Clin pharm Flashcards
1
Q
- The American College of Clinical Pharmacy (ACCP) it is as an area of pharmacy concerned with the science and practice of rational medication use.
- is a health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, and disease prevention.
- is one of the services provided by pharmacists in an attempt to promote rational drug therapy that is safe, appropriate, and cost-effective
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CLINICAL PHARMACY
2
Q
- provides direct patient care, medication therapy management and patient counseling. Clinical pharmacists work directly with other healthcare professionals to optimize patient care.
- They possess in-depth knowledge of medications that is integrated with a foundational understanding of the biomedical, pharmaceutical, sociobehavioral, and clinical sciences
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Clinical Pharmacist
3
Q
The art, practice, or profession of preparing, preserving, compounding, and dispensing medical drugs
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PHARMACY
4
Q
Choosing, preparing, storing, compounding, and dispensing medicines and medical devices Advising healthcare professionals and patients on their safe, effective and efficient use.
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HOSPITAL PHARMACY
5
Q
The term clinical Pharmacy was first used
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1953
5
Q
More oriented to the analysis of population needs with regards to medicines, ways of administration, patterns of use, drugs effects on the patients
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CLINICAL PHARMACY
6
Q
The clinical pharmacy movement began at
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University of Michigan in the early 1960s
6
Q
Most of the pioneering work was done at the end of the 1960’s.
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David Burkholder, Paul Parker, and Charles Walton at the University of Kentucky
7
Q
Medical center opened the first drug information center.
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1962 University of Kentucky
8
Q
signaled the transition to clinical pharmacy
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1970
9
Q
growth of clinical pharmacy practice because of the ability to promote cost effective medicines
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1980
10
Q
Pharmacists grade & time spent on wards were increased
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1997
11
Q
is the pioneering institution who practices and deploys clinical pharmacist in the Philippines and other leading hospitals have already adopted and practiced it
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St. Luke’s Medical Center
12
Q
as a system where the pharmacist visits wards regularly to monitor for completeness and accuracy of prescriptions, is available for consultation by medical and nursing staff and ensures that the drug distribution system is operating correctly.
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Ward pharmacy
13
Q
OBJECTIVES OF CLINICAL PHARMACY
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- minimizing the risk of treatment-induced adverse events
- maximizing the clinical effect of medicines
- minimizing the expenditures for pharmacological treatments
14
Q
Application of different scientific principles
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- Pharmacology
- Toxicology
- Therapeutics
- Clinical Pharmacokinetics
- Pharmacoeconomics
- Pharmacogenomics
15
Q
Three basic components of the clinical role in the practice of pharmacy
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Consult
Counsel
Communicate
16
Q
LEVELS OF ACTION OF CLINICAL PHARMACIST
BEFORE THE PRESCRIPTION
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- Drug trials
- Drug formularies
- Drug Information
17
Q
LEVELS OF ACTION OF CLINICAL PHARMACIST
DURING THE PRESCRIPTION
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- Counselling
- Can influence the attitudes and priorities of prescribers in their choice of correct treatments * Monitoring, detecting, and preventing medication related problems
- Special attention to the dosage of drugs which needs therapeutic monitoring
18
Q
LEVELS OF ACTION OF CLINICAL PHARMACIST
AFTER THE PRESCRIPTION
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- Counselling
- Drug use evaluation
- Outcome research
19
Q
ACTIVITIES OF CLINICAL PHARMACIST
● It involves evaluation of patient and its medical chart by the clinical pharmacist.
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Profile Patient Review
19
Q
ACTIVITIES OF CLINICAL PHARMACIST
● “It involves gathering and recording of information regarding past and present medications used by the patient through interview and reviewing of past medical records.”
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Patient Medication History
20
Q
ACTIVITIES OF CLINICAL PHARMACIST
● It involves prevention, detection, management and documentation (reporting) ———.
* Prevention
* Detection
* Treatment
* Reporting
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Adverse Drug Reaction Management
21
Q
ACTIVITIES OF CLINICAL PHARMACIST
● The clinical practice of measuring specific drugs at designated intervals to maintain a constant concentration in a patient’s bloodstream, thereby optimizing individual dosage regimens.
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Therapeutic Drug Monitoring (TDM)
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ACTIVITIES OF CLINICAL PHARMACIST
● Daily monitoring of laboratory values and dose adjustment as appropriate
Anticoagulation - heparin, warfarin
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ACTIVITIES OF CLINICAL PHARMACIST
● It involves collection, appraisal, utilization and presentation of information relating drug.
Information about medications to physicians, nurses, other health care practitioners
Drug Information Management
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ACTIVITIES OF CLINICAL PHARMACIST
● Prepare medications that may be needed during a code
● Assist with dose calculations to ensure therapeutic dose
Resuscitation/Code Pharmacists
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ACTIVITIES OF CLINICAL PHARMACIST
● Member of the healthcare team
● Promotion of rational drug therapy
● Timely interventions regarding dosing
Ward round participation
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ACTIVITIES OF CLINICAL PHARMACIST
● Review of medical prescribing, pharmacy dispensing, and patient use of drugs
Drug Utilization/Review
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ACTIVITIES OF CLINICAL PHARMACIST
● Resolving incompatibilities and adjusting the nutritional formula as appropriate
Nutrition support
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ACTIVITIES OF CLINICAL PHARMACIST
● A systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials (WHO)
● Use of treatment guideline such as (National antibiotic guideline) for empiric treatment and utilization of culture and sensitivity results for targeted and definitive treatment.
