Clinical pharmacy practice

Introduction
Clinical pharmacy can be delivered through
activities known as pharmaceutical care or
medicine management.
More recently, medicine management has
been defined as a holistic approach to patient
care through systematic management of the
patients medicines and a new partnership of
structured collaboration with the doctor.
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Type of
Pharmacist
Community
pharmacist
Hospital
pharmacist
Practice
pharmacist
Other

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Location

Example of activity

Pharmacy

Medication review

Hospital

Medication history
taking
Development of
prescribing policy

General
practice
Various

See community,
Hospital, Practice
pharmacists
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The origins of clinical pharmacy come from the

hospital setting.

Nowadays, however, clinical pharmacy

services can be delivered in every setting
where pharmacists are employed.
Many pharmacists now combine different
types of employment

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The Development of Clinical Pharmacy

Until the mid 1960s, pharmacists were almost
solely involved in the purchase, manufacture
and supply of medicines.
In the USA the development of clinical
pharmacy began and a more clinically oriented
pharmacy curriculum was developed with the
award of a PharmD degree.

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There are two distinct themes in the report

that should be applied to clinical pharmacy
services, namely the provision of quality
health care, and the maintenance of
professional competence through continuing
professional development (CPD)

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Clinical Governance
There are four main components of clinical
governance
1. Clear lines of responsibility and

accountability for the overall quality of

clinical care;
2. A comprehensive programme of quality

improvement activities;
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3. Clear policies aimed at managing risks;

4. Procedures for all professional groups to

identity and remedy poor performance.

Audit
Clinical audit refers to the process of audit
carried out within a particular profession,
usually by that profession.

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Clinical audit on the other hand is

multidisciplinary in nature and may be
undertaken by health care professionals from
any discipline.
Peer review
Assessing the performance of clinical
pharmacists involves issues of professional
judgment.

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Peer review is often used as part of a

professional development programme rather
than as part of a formal assessment of
clinical pharmacy practice.
The aim is to develop the clinical knowledge
and skills of pharmacists to improve the
quality of their practice.
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Rational medicine use

Drugs should be prescribed to maximize
effectiveness, minimize risks and costs, and
respect patients wishes.
Rational prescribing comprises five major
components :
a defensible formulation of the
patients problem;
Clarity of therapeutic intention;
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Access to independent data on drugs;

Communication with the patient;
Follow-up.
Evidence-based practice
Evidence-based practice should ideally
ensure that available resources are used
effectively and efficiently and that variation in
clinical practice is minimized.
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To provide for the pharmaceutical needs of

patient groups and promote rational
prescribing, a few key tools are essential :
* Guidelines;
* Local poliocies and protocols;
* Prescribing advice;
* Evaluated drug information;
* Formularies
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Guidelines
Guidelines are systematically developed
statements to assist practitioner and patient
decisions about appropriate health care for
specific clinical circumstances.
The majority of guidelines developed thus
far have been intended for medical
practitioners.
Pharmacists can be involved in the
development and implementation of
guidelines.
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For example with the increasing numbers of

medicine that are available for purchase from
community pharmacies without a prescription
(i.e OTC medicines), pharmacists need
guidance and support to ensure that sales of
these products maximize benefit and
minimize risk.
Local policies and protocols
Local protocols for the treatment of specific
clinical conditions can be derived from
national guidelines
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Patient group directions

The regulatory framework for the way
medicines are supplied and administered
was recently reviewed.
Prescribing advice
Information about individual or practice
prescribing is available to most prescribers.
This information need to be evaluated before
it can be used to promote rational prescribing.
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Pharmaceutical Service Provision

Clinical pharmacy services are often directed
towards indibivual patients. These may be
customers in community pharmacies,
inpatients or outpatients in hospitals,
housebound patients and clients in
residential homes. Clinical pharmacy
services can also be provided at a
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population level. This can include the

involvement of pharmacists in the
development, implementation and monitoring
of methods designed to promote the rational
use of medicines (e.g. guidelines, protocols ).
Pharmacists have a role, and indeed a
professional responsibility, to inform patients
receiving prescribed medicines and
customers purchasing OTC medicines, of the
risks associated with their use.
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Needs assessment
There are many diverse if patients for whom
health care must be planned.
The involvement of pharmacists essential,
since needs assessment must include
patients pharmaceutical needs.
Counselling and advice on prescribed
pharmacies and purchased medicine should
be available, as should compliance aids,
where necessary.
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Patient characteristics
Age
Most medicines are developed and tested
in adult populations before they gain their
licence. This means there is often little data
available regarding the use of medicines in
infants and children.

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Social Circumstances
Although the majority of patients live at
home, many will at some time experience a
hospital stay. Others live in residential or
nursing homes, in sheltered housing or in
other community-based settings. These
patients will experience varying degrees of
care.

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Pregnancy and breastfeeding

Women who are pregnant, considering
pregnancy or who are breastfeeding have
differing pharmaceutical needs.
The importance of avoiding the
unnecessary use of medicines in pregnancy
or during lactation is another role where
pharmacists can be involved.
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Mobility and disability

Many patients will be unable to have direct
access to their local community pharmacy
due to impaired mobility or disability.
For example, patients with visual impairment
may be unable to distinguish between
different medicines, therefore it is the
pharmacists responsibility to address this
problem.
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Prioritization of care
Prioritization of care can be achieved by
adopting a systematic approach to practice.
It should always be remembered that
pharmacists have a duty of care to every
patient and customer.
Formulating a pharmaceutical care plan
In all interactions with patients, pharmacists
require to formulate an action ( how they
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intend to achieve the aim) and a measure

that tells them that their aim has been
achieved.
The pharmacists has to respond to
symptoms, make a recommendation and
counsel the patient appropriately.
Monitoring patients
Various health care professionals monitor
patients to assess their progress with drug
therapy.
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Most commonly this involves doctors,

pharmacists and/or nurses.
Monitoring patients may be carried out for
one or more of the following reasons :
* to monitor health promotion measures;
* to monitor the progress of disease;
* to monitor for drug efficacy and/or drug
toxicity;
* to monitor the patients satisfaction with
drug therapy.
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Counselling and advising the patient or

carer

The pharmacist should ensure that the

patient or their carer understand the
medication regimen and is able to administer
it correctly.
The patient should be advised on the
disposal of discontinued medicines.

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Communication between health care

professionals
As patients are transferred from one
health care environment to another,
continuity of care relies on the
identification of, and effective
communication with, professionals
to whom responsibility is transferred.

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The confidentiality of information relating

to a patient and the patients family should
be respected throughout the transfer
process.
This also applies to the personal wishes
of the patient.

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