E R P R O F E SS IO N A L

INT
P R A C T I CE R E L A T E D
P H A R M A C O L O G Y
IN DUCATION, D I NT E RP R O FE S S IO N A L E
LLE
SUCH PREPARATION IS CA R E P RO F ES S IO NS
ID U A L S F R OM T W O O R M O
WHICH INVO LV ES IN D IV
E A C H O T H E R TO D E V E L O P
A B OU T , F RO M , A N D WIT H
LEAR N IN G T IV E
DES C O ND U C IV E T O E F F E C
ED GE , SK IL L S , A ND A TT IT U
KNOWL T H OU T C O M E S.
RO V E H EA L
TEAMWORK TO IMP
ABSTRACT
Interprofessional education (IPE) is a learning method that allows the clinical
clerkship to study together, exchange knowledge, and develop the skill that is
needed in interprofessional collaborative work practice. This analyzed
the elements within IPE including background, operational definition, goals and
benefits, implementation, as well as competency in IPE. Furthermore, the role
of IPE for medical students especially in pharmacology subject was discussed.
In summary, interprofessional collaboration (IPC) is needed to answer the high
demand and complexity of patient problems in minimizing medication errors due
to low IPC. The IPE is an early step towards realizing IPC where each profession
can understand each other’s roles and responsibilities to achieve comprehensive
patient health.

An example of interprofessional collaboration practice would be a doctor, nurse, physical therapist,

occupational therapist, and pharmacist working together to carry out an individualized plan of care in order
to improve a patient's health status.
INTRODUCTION
Pharmacology is one of a vital subject for medical students who want to be a medical
practitioner. Understanding of pharmacology principal is a crucial role in the therapy
management regarding the safe and effective use of medicines. Moreover, issues in health care
are getting complex lately, including
drug therapy problems and can be a challenge to the healthcare provider. The right medical
management services which involve multiple profession will give the high value for the patient.
In the case of drug therapy problem, the coordination and collaboration between health
professional and pharmaceutical care practice will be required to prevent, identify, and resolve
the problem. Therefore, introducing and implementing collaboration among health professional
early in pharmacology subject can improve the attitude and further medical management
services
Interprofessional practice between pharmacists and nurses can involve pharmacokinetic dosing of medications
in a hospital setting.
Pharmacy practice is, by its very nature, interprofessional. Pharmacists who practice in
hospitals, clinics, community pharmacies, and elsewhere collaborate on a regular basis with an
array of other health professionals. As medication experts, they advocate for the safe and
effective use of medications on behalf of patients, families, and caregivers, often with a focus on
minimizing costs to make improvements in health outcomes possible. Such advocacy requires an
impressive depth of knowledge about medications and medication use, which is built upon a
solid foundation of topics taught in Doctor of Pharmacy (PharmD) curricula ranging from
biochemistry, medicinal chemistry, and pharmacology to pharmacotherapy, patient safety, and
pharmacy law. To work effectively with other health professionals in a team environment,
pharmacists must be knowledgeable about other team members’ capabilities and contributions
to patient care. Additionally, they must possess strong interpersonal and communication skills.
This chapter will explore the landscape of interprofessional practice, the unique roles and
responsibilities pharmacists play as members of interprofessional teams, and the impact of
pharmacists’ contributions to team-based care on health outcomes.
The World Health Organization defines interprofessional practice as:

When multiple health workers from different professional backgrounds work together with patients, families,
and communities to deliver the highest quality of care. For context, the term caregiver, as opposed to career, is
more commonly used in the United States. It is important to note that this definition of interprofessional
practice has been endorsed and adopted throughout the United States, and it is an expectation that all PharmD
students will be adequately prepared for success in this area prior to graduation. Such preparation is called
interprofessional education and practice, which involves individuals from two or more professions learning
about, from, and with each other to develop knowledge, skills, and attitudes conducive to effective teamwork to
improve health outcomes. Emphasis on interprofessional practice and education, thus, is not unique to
pharmacy. In fact, it is a national movement that has been embraced throughout the health professions on both
the educational and practice sides of the healthcare sector. What is unique to pharmacy, however, is the
education and training of pharmacists. As medication experts on the team, pharmacists are uniquely prepared
to advocate for the safe and effective use of one of the most important and widely used tools to improve health.

