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AN ARTICLE ON PHARMACIST CLINICAL REVIEW PROCESS

Author: K Lalithendra, ASN PHARMACY COLLEGE TENALI

 

INTRODUCTION:

• CLINICAL PHARMACY IN INDIA:

a) Need for clinical pharmacy in India ;

Clinical pharmacy practice is concerned with the promotion of effective, safe and economical drug therapy. these include dispensing and drug distribution, drug information, health promotion, patient counseling, pharmacovigilance, medication reviews, academic details and sterile and non sterile manufacturing.

India is a country with many drug use problems. thereby results of socioeconomic, medical and political factors. These drug-related problems occur in different strategies i.e prescribers, patients, pharmacists, nurses etc.

Pharmacy practice in India

b) Scope for clinical pharmacy practice in India:

Clinical pharmacy practice plays a crucial role in the level of pharmacy profession. This was done by the support of medical staff in well-developed institutions.

The medical staff includes:

• Drug information services
• Clinical pharmacy input on ward rounds
• Information about new drugs
• Patient counseling and patient management

c) Clinical pharmacy education:

The postgraduate education in pharmacy offered by many Indian pharmacy colleges are established to expand the role of pharmacist in the health care system.

The pharmacy practice program deals:

• Pathophysiological basis of various
• Patient data analysis:

This is used to understand the student about significance of laboratory tests and other biological values.

• Applied therapeutics:

Used to understand the role of different diseases and their conditions, safety, efficacy, and rational selection of drugs.

• Clinical pharmacokinetics

Understand the kinetics of drug, especially when used during renal and hepatic impairment.

Excellent relationship are established with the medical profession are needed to ensure the progress pf clinical pharmacy.

CLINICAL PHARMACY IN INTERNATIONAL PERSPECTIVE:

Clinical pharmacy has evolved in many countries around the world for similar reasons And those reasons are,

• large increase in the number of drugs available
• Increase the complexity of therapy
• Need of usage of safe and effective drugs

The evaluation of drugs varied and different in results. During practice among countries, and also within countries due to different hospitals and other related settings.

COMMUNICATION SKILLS FOR PHARMACIST:

Communication is the most basic thing that helps to sending and receiving of information in pharmacy practice sight, hearing, touch, are used for communication. communication style depends on language, culture, social status, personality, interests, abilities and disabilities.

EMPATHY:

Empathy is the heart of communication.

It is defined as the ability to see and feel the way of another person does.

If feelings are not shared and empathy does not develop then communication can be impaired. The significance of empathy is that a sympathetic relationship based on understanding.

NON-VERBAL COMMUNICATION:

Nonverbal messages begin to be received and interpreted as soon as something catches attention of ours.

Ex: when two people first meet, before spoken impressions are formed from their signal, sound, smell and sometimes touch during that time,

What expressions on their face? How are they dressed?

How old are these?

What perfume they wearing? They appear to be friendly or not?

These unconscious impressions to be good during the process of communication.

VERBAL COMMUNICATION:

Verbal communication is about the meaning of words may be spoken or written. Ex:tone of voice pr the type face used

This should have mainly skills on Language

Interactive communication Listening skills.

STAGES IN VERBAL COMMUNICATION:

• Written communication:

It includes different writing styles, appropriate for different purposes.

• Special situations include:

Face-to-face interviewing.

Providing information, providing information about medicine is the common role of clinical pharmacist.

COMMUNICATION IN PROFESSIONAL PRACTICE:

• Communication with medical and health professionals:

During the establishment of clinical pharmacy service , interprofessional communication can be challenging.

Once a service is accepted the pharmacist establish their communication and creditability with new staff members or ward area .

Thereby,

Spoken messages:

Spoken messages can occur in person or over the telephone.

These are used to gain information about patient or their treatment and to provide medicine information to a practitioner or clarify modifications in patients therapy.

Case note annotation:

Case note of patient is important convey of providing information for the purpose of caring and record patients health management details.