Anti-Infective Stewardship/Anti-Microbial Stewardship
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ACTIVITIES OF CLINICAL PHARMACIST
● Medication reconciliation
Managing Transitions of Care
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ACTIVITIES OF CLINICAL PHARMACIST
● Pain management using opioid analgesics
Narcotic Stewardship
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ACTIVITIES OF CLINICAL PHARMACIST
● Evaluate genetic code of patients in order to better predict a drug response
Pharmacogenomics
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ACTIVITIES OF CLINICAL PHARMACIST
● Monitoring provided by a clinical pharmacist for specific patients to optimize drug therapy to achieve health outcomes.
● A systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a list of medication-related problems, and creating a plan to resolve them
Drug Therapy Monitoring
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ACTIVITIES OF CLINICAL PHARMACIST
● It involves patient counseling regarding medication use at the Time of discharge
Patient counseling
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ACTIVITIES OF CLINICAL PHARMACIST
● Participate in compliance with core measures by assuring core therapies are received by eligible patients
Outcomes Management
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ACTIVITIES OF CLINICAL PHARMACIST
● Means by which healthcare professionals communicate with one another
a. Physician consultations of the pharmacist
b. Drug information question results
c. Relevant drug serum concentrations and their interpretation
d. Patient education
Documentation
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ACTIVITIES OF CLINICAL PHARMACIST
● Services that optimize therapeutic outcomes for individual patients
● A systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a list of medication-related problems, and creating a plan to resolve them
Medication Therapy Management Services
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CLINICAL PHARMACY REQUIREMENTS
● Knowledge of drug therapy
● Knowledge of nondrug therapy
● Knowledge of the disease
● Knowledge of laboratory and diagnostic skills
● Communication skills
● Patient monitoring skills
● Physical assessment skills
● Drug Information skills
● Therapeutic skills
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* Any action by a pharmacist that directly resulted in a change to patient management or therapy
* The patients' pharmacotherapeutic follow-up is performed through a daily review of medical records by the clinical pharmacists, including medications and laboratory tests, where the need for intervention can be identified.
* In S.O.A.P Format (other hospitals use PDAR – Problem/Data/Assessment/Response or SBAR - Situation, Background, Assessment, Recommendation)
PHARMACIST INTERVENTION
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* The patient’s chief complaint
* The history of the patient’s present illness, as reported by the patient
* Social History, Family History
* Information that the patient reports concerning symptoms, previous treatments, medications used, and adverse effects encountered
S - SUBJECTIVE
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* done by the medical team and includes intervention of physicians and medical equipment summarized by values and numbers by which a proper diagnosis can be established.
* Objective data are measurable and reproducible.
O - OBJECTIVE
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* The summation of subjective and objective data includes conclusion and differential diagnosis and the reason for this diagnosis.
* Diagnosis or differential diagnosis
* Identification of Dose regimens problems
* Identification of drug-drug interactions
* Identification of drug-food interaction
A - ASSESSMENT
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* Specific solution for each problem
* Numbered list to match the Assessment
* Recommendations for
* drug dose
* frequency
* duration
* Monitoring
* Follow-up
P - PLAN
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* as a concept has moved the pharmacy profession from primarily focusing on the product (the drug itself) to the patient's drug therapy and how it should be optimized for the individual patient.
PHARMACEUTICAL CARE
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Patient was given ISDN for chest pain during a MI episode
Elimination or reduction of symptoms
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* Antibiotics given to patient with cellulitis
Cure of disease
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Giving Levodopa to a patient with parkinsons
Arrest or slowing of a disease process
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Pneumococcal vaccines
Prevention of disease or symptoms
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FUNCTION OF PHARMACEUTICAL CARE
1) identifying potential and actual medication-related problems,
2) resolving actual medication-related problems
3) preventing potential medication-related problems
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Medication-related problems
* Untreated indications
* Improper drug selection
* Subtherapeutic dosage
* Failure to receive medication
* Overdosage
* Adverse drug reaction
* Drug Interactions
* Medication use without indication
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Tools to implement the rational use of medicines effectively
● Essential Medicine List
● Drug Formulary
● Standard Treatment Guideline
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● is the application of pharmacological information together with the knowledge of the disease for its prevention, mitigation or cure.
PHARMACOTHERAPEUTICS
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* Essential medicines are those that satisfy the priority health care needs of a population.
* They are selected with due regard to:
* disease prevalence and public health relevance
* evidence of efficacy
* safety and comparative cost-effectiveness.
