1-introduction To Clinical Pharmacy 1d1m3o

Clinical Pharmacy Process

M. Junaid Hassan Sharif 1

Objectives A: Basic Concepts B: Clinical Pharmacy Requirements C: Drug use process indicators D: Level of Action of Clinical Pharmacists E: Activities of Clinical Pharmacists F: Consultation process 2

A- Basic Concepts • Clinical pharmacy is defined as that area of pharmacy concerned with the science and practice of rational medication use. • Shift the focus from product orientation towards patients • Ward pharmacy system : promote safer use of medication 3

1- Clinical Pharmacy • “Clinical pharmacy comprises a set of functions that promote the safe, effective and economic use of medicines for individual patients”. • Clinical Pharmacy includes all the services performed by pharmacists practising in hospitals, community pharmacies, nursing homes, home-based care services, clinics and any other setting where medicines are prescribed and used. • The term “clinical” does not necessarily imply an activity implemented in a hospital setting.  4

2- Pharmaceutical care • Pharmaceutical care is a cooperative, patient centered system for achieving specific and positive patient outcomes from the responsible provision of medicines. • The practice of clinical pharmacy is an essential component in the delivery of pharmaceutical care 5

Pharmaceutical care

‘’Pharmaceutical care is the direct,• responsible Cure of the disease • Elimination or reductio provision of medication-related care for the purpose of symptoms of achieving definite outcomes that improve a of a • Arrest or slowing disease process patient’s quality of life.’’ • Prevention of disease or symptoms

6

3- Medicines management • Medicines management encomes the way in which medicines are; 1. Selected, 2. Procured, 3. Delivered, 4. Prescribed, 5. istered 6. Reviewed •. to optimize the contribution that medicines make to producing informed and desired outcomes of patient care 7

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 istration, patterns of use and drugs effects on the patients. • The focus of attention moves from the drug to the single patient or population receiving drugs.

8

B: Clinical Pharmacy Requirements Knowledge of drug therapy Knowledge of nondrug therapy

Knowledge of the disease

Therapeutic planning skills

Knowledge of laboratory and diagnostic skills

Patient care

Drug Information Skills

Communication skills

Physical assessment skills

9

Patient monitoring skills

DUP Stage

C: Drug use process indicators Action

Need for a drug

Ensure there is an appropriate indication for each drug and that all medical problems are addressed therapeutically

Select drug

Select and recommend the most appropriate drug based upon the ability to reach therapeutic goals, with consideration of patient variables, formulary status and cost of therapy

Select regimen

Select the most appropriate drug regimen for accomplishing the desired therapeutic goals at the least cost without diminishing effectiveness or causing toxicity

10 Provide drug Facilitate the dispensing and supply process so that

DUP Stage

Action

Monitor drug therapy

Monitor drug therapy for effectiveness or adverse effects in order to determine whether to maintain, modify or discontinue

Counsel patient

Counsel and educate the patient or caregiver about the patient’s therapy to ensure proper use of medicines

Evaluate Evaluate the effectiveness of the patient’s drug effectivenes therapy by s reviewing all the previous steps of the drug use process and taking appropriate steps to ensure that the therapeutic goals are achieved

11

D: Level of Action of Clinical Pharmacists • Clinical pharmacy activities may influence the correct use of medicines at three different levels: 1. Before, 2. During 3. After the prescription is written.

12

1. Before the prescription • • • •

Clinical trials Formularies Drug information Drug-related policies

13

2. During the prescription

• 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 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. 14

Medication related problems Categories of medication-related problems  Untreated indication  Treatment without indication  Improper drug selection  Too little drug  Too much drug  Non-compliance  Adverse drug reaction  Drug interaction 15

3. After the prescription Counselling Preparation of personalised formulation Drug use evaluation Outcome research Pharmacoeconomic studies

16

E: Activities of Clinical Pharmacists The principle activities of a clinical pharmacist include: 1 Consulting Analysing therapies, advising health care practitioners on the correctness of drug therapy and providing pharmaceutical care to patients both at hospital and at community level. 2 Selection of drugs Defining "drug formularies" or "limited lists of drugs" in collaboration with hospital doctors, general practitioners and decision makers. 3 Drug information Seeking information and critically evaluating scientific literature; organising information services for both the health care practitioners and the patients. 17

Activities of Clinical Pharmacists 4 Medication Review Review medication chart, Review medication history 5 Attending Rounds 6 Drug use studies and research Drug use studies/ pharmacoepidemiology/ outcome research/ pharmacovigilance and vigilance in medicinal devices: collecting data on drug therapies, their costs and patient outcome through structured and scientific methods. 7 Pharmacokinetics/ therapeutic drug monitoring Studying the kinetics of drugs and optimising the dosage. 18

Activities of Clinical Pharmacists 9 Pharmacoeconomy Using the results of clinical trials and outcome studies to determine costeffectiveness evaluations.  10 Teaching & Training Pre- and post-graduate teaching and activities to provide training and education programmes for pharmacists and other health care practitioners

19

F: Consultation Process • The ability of a pharmacist to consult effectively is fundamental to pharmaceutical care and this includes establishing a platform for achieving adherence/concordance. • Nurturing a relationship with the patient is essential to understanding their medication related needs. 20

21

Mnemonics used in the pharmacy consultation process WWHAM • Who is it for? • What are the symptoms? • How long has it been going on? • Action taken? • Medicines taken?

22

AS METTHOD • Age of the patient? • Self or for someone else? • Medicines being taken? • Exactly what do you mean (by the symptom)? • Time and duration of the symptom • Taken any action (medicine or seen the doctor)? • History of any disease? • Other symptoms? • Doing anything to alleviate or worsen the symptom?

23

ENCORE • Evaluate the symptom, its onset, recurrence and duration. • No medication is always an option. • Care when dealing with specific patient groups, notably the elderly, the young, nursing mothers, pregnant women, those receiving specific medication such as methotrexate and anticoagulants, and those with particular disease, for example, renal impairment. • Observe the patient for signs of systemic disturbance and ask about presence of fever, loss of weight and any accompanying physiological disturbance. • Refer when in doubt. • Explain any course of action recommended. 24

Summary A: Basic Concepts B: Clinical Pharmacy Requirements C: Drug use process indicators D: Level of Action of Clinical Pharmacists E: Activities of Clinical Pharmacists F: Consultation process

25