Clinical Pharmacy 1 Lecture 1

CLINICAL PHARMACY 1 NOHA ALAA HAMDY, PHARM D, PHD ASSOC. PROF. OF CLINICAL PHARMACY FACULTY OF PHARMACY ALEXANDRIA UNIVERSITY NOHA ALAA, PHARMD, PHD 1 COURSE INSTRUCTORS Lectures Teaching Assistants  Assoc. Prof./ Riham El  Dr Yumna Mohamed Meslemany...

CLINICAL PHARMACY 1 NOHA ALAA HAMDY, PHARM D, PHD ASSOC. PROF. OF CLINICAL PHARMACY FACULTY OF PHARMACY ALEXANDRIA UNIVERSITY NOHA ALAA, PHARMD, PHD 1 COURSE INSTRUCTORS Lectures Teaching Assistants  Assoc. Prof./ Riham El  Dr Yumna Mohamed Meslemany  Dr Katrin Samir  Assoc. Prof./ Noha Alaa  Dr Nancy Mahfouz  Dr Engy Emam NOHA ALAA, PHARMD, PHD 2 PRE-REQUISITE PHARMACOLOGY & PHARMACOTHERAPEUTICS III NOHA ALAA, PHARMD, PHD 3  COURSE OBJECTIVE  The course covers in detail the definition and concepts of clinical pharmacy and pharmaceutical care, and qualification to become a clinical pharmacy.  Patient history ,medication reconciliation, therapeutic planning and drug-related problems, interpretation of clinical laboratory data and physical examination are discussed.  The course also provides the student with knowledge concerning providing medication. Additionally, the course introduces the student to the principles of management and supportive care of oncological diseases, blood disorders and nutritional deficiencies.  The course covers medication safety in different pharmacy practice settings and medication errors and the importance of pharmacovigilance in the collection, detection, assessment, monitoring and prevention of adverse effects.  The tutorials are based on integrated case-based learning (ICBL) to provide the students with the skills and competencies necessary for effective delivery of medication therapy management NOHA ALAA, PHARMD, PHD 4  REFERENCES  Karen J. Tietze, CLINICAL SKILLS FOR PHARMACISTS A Patient-Focused Approach, 3rd edition, ElSevier, St. Louis; 2012.  Marie Anne Koda-Kimble, Lloyd Yee Young, ed. Applied Therapeutics: The Clinical Use of Drugs, 9th edition, Lippincott Williams & Wilkins, Baltimore; 2009.  Terry L. Schwinghammer, Julia M. Koehler, ed. Pharmacotherapy Casebook. A Patient-Focused Approach. 7th edition, McGraw-Hill, New York; 2008.  Cate Whittlesea, Karen Hodson. Clinical pharmacy and therapeutics.6th edition, Elsevier. London; 2019 NOHA ALAA, PHARMD, PHD 5  ASSESSMENT PLAN Mid term (7th week) 15 marks (the first 5 lectures) Practical 25 marks Oral exam 10 marks Final written exam 50 marks Final Exam 2 hours NOHA ALAA, PHARMD, PHD 6 Week Lectures 1 Introducing Clinical Pharmacy (Noha) 2 Patient history & Patient profile ( Dr Riham) 3 SOAP analysis & Documentation (Engy) Laboratory data interpretation (Nancy) 4 PHS week: online (drug interactions, diagnostic procedure) 5 Laboratory data interpretation (Nancy) Guidelines of treatment 6 Medication errors & Adverse drug reactions (Engy) 7 Drug Prescribing (Noha) 8 IV drug administration (Nancy) Therapeutic planning & Monitoring Drug Therapy 9 (Dr Riham) 10 MTM & Patient Education & adherence (Noha) 7  LECTURE POLICY  You are allowed to enter the teaching room within the first 5 min of the lecture.  Students who do not behave appropriately will be asked to leave.  No photos or video taping are allowed. NOHA ALAA, PHARMD, PHD 8 NOHA ALAA, PHARMD, PHD 9  CLINICAL PHARMACY 1 LECTURE 1: INTRODUCING CLINICAL PHARMACY NOHA ALAA, PHARMD, PHD 10  INTENDED LEARNING OUTCOMES: At the end of this lecture, you will be able to:  Explain the patient-centered care pharmacy practice.  Define Clinical Pharmacist, Pharmaceutical Care.  Differentiate between clinical services and pharmaceutical care.  Discuss the qualification of the clinical pharmacist.  Enumerate the different patient care settings  Identify the Patient Medication Record (PMR) contents’ NOHA ALAA, PHARMD, PHD 11 NOHA ALAA, PHARMD, PHD 12  PHARMACIST Pharmacists are society’s experts of drugs NOHA ALAA, PHARMD, PHD 13  HISTORICALLY, PRODUCT – ORIENTED PHARMACY PRACTICE NOHA ALAA, PHARMD, PHD 14  PHARMACY PRACTICE  Pharmacy practice is moving toward a model that integrates patient-focused care (also known as patient centered care) and drug distribution services.  