Professional Documents
Culture Documents
Chapter 1
Chapter 1 Topics
Ancient Origins Pharmacist Pharmacy Technician Pharmacy Workplace of Today
Ancient Origins
Pharmacy comes from the Greek word, meaning drug Scientific approach to medicine began with the ancient Greeks Hippocrates
Proposed that disease came from natural, not supernatural causes Established the theory of humors (blood, phlegm, black bile, yellow bile)
Ancient Medicine
Ancient Egyptian Medicine -was highly advanced for the time (mummification) Ancient Chinese Medicine - Zhang Liang invented an instrument named "Meng" which is considered to be precursor of modern stethoscope. Ancient India Medicine- Indian snake root (Jones) Ancient Greek Medicine- Hemlock and the dealth of Socrates
Ancient Origins
Galen
Conducted animal experiments Produced a systematic classification of drugs for treatment of disease Galenical pharmacy described the process of creating extracts of active medicinals from plants
First century A.D. De Materia Medica (standard text on drugs for 1500 years)
Ancient Origins
Dr. John Morgan Eighteenth Century Supported the separation of the professions of pharmacy and medicine
Pharmacist
The profession of pharmacy exists to safeguard the health of the public The pharmacist is one who is licensed to prepare and dispense medications, counsel patients, and monitor outcomes pursuant to a prescription from a licensed health professional The role of the modern pharmacist evolved
from compounder and dispenser to providing medication information and preventing medication-related problems
Traditional Era
Early twentieth century Formulation and dispensing of drugs from natural sources
Pharmacognosy
The study of the medicinal properties of natural products of animal, plant, and mineral origins
Galenical pharmacy
Techniques for preparing medications
Scientific Era
Began after World War II Emergence of the pharmaceutical industry
Drugs made in factories, not apothecary shop
Clinical Era
1975: Millis Report, Pharmacists for the Future New educational emphasis on clinical (patient-oriented) pharmacy Pharmacokinetics
the activity of a drug within the body over a period of time; includes absorption, distribution, metabolism, and elimination
Pathophysiology
the study of disease and illnesses affecting the normal function of the body
Pharmaceutical-Care Era
1990: Hepler and Strand defined
Pharmaceutical care a philosophy that expanded the pharmacists role to include appropriate medication use to achieve positive outcomes with prescribed drug therapy includes -Monitoring response to therapy -Educating patients and dispensing prescriptions
Community Pharmacist
Dispenses drugs for exiting disease Involved in patient care initiatives to prevent or identify disease
Administration of immunizations screening for and educating about hypertension, diabetes, and other conditions providing education about lifestyle choices and dietary supplements
Runs a business
hires and supervises employees deals with insurance companies maintains inventory
Hospital Pharmacist
Dispenses oral medications Prepares and dispenses parenteral medications Sometimes specializes, with advanced training in an area of patient care Educates and counsels patients Provides drug information Administers a department
develops policies and procedures purchases drugs and supplies monitors drug use in the hospital
Learn more about hospital pharmacy at the web site of the American Society of Health-System Pharmacists (ASHP)
Educates patient or caregiver on appropriate and safe medication use Monitors patients response to prescribed therapies
Nursing homes
geriatrics
Nuclear Pharmacy
Nuclear pharmacist
Procures, stores, compounds, dispenses, and provides information about radioactive pharmaceuticals
Discussion
What are the differences and similarities between and among the various pharmacy practice settings?
Terms to Remember
compounding
over-the-counter (OTC)
Pharmacy Technician
A pharmacy technician, also called the pharmacy tech, is an individual working in a pharmacy who, under the supervision of a licensed pharmacist, assists in pharmacy activities that do not require the professional judgment of a pharmacist. Regardless of practice setting, the pharmacy tech can assist with workload.
The pharmacist provides the final check on the original prescription with the medication bottle and label before counseling the patient.
In community pharmacy the pharmacy tech evolved from clerk or cashier to a pharmacists assistant.
Technician activities may range from ordering, stocking, and inventorying drugs to preparing the IV order to assisting in the dispensing process.
the pharmacist must always check his or her work the pharmacist is responsible for patient counseling the technician functions in strict accordance with standard written procedures and guidelines
For an up-to-date list of states requiring certification of pharmacy technicians, see the Pharmacy Technician Certification Board Web site
Discussion
What is the relationship between the duties of the pharmacy technician and those of the pharmacist? How do the education and licensure of technicians and pharmacists relate to those duties?
