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Functional Elements Of Clinical Pharmacy Practice•Clinical pharmacy have evolved and still
evolving in a variety of ambulatory and institutional pharmacy settings
•Many hospitals now providing medication histories, patient drug counseling, patient drug monitoring, and drug information services
•Specialized clinical services such as clinical pharmacokinetics, nutritional support, clinical toxicology
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical
pharmacy•Definitions of clinical pharmacy:
▫Clinical pharmacy practice as a practice in which the pharmacist utilizes his professional judgment in the application of pharmaceutical sciences to foster the safe and appropriate use of drugs, in or by patients, while working with members of the health care team
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical pharmacy•Definitions of clinical pharmacy:
▫American Association of Colleges of Pharmacy : clinical pharmacy is that area within the pharmacy curriculum which deals with patient care with emphasis on drug therapy. Clinical pharmacy seeks to develop a patient oriented attitude. The acquisition of new knowledge is secondary to the attainment of skills in inter-professional and patient communication
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical
pharmacy•Definitions of clinical pharmacy:
▫Others: the primary mission of clinical pharmacy is the promotion and assurance of rational and safe drug therapy, the other health care practitioners share this goal with clinical pharmacists, though this is not their sole, intensive concern!
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical pharmacy• Definitions of clinical pharmacy:
▫Clinical pharmacy is a health science specialty whose responsibility is to assure the safe and appropriate use of drugs in patients through the application of specialized knowledge and function in patient care, and which necessities specialized education and/or structure training. It requires use of judgment in the collection and interpretation of data, patient- specific involvement, and direct inter-professional interactions
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical pharmacy•Definitions of clinical pharmacy:
▫In summery clinical pharmacy involves the application of drug knowledge on behalf of the patient, while considering the patient’s disease conditions and his need to understand drug therapy
▫The practice requires a close association between the pharmacy and the patient, physician, and other providing health care services
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical pharmacy• Factors influencing the development of clinical
pharmacy:1. Unresponsiveness of health care delivery system to
public needs2. Absence of a single discipline with broad responsibility
for drug use control3. Overeducated and underutilized pharmacists4. Diminished demand for the traditional compounding
skills of pharmacists5. Major unresolved problems with drug use in society6. Inadequate drug knowledge on the art of health
professionals and patients
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical pharmacy• Factors influencing the development of clinical
pharmacy:▫ In the past, the pharmacist has often isolate himself
from the patient and from other health practitioners▫ The health professions are now facing the problem of
how to design a health care system which will provide health maintenance for all people at the most reasonable cost
▫ It is becoming clear that such a system will depend on close cooperation among all health professions
▫ Clinical pharmacy stands to play a major role in the attainment
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical pharmacy•Factors influencing the development of
clinical pharmacy:▫ All of the health disciplines have involved to
some degree with drugs, but no particular discipline has exercised a broad responsibility for the total drug use process
▫ This resulted I drug misuse, overuse, abuse and in serious unwanted drug effects
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical pharmacy• Factors influencing the development of clinical
pharmacy:▫ All of the health disciplines have involved to some
degree with drugs, but no particular discipline has exercised a broad responsibility for the total drug use process
