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Clinical pharmacy
The document discusses the role and evolution of clinical pharmacy, highlighting its focus on patient-centered care and rational medication use. It contrasts clinical pharmacy with traditional pharmacy, emphasizing the importance of patient monitoring and therapy management. Key functions of clinical pharmacists are outlined, including patient education, drug policy management, and the prevention of medication-related problems.
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Clinical pharmacy
- 1. Clinical Pharmacy Prepared By ShivaneeVyas M Pharmacy Lakshmi Narain College of Pharmacy, Indore (MP)
- 2. Perceptions of Pharmacists Howdo others see us?
- 3. âThey just counta few tabletsâ
- 4. âThey just weighand measure thingsâ
- 5. âA bunch ofshop-keepersâ
- 6. âTell me howand when to use the Medicineâ
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- 8. âNot really healthcare practitioners â theyâre businessmenâ
- 9. âDo you needa degree to be a pharmacist?â
- 10. Introduction; Clinical Pharmacy Clinicalpharmacy may be defined as the science and practice of rationale use of medications, where the pharmacists are more oriented towards the patient care rationalizing medication therapy promoting health , wellness of people. It is the modern and extended field of pharmacy. â The discipline that embodies the application and development (by pharmacist) of scientific principles of pharmacology, toxicology, therapeutics, and clinical pharmacokinetics, pharmacoeconomics, pharmacogenomics and other allied sciences for the care of patientsâ. (Reference: American college of clinical pharmacy)
- 11. History Until the mid1960âs ; Traditional role. The development of clinical pharmacy started in USA. More clinically oriented curriculum were designed with the award of PharmD degree. These developments influenced the practice of pharmacy in U.K., Initially prescription and drug administration records were introduced followed by an increasing pharmacy practice in hospital wards. Master degree programs in clinical pharmacy were introduced for first time in 1976. The progress of clinical pharmacy development remained at low profile in the first decade after its birth in U.K. However, Nuffield report in1986 geared up the momentum for progression of clinical pharmacy. Until today, the clinical pharmacy practice in Nepal is in embryonic stage.
- 12. How does clinicalpharmacy differ from pharmacy?How does clinical pharmacy differ from pharmacy? The discipline of pharmacy embraces the knowledge on synthesis, chemistry and preparation of drugs Clinical pharmacy is more oriented to the analysis of population needs with regards to medicines, ways of administration, patterns of use ,drugs effects on the Patients, âthe overall drug therapy managementâ. The focus of attention moves from the drug to the single patient or population receiving drugs.
- 13. Clinical Pharmacy Requirements Knowledgeof nondrug therapy Therapeutic planning skills Drug Information Skills Physical assessment skills Patient monitoring skills Communication skills Knowledge of laboratory and diagnostic skills Knowledge of the disease Knowledge of drug therapy Patient care
- 14. Level of Actionof Clinical Pharmacists Clinical pharmacy activities may influence the correct use of medicines at three different levels: Before the prescriptionBefore the prescription During the prescriptionDuring the prescription and After the prescription is written.After the prescription is written.
- 15. 1. Before theprescription ⢠Clinical trials ⢠Formularies ⢠Drug information Drug-related policies
- 16. 2. During theprescription ⢠Counselling activity ⢠Clinical pharmacists can influence the attitudes and priorities of prescribers in their choice of correct treatments. ⢠The clinical pharmacist monitors, detects and prevents the medication related problems ⢠The clinical pharmacist pays special attention to the dosage of drugs which need therapeutic monitoring. ⢠Community pharmacists can also make prescription decisions directly, when over the counter drugs are counselled.
- 17. Medication-related Problems ⢠Untreatedindications. ⢠Improper drug selection. ⢠Sub therapeutic dosage. ⢠Medication Failure to receive ⢠Medication Over dosage. ⢠Adverse drug reactions. ⢠Drug interactions. ⢠Medication use without indication.
