Chapter 1The Profession of Pharmacy

Chapter 1 TopicsAncient OriginsPharmacistPharmacy TechnicianPharmacy Workplace of Today

Learning ObjectivesDescribe the origins of pharmacyDescribe the four stages of development of the pharmacy profession in the twentieth centuryEnumerate the functions of the pharmacistDiscuss the educational curriculum for todays pharmacy studentExplain the licensing requirements for pharmacistsIdentify the duties and work environments of the pharmacy technicianDifferentiate among the various kinds of pharmacies

Ancient OriginsPharmacy comes from the Greek word pharmakon, meaning drugScientific approach to medicine began with the ancient GreeksHippocratesProposed that disease came from natural, not supernatural causesEstablished the theory of humors (blood, phlegm, black bile, yellow bile)

Ancient OriginsGalenConducted animal experimentsProduced a systematic classification of drugs for treatment of diseaseGalenical pharmacy described the process of creating extracts of active medicinals from plants

DiascoridesFirst century A.D.De Materia Medica (standard text on drugs for 1500 years)

Ancient OriginsDr. John MorganEighteenth CenturySupported the separation of the professions of pharmacy and medicine

pharmakontheory of humorsgalenical pharmacyDe Materia MedicaTerms to RememberLearn more at American Institute of the History of Pharmacy (AIHP)

DiscussionHow has the profession and practice of pharmacy evolved since ancient times?

PharmacistThe profession of pharmacy exists to safeguard the health of the publicThe pharmacist is one who is licensed to prepare and dispense medications, counsel patients, and monitor outcomes pursuant to a prescription from a licensed health professionalThe role of the modern pharmacist evolvedfrom compounder and dispenserto providing medication information and preventing medication-related problems

Evolution of the Pharmacists RoleDuring the twentieth century, the pharmacy profession has evolved through four stages.

Traditional Era Scientific Era Clinical Era Pharmaceutical-care Era

Traditional EraEarly twentieth centuryFormulation and dispensing of drugs from natural sourcesPharmacognosyThe study of the medicinal properties of natural products of animal, plant, and mineral originsGalenical pharmacyTechniques for preparing medications

Scientific EraBegan after World War II Emergence of the pharmaceutical industryDrugs made in factories, not apothecary shopPharmacy education emphasized sciencesPharmacology The scientific study of drugs and their mechanism of action including side effectsPharmaceuticsRelease characteristics of drug dose forms

Clinical Era1975: Millis Report, Pharmacists for the FutureNew educational emphasis on clinical (patient-oriented) pharmacyPharmacokineticsthe activity of a drug within the body over a period of time; includes absorption, distribution, metabolism, and elimination Pathophysiologythe study of disease and illnesses affecting the normal function of the body

Pharmaceutical-Care Era1990: Hepler and Strand definedPharmaceutical carea philosophy that expanded the pharmacists role to include appropriate medication use to achieve positive outcomes with prescribed drug therapyincludesMonitoring response to therapyEducating patients and dispensing prescriptionsVisit the American Pharmacists Association (APhA)

DiscussionHow does the pharmaceutical care model affect the duties of pharmacists in the 21st Century? medication outcomes?

Terms to Remember

pharmacist pharmaceutics pharmacognosy pharmacokinetics galenical pharmacy pathophysiology pharmacology pharmaceutical care

Role of the PharmacistTodays pharmacist:Compounds and dispenses drugsGathers information about patientsCounsels on possible side effects and adverse reactionsMonitors for drug interactionsScreens, monitors, and advises for self-treatment with over-the-counter (OTC) products sold without a prescriptionProvides drug information to other healthcare professionalsAdvises on home healthcare supplies and medical equipment

Community PharmacistDispenses drugs for exiting diseaseInvolved in patient care initiatives to prevent or identify diseaseAdministration of immunizationsscreening for and educating about hypertension, diabetes, and other conditionsproviding education about lifestyle choices and dietary supplementsRuns a businesshires and supervises employeesdeals with insurance companiesmaintains inventory

