A BRIEF REVIEW ON THE ROLES AND SERVICES PROVIDED BY
A CLINICAL PHARMACIST
Author: KAVALI SWETHA
Clinical pharmacists collaborate closely with doctors, other medical experts, and patients to make sure that the drugs they are recommended for patients have the most positive impact on their health and for better outcomes. The clinical pharmacy services are rendered in a clinic for inpatients and OPD patients. The inpatient services comprise of entire patient care and supplies regarding the aspects involving drugs. The activities like ward rounds, safety, drug information services, patient counseling will be done by the clinical pharmacist. The main aim of the clinical pharmacist is to closely monitor the patient’s condition and take immediate intervention to improve the patient’s condition. The main aim of this review is to tell the importance of a clinical pharmacist and his roles in various services.
Clinical pharmacist, medication chat review, patient compliance, drug interactions, adverse drug reactions, patient education, therapeutic drug monitoring.
Clinical pharmacy comprises a set of functions that promote he safe, effective and economic use of medicines for individual patients. The emergence of clinical pharmacy has allowed pharmacists to shift from a product-oriented role toward direct engagement with patients and the problems they encounter with medicines. Clinical pharmacists are educated and trained in many direct patient care environments, including medical centers, clinics, and a variety of other healthcare settings. Clinical pharmacy is more oriented to the analysis of population needs with regards to medicines, ways of administration, patterns of use, drug effects on the patients. In this review, a brief description is given the medication chart review, role of clinical pharmacist in patient education, safe use of medicines, adverse drug reactions and therapeutic drug monitoring and drug interactions.
Medication review of a patient’s medication chart to identify potential risks associated with a patient’s medications and clarify information that is not clear or legitimate. Making sure pharmaceutical orders are suitable is one of a pharmacist’s core responsibilities. It acts as a springboard for more clinical pharmacy tasks (medication counseling, TDM, Drug interaction, and ADR). By classifying information according to medical conditions (such as diseases), it is possible to deconstruct a complex situation into its component elements. Reviewing the patient’s medical file with the record of medicine delivery is recommended. When deciding whether current medication Orders are suitable and when organizing each patient’s care, it is important to consider recent consultations, treatment plans, and daily progress. It is advisable to review all recent and current drug orders. he reduction of the possibility of medication errors at the level of prescription or drug administration is another crucial aim of treatment chart reviews. Any avoidable mistake that could result in improper pharmaceutical use or patient damage is a medication error. The medication chart should be thoroughly reviewed by pharmacists, and any areas where the drug order is unclear should be noted on the record in order to reduce the risk of morbidity and death that could result from these errors.
The clinical pharmacist should inform patients about the proper handling and storage of medications and poisons both at home and in medical facilities. The development of positive ties between local pharmacists and the general public should be encouraged. By working together and talking to colleagues who work in hospitals, they can act as a helpful bridge between the patient and secondary health care. The clinical pharmacist should also provide education and training to the medical and nursing staff as well as to other pharmacists. Every opportunity should be used to involve the clinical pharmacist in the instruction of undergraduate pharmacy students as well as nursing students. A clinical pharmacist has the benefit of ward experience, which enables him to understand some of the common issues faced by the nursing staff and to share some of his understanding of how medications are used in clinical settings. This is yet another method that the pharmacist may encourage safer and probably more cost-effective drug use, both in terms of patient administration and ward-level stock control. Their goals are to decrease medication errors, promote sane drug therapy, and ultimately benefit the patient.
The Pharmacist’s contribution, however, need not end there. Having achieved a desired therapeutic response, patients usually leave hospital and return home. It is often necessary to continue drug treatment after discharge and it is now well recognized that education of the patient in the use of drugs thus supplied to him is the weakest link in the therapeutic chain. In an attempt to improve upon the patient’s situation, it is essential that the dosage form, time and frequency of administration as well as other concurrent drug therapy are all tailored to help the patient. Pharmacist is in an excellent position to make sure that all instructions are understood and that the patient can actually cope physically, both on the ward and in the pharmacy department, from which he may hand over a supply of medications straight to the patient as it is presented to him, his medications are in the way. Additionally, pharmacists must ensure that patients get the information they need to use the drugs prescribed to them effectively.