▫ This resulted In drug misuse, overuse, abuse and in serious unwanted drug effects
▫ Led to the thinking that there was a need for one discipline to assume broad leadership and responsibility for the safe and appropriate use of drugs in society
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical
pharmacy•Factors influencing the development of
clinical pharmacy:▫ 1960s recognized that most pharmacist
were overeducated!▫ The climate was right for a major change
in pharmacy practice
Functional Elements Of Clinical Pharmacy PracticeHistorical development of clinical
pharmacy•Factors influencing the development of
clinical pharmacy:▫ Educators and practitioners began to
press for change in pharmacy practice and education
Functional Elements Of Clinical Pharmacy PracticeClinical pharmacy functions and servicesIncludes one or more of those activities as general or
specializedGeneral clinical pharmacy functions and services• Providing drug information to other health professionals• Aimed to• Defining therapeutic goals and endpoints of drug therapy• Selecting the most appropriate therapeutic agent for drug
therapy• Prescribing the most appropriate drug regimen• Monitoring the effect of drug therapy based upon indices
of effect and• Selecting methods for drug administration
Functional Elements Of Clinical Pharmacy PracticeGeneral clinical pharmacy functions and
services▫Significant improvement ▫Drug information and poison centers
Functional Elements Of Clinical Pharmacy PracticeGeneral clinical pharmacy functions and
services▫Obtaining patient medication histories and
using patient medication profiles to assure proper drug utilization Minimum it should contain ……… Additional drug specific monitoring
information may be obtained on patient files
Functional Elements Of Clinical Pharmacy PracticeGeneral clinical pharmacy functions and
services▫Monitoring drug therapy▫Effectiveness, ineffectiveness, ADR, toxicity
ect▫Food and drug administration adverse
reaction reporting programs▫Medication profile, laboratory data, physical
examination data, nurses’ and physicians’ notes and even the results of ECG, X ray are used monitor drug therapy response
Functional Elements Of Clinical Pharmacy PracticeGeneral clinical pharmacy functions and
services▫Providing patient education and medication
counseling
Functional Elements Of Clinical Pharmacy PracticeGeneral clinical pharmacy functions and
services▫Providing disease screening, monitoring,
and maintenance care for patients with chronic diseases
Functional Elements Of Clinical Pharmacy PracticeGeneral clinical pharmacy functions and
services▫Participation in the management of
emergency medical care
Functional Elements Of Clinical Pharmacy PracticeGeneral clinical pharmacy functions and
services▫Serving as a health information and
education source for the public
Functional Elements Of Clinical Pharmacy PracticeGeneral clinical pharmacy functions and
services▫Participation in drug use review and
patient care audits
Functional Elements Of Clinical Pharmacy PracticeGeneral clinical pharmacy functions and
services▫Providing in-service education for
physician, nurses, and other health professionals
Functional Elements Of Clinical Pharmacy PracticeSpecialized functions and services:
▫Nutritional support services▫Formal (written) drug therapy
consultations▫Clinical pharmacokinetics services▫clinical toxicology services▫Clinical drug investigations
Functional Elements Of Clinical Pharmacy Practice•Franck’s legacy-
40 years of clinical pharmacy•clinical pharmacy 30 years later !•clinical pharmacy and medication safety•scope of international clinical pharmacy
How To Get Involved in Medical RoundsPHCL 471Nouf AloudahClinical Pharmacy LecturerKing Saud University
How To Get Involved in Medical Rounds•Rationale For The Pharmacist’s
Participation In RoundsA. IMPROVED PATIENT CARE
1. Promotion Of Rationale Drug Therapy1. Evaluate appropriateness of the selected
drug2. Calculating the dosage consistent with the
renal and hepatic function of the patient3. Determining an acceptable dosage interval
that will ensure therapeutic benefit and compliance
4. Preventing drug related adverse effects
How To Get Involved in Medical Rounds•Rationale For The Pharmacist’s
Participation In Rounds2. Provision Of Drug Information
