Practical Clinical Pharmacy II – Lab.

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Concept of clinical pharmacy
Dr. Salah Mohammed

Definition
Clinical pharmacy is a health science discipline in which pharmacists provide patient
care that optimizes medication therapy and promotes health, wellness, and disease
prevention.
Clinical pharmacy comprises a set of functions that promote the safe, effective and
economic use of medicines for individual patients.
Clinical pharmacy process requires the application of specific knowledge of
pharmacology, pharmacokinetics, pharmaceutics and therapeutics to patient care.
Functions of clinical pharmacist
1. Prescribing drugs
2. Dispensing and administering drugs
3. Documenting professional services
4. Direct patient involvement
5. Reviewing drug use
6. Education
7. Consultation
Aims of clinical pharmacy

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Main goals of clinical pharmacy
1. To assist the physician in doing better job of prescribing and monitoring drug
therapy for the patient
2. To assist medical and para-medical staff and documenting drug incidents
correctly
3. To maximize patient’s compliance in drug use process
Qualities of clinical pharmacists
The qualities, which are essential for the clinical pharmacist to be a competent person
including:
1- strong medical science background,
2- good communication skills,
3- up-to-date knowledge,
4- creativity and innovation,
5- advanced clinical skills,
6- leadership,
7- behavior and social expectations,
8- intellectual ability
Medicines optimisation
The aim of medicines optimisation is to
1- help patients take their medicines appropriately
2- improve safety and outcomes,
3- avoid unnecessary treatment
4- reduce wastage.
Medicines optimisation
Guiding principles of medicines optimisation include the following
1- communicating with the patient and/or his or her carer about the patient’s choice
and experience of using medicines to manage his or her condition;
2- supporting the most appropriate choice of clinically and cost-effective medicines
3- ensuring that medicines use is as safe as possible, including safe processes and
systems, effective communication between professionals and the minimising
likelihood of unwanted effects and interactions;
4- making medicines optimisation part of routine practice by routinely discussing
with patient, carers and other health professionals how to achieve the best
outcomes from medicines.

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Key elements of the care process
1- Assessment: The main goal of assessment is to establish a full medication history
and highlight actual and potential medication- related problems
2- Care plan: The care plan should clearly state the goals to optimise care and the
responsibilities of both the pharmacist and the patient in attaining the stated goals.
3- Evaluation: The evaluation reviews progress against the stated patient outcomes.
Relevant patient details
1. Age
2. Gender
3. Ethnic or religious background
4. Social history
5. Presenting complaint
6. Working diagnosis
7. Medical history
8. Laboratory or physical findings
Pharmaceutical considerations in the administration of medicines
1- Dose: Is the dose appropriate, including adjustments for particular routes or
formulations?
2- Route: Is the prescribed route available (is the patient nil by mouth?) and
appropriate for the patient?
3- Dosage form: Is the medicine available in a suitable form for administration via
the prescribed route?
4- Documentation: Is documentation complete? Do nurses or carers require specific
information to safely administer the medicine?
5- Devices: Are devices required, such as spacers for inhalers?
Drug use process indicators
1. Establish need for a drug
2. Select drug
3. Select regimen
4. Provide drug
5. Administer drug
6. Monitor drug therapy
7. Counsel patient
8. Evaluate effectiveness

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Medication-related problems
Categories of medication-related problems
1. Untreated indication
2. Treatment without indication
3. Improper drug selection
4. Too little drug
5. Too much drug
6. Non-adherence
7. Adverse drug reaction
8. Drug interaction