CLINICAL PHARMACY

ADR TREATMENT
WITHOUT
UNTREATED INDICATION
INDICATION

TOO LITTLE
TOO MUCH DRUG
DRUG

IMPROPER DRUG
SELECTION DRUG
INTERACTION

NON-
COMPLIANCE

MEDICATION- RELATED PROBLEMS

MEDICATION-RELATED PROBLEMS
• Associated with significant morbidity and
mortality
• thus, ways to prevent and manage MRPs
remained to be the priority of many HC facilities
in the US and UK.
 CLINICAL PHARMACY
• Expanded
pharmaceutical service
beyond medicine
preparation and
distribution
• bundle of patient-
centered services

• “Health science discipline

in which pharmacists
provide patient care that
optimizes therapy,
promotes health, wellness
and disease prevention”
ACCP definition:
• “The area of pharmacy concerned
with the science and practice of
rational medication use”
Clinical Pharmacy practice
• CLINICAL PHARMACISTS OPTIMIZE
PATIENT MEDICATION, PROMOTE HEALTH,
WELLNESS AND DISEASE PREVENTION.

• PROVIDE CARE BY BLENDING CARING

ORIENTATION WITH SPECIALIZED
THERAPEUTIC KNOWLEDGE, EXPERIENCE
AND JUDGEMENT FOR THE PURPOSE OF
ENSURING OPTIMAL PATIENT OUTCOMES.
NEED FOR TRANSFORMATION
• a challenge mostly to
hospital pharmacists
due to :
▫ greater complexity and
cost of medications
being handled
▫ more drug interactions
▫ Poor compliance
▫ more medication
management issues
(drug related
problems)
OBJECTIVES OF CLINICAL PHARMACY
• PATIENT SAFETY
• PROMOTE RATIONAL DRUG USE
• FOSTER OPTIMAL PATIENT OUTCOMES
PRINCIPLE BEHIND CLINICAL PRACTICE:
• Observing patient care
• Access to the patient’s medical chart
to note the drug regimen, evaluate
doctor’s orders including selection,
administration , interaction and
toxicity
• Familiarization with medical
abbreviations, terminologies, lab tests
relative to drug regimen
• providing in-service education to the
members of the HC team and the
patient
• gaining additional hands-on
education relative to the disease of
the patient
FEATURES OF A CLINICAL PHARMACY
SERVICE
• Physical presence of the pharmacist
in patient care areas
• interpretation of doctor’s order
• Preparation of patient drug profile
• preparation of unit doses and
endorsement to the nurse
• Drug info (patient education and
counseling)
• drug therapy monitoring
• participation in the cardio-
pulmonary rescucitation
(CPR )activity
ADVANTAGES OF CLINICAL PHARMACY
PRACTICE
• TO THE PATIENT:
▫ creates a double check system
▫ enhances patient compliance
▫ Ensures accurate drug charges
▫ Provides education on drug actions,
missed doses, among others
• TO THE MANAGEMENT
▫ Reduce losses
▫ affords better stock inventory
management
▫ eliminates pilferage and drug waste
▫ enhances customer satisfaction and
hospital image
• TO THE DOCTOR:
▫ provides professional support and more
time to examine and diagnose the
patient
▫ Provides scientifically valid information
and recommendation regarding use of
medications
• TO THE NURSES:
▫ improves interpretation of
medication orders and delivery
systems by reducing errors in
transcription
▫ allow more time for direct patient
care
▫ Provide details on drug indication,
dosage, reconstitution, ADR,
stability and storage
▫ enhances monitoring of prescribed
medicines and IV fluids at a given
time
• TO THE PHARMACIST:
▫ enable the pharmacist to expand her practice
beyond dispensing
▫ creates rapport with patients
▫ appreciation on the roles of each member of the
HC team
▫ creates confidence and professional
FULFILLMENT
Clinical Pharmacists Competencies
• CLINICAL PROBLEM SOLVING,
JUDGMENTAND DECISION MAKING
▫ monitor patients in the HC setting
▫ assess patient-specific medical problems
▫ Evaluate patient drug therapy and therapeutic
problems
▫ design a comprehensive drug therapy plan
▫ collaborate with patients, caregivers and other
HC professionals
• COMMUNICATION AND
EDUCATION
▫ educate patients & HC professionals
▫ communicate effectively
▫ document intervention in the patient
medical record
• MEDICAL INFORMATION EVALUATION AND
MANAGEMENT
▫ demonstrate motivation and commitment to
become a lifelong learner
▫ retrieve biomedical literature using appropriate
search strategies
▫ interpret biomedical literature
▫ integrate data obtained from multiple sources to
derive an overall conclusion
• THERAPEUTIC KNOWLEDGE
AREAS
▫ apply disease-oriented knowledge
 anatomy/physio
 Epidemiology, etiology, risk factors, s/s
 Natural course
 prognosis
 lab & dx test interpretation
OTHER CLINICAL PHARMACY SERVICES
• Medication reconciliation
• Education
• collaborative practice
• immunizations
• primary care
• identifying and resolving drug-related problems
CARE PROCESS
Ms. Melanie M.
Castro,RPh.,MSPH
KEY ELEMENTS
• ASSESSMENT
▫ getting full medication history
▫ assess actual and potential drug-related problems
• CARE PLAN
▫ Setting and achieving goals of pharmacotherapy and
other approaches
• EVALUATION
▫ assessing progress based on the stated patient
outcomes
▫ determining prognosis
CARE PROCESS

PHARMACEUTICAL ESTABLISHING THE SELECTING ADMINISTERING

CONSULTATION NEED FOR MEDICATION MEDICINE
THERAPY

PROVIDING THE MONITORING PATIENT ADVICE EVALUATING

MEDICINE THERAPY AND EDUCATION EFFECTIVENESS
ROLES OF A CLINICAL PHARMACIST
• DRUG INFORMATION
• ADR MANAGEMENT
• DRUG PROTOCOL MANAGEMENT
• PARTICIPATING IN MEDICAL ROUNDS
• ADMISSION DRUG HISTORIES
KEY TO PHARMACEUTICAL CONSULTATION
• WWHAM AS METTHOD ENCORE
▫ who is it for?
▫ what are the symptoms
▫ How long it has been going on?
▫ Action taken?
▫ medicines taken?
▫ age of the patient?
▫ self or for someone else?
▫ medicines being taken?
▫ exactly what do you mean by the symptoms?
▫ time and duration of symptoms
▫ taken any action?
▫ history of any disease?
▫ other symptoms?
▫ doing anything to alleviate or worsen the symptom?
PHARMACEUTICAL DECISIONS/CHOICE OF
DRUGS
• EVIDENCE-BASED MANAGEMENT
▫ analysis of drug literature
▫ be involved in developing, evaluating and
implementing treatment guidelines for patients’
diseases
▫ promoted by ASHP and APHA
• THERAPEUTIC PROBLEM SOLVING
PROCESSES
▫ APPROACHES INCLUDE:
 SOAP (SUBJECTIVE FINDINGS, OBJECTIVE
FINDINGS, ASSESSMENT AND PLAN)
 FARM (FINDINGS, ASSESSMENT,
RECOMMENDATIONS AND MONITORING)
 CPR ( CLINICAL PHARMACIST
RECOMMENDATION) TAXONOMY
 PMDRP ( PHARMACISTS MANAGEMENT OF
DRUG-RELATED PROBLEM)