ROLE OF

CLINICAL
PHARMAC
Y IN
HOSPITAL
S
 CLINICAL PHARMACY
Ø All large acute hospitals have an on-site
pharmacy department .

Ø It ensures that the patients can receive

the right medicine at the right time by an
efficient and economical system.

Ø Application of the pharmaceutical

expertise to help maximize drug efficacy and minimize drug
toxicity.

Ø This concern of pharmacists for the outcome of treatment in an

individual patient, which has developed in the UK
over the last thirty years, characterizes
the practice of clinical pharmacy and
has led to the concept of pharmaceutical care
as the description of the role of the pharmacist
in patient care.
 DEVELOPMENT OF CLINICAL
PHARMACY
§ The late sixties, John Baker based at Westminster Hospital,
introduced the formulary concept and developed the role of the
pharmacist as part of the prescribing system.

§ The revolutionary feature of this

development was the presence of the
pharmacist on the ward.

§ This enabled some pharmacy

practitioners to become an active part of
the clinical team, a practice that is common
place today.

§This lead to huge rise in the profession of

pharmacy and lead to its commercial boom.
§ Clinical pharmacists are ideally placed to influence prescribing by
hospital doctors because they have the appropriate knowledge about
therapeutics and are in regular contact with prescribers.

§ A key feature of the policy is the use of clinical

pharmacists to monitor compliance with the agreed
selection of medicines.

§ These are the development of hospital policies by

which individual pharmacists to improve their skills
of the clinical process.

§The pharmacy profession took a view that they should champion the
formulary approach and clinical pharmacists supported by Drug
Information pharmacists have used them as an educational aid for junior
doctors as part of their training.
 PHARMACEUTICAL CARE
§ The term ‘Pharmaceutical Care’ was coined in
by Heppler and Strand .

§Definit ion:-
The responsible provision of drug therapy for the purpose of
achieving definite outcomes which improve the patient quality of life.

§ It also involves designing, implementing and monitoring a therapeutic

plan that will produce specific therapeutic outcomes for the patient.

§ Responsible for the outcomes of drug therapy,

that is to refocus clinical pharmacy activity from
process to outcomes.

§ The use of the more traditional term of clinical pharmacy was

superseded rapidly by pharmaceutical care.
Ø Clinical pharmacy reflected the participation of the pharmacist in the
clinical team, working with other professionals to improve patient care
and optimize the use of medicines.

ØPharmaceutical care is now a convenient shorthand term that

pharmacists use when describing their practice.

Ø The challenge for pharmacists is to ensure that

people are aware of the service provision that is
involved in delivering pharmaceutical care to patients.

ØSo, this lead to the birth of Pharmaceutical journals

in order to create an awareness about this
profession.
 IMPACT OF
INFOR MATI ON
TECHNO
q Prescriptions review LOGY
is a retrospective check on the prescribed
medication.

q Appropriate electronic prescribing system would enable these checks,

and is performed automatically as the prescription is written.

q The present hand written prescription chart does have many

virtues perhaps we should ensure that any IT solutions retain these
virtues as well as delivering the legibility, integration, education and
control.

q These will be driven by enthusiasts working with limited

resources since the investment required to develop
such a major system is beyond the budgets of most hospitals.
 WHERE ARE WE NOW?
Clinical pharmacy is now firmly established in many hospitals.

Recognition of this diversity of practice has led to the publishing a set

of statements of good clinical pharmacy practice developed by a
multidisciplinary steering group .
Clinical pharmacy can be effective by use of a structured approach to
training , audit and the practice of clinical pharmacy

The framework for practice …‘is based on a systematic approach

intended to assist individual pharmacists prioritize their workload and
focus on those aspects which will optimize their contribution to health
care’.
 Research work on various new aliments are also carried out.

This provides the good scope for dealing out with

the patients and enabling them to prescribe the medicines.

As such the knowledge in both in the fields of

medicine and medicaments is gained.

Technical development and rapid

materializations of sophisticated care
towards the patients has come into practice.
 CHALLENGES TO
PROGRESS
The scene is now set for the consolidation of clinical pharmacy in
secondary care.

Development of a coherent philosophy is underway together with a

coherent model for service provision.

Not least of these is the difficulty of recruitment of

qualified pharmacists in secondary care.

There is a need for the movement of pharmacists between primary and

secondary care to ensure manpower supply does not constrain the
development of clinical pharmacy in secondary care.

This may be achieved by collaborative ventures between pharmacists

in primary and secondary care designed to provide pharmaceutical care
support to general practitioners in primary care
 The quality and scope of research into pharmacy practice in secondary
care must be improved in order to sustain and develop this practice into
every hospital service.

Scope for improvement in links between the

academic units of pharmacy practice and hospital
departments in the area of research.

Collaboration between practicing pharmacists, their clinical colleagues

and academic centers is essential if the underpinning research required
for service development is to be undertaken.

These new research programmers will need to concentrate more on

evaluating the benefits for patients of developments in pharmacy
practice.

Many studies to date have concentrated on the economic benefits of

clinical pharmacy avoiding the challenge of evaluating the impact of
changes on patient outcomes.
 KEY RESEARCH
AREAS
v Clinical pharmacy is concerned with improving
the use of medicines.

v However there is little evidence that it has improved the safe use of
medicines, decreased iatrogenic disease or reduced adverse effects.

v Drug induced illness is a major cause of hospital admissions.

v Participation of clinical pharmacists in

discharge planning and advice to patients
about their medicines could reduce the
incidence of re-admission.

v Research programmes could test such options as involving

pharmacists in the training of pharmacy technicians or nurses to advise
patients about their medicines and to develop criteria which could
identify those patients that would benefit from discussing their
medication with a pharmacist.
 Different professional groups use different techniques when trying to
influence patients about medicines.

The adoption of evidence based best practice could

improve patient outcomes, assuming that taking their
medicine is good for patients.

Good communication by clinical pharmacists with

clinical colleagues is an essential part of their practice

Practice differs between hospitals.

Some hospitals use newsletters extensively

others rarely, and other formularies rigorously others
use a light touch.

New systems need to be evaluated before

their adoption by other hospitals.
CONCLUSION:
-
Evaluation of the different approaches in order to identify the most
appropriate methods would enable hospitals to use the resources of
clinical pharmacy more efficiently.

Service delivery system is far developed than

other mode of services.

The decentralized clinical pharmacy service has its

supporters.

The range of practice is increasing as the

multidisciplinary team approach to patient care is adopted
by more clinical teams.
 Pharmacists have a role both as team members and
as individual practitioners.

The impact of implementation needs to be audited

for health economic benefits and the benefits to
patients.

These challenges form part of a research agenda for

pharmacy practice in secondary care that will be met
by collaboration between pharmacists and other
members of the clinical team.

BUT INORDER TO ACHIEVE ALL THIS WE AS

PHAMACISTS SHOULD MAINTAIN A HEALTHY
LIFESTYLE.
 BY
D.M.SRUJA
&
NA
K.RAMYA

CMR
COLLEGE
OF