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PHARMACIST CLINICAL REVIEW PROCESS

Author: Cheruku Jabili

Daily appraisal of patient’s progress

Do you agree with me when I claim that all of the pharmaceuticals, we encounter daily are all safe, have no adverse effects, and may be used at any time, in any dose, and combination with anything?

Everybody occasionally runs into situations where they are supposed to take many medications and have no choices but to do so.

At that point, we are all wondering the same things about those prescriptions, such as:

We also expect that any medical professional can handle our pressure and relieve our burden. With the burdening and rush with patients, physicians are not able to keep track of the time and constantly pressurized to fill in the daily quota. Pharmacy professionals now play a significant role in medication therapy management [ MTM].

The clinical pharmacist is a crucial member of the healthcare team and makes a substantial contribution to patient care in both primary care and hospital settings. The job of the pharmacist has changed during the last few decades. The drug supply profile is shifting in favor of patient-centered care in order to address pharmacotherapeutic concerns and improve patients’ quality of life.

Therefore, in addition to identifying, resolving, and preventing prospective and actual issues linked to pharmacotherapy, the clinical pharmacist must engage in activities that promote the rational and reasonable use of medications. Now that their value as members of healthcare teams and in providing individualized patient care has been acknowledged.

It is acknowledged that medication errors and inappropriate prescribing are significant issues for the healthcare system, both clinically and financially. Particularly in certain groups including the elderly, young children, and pregnant women, they can have a major impact on patient morbidity and mortality as well as contribute to adverse drug reactions (ADRs) and adverse drug events (ADEs).

Medication errors alone result in 1.3 million injuries and at least one death every year in the United States of America. Although the prevalence of medication-related adverse events are thought to be comparable between low- and middle-income nations and high- income countries, the impact is nearly twice as great in terms of the years of healthy life lost.

Medication mistakes can occur for a variety of reasons, including healthcare worker exhaustion, patient misinformation, staff shortages, overcrowding, and inadequate training. Any one of these factors—or a combination of them—can have an impact on how pharmaceuticals are prescribed, dispensed, consumed, and monitored, which may lead to serious injury, disability, or even death.

A recent meta-analysis revealed that ADEs may occur in 16.88% of patients during hospitalization, whereas a major study found that ADRs accounted for 6.5% of hospital admissions.

By longer hospital stays and raising healthcare costs, ADEs may result in greater healthcare costs. A hospital stays for 16 patients who have an ADE is extended by an average of 2 days at a cost of an extra $2,000–$2,500. Medication errors costs healthcare systems a lot of money, yet many of them are preventable.₍₁₎

This can result in more serious consequences, particularly if the issue is overlooked or discovered after the medication has finished entering the patient’s system. During a patient’s hospital stay, about 1 in 5 medicine doses are given inappropriately. Handwritten prescriptions that are difficult to read are a common reason for errors. ₍₂₎

Errors might be caused by incomplete or missing data regarding concurrent prescriptions, previous dose-response relationships, laboratory readings, and allergy sensitivities. Prescription errors can happen when the wrong medication or dose is chosen, or when a regimen is excessively complicated. Sound-alike names might lead to mistakes when prescriptions are conveyed verbally. Similarly, when prescriptions are written by hand, medications with names that seem similar may be given out mistakenly.

Drug Therapy Monitoring

It involves going over, the patient’s prescription schedule to make sure the course of

treatment is appropriate, safe, efficient, and affordable.

Goals –

Drug therapy optimization and a reduction in medication-related errors or issues during prescribing, dispensing, and administration

How it can be accomplished?

Drug therapy monitoring is only achievable with the collaboration of the scientists, nurses, physicians, technical staff and pharmacists. The medical staff should be instructed by the community pharmacist on how to use medications rationally for better clinical results.

What is it’s importance –

Examining patient compliance, assessing if the intended treatment goals are being met, monitoring drug-related issues, and ensuring the usage is appropriate, rational, and ethical.

What comes under DTM –

1. Medication Chart Review
2. Clinical Review
3. Pharmacist Intervention

Clinical Review –

One of the essential elements of medication review is a clinical review, which ideally ought to be done every day. It is the evaluation of the patient’s progress to determine the effectiveness of the treatment. As previously said in the section on the assessment of treatment goals, the therapeutic aim for the particular condition should be distinctly identified before the review.

The clinical review’s main objectives are:

• Analyze the effectiveness of drug treatment and the safety of the recommended course of action.
• Analyze the disease’s progression, the need for any therapy changes, the need for monitoring, if any, and analyze how convenient therapy is (to improve compliance)

Do all types of medications require a clinical review?

Yes, every drug needs a clinical review, but only a relatively small number of drug classes truly demand rigorous clinical testing.

Procedure –

• Clinical reviews ought to be performed routinely for all patients. The attending doctors typically check the patient responses to medication therapy every day while examining their patients.
• The pharmacist may need to study biochemical, hematological, microbiological, and other studies while assessing a patient’s response to pharmacological therapy, if necessary.
• Patients and other healthcare providers may be able to provide further crucial information

Why Clinical Review?

