Clinical Pharmacy

ROLE OF CLINICAL PHARMAC Y IN HOSPITAL S

CLINICAL PHARMACY Ø All large acute hospitals have an on-site pharmacy department . Ø It ensures that the patients can receive the right medicine at the right time by an efficient and economical system. Ø Application of the pharmaceutical expertise to help maximize drug efficacy and minimize drug toxicity. Ø This concern of pharmacists for the outcome of treatment in an individual patient, which has developed in the UK over the last thirty years, characterizes the practice of clinical pharmacy and has led to the concept of pharmaceutical care as the description of the role of the pharmacist in patient care.

DEVELOPMENT OF CLINICAL PHARMACY § The late sixties, John Baker based at Westminster Hospital, introduced the formulary concept and developed the role of the pharmacist as part of the prescribing system. § The revolutionary feature of this development was the presence of the pharmacist on the ward. § This enabled some pharmacy practitioners to become an active part of the clinical team, a practice that is common place today.

§This lead to huge rise in the profession of pharmacy and lead to its commercial boom.

§ Clinical pharmacists are ideally placed to influence prescribing by hospital doctors because they have the appropriate knowledge about therapeutics and are in regular contact with prescribers. § A key feature of the policy is the use of clinical pharmacists to monitor compliance with the agreed selection of medicines.

§ These are the development of hospital policies by which individual pharmacists to improve their skills of the clinical process.

§The pharmacy profession took a view that they should champion the formulary approach and clinical pharmacists supported by Drug Information pharmacists have used them as an educational aid for junior doctors as part of their training.

PHARMACEUTICAL CARE § The term ‘Pharmaceutical Care’ was coined in by Heppler and Strand . §Definit ion:The responsible provision of drug therapy for the purpose of achieving definite outcomes which improve the patient quality of life. § It also involves designing, implementing and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient. § Responsible for the outcomes of drug therapy, that is to refocus clinical pharmacy activity from process to outcomes. § The use of the more traditional term of clinical pharmacy was superseded rapidly by pharmaceutical care.

Ø Clinical pharmacy reflected the participation of the pharmacist in the clinical team, working with other professionals to improve patient care and optimize the use of medicines. ØPharmaceutical care is now a convenient shorthand term that pharmacists use when describing their practice.

Ø The challenge for pharmacists is to ensure that people are aware of the service provision that is involved in delivering pharmaceutical care to patients. ØSo, this lead to the birth of Pharmaceutical journals in order to create an awareness about this profession.

IMPACT OF INFOR MATI ON q Prescriptions review is a retrospective check on the prescribed TECHNO LOGY medication. q Appropriate electronic prescribing system would enable these checks, and is performed automatically as the prescription is written. q The present hand written prescription chart does have many virtues perhaps we should ensure that any IT solutions retain these virtues as well as delivering the legibility, integration, education and control. q These will be driven by enthusiasts working with limited resources since the investment required to develop such a major system is beyond the budgets of most hospitals.

WHERE ARE WE NOW? Clinical pharmacy is now firmly established in many hospitals. Recognition of this diversity of practice has led to the publishing a set of statements of good clinical pharmacy practice developed by a multidisciplinary steering group . Clinical pharmacy can be effective by use of a structured approach to training , audit and the practice of clinical pharmacy

The framework for practice …‘is based on a systematic approach intended to assist individual pharmacists prioritize their workload and focus on those aspects which will optimize their contribution to health care’.

Research work on various new aliments are also carried out. This provides the good scope for dealing out with the patients and enabling them to prescribe the medicines.

As such the knowledge in both in the fields of medicine and medicaments is gained.

Technical development and rapid materializations of sophisticated care towards the patients has come into practice.

CHALLENGES TO PROGRESS The scene is now set for the consolidation of clinical pharmacy in

secondary care.

Development of a coherent philosophy is underway together with a coherent model for service provision.

Not least of these is the difficulty of recruitment of qualified pharmacists in secondary care.

There is a need for the movement of pharmacists between primary and secondary care to ensure manpower supply does not constrain the development of clinical pharmacy in secondary care. This may be achieved by collaborative ventures between pharmacists in primary and secondary care designed to provide pharmaceutical care support to general practitioners in primary care

The quality and scope of research into pharmacy practice in secondary care must be improved in order to sustain and develop this practice into every hospital service. Scope for improvement in links between the academic units of pharmacy practice and hospital departments in the area of research. Collaboration between practicing pharmacists, their clinical colleagues and academic centers is essential if the underpinning research required for service development is to be undertaken. These new research programmers will need to concentrate more on evaluating the benefits for patients of developments in pharmacy practice.

Many studies to date have concentrated on the economic benefits of clinical pharmacy avoiding the challenge of evaluating the impact of changes on patient outcomes.

KEY RESEARCH v Clinical pharmacy is concerned with improving AREAS the use of medicines. v However there is little evidence that it has improved the safe use of medicines, decreased iatrogenic disease or reduced adverse effects. v Drug induced illness is a major cause of hospital admissions. v Participation of clinical pharmacists in discharge planning and advice to patients about their medicines could reduce the incidence of re-admission. v Research programmes could test such options as involving pharmacists in the training of pharmacy technicians or nurses to advise patients about their medicines and to develop criteria which could identify those patients that would benefit from discussing their medication with a pharmacist.

Different professional groups use different techniques when trying to influence patients about medicines. The adoption of evidence based best practice could improve patient outcomes, assuming that taking their medicine is good for patients. Good communication by clinical pharmacists with clinical colleagues is an essential part of their practice Practice differs between hospitals. Some hospitals use newsletters extensively others rarely, and other formularies rigorously others use a light touch. New systems need to be evaluated before their adoption by other hospitals.

CONCLUSION:

-

Evaluation of the different approaches in order to identify the most appropriate methods would enable hospitals to use the resources of clinical pharmacy more efficiently. Service delivery system is far developed than other mode of services.

The decentralized clinical pharmacy service has its supporters. The range of practice is increasing as the multidisciplinary team approach to patient care is adopted by more clinical teams.

Pharmacists have a role both as team members and as individual practitioners.

The impact of implementation needs to be audited for health economic benefits and the benefits to patients.

These challenges form part of a research agenda for pharmacy practice in secondary care that will be met by collaboration between pharmacists and other members of the clinical team. BUT INORDER TO ACHIEVE ALL THIS WE AS PHAMACISTS SHOULD MAINTAIN A HEALTHY LIFESTYLE.

BY D.M.SRUJA & NA K.RAMYA CMR COLLEGE OF