INTRODUCTION

TO
CLINICAL PHARMACY

Dr.Anusha Joel
Associate professor
HOD, Department of Pharmacy practice
 DEFINITION

• Clinical pharmacy may be defined as the science and practice

of rationale use of medications, where the pharmacists are
more oriented towards the patient care rationalizing
medication therapy promoting health , wellness of people It
is the modern and extended field of pharmacy.

• “ The discipline that embodies the application and

development (by pharmacist) of scientific principles of
pharmacology, toxicology, therapeutics, and clinical
pharmacokinetics, pharmacoeconomics , pharmacogenomics
and other allied sciences for the care of patients”.
 HISTORY
• Until the mid 1960’s ; Traditional role.
• The development of clinical pharmacy started in USA.
• More clinically oriented curriculum were designed with the
award of Pharm D degree.
• These developments influenced the practice of pharmacy in
U.K., Initially prescription and drug administration records
were introduced followed by an increasing pharmacy practice
in hospital wards. Master degree programs in clinical
pharmacy were introduced for first time in 1976.
• The progress of clinical pharmacy development remained at
low profile in the first decade after its birth in U.K. However,
Nuffield(british industrialist) report in1986 geared up the
momentum for progression of clinical pharmacy.
• Until today, the clinical pharmacy practice in Nepal is in
embryonic stage
 How Does Clinical Pharmacy Differ From Pharmacy?

• The discipline of pharmacy embraces the knowledge on

synthesis, chemistry and preparation of drugs.
• Clinical pharmacy is more oriented to the analysis of
population needs with regards to medicines, ways of
administration, patterns of use ,drugs effects on the Patients,
‘the overall drug therapy management’.
• The focus of attention moves from the drug to the single patient
or population receiving drugs.
 Template For Evaluating A Clinical Pharmacist

• Competency domain 1: direct patient care

• Competency domain 2: pharmacotherapy knowledge
• Competency domain 3: systems-based care and population
health
• Competency domain 4: communication
• Competency domain 5: professionalism
• Competency domain 6: continuing professional development
 Competency domain 1: direct
patient care
Task
Direct patient care Conducts interviews to obtain
relevant subjective information as well as medication
use history C
Documents an accurate and complete list of
medications, difference between prescribed and actual
use of medications, allergies, and prior adverse drug
reactions in accordance with institution- specific
medication reconciliation processes.
Appropriately assesses patient data (e.g., physical
assessment, medical history, overall health status,
quality of life, cultural issues, educational level,
language , symptoms, lab or imaging study results) to
identify medication-related problems.
Establishes and documents patient-specific and
measurable outcomes; states the time interval for the
monitoring and follow-up of each identified drug
therapy problem
Advocates for the rational and cost-effective use of
tests (e.g., laboratory tests, cultures and sensitivities,
pharmacogenomic testing) to guide patient care
decision Orders, progress notes, or other
documentation by the clinical pharmacist
Suggested Examples for Performance Evaluation
Pharmacy progress notes and/or patient records—
Review and evaluate for compliance with accepted
standards and practice- or institution specific policies
Pharmacy progress notes and/or patient records—
Review and evaluate for compliance with accepted
standards and practice- or institution specific policies
Documentation of applicable and complete patient
assessment and treatment plans developed by the
clinical pharmacist Documentation of accurate and
complete medication therapy problem lists
Progress notes and other documentation by the
clinical pharmacist
Orders, progress notes, or other documentation by the
clinical pharmacist
 Competency domain 2:
pharmacotherapy knowledge

Task Suggested Examples for Performance

Evaluation
Retrieves, appraises, and assimilates Documentation of evidence-based clinical
evidence from published scientific studies decisions and recommendations •
and makes evidence-based decisions
related to a patient’s health problem(s)
Responds to drug information requests Assessment of the clinical pharmacist’s
completely, accurately, and in a timely therapeutic knowledge by fellow health
fashion Assessment of the clinical care providers
pharmacist’s therapeutic knowledge by
fellow health care providers
 Competency domain 3: systems-
based care and population health
Task Suggested Examples for Performance
Evaluation
Follows, maintains, and reinforces the Quality of drug utilization reviews
pharmacy/health system’s medication Membership in P&T committee or an
use policies and processes to ensure equivalent committee System error
proper and safe dosing, storage, identification and the potential system
handling, dispensing, and/or solutions proposed.
administration of medications and
compounded sterile products.
•Participates in institutional processes to Guidelines for cost-effective practice in
increase patients’ access to medications. which the clinical pharmacist has
s participated (including guideline
preparation) Development, promotion,
and/or implementation of pharmacy-wide
cost-saving initiative
 Competency domain 4:
communication
Task Suggested Examples for Performance
Evaluation
Uses effective verbal and written Direct observation of the clinical
communication skills consistent with a pharmacist’s communication skills
patient’s health literacy status during patient interviews, medication
counseling sessions, and/or presentations
to patient groups Evaluations received
from patients after a formal group
presentation Samples of educational
materials developed for patients..
 Competency domain 5:
professionalism
Task Suggested Examples for Performance
Evaluation
Treats patients, guests, staff, and Results of patient satisfaction surveys
trainees with care, concern, respect, and Student or resident evaluations of the
courtesy. clinical pharmacist as a preceptor Direct
observations Recognition (e.g., letters of
commendation/thanks from patients or
students) of the clinical pharmacist’s
professionalism Complaints received.
.
 Competency domain 6: continuing
professional development
Task Suggested Examples for Performance
Evaluation
Competency domain  Participates Documentation of participation in
consistently in continuing professional continuing education/continuing
development activities and pursues professional development activities and
professional and career development programs Documentation of
activities that enhance research and certifications earned or renewed.
scholarship.