Nearly 80% of all medical treatments in the United States involve the use of medications. By 2021, it is
estimated that approximately 5 billion prescriptions will be filled each year. Many different types of health
professionals, referred to as prescribers, order medications to treat patients and write prescriptions for them to
take at home; this includes dentists, nurse practitioners, physicians, and physician assistants .
 DISCUSSION
Definition of IPE
Interprofessional education, which previously is called “multidisciplinary care” and “interdisciplinary
care”, lately has various definitions. (Illingworth et al.9) claimed that IPE is an education which
accentuates the mutual interactions among individuals who work in the health care providers, in the
health education, which validated or not by a legal entity, or it can be validated independently by each
individual.
Multidisciplinary team care is comprised of at least one patient and multiple health professionals from
several different disciplines. Health professionals who participate in a multidisciplinary team, care,
collaborate and communicate together in order to address as many aspects of a patient's care as possible.
An interdisciplinary approach relies on health professionals from different disciplines, along with the
patient, working collaboratively as a team. The most effective teams share responsibilities and promote
role interdependence while respecting individual members' experience and autonomy.
An example of an interdisciplinary team would be a trauma team treating a patient after a motor vehicle
accident. The surgeon, emergency room physician, nurses, therapists, lab specialists and imaging
specialists all work together for the shared goal of the patient's treatment and recovery.
 Interprofessional practice between pharmacists and nurses can involve pharmacokinetic
dosing of medications in a hospital setting. This study describes student perceptions of an
interprofessional collaboration pharmacokinetics simulation on the Interprofessional Education
Collaborative (IPEC) 2016 Core Competencies. The investigators developed a simulation
activity for senior undergraduate nursing and second-year pharmacy students. Nursing students
completed head-to-toe assessment and pharmacy students gathered necessary information and
calculated empiric and adjusted doses with the use of SBAR (Situation, Background,
Assessment, and Recommendation). Additionally, the Interprofessional education (IPE) which is
defined by the World Health Organization as “when students from two or more professions
learn about, from, and with each other to enable effective collaboration and improve health
outcomes” . IPE is an important aspect in current health education and is necessary to train our
students for the collaborative practice environment. The simulation environment provides a
unique opportunity for students to apply information they have learned in a traditional lecture-
format environment to the setting of a patient care scenario. The 2016 Interprofessional
Education Collaborative (IPEC) Core Competencies for Interprofessional Collaborative
Practice serve as a guidance document for developing IPE activities.
THE IMPORTANCE OF IPE
The important of IPE to medical students in pharmacology subject (Barr et
al.12) stated that at least two-third of health higher education institutions in
England used IPE in their education system. Those institutions clarified that
the implementation of IPE is important to the health professionals’ candidate.
Considering the need for IPE and its massive benefit, the application of IPE,
therefore, need to be implemented as early as possible when the health
professionals candidate (including medical students were still in he education
phase).
 IMPLEMENTATION
The implementation of IPE amongst medical and pharmacy students. There
should be a commitment among health professional group from the beginning in
the education phase to foster a great health professional
teamwork to the student so that IPE implementation would be utmost. This is the
early step of IPC establishment which oriented to the improvement of patient
wellbeing comprehensively.Therefore, IPE should be inserted to the
health education curriculum, including medical and pharmacy.Medical and
pharmacy are two different majors, yet both are in the same academic cluster.
Thus, the value and knowledge development are quite similar. However, it should
be noticed that those two have unalike work practice scope as well as the cultural
organization. Hence, a collaborative approach between physicians and
pharmacists in delivering health services is a complex task for some individuals.
 A simple task could become complex as the superior-inferiority relationship which
often felt among professionals emerge. In addition, it should be considered that
some terminology, organizational culture, work algorithm, as well as work pressure
may vary among health professionals, and these will eventually affect professionals’
performance in teamwork. Apparently, there is a different viewpoint regarding
each clinicians’ role, in this case between physician and pharmacist. A physician
assumes that a pharmacist’s role is limited to the area of preparing and delivering
the medicine to the patient from the doctor’s prescription. Meanwhile, a
pharmacist has a different viewpoint that they too should be involved in deciding
the rationale drug for a patient. Another challenge of IPE implementation is that
not all health cluster students are from the same organization.
 Interprofessional education competency for medical students
Conducting IPE in the health cluster higher education will affect the
quality of the students. Thus, the expected
competent graduates as required in IPC will be produced. There are
five crucial competencies that have to be attached to the health
professionals in teambased collaborative work practices. Those are
understanding of the capacity and role of self; trust and self-believed
in working; able to solve the problem well; accepting the
differentiation; and having a leadership skill. Additionally, other
values that should be owned by the IPE students are understanding
their role, responsibility, and other professional’s competency, working
by patient-oriented, and there should be an interdependent
relationship with other health professions.
 CONCLUSION
The high demand and complexity of the patients’ problem required IPC in delivering health
services. The poor working practices collaboration among health professionals may result in
medication errors that endanger patients. To rectify IPC, fostering and habituating all the
competencies needed should be conducted. Therefore, IPE is the essential step to the actualization
of good IPC.
For a medical student, IPE is an important program, particularly in pharmacology subjects, as
they have to learn how to build cooperation with pharmacy students. The benefit of IPE for a
medical student in a pharmacy field
is that they will learn and habituate with the pharmacist candidate. Moreover, they will also learn
to understand each professionals’ role, responsibility, and competencies either their profession or
other health professionals. Finally, the pharmacotherapy given to the patient can be correct,
rationale, and oriented to patient wellbeing comprehensively.
 CURREN T T R E N D S
AND C L I NI C A L
AL E RT S IN N U R S I N G
PHARMA C O L O G Y
A. TECHNOLOGICAL ADVANCES TO PREVENT MEDICATION ERRORS

