Clinical Pharmacy Practice Overview

Study Notes

Clinical pharmacy comprises a set of skills that promote the optimal use of medicines for individual patients.
Optimizing the use of medicines requires a patient-centered approach that is grounded in principles of safety, evidence-based and consistent practice, and an understanding of the patient's experience.
Clinical pharmacy has enabled pharmacists to shift from a product-oriented role towards direct engagement with patients.
Achieving specific and positive patient outcomes from the optimal use of medicines is a characteristic of the pharmaceutical care process.
The practice of clinical pharmacy is an essential component of pharmaceutical care.
The three main elements of the care process are assessing the patient, determining the care plan and evaluating the outcome.

The emergence of clinical pharmacy as a form of professional practice has been attributed to the poor medicines control systems that existed in hospitals during the early 1960s.
In the UK the unification of the prescription and the administration record meant this document needed to remain on the hospital ward and required the pharmacist to visit the ward to order medicines.
Clinical pharmacy developed from the presence of pharmacists in these patient areas and their interest in promoting safer medicines use.

Clinical pharmacy in the 1980s grew because of its ability to promote the cost-effective use of medicines in hospitals.
As a result, the 1988 UK government endorsed the implementation of clinical pharmacy services to secure value for money from medicines.
This led several groups to develop ways of measuring pharmacists' clinical interventions.
Coding systems were necessary to aggregate large amounts of data in a reliable manner, and many of these drew upon the eight steps of the drug use process (DUP) indicators.

Ensure appropriate indication for each medicine
- All medical problems are addressed therapeutically.
- Consider deprescribing medicines that are no longer appropriate.
Select & recommend the most appropriate medicine based upon the ability to reach therapeutic goals
- Consider patient variables, formulary status, and cost of therapy.
Select the most appropriate medicines for accomplishing the desired therapeutic goals at the least cost without diminishing effectiveness or causing toxicity.
Facilitate dispensing and supply process so that the medicines are accurately prepared, dispensed in a ready-to administer form and delivered to the patient.
Monitor medicines for effectiveness or adverse effects to determine whether to maintain, modify or discontinue.
Counsel and educate the patient or the caregiver about the patients therapy to ensure proper use of medicines.
Evaluate the effectiveness of the patients medicines by reviewing all the previous steps of DUP and taking appropriate steps to ensure that the therapeutic goals are achieved.

Clinical Pharmacy
- Clinical pharmacy comprises a set of functions that promote the safe, effective and economic use of medicines for individual patients.
- The clinical pharmacy process requires the application of specific knowledge of pharmacology, pharmacokinetics, pharmaceutics therapeutics to patient care.
Pharmaceutical Care
- Pharmaceutical care is a patient-centered, outcomes-oriented pharmacy practice that requires the pharmacist to work in collaboration with other healthcare professionals to achieve optimal medication therapy outcomes for individual patients.