Sample Completed Care Plan Page 2
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2Medical
Desired Outcomes / Goals
Drug Therapy Problems
Therapeutic Alternatives
Recommendation
Monitoring Parameters
Condition /
of Therapy
(Pharmacologic and Non-
with Justification
Indication
pharmacologic)
Parameter Value
Parameter
Frequency
Timeframe
Who
Non-pharmacologic
Insomnia
Resolve morning
KL is experiencing morning
Non-pharmacologic
options will be chosen
Efficacy
drowsiness within one week
time drowsiness and is
- Reduce day time naps
given this patient is
-‐
A void
( or
m inimize)
Ensure patient is able to
unable to sleep at night, a
elderly and at risk of
Number of hours of sleep each night
sleep at least 8 hours per
possible indication for drug
serious side effective
by the patient
caffeine
l ater
l unch
night
therapy
from use of sedative
Morning fatigue by the patient
-‐
E nsure
a
q uiet
Decrease day time naps to
agents
environment
t o
s leep
no more than 1 hour per
In addition, the patient
Patient to monitor each day and
-‐
I ncrease
d aytime
e xercise
day
has a number of
pharmacist to follow up in 1 week
Prevent complications such
reversible lifestyle
then at each visit
-‐
R elaxation
t echniques
as falls, worsening
causes of insomnia
confusion or delirium
and sleep
Pharmacologic
Improve quality of life
disturbances that are
Safety
-‐
Benzodiazepine
Minimize events to
likely contributors
treatment
receptor
a gonists
None as non-pharmacologic therapy
chosen
-‐
Benzodiazepines
-‐
Antihistamines
Clinical
C are
P lan
T emplate
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A Y
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