ProfJameson.com

Ferris State University | College of Pharmacy | Professor of Pharmacy Practice


How to SOAP a Patient

Process

  • Gather data from progress notes, labs etc.
  • SOAP each medical problem separately. &nbs;&nbs;&nbs;&nbs;&nbs;(For example: Blood pressure is not a relevant objective parameter for Osteoarthritis)
  • Read about the problems in a medical or therapeutics textbook
  • Return to the chart for subjective and objective parameters that you realize you missed, now that you have read about the disease/problem.
  • Finish SOAP



SSubjective   This is information that was obtained from the patient that cannot be observed or measured. (Examples: felt feverish, nauseated,claims to have lost weight)

SObjective   This is information that can be observed or measured (Examples: Temp: 102 degrees, Patient vomited while in ER, Weight is 150 Kg and was 180 Kg on last admission). The current drugs for this patient are listed here under objective..

SAssessment   This is YOUR assessment of the current therapy. Is it the right drug, right dose etc. Is this problem being caused by a drug? How well is the current treatment plan working?

SPlan   This YOUR plan. This is what you think should be done now. It could be “continue current treatment”, or it could be “change from drug X to drug Y”, Etc… The Plan should include drugs, doses, routes for each problem, and should include what exactly you would monitor for efficacy AND for adverse effects.

      Note: A plan without monitoring for efficacy and toxicity is NOT a plan.