To determine whether or not the targeted goals are being attained, the data should be analyzed.

• All of the aforementioned factors assist pharmacists in determining the prognosis of the patient’s health, identifying any underlying disease that is the cause of the symptoms, or understanding that the current symptoms are a sign of any major underdiagnosed problem.
• We can also determine whether any medication errors are present, causing drug interactions, or have the potential to do
• Fluid balance chart monitoring is necessary for conditions like high blood pressure, dehydration, septic shock, vomiting, dysentery, and kidney-related problems even the water we drink needs to be
• Surgery, pregnancy, poisoning, ketoacidosis, diabetes mellitus, and wound healing all benefit from diabetic chart
• Monitoring electrolytes assists in determining whether prophylactic or supplementary therapy is necessary as an additional form of
• A complete blood count will aid in evaluating any infections that are contributing to or could exacerbate the problem as well as the antibiotic susceptibility tests necessary to avoid reserve antibiotics and to determine which antibiotic works

Examples –

1. A few common symptoms, such as nausea, vomiting, and headaches, might be brought on by a variety of conditions, including glaucoma, stroke, or any other underlying
2. A patient was involved in a bike accident and suffered only minor injuries; as a result, his parents drove him to a hospital in the area. There, the patient received treatment for his injuries and was told he would be discharged the following morning while also drinking water. He was discovered dead the next morning from a serious stomach infection. If a complete evaluation had been conducted in the aforementioned case, the patient might have survived.

• A patient, known case of diabetes mellitus presented to the hospital with a minor ailment. Instead of just treating the patient’s ailment, the ECG and Troponin levels were examined to determine the patient’s risk of heart disease. This is an illustration of how early diagnosis can aid in improved disease
• These goals, which should be tailored to the patient’s condition as noted previously, could include curing the disease, reducing the patient’s symptoms, stopping or delaying the progression of the illness, preventing illness, and enhancing the quality of
• If the therapeutic goals are not being met, the clinical pharmacist should assess whether the course of treatment is appropriate and should speak with the doctors about any pertinent issues.
• The intervention could be of any type (change of drug, dose adjustment, cessation of the drug, ), but the recommendations should be specific and directed towards achieving the therapeutic goals for the problem Identified.

In what we are lacking?

• Students are lacking in both professional training and adequate practical knowledge and abilities.
• inadequate exposure to genuine therapeutic settings and circumstances.
• Students are limiting their interaction and communication with patients, seniors, physicians, teachers,
• Students also lack the liberty to express their
• Most of us are not in a position to hire a pharmacist at our healthcare facilities due to our economic situation.
• The role of pharmacists in healthcare are not properly acknowledged in the current
• Lack of teachers for pharmacy students with the same educational background

because there aren’t as many of them.

• The other healthcare professionals in the hospital are less welcoming toward pharmacy
• A lot of learning facilities still need to be set up because the Doctor of Pharmacy is a relatively new course in India. Then, students should have compassion and stop whining about the things we lack so that we can fully utilize the equipment we do have

If these are properly adhered to, a clinical review can be conducted more effectively:

• Students must continually work to obtain practical knowledge, follow the curriculum, and reduce focusing on knowledge that is merely theoretical.

• Actively managing constructive connections or interactions with coworkers, doctors, teachers, seniors, and patients. All healthcare experts should collaborate for optimal patient outcomes.
• Always make an effort to support and tailor treatment by taking into account all of the patient’s particular
• Instead of teaching students in a theoretical manner, one might focus more on a clinically based For example, if we use case studies to thoroughly explain each topic, students would be better able to comprehend circumstances that might arise in a hospital during real-time.
• Instead of one or two pharmacists for a clinical setting, one pharmacist can be appointed for each This will relieve community pharmacists of some of their workload and stress while emphasizing the effective performance of their duties, allowing clinical reviews to be completed quickly and efficiently.

• It is important to the emphasizes that the government should create appropriate, strict laws and regulations to hire clinical pharmacists and to keep accurate patient records
• College-level personality and skill development exercises are necessary to help students overcome their inhibitions and present themselves more effectively in the field of work.
• Adding a few advanced equipments to the hospital environment would enable the pharmacist or other medical staff to keep track of the patient’s status wherever they are at all times, facilitating speedy judgments.
• One should try to figure out the root cause of the specific symptoms rather than treating the symptoms
• Pharmacists have a responsibility to educate the public about the importance of regular diagnosis and there is a need for implementing a few follow-up methods by healthcare providers
• It will be effective if the pharmacist can deliver a leaflet with information about the counseling points, such as food, next visit information, dosage form instructions, along with their discharge chart. The pharmacist should counsel every point in a very clear manner.

Conclusion –

What … Are your medications or treatment still causing you anxiety.

You are in the capable hands of pharmacists who are only concerned with your well-being, so don’t worry.

References –

1. https://www.who.int/news/item/29-03-2017-who-launches-global-effort-to- halve-medication-related-errors-in-5-years
2. https://www.amcp.org/about/managed-care-pharmacy-101/concepts-managed- care-pharmacy/medication-errors