Clinical pharmacy.pptx

brief review on clinical pharmacy, drug information centre & patient safety program

The lecture was presented at Al-Mahmoudiya General Hospital as part of the training course for fresh appointed pharmacist at 16/5/2023 at 11 & 15/5/2023

1. Clinical pharmacy, Pharmacy & therapeutics committee, Patients safety & Others Alaa Fadhel Hassan (MSc. Pharmacology) Al-Mahmoudiya General Hospital

2. Clinical Pharmacy Established at the 1990s (late 60s & early 70s) Describe a wide range of pharmacy practices that occur in a variety of settings, including health-systems, community pharmacies, clinics, pharmaceutical industry, and governmental agencies. incorporates the patient-oriented practices of pharmaceutical care as well as drug policy management, research, education and many other aspects within the field societies

3. Clinical Pharmacy Goals Maximizing the clinical effects of medicines: using the most effective treatments for each type of patient Minimizing the risk of treatments-induced adverse events: monitoring therapy course and the patient's compliance with therapy Minimizing the expenditures for pharmacological treatments born by the health system and by the patients: trying to provide the best treatment alternatives for the greatest number of patients

4. Basics of Clinical P harmacy Qualifications Process of care (Assessment of patient, Evaluation of medication – t herapy, Development & implementation - of a plan of care, Follow-up evaluation & medication monitoring) Documentation Level of Action

5. Clinical Pharmacists, Qualifications Are practitioners who provide comprehensive medication management and related care for patients in all health care settings. They are licensed pharmacists with specialized advanced education and training who possess the clinical competencies necessary to practice in team-based, direct patient care environments. Accredited residency training or equivalent post licensure experience is required for entry into direct patient care practice

6. Postgraduate-Residency years Programs (PGY1 & PGY2) PGY1 1 year of clinical/academic training & research program I ncluding all specialities : Medicine, Surgery, Gynaecology & Paediatrics PGY2 1 year of specialized clinical residency & research in 1 these specialities: Oncology and Hematology, Emergency, Cardiology, Operation Room and Surgery & Paediatrics

7. Process of Care Care is coordinated among providers and across systems of care as patients transition in and out of various settings, including: Assessment of the p atient Evaluation of medication t herapy Development and implementation of a plan of care Follow-up evaluation and medication m onitoring

8. Assessment of Patient Reviewing the medical record using a problem-oriented framework (interpreting & analyzing subjective & objective information) to determine the clinical status of the patient • Meeting with the patient/caregivers to obtain & document a complete medication history to identify all of the patient’s current medications (including regimens and administration routes ), medication-taking behaviors, adherence , allergies, and attitudes and experiences with medications. • Obtaining, organizing, and interpreting patient data; and p rioritizing patient problems and medication-related needs.

9. Evaluation of Medication Therapy Assessing, with other members of the health care team, the appropriateness of current medications on the basis of health conditions, indication , & the therapeutic goals of each medication • Evaluating the effectiveness, safety, and affordability of each medication

10. Evaluation of Medication Therapy • Assessing medication-taking behaviors and adherence to each medication • Identifying medication-related problems & evaluating collaboratively with other members of the health care team the need for intervention patient data & p rioritizing patient problems and medication- related needs.

11. Development and Implementation of a Plan of Care Reviewing the patient’s active medical problem list to inform & guide the development of an individualized assessment & plan for optimizing medication therapy Formulating a comprehensive medication management assessment & plane in collaboration with the health care team & implementing this plan to achieve patient-specific outcomes

12. Development and Implementation of a Plan of Care • Educating the patient/caregivers (both verbally and in writing) to ensure understanding of the care plan, to optimize adherence, & to improve therapeutic outcomes • Establishing patient-specific measurable parameters & time frames for monitoring & follow-up in collaboration with other members of the health care team .

13. Follow-up Evaluation and Medication Monitoring Coordinating with other providers to ensure that patient follow-up & future encounters are aligned with the patient’s medical & medication-related needs • Revisiting the medical record to obtain updates on the clinical status of the patient & then meeting with the patient/caregivers to obtain an updated medication history to identify , assess, and document any new medication related needs or problems

14. Follow-up Evaluation and Medication Monitoring • Conducting ongoing assessments & refining the plan of care to optimize medication therapy & ensure that individual goals are achieved • Monitoring, modifying, documenting, & managing the plan of care in collaboration with the patient/caregivers & his/her other health care providers.