1. Computerized physician order entry (CPOE)

• a system that allows prescribers to electronically enter orders for medications, thus
eliminating the need for written orders.
• CPOE increases the accuracy and legibility of medication orders; the potential for the
integration of clinical decision support; and the optimization of prescriber, nurse, and
pharmacist time (Agrawal, 2009).
• Decision support software integrated into a CPOE system can allow for the automatic
checking of drug allergies, dosage indications, baseline laboratory results, and potential drug
interactions. When a prescriber enters an order through CPOE, the information about the
order will then transmit to the pharmacy and ultimately to the MAR.
2. Electronic bar codes on medication labels and packaging
• A patient’s MAR (medication administration record) is entered
into the hospital’s information system and encoded into the
patient’s wristband, which is accessible to the nurse through a
handheld device. When administering a medication, the nurse
scans the patient’s medical record number on the wristband, and
the bar code on the drug. The computer processes the scanned
information, charts it, and updates the patient’s MAR record
appropriately (Poon et al., 2010).
3. Automated medication dispensing systems (AMDS)
• Provide electronic automated control of all medications, including narcotics.
Each nurse accessing
the system has a unique access code.
• The nurse will enter the patient’s name, the medication, the dosage, and the
route of administration. The system will then open either the patient’s
individual drawer or the narcotic drawer to dispense the specific medication. If
the patient’s electronic health record is linked to the AMDS, the medication and
the nurse who accessed the system will be linked to the patient’s electronic
record."
B. HIGH RISK MEDICATIONS
High risk medications are those that have a high chance of causing harm if they are
misused or used in error. They are generally medicines with a narrow therapeutic
index. This means that the difference between a medicine’s desired effect (efficacy)
and a lethal or toxic dose (potency) is very small. In other words, a small increase in
the medicine’s concentration in the body could lead to toxic levels and fatal
consequences (Roughead, Semple & Rosenfeld 2013).
The acronym APINCH is designed to serve as a reminder that even routinely
administered medicines pose a high risk to patient safety.
High-Risk Medicine Examples of medicines
Groups

A: Anti-infective Amphotericin
Aminoglycosides

P: Potassium and other Injections of potassium, magnesium, calcium, hypertonic sodium chloride
electrolytes

I: Insulin All insulins

N: Narcotics (opioids) Hydromorphone, oxycodone, morphine fentanyl, alfentanil, remifentanil and

and other sedatives analgesic patches,
Benzodiazepines, for example, diazepam, midazolam.
Thiopentone, propofol and other short term anaesthetics

