Pharmacy Settings and Role of Pharmacist Lecture PDF

Pharmacy Settings and Role of Pharmacist I (Community Pharmacy) Community pharmacists are the health professionals most accessible to the public. They supply medicines in accordance with a prescription or, when legally permitted, sell them without a prescription In addition, their pro...

Pharmacy Settings and Role of Pharmacist I (Community Pharmacy) Community pharmacists are the health professionals most accessible to the public. They supply medicines in accordance with a prescription or, when legally permitted, sell them without a prescription In addition, their professional activities also cover: Counselling Drug information to health professionals, patients and the general public. Participation in health-promotion programmes. They maintain links with other health professionals in primary health care. Work in community pharmacy : The comprehensive change in work environment “re-engineering” is defined as “The fundamental rethinking and radical redesign of business process to achieve dramatic improvements in critical measures of performance, such as cost, quality, service and speed” Role change To change from product-oriented to patient-oriented, systematically evaluate: Ø Pharmacy’s operations Ø Workflow Ø Staff activities Ø Manpower requirements Identify work activity Prescription dispensing is the major activity Ø Request for medication Ø Refill or new prescription entered into the computer Ø Product is selected Ø Bottle filled or product compounded  Prescription dispensing is the major activity Ø Labeling Ø Final check Ø Counseling Ø Paying to the pharmacy Redifining role : Pharmacist must retain responsibility for: Ø Verifying the accuracy of dispensed products Ø Doing prospective drug utilization review Ø Patient counseling Other tasks delegated to trained technicians Estimitting peersonal need : Percent of time each dispensing-related task is performed by a pharmacist, technician, or clerk Relative contribution of each staff category Re-engineering Ø Each individual task evaluated and responsibility reassigned Translate relative contribution percentage to calculated dispensing hours Staffing adjesment: Staff scheduling and hiring Ø Reassigning duties to existing staff Ø Hiring additional staff ü Optimal approach, hire workers earning the lowest wage Staff training Determine each staff member’s baseline skills Outline individual staff members’ training needs Use peer-training methods Develop appropriate job description Staff recuriment : Qualifications for technical staff Ø Good interpersonal skills Ø Detail oriented Ø Quick to learn new skills and concepts Ø Can deal with the stress of a demanding workload Qualifications for technical staff Ø For technician who will process prescriptions: Able to read and interpret physician orders Knowledge of drug names Familiar with pharmacy billing methods Computer literate Qualifications for technical staff Ø For technician who will process prescriptions: Above-average aptitude for math Professional appearance Ability to work independently Technician certification or medical training background Pharmacy Settings and Role of Pharmacist II (Hospital pharmacy) Hospital Pharmacy Definition: A department, service or domain in the hospital organization managed under the direction of a professionally, legally qualified pharmacist. 45Division of hospital pharmacy 1. In-Patient Pharmacy: Provide medications for all in- patients of the hospital on a 24-hour per day basis. 2. Out-Patient pharmacy: Compound and dispense out-patient prescriptions. 3. TPN Pharmacy: Nutritional therapy for patients who suffer from a poorly functioning GI tract or who have disorders requiring bowel rest. 4. CDR Pharmacy: Provide customized chemotherapy regimen. 5. Manufacturing pharmacy: Manufacture wide variety of items in common use at the hospital. 6. Drug & poison information: Provide drug information on drugs and drug therapy to doctors, nurses, medical and nursing students and the house staff. 7. Satellite pharmacy: Provides services for the patients which is dependent upon the centrally located pharmacy for administrative control, staffing, and drug procurement. 8. Store/Inventory pharmacy: Maintain drug inventory control. Purchase, receive, store and distribute drugs. GOALS OF HOSPITAL PHARMACY 1. To provide the benefits of a qualified hospital pharmacist to patients and health care institutions. 2. To assist in providing an adequate supply of such qualified hospital pharmacists. 3. To assure a high quality of professional practice through the establishment and maintenance of standards of professional ethics, education through the promotion of economic welfare. 4. To promote research in hospital pharmacy practices and in the pharmaceutical sciences in general. 5. To disseminate pharmaceutical knowledge by providing for interchange of information among hospital pharmacists and with members of allied specialties and professions. 10Types of services 1. Support services 2. Product services 3. Clinical services 4. Educational services 111: Support services Ordering and properly storing medications and maintaining an inventory of pharmaceuticals and associated medical supplies. Billing for services. Installing and maintaining computer systems. e.g. procurement and supply pharmacy (store) 2: Product services Dispensing, preparing and processing medication orders for inpatients and maintaining required patient records and drug control records. e.g. In-patient pharmacy 3: Clinical services Managing the formulary systems  Evaluating drug use. Reviewing drug orders for appropriateness. e.g. TDM pharmacy. 