15. Documentation Clinical pharmacists document directly in the patient’s medical record the medication-related assessment & plan of care to optimize patient outcomes . This documentation should be compliant with the accepted standards for documentation & billing within the health system, health care facility, outpatient practice , or pharmacy in which 1 works

16. Documentation, Includes Medication h istory brief summary, list of current medications, list of allergies/adverse events Active problem l ist with an assessment of each problem list of current heath condition & any additional drug related problem Plan of care to optimize m edication t herapy & improve p atient o utcomes specific medication therapy plan with dose rout frequency & monitoring parameters Collaborative follow up plan

17. Documentation, Ex.

18. Documentation, Ex.

19. Drug Information C entre Established at 2017, DIC duties include: Answering/responding to all request of physicians, pharmacists & patient whether in/outside the hospital Documenting all performed work via (Drug Information Centre Request Form) Performing medication periodic/wall flier Contribution in all scientific activities held within the hospital

20. Drug Information C entre

21. Pharmacy & Therapeutics C ommittee Archiving all instruction associated with the pharmacy department Hold monthly meeting with printed agenda discussing the available, scarce & missed medication & medical equipment's Making & updating institutional “Formulary List”, that depend/based on safety , efficacy , quality & cost effectiveness analysis & references such as BNF Maintaining reliance to the MOH “Standard treatment Protocols” in the institution Evaluating & monitoring subcommittees/units as (Antibiotic stewardship, Rational use of drugs, Physical changes & pharmacovigilance)

22. Patient Safety Patient safety is an issue in all countries that deliver health services , whether these services are privately commissioned or funded by the government Failing to adequately check the identity of a patient or prescribing antibiotics without regard for the patient’s underlying condition or administering multiple drugs without paying attention to the potential for adverse drug reactions can lead to patient injury.

23. Patient safety, Mistake/Error A mistake is a failure of planning (i.e. the plan is wrong). This can be either rule-based, when the wrong rule is applied, or knowledge-based, when a clinician does not take the correct course of action. An example of a rule-based mistake would be getting the diagnosis wrong and so embarking on an inappropriate treatment plan. Knowledge-based mistakes tend to occur when health-care providers are confronted with unfamiliar clinical situations

24. Patient Safety

25. Patient S afety

26. Patient Safety Patients are not only harmed by the misuse of technology, but can also be harmed by poor communication between different health-care providers, or delays in receiving treatment Training to become an excellent team member starts in professional school. Learning how to substitute roles and appreciate the other’s perspective is central to effective teamwork

27. Patient safety Leaders in patient safety have defined patient safety as follows: “A discipline in the health-care sector that applies safety science methods towards the goal of achieving a trustworthy system of health-care delivery. Patient safety is also an attribute of health-care systems; it minimizes the incidence and impact of, and maximizes recovery from adverse events”

28. Patient Safety Program Established at 2014, duties include:

29. Patient S afety

30. Patient safety High alert medications: medication s which have a higher risk of causing harm when an error occurs . They must be double checked prior to administration by two licensed caregivers who are authorized to administer or dispense medications Limiting access to high-alert medications Using auxiliary labels and automated alerts Employing redundancies Improving access to information about these drugs

31. Patient safety Look-alike sound-alike (LASA) Medications: Prescribing medication errors can occur because of similar medication names or poor handwriting which can make many of these medications look alike 1 way to differentiate two similar sounding medications is to know the disease state that is being treated. When transcribing a verbal order, always read back to the prescriber what was written or entered. Medications on the LASA lists will be separated in clinics or on units & should not be stocked close to each other

32. Rational use of Medications/Drugs Marinating institutional reliance to medication compounding/mixing MOH protocols for ex., chemo/biological therapy & intravenous fluids Sending/sharing seasonal clinical pharmacy-associated reports such as: Antibiogram, antibiotic stewardship surveillance & reports, meropenem prescription surveillance

33. References Standards of Practice for Clinical Pharmacists. Pharmacotherapy (2014), 34: 794-797. https:// doi.org/10.1002/phar.1438 MOH, Directorate of technical affairs, , Pharmacy department. Clinical pharmacy section. Clinical pharmacist standard of practice, 2022. MOH, Directorate of technical affairs, , Pharmacy department . Training package for newly graduated pharmacists, 2015. Patient Safety Curriculum Guide: Multi-professional Edition World Health Organization 2011 The Institute for Safe Medication Practices (ISMP) Recommendations https://www.ismp.org/resources?field_resource_type_target_id[13]=13#resources--resources_list