Description
This is a presentation explains Industrialization of production of medicines, quality care standards, pharmacy education alongwith examples of medical management.
STANDARDS OF CARE
IN COMMUNITY PHARMACY PRACTICE
1
Community pharmacy
Industrialisation of production of medicines
2
Community pharmacy
Advisor on health-related issues
3
Community pharmacy
• Quality policy and assessment
4
Community pharmacy
Strengths
• Employment
Weaknesses
• Apparent loss of traditional role
• Accessibility
• Deprofessionalisation
• Economic scenario
5
Community pharmacy
“Some form of quality programme
should be implemented
internationally within the profession or even better within the pharmacy itself”
6
Community pharmacy
• Quality policy and assessment
• Establishment of pharmacy standards
7
Quality Care Standards Good Pharmacy Practice Guidelines 1993 Adopted in Japan. 1997 In Vancouver presentation of revised version endorsed by the WHO Expert Committee on Specifications for Pharmaceutical Preparations. 1998 In The Hague adoption of the guidelines on Good Pharmacy Practice in Developing Countries. 2003 In Sydney presentation of results from the Working Group on Quality Care Standards
8
Quality Care Standards Working Group Response (2003) 23 organisations replied (n=110, 21%) 21 organisations had quality care standards
EUROPE Croatia Denmark Finland France Germany Israel Malta The Netherlands Norway Nordic Association Portugal Serbia* Sweden Switzerland United Kingdom
Western Hemisphere Canada USA AFRICA Uganda JAPAN Japan ASIA, PACIFIC Australia** India Indonesia*
9
Quality Care Standards
Purpose for development
• •
Area specific Generic approach
10
Quality Care Standards
Purpose for development
Area Specific
? Drug information and counselling
(Nordic Association) ? Provision of pharmacist recommended medicines (Australia, Pharmaceutical Society)
? Prevention of errors in drug dispensing (Japan)
11
Quality Care Standards Presentation
•
Guidelines
•
Audit
12
Quality Care Standards
Presentation
Quality Care Standards: Guidelines
Guidelines are presented to create a quality environment, to promote responsibility for quality, to present aims and objectives of service provided and to present standard procedures.
13
Quality Care Standards
Presentation - Guidelines
Examples - Dutch Pharmacy Standard
Informing and advising the patient
1.1.0 The pharmacist’s first concern is the welfare of the client. He will respect the client’s own responsibility. 1.2.0 The pharmacist supports the client to make well considered decisions regarding the use of medicines and health care products.
14
Quality Care Standards
Presentation
Quality Care Standards: Audit
? Procedures to be followed are presented
? Quantitative approach - scoring ? Objective results
15
Quality Care Standards
score
Greeting the patient I. The pharmacist gives immediate attention to the patient in an orderly way 3 The pharmacist greets the patient with a friendly message 2
II.
III. The pharmacist addresses the patient by
name 2
IV. The pharmacist is recognised by the patient or introduces himself to the patient 3
16
Quality Care Standards
Areas included in generic standards (FIP working group, 2003)
Extemporaneous preparations 15 (83%) Handling of stock Interaction with patients Non-presc medicines 14 (78%) 13 (72%) 13 (72%)
Setting of the pharmacy
Documentation systems Dispensing presc. medicines
13 (72%)
12 (67%) 11 (61%)
17
Quality Care Standards
Extemporaneous preparations
India
Written standard operating procedures as well as standard formulations should be maintained for commonly made extemporaneous preparations.
Batch numbers of each medicine used for compounding should be recorded.
18
Quality Care Standards
Areas included in generic standards (FIP working group, 2003)
Extemporaneous preparations 15 (83%) Handling of stock Interaction with patients Non-presc medicines 14 (78%) 13 (72%) 13 (72%)
Setting of the pharmacy
Documentation systems Dispensing presc. medicines
13 (72%)
12 (67%) 11 (61%)
19
Quality Care Standards Handling of stock
United Kingdom
Pharmacists must not purchase or supply any medicines, food supplement or health care related product where they have reason to doubt its quality or safety.
20
Quality Care Standards Handling of stock
Canada The pharmacist ensures the removal of outdated, mislabelled or deteriorated drugs, and those recalled from regular stock, for storage in a separate area for appropriate disposal.
21
Pharmacy Education
Community pharmacists contribute to patient care in multiple processes by identifying, resolving and preventing medicine-related
problems and facilitating access to safe and effective pharmacotherapy.
22
Pharmacopoeia
Drug information Formularies Listing of drugs used in a particular setting eg. British National Formulary (BNF)
Compendium
containing descriptions,
standards, official
assays for medical substances eg.
