CLINICAL PHARMACY, RELATED TERMS &

COMPARISON WITH OTHER CLINICAL Dr Noor Kamil

FIELDS
ILOS
After completion of this lecture students will be able to
Explain pharmaceutical care, and MTM
Enlist credentials of pharmacist
Understand physician specialties and subspecialties
Learn clinical environment
PATIENT-FOCUSED PHARMACY PRACTICE
Clinical pharmacy historically described patient oriented pharmacy
practice.
Clinical pharmacist (Patient-focused pharmacists) a pharmacist
 to interact with the health care team,
 interview and assess patients,
 make patient specific therapeutic recommendations,
 monitor patient response to drug therapy,
 and provide drug information
Pharmaceutical care is the broad-based, patient-focused
responsibilities of pharmacists
 PATIENT-FOCUSED CARE IN THE COMMUNITY PHARMACY

Patient-focused care is an integral part of the practice of pharmacy in all patient care settings. (Hopper T:
Mosby’s pharmacy technician: Principles and practice, ed 2, St Louis, Saunders, 2007.)
PHARMACEUTICAL CARE
Hepler and Strand define pharmaceutical care as the “responsible provision of drug
therapy for the purpose of achieving definite outcomes that improve a patient’s
quality of life.”
The four outcomes identified include the following:
1. Cure of disease
2. Elimination or reduction of symptoms
3. Arrest or slowing of a disease process
4. Prevention of disease or symptoms

Pharmaceutical care requires

 an expert knowledge of therapeutics
 a good understanding of disease processes
 knowledge of drug products
 strong communication skills
 drug monitoring, drug information, and therapeutic planning skills
 ability to assess and interpret physical assessment findings
PATIENT CARE REQUIRES INTEGRATION OF KNOWLEDGE AND SKILLS.
MEDICATION THERAPY MANAGEMENT
“A distinct service or group of services that optimize
therapeutic outcomes for individual patients.
Medication Therapy Services are independent of, but can
occur in conjunction with, the provision of a medication
product”
MEDICATION THERAPY MANAGEMENT (MTM)
CORE ELEMENTS
• Provide a comprehensive or targeted medication therapy review
• Complete and update the patient’s personal medication record (PMR)
• Develop a medication-related patient-directed action plan (MAP)
• Intervene and/or refer when appropriate
• Document all services and interventions, communicate results of the MTM
encounter, and provide appropriate follow-up
PHARMACIST PRACTICE AREAS (SITES AND TYPES OF PRACTICE)
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
REQUIREMENTS AND VOLUNTARY CREDENTIALING AND
CERTIFICATE PROGRAMS

Licensure. graduates of a college of pharmacy accredited by the American

Council on Pharmaceutical Education (ACPE)
Foreign pharmacy schools are eligible for licensure if they have earned the
Foreign Pharmacy Graduate Examination Committee (FPGEC) certification
All states except California require successful completion of the North
American Pharmacist Licensure Examination (NAPLEX) (California administers
its own licensing examination.)
Many states also require successful completion of the Multi-State Pharmacy
Jurisprudence Examination (MPJE)
Relicensure. Most licensing boards require that pharmacists earn continuing
education units (CEUs) for relicensure
 VOLUNTARY CREDENTIALING AND
CERTIFICATE PROGRAMS
Postlicensure credentialing is voluntary and is available at the specialist or disease
level indicate that the pharmacist has additional expertise above and beyond what is
required for licensure.
Specialist credentialing. Board certification (official recognition of specific knowledge
and skills) is achieved in addition to state and federal profession. The Board of
Pharmacy Specialties (BPS)
Added Qualifications (AQ). (e.g., Board Certified with Added Qualifications). Added
Qualifications in infectious diseases pharmacotherapy and cardiology
pharmacotherapy are currently available within the pharmacotherapy specialty practice
area.
 PHARMACIST CREDENTIALS

Pharmacists are eligible for a variety of voluntary credentials

BCNP, Board Certified Nuclear Pharmacist,
BCNSP, Board Certified Nutrition Support Pharmacist
BCOP, Board Certified Oncology Pharmacist
BCPP, Board Certified Psychiatric Pharmacist
BCPS, Board Certified Pharmacotherapy Specialist
MULTIDISCIPLINARY DISEASE-SPECIFIC
CREDENTIALING
Certification in select disease-specific multidisciplinary certification
programs.
Residency is defined as an “organized, directed, postgraduate
training program in a defined area of pharmacy practice.
 Residencies provide pharmacists with 1 to 2 years of supervised experience
in practice and management activities.
 Postgraduate year 1 (PGY-1) residency programs train generalists
 Postgraduate year 2 (PGY-2) residency programs train pharmacists in a specialty patient care area

Fellowship is a highly individualized program designed to prepare

the pharmacist to become an independent researcher.
 Fellows spend approximately 80% of their time in research-related activities
THE CLINICAL ENVIRONMENT
 Acute care hospitals provide inpatient care.
 Patients are hospitalized for major surgery, treatment of acute disorders, and diagnostic
evaluations and procedures.
 Long-term care facilities, such as nursing homes and rehabilitation centers,
provide health care for patients who require skilled management of chronic
disorders.
 Home health care services are available for chronically ill and disabled patents.
 The medical home is a relatively new concept.
 “a concept or model of care delivery that includes an ongoing relationship between a
provider and patient, around-the-clock access to medical consultation, respect for a
patient’s cultural and religious beliefs, and a comprehensive approach to care and
coordination of care through providers and community services”
HEALTH CARE SETTINGS
OUTPATIENT
Clinics
Day surgery units
Emergency departments
Home health care
Private offices
INPATIENT
Hospitals
LONG-TERM CARE
FACILITIES
Rehabilitation centers
Skilled nursing homes
HEALTH CARE PROFESSIONALS
The American Medical Association recognizes more than 80 health
care–related careers, including physician, pharmacist, nurse, and
allied health professional
 Allied health care professionals, also known as paramedicals, provide health care
services and perform tasks under the direction of physicians.

