This Action Items Template provides pharmacists and pharmacy technicians with a structured way to document crucial follow-up tasks arising from patient consultations, MTM sessions, and medication reviews. It helps ensure no critical steps are missed, improving patient care and compliance. Use this template to create clear, actionable plans for your patients and track completion efficiently.
Patient & Session Details
Jane Doe, MRN: 12345
Enter the patient's full name or unique identifier.MTM Session, Counseling - New Rx, Medication Review
Specify the type of interaction with the patient.YYYY-MM-DD
Record the date the patient interaction took place.R. Ph. John Smith
Identify the pharmacy professional conducting the session.Key Discussion Points
Patient experiencing dizziness on new antihypertensive; Adherence check for diabetes meds.
Summarize the main issue or purpose of the patient's visit.Warfarin + Bactrim (increased INR risk); Metformin + Contrast Dye (AKI risk)
List any significant drug-drug or drug-disease interactions discussed.Concerned about insulin injection pain; Asked about OTC cold remedies while on blood thinners.
Document specific questions or worries raised by the patient.Action Items for Pharmacist
Contact prescribing physician regarding potential Warfarin-Bactrim interaction; Research alternative antihypertensive.
Describe the specific task the pharmacist needs to complete.YYYY-MM-DD
Set a target completion date for the action item.High, Medium, Low
Assign a priority level to help organize tasks.Pending, In Progress, Completed, Deferred
Update the current state of the action item.Action Items for Patient
Monitor blood pressure daily and record readings; Schedule follow-up with PCP in 2 weeks; Take medication with food.
Outline specific tasks the patient needs to perform.Explained signs of hypoglycemia; Demonstrated proper inhaler technique; Reviewed importance of adherence.
Note the key educational points delivered to the patient.Yes / No (Patient verbalized understanding of insulin administration)
Indicate if the patient demonstrated comprehension of instructions.Follow-Up Plan
Call patient in 3 days to check on new medication; Schedule MTM follow-up in 1 month.
Detail the planned subsequent interactions or checks.YYYY-MM-DD @ HH:MM
Specify when the next interaction is scheduled.Patient reported improved symptoms; Physician adjusted dosage as recommended.
Document the results or resolution of the follow-up.How to Use This Template
- Open the 'Action Items Template' in CraftNote when starting a new patient consultation or medication review.
- Fill in the 'Patient & Session Details' section with accurate demographic and session information.
- Document key discussion points, including identified drug interactions and patient concerns, in the 'Key Discussion Points' section.
- Create detailed 'Action Items for Pharmacist' and 'Action Items for Patient', assigning due dates and priorities as needed.
- Regularly review and update the 'Status' of action items and record 'Follow-Up Plan' details to ensure comprehensive patient care.
Customization Tips
- Add a 'Billing Code' field to specific sections for MTM or clinical services to streamline billing processes.
- Create a dropdown for 'Drug Class' within the 'Key Discussion Points' to quickly categorize medications involved in interactions.
- Integrate a 'Referral Made To' field in the 'Follow-Up Plan' for easier tracking of specialist or external healthcare provider referrals.