Dispensing to Ambulatory Patients in Pharmacy Practice

Ambulatory Care Definition

• Ambulatory patients refer to patients not occupying beds at a hospital, including those in physician's offices, clinics, and health centers.
• Ambulatory care can be classified into three types: emergency care, referral or tertiary care, and primary care.

Emergency Care

• Emergency care is provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity.
• The absence of immediate medical attention could result in serious health jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

Tertiary Care

• Tertiary care is specialized consultative health care, usually given to inpatients, and includes complex procedures and interventions.
• May be long-term care, and basic evaluation is done in primary care.

Primary Care

• Primary care is the majority care, providing daily personal health needs, including prevention, health, and initial care.
• Basic health evaluation, general discomfort, early complaints, symptoms, and issues are addressed in primary care.

Ambulatory Care Growth Attributes

• Ambulatory care growth is attributed to the supplementation of in-patient teaching programs, demands of population growth and increase in access to healthcare services, community health program participation, and focus on primary care.

Ambulatory Care Pharmaceutical Services

• Pharmaceutical services in ambulatory care encompass the provision of health care services and education to patients who seek medical attention but do not require admission.
• Patient-oriented pharmaceutical services are deemed required, and directors are responsible for developing and maintaining comprehensive pharmaceutical services.
• Activities include obtaining and documenting patient medication histories, monitoring safety and efficacy of drug therapy, providing drug information, assisting prescribers in proper selection and adjustment of drug therapies, and detecting and reporting adverse drug reactions, interactions, and non-compliant behavior of patients.

Minimum Standards for Ambulatory Care

• Pharmaceutical services in ambulatory care must be directed by a qualified pharmacist.
• The appropriateness of therapy should be verified by a pharmacist.
• Prevention of duplication of drug therapies and contraindications is ensured.
• All medicines dispensed to patients are correctly and completely labeled and in accordance with all applicable regulations and standards of practice.
• Upon receipt, it is the responsibility of the pharmacist to ensure patient or caretaker's understanding related to the use of medicine.

Residency Training in Ambulatory Care

• Residency programs are post-graduate programs of training that provide clinical pharmacy services to ambulatory care patients.
• Training sites should include institutional ambulatory care settings, satellite clinics, and have minimum standards of ASHP.

Dispensing Routine in Ambulatory Care

• Dispensing routine in ambulatory care is similar to both discharge and community care.
• Patients take written prescriptions by the physician, which are given to the pharmacist, where they are dispensed.
• The pharmacist guarantees that the patient gets the right medication, provides instructions, and labels the medicine.
• Maintenance of payments by the pharmacist and finally, payment by the patient.

Labeling Requirements

• Labeling requirements vary according to federal laws and include minimum standards such as name, address, and telephone number of the pharmacy, date of dispensing, serial number of the prescription, patient's full name, name, strength, and dosage form of the medication, directions to the patient for use of the medication, authorized refills, name of the prescriber, precautionary information, and initials (or name) of the responsible pharmacist.

Medication Orders

• All medication orders shall be reviewed for legality and clinical appropriateness by a pharmacist before being dispensed.
• Medication orders shall contain at a minimum the patient's name and address, medication name, dose, frequency, route, and quantity or duration, prescriber's name, address, and telephone number, and DEA number for controlled substances.

Assess your knowledge of ambulatory care pharmaceutical services, including dispensing processes and minimum standards. This quiz covers pharmacy practice and residency training in ambulatory care settings.