Role of Skills for Clinical, Hospital and Community Pharmacist in Pharmaceutical Care
Anantha Naik Nagappa1*, Vinuth Chikkamath2, Vaishnavi Naik2, Alisiya M Thomas2 and Krithi Krishnan L2
1Amity Institute of Pharmacy, Amity University of Madhya Pradesh,India
2Department of Pharmacy Practice, SCS College of Pharmacy, India
Submission: August 29, 2018;Published: October 15, 2018
*Corresponding author: Anantha Naik Nagappa, Amity Institute of Pharmacy, Amity University of Madhya Pradesh, Gwalior, Madhya Pradesh, India
How to cite this article: Anantha Naik N, Vinuth C, Vaishnavi N, Alisiya M T, Krithi K L. Role of Skills for Clinical, Hospital and Community Pharmacist in Pharmaceutical Care. Glob J Pharmaceu Sci. 2018; 6(2): 555684. DOI: 10.19080/GJPPS.2018.06.555684.
Abstract
Due to increased evidence of long term safety issues, the careless use of medication is not only risky but dangerous. It is well established that all the drugs are having potential to cause injuries with long term use. The habits of self-medication are to be replaced by informed selfmedication by qualified pharmacist in the community pharmacy. In hospitals, the contributions of clinical pharmacist and hospital pharmacist, is been found to result into a win-win benefits to all stakeholders like hospitals, individual Doctors, Nurses and Patients. There are in most need to identify important skills and create a conducive atmosphere to develop best pharmacy practice services. In this article, an attempt has been made to highlight the skills for development of delivering pharmaceutical care in clinical, hospital and community settings.
Keywords: Pharmacist; Hospital; Skills; Diagnosing; Nurses; Health care
Introduction
The pharmacists are intermediate professionals linking physicians, Nurses, and other health care professionals.In the system of health care delivery, the emphasis is on equity for all health care providers to identify their domain of services. The doctors are dedicated to diagnosing and prescribe the medicines with consultation of clinical pharmacist. The Nurses are supposed to provide the nursing to the patients and collaborate with the Doctors and Pharmacist in the therapy.Pharmacists and Nurses are engage in the several activities in monitoring the patients’ health condition and documenting the services provided. The pharmacist participates in the health care delivery in three major areas as Clinical services, Hospital services and Community services. In providing such services have to collaborate with the Doctor and Nurse. He has to interact with patients and their attendees to provide health care delivery. The task of health care delivery has to be a team work with integrated communications to achieve excellence in healthcare delivery. In this article, the emergency of pharmaceutical care and its growth in health care delivery is becoming ambiguous across all the services of healthcare delivery[1-3].
i. Skills for Clinical pharmacy services
ii. Skills for Hospital pharmacy services
iii. Skills for Community pharmacy services
Skills for Clinical Pharmacy Services
Clinical Pharmacist is a core member of the clinical team, who is the responsible for attending the inpatients in Hospital. In the general ward the patients who are admitted to medicine, Nephrology, cardiology, skin, pediatrics, orthopedics and other patients for treatments are attended by the clinical pharmacist. Patients are also admitted in an intensive care unit (ICU) and special wards are also attended by clinical pharmacist. The prescription review, dose calculations, drug-drug interactions, drug-food interactions, drug allergy and soap analysis are examined by the qualified clinical pharmacist. Clinical pharmacist shall participate in ward rounds and provide the drug information services to doctors and nurses. They are also expected to take the medication history of the patients with newly admitted to the hospital and also provide discharge medication advice. They are responsible to publish and update the hospital formulary and treatment protocols. He is also coordinator for Drugs and Therapeutics Committee; where in recommendations for inclusion of drugs is decided upon based on the merits, availability and price of the drugs. They should also provide the services of Therapeutic drug monitoring services on demand. These services are to be given as soon as possible, and there should be quality in services, the accuracy of information is going to affect the treatments course, cost, and outcomes of treatment[4,5].
