Clinical Pharmacy Orientation

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Dr.Maqsood khan

Pharm.D, BCPS,

BCLS,ACLS,MACCP ,MSCCM.

Clinical Pharmacy Specialist

Infectious diseases and Medical Oncology


Objective

Define clinical pharmacy Differentiate between traditional pharmacists role

and Clinical Pharmacist Explain the qualification required for clinical

pharmacists List the clinical pharmacists responsibility Describe the daily work activity of clinical

pharmacists.

Clinical Pharmacy:From Theory to Practic

Pharmacists should move from behind the counter

and start serving the public by providing

care instead of pills only.

There is no future in the mere act of dispensing.

That activity can

and will be taken over by the internet, machines,

and/or hardly trained technicians.

Clinical Pharmacy

A health science discipline that embodies the application and development.

By pharmacists, of scientific principles of pharmacology, toxicology, therapeutics, clinical pharmacokinetics, pharmacoeconomics, pharmacogenomics, and other life sciences for the care of patients

Clinical Pharmacy Clinical pharmacy is defined as “a patient centered,

outcomes oriented pharmacy practice that requires the pharmacist to work together with the patient and the healthcare team members to:

- promote health - to prevent disease -to assess, monitor, initiate and modify medication

use.


After Clinical Rounds with MED ONC TEAM

Clinical Pharmacy . Maximizing the clinical effect of medicines, i.e.,

using the most effective treatment for each type of patient

Minimizing the risk of treatment induced adverse events, i.e., monitoring the therapy course for adverse reactions as well as patient's compliance with therapy

Minimizing the expenditures for pharmacological treatments by governments and by the patients, i.e., trying to provide the best treatment options for the greatest number of patients at the most cost effective.

Clinical Pharmacy

Clinical pharmacy is defined as that area of pharmacy concerned with the science

and practice of rational medication use.

What is the difference?

Clinical Pharmacy

Pharmaceutical care

Pharmaceutical care

‘’Pharmaceutical care is the direct, responsible

provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life.’’

• Cure of the diseaseCure of the disease• Elimination or reductionElimination or reductionof symptomsof symptoms• Arrest or slowing of aArrest or slowing of a disease processdisease process• Prevention of disease Prevention of disease or symptomsor symptoms

Clinical PharmacyClinical 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.

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 and drugs effects on the patients.

The focus of attention moves from the drug to the single patient or population receiving drugs.

Goal

to promote the correct and appropriate use of medicinal products and devices.

These activities aim at: maximising the clinical effect of medicinesminimising the risk of treatment-induced adverse

eventsminimising the expenditures for pharmacological

treatments.

Clinical Pharmacy Requirements

Knowledge of 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

Level of Action of Clinical Pharmacists

Clinical pharmacy activities may influence the correct use of medicines at three different levels: before, during and after the prescription is written.

1. Before the prescription

Clinical trials Formularies Drug information drug-related policies

. Pharmacists have direct interaction with physician and medical team regarding drug therapy.

Pharmacists make medical rounds with physicians.

Pharmacist make recommendations on drug therapy.

Pharmacists are in patient care areas

Pharmacists participate on hospital committees

Pharmacist role during prescription

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.

Pharmacy and Therapeutics Committee

Drug Use Evaluation

Adverse Drug Reactions

Medication Error

Infection Control and Antibiotics committee

Hospital Pharmacy: Clinical Committees

Medication-related Problems Untreated indications. Improper drug selection. Subtherapeutic dosage. Medication Failure to receive Medication Overdosage. Adverse drug reactions. Drug interactions. Medication use without indication.

3. After the prescription

Counselling Preparation of personalised formulation Drug use evaluation Outcome research Pharmacoeconomic studies

On Round with Med Onc team

Pharmaceutical Care Plan

.

Reduction of the rate of preventable adverse drug events caused by ordering errors

A study published in JAMA in 1999 found that the pharmacist's participation in medical rounds in the intensive care unit reduced the occurrence of preventable adverse drug events caused by ordering errors by 66% .

The study was conducted at the Massachusetts General Hospital in Boston in collaboration with the Harvard School of Public Health.

Leaps LL, Cullen DJ, Clapp M. Dempsey et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999;282(3):2(37‑270.

Additional Supporting Evidence

Clinical Pharmacy Services associated with decreased mortality rates1. Pharmacist-provided drug use evaluation (4491

reduced deaths p=0.016)2. Pharmacist-provided in-service education (10,660

reduced deaths, p=0.037)3. Pharmacist-provided ADR management (14,518

reduced deaths, p=0.012)4. Pharmacist-provided drug protocol management

(18,401 reduced deaths, p=0.017)5. Ref# Pharmacotherapy 2007;27(4):481–493

Clinical Pharmacy from theory to Practice

LLearn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning."

Albert Einstein

Activities of Clinical Pharmacists The principle activities of a clinical pharmacist include:

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.

Selection of drugs Defining "drug formularies" or "limited lists of drugs" in collaboration with hospital doctors, general practitioners and decision makers.