Hospital PharmacistDispenses oral medicationsPrepares and dispenses parenteral medicationsSometimes specializes, with advanced training in an area of patient careEducates and counsels patientsProvides drug informationAdministers a departmentdevelops policies and procedurespurchases drugs and suppliesmonitors drug use in the hospitalLearn more about hospital pharmacy at the web site of the American Society of Health-System Pharmacists (ASHP)

Home Healthcare PharmacistPrepares medications and IVs for home delivery and useincluding IV nutrition and antibioticscancer chemotherapypain medicationsEducates patient or caregiver on appropriate and safe medication useMonitors patients response to prescribed therapies

Other Pharmacy SettingsHealth maintenance organization (HMO)Long-term care facilitiesSpecialized practicepsychiatrydrug abuseNursing homesgeriatrics

Nuclear Pharmacy Nuclear pharmacistProcures, stores, compounds, dispenses, and provides information about radioactive pharmaceuticals used for diagnostic and therapeutic purposesLearn more about nuclear pharmacy at the Cardinal Web site

Education and Licensing Requirements Education6 year program2 years prePharmacycalculus, chemistry, biologyPharmacy College Admission Test (PCAT)Doctor of Pharmacy (PharmD) degreebasic science courses practice setting experienceResidency in specialty area is optionalFor a listing of accredited schools of pharmacy, visit the Web site for the American Association of Colleges of Pharmacy (AACP)

Education and Licensing RequirementsLicensingrequired by all statesoverseen by board of pharmacyinvolvesgraduation form an accredited college of pharmacypassing state board certification examinationserving an internshipcontinuing education for license renewal

Discussion What are the differences and similarities between and among the various pharmacy practice settings?

How does specialized training affect the role of the pharmacist?

Terms to Remember

compounding

over-the-counter (OTC)

Pharmacy TechnicianA pharmacy technician, also called the pharmacy tech, is an individual working in a pharmacy who, under the supervision of a licensed pharmacist, assists in pharmacy activities that do not require the professional judgment of a pharmacist. Regardless of practice setting, the pharmacy tech can assist with workload. The pharmacist provides the final check on the original prescription with the medication bottle and label before counseling the patient.

Evolution of the Pharmacy Technicians RoleWithout pharmacy technicians, pharmacists would not have sufficient time for the duties involved in pharmaceutical care.counseling patientsreviewing medication profilesmonitoring for side effects and adverse reactionsscreening patients for diseasediscussing cost-effective drug therapy options with the prescriber

Evolution of the Pharmacy Technicians RolePharmacy technicians play a valuable role in reducing the risk of medication errors.Safety Note!

Evolution of the Pharmacy Technicians RoleOriginally, many pharmacy techs were trained as medics in the military.returned after service to take positions in hospitals In community pharmacy the pharmacy tech evolved from clerk or cashier to a pharmacists assistant.

Evolution of the Pharmacy Technicians RoleA pharmacy technician assists the pharmacist with routine functions.leaves professional decision making and judgment calls to the pharmacistTechnician activities may range from ordering, stocking, and inventorying drugs to preparing the IV order to assisting in the dispensing process.the pharmacist must always check his or her work the pharmacist is responsible for patient counseling the technician functions in strict accordance with standard written procedures and guidelines

Evolution of the Pharmacy Technicians RoleThe pharmacy technicians works under the direction of the supervising pharmacist.Safety Note!

Evolution of the Pharmacy Technicians RoleCentral defining feature of the technicians job is accountability to the pharmacist for the quality and accuracy of his or her work. The essential differences in the duties of a pharmacist and a technician involve: accountabilitymaking decisions about the patients healthcare

Education and Licensing RequirementsMost state boards of pharmacy recognize the existence and importance of the pharmacy technician. Each state board of pharmacy regulates:the activities of pharmacy technicianssometimes the ratio of pharmacy techs to pharmacists

Education and Licensing RequirementsIn the past, on-the-job training was sufficient for the tech working in a pharmacy. Now formal technician training programs train pharmacy technicians for their expanded roles. Initially centered in hospitals to train staff in the necessary functions of the hospital pharmacy. Now many programs are offered by community colleges and technical schools.

