Lecture – 01

The Healthcare Environment

Keywords: Drug, Medicine, Over the counter, Pharmacist, Prescription, Pharmacotherapy

Pharmacists are experts on the actions and uses of drugs, including their chemistry, their
formulation into medicines and the ways in which they are used to manage diseases. The
principal aim of the pharmacists is to use this expertise to improve patient care. Pharmacists are
in close contact with patients and so have an important role both in assisting patients to make the
best use of their prescribed medicines and in advising patients on the appropriate self-
management of self limiting and minor conditions. Increasingly this latter aspect includes over
the counter (OTC) prescribing of effective and potent treatments pharmacists are also in close
working relationships with other members of the healthcare team – doctors, nurses, dentists and
others- where they are able to give advice on a wide range of issues surrounding the use of
medicines.

Pharmaceutical care practitioners accept responsibility for optimizing all of a patient's drug
therapy, regardless of the source (prescription, nonprescription, alternative, or traditional
medicines), to achieve better patient outcomes and to improve the quality of each patient's life.
This occurs with the patient's cooperation and in coordination with the patient's other health care
providers.

The practitioner uses a rational decision-making process called the Pharmacotherapy Workup to
make an assessment of the patient's drug-related needs, identify drug therapy problems, develop
a care plan, and conduct follow-up evaluations to ensure that all drug therapies are effective and
safe. Together, these steps are the patient care process.

The Patient's Drug-Related Needs

During a pharmaceutical care encounter, the patient, his/her medical conditions, and all of the
drug therapies are assessed to determine if the following drug-related needs are being met:
1. The medication is appropriate.
2. There is a clinical indication for each medication being taken.
3. All of the patient's medical conditions that can benefit from drug therapy have been
identified.
4. The medication is effective.
5. The most effective drug product is being used.
6. The dosage of the medication is sufficient to achieve the goals of therapy.
7. The medication is safe.
8. There are no adverse drug reactions being experienced.
9. There are no signs of toxicity.
10. The patient is compliant (inclined to agree with others or obey rules ).
11. The patient is willing and able to take the medications as intended.
Pharmacists are employed in many different areas of practice. These include the traditional ones
of hospital and community practice as well as newer advisory roles at health authority/ health
board level and working directly with general practitioners as part of the core practice based
primary health care team. Additionally, pharmacists are employed in the pharmaceutical
industry and in academia.
Pharmacists available job sectors are –
A. Pharmaceutical industry
 Production
 Quality assurance
 Quality compliance
 Quality control
 Research & development
 Warehouse
 Product management
 Technical service
 Sales
 Medical service
 Regulatory affairs
 Training

B. Pharmacy shop
 Dispensing
 Retail
 Community

C. Hospital
 Dispensing
 Councelling
 Inventory management
 Palliative care

D. Drug administration
E. Teaching

Members of the general public are most likely to meet pharmacists in high street pharmacies or
on a hospital ward. However, pharmacists also visit residential homes, make visits to patients’
own homes and are now involved in running chronic disease clinics in primary and secondary
care. In addition, pharmacists will also be contributing to the care of patients through their
dealings with other members of the healthcare team in the hospital and community setting.

ROLE OF HOSPITAL PHARMACIST

A pharmacist’s role in a hospital might appear straightforward. Simply assess the patients in their care
and dispense any drugs that are deemed necessary by the doctors, right? Certainly not.

While the delivery of medication is a major part of the job, the role extends far beyond this, as they are
seen as a core member of the hospital team, when it comes to delivering patient care.

Hospital pharmacist jobs are unlike community pharmacy, prison pharmacy or primary care pharmacy in
many ways. So what makes a hospital pharmacist’s job so different?
Medicine Management

A key role in a hospital pharmacist’s job is determining which form of medication best suits each patient.
Each decision must be made in a timely and efficient manner and requires significant input from doctors,
nurses and other healthcare professionals.

Hospital pharmacists will often monitor the effects of the medications they prescribe and counsel their
patients on the effects of the drugs.

Another aspect of this role is to recommend administration routes and dosages, all of which are
dependent on an individual's needs. 

A source of information

A hospital pharmacist is often a great source of advice for patients. They can also be called upon to
recommend safe combinations of medicines or solutions to specific patient problems. 

Hospital pharmacists can offer information on potential side effects and check that medicines are
compatible with existing medication. They will often also monitor the effects of treatments to ensure that
they are proving effective, safe and appropriate to the user.

Monitoring drug charts

As hospital pharmacists are required to work closely with other members of staff, such as physicians,
nurses and dieticians, information must be passed on in a way that is clear to understand. While this
might seem simple, performing hand-overs between shifts has the potential to make this aspect of the role
a little more complicated.

Luckily, drug charts provide a vital source of information and act as an efficient method of
communication between hospital pharmacists and other members of medical staff. Hospital pharmacists
must monitor these charts and ensure that the correct medication is being provided to each patient.

Such information may include which form of medication a patient requires, with options including
tablets, injections, ointments or inhalers. How the medication should be administered must also be
communicated.

Discharging patients

Discharging patients is another important role. It is the duty of a hospital pharmacist to keep track of
which patients are being discharged and inspect the discharge summary. This requires the pharmacist to
inspect the patient’s drug chart to ensure that the medication prescribed matches that contained in the
discharge summary. It is then the responsibility of the pharmacist to dispense the correct medication.

Many hospital pharmacists are also qualified to prescribe medication, however, this does not apply to all
those in the profession.

Keeping up to date

As with any healthcare job, hospital pharmacists are expected to remain up to date with all aspects of
medicine. This includes their usage and any new developments that may occur.

To do this, hospital pharmacists must use electronic databases and read research papers. These provide
invaluable data that enables pharmacists to learn more about new drugs before recommending that they
are purchased by the hospital.

Utilizing these resources regularly will allow hospital pharmacists to remain an excellent source of
pharmaceutical advice.
Community pharmacists work at the front line of healthcare in cities, towns and
villages. They work from their own pharmacies or out of local healthcare centres and
doctor’s surgeries. 

As a community pharmacist your job would be all about helping patients and the public,
assessing their conditions and making decisions about which medicines they should take.  

You’ll be involved in dispensing medicines and offering your patients advice and practical
help on keeping healthy. It is a very responsible job and community pharmacists tend to be
highly respected members of their communities.  

Community pharmacists are also taking on more of the clinical roles that have traditionally
been undertaken by doctors, such as the management and monitoring of long term
conditions, for example asthma and diabetes, as well as delivering flu vaccinations, and
conducting medicines reviews. They also help people give up smoking, alter their diets to
make them healthier and advise on sexual health matters.  

Some community pharmacists own their own businesses and enjoy the challenges of
management and having responsibility for staff, stock and premises that this brings. Others
work for large pharmacy chains and have the opportunity to move around and/or progress
onto more senior roles within an established company structure .

Questions

1. What is pharmacy practice? Write a short note about it.

2. What is prescription?
3. What is prescription medicine?
4. What is OTC drug?
5. Write the points of patients drug related needs.
6. What is hospital pharmacy?
7. What is community pharmacy?
8. Write about the job opportunities of pharmacists.
9. Write the scope of pharmacist in different sectors of pharmacy.
10. Write briefly about patient councelling.