How To Get Involved in Medical Rounds•Rationale For The Pharmacist’s
Participation In RoundsB. EDUCATION OF THE PATIENT AND
THE HEALTH CARE TEAM1. Educating and interacting with the
patient2. Educating the pharmacist3. Educating other health professionals4. Educating patients and hospital staff
about pharmacy services
How To Get Involved in Medical Rounds•Types Of Rounds
▫Medical teaching service rounds▫Private physician rounds▫Special unit rounds▫Interdisciplinary rounds▫Pharmacy rounds
How To Get Involved in Medical Rounds•Factors In The Pharmacist’s Selection Of
a Rounding Team▫Time available▫Ability to work with the physician▫Continuity of patient care▫Personal interests▫Acceptance by the rounding team
How To Get Involved in Medical Rounds•Pharmacist’s Preparation For Rounds
A. Self preparation Become familiar with appropriate references Keep abreast of current research Determine appropriate patient monitoring
criteria Understand and maintain the rounding
schedule
How To Get Involved in Medical Rounds• Pharmacist’s Preparation For Rounds
B. Specific Planning Develop a monitoring profile and/or patient log
sheet Determine the best method for communicating with
the rounding team Reassess specific drug therapy periodically Prepare lectures on related drug topics Work out a system where you can be contacted
readily Make certain that other pharmacists and supportive
personnel understand what you are doing
How To Get Involved in Medical Rounds•Pharmacist’s Preparation For Rounds
C. Preparation of specific monitoring aids and a daily rounding checklist
Monitoring Drug TherapyPHCL 471Nouf M AloudahClinical Pharmacy LecturerCollege of pharmacyKing Saud University
Monitoring Drug Therapy
•is a process which encompass all those functions necessary to ensure appropriate, safe, efficacious and economical drug therapy to the patient
•functions
Monitoring Drug Therapy
•Rationale•literature identified some significant
problems with regards to the drug therapy of patients due to increasing no of available drugs
•problem includes…
Monitoring Drug Therapy• Use Of Medical Records• you should be familiar with patients medical
records• types of patient records
▫ the source oriented record▫ the problem oriented record
data base section problem list plan progress notes discharge summery
Monitoring Drug Therapy
•Setting Priorities•do not have staff to be able to monitor
each and every patient receiving drug therapy
•at risk of developing adverse effects from drug therapy should be identified▫patient selection by disease state▫patient selection by drug therapy
Monitoring Drug Therapy
•The Process Of Monitoring Drug Therapy
A. problem orientation off patient data
Monitoring Drug Therapy
•The Process Of Monitoring Drug Therapy
B. determination of the appropriateness of specific therapy
Monitoring Drug Therapy
•The Process Of Monitoring Drug Therapy
C. development of specific therapeutic goals
Monitoring Drug Therapy
•The Process Of Monitoring Drug Therapy
D. development of specific monitoring parameters
Monitoring Drug Therapy
•The Process Of Monitoring Drug Therapy
F. development of alternatives or solutions to problems
Monitoring Drug Therapy
•The Process Of Monitoring Drug Therapy
G. communication of findings and recommendations
Teaching And Counseling Patients About DrugsPHCL 471Nouf M AloudahClinical Pharmacy LecturerCollege of PharmacyKing Saud University
Introduction•Practiced several years and years•Innovative ways•Limited by financial constrains and the
willingness of pharmacists to participate in this activities
•Understanding the need is basic for designing quality programs
Teaching And Counseling Patients About Drugs
•Who should teach and counsel?▫Not drug information you want to change
behavior▫Noncompliance occur in 30-50%▫Oral or written intervention by the
pharmacist improved compliance
Teaching And Counseling Patients About Drugs
•Who should teach and counsel?▫Physician?
First to see pt They remember 20-40 of what been told to
them Multiple demands on them
Teaching And Counseling Patients About Drugs
•Who should teach and counsel?▫Nurse?
Happened in many institutions Identify it to prevent duplication Approached positively they will welcome Provide educational material Administer drug daily, it is a good chance!
Teaching And Counseling Patients About Drugs
•Who should teach and counsel?▫Pharmacist?