Communication with patients:

• Medication history interview by checking whether prescription is prescribed or not? Is any OTC drugs used or not?
• Vaccinations
• Any traditional remedies?
• Allergic reactions

Checking labeling of the medicines

1. name of the medicine
2. Dosage form and number of units
3. Administration guidance
4. Patient name
5. Date of dispensing
6. Batch number and expiry

ROLES OF CLINICAL PHARMACIST:

Interventions by clinical pharmacist during outpatients

²  PATIENT COUNSELLING :

Patient counseling is the process of providing information advice to help the patients in their use of medications approximately.

This information is given by the pharmacist directly to the patient or any patients representatives.

This may include about patient illness and recommended life style changes

Patient counseling at prescription center

Steps of patient counseling:

a) preparing for the session:

• Pharmacist should be skilled and knowledge
• Need to know about the past medication history of the

b) opening the session:

• Here, pharmacist should introduce himself to the patient and greet them by
• He should explain all details about counseling including time taking period also .
• Next pharmacist gather information from the patient about their understanding on the session of

c) Counselling content:

• It is heart of counselling It may include,
• Name and strength of the medication
• Reason for prescribed
• Route of administration
• Expected duration of treatment
• Expected benefits of treatment
• Adverse effects
• Dietary interaction
• Advice on correct dosage
• What to do if dose is missed
• TDM requirement,blood test

d) Closing the session:

• Before ending the session pharmacist should check the patient by asking feedback questions
• Can you remember what this medication is used?
• How long should you take this medication?
• We should be ended the session by asking the patient that he has any questions regarding to his health .
• Patient counseling is an essential component of clinical pharmacy practice in hospital and in community pharmacy

MEDICATION ADHERENCE:

Pharmacists are in a unique position to improve medication adherence because pharmacist show the medication to the patient and related any information to the medication

The patient received both oral education and written instructions in the local language about the disease need for regular medication, and importance of each medication by pharmacist.

DRUG INTERACTIONS:

Pharmacists play a valuable role in screening of interactions and advising on management of such interactions when they occur

a) Pharmacokinetic interactions:

• Drug absorption
• Drug distribution
• Drug metabolism
• Drug excretion

b) Pharmacodynamic interactions

• Synergism
• Antagonism

GUIDANCE ON IDENTIFYING AN ADVERSE DRUG INTERACTION:

• These are done by pharmacist, asking the patient what he experienced
• By checking the medication and reaction history
• Managing an adverse interaction by observing TDM(therapeutic drug monitoring)values
• During that time if any new or rare interactions are raised those should be reported by pharmacist
• And screening patient’s medication history to prevent drug interactions
• Asking the patient,any interactions are occurred during taking of certain or specific food items
• Pharmacist have good educational base on which help to develop expertise in drug interactions and so make a valuable contribution to the patient

INTERPRETING THE LABORATORY DATA:

• Laboratory data must always be interpreted with reference to the clinical status of patient
• The details of the patient that interpreted by pharmacist are serum creatinine,GFR, serum urea,blood urea nitrogen,serumelectrolytes,serum sodium, serum potassium,serum calcium
• Liver function tests: Blood glucose test Haemoglobin test WBC count

Platelet count

• Others:

ESR – erythrocyte sedimentation rate CRP- C reactive protein

MEDICATION REVIEW:

Medication review involves the review of patient’s information to ensure therapy is appropriate, safe, efficacious and fast effective

This can be achieved by pharmacist attending ward rounds.

Pharmacist medication recounselling procedure

SIGNIFICANCE OF MEDICATION REVIEW:

Desired therapeutic outcomes are being achieved Monitor drug related problems or toxicity Ensure rational and quality use of medicines Assess patient compliance

Assess the completeness of medication charts

STEPS INVOLVED IN MEDICATION ORDER REVIEW BY PHARMACIST:

• Collection and interpretation of patient specific information including medication history interview
• Therapeutic goals
• Identification of drug related problems
• Monitoring of treatment
• Documentation

WARD ROUND PARTICIPATION:

The pharmacist impact can be substantially greater if impact is provided at the time of prescribing

Clinical pharmacist are ideally placed to favorably influence prescribing and improve the quality and safety of medicine.

