CLINICAL PHARMACY 2.

Select a drug – (therapeutic goals)

3. Select Regimen –
 Comprises a set of functions that promote the safe, 4. Provide drug – (accurately prepared and
effective and economic use of medicines for dispensed)
individual patients while working with members of 5. Drug administration –
the health care team 6. Monitor drug therapy – (effectiveness or adverse
 Emergence: product oriented – direct engagement effects)
with patients and the problems encountered with 7. Counsel patient - (proper use of medicine)
medicines 8. evaluate effectiveness – (review DUP)

 Health science specialty whose responsibility is to CLINICAL PHARMACIST

assure the safe and appropriate use of drugs in  Interact with the health care team
patients through the application of specialized
knowledge and functions in patient care.  Interview and assess patients

 1960’s : poor medicine control in the hospital  Make therapeutic recommendations

 USA : Adopted UDDS and Decentralization of
Pharmacy Services
 UK : “ward pharmacy”
 1970’s : transition of clinical pharmacy
 Monitor patient response to drug therapy
 Provide drug information
KNOWLEDGE AND SKILLS REQUIRED IN CLINICAL
PHARMACY

 1980’s : grew because of its ability to promote cost-  Knowledge on:

effective medicines use
o Diseases
 1988 : recognized by UK government
o Drug therapy
 endorsed implementation to secure value for
money from medicines o Non-drug therapy

 Awareness and interventions o Laboratory and diagnostic testing

 Coding system – DUP SKILLS

- 1997 : very high physicians acceptance rate  Communication

 Select regimen  Patient monitoring skills

 Need for drug  Physical assessment

 Drug use processes  Drug information provision

FRUSTATIONS  Therapeutic planning

 Lack of certainty about the fundamental purpose of
clinical pharmacy
 Tensions between the drive towards specialization in
clinical pharmacy
 Need to improve services of a more general level in
hospitals and other care settings
GENERAL CLINICAL PHARMACY FUNCTIONS
 Providing drug information to physicians and other
health professionals
 Medication history taking
 Medication profile preparation
 Drug therapy monitoring

 Patient education and medication

 Counseling

 Disease screening, monitoring and maintenance care

for patients with chronic diseases
DRUG USE PROCESS (DUP)
 Participation in the management of emergency
1. Need for a drug - (indication) medical care
  Health information source to the public  medicines information

 Drug use review and patient care audits  Clinical research

 In- service education for physicians, nurses and other  Active pharmacist participation
health professionals
 Pharmacists undertaking admission medication
 Specialized functions and services histories

The Practice of CP is generally an essential component of Prevention and

pharmaceutical care
Management of medicine-related problems
PHARMACEUTICAL CARE
o Medicine reconciliation
 Is a cooperative, patient centered system for
achieving specific and positive patient outcomes from MEDICINE RECONCILIATION
the responsible provisions of medicines o Collecting information on medication history using
 Is the responsible provision of drug therapy for the the most recent and accurate sources of information
purpose of achieving definite outcomes that improves to create a full and current list of medicines
a patient’s quality of life
PHARMACEUTICAL CONSULTATION
 A patient centered practice in which the practitioner
 Establishing a therapeutic relationship
assumes responsibility for a patient’s drug related
needs and is held accountable for his commitment  The relationship must be a partnership in which the
pharmacist works with patient to resolve medication-
MAJOR FUNCTIONS OF PC
related issues in line with the patient’s wishes,
 Identifying potential and actual drug-related expectations and priorities
problems
3 key elements of care process
 Resolving actual drug related problems
ASSESSMENT
 Preventing potential drug related problems
o Establish full medication history
CATEGORIES OF MEDICATION-RELATED PROBLEMS
o Potential Drug-related problems
 Untreated indication
CARE PLAN
 Treatment without indication
o Goal: optimize care
 Improper drug selection
o Attain the goal
 Too little drug
EVALUATION
 Too much drug
o Reviews progress
 Non-compliance

 Adverse drug reaction

 Drug interaction

EXPECTED OUTCOMES OF PC

 Cure of disease MEDICINE USE REVIEW (MUR)

 Elimination or reduction of symptoms o Approach in community pharmacy that help patients
used their medicines more effectively
 Arrest or slowing down of a disease process
o Uses the skills of pharmacists to help patients
 Prevention of diseases or symptoms
understand :
BENEFITS OF PHARMACEUTICAL CARE
 How their medicines should be used
Reduced mortality rates
 Why they take them and
o Services:
  to identify any problems patients have in 3. Select Regimen –
relation to their medicines 4. Provide drug – (accurately prepared and dispensed)
5. Drug administration –
 Providing feedback to the prescriber 6. Monitor drug therapy – (effectiveness or adverse
2 goals: Improve Adherence, Reduce medicines wastages effects)
7. Counsel patient - (proper use of medicine)
Medicines-taking behavior 8. evaluate effectiveness – (review DUP)
Adherence PRACTICAL STEPS IN THE DELIVERY OF
PHARMACEUTICAL CARE
Non-adherence
Step 1. Establishing the need for drug therapy
 Factors:
1.1 Relevant patient details
o Characteristics of the disease and treatment used to
manage it 1.2Medication history

o Patient’s beliefs about their illness and their Step 2. Selecting the medicine
medicines
2.1 Identify drug patient interaction
o Quality of the interaction between the patient and
2.2 Identify drug disease interaction
healthcare practitioner
2.3 drug-drug interaction
 2 types of non-adherence
Step 3. Administering the medicine
o Intentional (Deliberate)
3.1 Calculating the appropriate dose
 Own belief
3.2 selecting an appropriate regimen
o Unintentional
Step 4. Providing the medicine
 Physical or sensory barriers: unable to swallow;
unable to read labels; forgetfulness; poor Step 5. Monitoring therapy
comprehension
Step 6. Patient advice or education
Consultation Process
Step 7. Evaluating effectiveness
 The ability of a pharmacist to consult effectively is
fundamental to PC and this includes establishing a
platform for achieving adherence/concordance.

 WWHAM, AS METTHOD and ENCORE

mnemonics

o provide rigid structure to use when questioning

about the symptoms: symptoms or disease focused
rather than patient focused

Pharmaceutical Consultation Process

 Introduction

 Data collection and problem identification

 Actions and solutions

 Closure

DRUG USE PROCESS (DUP)

1. Need for a drug - (indication)

2. Select a drug – (therapeutic goals)