4: Educational services Providing education about medications to pharmacy staffs, other healthcare professionals, the public and patients and their caregivers. e.g. Drug information/Out-patient pharmacies Hospital Pharmacy Personnel The personnel in a hospital pharmacy are classified into 3 categories : Professional: All pharmacists and management. Technical: Pharmacy technicians involved in the drug- related process. Support: Non-licensed personnel involved in providing services that support the drug-related process and/or management functions. Roles and Responsibilities of Hospital Pharmacists 1. Interact closely with the prescriber and promote the rational prescribing and use of drugs 2. In larger hospital pharmacies, is usually one of several pharmacists, and thus has a greater opportunity to interact with others, to specialize and to gain greater expertise. 3. Having access to medical records, is in a position to influence the selection of drugs and dosage regimens, to monitor patient compliance and therapeutic response to drugs, and to recognize and report adverse drug reactions. 4. Can more easily than the community pharmacist assess and monitor patterns of drug usage and thus recommend changes when necessary. 5. Serves as a member of policy-making committees, including those concerned with drug selection, the use of antibiotics, and hospital infections (Drug and Therapeutics Committee) and thereby influences the preparation and composition of an essential- drug list or formulary 6. Is in a better position to educate other health professionals about the rational use of drugs. 7. More easily participates in studies to determine the beneficial or adverse effects of drugs, and is involved in the analysis of drugs in body fluids. 8. Can control hospital manufacture and procurement of drugs to ensure the supply of high-quality products; 9. Takes part in the planning and implementation of clinical trials Pharmacy Settings and Role of Pharmacist III (Pharmaceutical Industry)) Industrial Pharmacy  Definition: A discipline which includes manufacturing, development, marketing, and distribution of drug products including quality assurance of these activities. 3Purpose of Pharmaceutical industry A pharmaceutical industry is a commercial business licensed to research, develop, market and/or distribute drugs, most commonly in the context of healthcare. They can deal in generic and/or brand medications. It is a major source of medical innovation. It is also a heavily regulated industry. Drugs are evaluated for safety, efficacy, and manufacturing quality as a condition of market access, and promotional messages must adhere to approved product characteristics. Areas pharmacists can work in include: – Research and development (R&D). – Manufacturing & Quality Assurance (QA). – Drug Information. – Patent applications and drug registration. – Clinical trials and post-marketing surveillance. – Sales and marketing. – Management (Regulatory Affairs). – Pharmacovigilance. Research & Development Work with other scientists to develop and select drug compounds that may be valuable as medicines. They will also help the project team, which might include medicinal chemists, bioscientists, toxicologists, pharmacokineticists and others, to understand the – biopharmaceutical properties of the compound – the dosage form – how the route of administration might affect the rate and extent of absorption Formulation and packaging development: – Pharmacist work in the areas of formulation and packaging development. This includes, highly specialized formulations such as targeted release and skin patches. Manufacturing & QA  The pharmacist’s broad knowledge of the pharmaceutical sciences ensures an integrated approach to quality assurance (including good manufacturing practice) through the validation of the various stages of production and the testing of products before release. Drug information The pharmacist has the knowledge and expertise to provide detailed information on medicines to members of the health professions and the public. Also, pharmacists provide an information service within the company. Patent applications & drug registration The pharmacist is ideally qualified to understand and collate the diverse information required for patent and authorization submissions. Clinical trials and post-marketing surveillance. The pharmacist has the knowledge of drugs and health care provision required to facilitate collaboration between companies, health professionals and governments in relation to clinical trials and surveillance. The pharmacist, whose professional ethics demand a concern for the interest of patients, can make a contribution to proper marketing practices related to health care and to the provision of appropriate information to health professionals and the public. Management The inclusion of pharmacists in all levels of management promotes an ethical approach within management policies. Pharmacovigilance Pharmacovigilance has been defined as the process of identifying and responding to drug safety issues. The aims of pharmacovigilance within the industry is to protect patients from unnecessary harm by identifying previously unrecognized drug hazards, elucidating pre-disposing factors, refuting false safety signals and quantifying risk in relation to benefit. Principles of Biomedical Ethics Functional definitions Ethics: Moral principles that govern a person's behaviour or the conducting of an activity. Medical ethics: Moral principals that governs the practice of medicine. 4Biomedical ethics  Biomedical ethics: a practical discipline that aims to resolve ethical questions or disagreements that emerge in the practice of health care. It is to identify, analyze, and resolve value conflicts that arise when providers, patients, families and other stakeholders are uncertain about the ethically best course of action. Ethical Principles Autonomy Nonmaleficence Beneficence Justice Fidelity Confidentiality Veracity Accountability Autonomy The freedom to make decisions about oneself-self rule. The right to self-determination. Healthcare providers need to respect patient’s rights to make choices about healthcare, even if the healthcare providers do not agree with the patient’s decision. Autonomy Informed Consent: Informed consent in regard to a patient’s treatment is a legal, and ethical, issue of autonomy. Informed consent is respecting a person’s autonomy to make personal choices based on the appropriate appraisal of information about the actual