Documentation of certifications earned

Maintains competency through or renewed
certification and maintenance of
certification
 Roles and Responsibilities of a
Clinical Pharmacist

• Assuring safe, accurate, rational and cost- effective use of

medications
• Engage in collaborative practice with other healthcare
practitioners for the purpose of improving care and conserving
resources
• Make patient-focused transitions into and out of acute care
practice settings, ambulatory care or alternative site settings with
the patient’s best interest in mind
• Possess in-depth knowledge of medications that is integrated with
a foundational understanding of the biomedical, pharmaceutical,
socio behavioral, and clinical sciences
• Assume responsibility and accountability for managing
medication therapy in direct patient care settings, whether
practicing independently or in consultation/collaboration with
other health care professionals
• Within the system of health care, clinical pharmacists are experts
in the therapeutic use of medications
• Routinely provide medication therapy evaluations and
recommendations to patients and health care professionals.
• To achieve desired therapeutic goals, the clinical pharmacist
applies evidence-based therapeutic guidelines, evolving sciences,
emerging technologies, and relevant legal, ethical, social, cultural,
economic and professional principles
 Scope of Practice for Clinical
Pharmacists
 Professional Practice
 Education
 Accountability
 Responsibility
 Professional Practice

 Clinical pharmacists are licensed professionals with advanced education and

training who practice in all types of patient care settings.
 They participate as members of the health care team to provide high-quality,
coordinated, patient-centered care to ensure that individuals and populations
achieve the best possible outcomes from their medications.
 Clinical pharmacists assess medication- related needs, evaluate medication
therapy, develop and implement plans of care, and provide follow-up evaluation
and medication monitoring in collaboration with other members of the health
care team.
 In the course of this practice, clinical pharmacists interpret diagnostic and
laboratory tests, identify the most appropriate drug and nondrug therapies, and
teach patients and caregivers about medications and how to use them.
 They also serve as health care researchers, university and college faculty,
medication information specialists, organizational leaders, consultants, and
authors of books and articles on pharmacology and medication therapy
 Education
• Today’s clinical pharmacists complete 6–8 years of undergraduate and
professional education leading to the doctor of pharmacy (Pharm.D.) degree,
including 2–3 years of coursework that emphasizes pharmacology and the
clinical assessment, monitoring, and treatment of disease; and 1–2 years in
supervised, direct patient care settings, where, as members of the health care
team, they engage in the assessment, treatment, monitoring, and teaching of
patients.
• They also complete 1–2 years of accredited postgraduate residency training as
licensed clinical practitioners, where they work in team- based settings under the
guidance of expert practitioners in clinical pharmacy and other health disciplines.
• Clinical pharmacists achieve board certification in their area(s) of specialization
and maintain competence through recertification, mandatory continuing
education, and self-directed continuous professional development.
 Accountability
• As accountable members of the health care team, clinical pharmacists establish
and maintain written collaborative practice agreements with individual
physicians, medical groups, or health systems and/ or practice under formally
granted clinical privileges from the medical staff or credentialing system of the
organization in which they practice.
• These agreements, together with state pharmacy practice acts, confer specific
authorities, responsibilities, and accountabilities to the clinical pharmacist.
• Clinical pharmacists are committed to promoting quality care that improves
patients’ health outcomes.
• This is accomplished by leading and participating in health care
organizations, conducting research, disseminating research findings, and
applying these findings to clinical practice.
 Responsibility
• Clinical pharmacists have a covenantal, “ fiducial ” relationship with their
patients.
• This relationship relies on the trust placed in the clinical pharmacist by the
patient and the commitment of the clinical pharmacist to act in the best
interests of individual patients and patient populations.
• Clinical pharmacists exhibit the traits of professionalism: responsibility,
commitment to excellence, respect for others, honesty and integrity, and care
and compassion.
• They subscribe to the pharmacy profession’s code of ethics and adhere to all
pharmacist-related legal and ethical standards.
• Clinical pharmacists also assume responsibility for advancing their discipline
through involvement in professional societies and participation in health
policy at local, state, national, and international levels.
THANK YOU