Introduction To Clinical Pharmacy PDF

INTRODUCTION TO CLINICAL PHARMACY DR. AUDREY WAGAH MPHARM, BPHARM UON Expected learning outcome 1. State the roles of clinical pharmacy. 2. Formulate a pharmaceutical care plan. 3. Identify the components of rational prescribing. 4. Manage poisoned patients. 5. Outline hospital and commu...

INTRODUCTION TO CLINICAL PHARMACY DR. AUDREY WAGAH MPHARM, BPHARM UON Expected learning outcome 1. State the roles of clinical pharmacy. 2. Formulate a pharmaceutical care plan. 3. Identify the components of rational prescribing. 4. Manage poisoned patients. 5. Outline hospital and community pharmacy practice. 6. Describe rational use of drugs in paediatrics and geriatrics Pharmacy Scope Clinical Pharmacy Practice  Clinical pharmacy comprises a set of skills that promote the optimal use of medicines for individual patients.  Optimising the use of medicines requires a patient- centred 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 and the value they derive from, or the problems they encounter with, their medicines. General  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.  Development of Clinical Practice in Pharmacy  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. This was initially termed History of CP  Clinical pharmacy in the 1980s grew because of its ability to promote the costeffective use of medicines in hospitals and as a result,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.  Drug Use Process Indicators. DUP Stage Action Establish the need for a drug Ensure appropriate indication for each medicine All medical problems are addressed therapeutically. Consider deprescribing medicines that are no longer appropriate. Selection of the drug Select & recommend the most appropriate medicine based upon the ability to reach therapeutic goals, with consideration of the patient variables, formulary status and cost of therapy. Select regimen Select the most appropriate medicines for accomplishing the desired therapeutic goals at the least cost without diminishing effectiveness or causing toxicity. Provide drug Facilitate dispensing and supply process so that the medicines are accurately prepared, dispensed in a ready-to administer form and delivered to the DUP.. DUP STAGE ACTION Monitor drug therapy Monitor medicines for effectiveness or adverse effects to determine whether to maintain, modify or discontinue. Counsel the Patient Counsel and educate the patient or the caregiver about the patients therapy to ensure proper use of medicines. Evaluate the effectiveness 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. DEFINITIONS Clinical Pharmacy  Clinical pharmacy comprises a set of functions that promote the safe, effective and economic use of medicines for individual patients.  Clinical pharmacy process requires the application of specific knowledge of pharmacology, pharmacokinetics, pharmaceutics therapeutics to patient care. Pharmaceutical Care  Pharmaceutical care is a cooperative, patientcentred system for achieving specific and positive patient outcomes from the responsible provision of medicines.  The practice of clinical pharmacy is an essential component in the delivery of pharmaceutical care. Key elements of the Pharmaceutical Care. Element Purpose Assesment The main goal of assessment is to establish a full medication history and highlight actual and potential medication-related problems. Care Plan The care plan should clearly state the goals to optimise Care and the responsibilities of both the pharmacist and the patient in attaining the stated goals. Evaluation The evaluation reviews progress against the stated patient outcomes. Medicines optimization  Medicines optimisation aims to ensure that the right patients get the right choice of medicine at the right time.  The purpose is to help patients take their medicines appropriately and, by doing so, avoid unnecessary treatment, improve safety and outcomes, and reduce wastage.  Ultimately it can support patients to take greater ownership of their treatment. Medication Related Problems  A medication-related problem is anything involving drug therapy that interferes with (or has the potential to interfere with) the desired outcome for a patient.  Some MRPs are associated with signiicant morbidity and mortality. Categories of medication- related problems  Untreated indication  Treatment without indication  Improper drug selection  low dose  high dose  Non-adherence  Adverse drug reaction  Drug interaction Medicine optimization  The aim of medicines optimisation is to help patients take their medicines appropriately and, by doing so, improve safety and outcomes, avoid unnecessary treatment and reduce wastage.  Ultimately it supports patients in taking greater ownership of their treatment.  Guiding principles for medicine optimization  communicating with the patient and his or her carer about the patient’s choice and experience of using medicines to manage his or her condition.  supporting the most appropriate choice of clinically and costeffective medicines (informed by the best available evidence base);  ensuring that medicines use is as safe as possible, including safe processes and systems, effective communication between professionals and the minimising likelihood of unwanted effects and interactions;  making medicines optimisation part of routine practice by Consultation Process  The ability of a pharmacist to consult effectively is fundamental to pharmaceutical care, and this includes establishing a platform for achieving adherence/concordance.  Nurturing a relationship with the patient is essential to understanding the patient’s medication-related needs.  Descriptions of pharmaceutical consultation have been confined largely to the use of mnemonics such as WWHAM, AS METTHOD and ENCORE. Mnemonics used in the pharmacy consultation process WWHAM  Who is it for?  What are the symptoms?  How long has it been going on?  Action taken?  Medicines taken? AS METTHOD  Age of the patient?  Self or for someone else?  Medicines being taken?  Exactly what do you mean (by the symptom)?  Time and duration of the symptom?  Taken any action (medicine or seen a healthcare practitioner)?  History of any disease?  Other symptoms?  Doing anything to alleviate or worsen the symptom?  Cntd.. ENCORE  Evaluate the symptom, its onset, recurrence and duration.  No medication is always an option.  Care when dealing with specific patient groups, notably the elderly, the young, nursing mothers, pregnant women, those receiving specific medication such as methotrexate and anticoagulants, and those with a particular disease, for example, renal impairment.  Observe the patient for signs of systemic disturbance and ask about presence of fever, loss of weight and any Lastly..  Refer when in doubt.  Explain any course of action recommended. The ability to consult with patients is a key process in the delivery of pharmaceutical care and consequently requires regular review and development, regardless of experience. To ensure these core skills are developed, individuals should use trigger Questions to prompt relection on their approach to ….