Last to see the pt Needs to develop skills Ethical responsibility Obtain data to support the program
Teaching And Counseling Patients About Drugs
•Who should be taught and counseled?▫Time and manpower determine who one
can teach and what type of educational programs pt referred by physicians Pt with specific disease status Pt receiving specific drug classes Elderly populations Pediatric populations Pt being discharged
Teaching And Counseling Patients About Drugs
• How to teach and counsel?▫Pt education not information▫Not only to teach but to negotiate a regimen▫Assessment phase
Open ended questions Reflective questions Closed ended questions Suggestive questions
▫Planning and implementation phase Verbal communication Nonverbal communication listening
▫Evaluation phase
Teaching And Counseling Patients About Drugs
•What to teach about drugs?▫Major points, helpful to identify which
information specific to retain▫Drug should be researched toughly prior to
session▫Planned presentation to ensure covering
important points
Teaching And Counseling Patients About Drugs
•What to teach about drugs?1. Description and strengths2. Use and schedule3. Mechanism of action4. Effect on life style5. Storage6. Potential adverse effects7. Potential drug or delivery interactions
Teaching And Counseling Patients About Drugs
•Where to teach and counsel?▫Private setting without interruptions▫Better recall if counseled in private areas▫At least 15 min per session
Teaching And Counseling Patients About Drugs
•Where to teach and counsel?▫Inpatient setting
During hospital stay, at the time of discharge▫Outpatient setting
Teaching And Counseling Patients About Drugs
•Teaching aids?▫Printed materials▫Audiovisual materials▫Compliance aids▫Educational display
Teaching And Counseling Patients About Drugs
Providing drug information to health professionalsPHCL 472Nouf M AloudahClinical Pharmacy lecturerKing Saud University
Providing drug information to health professionals•Who needs to know what?•Specific categories of drug information
questions and how these questions differs among various types of health professionals
Providing drug information to health professionals•Drug information categories•If you know question type you will
understand the need, aids in selecting references
Providing drug information to health professionalsMost questions falls into one of the following
categories• Adverse drug reactionsCommon side effects to ADR to be reported to FDA• Ex
▫Which sedative, …………. Or ……… causes the least amount of hangover?
▫ If the pt allergic to ………. Can we safely administer ………?
▫Has leukemia ever been associated with the use of …?
Providing drug information to health professionalsMost questions falls into one of the
following categories•availabilityProduct- oriented questions about old and
new drugs•Ex
▫Has …. Been released yet?▫Who makes …?▫What strength doses …. Come in?
Providing drug information to health professionalsMost questions falls into one of the
following categories•Drug interactionDrug-drug, drug- food, drug- laboratory
interactions•Ex
▫Can … be used safely with …?▫Dose food affect the absorption of …?▫Will administering … cause a change in the
serum level of …?
Providing drug information to health professionalsMost questions falls into one of the
following categories•Foreign drugs•Ex
▫An article about … recently appeared in a British journal. What is it?
▫A patient recently returned from europ with a Rx of … what its equivalent?
Providing drug information to health professionalsMost questions falls into one of the
following categories• identification•Ex
▫What is this tablet?▫What are the ingredients in …?▫Is an … OTC product?
Providing drug information to health professionalsMost questions falls into one of the
following categories•Pharmaceutical calculations•Ex
▫How many mEq of calcium are in 500 mg of …?
▫How fast should a … drip be run to deliver 5 mcg /min?
Providing drug information to health professionalsMost questions falls into one of the
following categories•Toxicity and poisoningOverdose or toxic exposures are in this
category•Ex
▫what symptoms can be expected in a pt who has taken a bottle of ….?
▫Should a child who has ingested … receive ipecac?