To be successful, pharmacists must understand and speak the language of the health care system and function in a system that is foreign and excessively complex. NOHA ALAA, PHARMD, PHD 15  CLINICAL PHARMACY DESCRIBED PATIENT- ORIENTED PHARMACY PRACTICE Patient-focused pharmacists work closely Nurse Physician with physicians and other Dietician Pharmacist health care professionals to provide optimal Patient patient care NOHA ALAA, PHARMD, PHD 16  CLINICAL PHARMACIST  The term clinical pharmacist was used to describe a pharmacist whose primary job was to:  Interact with the health care team.  Interview and assess patients.  Make patient-specific therapeutic recommendations.  Monitor patient response to drug therapy.  Provide drug information. NOHA ALAA, PHARMD, PHD 17  CLINICAL PHARMACIST Clinical pharmacists, working primarily in acute care settings, were viewed as “drug experts”; other pharmacists could occasionally use “clinical” skills, but they remained focused on product management. NOHA ALAA, PHARMD, PHD 18  THE CLINICAL PHARMACIST IS AN EXPERT IN THE THERAPEUTIC USE OF MEDICATIONS  In addition, this expertise is used proactively to ensure and advance rational drug therapy.  Stating that the clinical pharmacist is a primary source of scientifically valid information and advice on the best use of medications emphasizes that the clinical pharmacist serves as an objective, evidence-based source of therapeutic information and recommendations. NOHA ALAA, PHARMD, PHD 19  PHARMACEUTICAL CARE  The term Pharmaceutical Care is used to describe patient-focused responsibilities of pharmacists.  Helper and Strand (in 1990) define pharmaceutical care as the “ responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life”. NOHA ALAA, PHARMD, PHD 20  PHARMACEUTICAL CARE The four outcomes of Pharmaceutical Care identified include the following: 1. Cure of disease 2. Elimination or reduction of symptoms 3. Arrest or slowing of a disease process 4. Prevention of disease or symptoms NOHA ALAA, PHARMD, PHD 21  PATIENT CARE REQUIRES THE INTEGRATION OF KNOWLEDGE AND SKILLS Knowledge Therapeutic of disease Knowledge planning of drug skills therapy Drug Knowledge information skills Patient of nondrug therapy Care Physical Knowledge of assessment laboratory and skills diagnostic testing Patient monitoring Communication skills skills NOHA ALAA, PHARMD, PHD 22  CLINICAL PHARMACISTS AIMS TO Minimize Maximize drug efficacy drug toxicity Promote cost- effectiveness NOHA ALAA, PHARMD, PHD 23 REQUIRED READING NOHA ALAA, PHARMD, PHD 24  DEFINITION OF CLINICAL PHARMACY  Clinical pharmacy is defined as that area of pharmacy concerned with the science and practice of rational medication use.  Clinical pharmacy is a health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention. NOHA ALAA, PHARMD, PHD 25  PHARMACEUTICAL CARE VS CLINICAL SERVICES The fact that clinical pharmacist cares for patients in all health care settings emphasizes two points:  That clinical pharmacists provide care to their patients (i.e., they don’t just provide clinical services)  That this practice can occur in any practice setting. NOHA ALAA, PHARMD, PHD 26  PHARMACEUTICAL CARE VS CLINICAL SERVICES  Managing therapy in direct patient care settings is particularly important because it reinforces existing definitions of the term “clinical.”  For example, the American Heritage College Dictionary defines clinical as “involving or based on direct observation of the patient”; that is, clinical pharmacists are involved in direct interaction with, and observation of the patient. NOHA ALAA, PHARMD, PHD 27  Medication list Monitoring Plan & Transition of care Evaluation of patient Medication response Action Plan NOHA ALAA, PHARMD, PHD 28  PHARMACIST PRACTICE AREAS  Ambulatory care  Nephrology  Critical care  Obstetrics and gynecology  Drug information  Pulmonary disease  Geriatrics and long-term care  Psychiatry  Internal medicine and subspecialties  Rheumatology  Cardiology  Nuclear pharmacy  Endocrinology  Nutrition  Gastroenterology  Pediatrics  Infectious disease  Pharmacokinetics NOHA ALAA, PHARMD, PHD  Neurology  Surgery 29  REQUIRED READING NOHA ALAA, PHARMD, PHD 30 PHARMACY EDUCATION NOHA ALAA HAMDY, PHARMD, PHD 31  BPHARM, PHARMD, MPHARM  In Egypt: BPharm Bachelor of Science in Pharmacy degree (BSPharm, BSc. or BPharm), was the undergraduate program till 2018.  