Ward round participation

OBJECTIVES OF CLINICAL PHARMACIST ON WARD ROUND:

Gain and understanding of the patients clinical status and progress,planned investigations and therapeutic goals

Provide information on various aspects such as:

• Patients drug therapy
• Pharmacology
• Pharmacokinetics
• Drug availability
• Cost
• Drug interactions
• Adverse reactions

Optimise therapeutic management by influencing drug therapy selection ,implementation and monitoring and its follow up

Detect adverse drug reactions and drug interactions Participate in patient discharge planning

THERAPEUTIC DRUG MONITORING(TDM):

Pharmacist can help ensure the appropriate use ,timing and interpretation of TDM Routine monitoring is not required for clinically stable patient

TDM results may influenced by:

• Serum drug concentration
• Renal function
• Medication compliance
• Sampling time
• Genetic variability
• Protein binding
• Other drug therapies

FACTORS CONSIDERATION DURING TDM ARE:

• Patient data
• Dosage regimen
• Sampling time
• Indication for therapy
• Patient adherence
• Reduced protein binding
• Drug interactions
• Pathological factors
• Tobacco use
• Alcohol use
• Medication or sampling errors
• Laboratory errors

Clinical pharmacists have an important role in advising on the appropriate use of TDM and in the interpretation of assay results

ETHICAL ISSUES IN CLINICAL RESEARCH

One of the primary legal and ethical obligations of researchers and their teams is to protect the human participants who take part in the research

DOCUMENTS AN ETHICS COMMITTEE MUST REVIEW:

• Trial protocol/amendments/with data and version
• Written informed consent form
• Written information to be provided to the subjects
• Subject recruitment procedures
• Investigator brochure
• Information about payments and compensation available to subjects
• Investigators current curriculum vitae ,other documentation evidencing qualifications
• Insurance policy/adverse events occuring during study participation
• Investigators agreement with the sponser

Drug related problems in clinical area

For example: clinical pharmacist interventions on inappropriate prophylactic acid suppressant use in hepatobiliary surgical patients undergoing elective operations

A total of 500 patients were enrolled in this study, 250 patients in each group, Then, 52 patients who didn’t meet our criteria were excluded. At last, 448 patients in total were included for further research with 218 in the pre-intervention group and 230 in the post- intervention group. General characteristics of the patients in two groups. The 2 groups were similar with respect to demographics and clinical characteristics, such as sex, age, body mass, medical history, surgery type and operative duration (P > 0.05). There was no significant difference in post-operative bleeding between the two groups (P > 0.05). Three cases received therapeutic acid suppressant after surgery, so they were excluded when analyzing the rationality of prescriptions and the cost-benefit results

RESULT:

Clinical pharmacist interventions significantly decreased the rate of the use of no indications for prophylactic acid suppressant and of the cases of inappropriate drug selection, dose, route, replacement and prolonged duration of prophylaxis (P < 0.05 or P < 0.001), resulting in significant increase by 10.65% in the percentage of cases adhering to all the criteria (P < 0.001). Moreover, significant reductions were found in the average usage quantity (P<0.001), mean cost (P = 0.03) and mean duration (P < 0.001) of prophylaxis acid suppressant. The ratio of the mean cost savings for acid suppressants to the mean cost of pharmacist time.

FINAL REPORT: This review concluded by, the clinical pharmacist’s real-time interventions facilitated the rational use of prophylactic acid suppressant and resulted in favorable economic outcomes in hepatobiliary surgery.

CONCLUSION:

Here we concluded that pharmacist activities and interventions on patient who suffering from prophylactic acid suppressants on surgical patients

A clinical pharmacist plays a vital role in the development of patient health management in all aspects.

And he is the main lead for the performing different types of therapies which was conducted by highly health care professionals by checking, interpreting all the details of patient who are admitted in the hospital he should responsible for all the information such as patient demographics, medication history, past allergic conditions , and patient counseling during admission and discharge .

In this article we can get some of the aspects of the pharmacist that related to his profession and the pharmacy practice or clinical pharmacy growth in India by comparing with other countries.