LEC6 22-04-2024 Dispensing to Ambulatory care.pdf

Dispensing to Ambulatory Patients PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content Definition and Type of Ambulatory Care Pharmaceutical Services in Ambulatory Care Setting Minimum Stan...

Dispensing to Ambulatory Patients PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content Definition and Type of Ambulatory Care Pharmaceutical Services in Ambulatory Care Setting Minimum Standard for Ambulatory Care Pharmaceutical Service Residency Training in Ambulatory Care Process of Dispensing in Ambulatory Care  Definition  Ambulatory Patients refers to Patients not occupying beds at a hospital  Physician’s office  Clinics  Health centers  Can be classified into  Emergency  Referral or Tertiary Care  Primary Care  Definition Emergency Care Self explanatory Services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in: a) Placing the patient’s health in serious jeopardy; b) Serious impairment to bodily functions; c) Serious dysfunction of any bodily organ or part  Definition Tertiary Care Tertiary care is specialized consultative health care, usually given to inpatients. Basic evaluation is done in primary care Include complex procedures and interventions May be long term care  Definition Primary Care Majority care Daily personal health needs Includes prevention health and initial care Basic health evaluation General discomfort Early complaints, symptoms & issues  Ambulatory Care Growth attributes Supplementation of in-patients teaching programs Demands of population growth and increase in access to healthcare services Community health program participation Focus on primary care  Ambulatory Care Pharmaceutical Services  ASHP statement –  Ambulatory care encompasses the provision of health care service and education to patients who seek medical attention but do not require admission  Patient oriented pharmaceutical services is deemed required  Directors are responsible to develop and maintain comprehensive pharmaceutical service  Ambulatory Care 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  Detecting and reporting adverse drug reactions, interactions and non – compliant behavior of patients  Ambulatory Care Pharmaceutical Services  Activities Include  Participation in drug utilization reviews, patient care audits and clinical drug investigations  Participation in Educational projects  Supervision in storage, preparation, dispensing and administration of medication in patient care area  Developing system of delivery of pharmacy services in institution and community  Developing and utilizing system for finances and reimbursement  Ambulatory Care Minimum Standards  Must be directed by a qualified pharmacist  Appropriateness of therapy should be verified by pharmacist  Prevention of duplication of drug therapies and contraindications  All medicines dispensed to patients are correctly and completely labelled and in accordance with all applicable regulations and standards of practice  Upon receipt, it is responsibility of pharmacist to ensure patient or caretaker’s understanding related to use of medicine  All drugs in ambulatory care service are properly controlled  Ambulatory Care Supplemental Standards  Residency program  Post graduate program of training  Provision of training in providing clinical pharmacy services to ambulatory care patients  Training site should include institutional ambulatory care settings, satellite clinics  Should have minimum standards of ASHP  Ambulatory Care Supplemental Standards  Specific requirements for ambulatory care service program  Medical Records – Accessible on real time  Drug Information Resources – Centralized medical literature  Well Defined Scope  Preceptors  Review of Quality  Area of Emphasis should be directed towards solving clinical problems  Program should also focus on drug literature analysis and associated communication skills  Program should incorporate research and rotation among departments  Ambulatory Care Location of Dispensing Are  No specific rule a  Best to establish separate out patient dispensing area if the scope of geography is separate  Specialized services  Disadvantage of separate staff  Can be merged with in patient dispensing area with similar window or separate window  Ambulatory Care Types of Prescription  Depends on location and kind of hospital  Private patients  Indigent patients (patients having no insurance – welfare patients)  Prescription needed to be identified  Employees  Discharged patients  Ambulatory Care Dispensing Routine  For Ambulatory care, it is similar in both discharge and community care  Patients take written prescription by the Physician, which is given to the pharmacist where it is dispensed.  The pharmacist guarantees that the patient gets the right medication.  The pharmacist gives instructions to the patient about dispensed medicine.  Labeling of medicine.  Maintenance of payments by Pharmacist.  Finally, payment by the patient.  Ambulatory Care Dispensing Routine  Ambulatory Care Labelling Requirement  Vary according to federal laws  Minimum standards follow presence of  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;;  Initials (or name) of the responsible pharmacist  Ambulatory Care Medication Orders  All medication orders shall be reviewed for legality and clinical appropriateness by a pharmacist before being dispensed  Medication orders (or prescriptions) shall contain at a minimum the following information  Patient name and address; medication name, dose, frequency, Route, and quantity or duration;  Prescriber name, address, and telephone number; and prescriber DEA number for controlled substances  Any discrepancies to be resolved and Information concerning changes should be appropriately communicated to the patient, caregiver, and other involved healthcare providers  Ambulatory Care Home Care Routine  Home care prescriptions are dispensed and refilled from the ambulatory pharmacy as a service to this patient population.  Assessment of drug therapy is done during each dispensing of a new or refilled prescription including  Allergies, adherence, duplicate therapy,  Untreated conditions and over/under-dosing, taking renal and hepatic function.  Drug-drug, drug-food, drug-disease interactions  Ambulatory Care Home Care Routine  Criteria is established by relevant authorities  Criteria for a patient to have a home medicines review are one or more of the following. (Examples)  Currently taking 5 or more medications or 12 doses or more in a day.  Significant changes made to medication regimen in the last 3 months.  Medications with a narrow therapeutic index or medications requiring monitoring.  Symptoms suggestive of an adverse reaction.  Sub-therapeutic response to treatment with medicines.  Suspected non-adherence to prescribed medications or inability to manage medication related therapeutic devices.  Having difficulty managing their own medicines.  Attending several different doctors, both general practitioners and specialists.  Ambulatory Care Vaccination Services  Also known as immunization  Now part of community services  Verification of vaccination order is responsibility of pharmacist  Why pharmacist  The epidemiology of and patient populations at risk for vaccine-preventable diseases  Public health goals for immunization (e.g., local, regional, state, and federal goals)  Vaccine safety (e.g., risk–benefit analysis)  Screening for contraindications and precautions of vaccination in each patient  Vaccine stability and transportation and storage requirements  Immunologic drug interactions  Ambulatory Care Dispensing to Emergency Patie nts  Prescription is handled in the same pattern  Concept of pre packaged medication bins  Life saving medication are kept in areas of ready access  24 hours supply is maintained and dispensed as pre labelled medication  Injectable and irrigation solutions  Cardiac emergency medicines  Ambulatory Care Summary  Type of Patient Care  Minimum standards and supplemental standards  Pharmaceutical service  Dispensing routine Thank you