or potential circumstances of a situation. Nonmaleficence Requires that no harm be caused to an individual, either unintentionally or deliberately. This principle requires pharmacists to protect individuals who are unable to protect themselves. Beneficence This principle means “doing good” for others Pharmacists need to assist clients in meeting all their needs Biological Psychological  Social Justice Every individual must be treated equally. This requires pharmacists to be nonjudgmental. Fidelity Loyalty The promise to fulfill all commitments. The basis of accountability. Includes the professionals faithfulness or loyalty to agreements and responsibilities accepted as part of the practice of the profession. Confidentiality Anything stated to health-care providers by patients must remain confidential. The only times this principle may be violated are: 1. If patients may indicate harm to themselves or others. 2. If the patient gives permission for the information to be shared. Veracity This principle implies “truthfulness” Pharmacists need to be truthful to their clients. Veracity is an important component of building trusting relationships. Accountability Individuals need to be responsible for their own actions. Pharmacists are accountable to themselves and to their colleagues. Ø Morals, Values and Ethics Morals: refers to practices. Values: influence judgment and choices. Ethics: deal with right and wrong, etc. Ø Morals An individual’s own code for acceptable behavior. Arise from an individual’s conscience. They act as a guide for individual behavior. They are Learned. 8Ethics Ethics deals with the “rightness” or “wrongness” of human behavior. Concerned with the motivation behind the behavior. Bioethics is the application of these principles to life-and-death issues. 19Morals and Laws Laws Establish minimum standards of behaviour that everyone must meet. Morality System of right and wrong enforced through societal pressure. Ethics Lies between law and morality. Seeks ideal or maximum standards of behavior. In medicine, law, morality and ethics are highly linked Code of Ethics and Oath of Pharmacist Professional Ethics Professional ethics in an organization would mean set of values, principles and morals followed in the best defined manner. Ø Code of Ethics Codes of ethics that define what is right and what is wrong, which decision to take and which one to leave. Code of ethics for pharmacists are principles based on moral obligations and virtues established to guide pharmacists in relationships with patients, health professionals, and society. Ø 5Components of a Code of Ethics A pharmacist respects the covenantal relationship between the patient and pharmacist. Considering the patient-pharmacist relationship as acovenant means that a pharmacist has moral obligations inresponse to trust received from society. In return for thistrust, a pharmacist promises to help individuals achieveoptimum benefit from their medications, to be committedto their welfare, and to maintain their trust. A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner. A pharmacist places concern for the well-being of the patient at the center of professional practice. A pharmacist is dedicated to protecting the dignity of the patient. With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner ‫ﻛراﻣﺔ‬A pharmacist respects the autonomy and dignity of each patient.  A pharmacist promotes the right of self-determination andrecognizes individual self-worth by encouraging patients to participate in decisions about their health A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients ‫ ﻧزاھﺔ‬A pharmacist acts with honesty and integrity in professional relationships. A pharmacist has a duty to tell the truth and to act with conviction of principles A pharmacist avoids discriminatory practices, behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients A pharmacist maintains professional ‫ اﻟﻜﻔﺎءة اﻟﻤﮫﻧﯿﺔ‬.competence A pharmacist has a duty to maintain knowledge and abilities as new medications, devices, and technologies become available and as health information advances A pharmacist respects the values and abilities of colleagues and other health professionals. When appropriate, a pharmacist asks for the consultation of colleagues or other health professionals or refers the patient. A pharmacist acknowledges that colleagues and other health professionals may differ in the beliefs and values they apply to the care of the patient A pharmacist serves individual, community, and societal needs The primary obligation of a pharmacist is to individual patients. However, the obligations of a pharmacist may at times extend beyond the individual to the community and society. In these situations, the pharmacist recognizes the responsibilities that accompany these obligations and acts accordingly A pharmacist seeks justice in the distribution of health resources. When health resources are allocated, a pharmacist is fair and equitable, balancing the needs of patients and society. 14Examples of Oath of Pharmacists 15The Hippocratic Oath of a Pharmacist I promise to devote myself to a lifetime of service to others through the profession of pharmacy. I will hold myself and my colleagues to the highest principles of our profession's moral, ethical and legal conduct. I will embrace‫ اﺗﺒﻨﻰ‬and advocate‫ اداﻓﻊ‬changes that improve patient care. American Pharmacists Association (APhA)  "I promise to devote myself to a lifetime of service to others through the profession of pharmacy. :‫ اﻟﻌﮭﺪ‬In fulfilling this vow I will consider the welfare ‫ رﻓﺎھﯿﺔ‬of humanity and relief of suffering my primary concerns. I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients. I will respect and protect all personal and health information entrusted to me. I will accept the lifelong obligation to improve my professional knowledge and competence. 17:‫ اﻟﻌﮭﺪ‬In fulfilling this vow I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct. I will embrace and advocate changes that improve patient care. I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.”