Clinical Pharmacy


Clinical pharmacy, that is, the practice of pharmacy ‘at the bedside’, or at least, on wards and in clinical departments, started to develop in the USA in the late 1960s and in the UK during the 1970s. Initially, pharmacists performing ward pharmacy did little more than collect stock orders and transcribe patient-specific drug orders from drug charts, engaging in little contact with doctors, nurses or patients. Gradually,
pharmacists started to use their expert pharmaceutical knowledge to monitor prescribing, intervening when appropriate to optimise drug treatment for individual patients. 

Now, many hospital pharmacists are fully integrated into the clinical team, working alongside doctors, nurses, physiotherapists and other members of the multidisciplinary team, to deliver optimal care to patients. With the pharmacist present at the time of prescribing, errors in selection of appropriate drug and dosing regimen are minimised, ensuring that the patient receives maximum benefit from their treatment with minimal side-effects.

Pharmaceutical care Pharmaceutical care is the term most often used to describe what a clinical pharmacist
does. It entails regular monitoring of drug treatment for each patient under their care, including screening prescription charts for safety, appropriateness, efficacy and side-effects. Concepts and definitions in clinical pharmacy are changing frequently. Over the years, different jargon has been used to describe the work of the clinical pharmacist. In 1990, Hepler and Strand defined the concept of pharmaceutical care for the first time as ‘the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life’.

The process of pharmaceutical care can be carried out in a variety of ways. Most clinical pharmacists have responsibility for particular wards; they will make regular visits (usually daily, Monday to Friday) to these wards to carry out a pharmacist ward round, which involves inspecting each patient’s prescription chart, as
described above, and, when necessary, observation charts and medical notes. During these rounds, the pharmacist will talk with the patient to confirm details such as medication history, when and how a patient takes their medication, and also to enquire whether certain medication, such as antiemetics (drugs to prevent and treat nausea and vomiting) or analgesics (painkillers) are working and being tolerated. In order to perform effectively, the pharmacist must have good communication skills to gather all the information they need from both patients and other health professionals.

Most pharmacy departments have an out-ofhours on-call system. These systems vary from a residency service, where a small team of resident pharmacists (often junior grades) take turns (on a rota) to stay on site over night in order to provide a complete pharmaceutical supply and advice service, to an ‘at home’ on-call service, where all the pharmacists in a department take turns (on a rota) to provide an ‘emergency only’
service. In this system, pharmacists go home at the end of the working day, but hospital staff can contact the pharmacist for advice via a pager. 

There is usually an ‘emergency drug cupboard’ at the hospital that contains drugs that are not available elsewhere in the hospital and that nurses and doctors can access out of hours. A residency service offers a similar level of service to that available during the working day; an ‘emergency only’ service offers help and supply of drugs only when it is vital that there is no delay in treatment. The on-call service offered by a pharmacy department is usually determined by the amount of funding available for the service; clearly it is more expensive to run a residency service, as more pharmacists are needed to support it, and not all trusts have sufficient funds to support this.

Many clinical pharmacists participate in doctors’ ward rounds. This enables the pharmacist to obtain greater in-depth knowledge of a patient’s condition, and to have a direct influence on prescribing – being present when a therapeutic decision is made enables the pharmacist to ensure that the choice of drug is appropriate for the patient before the prescription is written. The pharmacist can also ensure the drug is available, so the patient’s treatment is not delayed. This combination of prescribing advice and supply of medication ensures
timely and safe treatment and improves patient care.

Pharmacists also help and advise nurses on the safe administration and monitoring of drug treatment, discuss possible food–drug interactions with dietitians, and ascertain from speech and language therapists whether a patient can swallow medications safely. Pharmacists may also participate in outpatient clinics. Pharmacists are frequently involved in anticoagulant clinics, where they are responsible for checking patients’ blood results, advising on warfarin dose adjustment, and counselling new patients on their warfarin treatment. (Warfarin is an anticoagulant drug – it reduces the ability of the blood to form clots. Warfarin is used in conditions that increase the risk of the blood clotting such as atrial fibrillation.)

by Umaee

source: Foundation in pharmacy practice
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