Clinical Pharmacy and Duties

Clinical Pharmacy

• Clinical pharmacy is defined as the area of pharmacy focused on the science and practice of rational medication use.
• Clinical pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.

Clinical Duties

• Prescription monitoring
• Prescribing advice to medical and nursing staff
• Medication errors and adverse drug reaction reporting
• Medication history-taking and reconciliation
• Patient education and counseling
• Pharmacokinetics and therapeutic drug level monitoring
• Personalized medicine
• Education and training
• Medicines formularies
• Clinical outcomes
• Professional and clinical audit

Prescription Monitoring

• Reviews prescriptions for medication dosing errors, appropriate administration route, drug interactions, and potential problems.
• Questions patients about their medication history, including allergies, intolerances, treatment efficacy, and adverse drug reactions (ADRs).

Medication Errors and Adverse Drug Reaction Reporting

• Adverse events occur in approximately 10% of hospital admissions.
• Medication errors account for about one-quarter of incidents that threaten patient safety.
• Clinical pharmacists play a key role in detecting and managing adverse drug reactions (ADRs) and reporting them.
• The Yellow Card Scheme allows pharmacists and other health professionals to report suspected ADRs.

Medication History-Taking and Reconciliation

• Pharmacists can take more accurate medication histories than other healthcare staff.
• Medicines reconciliation is recommended as soon as possible after admission to hospital.

Patient Education and Counseling

• Helping patients understand their medications and administration is a crucial part of clinical pharmacy.
• Empowers patients to take an active role in managing their own care.
• Improves patient knowledge of their treatment which leads to improved adherence.

Patient Compliance

• Defined as adherence to the prescribed treatment regimen.
• Adherence can be poor, especially with long-term conditions, and increases with the number and complexity of medications.
• Non-compliance can increase costs and lead to complications.

Concordance

• Use of "compliance" is being criticized in recent years, as it implies patients simply follow orders rather than making informed decisions.
• "Concordance" suggests a more appropriate description of the patient-healthcare professional relationship.
• Concordance is an agreement reached between patients and healthcare professionals where the patients' beliefs and preferences are considered in determining how medications are taken.
• Concordance involves patient education so patients can make informed choices about their medication.

Why Patient Education and Counselling?

• Nothing about me, without me - patients should be informed and involved in their treatment decisions.
• Importance of patients' understanding of treatment regimens.
• Improves patient adherence to treatment.

Self-Administration Schemes

• Systems to allow patients to administer their own medications while hospitalized.
• Provides diagnostic, educational, and empowering roles for patients.

Integrated Medicines Management

• Combines various clinical pharmacy services to improve patient care throughout their stay, especially at crucial phases like admission, monitoring, and discharge.

Pharmacokinetics and Therapeutic Drug Level Monitoring

• Knowledge of drug pharmacokinetics assesses dosing requirements for various patients.
• Clinically important drug interactions and adverse reactions can sometimes be predicted.
• Therapeutic drug monitoring (TDM) is often necessary for certain drugs with a narrow therapeutic index to keep it safe.

Personalized Medicine

• Focuses on tailoring treatment to individual patients' responses.
• Use of biomarkers helps improve treatment effectiveness.
• Pharmacogenetics helps to assess and account for significant variability in patient responses to medications.

Principles in the Use of Medicines

• Medicines should be used only when necessary.
• Benefit of use must be considered and balanced with possible risks.

Barriers to Proper Use of Medicines

• Patient compliance issues
• Patient confusion
• Communication problems
• Side effects
• Dispensing errors
• Cost of medicines
• Accessibility and availability

Education and Training

• Increased emphasis on postgraduate training for pharmacists.
• Clinical pharmacists play a role in training other healthcare staff.

Medicines Formularies

• Formularies are lists of recommended drugs for a given population.
• Formularies help to manage prescribing and initiate, develop, monitor, manage, and review local prescribing policies.

Clinical Outcomes

• Clinical outcomes are the best validation for the effectiveness and quality of medical care.
• Standardized mortality rates are used in large medical institutions to measure overall success.
• Patient reported outcome measures (PROMs) provide feedback on patient satisfaction in their healthcare experience,

Professional and Clinical Audit

• Brings together healthcare professionals from different sectors to assess and evaluate clinical practice.
• Aims to improve clinical care and outcomes for patients.
• Clinical pharmacists play role in clinical audit, analyzing and improving drug use practices.

Guidelines

• Guidelines are systematically developed statements to assist practitioners and patients, providing guidance for appropriate healthcare based on evidence and clinical practice.

Evidence-based Pharmacy

• Evidence behind therapy (effectiveness) based on systematic literature reviews, randomized controlled trials, observational studies, and expert opinions.

Identifying Patient Needs - Liver disease

• Liver disease can alter drug response due to metabolism issues.
• Lower doses are usually advised in patients with severe liver disease, and dose variations must be considered.

Identifying Patient Needs - Renal Impairment

• Renal impairment can cause issues with excreting drugs or metabolites.
• Dose adjustment is often necessary.

Adverse Drug Reactions (ADRs)

• ADRs are any unwanted effects to medications.
• ADR detection and recording are crucial.
• ADRs have classifications to determine their seriousness, and they can be mild, severe, or fatal reactions.

Pharmacist Actions in ADR Monitoring

• Analysis of ADR reports to identify high-risk patients or drugs.
• Educating prescribers and other healthcare personnel on the ADR program.
• Reporting to relevant authorities.

Drug Interactions

• Interactions (positive or negative) between medications can occur when multiple drugs are used simultaneously.
• Clinical significance and potential harm must be carefully evaluated.

Medication Errors

• Inappropriate prescribing, dispensing errors, or incorrect administration.
• Causes for errors are reviewed.

Practices to reduce medication errors

• Avoid unnecessary use of decimal points in drug quantities.
• Avoid using abbreviations for drug units.
• Names of drugs should be clearly written and not abbreviated.

Explore the essential aspects of clinical pharmacy, including medication therapy management and patient care practices. This quiz covers the roles of clinical pharmacists in prescription monitoring, medication safety, and patient education, emphasizing rational medication use and optimal health outcomes.