Characteristics
A successful pharmacy technician must possess a wide range of skills, knowledge, and aptitudes.
broad knowledge of pharmacy practice dedication to providing a critical healthcare service to customers and patients high ethical standards willingness to follow instructions eagerness to learn an eye for detail manual dexterity
facility in basic mathematics excellent communication skills good research skills ability to perform accurately and calmly in hectic or stressful situations ability to multi-task or work on several projects at the same time
Discussion
What makes each of the listed characteristics of a pharmacy technician important?
Terms to Remember
Pharmacy technician
Multi-task
Community Pharmacy
Three fifths of all pharmacists in the United States work in a community pharmacy (retail pharmacy).
an independent or chain pharmacy that dispenses prescription medications to outpatients
Community Pharmacy
Most community pharmacies are divided into
a back prescription area offering prescription merchandise and related items a front area offering over-the-counter (OTC) drugs, toiletries, cosmetics, and greeting cards
Community Pharmacy
A chain pharmacy is a community pharmacy that consists of several similar pharmacies in the region (or nation) that are corporately owned. May be national or regional
in department stores (e.g., Wal-Mart, Target) grocery stores (e.g., Kroger, Publix) typical corner drugstores (e.g., Walgreens, Eckerds, CVS, Rite-Aid).
Located to allow for large-volume dispensing with heavy use of both pharmacy techs and automation Administrative decisions are made at the corporate level
Community Pharmacy
An independent pharmacy is a community pharmacy that is privately owned by the pharmacist. May be owned and operated by a group of pharmacists (rather than a corporation) A pharmacist owner makes his or her own decisions regarding the practice of pharmacy
more attention and time spent to keep customers
Community Pharmacy
A franchise pharmacy is member of a small chain of professional community pharmacies that dispense and prepare medications but are independently owned; sometimes called an apothecary. Combines characteristics of independent business and large retail chain A large retail company, the franchiser grants exclusive use of the company name and rights to sell company products to a store owner/operator, the franchisee Most sell only medication and health-related products/services Visit The Medicine Shoppe
Community Pharmacy
Pharmacy technicians employed in a community pharmacy typically aid the pharmacist in the filling, labeling, and recording of prescriptions operate and are responsible for the pharmacy cash register stock and inventory prescription and over-thecounter (OTC) medications maintain computerized patient records prepare insurance claim forms order and maintain parts of the front-end stock
Community Pharmacy
A mail-order pharmacy is a large-volume centralized pharmacy operation that uses automation to fill and mail prescriptions to the patient.
somewhat related to retail pharmacy
Community Pharmacy
Mail-order pharmacy Economies of scale allow lower acquisition costs
savings to insurers and customers
Limitations:
if the patient experiences a side effect or adverse reaction, or the physician changes the medication, then the drug savings could be offset by drug wastage impersonal counseling, which is limited to a drug printout or calling a toll-free number time delay safety of delivery of pain medications through the mail
Discussion
What are the advantages and disadvantages of each type of community pharmacy operation?
Terms to Remember
community pharmacy chain pharmacy independent pharmacy franchise pharmacy mail-order pharmacy
Institutional Pharmacy
Institutional pharmacies are organized under a corporate structure, following specific rules and regulations for accreditation. A pharmacy associated with any organized healthcare delivery system
hospital pharmacy is the most common example more recent examples of places where institutional pharmacies can be found include :
home healthcare long-term care facilities managed-care organizations
Institutional Pharmacy
A hospital pharmacy is an institutional pharmacy that dispenses and prepares drugs and provides clinical services in a hospital setting. One fourth of all pharmacists work in a hospital setting
an institution that offers 24-hour healthcare service; that has six or more beds, a governing authority, and an organized medical staff; and that offers nursing and pharmacy services carries out the functions of maintaining drug treatment records and ordering, stocking, compounding, repackaging, and dispensing medications and other supplies
Institutional Pharmacy
The pharmacy technician in a hospital setting
takes part in functions involving delivery, stocking, or inventorying of medications anywhere in the hospital may operate manual or computerized robotic dispensing machinery
Institutional Pharmacy
Hospital pharmacies (and drugstore chains) are more likely than community pharmacies to require that pharmacy technicians be certified. Some pharmacy employers encourage technicians to become certified
by paying for the certification exam by giving raises to those who pass it
Institutional Pharmacy
A home healthcare pharmacy is a pharmacy that dispenses, prepares, and delivers drugs and medical supplies directly to the home of the patient. Spiraling hospitalization costs, regulatory changes, and advances in parenteral therapies have created an explosion in this field The home healthcare market continues to grow because of our aging society and as an alternative to the higher cost of hospitalizations
Many hospitalized patients are discharged as soon as possible to continue their recovery at home with IV solutions.