Problems of medication safety are now a concern of many persons involved with patient care, such as administrators, physicians, pharmacists and nurses. The multiplicity of drugs, the increased number and kinds of medications prescribed per patient, the increased number both of inpatients and out patients who are being treated and the ever changing concepts of medical care make it mandatory that a system of safe medication practices be developed and maintained to ensure that the patient receives the best possible care and protection. In recent years the rapid obsolescence of drugs, the availability of more specific drugs per disease entity, and the general increase in the prescribing of medications have placed a greater responsibility on pharmacy and nursing services in dispensing and administering medications. The increased use of medications has increased the hazard of possible error. The fact that medication errors are one of the major causes of accidents in hospitals may be a sign of how serious the issue is. These regrettable instances can occur in homes, retail pharmacies, doctor’s offices, and hospitals, among other places.
The distribution function of a department’s PREVENTION OF MEDICATION ERRORS cannot be completely separated from ward pharmacy. A complete stock system is costly in terms of the amount of stock that each ward must carry and dangerous for patient safety unless a pharmacist is involved who Visits the ward frequently to keep an eye on all prescriptions and to verify inventory levels. When all medications are distributed as stock and no pharmacist visits the wards, patients may get medications from the ward stock without the nursing staff being aware of all possible variations in terms of strength, formulation, dosage form, etc. When specified dosages are not prescribed, this is especially dangerous. So a clinical pharmacist is employed in order to avoid the harmful and hazardous effects in patients.
Drug therapy monitoring is also an important function of many pharmacists working in the clinical field. One aspect of this is participation in schemes devised to monitor for adverse drug reactions, the objective, being to diminish the time interval between the general releases of a new drug and the full recognition of any undesirable effects it might produce. This is particularly important in the case of side effects occurring either infrequently or only after a prolonged administration. Such effects are unlikely to be detected during premarketing trials. It is also important to investigate fully those adverse reactions already identified in order to ascertain their frequency and distribution and to disseminate such information to the medical, nursing and pharmaceutical profession.
In hospitals which operate a stock system of drug distribution to the wards without a comprehensive ward pharmacy service, prescriptions are frequently interpreted by nurses who may consult the prescriber or perhaps other nursing colleague only when the dose appearing unusual or when there is a problem its very few safeguards for the patient against in errors in prescribing and there is very little attempt to detect inappropriate concurrent prescribing or potential drug interactions to both medical and nursing staff on the optimum dosage, dosing frequency, dosage forms, as well as the times and routes of administration Drugs are some times used inappropriately due to lack of knowledge of formulation on the part of the prescriber. Having all the relevant information to hand on the ward, the clinical pharmacist is able to advise on the best formulation to suit a particular patient’s needs. Likewise, unnecessary or excessive drug use can be discouraged more effectively whilst on the ward than from a distance, where the relevant background information is not usually available.
The safe administration of pharmaceuticals in healthcare facilities such as hospitals, nursing homes, etc., as well as the accuracy of the label’s content. Typically, the Unit Dose System is introduced into the operation may reduce prescription administration errors to a great extent while also offering the highest level of drug control, packaging, and distribution. It is imperative that the pharmacist maintain a drug interaction surveillance program in order to guarantee the patient and doctor complete drug safety. Such a program ought to have a way to monitor drug-drug and drug-lab test reactions. The classification of drug interaction mechanisms is particularly challenging since more than one mechanism may be quite complex, and the practice there is a sort of specialization in pharmacy. However, by implementing a program of working directly from the doctor’s original prescription sheet, the ordinary hospital pharmacist practitioner can maintain appropriate surveillance. This program entails creating patient drug profiles and medication interaction reporting forms. These, along with the thoughtful selection and application of the most recent publications on the subject, will guarantee to all parties involved that adequate drug safety practices are employed.
The Indian healthcare system will undoubtedly rely heavily on clinical pharmacists. CPS will have many positive effects on patients, doctors, other healthcare professionals, hospitals, and various sectors [Figure 3]. However, there is also a pressing need to take into account a number of open issues. The moment has arrived, in our opinion, for India to implement the most CPS for the benefit of the greatest number of people and to make the PharmD the minimum educational requirement for pharmacists in the nation.
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