacy and Pharmaceutical Sciences
Department of Clinical & Social Pharmacy
[Pharmaceutical Care Plan Documentation]

Albumin 35.0-52.0
g/L
Globulin 25.0-35.0
g/L
Bilirubin-total 0.0-17.0
umol/L
Bilirubin-direct 0.0-3.4
umol/L
Bilirubin-indirect 1.5-14.0
umol/L
Urea 2.50-8.30
umol/L
Creatinine 44-80
umol/L
Bun to Creat. Ratio 8.0-35.0

Haematology
Parameter Reference Dates
Range
WBC 4.0-
10.00×103/uL
RBC 2.50-
5.50×106/uL
HGB 11.5-16.0g/dL
HCT 26.0-50.0%
MCV 86.0-110.0fL
MCH 26.0-38.0pg
MCHC 31.0-37.0g/dL
PLT 150.0-
400×103/uL
RDW-SD 37.0-54.0fL
RDW-CV 11.0-16.0%
PDW 9.0-17.0fL
MPV 9.0-13.0fL
P-LCR 13.0-43.0%
PCT 0.17-0.35%
NEUT 1.5-7.0×103/uL
LYMPH 1.0-3.7×103/uL
MONO 0.0-0.7×103/uL
EO 0.0-0.4×103/uL
BASO 0.0-0.1×103/uL
Kwame Nkrumah University of Science and Technology
Faculty of Pharmacy and Pharmaceutical Sciences
Department of Clinical & Social Pharmacy
[Pharmaceutical Care Plan Documentation]

RET 0.0-0.99×106/
uL

Electrolyte
Parameter Reference Dates
Range
Sodium 135-145
mmol/L
Potassium 3.5-5.1
mmol/L
Chloride 97-110mmol/L

Microbiology (Urinalysis)
Parameter Reference Dates
Range
Appearance
Colour
Sp. Gravity
pH
Sugar
Protein
RBC
WBC
Other cells
Clot
Cast

NOTES /others
Kwame Nkrumah University of Science and Technology
Faculty of Pharmacy and Pharmaceutical Sciences
Department of Clinical & Social Pharmacy
[Pharmaceutical Care Plan Documentation]

Current Medications (on ward)


Medication Comment
name and Dose/ Start End Reason for use /
strength Frequency Date Date change
Kwame Nkrumah University of Science and Technology
Faculty of Pharmacy and Pharmaceutical Sciences
Department of Clinical & Social Pharmacy
[Pharmaceutical Care Plan Documentation]

Medical Problems/ Diagnosis


1.

2.

3.

4.

5.

6.

Pharmaceutical care issues/ Problems


(What are the issues of concern to the pharmacist, list according to importance)
1. 4.

2. 5.
Kwame Nkrumah University of Science and Technology
Faculty of Pharmacy and Pharmaceutical Sciences
Department of Clinical & Social Pharmacy
[Pharmaceutical Care Plan Documentation]

3. 6.

PHARMACEUTICAL CARE PLANS (SOAPO)


YOU MUST NOT USE MORE THAN 3 PAGES (ONE-SIDE OF A4) PER SOAPO (12-pt
Times New Roman )

Pharmaceutical Care Issue/Problem 1


Subjective & Objective Data

Assessment
Plan

Outcome

Pharmaceutical Care Issue/Problem 2


Subjective & Objective Data

Assessment
Plan

Outcome

Explain the pharmacist’s role in managing this patient

References

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