Shaukat Khanum Memorial Cancer Hospital & Research Centre.
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Transcript of Shaukat Khanum Memorial Cancer Hospital & Research Centre.
Dr.Maqsood khan
Pharm.D, BCPS,
BCLS,ACLS,MACCP ,MSCCM.
Clinical Pharmacy Specialist
Infectious diseases and Medical Oncology
Shaukat Khanum Memorial Cancer Hospital & Research Centre
Objective
Define clinical pharmacy Differentiate between traditional pharmacists role
and Clinical Pharmacist Explain the qualification required for clinical
pharmacists List the clinical pharmacists responsibility Describe the daily work activity of clinical
pharmacists.
Clinical Pharmacy:From Theory to Practic
Pharmacists should move from behind the counter
and start serving the public by providing
care instead of pills only.
There is no future in the mere act of dispensing.
That activity can
and will be taken over by the internet, machines,
and/or hardly trained technicians.
Clinical Pharmacy
A health science discipline that embodies the application and development.
By pharmacists, of scientific principles of pharmacology, toxicology, therapeutics, clinical pharmacokinetics, pharmacoeconomics, pharmacogenomics, and other life sciences for the care of patients
Clinical Pharmacy Clinical pharmacy is defined as “a patient centered,
outcomes oriented pharmacy practice that requires the pharmacist to work together with the patient and the healthcare team members to:
- promote health - to prevent disease -to assess, monitor, initiate and modify medication
use.
Clinical Pharmacy . Maximizing the clinical effect of medicines, i.e.,
using the most effective treatment for each type of patient
Minimizing the risk of treatment induced adverse events, i.e., monitoring the therapy course for adverse reactions as well as patient's compliance with therapy
Minimizing the expenditures for pharmacological treatments by governments and by the patients, i.e., trying to provide the best treatment options for the greatest number of patients at the most cost effective.
Clinical Pharmacy
Clinical pharmacy is defined as that area of pharmacy concerned with the science
and practice of rational medication use.
Pharmaceutical care
‘’Pharmaceutical care is the direct, responsible
provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life.’’
• Cure of the diseaseCure of the disease• Elimination or reductionElimination or reductionof symptomsof symptoms• Arrest or slowing of aArrest or slowing of a disease processdisease process• Prevention of disease Prevention of disease or symptomsor symptoms
Clinical PharmacyClinical Pharmacy includes all the services
performed by pharmacists practising in hospitals, community pharmacies, nursing homes, home-based care services, clinics and any other setting where medicines are prescribed and used.
The term “clinical” does not necessarily imply
an activity implemented in a hospital setting.
How does clinical pharmacy differ from pharmacy?
the discipline of pharmacy embraces the knowledge on synthesis, chemistry and preparation of drugs
clinical pharmacy is more oriented to the analysis of population needs with regards to medicines, ways of administration, patterns of use and drugs effects on the patients.
The focus of attention moves from the drug to the single patient or population receiving drugs.
Goal
to promote the correct and appropriate use of medicinal products and devices.
These activities aim at: maximising the clinical effect of medicinesminimising the risk of treatment-induced adverse
eventsminimising the expenditures for pharmacological
treatments.
Clinical Pharmacy Requirements
Knowledge of nondrug therapy
Therapeutic planning
skills
Drug Information Skills
Physical assessment
skills
Patient monitoring
skills
Communication skills
Knowledge of laboratory
and diagnostic skills
Knowledge of the disease
Knowledge of drug therapy
Patient care
Level of Action of Clinical Pharmacists
Clinical pharmacy activities may influence the correct use of medicines at three different levels: before, during and after the prescription is written.
. Pharmacists have direct interaction with physician and medical team regarding drug therapy.
Pharmacists make medical rounds with physicians.
Pharmacist make recommendations on drug therapy.
Pharmacists are in patient care areas
Pharmacists participate on hospital committees
Pharmacist role during prescription
2. During the prescription
Counselling activity
Clinical pharmacists can influence the attitudes and priorities of prescribers in their choice of correct treatments.
The clinical pharmacist monitors, detects and prevents Medication related problems
The clinical pharmacist pays special attention to the dosage of drugs which need therapeutic monitoring.
Community pharmacists can also make prescription decisions directly, when over the counter drugs are counselled.
Pharmacy and Therapeutics Committee
Drug Use Evaluation
Adverse Drug Reactions
Medication Error
Infection Control and Antibiotics committee
Hospital Pharmacy: Clinical Committees
Medication-related Problems Untreated indications. Improper drug selection. Subtherapeutic dosage. Medication Failure to receive Medication Overdosage. Adverse drug reactions. Drug interactions. Medication use without indication.
3. After the prescription
Counselling Preparation of personalised formulation Drug use evaluation Outcome research Pharmacoeconomic studies
Reduction of the rate of preventable adverse drug events caused by ordering errors
A study published in JAMA in 1999 found that the pharmacist's participation in medical rounds in the intensive care unit reduced the occurrence of preventable adverse drug events caused by ordering errors by 66% .
The study was conducted at the Massachusetts General Hospital in Boston in collaboration with the Harvard School of Public Health.
Leaps LL, Cullen DJ, Clapp M. Dempsey et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999;282(3):2(37‑270.
Additional Supporting Evidence
Clinical Pharmacy Services associated with decreased mortality rates1. Pharmacist-provided drug use evaluation (4491
reduced deaths p=0.016)2. Pharmacist-provided in-service education (10,660
reduced deaths, p=0.037)3. Pharmacist-provided ADR management (14,518
reduced deaths, p=0.012)4. Pharmacist-provided drug protocol management
(18,401 reduced deaths, p=0.017)5. Ref# Pharmacotherapy 2007;27(4):481–493
Clinical Pharmacy from theory to Practice
LLearn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning."