Drug information Seeking information and critically evaluating scientific literature; organising information services for both the health care practitioners and the patients.

.

Activities of Clinical Pharmacists The principle activities of a clinical pharmacist include:

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.

Selection of drugs Defining "drug formularies" or "limited lists of drugs" in collaboration with hospital doctors, general practitioners and decision makers.

Drug information Seeking information and critically evaluating scientific literature; organising information services for both the health care practitioners and the patients.

.

Activities of Clinical Pharmacists Medication Review

Review medication chart, Review medication history

Attending Rounds

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.

Pharmacokinetics/ therapeutic drug monitoring Studying the kinetics of drugs and optimising the dosage.

Clinical Trials Planning, evaluating and participating in clinical trials

Clinical Pharmacy from theory to Practice

When it becomes more difficult to suffer than to change ... you will change."

Albert Einstein

Activities of Clinical Pharmacists

.

Teaching & Training

Pre- and post-graduate teaching and activities to provide training and education programmes for pharmacists and other health care practitioners

Information Source

Medical recordPatientFamilyHealth care team

Medical Record

•Admission Information

•Initial history

• physical examination

•Progress notes

•Consultations

•Nursing notes

•Laboratory data

•Diagnostic Procedures

•Radiology

•Surgery

•Orders

•Medication

administration orders

•Consent forms

Medical Team

Clinical Pharmacy Practice areas

Ambulatory care Critical care Drug Information Geriatrics and long –term care Internal medicine and

subspecialties Cardiology Endocrinology Gastroenterology Infectious disease Neurology

Nephrology Obstetrics and gynecology Pulmonary disease Psychiatry Rheumatology Nuclear pharmacy Nutrition Pediatrics Pharmacokinetics Surgery

Practice Guidelines for Pharmacotherapy Specialists The pharmacotherapy specialist designs, implements,

monitors, evaluates, and modifies patient pharmacotherapy to ensure effective, safe and economical patient care.

A Position Statement of the American College of Clinical Pharmacy

Practice Guidelines for Pharmacotherapy Specialists

The pharmacotherapy specialist retrieves , analyzes, evaluates, and interprets the scientific literature as a means of providing patient- and population-specific drug information to health professionals and patients


Practice Guidelines for Pharmacotherapy Specialists

The pharmacotherapy specialist participates in the generation of new knowledge relevant to the practice of pharmacotherapy, clinical pharmacy and medicine

The pharmacotherapy specialist educate health care professionals and students, patients, and the public regarding rational drug therapy

The pharmacotherapy specialist continually develops his/her knowledge and skills in applicable practice areas and demonstrates a commitment to continued professional growth by engaging in a lifelong process.


ResponsibilitiesDesigning patient-specific drug dosage

regimens

Recommending or scheduling measurements of drug concentrations in biological fluids

Monitoring and adjusting dosage regimens

Evaluating unusual patient responses to drug therapy for possible pharmacokinetic and pharmacologic explanations.

Responsibilities

Communicating patient-specific drug therapy information to physicians, nurses, and other clinical practitioners and to patients orally and in writing, and including documentation of this in the patient’s health record.

Responsibilities

Educating pharmacists, physicians, nurses, and other clinical practitioners about pharmacokinetic principles and appropriate indications for clinical pharmacokinetic monitoring, including the cost-effective use of drug concentration measurements.

ResponsibilitiesDeveloping quality assurance programs for

documenting improved patient outcomes and economic benefits

Promoting collaborative relationships with other individuals and departments involved in drug therapy

Responsibilities

Pharmacists with specialized education, training, orexperience may have the opportunity to assume the

following additional responsibilities:

1. Designing and conducting research

2. Developing and applying computer programs andpoint-of-care information systems to enhance theaccuracy and sophistication of pharmacokinetic modelingand applications to pharmaceutical care.

Responsibilities

3. Serving as an expert consultant to pharmacists with a general background in clinical pharmacokinetic monitoring.

Responsibilities

3. Serving as an expert consultant to pharmacists with a general background in clinical pharmacokinetic monitoring.

Clinical pharmacokinetics

Clinical pharmacokinetics is the process of applying pharmacokinetic principles to determine the dosage regimens of specific drug products for specific patients

to maximize pharmacotherapeutic effects and minimize toxic effects.

TDM stands for therapeutic drug mointoring

Change your view

Knowledge into actionKnowledge into action

Aseptic ServicesUnit dose dispensing System

General Dispensing ServicesClinical Pharmacy ServicesDrug Information ServicesTraining and Education ServicesInventory Control Management

Services


Conclusion

Clinical Pharmacy is Really Rewarding & Clinical Pharmacy is Really Rewarding & Interesting ,but Interesting ,but

Its Highly Challenging .Its Highly Challenging .

If you want to be a Clinical Pharmacist than If you want to be a Clinical Pharmacist than go beyond the limits of Excellency in Science go beyond the limits of Excellency in Science

and Knowledgeand Knowledge

Documents

Clinical Pharmacy Orientation