Blog

CLINICAL PHARMACIST LIABILITY IN JUDGING; PROCESSING QUALITY OF TREATMENT

Author: Xakib

INTRODUCTION

A clinical pharmacy is a discipline introduced in the health care system where clinical pharmacist services are provided in an attempt to ensure rational drug therapy that is safe, relevant, and economical. Although clinical pharmacist services (CPS) are well established in some major nations, it is still progressing in others, such as India.

In the present world, clinical pharmacists are playing a significant role in the healthcare sector. The change in pharmacy practice, from a product to a patient focus would not have been possible, without parallel changes in the undergraduate and postgraduate curriculums.

The impact of these changes was strong enough that even countries lacking adequate health infrastructure and educational facilities were eager to produce future pharmacists trained in these concepts

Through the launching of the study program – Doctor of Pharmacy (Pharm D) serious discussions about clinical pharmacists (CP’S) and their role in proactively and early tackling drug-related problems, during the medication management process has been increased.

CP’S works collaboratively with physicians, other health professionals, and patients so as to ensure that prescribed medications contribute to the maximum patient’s well-being while on drug therapy, following appropriate and safe use of drugs.

CP’S work results in some degree of reduced disease & drug–related issues, and enhanced patient quality of life.

SKILLS REQUIRED TO BECOME A COMPETENT CLINICAL PHARMACIST

• Strong basic medical sciences background
• Communication skills
• Up-to-date knowledge
• Creativity and innovation
• Leadership
• Advanced clinical skills
• Intellectual ability
• behavioral and social understanding

WHY DO WE NEED CLINICAL PHARMACISTS IN HEALTH CARE?

The number of pharmaceutical products available for human consumption has expanded dramatically. These result in broad improvements in disease monitoring and diagnosis as well as a rapid expansion of therapy options.

As a result of this advancement, the complexity of information in fields including pharmaceutical formulation, pharmacokinetics, dosage, pharmacodynamics, side effects, medication interactions, patient compliance, and pharmacoeconomics has greatly expanded.

It was extremely challenging for the medical profession to maintain expertise in medication therapy as well as disease state diagnosis and management due to the sheer amount of new pharmaceuticals and the complexity of information.

It made sense for pharmacists to respond to this clinical need and work with medical practitioners to help patients utilize medications more safely and effectively, which could lead to better patient outcomes.

WHAT DOES A CLINICAL PHARMACIST DO?

Clinical pharmacist applies their professional training in more clinical ways rather than as a strategy to lower the number of pharmacists on the market.

ROLE OF CLINICAL PHARMACIST IN A HOSPITAL

Clinical pharmacists has significant role from the time a patient is hospitalised through discharge, until their ailment has been treated

CLINICAL PHARMACIST LIABILITY IN EVALUATION OF THE TREATMENT PROCESS

STEPS IN THE TREATMENT REVIEW PROCESS BY CP

• Medication history interview / Ward round participation
• Patient Information provided to healthcare professionals
• Keep an eye on drug therapy by utilizing prescription audits & medication reconciliation.
• Screening, monitoring, & maintenance of patient care.
• Detection of medication errors & management of adverse drug reactions
• Reviewing & evaluating drug utilization
• Assessment of therapeutic goals
• Educating patients counselling them.
• Dosage adjustment and modification of drug therapy
• Special care to vulnerable patient populations & in the case of pediatrics/ geriatrics, in pregnancy & lactation.
• Clinical toxicological services
• Clinical pharmacokinetic services
• Nutritional support services
• Medication chart endorsement
• Documentation

A medication history interview – is defined as obtaining accurate information on a patient’s medication use that may assist in the overall healthcare of the patient by interviewing.

Throughout the interview, the pharmacist should assess the patient’s understanding and attitude towards their medications and health condition. The patient should be encouraged to speak freely, while the interviewer listens carefully and observes.

It includes –

A complete account of all prescribed and non-prescribed medications that a patient had taken or is currently taking.

Patient allergic tendencies, self- medications with complementary and alternative medicines.

Medication review – involves the review of the patient’s medication regimen to optimize drug therapy and patient health outcomes by identifying and solving drug-related problems, and ensuring that all therapeutic objectives are being achieved.

Steps involved in Medication review-

• Collection and interpretation of patient-specific information, including medication history interview [MHI]
• Assessment of therapeutic goals
• Identification of drug-related problems
• Individualizing medication regimes
• Monitoring of treatment outcomes
• Medication chart endorsement
• Documentation

Ward round participation – is a process where the pharmacist visits wards regularly to monitor for the completeness and accuracy of prescriptions. The pharmacist is also available for consultation with the medical and nursing staff to make sure that the drug distribution system is operating correctly. Ward round participation enables to contribute prospectively to patient care, gain an improved understanding of patients’ clinical status through

• Current treatment plan investigation
• The provision of drug information and promotion of rational drug therapy.
• By proper communication

Classification of ward round participation-

• Preliminary (pre-ward) rounds – Interns or medical PGs perform daily review of the patients in their unit or ward. Clinical pharmacist can join them and perform clinical reviews at this time.
• Register/Resident rounds – Residents in hospitals individually or as a team conduct ward rounds. These are useful rounds for clinical pharmacists
• Professor/chief rounds – Chief Doctor of the ward conducts ward rounds to review previous rounds decisions and their results, give instructions about the further course of treatment to the patient and his team make note of it. Clinical pharmacist can use these briefings to improve their knowledge & participate if required & asked to do so.
• Teaching rounds – In teaching hospitals, academic staff of medical departments conduct ward rounds for the purpose of teaching students about relevant cases admitted in the wards. The purpose is to discuss about the case & follow up classes of the same / particular topic or disease will be held in the class room.

How does clinical pharmacist make discussion in management of treatment?

Active interventions – Opportunities for interventions arise during provision of various clinical pharmacy activities like medication history interviews, Treatment chart review, drug therapy monitoring, and patient counselling.

Provision of treatment guidelines (standard therapeutic guidelines) to influence the prescribing is active type of intervention.

Passive intervention – Provision of drug information in response to drug related / disease related or any query is passive type of intervention. Patient counselling also comes under this type of intervention. This is the most type of intervention clinical pharmacist usually provide.

Patient counselling – is defined as providing information regarding the disease, medications, diet, and lifestyle changes to patients or patients’ representatives in layman’s language. Provide medication information orally, or in written form to the patients.

Steps pharmacists should follow in patient counselling-

• Establishing pharmacist-patient relationship
• Assessment of the patient’s knowledge regarding his condition.
• Provide information orally and use visual aids
• Verify the patient’s knowledge and understanding of medication use.

Patient counselling is the simplest act to interact with or eliminate barriers for pharmacists in providing pharmaceutical care.

Communication skills for effective counselling–

Language – simple language, if possible in the patient’s own language.

Tone – change in range/ level of pitch conveys attitude and feelings of the speaking person.

Speed – clarity of communication is needed for proper understanding.

Eye contact – It helps in knowing the timidity, sadness, or depression of the patient.

Facial expression – this can demonstrate empathy towards the patient.

Preparing for the session – The success of patient counselling depend on how the clinical pharmacist opens the session, the content of the session, and the closing of the session.

It’s all about the impact the clinical pharmacist creates in the patient’s mind.