The clinical pharmacist is supposed to deliver quickly the correct information with zero errors as the input affects the outcome of therapy. He should practice regularly the search methodology from the internet and databases. It is very important that he must update the knowledge in a systematic fashion. There are free and paid databases of drug information which need to be understood. The effective communication is a basic requirement along with maintaining brevity in the volume of information. The dose calculations are very important as the doctors are busy in diagnosing and nurses in patient care. The skills of calculating the dose depending on the patient specifications like body weight, height, gender, and age play an important role in customizing the number of drugs to be administered. The checking of drug interaction with drugs and food is a routine activity a clinical pharmacist must carry out.
The prescribing information must be put in the drug information system and shall be getting the information needed. One should be careful of search term as the response depends on the question/search term fed to the database. Drug information services are another responsibility a clinical pharmacist has to provide. Here he should be able to assess who, why and what time the information is to be delivered. If the information request is from an ICU/Emergency ward, it should be answered in priority. The team of health care provider is waiting for the information based on which they are going to take decisions. If the information is from wards, then the information required may not be very immediate, and shall be about dose, disease or any precautions. It may be the duty doctor, nurse or patients. Now-a-days, handheld devices of drug information are available; with these ones can get the information, the process by screening and provide the information. Understanding the nature of the query and providing the optimized information is the skill, a clinical pharmacist should concentrate upon[6].
Therapeutic drug monitoring is a highly important activity that a clinical pharmacist should provide. There are drugs with very narrow therapeutic index and low margin of safety, for such drugs, it becomes all the more important to maintain the blood concentrations well within the boundaries of therapeutic window. For example: Digitalis, Phenytoin and Antibiotics like Gentamycin and mood stabilizers like Lithium carbonate[7].
Skills for Community Pharmacist
Skills for Hospital Pharmacist
![Click here to view Large Figure 1](images/GJPPS.MS.ID.555684.G001.png)
Community Pharmacy is a place where the patients bring the prescriptions written by the doctors for dispensing the medications. The community pharmacist shall be conducting the act of business. The peer competition among community pharmacy can bring the best practices to attract good number of prescriptions. Community pharmacy may be independent or a chain pharmacy. Here the pharmacist has to scrutinize the prescription for Indications and disease conditions, dose appropriateness, drug-drug/food interactions, adverse drug reactions and medication errors. The community pharmacist can maintain the patient profile in the form of Electronic Health Record, update periodically, on demand he may provide the same to doctors. Such services by community pharmacists are going to be appreciated by fellow health care providers and patients and pays back to pharmacy in terms of customers and referrals for the pharmacy. Community pharmacy are also engaged home based services like home medication reviews[9] (Figure 1&2).
![Click here to view Large Figure 2](images/GJPPS.MS.ID.555684.G002.png)
Conclusion
With the increased complexity of disease, drugs and lifestyle, it has become mandatory to view the safety issues and outcome issues of every treatment. The shift from product centric therapy to patient centric therapy has its origins, when patients were not at all satisfied with clinical outcomes. They demanded the quality of life should be better than before therapy and started asking about the value of therapy in terms of money spent on therapy. The patient requirement can only be served if a pharmaceutical care is provided to all therapies. However, in the past, there were no opportunities for the pharmacist to intervene in the therapy as everything in modern medicine was never used to be questioned. The changed scenario of documentation and accountability has exposed the lacunae in existing health care delivery, which got metamorphosed into patient-centric care. Now through the pharmacy practice one can ensure satisfactory therapy. Hence the skills of pharmacy practice are all that important.
A communication skill helps to precise identifications of the patient’s difficulties, the improvement of the level of patient’s engagement and approval with the care, and patient’s loyalty to treatment. Relationship with patients based on adequate communication decreases patient’s anxiety and depression. A patient has his or her own position in the world as a citizen, worker and family member. A disease intimidates such a social background of a patient. One has to realize that patients suffer not only from diseases, but also from psychosocial pain. Such appreciation is the most important basis to improve health communication that creates a worthy relationship with patients.
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