Education and Licensing RequirementsASHP developed a model curriculum to meet the needs of all practice settings. In some states pharmacy technicians must be certified to practice. Academic programs help to prepare the student to pass the certification examFor an up-to-date list of states requiring certification of pharmacy technicians, see the Pharmacy Technician Certification Board Web site

Discussion What is the relationship between the duties of the pharmacy technician and those of the pharmacist?

How do the education and licensure of technicians and pharmacists relate to those duties?

Work Environments and ConditionsPharmacy technicians are employed in most of the same settings as pharmacistscommunity pharmacies (i.e., drugstores)hospital pharmacieshome healthcare and long-term care facilities specialized area of practice (e.g., nuclear pharmacy) with additional training

Work Environments and Conditions

Pharmacy technicians usually work in clean, well-lighted, and well-ventilated environments. To ensure a sterile environment and minimize infectious disease, many techs in the hospital and other practice settings work either in a clean room or under specialized ventilation cabinets called laminar flow hoods when they prepare infusions, total parenteral nutrition, or cancer chemotherapy.Gowns, masks, hairnets, foot booties, and gloves are often needed in this environment.

Work Environments and ConditionsPharmacy tech work requires standing, often for long hours. Pharmacists and pharmacy technicians may be on call or work days, nights, weekends, and holidays. At any time, 24 hours a day, some number of the estimated 250,000 pharmacy technicians currently employed are on the job.

Characteristicsbroad knowledge of pharmacy practice dedication to providing a critical healthcare service to customers and patientshigh ethical standardswillingness to follow instructionseagerness to learn an eye for detailmanual dexterityfacility in basic mathematicsexcellent communication skillsgood research skills ability to perform accurately and calmly in hectic or stressful situations ability to multi-task or work on several projects at the same time

A successful pharmacy technician must possess a wide range of skills, knowledge, and aptitudes.

DiscussionWhat makes each of the listed characteristics of a pharmacy technician important?

Terms to Remember

Pharmacy technician

Multi-task

Pharmacy Workplace of TodayPharmacists work primarily in community and hospital pharmacies Some go on to pursue further education and higher degrees, residencies, or fellowshipsOther fields include managed care, mail-order pharmacy, home healthcare, long-term care, nuclear pharmacy, academia, drug information, sales, marketing, or research.The need for both pharmacists and pharmacy technicians is expected to continue.new life-saving drugsincrease in the aging population in the United States

Community PharmacyThree fifths of all pharmacists in the United States work in a community pharmacy (retail pharmacy). an independent or chain pharmacy that dispenses prescription medications to outpatients

Community PharmacyMost community pharmacies are divided into a back prescription area offering prescription merchandise and related items a front area offering over-the-counter (OTC) drugs, toiletries, cosmetics, and greeting cards Community pharmacies may beindependently owned small businessespart of large retail chainsfranchise operations The recent trend is toward fewer independent pharmacies

Community PharmacyA chain pharmacy is a community pharmacy that consists of several similar pharmacies in the region (or nation) that are corporately owned. May be national or regionalin department stores (e.g., Wal-Mart, Target)grocery stores (e.g., Kroger, Publix)typical corner drugstores (e.g., Walgreens, Eckerds, CVS, Rite-Aid). Located to allow for large-volume dispensing with heavy use of both pharmacy techs and automation Administrative decisions are made at the corporate level

Community PharmacyAn independent pharmacy is a community pharmacy that is privately owned by the pharmacist. May be owned and operated by a group of pharmacists (rather than a corporation) A pharmacist owner makes his or her own decisions regarding the practice of pharmacy more attention and time spent to keep customers Most compounding of prescriptions is done in this type of pharmacy