C: Chemotherapeutic Vincristine ,Methotrexate,Etoposide, Azathioprine

agents
H: Heparin and Warfarin, enoxaparin, rivaroxaban, dabigatran, apixaban
anticoagulants
C. SAFE HANDLING OF CYTOTOXIC DRUGS
The toxicity of cytotoxic drugs means that they can present significant risks to those who
handle them. Occupational exposure can occur when control measures are inadequate.
Cytotoxic drugs including cyclophosphamide, busulfan, and bleomycin may cause acute and
chronic lung disease. Establishing the diagnosis of cytotoxic drug injury is important in the
setting of cancer treatment, as it may require a reformulation of treatment. Exposure may be
through skin contact, skin absorption, inhalation of aerosols and drug particles, ingestion and
needle stick injuries resulting from the following activities:
• drug preparation
• drug administration
• handling patient waste
• transport and waste disposal, or
• cleaning spills.
Cytotoxic drugs (sometimes known as antineoplastics) describe a group of
medicines that contain chemicals which are toxic to cells, preventing their
replication or growth, and so are used to treat cancer. Inadequate control measures
could lead to;
• Abdominal pain, hair loss, nasal sores, vomiting, and liver damage
• Contact dermatitis and local allergic reactions.
• Fetal loss in pregnant women and malformations in the children of pregnant
women
• Alterations to normal blood cell count
• Abnormal formation of cells and mutagenic activity or mutations forming
Anyone working with patients receiving cytotoxic drugs is at risk of exposure. This
therefore includes pharmacists, pharmacy technicians, medical and nursing staff,
laboratory
staff, and others.
 D. NURSING CARE AND MANAGEMENT OF PATIENTS WHO HAVE RECEIVED
CHEMOTHERAPEUTIC AGENTS
Potential duration of excretion of chemotherapy agents and their metabolites are not well
defined. While there is some data derived from the adult population, the extent to which this
is applicable to children is unclear. Therefore, there is a real potential risk to health care
professionals and parents who are caring for children following the administration of
chemotherapy agents. It is suggested that PPE should be worn up to 48 hours post
administration of intravenous (IV) chemotherapy agents and for up to 7 days post oral
chemotherapy agents administration. Personal Protective Equipment (PPE) .PPE must be
worn when handling any patient’s blood or body fluids.
• Plastic Face Shields should be worn when there is a risk of splash, e.g., flushing toilet,
changing diapers, frequent or unpredictable vomiting.
• Parents must be gloved when handling excreta and diapers up to 7 days post treatment.
• Gloves should be discarded after each patient use, and when soiled or contaminated with
body fluids, in appropriately labeled containers.
• Gloves and gowns should not be worn outside of the drug administration area.
Flushing of Toilets
• All toilets should be flushed twice, as recommended in the literature but not evidence based (Brown et.
al, 2001, p.70).
• The toilet bowl (seat up) should be covered with a plastic-lined, absorbent pad (absorbent side facing
down) prior to flushing. These pads should be disposed of in biohazard containers after each use.
Disposal of Diapers
• Diapers should be disposed of in a biohazard container for up to 7 days after chemotherapy
administration.
Disposal of Contaminated Linen
• Contaminated, non-disposable, linen should be handled with gloves and gowns and should be
dealt with in a manner consistent with institutional policies regarding handling and disposal
of infectious linens.
• Parents should not clean up contaminated linens or clothing. This should be done by gowned
and gloved health care personnel.
Patients who go to Other Areas of the Hospital
• Personnel in other areas of the Hospital (e.g., Diagnostic Imaging, Echocardiography) should observe
these safe handling guidelines when handling patients who have received chemotherapy agents.
• These guidelines should be disseminated to all hospital personnel who may care for oncology patients
in other areas.
Disposal of Biohazardous Contaminated Materials
All areas where chemotherapy drugs are handled should have specific disposable containers close at
hand for easy and safe disposal.
• Needles and syringes should be disposed intact.
• Sharps and breakable items e.g. vials, ampoules should be disposed of in leak proof, puncture resistant
containers with labels indicating chemotherapy (cytotoxic) waste.
• Non-sharp chemotherapy drug waste, e.g. plastic IV bags and tubing, personal protection equipment,
should be sealed in leak proof, puncture resistant containers with appropriate labels.
• These containers should be of a different colour from regular disposal of hazardous waste
containers."
 Accidental Contamination and Chemotherapy Spills

• Every institution should have policy and procedures in place for the
management of accidental contamination and chemotherapy spills.

• All health care professionals who handle chemotherapy agents should be

oriented and familiar with these policy and procedures.

• It is strongly recommended that a spill management kit be readily available

within the work area.
1.
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