Starting from 2019 students enrolled in pharmacy degree will be graduated as PharmD  BPharm: 5 years degree with certain number of training hours (usually performed during the summer)  After BPharm, students were enrolled in PharmD (post graduate degree)  PharmD (undergraduate): 6 Years ( 5 Years academics + 1 Year Internship) = Total 6 Years  MPharm: 2 Years ( 1 Year academics + 1 Year Research Work) after BPharm ( 4 Years) = Total 6 Years (Not applied in Egypt) 32 NOHA ALAA HAMDY, PHARMD, PHD  PHARMD, MPHARM  PharmD Program (post-graduate Doctor of Pharmacy (PharmD) degree ) mainly focused on Hospital/Clinical Pharmacy services, students will be trained in Hospital as Bedside Teaching  This two-year professional degree provides advanced education in clinical pharmacy practice.  The Graduate PharmD also requires further formal education in specialty residencies.  It includes courses of courses in pharmacokinetics, clinical pharmacokinetics, clinical trials, statistics, pharmacy administration, pharmacotherapeutics and pharmacoeconomic  In Master of Pharmacy Program's student will not be getting the bedside learning experience and they will not be trained in hospital. Mainly they are intended to learn research and drug manufacturing skills ( Except MPharm Pharmacy Practice). 33 NOHA ALAA HAMDY, PHARMD, PHD  QUALIFICATIONS  Clinical pharmacists are practitioners who provide comprehensive medication management and related care for patients in all health care settings.  They are licensed pharmacists with specialized advanced education and training who possess the clinical competencies necessary to practice in team-based, direct patient care environments.  Accredited residency training or equivalent post-licensure experience is required for entry into direct patient care practice.  Board certification is also required once the clinical pharmacist meets the eligibility criteria specified by the Board of Pharmacy Specialties (BPS). NOHA ALAA, PHARMD, PHD 34  QUALIFICATIONS  Licensure: To be eligible for licensure, pharmacists must be graduates of an accredited college of pharmacy  Internship: licensure candidates must complete a specified number of internship hours earned before graduation from pharmacy school, prior to seeking licensure.  Some or all of the hours are to be earned after graduation and it may require you to complete certain number of years of pharmacy school.  Relicensure: Most licensing boards require that pharmacists earn continuing education units (CEUs) for relicensure. NOHA ALAA, PHARMD, PHD 35  QUALIFICATIONS  Postlicensure credentialing: Postlicensure credentialing is voluntary and is available at the specialist or disease level. Postlicensure credentials indicate that the pharmacist has additional expertise above and beyond what is required for licensure.  Specialist credentialing. Board certification NOHA ALAA, PHARMD, PHD 36  THE BOARD OF PHARMACY SPECIALTIES (BPS) The Board of Pharmacy Specialties (BPS), created in 1976 by the American Pharmacists Association (APhA), is responsible for setting standards for certification and recertification and for administering the certification and recertification processes. https://www.bpsweb.org/bps-specialties/ Specialties NOHA ALAA, PHARMD, PHD 37  RESIDENCY  A residency is defined as an “organized, directed, postgraduate training program in a defined area of pharmacy practice”.  Residencies provide pharmacists with 1 to 2 years of supervised experience in practice and management activities.  Postgraduate year 1(PGY-1) residency programs train generalists; postgraduate year 2 (PGY-2) residency programs train pharmacists in a specialty patient care area. Most residencies are based in hospitals.  Residents generally gain experience by providing a variety of inpatient and outpatient pharmacy services under the supervision of one or more preceptors. NOHA ALAA, PHARMD, PHD 38  FELLOWSHIP  A fellowship is a highly individualized program designed to prepare the pharmacist to become an independent researcher.  Minimum of two years. NOHA ALAA, PHARMD, PHD 39  QUESTIONS Board certification for pharmacists is Pharmacy fellowship programs prepare not available in which one of the pharmacists to become which of the following areas? following? a. Pharmacokinetics a. Educators b. Pharmacotherapy b. Practitioners c. Nutrition c. Business leaders d. Nuclear pharmacy d. Researchers e. Psychiatric pharmacy practice e. Administrators NOHA ALAA, PHARMD, PHD 40 THE NEW “DISRUPTERS” IN HEALTHCARE – PATIENTS AND PHARMACISTS | RAJIV SHAH | TEDXFARGO (YOUTUBE.COM) THE NEW “DISRUPTERS” IN HEALTHCARE – PATIENTS AND PHARMACISTS RAJIV SHAH TEDXFARGO NOHA ALAA, PHARMD, PHD 41  STANDARDS OF PRACTICE OF CLINICAL PHARMACISTS NOHA ALAA, PHARMD, PHD 42  PROCESS OF CARE  Clinical pharmacists work in collaborations with other providers to deliver comprehensive medication management that optimizes patient outcomes.  