Clinical Pharmacy Practise

8/10/2019 Clinical Pharmacy Practise

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Clinical pharmacy practice

IntroductionClinical pharmacy can be delivered through

activities known as pharmaceutical care or

medicine management.

More recently, medicine management has

been defined as a holistic approach to patientcare through systematic management of the

patients medicines and a new partnership of

structured collaboration with the doctor.


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Type of

Pharmacist

Location Example of activity

Community

pharmacist

Hospital

pharmacist

Practice

pharmacist

Other

Pharmacy

Hospital

General

practice

Various

Medication review

Medication history

taking

Development ofprescribing policy

See community,Hospital, Practice

pharmacists


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The origins of clinical pharmacy come from the

hospital setting.

Nowadays, however, clinical pharmacy

services can be delivered in every setting

where pharmacists are employed.

Many pharmacists now combine differenttypes of employment


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The Development of Clinical Pharmacy

Until the mid 1960s, pharmacists were almost

solely involved in the purchase, manufacture

and supply of medicines.

In the USA the development of clinical

pharmacy began and a more clinically oriented

pharmacy curriculum was developed with theaward of a PharmD degree.


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There are two distinct themes in the report

that should be applied to clinical pharmacy

services, namely the provision of quality

health care, and the maintenance of

professional competence through continuing

professional development (CPD)


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Clinical Governance

There are four main components of clinical

governance

1. Clear lines of responsibility and

accountability for the overall quality of

clinical care;

2. A comprehensive programme of quality

improvement activities;


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3. Clear policies aimed at managing risks;

4. Procedures for all professional groups to

identity and remedy poor performance.

Audit

Clinical audit refers to the process of audit

carried out within a particular profession,usually by that profession.


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Clinical audit on the other hand is

multidisciplinary in nature and may be

undertaken by health care professionals from

any discipline.

Peer review

Assessing the performance of clinical

pharmacists involves issues of professionaljudgment.


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Peer review is often used as part of a

professional development programme rather

than as part of a formal assessment of

clinical pharmacy practice.

The aim is to develop the clinical knowledge

and skills of pharmacists to improve thequality of their practice.


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Rational medicine use

Drugs should be prescribed to maximize

effectiveness, minimize risks and costs, and

respect patients wishes.

Rational prescribing comprises five major

components :

a defensible formulation of thepatients problem;

Clarity of therapeutic intention;


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Access to independent data on drugs;

Communication with the patient;

Follow-up.

Evidence-based practice

Evidence-based practice should ideally

ensure that available resources are used

effectively and efficiently and that variation inclinical practice is minimized.


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To provide for the pharmaceutical needs of

patient groups and promote rational

prescribing, a few key tools are essential :

* Guidelines;

* Local poliocies and protocols;

* Prescribing advice;

* Evaluated drug information;* Formularies


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Guidelines

Guidelines are systematically developed

statements to assist practitioner and patientdecisions about appropriate health care for

specific clinical circumstances.

The majority of guidelines developed thusfar have been intended for medical

practitioners.

Pharmacists can be involved in thedevelopment and implementation of

guidelines.


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For example with the increasing numbers of

medicine that are available for purchase from

community pharmacies without a prescription(i.e OTC medicines), pharmacists needguidance and support to ensure that sales ofthese products maximize benefit and

minimize risk.

Local policies and protocols

Local protocols for the treatment of specific

clinical conditions can be derived fromnational guidelines


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Patient group directions

The regulatory framework for the way

medicines are supplied and administered

was recently reviewed.

Prescribing advice

Information about individual or practice

prescribing is available to most prescribers.

This information need to be evaluated before

it can be used to promote rational prescribing.


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Pharmaceutical Service Provision

Clinical pharmacy services are often directed

towards indibivual patients. These may be

customers in community pharmacies,

inpatients or outpatients in hospitals,

housebound patients and clients in

residential homes. Clinical pharmacyservices can also be provided at a


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population level. This can include the

involvement of pharmacists in the

development, implementation and monitoringof methods designed to promote the rational

use of medicines (e.g. guidelines, protocols ).

Pharmacists have a role, and indeed a

professional responsibility, to inform patients

receiving prescribed medicines and

customers purchasing OTC medicines, of the

risks associated with their use.


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Needs assessment

There are many diverse if patients for whom

health care must be planned.

The involvement of pharmacists essential,

since needs assessment must include

patients pharmaceutical needs.

Counselling and advice on prescribed

pharmacies and purchased medicine should

be available, as should compliance aids,

where necessary.


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Patient characteristics

Age

Most medicines are developed and tested

in adult populations before they gain their

licence. This means there is often little data

available regarding the use of medicines in

infants and children.


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Social Circumstances

Although the majority of patients live at

home, many will at some time experience a

hospital stay. Others live in residential or

nursing homes, in sheltered housing or in

other community-based settings. These

patients will experience varying degrees of

care.


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Pregnancy and breast feeding

Women who are pregnant, considering

pregnancy or who are breastfeeding have

differing pharmaceutical needs.

The importance of avoiding the

unnecessary use of medicines in pregnancy

or during lactation is another role wherepharmacists can be involved.


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Mob i l ity and disabi l i ty

Many patients will be unable to have directaccess to their local community pharmacy

due to impaired mobility or disability.

For example, patients with visual impairmentmay be unable to distinguish between

different medicines, therefore it is the

pharmacists responsibility to address thisproblem.


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Prioritization of care

Prioritization of care can be achieved by

adopting a systematic approach to practice.

It should always be remembered that

pharmacists have a duty of care to every

patient and customer.

Formulating a pharmaceutical care plan

In all interactions with patients, pharmacists

require to formulate an action ( how they


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intend to achieve the aim) and a measure

that tells them that their aim has been

achieved.The pharmacists has to respond to

symptoms, make a recommendation and

counsel the patient appropriately.

Monitoring patients

Various health care professionals monitor

patients to assess their progress with drug

therapy.


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Most commonly this involves doctors,

pharmacists and/or nurses.

Monitoring patients may be carried out for

one or more of the following reasons :

* to monitor health promotion measures;

* to monitor the progress of disease;

* to monitor for drug efficacy and/or drug

toxicity;* to monitor the patients satisfaction with

drug therapy.


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Counselling and advising the patient or

carer

The pharmacist should ensure that the

patient or their carer understand the

medication regimen and is able to administer

it correctly.

The patient should be advised on the

disposal of discontinued medicines.


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Communication between health care

professionals

As patients are transferred from onehealth care environment to another,

continuity of care relies on the

identification of, and effective

communication with, professionals

to whom responsibility is transferred.


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The confidentiality of information relating

to a patient and the patients family should

be respected throughout the transfer

process.

This also applies to the personal wishes

of the patient.

Documents

Clinical Pharmacy Practise