Albert Einstein
Activities of Clinical Pharmacists The principle activities of a clinical pharmacist include:
Consulting Analysing therapies, advising health care practitioners on the correctness of drug therapy and providing pharmaceutical care to patients both at hospital and at community level.
Selection of drugs Defining "drug formularies" or "limited lists of drugs" in collaboration with hospital doctors, general practitioners and decision makers.
Drug information Seeking information and critically evaluating scientific literature; organising information services for both the health care practitioners and the patients.
.
Activities of Clinical Pharmacists The principle activities of a clinical pharmacist include:
Consulting Analysing therapies, advising health care practitioners on the correctness of drug therapy and providing pharmaceutical care to patients both at hospital and at community level.
Selection of drugs Defining "drug formularies" or "limited lists of drugs" in collaboration with hospital doctors, general practitioners and decision makers.
Drug information Seeking information and critically evaluating scientific literature; organising information services for both the health care practitioners and the patients.
.
Activities of Clinical Pharmacists Medication Review
Review medication chart, Review medication history
Attending Rounds
Drug use studies and research Drug use studies/ pharmacoepidemiology/ outcome research/ pharmacovigilance and vigilance in medicinal devices: collecting data on drug therapies, their costs and patient outcome through structured and scientific methods.
Pharmacokinetics/ therapeutic drug monitoring Studying the kinetics of drugs and optimising the dosage.
Clinical Trials Planning, evaluating and participating in clinical trials
Clinical Pharmacy from theory to Practice
When it becomes more difficult to suffer than to change ... you will change."
Albert Einstein
Activities of Clinical Pharmacists
.
Teaching & Training
Pre- and post-graduate teaching and activities to provide training and education programmes for pharmacists and other health care practitioners
Medical Record
•Admission Information
•Initial history
• physical examination
•Progress notes
•Consultations
•Nursing notes
•Laboratory data
•Diagnostic Procedures
•Radiology
•Surgery
•Orders
•Medication
administration orders
•Consent forms
Clinical Pharmacy Practice areas
Ambulatory care Critical care Drug Information Geriatrics and long –term care Internal medicine and
subspecialties Cardiology Endocrinology Gastroenterology Infectious disease Neurology
Nephrology Obstetrics and gynecology Pulmonary disease Psychiatry Rheumatology Nuclear pharmacy Nutrition Pediatrics Pharmacokinetics Surgery
Practice Guidelines for Pharmacotherapy Specialists The pharmacotherapy specialist designs, implements,
monitors, evaluates, and modifies patient pharmacotherapy to ensure effective, safe and economical patient care.
A Position Statement of the American College of Clinical Pharmacy
Practice Guidelines for Pharmacotherapy Specialists
The pharmacotherapy specialist retrieves , analyzes, evaluates, and interprets the scientific literature as a means of providing patient- and population-specific drug information to health professionals and patients
A Position Statement of the American College of Clinical Pharmacy
Practice Guidelines for Pharmacotherapy Specialists
The pharmacotherapy specialist participates in the generation of new knowledge relevant to the practice of pharmacotherapy, clinical pharmacy and medicine
The pharmacotherapy specialist educate health care professionals and students, patients, and the public regarding rational drug therapy
The pharmacotherapy specialist continually develops his/her knowledge and skills in applicable practice areas and demonstrates a commitment to continued professional growth by engaging in a lifelong process.
A Position Statement of the American College of Clinical Pharmacy
ResponsibilitiesDesigning patient-specific drug dosage
regimens
Recommending or scheduling measurements of drug concentrations in biological fluids
Monitoring and adjusting dosage regimens
Evaluating unusual patient responses to drug therapy for possible pharmacokinetic and pharmacologic explanations.
Responsibilities
Communicating patient-specific drug therapy information to physicians, nurses, and other clinical practitioners and to patients orally and in writing, and including documentation of this in the patient’s health record.
Responsibilities
Educating pharmacists, physicians, nurses, and other clinical practitioners about pharmacokinetic principles and appropriate indications for clinical pharmacokinetic monitoring, including the cost-effective use of drug concentration measurements.
ResponsibilitiesDeveloping quality assurance programs for
documenting improved patient outcomes and economic benefits
Promoting collaborative relationships with other individuals and departments involved in drug therapy
Responsibilities
Pharmacists with specialized education, training, orexperience may have the opportunity to assume the
following additional responsibilities:
1. Designing and conducting research
2. Developing and applying computer programs andpoint-of-care information systems to enhance theaccuracy and sophistication of pharmacokinetic modelingand applications to pharmaceutical care.
Responsibilities
3. Serving as an expert consultant to pharmacists with a general background in clinical pharmacokinetic monitoring.
Responsibilities
3. Serving as an expert consultant to pharmacists with a general background in clinical pharmacokinetic monitoring.
Clinical pharmacokinetics
Clinical pharmacokinetics is the process of applying pharmacokinetic principles to determine the dosage regimens of specific drug products for specific patients
to maximize pharmacotherapeutic effects and minimize toxic effects.
TDM stands for therapeutic drug mointoring
Aseptic ServicesUnit dose dispensing System
General Dispensing ServicesClinical Pharmacy ServicesDrug Information ServicesTraining and Education ServicesInventory Control Management
Services
Conclusion
Clinical Pharmacy is Really Rewarding & Clinical Pharmacy is Really Rewarding & Interesting ,but Interesting ,but
Its Highly Challenging .Its Highly Challenging .
If you want to be a Clinical Pharmacist than If you want to be a Clinical Pharmacist than go beyond the limits of Excellency in Science go beyond the limits of Excellency in Science
and Knowledgeand Knowledge