Clinical pharmacy introduction

Description
This is a presentation on Developing clinical practice, Drug use process , Medication related problems, Pharmaceutical care plan and Administration of drugs.

Clinical pharmacy

Key points
• • • • • • • Safe, effective and economic use of drugs Product oriented role Pharmaceutical care Specific positive patient outcome Patient assessment Regular review with patient develop pharmacy skills

Developing clinical practice • • • • Unit dose dispensing in USA . Cost effective safe drugs ( 1988 uk) Coding system ( drug use process) High physicians acceptance rate ( intensive care and pediatric practice) • Pharmacist involvement in wards

Drug use process indicators • • • • • • • • Need for a drug Select a drug Select regimen Provide drug Drug administration Monitor drug therapy Counsel patient Evaluate effectiveness

Medication related problems • • • • • • • • Untreated problem Treatment without indication Improper drug selection Subordinate and substandard dose Very high dose Non-compliance ADRs Drug interactions

Pharmaceutical care plan • Assessment: establish complete medical history, highlight drug related problems • Care plan: goals to optimize the care responsibilities to attain patient requirements • Evaluation: review progress

Consultation process • Building therapeutic relationship • Identify patient medication related needs • Establish an acceptable management plan with patient and patient information • Safety strategies and provide information guide.

Consultation process

• Pre consultation • Consultation behavior • Post consultation analysis

Functions of clinical pharmacy: steps • • • • • • • Need for drug therapy Select drug Administration of drugs Providing drugs Monitor therapy Patient advise and education Evaluating effectiveness

Patient details • • • • • • • Age Gender Ethnic /religious background Social history Presenting complaint Previous medical history Physical examinations and laboratory investigations • Diagnosis

Drug selection • • • • • • Identify drug-patient interactions Drug disease interactions Drug drug interactions Compare with guidelines Consult medical / healthcare staff Refer to higher hospitals

Administration of drugs
• • • • Dose Route Dosage form Documentation: information to care taker/nurse

Rational and effective prescribing

• • • • •

Maximize efficacy Minimize risk Minimize cost Respect patient choice Understand about inappropriate prescribing

Factors influencing prescribing • • • • • • Pharmaceutical industry Colleagues Pharmacist Budget Hospital patient

Patient journey • • • • Before admission On admission During stay On discharge

Delivery of pharmaceutical care • • • • • Prescribing monitoring Prescribing advise to medical and nursing staff Medication error and reporting ADRs Medication history Patient education and couprofessional and clinical auditsnselling • Therapeutic drug level monitoring

Critical care pharmacist • • • • • Multi organ failure and pharmacokinetics Multiple drugs and risk of interactions Difficulties to identify drug interactions Physical and chemical incompatibilities 24 hour availability of pharmacist

Oncology unit • Prescribing regimen • Dose modification in renal and hepatic insufficiency • Antimicrobial therapy • Nausea and vomiting • Anaphylactic shock • Palliative care



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