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Clinical Pharmacy Practice Overview

• Development of Clinical Pharmacy

  • Aimed at promoting optimal use of medicines for individual patients.

  • Requires a patient-centered approach, grounded in safety and evidence-based practice.

  • Emerged in response to poor medicine control in the 1960s; evolved differently in the USA and UK.

Key Features of Clinical Pharmacy

• Shift from Product to Patient Focus

  • Pharmacists transitioned to engaging directly with patients and addressing their medicine-related issues.

• Patient Care Process

  • Involves assessing the patient, determining care plans, and evaluating outcomes.

  • Each step requires the pharmacist to consult with patients regularly.

• Cost-Effective Medicine Use

  • Clinical pharmacy helps promote cost-effective medicine use in hospitals, recognized by government endorsements.

Elements of Pharmaceutical Care

• Three Main Elements

  • Assessment, Care Planning, and Evaluation of outcomes.

• Consultation Skills

  • Continuous practice needed for effective consulting.

• Medication Safety

  • Initially driven by safety concerns, then expanded to include cost containment.

Development of Clinical Pharmacy Practices

• 1960s Roots

  • Emergence attributed to existing poor pharmaceutical practices.

• 1980s Growth

  • Increased focus on promoting the safe and effective use of medicines.

  • Transition from 'ward pharmacy' to participating in medical rounds.

Principles of Medicines Optimisation

• Aim

  • Help patients take medicines appropriately to improve safety and outcomes.

• Philosophy

  • Focused on achieving better outcomes through professional engagement and understanding patient needs.

Definitions Related to Clinical Pharmacy

• Clinical Pharmacy

  • Functions promoting safe and effective use of medicines for patients.

• Pharmaceutical Care

  • Cooperative, patient-centered system focused on achieving positive outcomes through responsible medicine provision.

• Medicines Optimisation

  • Ensures the right patient receives the right medicine at the right time, enhancing adherence and minimizing waste.

Process of Pharmaceutical Care

Drug Use Process (DUP) Steps

1. Establish Need for a Drug

   • Ensure proper indications, consider deprescribing unnecessary medicines.

2. Select Drug

   • Recommend appropriate medicine based on therapy goals and patient context.

3. Select Regimen

   • Choose effective medicines at minimal cost without compromising efficacy.

4. Provide Drug

   • Ensure accurate preparation and timely delivery to patients.

5. Administer Drug

   • Use proper techniques for medicine administration.

6. Monitor Therapy

   • Observe effectiveness and side effects to adjust therapy as necessary.

7. Counsel and Educate

   • Ensure proper understanding of therapy by the patient.

Monitoring and Safety Procedures

• Evaluate Effectiveness

  • Review steps to confirm achieved outcomes.

• Patient Advice and Education

  • Provide clear, helpful information tailored to patient needs.

• Documentation

  • Record all relevant patient history, medications taken, and advice given.

Addressing Medication-Related Problems (MRPs)

• Types of MRPs

  • Untreated conditions, improper selections, adherence issues, adverse drug reactions, and drug interactions.

• Strategies for Prevention

  • Employing decision support tools and having thorough patient conversations to avoid MRPs.

Outcome and Financial Implications

• Preventable Hospital Admissions

  • Estimations indicate significant rates of medication-related admissions, highlighting the value of clinical pharmacy in public health.

• Cost Containment

  • Savings associated with improved medication use and reduced admissions due to adverse drug events.

Conclusion

• Evolving Role of Clinical Pharmacy

  • Shift towards a holistic approach where pharmacists engage deeply with both patients and other healthcare professionals, fostering a collaborative healthcare environment.