Clinical pharmacist in TB & Renal Ward

This presentation will help to understand the role of clinical pharmacist in TB & Renal Ward

1. Clinical Pharmacy in
TB & Renal Ward
MADE BY : DHANVI SHAH
ROLL NO : 17
SUBJECT : CLINICAL PHARMACY
CLASS : FOURTH YEAR PHARM D (2016-17 )

2. CLINICAL PHARMACIST IN TB
WARD
The objectives of clinical pharmacist in TB ward are as follow :
Reduce mortality and morbidity due to TB
Prevent the development of drug resistance and hence, multi-drug resistant TB (MDR-TB) and
extensively drug resistant tuberculosis (XDR-TB) and
Ensure accurate measurement and evaluation of the performance of the programme
Furthermore, community pharmacies dispense prescriptions for anti- TB medicines made out by
private practitioners. They therefore need to be aware of the current treatment regimens and be in
a position to advise the patients accordingly.

3. The Role of the pharmacist

•Management of TB patients requires a multi-disciplinary approach by multi-disciplinary team.
•Pharmacists form a crucial part of that multi-disciplinary team.
•As part of the multi-disciplinary team, pharmacists can be involved at different stages in the value
chain for TB control.
Private-public sector collaboration
•Ideally, there should be close collaboration between healthcare professionals in the private and the
public sector.
•All patients on TB treatment are required to be entered into a TB register to enable completion of
quarterly reports which assist government in TB control at local, provincial and national levels.
•Although some patients may be managed at private healthcare facilities, they should however remain
on the clinic TB patient registers.
•Private healthcare professionals should therefore encourage and assist patients in identifying TB
control centres within their communities to ensure that these cases are recorded as part of the TB
recording and reporting system

4. Availability of anti-TB medicines
 
•Inconsistent and partial treatment results in the development of drug-resistant TB
and threatens TB control. The development of drug resistance and hence the
development of complications such as MDR-TB has often been attributed to erratic
drug supply, poor drug quality and/or use of expired medicines.
•The pharmacist therefore has a key role to play in drug procurement;distribution;
provision of drug information and ensuring rational use of drugs. This can be done by
ensuring:
 That all essential medication and this include anti-TB medicines are available in
sufficient quantities and are of good quality
That proper forecasting of drug needs is done at each facility to avoid any stock-out
situations
That the ordering of medicines is prioritized by pharmacists
The correct storage of medicines a teach facility
The availability and use of fixed-dose combination (FDC) drugs of proven efficacy

5. Patient education
•Pharmacists interact with a large number of people on a daily basis and are therefore in an ideal position to
distribute educational material to the public, not only on the treatment of TB but also on preventative
measures.
•The pharmacist should establish a relationship with his/her patients so that he/she can act as the patient’s
source of information on their disease condition as well as the treatment they have been prescribed.
•For example, pharmacists can provide public information on respiratory hygiene and cough etiquette. This
involves provision of information to TB patients on how to cover their nose and mouth when coughing or
sneezing.
Treatment and care
• As TB treatment takes months to complete and has to be taken regularly, most patients require
encouragement in order to adhere to their treatment.
•The premature interruption of treatment presents a problem for patients, their family members,those who
care for them, for health workers and the entire healthcare system.
•Assisting patients to adhere to their treatment regimens therefore becomes critical.
•Adherence to treatment means following the recommended course of treatment by taking all the prescribed
medications in the prescribed manner for the recommended duration of treatment.
•Adherence to treatment is however a complex behavioral issue and improving treatment outcomes for
tuberculosis requires a full understanding of the factors that prevent people taking their medicines
correctly and those tha thelp them complete their treatment.

6. •Pharmacies can act as centers for directly observed treatment short-course therapy (DOTS) for patients
living in their vicinity.
•The DOTS programme ensures that patients take each dose of anti-TB medication as prescribed and
helps prevent the emergence of drug resistance.
Treatment-related barriers to adherence for example can include:
• TB treatment needs to be taken regularly and for a prolonged period of time
• Adverse effects experienced by patients which are often unpleasant
• Complexity of regimen
• Drug interactions which can interfere efficient TB control
There are a number of strategies that can be adopted by pharmacists to promote adherence to treatment.
These can involve:
•The provision of pill boxes – a pill box is a special box for storing scheduled doses of one’s medications.
These are usually made with compartments for each day of the week. They sometimes have sections for
different times of the day. They are viewed as a way to prevent or reduce medication errors on the part
of the patient.
•Patient medication diary – this diary includes not only the schedule prescribed for the medication but
also the side-effects, date the medication was started and stopped, and so forth.
•Alarm watches to remind patients to take their medication etc.

