Clinical Pharmacy Services and Prioritizing Care Flashcards
(32 cards)
What are the 2 Hospital Pharmacy Services in BC
- Dispensary services
- Direct Patient care (clinical)
Dispensary services
Safe provision of drug products to patients
What is clinical pharmacy
A health science discipline in which pharmacists provide patient care that optimized medication therapy and promotes health, wellness, and disease prevention and embraces the philosophy of pharmaceutical care
What is the role of clinical pharamacies?
To promote safe, effective and cost-consious drug therapy and improve patient outcomes
Do most hospitals in BC have at least some direct patient care provided by clinical pharmacists?
Yes
What doe Clinical Pharmacists do?
- Medication reconcilation on admission/discharge
- Resolve DTPs
- Patient education during hospital stay
- Interprofessional patient care rounds
- Care plan
- Patient education at discharge
What are the benefits of clinical pharmacy services:
- Improvement in patient outcomes
- Reduction in mortality
- Shorter length of hospital stays
- Reduced hospital readmissions
- Reduction in ADRs
- Reduction in medication errors
-Improved medication appropriateness - Improved patient medication understanding and adherence
- Improved patient quality of life
- Reduction in costs
What is the ideal clinical pharmacy Scenario?
Comprehensive Pharmaceutical Care
- Full work up BPMH
- Daily drug therapy review and monitoring
- Daily patient assessment and education
- Proactive drug therapy interventions
- Discharge planning and counseling
Quantity and type of clinical pharmacy services provided varies based on:
Type of Setting:
- Academic teaching hospital vs community or rural hospital
- Acuity of patients (ex. critical/acute care versus residential)
- Type of ward (ex. medical vs. surgical)
What are the 2 primary factors of inpatient clinical pharmacy?
Resource and staffing contraints:
- Currrently, lower mainland pharmacy services (LMPS) faces a 15-20% shortage of pharmacists, with shortages exceeding 40% outside the Lower Mainland
Pharmacists must find a balance between?
- Comprehensive care for all and reactive care
Typical Clinical pharmacy scenario:
-Pharmacists must prioritize
-Acute care medical/surgical unit
- + Dispensary duties and/or teaching and administrative duties
What is the goal with inpatient pharmacy?
- To provide the most impactful pharmacy care possible within the context of the time and resources available
What are pharmacist strategies to prioritize care?
- Must dos
- Targeted Clinical Pharmacy services
- Clinical Pharmacist identified issues
- Reports and tools to help identify DTPS
- To do list for the day
What are Automated Reports/Tools to help identify DTPs
- Paper based systems
- ex. pt. workup form
-Pt. workup form only updated in the morning - Electronic systems
-ex. EMR - EMR continuously updates
- Targeted Drug List
-Specialized Reports
-Clinical Pharmacists Worklist
What is a targeted drug list?
A computer generated list of medications that a pharmacist should assess
What does the targeted drug list include?
- Varies by hospital
- Broad spectrum antibiotics
- High risk drugs: warfarin, digooxin, others
- Drugs that require therapeutics monitoring (ex. warfarin, phenytoin, carbamazepine, vancomycin, aminoglycosides, tacrolimun)
- High cost meds
- IV meds that may be able to be stepped down to oral alternatives (ex. PPIs, antibiotics)
- May include non-formulary meds as “meds not available”
-Drugs that may require PK assessment and monitoring
-Nonformulary meds
What are specialized reports?
Computer-generated reports that combine drug, lab and other data to make it easier to spot DTPs
What are examples of specialized reports?
- Renal dosing reports
- Drug Levels Report
-Positive C.diff toxin report
-Warfarin and INRs
What happens on specialized reports about renal failure meds report?
Cross-references patients with eGFR less than 50 mL/min and any meds they are receiving that require dose adjustment in renal impairment
What happens on specialized reports of DMS Lab Report>
DMS=Drug measurement services (drug levels)
- Run once in the morning and then manually as needed
What are some potential advantages of EMR?
- Can provide timely decision-support
- some reports combine lab data, patient characteristics and med info
- Info avail. in real time, updated based on new info
- Alerrts can be “pushed” to the user rather than relying on the user to review a paper report
- Customizable
Must do: What does it mean to troubleshoot order? And what priority are they?
- Orders flagged by the dispensary that require involvement/resolution by the clinical pharmacists
- High priority because the patient may not receive the required medication until a pharmacist assess therapy or resolves the issues
Must dos: Give examples of trouble shoot orders
- Nonformulary meds
- Unclear order
-Orders that require clinical pharmacist follow-up (ex. pharmacist to adjust vanco dosing)
