Shaukat Khanum Memorial Cancer Hospital & Research Centre

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

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.

Shaukat Khanum Memorial Cancer Hospital & Research Centre

After Clinical Rounds with MED ONC TEAM

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.

What is the difference?

Clinical Pharmacy

Pharmaceutical care

Pharmaceutical care

Pharmaceutical care is the direct, responsiblethe disease Cure of Elimination or reduction provision of medication-related care for the purpose of of symptoms achieving definite outcomes that improve aor slowing of a Arrest patients disease process quality of life.
Prevention of disease or symptoms

Clinical Pharmacy
Clinical 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 medicines minimising the risk of treatment-induced adverse events minimising the expenditures for pharmacological treatments.

Clinical Pharmacy Requirements

Knowledge of drug therapy Knowledge of nondrug therapy Knowledge of the disease

Therapeutic planning skills Patient care

Knowledge of laboratory and diagnostic skills

Drug Information Skills

Communication skills

Physical assessment skills

Patient monitoring skills

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.

1. Before the prescription

Clinical trials Formularies Drug information drug-related policies

Pharmacist role during prescription

. 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

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.

Hospital Pharmacy: Clinical Committees

Pharmacy and Therapeutics Committee

Drug Use Evaluation Adverse Drug Reactions Medication Error

Infection Control and Antibiotics committee

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

On Round with Med Onc team

Pharmaceutical Care Plan

.

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 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# Pharmacotherapy 2007;27(4):481493

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

Information Source
Medical record Patient Family Health care team

Medical Record

Admission Information Initial history physical examination Progress notes Consultations

Diagnostic Procedures

Radiology
Surgery Orders Medication administration orders Consent forms

Nursing notes
Laboratory data

Medical Team

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

Responsibilities
Designing 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 patients 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.

Responsibilities
Developing 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, or experience may have the opportunity to assume the following 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.

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

Change your view Knowledge into action

WHAT DOES LOCAL DATA SAY ABOUT VALUE OF PHARMACIST? SKM 150 BEDS HOSPITAL INCLUDING 10 ICU BEDS

19

HOSPITAL PHARMACISTS, WITH FULL TIME DEDICATED CLINICAL PHARMACISTS PATIENTS TO PHARMACIST RATIO AT ANY ATC IS 15-20/1 SPECIALIZED CLINICAL PHARMACY SERVICES TO MEDONC IM.I.D TEAM: IN THE NEAR FUTURE HIRING MORE PHARMACISTS. STARTED RESIDENCY PROGRAM FOR CLINICAL PHARMACY.

Aseptic Services
Unit dose dispensing System

General Dispensing Services Clinical Pharmacy Services Drug Information Services Training and Education Services Inventory Control Management Services

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

700 600 Clinical Interventions Number

577 493 416 389 471

500
400

300
200 100 0

328

341

344

334

330 265

Series1

Jan, 11

Feb

Mar

Apr

May

Jun Jul Months

Aug

Sep

Oct

Nov

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

5%

Rejection Acceptance

95%

1400
1200 1000 800 600 400 200 0 01 4 132 0 3 1 15 9 1 3 30 28 3 507 1198 976

492

320
222 86 99 5 25 0

51 6 0 31 0

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Conclusion

Clinical Pharmacy is Really Rewarding & Interesting ,but Its Highly Challenging . If you want to be a Clinical Pharmacist than go beyond the limits of Excellency in Science and Knowledge