**2. STARZ-DRP**

### **2.1 Essential behavior**

Nurses who provide PHCS must act or conduct themselves appropriately in response to a particular situation or practice. Such attitudes ensure they have a desire to perform the exact duties or services. Firstly, they must be ready to engage in providing PHCS. PHCS is constantly carried out at the place where the patient lives permanently. For such scenario, they must also possess the skills to communicate effectively or be involved directly with a member of their patient's family [12]. Otherwise, the family members might not have the chance to be actively interested in and concerned for the success of PHCS. Furthermore, the patient needs for assistance especially financial support as necessities for PHCS.

#### *STARZ-DRP: An Advance Nursing Approach for Palliative Home Care Services DOI: http://dx.doi.org/10.5772/intechopen.103809*

In addition to that, they must have considerable skills to communicate with the necessary confidentiality with other healthcare providers [13]. They should share or exchange information, news, or ideas using the principal method of communication which consists of comprehensive words in a structured and conventional mode and conveyed by speech, writing, or gesture [13]. Such communication skills should include or deal with all or nearly all elements or aspects of PHCS. The elements shall ensure the successful conveying or sharing of ideas and feelings by speaking, writing, or using some other mediums. Foremost, it shall make PHCS recognized, familiar, or within the scope of knowledge of patients and other healthcare providers.

They should have the ability to understand and share the feelings of another, particularly with the patients or their family members. Nonetheless, the feelings should be emphasized in the context of empathy. Such course of action shall ensure their feelings are not being bonded with their patients or family members. Moudatsou et al. notified that healthcare providers with high levels of empathy are having the chance to elicit better therapeutic outcomes [14]. The empathetic relationship between nurse and patient shall reinforce the need to complete the drug therapy plan as a way to achieve a desired outcome in the absence of medical or medication errors [15]. As a consequence, it shall enhance the quality of PHCS.

### **2.2 STARZ-DRP: a tool to provide a PHCS**

STARZ-DRP is a simple mnemonic which established to assist the healthcare providers to make an accurate triage-decision as well as identify, prevent, and resolve the actual or potential drug-related problem. STARZ-DRP was developed by a group of clinical researchers from Universiti Sains Malaysia, Malaysia to meet a specified degree which proposed by the philosophy of Pharmaceutical Care (PC) [9]. The philosophy of PC acquires the healthcare providers to response to the patients' drug-related needs [16]. In addition to that, PC maneuvers them to identify, prevent, and resolve the actual or potential drug-related problems (DRPs) [16]. Such course of action is critical to put in the picture because DRPs shall have the chance to cause someone to be vulnerable or at risk of death or decrease his or her health quality of life. Whereas, an act of reacting quickly or positively to drug-related needs of an individual shall persuade the patient to meet the aims of PHCS as well as enhance compliance behavior towards therapy plan.

STARZ-DRP had involved in the previous study to determine its feasibilities to perform an accurate and quick triaging action as well as exercise a particular ability to proficiency identify, prevent, and resolve DRPs repeatedly or regularly [10]. Foremost, each component in STARZ-DRP was evaluated and estimated by a group of physicians and pharmacists to ascertain its nature, ability, and quality of making a triage-decision and identify the actual or potential DRPs [17]. Therefore, STARZ-DRP is having a chance to maneuver the healthcare provider to be an expert with adequate skill and knowledge in a particular field.

STARZ-DRP (**Table 1**) consists of the five most significantly original and influential alphabetic characters (S-T-A-R-Z). The first letter, **S**, represents the patient's presenting symptoms. The second letter, **T**, denotes the time of onset and duration of the presenting symptoms. The third letter, **A**, stands for the associated or related symptoms. The fourth letter, **R**, stands for recurrence or repeated symptoms. 'S-T-A-R' shall maneuver the nurses to evaluate or estimate the nature of patients' complaints about medical or medication issues. 'S-T-A-R' consists of specific questions, particularly in an official context as reflected in **Table 1**. Lastly, 'Z' means zoom into the patient's medical and