Providing drug information to health professionalsNeeds of health professionals•Each one may ask any of the question
mentioned but each has a different need•Physicians:Questions related to prescribing or monitoring
drug therapy•Nurses:Drug administration, adverse drug reaction•Pharmacists:Numerous questions need access to resources
Providing drug information to health professionalsDrug information sources•Basic drug information reference libraryReferences which contain information on
ten categories •Extent depends on funding
▫“Must have”▫“Should have”▫“Nice to have”
Providing drug information to health professionals•“Must have reference”: tertiary
references (textbooks) five basic types:1. Product oriented2. Drug oriented3. Disease oriented4. Specific topic5. specialty
Providing drug information to health professionals•Product- Oriented ReferencesBest source for availability and identification
questions•Ex
▫Facts and comparison: product monographs, comparative information on similar products, cost index
▫Handbook of nonprescription drugs: contain monographs on various classes of nonprescription drugs, compare contents of products in similar classes
Providing drug information to health professionals•Drug- Oriented ReferencesStronger emphasis on the particular drug
or drug class than on the product•Ex
▫Martindale, the extra pharmacopeia published every five years, contain extensive referenced monographs on drugs and drug classes with international coverage excellent source for adverse reactions, therapeutic and pharmacology
Providing drug information to health professionals•Disease- Oriented ReferencesChapters on disease states, very useful for
questions in the therapeutics and pharmacology category from disease perspective
•Ex▫Applied therapeutics published every 3-4
years
Providing drug information to health professionals•Specific topic referencesCompatibilities of IV drugs, DI, and
poisoning •Ex
▫Handbook of injectable drugs▫Handbook of poisoning▫Applied pharmacokinetics
Providing drug information to health professionals• a “must have” list would be incomplete
without primary references or journals•Ex
▫American journal of hospital pharmacy
Providing drug information to health professionals• Should have “ referencesAfter selection of your “must have” reference the others
can be considered “should have”• Specialty references could be considered “should have”
▫ Cancer chemotherapy▫ Pediatrics▫ infectious disease
• At least one journal which discuss drugs and drug therapy
• Ex▫ The medical letter▫ pharmacotherapy
Providing drug information to health professionals•“nice to have” referencesSecondary source of drug information•Ex
▫Clin -alert▫IOWA drug information services
• Pharmaceutical manufactures
Providing drug information to health professionalsAnswering questions•Knowing the real question
▫What the requester actually wants to know, classify the requester (physician, nurse, pharmacist) and obtain the necessary background information
▫What is the dose of …?possibilities are endless
▫Patient information: age, weight…, disease condition…, whole medical history ! extent of the question asked
Providing drug information to health professionalsAnswering questions•Systemic search
▫Which category?▫which reference? update?▫Not found in tertiary references go to
secondary references
Providing drug information to health professionalsAnswering questions•Communicate an answer
▫Timing ex administration maximum 6 hours▫Brief , concise, accurate▫Verbally ▫Sometimes written, should be well
organized, grammatically correct, timely manner
Providing drug information to health professionalsAnswering questions•Follow up
▫When possible with certain types of questions especially directed to pt care
▫Ex adverse reaction
Providing drug information to health professionalsAnswering questions•As more questions are asked the more
confidence will grow•The key to increase the clinical role is
exposure
Providing drug information to health professionalsDrug information support to hospital
committeeParticipation increase exposure and aids in
recognition of our role• The P & T committee• It is a policy recommending body, several
functions can be supported by DI• Evaluating drug for inclusion in the hospital
formulary• What to includes?• Decision is more difficult, keep it simple
Providing drug information to health professionalsDrug information support to hospital
committee•Decision is more difficult, keep it simple•Educational function of the committee
Providing drug information to health professionalsDrug information support to hospital
committee•DUR
▫Frequently asked questions may pinpoint areas for which drug use review studies are needed
•Others▫Human research committee, infection
control committee, nutrition committee
Providing drug information to health professionalsVehicles for providing drug information• Pharmacy newsletter• Provide information and help in pharmacist
recognition as drug information source• Selecting topics:
▫drug information▫P & T committee actions▫DUR programs▫Journal articles
• Writing for a particular audience• Publication and disterbution• Verbal presentation
Providing drug information to health professionalsVehicles for providing drug information•Verbal presentation
▫Formal or informal lectures, in service presentations, ground rounds,
▫Starts by the pharmacists▫Topics▫Particular audience▫Teaching techniques and strategies: length,
formality, objectives, instructional aids, handouts, summery
Providing drug information to health professionalsIn summery•Drug information is a component of all
clinical pharmacy services•Providing DI can be rewarding by
▫Fully utilized our knowledge▫We become more active members of the
team▫It can open doors to other clinical functions▫Achieving rational therapeutics leading to
improved pt care
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