European
Pharmacopoeia (EP)
Pharmacopoeia
23
Standards
•
• •
Standards
• Quality Care
Quality Control
Quality Assurance Good
Standards
• Good Clinical Practice
Manufacturing
Practice (GMP)
•
• Treatment protocols
• Chronic disease
Good Distribution
management
Practice (GDP)
•
Good Laboratory Practice (GLP)
•
ISO
24
Example of Treatment Protocol for Heart Failure:
1.
ACE inhibitors: standard of care unless there is
a contra-indication to their use
2. 3. 4. 5.
Beta-adrenoceptor blockers: carvedilol Diuretics: thiazide/loop, spironolactone Digoxin Isosorbide dinitrate+hydralazine
25
Example of Chronic Disease Management:
Management of hypertension
? confirmation of diagnosis through repeated blood
pressure measurement
? patient assessment ? reviewing treatment options ? establishing treatment goals ? identification and management of other risk
factors (eg hyperlipidaemia)
? follow-up
26
Example of Chronic Disease Management:
Management of hypertension
27
Example of Chronic Disease Management:
Management of hypertension
Physiology, Biochemistry
?
Peripheral vascular resistance (depends on arteriolar volume)
?
Cardiac output (depends on heart rate, contractility, filling pressure, blood volume)
Blood Pressure= Cardiac Output X Peripheral Vascular Resistance
28
Example of Chronic Disease Management:
Management of hypertension Blood Pressure Measuring Equipment
? traditional mercury sphygmomanometer ? semi-automatic apparatus ? automatic apparatus ? Accuracy - Quality - CE marking
Medical devices
29
Example of Chronic Disease Management: Management of hypertension
Pharmacology, Medicinal Chemistry
Angiotensin Converting Enzyme Inhibitors
? Sulfhydryl group in captopril ? Dicarboxylate-containing ACE inhibitors
eg enalapril, perindopril
? Hydrophobic, heterocyclic rings
captopril
enalapril
perindopril
30
Example of Chronic Disease Management:
Management of hypertension- Pharmacist review
?To monitor blood pressure
?To provide patient support with drug therapy and
lifestyle modifications
?To discuss symptoms and medication (identify
unwanted drug effects, any other drugs taken by patient for other disease states)
?To evaluate need for patient referral to physician ?To consider use of other drugs that reduce
cardiovascular risk (aspirin and statin therapy)
31
doc_705397148.ppt
This is a presentation explains Industrialization of production of medicines, quality care standards, pharmacy education alongwith examples of medical management.
STANDARDS OF CARE
IN COMMUNITY PHARMACY PRACTICE
1
Community pharmacy
Industrialisation of production of medicines
2
Community pharmacy
Advisor on health-related issues
3
Community pharmacy
• Quality policy and assessment
4
Community pharmacy
Strengths
• Employment
Weaknesses
• Apparent loss of traditional role
• Accessibility
• Deprofessionalisation
• Economic scenario
5
Community pharmacy
“Some form of quality programme
should be implemented
internationally within the profession or even better within the pharmacy itself”
6
Community pharmacy
• Quality policy and assessment
• Establishment of pharmacy standards
7
Quality Care Standards Good Pharmacy Practice Guidelines 1993 Adopted in Japan. 1997 In Vancouver presentation of revised version endorsed by the WHO Expert Committee on Specifications for Pharmaceutical Preparations. 1998 In The Hague adoption of the guidelines on Good Pharmacy Practice in Developing Countries. 2003 In Sydney presentation of results from the Working Group on Quality Care Standards
8
Quality Care Standards Working Group Response (2003) 23 organisations replied (n=110, 21%) 21 organisations had quality care standards
EUROPE Croatia Denmark Finland France Germany Israel Malta The Netherlands Norway Nordic Association Portugal Serbia* Sweden Switzerland United Kingdom
Western Hemisphere Canada USA AFRICA Uganda JAPAN Japan ASIA, PACIFIC Australia** India Indonesia*
9
Quality Care Standards
Purpose for development
• •
Area specific Generic approach
10
Quality Care Standards
Purpose for development
Area Specific
? Drug information and counselling
(Nordic Association) ? Provision of pharmacist recommended medicines (Australia, Pharmaceutical Society)
? Prevention of errors in drug dispensing (Japan)
11
Quality Care Standards Presentation
•
Guidelines
•
Audit
12
Quality Care Standards
Presentation
Quality Care Standards: Guidelines
Guidelines are presented to create a quality environment, to promote responsibility for quality, to present aims and objectives of service provided and to present standard procedures.
13
Quality Care Standards
Presentation - Guidelines
Examples - Dutch Pharmacy Standard
Informing and advising the patient
1.1.0 The pharmacist’s first concern is the welfare of the client. He will respect the client’s own responsibility. 1.2.0 The pharmacist supports the client to make well considered decisions regarding the use of medicines and health care products.
