dr.khan clinical pharmacy orientation

8/2/2019 Dr.khan Clinical Pharmacy Orientation

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Shaukat Khanum Memorial Cancer Hospital &

Research Centre


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Dr.Maqsood khan

Pharm.D, BCPS,BCLS,ACLS,MACCP ,MSCCM.

Clinical Pharmacy Specialist

Infectious diseases and MedicalOncology

Shaukat Khanum Memorial CancerHospital & Research Centre


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Objective

Define clinical pharmacy

Differentiate between traditional pharmacists roleand Clinical Pharmacist

Explain the qualification required for clinicalpharmacists

List the clinical pharmacists responsibility

Describe the daily work activity of clinical

pharmacists.


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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.


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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


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Clinical Pharmacy

Clinical pharmacy is defined as a patient centered,outcomes oriented pharmacy practice that requiresthe pharmacist to work together with the patientand the healthcare team members to:

- promote health - to prevent disease -to assess, monitor, initiate and modify medication

use.


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Shaukat Khanum Memorial Cancer Hospital & Research Centre

After Clinical Rounds with MED ONC TEAM


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Clinical Pharmacy

.Maximizingthe clinical effect of medicines, i.e.,using the most effective treatment for each type ofpatient

Minimizing the risk of treatment induced adverseevents, i.e., monitoring the therapy course for adversereactions as well as patient's compliance with therapy

Minimizingthe expenditures for pharmacologicaltreatments by governments and by the patients, i.e.,trying to provide the best treatment options for thegreatest number of patients at the most cost effective.


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Clinical Pharmacy

Clinical pharmacy is defined as that area ofpharmacy concerned with the science

and practice of rational medication use.


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What is the difference?

Clinical Pharmacy

Pharmaceutical care


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Pharmaceutical care

Pharmaceutical care is the direct, responsible

provision of medication-related care for the purpose of

achievingdefinite outcomesthat improve a patientsquality of life.

Cure of the disease Elimination or reductioof symptoms Arrest or slowing of adisease process

Prevention of diseaseor symptoms


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Clinical Pharmacy

Clinical Pharmacy includes all the servicesperformed by pharmacists practising inhospitals, community pharmacies, nursinghomes, home-based care services, clinics and

any other setting where medicines areprescribed and used.

The term clinical does not necessarily implyan activity implemented in a hospital setting.


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How does clinical pharmacy differfrom pharmacy?

the discipline of pharmacy embraces the knowledge onsynthesis, chemistry and preparation of drugs

clinical pharmacy is more oriented to the analysis ofpopulation needs with regards to medicines, ways ofadministration, patterns of use and drugs effects on thepatients.

The focus of attention moves from the drug to the singlepatient or population receiving drugs.


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Goal

to promote the correct and appropriate use ofmedicinal products and devices.

These activities aim at:

maximising the clinical effect of medicinesminimising the risk of treatment-induced advers

events

minimising the expenditures for pharmacologicatreatments.


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Clinical Pharmacy Requirements

Knowledge ofnondrug therapy

Therapeuticplanning

skills

Drug InformationSkills

Physicalassessment

skills

Patientmonitoring

skills

Communicationskills

Knowledge oflaboratory

and diagnostic skills

Knowledge ofthe disease

Knowledge ofdrug therapy

Patient care


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Level of Action of ClinicalPharmacists

Clinical pharmacy activities may influence

the correct use of medicines at threedifferent levels: before, during and afterthe prescription is written.


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1. Before the prescription

Clinical trials

Formularies

Drug information

drug-related policies


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. Pharmacists have direct interaction with physicianand 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


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2. During the prescription

Counselling activity

Clinical pharmacists can influence the attitudes and priorities ofprescribers in their choice of correct treatments.

The clinical pharmacist monitors, detects and preventsMedication related problems

The clinical pharmacist pays special attention to the dosage of drugwhich need therapeutic monitoring.

Community pharmacists can also make prescription decisionsdirectly, when over the counter drugs are counselled.


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Pharmacy and Therapeutics Committee

Drug Use Evaluation

Adverse Drug Reactions

Medication Error

Infection Control and Antibiotics committee

Hospital Pharmacy: Clinical Committees


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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.


