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


tympanic, or rectal). In addition to that, too many associated symptoms, frequent emergence undesired symptoms, or too long-suffering of unresolved symptoms notified among the patients might reflect the actual or potential unexpected, undesired, untreated, or unresolved medical conditions. Foremost, it might suggest as potentially harmful or threatening to the patients' life. For such course of action, they should urgently contact or inform the physician or pharmacist as a way to resolve the condition.

Undesired or unresolved signs and symptoms should be and must be evaluated or estimated its natures if they need for a medication or a medication is the main cause.



Such a particular condition requires the nurses to collaborate with the physician and pharmacist to determine an appropriate therapy plan. Their expert skill or knowledge in a particular field might have the chance to resolve the undesired medical condition.


#### **Table 3.**

*Signs and symptoms that need urgent medical attention.*

For example, the pharmacist might perform a therapeutic drug monitoring test as a potential approach to establish exactly an appropriate dose of a particular medication for an individual patient. The course of action shall ensure the patient is the absence of undesired adverse drug reactions. Foremost, an accurate dose of a medication shall provide an assurance that the patient might gain the benefits of such therapy.

### **2.4 Drug-related problems**

Nurses must identify, prevent, and resolve the actual or potential DRPs among the patients who consume medications. Such a role shall have a chance to magnify the values of PHCS as well as have an effect on the character, development, or behavior of patients towards the service. For example, undesired side-effects or adverse drug reactions shall cause the patients to refuse to consume a specific medication. In addition to that, failure to resolve the medical condition might give rise to an idea that the patient might potentially dispose to agree with the medication's dosage regimen or its route of administration. For that reason, the nurses should have adequate training to ensure each medication is indicated, safe, and effective [21]. Foremost, they must ensure the patients are complying with the medication's dosage regimen [21].

*Indicated:* nurses must be ready to determine if the patients require an additional prescription or non-prescription medication to alleviate or resolve the illnesses or undesired and unexpected medical conditions. They must inform and advise the physician about the justification for the need of such medication. Such course of action shall make sure the medication is having the chance to eliminate disease or relieve them of undesired signs and symptoms.

*Effectiveness:* each medication must be effective to alleviate or resolve the unwanted medical condition. For that reason, they must collaborate with the physician to carefully choose medication as being the best or most suitable. Afterward, they should monitor and inform the physician about the effectiveness of the medication to resolve the medical problem. For example, they can appraise the physicians of the potential dose is too low for their patients. In addition to that, they should determine if there

are other factors that interfere with medication intake to decrease its effectiveness. For example, the consumption of alcohol [22], caffeine [23], and smoking [24] are having the chance to interrupt the effectiveness of some medications. In other words, they can look at closely or with interest their patients on behalf of physicians about desired or undesired outcomes before or after consuming a specific medication.

*Safety*: all medications must not cause unwanted effects to the patients such as undesired side-effects or adverse drug reactions (ADRs). Undesired side-effects might have the potential to set or serve as a limit to the patients' daily activities. For example, the patient might feel too sleepy and hard to be awake the whole day after consuming a tablet of *Chlorpheniramine*. Whereas, ADRs might cause life-threatening if not immediately being treated. For example, there is a tendency for a gouty-patient to experience extremely ADRs such as *Stephen-Johnson Syndrome* after consuming a tablet of *Allopurinol*. For that reason, they must ensure each medication is the absence of potential allergic to the patient, ADRs, potential drug-disease or drug–drug interaction, as well as too high dose.

*Compliance:* the accomplishment of an aim or purpose of the therapy plan determined by the compliance behavior among the patients. Failure to comply with the dosage regimen might have a chance to make the medical condition become worse or even not being well treated. For that reason, they must identify the actual or potential factors which have an effect on the incompliance behavior. For example, the problem that arises from the financial impact of therapy or interference by cultural or religious beliefs might be the factors. Those factors can be eliminated if the patients are well educated about the critical needs of such a therapy plan. Therefore, the nurses must have adequate training as good educator.

#### **2.5 Clinical parameters to monitor**

They must also be aware of the facts, information, and skills acquired through experience or education the theoretical or practical understanding of laboratorybased health screening tests [25]. Such a test shall provide comprehensive information in revealing the degree to which the medical problems are in good health. In addition, it shall reflect the effectiveness of certain medications to alleviate or resolve a specific medical condition. For example, the hematology profile might have the chance to reflect the conditions of red blood cells and hemoglobin and their characters. Lack of both substances shall have an effect on the oxygen level in the bloodstreams. Whereas, the renal profile might give consideration to the selection of medications that have less undesired effects on the kidneys. The liver profile shall give a rise to awareness of medications that are potentially harmful to the liver. Lipid profile shall maneuver the practitioner to determine the effectiveness of statin drugs to lower the cholesterol readings. In short, the entire information obtained in the test shall have a chance to assist them towards an excellence way of performing PHCS in the healthcare system.

They should also work jointly with physicians on an activity to determine the effectiveness of the therapy plan through results such as *X-Ray* [26], *Magnetic Resonance Image* [27], or else. Such advanced medical technologies are helpful to give an exact topography of internal organs which reflect actual or potential abnormalities. Any findings obtained from the test shall maneuver them to be more focused on providing a specific therapy plan. In addition, it shall ensure the end result obtained from the test shall be the center of interest or activity.

Foremost, they should determine PHCS is able to enhance the health quality of life of their patients. They can utilize EQ-5D questionnaire as a tool to assess the clinical

parameter [28]. The tool consists of two parts: (1). descriptive assessment which comprises of five domains—mobility, self-care, usual activities, pain or discomfort, and anxiety or depression, (2). visual analog scale to indicate the general health status with 100 indicating the best health status. Such a tool is easier to use and it is helpful while providing PHCS.

#### **2.6 Barriers**

A role to identify, prevent, and resolve DRPs is not well-known in nursing practice. Nonetheless, they should take the responsibility to perform such a role because it has had a chance to keep undesired ADRs from happening. ADRs are potentially life-threatening. For that reason, they must take the role of a medication protector in the absence of physicians and pharmacists. They are ready to take, hold, or deploy the skills to determine DRPs even though the basic training might consume cash and time respectively.

STARZ-DRP which has a chance to maneuver them to identify, prevent, and resolve DRPs was patented under the Copyright Act 1987 by Universiti Sains Malaysia with a reference number is CRLY00004047. It was ethically approved to perform towards patients in the previous studies by Universiti Sains Malaysia—Lam Wah Ee Hospital Joint Committee for Clinical Study Ethics (reference number is USM-HLWE/IEC/2008(0026) and Human Research Ethics Committee Universiti Sains Malaysia Centre for Research Initiatives, Clinical and Health Sciences, Universiti Sains Malaysia Health Campus (reference number is USM/JEPeM/15040145). For that reason, it is essential to officially inform the author if they would like to utilize STARZ-DRP as their modus operandi.

#### **2.7 Perception to STARZ-DRP**

STARZ-DRP is having constructive, optimism, or confidence among other healthcare providers such as physicians and pharmacists. Their responses had been published in other scientific journals [29]. For that reason, the approach might have the chance to establish an excellent working collaboration relationship with other healthcare providers. In addition, the experts in the healthcare system had notified STARZ-DRP as a potential approach to make an accurate and quick triaging decision as well as identify, prevent, and resolve the actual or potential DRPs. Foremost, the stakeholders noticed the potential of the approach to assess and counsel patients respectively [29].