14
Quality Care Standards
Presentation
Quality Care Standards: Audit
? Procedures to be followed are presented
? Quantitative approach - scoring ? Objective results
15
Quality Care Standards
score
Greeting the patient I. The pharmacist gives immediate attention to the patient in an orderly way 3 The pharmacist greets the patient with a friendly message 2
II.
III. The pharmacist addresses the patient by
name 2
IV. The pharmacist is recognised by the patient or introduces himself to the patient 3
16
Quality Care Standards
Areas included in generic standards (FIP working group, 2003)
Extemporaneous preparations 15 (83%) Handling of stock Interaction with patients Non-presc medicines 14 (78%) 13 (72%) 13 (72%)
Setting of the pharmacy
Documentation systems Dispensing presc. medicines
13 (72%)
12 (67%) 11 (61%)
17
Quality Care Standards
Extemporaneous preparations
India
Written standard operating procedures as well as standard formulations should be maintained for commonly made extemporaneous preparations.
Batch numbers of each medicine used for compounding should be recorded.
18
Quality Care Standards
Areas included in generic standards (FIP working group, 2003)
Extemporaneous preparations 15 (83%) Handling of stock Interaction with patients Non-presc medicines 14 (78%) 13 (72%) 13 (72%)
Setting of the pharmacy
Documentation systems Dispensing presc. medicines
13 (72%)
12 (67%) 11 (61%)
19
Quality Care Standards Handling of stock
United Kingdom
Pharmacists must not purchase or supply any medicines, food supplement or health care related product where they have reason to doubt its quality or safety.
20
Quality Care Standards Handling of stock
Canada The pharmacist ensures the removal of outdated, mislabelled or deteriorated drugs, and those recalled from regular stock, for storage in a separate area for appropriate disposal.
21
Pharmacy Education
Community pharmacists contribute to patient care in multiple processes by identifying, resolving and preventing medicine-related
problems and facilitating access to safe and effective pharmacotherapy.
22
Pharmacopoeia
Drug information Formularies Listing of drugs used in a particular setting eg. British National Formulary (BNF)
Compendium
containing descriptions,
standards, official
assays for medical substances eg.
European
Pharmacopoeia (EP)
Pharmacopoeia
23
Standards
•
• •
Standards
• Quality Care
Quality Control
Quality Assurance Good
Standards
• Good Clinical Practice
Manufacturing
Practice (GMP)
•
• Treatment protocols
• Chronic disease
Good Distribution
management
Practice (GDP)
•
Good Laboratory Practice (GLP)
•
ISO
24
Example of Treatment Protocol for Heart Failure:
1.
ACE inhibitors: standard of care unless there is
a contra-indication to their use
2. 3. 4. 5.
Beta-adrenoceptor blockers: carvedilol Diuretics: thiazide/loop, spironolactone Digoxin Isosorbide dinitrate+hydralazine
25
Example of Chronic Disease Management:
Management of hypertension
? confirmation of diagnosis through repeated blood
pressure measurement
? patient assessment ? reviewing treatment options ? establishing treatment goals ? identification and management of other risk
factors (eg hyperlipidaemia)
? follow-up
26
Example of Chronic Disease Management:
Management of hypertension
27
Example of Chronic Disease Management:
Management of hypertension
Physiology, Biochemistry
?
Peripheral vascular resistance (depends on arteriolar volume)
?
Cardiac output (depends on heart rate, contractility, filling pressure, blood volume)
Blood Pressure= Cardiac Output X Peripheral Vascular Resistance
28
Example of Chronic Disease Management:
Management of hypertension Blood Pressure Measuring Equipment
? traditional mercury sphygmomanometer ? semi-automatic apparatus ? automatic apparatus ? Accuracy - Quality - CE marking
Medical devices
29
Example of Chronic Disease Management: Management of hypertension
Pharmacology, Medicinal Chemistry
Angiotensin Converting Enzyme Inhibitors
? Sulfhydryl group in captopril ? Dicarboxylate-containing ACE inhibitors
eg enalapril, perindopril
? Hydrophobic, heterocyclic rings
captopril
enalapril
perindopril
30
Example of Chronic Disease Management:
Management of hypertension- Pharmacist review
?To monitor blood pressure
?To provide patient support with drug therapy and
lifestyle modifications
?To discuss symptoms and medication (identify
unwanted drug effects, any other drugs taken by patient for other disease states)
?To evaluate need for patient referral to physician ?To consider use of other drugs that reduce
cardiovascular risk (aspirin and statin therapy)
31
doc_705397148.ppt