- 18. 3. After theprescription ⢠Counselling ⢠Preparation of personalised formulation ⢠Drug use evaluation ⢠Outcome research ⢠Pharmacoeconomic studies
- 19. Functions of ClinicalPharmacistsFunctions of Clinical Pharmacists 1. Taking the medical history of the patient 2. Patient Education 3. Patient care 4. Formulation and management of drug policies 5. Drug information 6. Teaching & training to medical and paramedical staff
- 20. 7.Research and development 8.Participationin drug utilization studies 9.Patient counseling 10.Therapeutic drug monitoring 11.Drug interaction surveillance 12.Adverse drug reaction reporting 13.Safe use of drugs 14.Disease management cases 15.Pharmacoeconomics
- 21. The service includingclinical pharmacy/clinical pharmacistThe service including clinical pharmacy/clinical pharmacist -Patients get right care from all the facets (all the drug related problems can easily be eliminated) -Physicians n other health care professionals get more focused in their own, work-load to them is low -Patients feel more comfortable Â Â ď¨ "Every drug is poison, itâs the dose that differentiate poison or drug the substance is." Â ď¨ "To kill ill by pill, not by bill" Â
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- 23. Essential Components ofPharmaceutical Care 1.Pharmacist-patient relationship Collaborative effort between pharmacist & patient 2.Pharmacistâs workup of drug therapy (PWDT) Provision of pharmaceutical care is centered around this, although the methods used for this purpose may vary. Components are: I.Data collection: Collect, synthesize & interpret relevant information Patientâs demographic data: age, sex, race etc. Pertinent medical information
- 24. Medication Counseling Patient counselling is defined as providing medication information orally or in written form to the patients or their representatives on directions of use, advice on side effects, precautions, storage, diet and life style modifications Objectives of patient counseling 1. Patient should recognize the importance of medication for his well being. 2. A working relationship and a foundation for continuous interaction and consultation should be established. 3. Patient's understanding of strategies to deal with medication side effects and drug interactions should be improved. 4. Should ensure better patient compliance. 5. Patient becomes an informed, efficient and active participant in disease treatment and self care management. 6. Drug interactions and adverse drug reactions should be prevented.
- 25. Clinical Output Review â˘process by which health care professionals evaluate each otherâs clinical performance
- 26. Clinical skills &pharmacistâs role in Pharmaceutical Care Patient assessment Physical assessment Barriers to adherence Psychosocial issues Education & counseling Interview skills Communication skills (e.g. empathy, listening, speaking or writing at patient's level of understanding) Ability to motivate & inspire Develop & implement patient education plan based on an initial education assessment Identification & resolution of compliance barriers
- 27. Patient Specific Pharmacist Care Plan Recognition, prevention &management of drug interactions Pharmacology & therapeutics Interpretation of lab tests Knowledge of community resources, professional referrals Communication & support with community medical providers Drug Treatment Protocol Develop & maintain (update) protocols Follow protocols as pharmacist-clinician Monitor,aggregate adherence to the treatment protocols e.g. drug utilization evaluation, especially for managed care or health system facility
- 28. Dosage adjustment Identify patients athigh risk for exaggerated or subtherapeutic response Apply pharmacokinetic principles to determine patient specific dosing  Prescriptive authority In designated practice site and positions Â
- 29. A case ď¨ 44year old lady with fever and green sputum and cough â no known previous medical history â Diagnosed with URTI, Prescribed: ďĄ Co-Amoxiclav 1 tds ďĄ Doxycycline 100mg D ďĄ Prednisolone 40mg D ďĄ Theophylline 200mg bd ďĄ Omeprazole 20mg D ďĄ Metoclopramide 10mg tds ďĄ Salbutamol 2 puff inhale prn Pharmaceutical problems Common organisms for URTI? History of asthma â risk vs benefit? Need for acid suppression? Why is she nauseous? Benefit of brochodilation? Does she know what to take? Will she take it?
- 30. Question? ⢠Think ofsomeone in your family or a friend that has had something go âwrongâ with their medicines? â Caused an adverse or unwanted effect ? â Had medicines stopped when should have continued? â Not worked? â What happened ? â Could it have been avoided ?
- 32. So drugs aresafeâŚâŚâŚâŚâŚâŚ.. Photosensitivity from Amiodarone Severe extravasation of amiodarone infusion
- 33. NSAID induced pepticulcer
- 34. Formulary Prescribing protocols Prospective review Clinicalpharmacy Admission medication history Allergy check Drug distribution system Opportunity For Error Administration instructions Clinical Pharmacy Role in Reducing Risks
- 35. Formulary Prescribing protocols Prospective review Clinicalpharmacy Admission medication history Allergy check Drug distribution system Opportunity For Error Administration instructions What if we are not there!
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