Care is coordinated among providers and across systems of care as patients transition in and out of various settings. NOHA ALAA, PHARMD, PHD 43  HEALTH CARE SETTINGS INPATIENT OUTPATIENT  Hospitals  Clinics LONG-TERM CARE  Day surgery units FACILITIES  Emergency departments  Rehabilitation centers  Home health care  Skilled nursing homes  Private offices NOHA ALAA, PHARMD, PHD 44  THE CLINICAL PHARMACIST’S PROCESS OF CARE COMPRISES THE FOLLOWING COMPONENTS: Follow-up evaluation and Assessment medication of the patient monitoring Development Evaluation of and medication implementation therapy of a plan of care NOHA ALAA, PHARMD, PHD 45  THE PHARMACIST DAILY ACTIVITIES START BY:  Attending the round in the patient ward and joining with the healthcare team (the physician, the nurse, the medical student,……)  This pharmacist is named the Ward Pharmacist. NOHA ALAA, PHARMD, PHD 46  ASSESSMENT OF THE PATIENT The clinical pharmacist assesses medication-related needs by:  Reviewing the medical record using a problem- oriented framework (e.g., interpreting and analyzing subjective and objective information) to determine the clinical status of the patient. NOHA ALAA, PHARMD, PHD 47  PATIENT MEDICAL RECORD (PMR)  The inpatient medical record, also known as the chart, is a legal document  Most charts include sections for medication orders and other types of orders (e.g., laboratory testing, dietary orders, diagnostic procedures)  Access to patient charts is restricted to authorized health care professionals.  Upon patient discharge, the medical record is stored in the medical records department and is retrievable by referencing the patient’s hospital admission number. NOHA ALAA, PHARMD, PHD 48  MEDICAL RECORD CONTENT Section Type of Information Admitting data* Name, address, date of birth, insurance Consent forms Consent for surgery, procedures, research studies Physician orders Medication, dietary, and laboratory orders Flow sheets and 24-hour charts of blood pressure, heart rate, respiratory graphic charts* rate, temperature, and fluid intake and output *Inpatient charts only. NOHA ALAA, PHARMD, PHD 49  MEDICAL RECORD CONTENT Section Type of Information Progress notes Daily progress notes written by every health care professional who interacts with the patient, physician notes, consultations notes, nursing shift notes, laboratory results, and radiology and surgery reports. Laboratory data Blood chemistry panel, arterial blood gas analysis, culture and sensitivity testing, histopathology reports Diagnostic Radiology and other diagnostic procedures reports procedures Operating room Preoperative checklist, anesthesia record, graphic records of reports* vital signs, description of events during surgery NOHA ALAA, PHARMD, PHD *Inpatient charts only. 50  MEDICAL RECORD CONTENT Section Type of Information Admission history and Initial history and physical examination findings physical examination* Medication Date, time, dose of medications administered; names administration record* and initials of nurses who administered medications; lists of all ordered medications Miscellaneous* Emergency department record *Inpatient charts only. NOHA ALAA, PHARMD, PHD 51  QUESTIONS Outpatient health care settings include all Admission data includes all of the except which of the following? following except: a. Clinics a) Name, b. Day surgery units b) Address, c. Rehabilitation centers c) Date of birth, d. Emergency departments d) Insurance e. Private offices e) Informed consent NOHA ALAA, PHARMD, PHD 52  REFERENCES  Karen J.Tietze, CLINICAL SKILLS FOR PHARMACISTS A Patient- Focused Approach, 3rd edition, ElSevier, St. Louis; 2012.  Marie Anne Koda-Kimble, Lloyd Yee Young, ed. Applied Therapeutics:The Clinical Use of Drugs, 9th edition, Lippincott Williams & Wilkins, Baltimore; 2009.  Terry L. Schwinghammer, Julia M. Koehler, ed. Pharmacotherapy Casebook. A Patient-Focused Approach. 7th edition, McGraw-Hill, New York; 2008.  American College of Clinical Pharamcy.The Definition of Clinical Pharmacy. Pharmacotherapy, 2008; 28(6): 816-817. NOHA ALAA, PHARMD, PHD 53  Thank You NOHA ALAA, PHARMD, PHD 54