Clinical Pharmacy Process

Reference Book: Clinical Pharmacy and Therapeutics

Authors: D. G. Webb, J. G. Davies and D. McRobbie

Key Points

• Clinical pharmacy promotes the safe, effective, and economic use of medicines for individual patients.
• Shift from product-oriented roles to direct patient engagement.
• The three key elements of the care process: patient assessment, care plan determination, and outcome evaluation.
• Consultation skills are fundamental to delivering pharmaceutical care.

Overview

Clinical pharmacy is a practice where pharmacists shift focus from a solely product-oriented role toward more direct engagement with patients and their medicine-related problems. It embraces the philosophy of Pharmaceutical Care, which is a patient-centered system aimed at achieving specific positive outcomes.

Table 1.1: Drug Use Process (DUP) Indicators

DUP Stage	Action
Need for a drug	Ensure appropriate indication and that all medical problems are addressed.
Select drug	Recommend the most appropriate drug based on therapeutic goals, patient variables, and cost.
Select regimen	Select the most appropriate regimen to achieve goals at the least cost without toxicity.
Provide drug	Facilitate accurate dispensing and timely delivery in ready-to-administer form.
Drug administration	Ensure appropriate devices and techniques are used.
Monitor therapy	Monitor for effectiveness or adverse effects to maintain, modify, or discontinue.
Counsel patient	Educate the patient/caregiver to ensure proper use.
Evaluate effectiveness	Review all previous steps to ensure therapeutic goals are achieved.

Table 1.2: Core Definitions

Term	Definition
Clinical Pharmacy	Functions that promote safe, effective, and economic use of medicines for individual patients.
Pharmaceutical Care	A co-operative, patient-centred system for achieving positive patient outcomes.
Medicines Management	How medicines are selected, procured, delivered, prescribed, administered, and reviewed to optimize outcomes.

Medication-Related Problems (MRPs)

Preventable medication-related hospital admissions account for approximately 4.3% of cases in both the USA and UK. Many of these issues are linked to prescribing, monitoring, or adherence.

Pharmaceutical Consultation

Effective consultation involves establishing a therapeutic relationship. This is often more than just scientific expertise; it requires a partnership with the patient.

Clinical Pharmacy Functions

Step 1: Establishing Need

Identifying the patient's condition and expected therapy. Requires gathering details like age, gender, social history, and laboratory findings (Renal/Liver function).

Step 2: Selecting the Medicine

Checking for:

• Drug-Patient interactions: Allergies, age-related contraindications.
• Drug-Disease interactions: Medicine worsening a pre-existing condition.
• Drug-Drug interactions: Effects on metabolism (P450 system) or opposing actions.

Step 3: Administering the Medicine

Choosing the best route (Oral is preferred) and calculating accurate doses, especially for parenteral therapy.

Step 4: Providing the Medicine

Ensuring prescriptions are legal, legible, and that medicines are labeled accurately for the patient's specific needs.

Step 5: Monitoring Therapy

Scrutinizing medicines with narrow therapeutic indices (e.g., Digoxin, Warfarin, Phenytoin).

Case Study: Mr. JB

Profile: 67-year-old male, CHD, coronary artery stent, history of asthma (well-controlled).

PharmaQMS