Institutional Pharmacy
Pharmacists and pharmacy technicians working in home healthcare
provide educational materials carry out traditional compounding and delivery functions prepare and provide infusions and infusion equipment often must be available for emergencies on a 24-hour basis
Institutional Pharmacy
A long-term care facility is an institution that provides care for geriatric and disabled patients. An extended-care facility (ECF) provides institutional services predominantly to older adults or disabled residents who unable to provide for routine or medical care for themselves
includes adults who suffer from chronic (long-lasting) or such debilitating illnesses as stroke or Alzheimers disease both medical and residential care is provided with very few discharges
Institutional Pharmacy
Skilled-care facilities (SCF) are limited to patients requiring more round-the-clock nursing care (such as IV infusions) or recovery after a recent hospitalization
most patients are discharged from SCF to home when they have adequately recovered
Other long-term care facilities include patients with acute or chronic psychiatric disorders or rehabilitation facilities for those with serious traumatic brain or spinal cord injuries
Institutional Pharmacy
Some long-term care facilities have an in-house pharmacy
others contract with a community pharmacy or allow each resident to choose his or her pharmacy
Licensed pharmacists
establish record-keeping systems related to controlled substances review drug regimens monitor repackaging and storage of pharmaceuticals ensure that medications are uncontaminated and have not expired note medication errors and adverse reactions or interactions educate residents on drug therapies and self-medication provide medications to outpatients or residents on weekend leave
Institutional Pharmacy
The pharmacist may play a crucial role in ensuring regulatory compliance a licensed pharmacist must do a monthly check of each patient profile in a long-term care facility The professional organization for geriatric pharmacists is the American Society of Consultant Pharmacists (ASCP)
Institutional Pharmacy
A pharmacy technician in a long-term care facility may:
log prescriptions and refill orders via computer prepare billings maintain drug boxes or trays for emergencies package and label medications deliver medications to the nursing home maintain records, retrieve and organize patient charts conduct inspections of drugs in inventory and in nursing stations
Institutional Pharmacy
In-house pharmacies may provide a 7-day supply of medication in blister packs. Community pharmacies fill medication carts or trays with a 30-day supply of medication medication orders rarely change in this environment
Managed Care
Managed care is a type of health insurance system that emphasizes keeping the patient healthy of diseases controlled to reduce healthcare costs. A relatively new form of healthcare that has grown dramatically over the past 35 years
One of the first managed-care organizations was Kaiser Permanente
Managed Care
HMOs encourage patients to take an active role in their own healthcare by:
eating right exercising often avoiding negative life-style choices
Managed Care
Most HMOs have their own staff physicians who are on salary
Patients who need a specialist must first get a referral
HMOs have been successful in slowing the pace of the inflationary increases in healthcare without compromising the quality of care Many employers now include an HMO option on their health plans
Managed Care
Most HMOs are centralized primary-care clinics
they serve patients with pharmacy, x-ray, and laboratory departments under one roof
An HMO, like a hospital, usually has an approved drug list or formulary that has been recommended by a drug information pharmacist and approved by the medical staff
Managed Care
The formulary plus the use of low-cost generic drugs allows the organization to volume purchase select drugs to lower operational and patient cost
unlike a community pharmacy, an HMO pharmacy does not stock every brand of drug available
Many HMO pharmacies have a tiered pricing plan so that patients pay one price for a generic drug, a higher price for a preferred brand name drug, and an even higher price for a nonpreferred brand name product
most patients and physicians use the lower-cost alternatives whenever possible
Managed Care
After the patient sees the physician, the patient may go to the HMO pharmacy to fill a prescription Patients needing refills may call an automated telephone number to expedite processing and reduce waiting times
this time savings also allows the pharmacist to spend more time reviewing the computerized medication profile and counseling the patient
Managed Care
The pharmacy technician in managed care performs similar functions to those in the community pharmacy
although insurance billing and cashiering are minimal
Clinical pharmacists may work closely with the primary-care physicians to better control chronic disease
educating monitoring adjusting doses of medications per physician-approved protocols
Discussion
What are the similarities between and among the various institutional pharmacy environments?
What are the differences?
Terms to Remember
Pharmacy Workplace: Institutional Pharmacy
institutional pharmacy hospital pharmacy home healthcare pharmacy long-term care facility managed care health maintenance organization (HMO) formulary
Learning Objectives
Describe the origins of pharmacy Describe the four stages of development of the pharmacy profession in the twentieth century Enumerate the functions of the pharmacist Discuss the educational curriculum for todays pharmacy student Explain the licensing requirements for pharmacists Identify the duties and work environments of the pharmacy technician Differentiate among the various kinds of pharmacies
Discussion
How does the pharmaceutical care model affect the duties of pharmacists in the 21st Century? medication outcomes?
Terms to Remember
pharmacist pharmacognosy pharmaceutics pharmacokinetics