A1: Pharmacist's Role Flashcards
What is a professional?
- Relating to or belonging to a profession more than worthy of or appropriate to a professional
person - Engaged in an activity as a paid occupation
rather than as an amateur - A professional person > a person having
impressive competence in a particular activity
Characteristics of a profession
- Specialist knowledge and lengthy training
- Service orientation – (altruism)
- Protected area of expertise / monopoly over practice
- Self-regulating / self-policing
- Ethical and moral obligations
- Accountable to those served and to society
Medicines Optimisation
Making sure the right patients get the right choice
of medicine, at the right time.
What does Medicine Optimisation focus on
Patients + their experience, to help:
- improve outcomes
- take medicines correctly
- avoid taking unnecessary medicines
- reduces medicines wastage
- improves medicines safety
Clinical audit
process for quality improvement
1) set standards
2) measure current practise
3) compare results of practise to standard set
4) reflect, plan & implement change
5) re-audit
Principles of medicine optimisation
Understand patients experience
evidence based choice of medicines
ensure medicines use is as safe as possible
make medicines optimisation routine practise
— it is a patient centred approach
Example of clinical audit
Post-operative nausea and vomiting guideline
GPhC
Regulator in GB for Pharmacists,
Pharmacy technicians + pharmacy premises
Types of ADR
Type A
Type B
Type A ADR
- Predictable – related to its pharmacology
- Dose-dependent
- Common
- Low mortality (rarely fatal)
- Response to dose reduction
- – E.g. Bleeding due to aspirin
Type B ADR
- Unpredictable (but now some are predictable – genetic
variations) - Not related to pharmacology
- Not dose-related
- Rare
- High mortality (often serious & may be fatal)
- Response to drug withdrawal
— E.g. Anaphylactic reaction to ampicillin
Burden of ADRs on Healthcare Systems + patients
- Make people ill and can kill
- May mimic disease
- Affect quality of life and adherence
- Lead to loss of confidence in healthcare professionals
- Increase cost in patient care
- Worry patient
Yellow card scheme
Spontaneous reports of suspected adverse drug reactions,
medical device incidents, defective medicines and suspected counterfeit medicines
Acts as an early warning system to identify problems, ADRs and risk factors
MHRA can detect duplicate reports
Yellow card scheme
introduced in 1964
Spontaneous reports of suspected adverse drug reactions,
medical device incidents, defective medicines and suspected counterfeit medicines
Acts as an early warning system to identify problems, ADRs and risk factors
MHRA can detect duplicate reports
Doctors, dentists, pharmacists, coroners, nurses, midwifes,
health visitors
Non-medical prescribers and now patients
Pharmacists role in avoiding ADRs
- Selecting products based on patient’s risk factors
- Advising HCPs about the selection of medicine in reducing
likelihood of ADRs - Advising patients on likely occurrence of ADRs
What raises suspicion of an ADR
- Timing
- Abnormal clinical measurements e.g. blood pressure,
pulse, blood glucose and weight - Abnormal laboratory results (elevation of certain enzyme)
- New therapy started which could be used to treat ADR
- Patient risk factors
- Listening to patients concerns
What raises suspicion of an ADR
- Timing
- Abnormal clinical measurements e.g. blood pressure,
pulse, blood glucose and weight - Abnormal laboratory results (elevation of certain
enzyme) - New therapy started which could be used to treat ADR
- Patient risk factors
- Listening to patients concerns
Pharmacists role in detecting ADRs
Detection of potential ADRs
- Based on patient’s risk factors
- Based on patient’s request of OTC remedies
- Listening to and observing patients for symptoms of ADRs
When an ADR occurs
- Advising patients on what to do
- Communicate with HCPs about treatment of ADRs
Reporting suspicion of an ADR
- Informing patient’s doctor of any suspicion of ADRs from their
medicine
- Reporting suspicion of ADR to the yellow card scheme
- Advising patients to report to the yellow card scheme.
Drugs that cause ADR-related admissions to hospital
Cardiovascular drugs
CNS drugs
NSAIDs
Reactions/conditions leading to hospital admission of using drugs that commonly cause ADR
GI complaints
Metabolic complications
Haemorrhagic complaints
Common ADRs seen in community
GI + CNS symptoms
Skin reactions
Define ADR
A reaction that is noxious
(harmful) and unintended and occurs at doses normally used in man for the prophylaxis, diagnosis or
treatment of disease or the modification of physiological function.
What is an ADR under
Side effect
Mid-staffordshire Hospital
- Between 2005 & 2009 – conditions of appalling care
- Excess deaths
- Patient and family complaints not listened to
- Inquiry launched by the Government to look into what
happened and how to prevent it happening again
Francis Report (Mid-Staffordshire public inquiry)
Understand the lessons to be learned 290 recommendations covering areas including: - Putting patients first - Fundamental standards of behaviour - Common culture - Responsibility for health care standards and systems governance - Patient, public and local scrutiny - Training and education - Openness, transparency and candour
Berwick Report
- Place quality of patient care above all other aims
- Engage, empower and hear patients can carers
- Foster the growth and development of all staff
- Embrace transparency unequivocally and everywhere
How did the Government respond to the Mid-Staffordshire Hospital
New standards for CQC in inspecting hospitals:
- New standards for involving patients and the public in decisions about
their care and services
- NHS leadership programme
- Duty of candour for all HCPs
- ‘Freedom to Speak Up’ guardians in every Trust
Plans in place for:
- Training & check for all care workers & new criminal offences
Examples of health policy
National service frameworks (NSFs)
- Set clear quality requirements for care based on the best
available evidence
- offer strategies to help organisations achieve this.
Patient safety
- Aims to improve the safety and quality of care through reporting, analysing and learning from adverse incidents and ‘near misses’ involving NHS patients
On September 2010, what did the RPSGB become
It split to
▫ General Pharmaceutical Council (GPhC) – regulator for the profession
▫ Royal Pharmaceutical Society (RPS) – professional leadership body for pharmacists
GPhC
Regulator in Great Britain for:
▫ Pharmacists
▫ Pharmacy technicians
▫ Pharmacy premises
Structure:
1) Council
2) Chief + executive registrar
3) Inspection + fitness to practise; Policy + communications; Resources and customer services
RPS
Professional leadership body for pharmacists
Structure:
1) Assembly (14 people)
2) Welsh, Scottish + English pharmacy board
Priority areas for English pharmacy board
• Improving the urgent and emergency care through
better use of pharmacists
• Pharmacists improving care in care homes
• Pharmacists and GP surgeries
• Pharmacist-led care of people with long term
conditions
• Pharmacist access to the patient health record
Local practise forum
▫ Support for education, continuing professional development and revalidation ▫ Local leadership ▫ Practice and science research ▫ Sharing best practice ▫ Improved ▫ Mentoring ▫ Networking
Aim to understand patients experience
To ensure the best possible outcomes from medicines, there is an ongoing, open dialogue with the patient and/or their carer about the patient’s choice and experience of using medicines to manage their condition; recognising that the patient’s experience may change over time.
Evidence based choice of medicines
Ensure that the most appropriate choice of clinically and cost effective medicines (informed by the
best available evidence base) are made that can best meet the needs of the patient.
Ensure medicines use is as safe as possible
The safe use of medicines is the responsibility of all professionals, healthcare organisations and
patients, and should be discussed with patients and/or their carers. Safety covers all aspects of
medicines usage, including unwanted effects, interactions, safe processes and systems, and effective
communication between professionals.
Make medicines optimisation part of routine practice
Health professionals routinely discuss with each other and with patients and/or their carers how to get
the best outcomes from medicines throughout the patient’s care.