Physicians
Physicians, doctors who have medical or osteopathic degrees, are
generally considered the health care team leaders.
 Allopathic physicians rely on standard treatment modalities
 Osteopathic physicians use the additional technique of spine and joint
manipulation to treat disease
ALLIED HEALTH CARE PROFESSIONALS
 Anesthesiologist assistant
 Anesthesia technologist/technician
 Athletic trainer
 Cardiovascular technologist
 Electroneurodiagnostic technologist
 Emergency medical technician/paramedic
 Exercise scientist
 Kinesiotherapist
 Medical assistant
 Medical illustrator
 Occupational therapist
 Orthotist and prothetist
 Perfusionist
 Polysomnographic technologist
 Respiratory therapist
 Surgical assistant
 Surgical technologist
Nurses
Nurses care for the physical and psychosocial needs of patients
and carry out physician-directed orders regarding patient care.
 associate degree in nursing (ADN) & bachelor of science in nursing (BSN)
are registered nurses (RNs)
 Certified Critical Care Registered Nurse (CCRN)
 NP education is shifting from master’s degrees and/or post-master’s certificates to the doctor of
nursing practice (DNP).
 NPs typically have unlimited prescriptive authority

Physician Assistants
 Practice medicine with physician supervision
 PAs perform many routine tasks (patient interviews, patient examinations), order and
interpret laboratory and diagnostic tests, treat minor illness, counsel patients, and provide
patient education.
 PAs can prescribe medications in many states.
THE HEALTH CARE TEAM
The health care team consists of all health care professionals who
have responsibility for patient care plus the patient.
All members of the health care team contribute their profession’s
unique knowledge and skills.
Pharmacists, the “drug experts” on the team, help teams develop,
implement, and monitor the therapeutic regimen and provide
drug information and education services to the patient and team.
Students have a unique role on the health care team.
 For example, pharmacy students are expected to provide patient focused care under the
direct supervision of a licensed pharmacy preceptor
THE HEALTH CARE TEAM. THE HEALTH CARE TEAM CONSISTS OF THE
PATIENT AND ALL HEALTH CARE PROFESSIONALS TAKING CARE OF THE
PATIENT, INCLUDING STUDENTS IN HEALTH CARE PROFESSIONS
THE MEDICAL TEAM
Medical teaching teams composed of physicians, medical students, and,
depending on the hospital, other health care professionals
 ATTENDING TEAM ROUNDS. ATTENDING TEAM ROUNDS
OFTEN TAKE PLACE IN A CONFERENCE ROOM

Attending team rounds often take place in a conference room. (From Perry AG: Clinical nursing skills and techniques, ed 7, St Louis, Mosby.)
MEDICAL TEAM COMPOSITION IN TEACHING HOSPITALS

TYPICAL TEAM MEMBERS

Attending physician
Senior or junior medical resident
Intern
Senior medical student
Junior medical student
OTHER TEAM MEMBERS
Medical ethicist
Nurse
Occupational therapist
Pharmacist
Respiratory therapist
Social worker
Students (dental, nursing,
pharmacy)
THE HOSPITALIZED PATIENT. TEAM ROUNDS MAY BE CONDUCTED IN
THE PATIENT’S ROOM.

(From Frownfelter D: Cardiovascular and pulmonary physical therapy: evidence and practice, ed 4, St Louis, 2006, Mosby.)
Attending Physician
 The attending physician is the senior physician on the medical team.
 The attending physician assumes responsibility for all patients assigned to the team and provides guidance
and direction to team members.
 Patient presentations may take place in a conference room, in the hallway outside of the patient’s room, or in
the patient’s room

Fellows
 Medical fellows are physicians who have completed residency training and have elected to continue their
training in a research-oriented fellowship program.

Residents
 Medical residents are physicians who have graduated from medical school and are in structured and
supervised residency training programs.
 First-year residents (sometimes designated as postgraduate year 1, PGY1, or PG1 trainees) are known as
interns.
 Second-year internal medicine residents (sometimes designated as postgraduate year 2, PGY2, or PG2 trainees)
also are known as junior admitting residents (JARs).
 Third-year medical residents (sometimes designated as postgraduate year 3, PGY3, or PG3 trainees), also
known as senior admitting residents (SARs),
 The chief medical resident is a senior medical resident who, in addition to the usual resident responsibilities, has
administrative responsibility
THE OUTPATIENT ENVIRONMENT
 Examples of outpatient (ambulatory) settings include private offices,
outpatient clinics, day surgery units (also known as short procedure units), and
emergency departments.
 Physicians and other health care professionals (e.g., PAs, NPs, pharmacists)
interact with and care for ambulatory patients in private offices and clinics
THE AMBULATORY PATIENT. THE PATIENT AND HEALTH
CARE PROFESSIONAL IN AN AMBULATORY PATIENT CARE SETTING

(From Wilson SF, Giddens JF: Health assessment for nursing practice, ed 4, St Louis, 2009, Mosby.)
THE MEDICAL RECORD
 The inpatient medical record, also known as the chart, is a legal document
that includes sections for hospital specific admission and insurance
information, initial history and physical examination, daily progress notes
written by every health care professional who interacts with the patient,
consultations, nursing notes, laboratory results, and radiology and surgery
reports.
 Most charts include sections for medication orders and other types of orders
(e.g., laboratory testing, dietary orders, diagnostic procedures
 Problem-oriented medical record (POMR)
 Electronic medical record (EMR)