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3. After the prescription

Counselling

Preparation of personalised formulation

Drug use evaluation

Outcome researchPharmacoeconomic studies


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On Round with Med Onc team


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Pharmaceutical Care Plan

.


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Reduction of the rate of preventable adverse drugevents caused by ordering errors

Astudy published in JAMA in 1999 found that the pharmacist'sparticipation in medical rounds in the intensive care unit reducedthe occurrence of preventable adverse drug events caused byordering errors by 66% .

The study was conducted at the Massachusetts GeneralHospital in Boston in collaboration with the Harvard School ofPublic Health.

Leaps LL, Cullen DJ, Clapp M. Dempsey et al. Pharmacistparticipation on physician rounds and adverse drug events inthe intensive care unit. JAMA 1999;282(3):2(37-270.


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Additional Supporting Evidence

Clinical Pharmacy Services associated with decreasedmortality rates

1. 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# Pharmacotherapy2007;27(4):481493


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Clinical Pharmacy from theory toPractice

LLearn from yesterday, live for today, hope for tomorrow. Theimportant thing is not to stop questioning."

Albert Einstein
http://en.thinkexist.com/quotation/learn_from_yesterday-live_for_today-hope_for/222120.htmlhttp://en.thinkexist.com/quotation/learn_from_yesterday-live_for_today-hope_for/222120.htmlhttp://en.thinkexist.com/quotation/learn_from_yesterday-live_for_today-hope_for/222120.htmlhttp://en.thinkexist.com/quotation/learn_from_yesterday-live_for_today-hope_for/222120.htmlhttp://en.thinkexist.com/quotation/learn_from_yesterday-live_for_today-hope_for/222120.htmlhttp://en.thinkexist.com/quotation/learn_from_yesterday-live_for_today-hope_for/222120.htmlhttp://en.thinkexist.com/quotation/learn_from_yesterday-live_for_today-hope_for/222120.html


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Activities of Clinical Pharmacists

The principle activities of a clinical pharmacist include:

ConsultingAnalysing therapies, advising health care practitioners on thecorrectness of drug therapy and providing pharmaceutical care topatients both at hospital and at community level.

Selection of drugsDefining "drug formularies" or "limited lists of drugs" in collaborationwith hospital doctors, general practitioners and decision makers.

Drug informationSeeking information and critically evaluating scientific literature;

organising information services for both the health care practitionersand the patients.

.


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The principle activities of a clinical pharmacist include:

ConsultingAnalysing therapies, advising health care practitioners on thecorrectness of drug therapy and providing pharmaceutical care topatients both at hospital and at community level.

Selection of drugsDefining "drug formularies" or "limited lists of drugs" in collaborationwith hospital doctors, general practitioners and decision makers.

Drug informationSeeking information and critically evaluating scientific literature;

organising information services for both the health care practitionersand the patients.

.


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Medication ReviewReview medication chart, Review medication history

Attending Rounds

Drug use studies and research

Drug use studies/ pharmacoepidemiology/ outcome research/pharmacovigilance and vigilance in medicinal devices: collectingdata on drug therapies, their costs and patient outcome throughstructured and scientific methods.

Pharmacokinetics/ therapeutic drug monitoring

Studying the kinetics of drugs and optimising the dosage.

Clinical TrialsPlanning, evaluating and participating in clinical trials


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Clinical Pharmacy from theory toPractice

When it becomes more difficult to suffer than to change ... you willchange."

Albert Einstein
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.

Teaching & Training

Pre- and post-graduate teaching and activities toprovide training and education programmes forpharmacists and other health care practitioners


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Information Source

Medical record

Patient

FamilyHealth care team


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Medical Record

Admission Information

Initial history

physical examination

Progress notes

ConsultationsNursing notes

Laboratory data

Diagnostic Procedures

Radiology

Surgery

Orders

Medication

administration orders

Consent forms


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Medical Team


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Clinical Pharmacy Practice areas

Ambulatory care Critical care Drug Information Geriatrics and longterm 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


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Practice Guidelines for

Pharmacotherapy Specialists The pharmacotherapy specialist designs, implements,

monitors, evaluates, and modifies patientpharmacotherapy to ensure effective, safe andeconomical patient care.