Formulary List or Essential List
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also known as Clinical Guidelines is a systematically developed statement designed to assist practitioners and patients in making decisions about appropriate healthcare for specific clinical circumstances
Standard Treatment Guideline
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● Evidence based medicine is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (David Sackett, 1996)
EVIDENCE-BASED MEDICINE
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The Three Component of Evidence-Based Medicine
1. Patient Values and Preferences
2. Best Evidence
3. Clinical Expertise
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The practice of evidence-based medicine involves five essential steps:
5A’s
● Assess your patient
● Ask clinical questions
● Acquire the best evidence
● Appraise the evidence
● Apply evidence to patient care
55
Also known as Medical Record
An orderly written document encompassing the patient’s identification data, health history, physical examination findings, the surgical procedures, and hospital course.
Contains systematic documentation of an individual patient’s important clinical data and medical history over time
It serves as both a medical and legal document, detailing a persons’ diagnoses, treatment, response to treatment and other factors that affect his/her health state
Readily accessible
Easily used for retrieving and compiling Information.
Patient Medical Chart
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sufficient data to identify the patient, justify diagnosis and warrant treatment and outcome
Complete
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all necessary forms and all relevant clinical information
Adequate
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❑ Patient demographics
❑Name
❑Date of Birth
❑Marital Status
❑Gender
❑Race
❑Language
❑Contact Information
Identification Information
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capable of quantitative analysis
Accurate
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A description of the development of the patient’s present illness. The HPI is usually a chronological description of the progression of the patient’s present illness from the first sign and symptom to the present
History of present illness
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Concise statement in English or other natural language of the symptoms that caused a patient to seek medical care.
A triage nurse or registration clerk records a patient's chief complaint at the very beginning of the medical care process
It is a statement of the reason that a patient seeks medical care (ncbi.nlm.nih.gov)
Chief Complaint
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Including vital signs & review of system
Physical Examination
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Present and Past Diagnosis
Medical History
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❑Allergies – NSAIDs, Penicillin, Chicken, Micropore tape
❑Treatments
❑Present and Past diagnosis
❑Personal/Social History
❑Family History
Medical History
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* Birth, Nutritional and Developmental history
* Immunization history, childhood illnesses
* Operations/Treatments/Transfusions
* Obstetric and Gynecological history menstrual, marital and sexual history)
Past history
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* occupation, family situation, education, and habits, e.g., smoking status, alcohol consumption, diet, exercise, and sexual history.
Personal and Social History
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METHODS OF PHYSICAL EXAMINATION [For ABDOMEN]
1. Inspection
2. Auscultation
3. Percussion
4. Palpation
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METHODS OF PHYSICAL EXAMINATION [NOT for ABDOMEN]
1. Inspection
2. Palpation
3. Percussion
4. Auscultation
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like laboratories, diagnostic tests, and radiological tests
Orders
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(IV meds, oral meds etc)
Medication Orders
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> Doctor’s progress notes are located in the left part, written in SOAP format
> Doctor’s orders are written at the right part directly opposite the progress notes
> Doctor’s orders must always compliment the assessments written in the progress notes
Progress notes
68
Used by all other medical professionals except for physicians for documentation
Multidisciplinary Progress Notes
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* Includes gross and microbiological findings
Laboratory, diagnostic tests results
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Summary of all information collected by the nurse during the shift
Graphic Chart
69
* All doses must be accurately documented (dose, route, frequency and time of actual administration)
Medication Administration Record (MAR)
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* Includes enteral and parenteral fluids taken by the patient
* Urine output and bowel movement are also indicated her
Fluid Input and Output Record/Fluid Balance Sheet
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* Accomplished by the service concerned
* All records of treatment whether for diagnostic or treatment purposes Always written in detail
Medical or Surgical Treatment Records
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* Forms used by other physicians for a particular problem which can’t be resolved by the primary physician of the patient.
Consultation, Examination and Findings
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Electronic version of a patient's medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person's care
Electronic Health Record
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Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination.
For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.
Consent
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Disadvantages of EHR
*Privacy and Security Risks
*Data Accuracy Issues
*Implementation and Maintenance Requirements
*Malpractice Liability Concerns
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Are record of information relative to the drug therapy of the patient
* Gives pharmacy personnel the opportunity to actively participate in monitoring patient care.
* The participation of pharmacists in the documentation of medication history has been shown to result in significant improvement in its accuracy and comprehensiveness
Patient Medication Profile
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Patient Medication Profile
* Current medications
* Past medications
* OTC medications
* Herbal intake
* Drug allergies
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Characteristics Patient Medication Profile
1. Confidential
2. Always up-to-date
3. Must be used each time there is a health care professional service performed
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* An emergency cart is a wheeled cabinet or chest of drawers which contains all of the equipment necessary for emergency resuscitation.
*E-Cart are conveniently positioned throughout the hospital for quick access in emergency cases. It contains medications as well as equipment for defibrillation, intubation, IV supplies and tubings.
EMERGENCY CART MEDICATIONS
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is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately.
Ambu bag or “self inflating bag”,
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an apparatus used to control heart fibrillation by application of an electric current to the chest wall or heart.
Defibrillator
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They are used to provide electrolytes, nutrients or medications via intravenous route.
IV supplies and tubing
