Cp Flashcards
comprises a set of functions that promote the safe, effective and economic use of medicines for individual patients.
Clinical pharmacy
has allowed pharmacists to shift from a product-oriented role towards direct engagement with patients and the problems they encounter with medicines.
• The emergence of clinical pharmacy
• is generally an essential component of pharmaceutical care.
The practice of clinical pharmacy
is a co-operative, patient-centred system for achieving specific and positive patient outcomes from the responsible provision of medicines.
• Pharmaceutical care
• The three key elements of the care process are
patient assessment, determining the care plan and evaluating the outcome.
• The ability to consult with_______is a key process in the delivery of pharmaceutical care and requires regular review and development regardless
of experience.
•
patients
has been incorporated into a professional development framework that can be used to enhance skills and knowledge.
clinical pharmacy process
, unlike the discipline of pharmacy, is a comparatively recent and variably implemented form of prac- tice. It encourages pharmacists and support staff to shift their focus from a solely product-oriented role towards more direct engagement with patients and the problems they encoun- ter with medicines.
Clinical pharmacy
as a form of practice has been attributed to the poor medicines control systems that existed in hospitals during the early 1960s (Cousins and Luscombe, 1995).
The emergence of clinical pharmacy
In the_______, the approach was to adopt unit dose dispens- ing and pursue decentralisation of pharmacy services. In the_______the unification of the prescription and the administra- tion record meant this document needed to remain on the hospital ward and required the pharmacist to visit the ward to order medicines
USA
UK
Clinical pharmacy thereby emerged from the presence of pharmacists in these patient areas and their inter- est in promoting safer medicines use. This was initially termed _______but participation in medical ward rounds in the late 1970s signalled the transition to clinical pharmacy.
ward pharmacy
Medication safety may have been the spur but clinical phar-macy in the ______grew because of its ability to promote cost- effective medicines used in hospitals. This role was recognised by the UK government, which, in ________endorsed the imple- mentation of clinical pharmacy services to secure value for money from medicines.
1980s
1988
were necessary to aggregate large amounts of data in a reliable manner and many of these drew upon the eight steps (Table 1.1) of the drug use process (DUP) indicators (Hutchinson et al., 1986).
Coding systems
Drug use process indicators
Need for a drug
Select drug
Select regimen
Provide drug
Drug administration
Monitor drug therapy
Counsel patient
Evaluate effectiveness
Ensure there is an appropriate indication for each drug and that all medical problems are addressed therapeutically
need for a drug
Select and recommend the most appropriate drug based upon the ability to reach therapeutic goals, with consideration of patient variables, formulary status and cost of therapy
Select drug
Select the most appropriate drug regimen for accomplishing the desired therapeutic goals at the least cost without diminishing effectiveness or causing toxicity
Select drug regimen
Facilitate the dispensing and supply process so that drugs are accurately prepared, dispensed in ready-to- administer form and delivered to the patient on a timely basis
Provide drug
Ensure that appropriate devices and techniques are used for drug administration
Drug administration
for effectiveness or adverse effects in order to determine whether to maintain, modify or discontinue
Monitor drug therapy
Counsel and educate the patient or caregiver about the patient’s therapy to ensure proper use of medicines
COUNSEL PATIENTS
Evaluate the effectiveness of the patient’s drug therapy by reviewing all the previous steps of the drug use process and taking appropriate steps to ensure that the therapeutic goals are achieved
Evaluate effectiveness
comprises a set of functions that promote the safe, effective and economic use of medicines for individual patients.
Clinical pharmacy
requires the application of specific knowledge of pharmacology, pharmacokinetics, pharmaceutics and therapeutics to patient care select drug select and recommend the most appropriate drug based upon the ability to reach therapeutic goals, with consideration of patient variables, formulary status and cost of therapy select regimen select the most appropriate drug regimen for accomplishing the desired
therapeutic goals at the least cost without diminishing effectiveness or causing toxicity
Clinical pharmacy process
is a co-operative, patient-centred system for achieving specific and positive patient outcomes from the responsible provision of medicines. The practice of clinical pharmacy is an essential component in the delivery of pharmaceutical care
Pharmaceutical care
encompasses the way in which medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution that medicines make to producing informed and desired outcomes of patient care
medicines management
is dependent on the practice of clinical pharmacy but the key feature of care is that the practitioner takes responsibility for a patient’s drug- related needs and is held accountable for that commitment.
delivery of pharmaceutical care
has enabled pharmaceutical care to permeate community pharmacy, particularly in Europe, in a way that clinical pharmacy and its bedside connotations did not.
avoidance of factionalism
Box 1.1 Categories of medication-related problems
Untreated indication
Treatment without indication
Too little drug
Too much drug
improper drug selection
non-compliance
Drug interaction
adverse drug reaction
are associated with significant morbidity and mortality. Preventable medication-related hospital admissions in the USA have a prevalence of 4.3%, indicating that gains in public health from improved medi- cines management would be sizeable (Winterstein et al., 2002).
MRPs
, defined as pre- ventable events that may cause or lead to inappropriate medi- cines use or harm, in NHS hospitals has been estimated to lie between £200 and £400 million per year. To this should be added the costs arising from litigation (DH, 2004).
The direct cost of medication errors
Recognition that many patients either fail to benefit or experience unwanted effects from their medicines has elicited two types of response from the pharmacy profession.
The first response has been to put in place, and make use of, a range of post- graduate initiatives and programmes to meet the develop- mental needs of pharmacists working in clinical settings.
The second has been the re-engineering of pharmaceutical services to introduce schemes for medicines management at an organisational level.