Community PharmacyA franchise pharmacy is member of a small chain of professional community pharmacies that dispense and prepare medications but are independently owned; sometimes called an apothecary. Combines characteristics of independent business and large retail chain A large retail company, the franchiser grants exclusive use of the company name and rights to sell company products to a store owner/operator, the franchisee Most sell only medication and health-related products/servicesVisit The Medicine Shoppe

Community PharmacyPharmacy technicians employed in a community pharmacy typically aid the pharmacist in the filling, labeling, and recording of prescriptions operate and are responsible for the pharmacy cash register stock and inventory prescription and over-the-counter (OTC) medications maintain computerized patient records prepare insurance claim forms order and maintain parts of the front-end stock

Community PharmacyA mail-order pharmacy is a large-volume centralized pharmacy operation that uses automation to fill and mail prescriptions to the patient.somewhat related to retail pharmacy Run by a centralized operation using both automation and pharmacy techs dispense and mail large volumes of prescriptions every daymore and more prescriptions are being filled by mail-order pharmacies

Community PharmacyMail-order pharmacyEconomies of scale allow lower acquisition costs savings to insurers and customersLimitations: if the patient experiences a side effect or adverse reaction, or the physician changes the medication, then the drug savings could be offset by drug wastage impersonal counseling, which is limited to a drug printout or calling a toll-free numbertime delay safety of delivery of pain medications through the mail

DiscussionWhat are the advantages and disadvantages of each type of community pharmacy operation?

Terms to Remembercommunity pharmacychain pharmacyindependent pharmacyfranchise pharmacymail-order pharmacy

Institutional PharmacyInstitutional pharmacies are organized under a corporate structure, following specific rules and regulations for accreditation. A pharmacy associated with any organized healthcare delivery system hospital pharmacy is the most common examplemore recent examples of places where institutional pharmacies can be found include :home healthcarelong-term care facilitiesmanaged-care organizations

Institutional PharmacyA hospital pharmacy is an institutional pharmacy that dispenses and prepares drugs and provides clinical services in a hospital setting. One fourth of all pharmacists work in a hospital setting an institution that offers 24-hour healthcare service; that has six or more beds, a governing authority, and an organized medical staff; and that offers nursing and pharmacy services carries out the functions of maintaining drug treatment records and ordering, stocking, compounding, repackaging, and dispensing medications and other supplies

Institutional PharmacyThe pharmacy technician in a hospital setting takes part in functions involving delivery, stocking, or inventorying of medications anywhere in the hospital may operate manual or computerized robotic dispensing machinery

Typical hospital pharmacy staff may include:administrators with masters degrees or PharmD degreesstaff pharmacists with Bachelor of Science (BS) degreesstaff and clinical pharmacists with PharmD degrees pharmacy technicians

Institutional PharmacyHospital pharmacies (and drugstore chains) are more likely than community pharmacies to require that pharmacy technicians be certified. Some pharmacy employers encourage technicians to become certified by paying for the certification exam by giving raises to those who pass it

Institutional PharmacyA home healthcare pharmacy is a pharmacy that dispenses, prepares, and delivers drugs and medical supplies directly to the home of the patient. Spiraling hospitalization costs, regulatory changes, and advances in parenteral therapies have created an explosion in this field The home healthcare market continues to grow because of our aging society and as an alternative to the higher cost of hospitalizations Many hospitalized patients are discharged as soon as possible to continue their recovery at home with IV solutions.

Institutional PharmacyPharmacists and pharmacy technicians working in home healthcare provide educational materialscarry out traditional compounding and delivery functionsprepare and provide infusions and infusion equipmentoften must be available for emergencies on a 24-hour basis

Institutional PharmacyA long-term care facility is an institution that provides care for geriatric and disabled patients. An extended-care facility (ECF) provides institutional services predominantly to older adults or disabled residents who unable to provide for routine or medical care for themselves includes adults who suffer from chronic (long-lasting) or such debilitating illnesses as stroke or Alzheimers disease both medical and residential care is provided with very few discharges

