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Clinical Pharmacy Process

M. Junaid Hassan Sharif


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Objectives
A: Basic Concepts
B: Clinical Pharmacy Requirements
C: Drug use process indicators
D: Level of Action of Clinical
Pharmacists
E: Activities of Clinical Pharmacists
F: Consultation process

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A- Basic Concepts
Clinical pharmacy is defined as that
area of pharmacy concerned with the
science and practice of rational
medication use.
Shift the focus from product
orientation towards patients
Ward pharmacy system : promote
safer use of medication

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1- Clinical Pharmacy
Clinical pharmacy comprises a set of functions
that promote the safe, effective and economic
use of medicines for individual patients.
Clinical Pharmacy includes all the services
performed by pharmacists practising in
hospitals, community pharmacies, nursing
homes, home-based care services, clinics and
any other setting where medicines are
prescribed and used.
The term clinical does not necessarily imply
an activity implemented in a hospital setting.
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2- Pharmaceutical care
Pharmaceutical care is a co-
operative, patient centered system
for achieving specific and positive
patient outcomes from the
responsible provision of medicines.
The practice of clinical pharmacy is
an essential component in the
delivery of pharmaceutical care

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Pharmaceutical care

Pharmaceutical care is the direct, responsible


Cure of the disease
Elimination or reductio
provision of medication-related care for the purpose
of symptoms
of achieving definite outcomes that improve
Arrest a of a
or slowing
patients quality of life. disease process
Prevention of disease
or symptoms

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3- Medicines management
Medicines management encompasses the way in which
medicines are;
1. Selected,
2. Procured,
3. Delivered,
4. Prescribed,
5. Administered
6. Reviewed

. to optimize the contribution that medicines make to


producing informed and desired outcomes of patient
care

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How does clinical pharmacy differ
from pharmacy?

The discipline of pharmacy embraces the


knowledge on synthesis, chemistry and
preparation of drugs

Clinical pharmacy is more oriented to the


analysis of population needs with regards to
medicines, ways of administration, patterns of
use and drugs effects on the patients.

The focus of attention moves from the drug to


the single patient or population receiving drugs.

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B: Clinical Pharmacy
Requirements
Knowledge of
drug therapy

Knowledge of
Knowledge of
nondrug
the disease
therapy

Knowledge of
Therapeutic
laboratory
planning
and diagnostic
skills
Patient skills

care

Drug
Communication
Information
skills
Skills

Physical Patient
assessment monitoring
skills skills

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C: Drug use process
indicators
DUP Action
Stage
Need for a Ensure there is an appropriate indication for each
drug drug and
that all medical problems are addressed
therapeutically
Select drug Select and recommend the most appropriate drug
based upon the ability to reach therapeutic goals,
with consideration of patient variables, formulary
status and cost of therapy
Select Select the most appropriate drug regimen for
regimen accomplishing
the desired therapeutic goals at the least cost
without
diminishing effectiveness or causing toxicity
Provide drug Facilitate the dispensing and supply process so that
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DUP Action
Stage
Monitor Monitor drug therapy for effectiveness or adverse
drug effects in
therapy order to determine whether to maintain, modify
or
discontinue
Counsel Counsel and educate the patient or caregiver
patient about the
patients therapy to ensure proper use of
medicines
Evaluate Evaluate the effectiveness of the patients drug
effectivenes therapy by
s reviewing all the previous steps of the drug use
process and
taking appropriate steps to ensure that the
therapeutic goals
are achieved
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D: Level of Action of Clinical
Pharmacists
Clinical pharmacy activities may
influence the correct use of
medicines at three different levels:
1. Before,
2. During
3. After the prescription is written.

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1. Before the prescription

Clinical trials
Formularies
Drug information
Drug-related policies

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2.During the
prescription
Counselling activity

Clinical pharmacists can influence the attitudes and


priorities of prescribers in their choice of correct
treatments.

The clinical pharmacist monitors, detects and


prevents Medication related problems

The clinical pharmacist pays special attention to the


dosage of drugs which need therapeutic monitoring.

Community pharmacists can also make prescription


decisions directly, when over the counter drugs are
counselled.
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Medication related problems
Categories of medication-related problems
Untreated indication
Treatment without indication
Improper drug selection
Too little drug
Too much drug
Non-compliance
Adverse drug reaction
Drug interaction

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3. After the prescription

Counselling
Preparation of personalised formulation
Drug use evaluation
Outcome research
Pharmacoeconomic studies

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E: Activities of Clinical
Pharmacists
The principle activities of a clinical pharmacist include:
1 Consulting
Analysing therapies, advising health care practitioners
on the correctness of drug therapy and providing
pharmaceutical care to patients both at hospital and at
community level.

2 Selection of drugs
Defining "drug formularies" or "limited lists of drugs" in
collaboration with hospital doctors, general
practitioners and decision makers.

3 Drug information
Seeking information and critically evaluating scientific
literature; organising information services for both the
health care practitioners and the patients.
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Activities of Clinical Pharmacists
4 Medication Review
Review medication chart, Review medication history

5 Attending Rounds

6 Drug use studies and research


Drug use studies/ pharmacoepidemiology/ outcome
research/ pharmacovigilance and vigilance in
medicinal devices: collecting data on drug
therapies, their costs and patient outcome through
structured and scientific methods.

7 Pharmacokinetics/ therapeutic drug


monitoring
Studying the kinetics of drugs and optimising the
dosage.
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Activities of Clinical
Pharmacists
9 Pharmacoeconomy
Using the results of clinical trials and
outcome studies to determine cost-
effectiveness evaluations.

10 Teaching & Training


Pre- and post-graduate teaching and
activities to provide training and education
programmes for pharmacists and other
health care practitioners

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F: Consultation Process
The ability of a pharmacist to consult
effectively is fundamental to
pharmaceutical care and this
includes establishing a platform for
achieving adherence/concordance.
Nurturing a relationship with the
patient is essential to understanding
their medication related needs.

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Mnemonics used in the pharmacy
consultation process
WWHAM
Who is it for?
What are the symptoms?
How long has it been going on?
Action taken?
Medicines taken?

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AS METTHOD
Age of the patient?
Self or for someone else?
Medicines being taken?
Exactly what do you mean (by the
symptom)?
Time and duration of the symptom
Taken any action (medicine or seen the
doctor)?
History of any disease?
Other symptoms?
Doing anything to alleviate or worsen the
symptom? 23
ENCORE
Evaluate the symptom, its onset, recurrence and
duration.
No medication is always an option.
Care when dealing with specific patient groups,
notably the elderly, the young, nursing mothers,
pregnant women, those receiving specific medication
such as methotrexate and anticoagulants, and those
with particular disease, for example, renal
impairment.
Observe the patient for signs of systemic disturbance
and ask about presence of fever, loss of weight and
any accompanying physiological disturbance.
Refer when in doubt.
Explain any course of action recommended.
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Summary
A: Basic Concepts
B: Clinical Pharmacy Requirements
C: Drug use process indicators
D: Level of Action of Clinical Pharmacists
E: Activities of Clinical Pharmacists
F: Consultation process

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