7. CLINICAL PHARMACIST IN
RENAL WARD
IN-PATIENT CARE FOR PATIENTS WITH KIDNEY DISEASE
Patients with kidney disease require lifelong treatment for their condition and other co-
morbidities.
They receive a wide range of pharmacotherapeutic agents and are therefore at higher risk to
experience drug related problems that may lead to increased morbidity, which can affect patient’s
quality of life or cause increase in mortality.
Workflow for Renal Ward Pharmacy Activities
i) Medication History Taking / Reconciliation
Form used: Medication History Assessment Form
- Pharmacist must acquire the skills to interview patient to obtain an accurate and informative
medication history of the patient. Two main sources of information can be extracted, that is from
the case notes and through patient interview.
- The form should be filed together with the patient’s case notes, serving as a reference together
healthcare providers.

8. ii) Case Clerking and Medication Review
- Form used : Pharmacotherapy Review Form
- Case clerking is the term used when a case is being studied and documented for the first
time. The subsequent revision of the case is known as case reviewing.
- Pharmacist should be able to extract relevant information from medication chart, case
notes, laboratory data and other relevant details through patient interview
iii) Ward Rounds
- Ward rounds including routine rounds, pharmacist rounds, and grand ward rounds
- Active participation in ward rounds requires good clinical knowledge and adequate
information drug availability and dosage form.
- Participate effectively during discussion by presenting relevant PCI and respond to
questions and enquiries promptly.
- Intervene when necessary and monitor outcome
- Record all the interventions and activities in the relevant forms

9. iv) Bedside Medication Counseling
-Select and identify patient who needs counselling
-- Prioritize potential patient based on :
• Complexity of therapeutic plan
• Compliance status
• Patient with special device needs
• Patient dependant on caregiver
- Pharmacists must have thorough understanding of the patient’s condition and disease in
order to get the patient involved in their drug therapy plan during medication counselling.
Identify relevant issues to be emphasized during counselling.
v) Discharge Plan
- The pharmacy discharge plan will include past medication history taking, medication
reconciliation, and discharge counselling.
vi) Referral to Medication Therapy Adherence Clinic (MTAC)
- Prioritize patient that need MTAC follow up:
• Transplant patient
• Complex medication regimen
• Uncontrolled DM/HTN
• Poor compliance
- If a patient needs referral to MTAC programme, the patient should be registered under a
particular MTAC programme and given a follow up date

10. AMBULATORY CARE FOR PATIENTS WITH KIDNEY DISEASE

Renal Medication Therapy Adherence Clinic (MTAC) Program

•Ambulatory patients who have kidney disease are dispensed multiple number of medications for their
various co-morbidities.
•Proper counselling and follow-up strategies are needed to educate and improve patients’
understanding on their complex medication regimen as well as to inform their targets in improving
their disease outcomes.
•The renal MTAC program should be outlined to complement the pharmacy activities in the outpatient
settings.
•Specialised ambulatory care for kidney disease patients by pharmacists have been shown to improve
patient outcomes.
•The core areas that should be targeted are the chronic kidney disease (Stage 1- 4 of CKD), dialysis
(Stage 5 of CKD) and renal transplantation.

11. Chronic Kidney Disease (CKD) MTAC

•Apart from renal system, cardiovascular system involvement (lipids and blood pressure), diabetes
management and dietary restrictions affects chronic kidney disease (CKD) patients.
•This may result in many different practice areas to be involved in the care of a CKD patient.
•While the primary care physician may play a role in care coordination, dieticians, nephrologists,
endocrinologists, cardiologists and pharmacists are essential when addressing the many interacting
disorders.
•Without interdisciplinary involvement, care for patients may become fragmented. Preventing progression
to ESRD may improve quality of life and help to reduce health care budget.
•Thus MTAC CKD program is one of the ways for pharmacist to have a role in promoting adherence and
medication knowledge among CKD patient as well as to ensure that co-morbidities such as hypertension,
diabetes, anaemia and bone and mineral metabolism disorders are appropriately evaluated and managed.

12. References:
1. NORKASIHAN IBRAHIM ; Renal Pharmacy Service Guideline , Pharmaceutical Service
Division , December 2011 Page no :11 to 22
2. Gail Mkele, BPharm, MSc(Med)Pharm ; SA Pharmaceutical Journal The role of the pharmacist
in TB management 3/11/2010 3:23:55 PM Page no : 18 – 20