HOSPIPHAR LEC CLINICAL PHARMACY
Health-system pharmacy pioneers were advocating that pharmacists go to patient care areas and create a clinical role (e.g. rounds)
1970s-1980s
1950s
ACCP and ASHP
Pharmacists in health-system settings were creating many new clinical roles Pharmacy organizations creating policies and activities to enhance the clinical skills of their members encouraged the colleges and schools of pharmacy to train their students to become clinicians
American Society of Health-System Pharmacists (ASHP)
“Directions for Clinical Practice in Pharmacy” Hilton Head Island, South Carolina American Society of Health-System Pharmacists (ASHP)
Clinical Pharmacy “The area of pharmacy concerned with the sciences and practice of rational medication use.” “The concept of a PATIENTORIENTED RATHER THAN A PRODUCT-ORIENTED PHARMACY PARACTITIONER.” Clinical Pharmacists “Provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.” Focus 1. The discipline of clinical pharmacy 2. The clinical pharmacist 3. The roles of the clinical pharmacist
”Medication use in hospitals and health-systems is a prominent therapy for virtually all patients, and it is inherently complex and dangerous.”
Joint Commission of Pharmacy Practitioners (JCCP)
American College of Clinical Pharmacy (ACCP)
Vision
1985
Described competencies and training necessary to provide clinical pharmacy services Vision will increasingly Pharmacists become board certified if they provide direct patient care in specialty areas
Vision for pharmacy practice in 2015 “Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes. This will occur because pharmacists will have the authority and autonomy to manage medication therapy and will be accountable for patients’ therapeutic outcomes.”
Ultimate goal of Clinical Pharmacy
“Every patient who needs the clinical drug knowledge and skill of the pharmacist does in fact receive the services.”
Hepler and Strand
Pharmaceutical Care ”Responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.”
Lacorte, Aries S. 3D-PH | PHAR 5
identification and management of drugrelated problems
FOCUS 1: DISCIPLINE OF CLINICAL PHARMACY Evidence-Based Process
Evidence-based care decisions that Health incorporate the best evidence currently available in the scientific literature and systematic study of what works best in patient population
FOCUS 2: THE CLINICAL PHARMACIST Clinical Pharmacist
American Pharmacists Association (APhA)
Pharmacists should be directly involved in developing, evaluating, and implementing clinical guidelines for diseases Clinical guidelines should be developed using interprofessional approaches and be built on the best scientific data that is evaluated regularly to ensure the guidelines reflect current practice standards
A highly educated and well-trained individual, with specialized knowledge and experience, who contributes to the outcomes of patients by using this knowledge to enhance drug therapy Must be dedicated to life-long learning to ensure their value to the interprofessional health care team
Clinical Pharmacist Competencies (ACCP)
ASHP’s 2015 Initiative
By 2015, pharmacists in 90% of hospitals “will be actively involved in providing care to individual patients that is based on evidence, such as the use of quality drug information resources, published clinical studies or guidelines, and expert consensus advice.”
Therapeutic Problem Solving Processes
SOAP
Subjective findings Objective findings Assessment Plan FARM Findings Assessment Recommendations Monitoring Clinical Pharmacist Recommendation (CPR) Developed for use by clinical pharmacists and be able to compare clinical pharmacy intervention trials Pharmacists’ Management of Drug -Related Problems (PMDRP) Designed to reduce variation in monitoring forms and to focus more specifically on the
Education, Training, and Credentials
Doctor of Pharmacy Degree that provides more clinical education Residency Serves as a bridge between education and practice.
Lacorte, Aries S. 3D-PH | PHAR 5
Postgraduate Year 1 (PGY 1) Residency General in nature Designed to expose the resident to variety of practice areas Instructional emphasis is on the progressive development of clinical judgment under the guidance of model practitioners PGY 1 resident: beyond Grow entry-level competence in direct patient care and in pharmacy operational service Develop leadership skills to apply in any position in any setting Acquire competencies in “managing and improving” medication-use process Provides evidencebased, patientcentered medication therapy management with interprofessional teams Exercise leadership and practice management skills Demonstrate project management skills Provide medication and practicerelated education/training medical Utilize informatics
Postgraduate Year 2 (PGY 2) Residency More specialized in nature Completion lead to preparation for board certification PGY 2 resident: Manage medication therapy of specialty patients Develop accountability practice patterns, skills, habits, and expert knowledge, skills, attitudes, and abilities in the respective advanced area of pharmacy practice
Board Certification Process by which a clinician specialist may be recognized as possessing a high level of knowledge about the specialty Certified by Board of Pharmacy Specialties (BPS) Current specialties Nuclear pharmacy o Nutrition support pharmacy o o Oncology pharmacy Pharmacotherapy o Psychiatric pharmacy o Ambulatory care o Credentials evidence of Documented professional qualifications Include o Academic degrees State licensure o Residency program certificate o of completion o Board certification in a pharmacy specialty Fellowship 1-3 years Research-related experience May contain small portion of associated clinical practice skill development
FOCUS 3: ROLES OF CLINICAL PHARMACIST Bond and Raehl
Evaluated associations of clinical pharmacy services and level of pharmacy staffing with reductions in hospital mortality rates Five (5) clinical pharmacy services associated with reductions in hospital mortality, decreased drug and total cost of care, and reductions in length of stay and medication errors: 1. Drug information 2. Adverse drug reaction management 3. Drug protocol management 4. Participating in medical rounds 5. Admission drug histories
Lacorte, Aries S. 3D-PH | PHAR 5
Elizabeth Flynn and colleagues
Less than a third of patients were automatically counseled by pharmacists when receiving new prescriptions for medications
Designing systems that prevent drugrelated problems at the individual and population level Pharmacists as medication safety officers Developing programs designed to identify and prevent drug problems
Other Clinical Pharmacy Services
ONE OF THE MOST IMPORTANT AREAS FOR
Medication Reconciliation by pharmacists in Provided response to the understanding that medication errors occur too frequently when patients are transferred from one setting to another Education associated with Institutions educating pharmacy students generally provide more clinical pharmacy services than institutions that do not Collaborative Practice Allow pharmacists to control medication therapy of specified patients and diseases in collaboration with one or more prescribers Immunization Administering an injection should NOT be considered a clinical pharmacy service Determining a patient ’s need for an immunization and setting up a tracking and reminder program to ensure that patients are immunized is a clinical service Primary Care Most often done as part of a collaborative practice where access to patient data is easiest Electronic medical records Identifying and resolving drugrelated problems in populationbased care Development and enforcement of guidelines Medication therapy management programs to large groups of patients
CLINICAL PHARMACY SERVICE PROVISION LIES IN IDENTIFYING AND RESOLVING DRUG-RELATED PROBLEMS IN DIRECT PATIENT CARE
Lacorte, Aries S. 3D-PH | PHAR 5