A Position Statement of the American College of Clinical Pharmacy


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Pharmacotherapy Specialists The pharmacotherapy specialist retrieves , analyzes, evaluates,

and interprets the scientific literature as a means of providingpatient- and population-specific drug information to healthprofessionals and patients



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Pharmacotherapy Specialists

The pharmacotherapy specialist participates in thegeneration of new knowledge relevant to the practice ofpharmacotherapy, clinical pharmacy and medicine

The pharmacotherapy specialist educate health careprofessionals and students, patients, and the publicregarding rational drug therapy

The pharmacotherapy specialist continually develops

his/her knowledge and skills in applicable practice areaand demonstrates a commitment to continuedprofessional growth by engaging in a lifelong process.



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Responsibilities

Designing patient-specific drug dosageregimens

Recommending or scheduling measurements of drug

concentrations in biological fluids

Monitoring and adjusting dosage regimens

Evaluating unusual patient responses to drug therapyfor possible pharmacokinetic and pharmacologicexplanations.


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Responsibilities

Communicating patient-specific drug therapyinformation to physicians, nurses, and otherclinical practitioners and to patients orallyand in writing, and including documentationof this in the patients health record.


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Responsibilities

Educating pharmacists, physicians,nurses, and other clinical practitionersabout pharmacokinetic principles and

appropriate indications for clinicalpharmacokinetic monitoring, including thecost-effective use of drug concentration

measurements.


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Responsibilities

Developing quality assurance programs fordocumenting improved patient outcomes andeconomic benefits

Promoting collaborative relationships with otherindividuals and departments involved in drugtherapy


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Responsibilities

Pharmacists with specialized education, training, or

experience may have the opportunity to assume thefollowing additional responsibilities:

1. Designing and conducting research

2. Developing and applying computer programs and

point-of-care information systems to enhance the

accuracy and sophistication of pharmacokinetic modeling

and applications to pharmaceutical care.


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Responsibilities

3. Serving as an expert consultant to pharmacistswith a general background in clinicalpharmacokinetic monitoring.


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Responsibilities

3. Serving as an expert consultant to pharmacistswith a general background in clinicalpharmacokinetic monitoring.


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Clinical pharmacokinetics

Clinical pharmacokinetics is the process of applyingpharmacokinetic principles to determine the dosageregimens of specific drug products for specific patients

to maximize pharmacotherapeutic effects and minimizetoxic effects.

TDM stands for therapeutic drug mointoring


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Change your view

Knowledge into action


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WHAT DOES LOCAL DATA SAY ABOUT VALUE OF

PHARMACIST?

SKM 150 BEDS HOSPITAL INCLUDING 10 ICU BEDS 19HOSPITAL PHARMACISTS, WITH 6 FULL TIME DEDICATEDCLINICAL PHARMACISTS PATIENTS TO PHARMACISTRATIO AT ANY ATC IS 15-20/1

SPECIALIZED CLINICAL PHARMACY SERVICES TO MEDONC

IM.I.D TEAM: IN THE NEAR FUTURE HIRING MOREPHARMACISTS.

STARTED RESIDENCY PROGRAM FOR CLINICALPHARMACY.


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Aseptic ServicesUnit dose dispensing System

General Dispensing ServicesClinical Pharmacy Services

Drug Information Services

Training and Education ServicesInventory Control Management Services

SKM - Clinical Pharmacy Interventions Trend (Jan to Nov


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416

328 341 344 334 330

265

493

389

577

471

0

100

200

300

400

500

600

700

Jan,

11

Feb Mar Apr May Jun Jul Aug Sep Oct Nov

Cli

nica

lInte

rventi

ons

Numb

er

Months

SKM - Clinical Pharmacy Interventions Trend (Jan to Nov,2011)

Series


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5%

95%

SKM Pharmacy InterventionsAcceptance / Rejection Rate (Jan - Nov, 11)

RejectionAcceptance

1400


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0 4 0 1 9 1 30 28 3 5 25 0 6 3151

186

3 15

132

3

492

1198

99

320

976

507

0 0

222

0

200

400

600

800

1000

1200


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Shaukat Khanum Memorial CancerHospital & Research Centre


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Conclusion

Clinical Pharmacy is Really Rewarding &Interesting ,but

Its Highly Challenging .

If you want to be a Clinical Pharmacist thango beyond the limits of Excellency in Scienceand Knowledge

dr.khan clinical pharmacy orientation

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