Institutional PharmacySkilled-care facilities (SCF) are limited to patients requiring more round-the-clock nursing care (such as IV infusions) or recovery after a recent hospitalization most patients are discharged from SCF to home when they have adequately recoveredOther long-term care facilities include patients with acute or chronic psychiatric disorders or rehabilitation facilities for those with serious traumatic brain or spinal cord injuries

Institutional PharmacySome long-term care facilities have an in-house pharmacyothers contract with a community pharmacy or allow each resident to choose his or her pharmacyLicensed pharmacists establish record-keeping systems related to controlled substances review drug regimensmonitor repackaging and storage of pharmaceuticals ensure that medications are uncontaminated and have not expired note medication errors and adverse reactions or interactions educate residents on drug therapies and self-medication provide medications to outpatients or residents on weekend leave

Institutional PharmacyThe pharmacist may play a crucial role in ensuring regulatory compliance a licensed pharmacist must do a monthly check of each patient profile in a long-term care facility The professional organization for geriatric pharmacists is the American Society of Consultant Pharmacists (ASCP)Visit the ASCP Web site

Institutional PharmacyA pharmacy technician in a long-term care facility may: log prescriptions and refill orders via computerprepare billingsmaintain drug boxes or trays for emergenciespackage and label medicationsdeliver medications to the nursing homemaintain records, retrieve and organize patient chartsconduct inspections of drugs in inventory and in nursing stations repackage drugs in unit doses labeled for each patient

Institutional PharmacyIn-house pharmacies may provide a 7-day supply of medication in blister packs. Community pharmacies fill medication carts or trays with a 30-day supply of medicationmedication orders rarely change in this environment

Managed CareManaged care is a type of health insurance system that emphasizes keeping the patient healthy of diseases controlled to reduce healthcare costs. A relatively new form of healthcare that has grown dramatically over the past 35 years One of the first managed-care organizations was Kaiser Permanente Another name for managed care is health maintenance organization (HMO)

Managed CareHMOs encourage patients to take an active role in their own healthcare by:eating rightexercising oftenavoiding negative life-style choices HMOs encourage patients to:have annual checkupsget all their immunizations on schedule get necessary laboratory (like a cholesterol or sugar test) and diagnostic tests (like a pap smear or mammogram) to detect early diseases, which may be surgically correctible

Managed CareMost HMOs have their own staff physicians who are on salaryPatients who need a specialist must first get a referralHMOs have been successful in slowing the pace of the inflationary increases in healthcare without compromising the quality of care Many employers now include an HMO option on their health plans

Managed CareMost HMOs are centralized primary-care clinicsthey serve patients with pharmacy, x-ray, and laboratory departments under one roofAn HMO, like a hospital, usually has an approved drug list or formulary that has been recommended by a drug information pharmacist and approved by the medical staff

Managed CareThe formulary plus the use of low-cost generic drugs allows the organization to volume purchase select drugs to lower operational and patient cost unlike a community pharmacy, an HMO pharmacy does not stock every brand of drug available Many HMO pharmacies have a tiered pricing plan so that patients pay one price for a generic drug, a higher price for a preferred brand name drug, and an even higher price for a nonpreferred brand name product most patients and physicians use the lower-cost alternatives whenever possible

Managed CareAfter the patient sees the physician, the patient may go to the HMO pharmacy to fill a prescription Patients needing refills may call an automated telephone number to expedite processing and reduce waiting times this time savings also allows the pharmacist to spend more time reviewing the computerized medication profile and counseling the patient

Managed CareThe pharmacy technician in managed care performs similar functions to those in the community pharmacyalthough insurance billing and cashiering are minimal Clinical pharmacists may work closely with the primary-care physicians to better control chronic disease educatingmonitoringadjusting doses of medications per physician-approved protocols

DiscussionWhat are the similarities between and among the various institutional pharmacy environments?

What are the differences?

Terms to RememberPharmacy Workplace: Institutional Pharmacyinstitutional pharmacyhospital pharmacy home healthcare pharmacylong-term care facilitymanaged carehealth maintenance organization (HMO)formulary