*a This is not a diagnostic tool, rather it is a format with the purpose of organizing a nurse's knowledge in a manner that allows him/her to begin identifying the actual and potential DRPs and subsequently referring triage patients to the appropriate healthcare professionals.*

*b The patient's vital signs will be measured when necessary. At times, the patient's blood pressure, pulse rate, and body temperature are measured to aid the nurses in assessing the appropriateness of symptoms for self-medication.*

#### **Table 1.**

*Definition of alphabetical characters in STARZa, <sup>b</sup> .*

medication experience. Carefully guides the nurses to assess and evaluate medical and medication histories. 'Z' encourages them to devote their theoretical and practical understanding of clinical knowledge and experience to determine if the medical condition needs either medication or medical attention (**Table 1**). Therefore, the entire modus operandi of STARZ-DRP must be accomplished successfully as a way to ensure they do not fail to notice, hear, understand and keep in writing essential or critical information. Otherwise, PHCS shall be the absence of degree of excellence, abilities, qualities, or achievements.

Role to determine DRPs is a vigorous action in PHCS [18]. Such activity shall ensure the safety of patients when they start to consume medications [18]. STARZ-DRP is able to maneuver the nurses to identify a wide range of DRPs as notified in **Table 2**. Nonetheless, they should have adequate knowledge of pharmacological of basic therapeutic as a way to enhance their skill to perform the activities. For that reason, they should attend an accredited training involving those experts who are very knowledgeable about or skillful in identifying, preventing, and resolving DRPs. Furthermore, the trainers shall be a source of information if they want to ascertain something.

Interestingly, STARZ-DRP is able to be used or obtained in a documentation form (see **Figure 1** – Pharmacy Self-care Advice Form) [19]. The form eases them to evaluate the nature of the patient's complaint, a physical or mental feature, medical condition, and medication histories [19]. Such documentation activities shall provide information or

*STARZ-DRP: An Advance Nursing Approach for Palliative Home Care Services DOI: http://dx.doi.org/10.5772/intechopen.103809*


**Table 2.**

*List of DRPs.*

evidence that serves as a permanent record for later reference. Furthermore, the course of action ensures the nurses might not fail to include critical information for further detailed examination. Foremost, the documentation form makes sure the nurse and patient have in or be able to bring to one's mind an awareness of something from the past.

Nurses shall have the chance to put in the picture their conclusion or resolution reached after considering the latter information in a documentation form as reflected in **Figure 1**. They shall write down their triaging decision if the patient needs a specific medication, referral for urgent medical attention, or further health screening test or examination. In addition to that, they shall draw special attention to DRPs by pointing out them in the form (**Figure 2**). Such documentation shall help them to evaluate and monitor the effectiveness of their essential actions.

Referral activities can be performed using a form that is reflected in **Figure 3**. The form shall have the chance to ease them to share or exchange critical information with other healthcare providers, particularly physicians and pharmacists. They can highlight the reason of referral as well as a category of DRPs to make physicians or pharmacists aware of a fact or circumstance. Subsequently, the other healthcare providers are able to take immediate action and behave in a specified way to resolve the medical problem. Such act of referral might have the chance to enhance the good quality and excellent of PHCS.

STARZ-DRP is having the chance to maneuver them to provide an excellent service in PHCS. A step-by-step approach notified in the modus operandi shall help them to make an accurate and quick triaging-decision as well as identify, prevent, and resolve DRPs. Foremost, the official documentation shall have the chance to establish a collaboration working relationship with other physician or pharmacist as a way to improve their patient's health quality of life.

### **2.3 Vital signs and symptoms**

Nurses must be ready to methodically and systematically assess the essential information to evaluate and determine their patient's chief complaint. For that


#### **Figure 1.**

*Pharmacy self-care advice form.*

reason, they must establish or indicate who or what are the critical signs and symptoms that acquire for immediate medical attention or examination. **Table 3** reflects the signs and symptoms that need intervention by the physicians [20].

Among signs and symptoms that are serious to handle themselves are abnormal readings of systolic and diastolic, heart rate, and body temperature (forehead,
