Clinical Pharmacy

Role of clinical Pharmacologist/Pharmacist 

Dr.Ajay Chandra

1)Prescription audit:

Audit of prescriptions in the ward patients will give a clear picture of rationality in prescription writing and if possible in the outpatient department for the better patient care.

 2)Medication history interview:

 Interview regarding the medication which patients are supposes to take "right drug at right time in right dose". This will increase the medication compliance and better patient care.

 3)Patient counseling:

Patient counseling is the sympathetic relation of pharmacist with patients while taking medicaments. The patient counseling has four phases viz. opening of session, interacting session, advising session, closing of session.

 4)Drug-drug interaction(DI):  

 DI is the interaction of two drugs when a patient is taking two or more drugs. This practice also considered as poly pharmacy.  The DI is of two types mainly Pharmacokinetic DI and Pharmacodynamic DI. Drug can also interact with food and herbs which cause various life-threatening effects. Hence we have to assess the prescription in DI severity at least with major drug interaction which is harming the 4% of total inpatient and also increase the cost of treatment. According to WHO A clinical Pharmacologist has a crucial role in preventing such DI.

Eg. Clopidogrel with PPI decrease the efficacy of clopidogrel.

 5)Adverse drug reaction monitoring:

The adverse drug reaction is obnoxious, unintended effect of drug at the specific therapeutic drug concentration. Sometimes it is very serious that we have to monitor. In post marketing surveillance the ADR monitoring in ongoing process of drug especially new drug. Eg. The reporting of Steven John’s syndrome with cephalosporins.

 6)Therapeutic drug monitoring:

The therapeutic drug monitoring is team work in which the pharmacist has process to assess for the narrow therapeutic index drug.When it is require and necessary.

eg. For Valporic acid, carbamezepine, methotrexate, Lithium carbonate.

 7)Pharmacoecnomics:

Pharmacoeconomic where we can educate the health care team about the cost effective treatment for better health related quality of life in treating the patient.

 8)Dose  adjustment

Dose adjustment in the specific group of patients is necessary. Special care should be taken to those patients who are hepatic failure and renal failure.

 9) Health awareness program /Medical camp:

Conducting of health related program in community to educate the patient       about disease as well as drug.

10) Drug information centre(DIC)

  The drug information centre has to provide the information of drug related information to the health care professionals and patients whenever required. The DIC bear all the source of information like primary source, secondary source, and tertiary source.

11)Community services and community patient education

    The community pharmacy services like counseling patients about drug administration and its effect is also an important part of our duty .Also to educate the patient about disease.

12)Pharmacovigilance

  Pharmacovigilance (PV) is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem.

Others

1. In patient: To check the drug flow in satellite pharmacy and to minimize the irregularities.
2. In inpatients those who is consumes more than eight drugs in such patient we would like to include a PHARMACIST ASSESSMENT FORM  to check the severity of drug interaction and patient counseling as pilot work
3. Hospital formulary: To complete the hospital formulary and keep this updated.
4. Home care services: With the reference of patient data base we give the home delivery system and also screening bar intervening the chronic patient
5. Chain pharmacy: We conduct pilot survey of patient around his/her residential area and establish several pharmacies within Kathmandu valley and outside valley where patient do not have any difficulty to approach the nearest pharmacy and services of our hospital.

Responsibilities of clinical pharmacist

Pharmacists are active members of the patient care team, responsible for overseeing the optimal, safe and cost effective medication therapy management using evidenced-based medicine to improve overall patient care in all patients:

• Each inpatient unit has a pharmacist dedicated to performing patient care activities each day
• Pharmacists participate and maintain a significant role in multidisciplinary patient care rounds
• Pharmacists are involved in all processes of care - including product selection, dosing, route selection, regimen review, ensuring safe medication administration, monitoring for desired therapeutic outcomes, identifying and avoiding medication errors and adverse drug events, etc.
• Pharmacists review all non-emergent medications orders prior to the first dose being administered to a patient
• Pharmacists include appropriate indications for each patient medication order during the order entry/transcription process to eliminate nursing and physician confusion regarding the use of the medication
• Pharmacists clarify all vague medication orders with the prescriber in an effort to facilitate safe and effective administration of patient medications  
• A pharmacist interviews all patients upon admission to the hospital to obtain a complete list of the patient's home medications and to make sure the medications are properly continued throughout their hospital stay
• A pharmacist is also involved in the education of patients about new medications and in the education of all patients about their discharge medications.

Dr. Ajay Chandra

Clinical Pharmacologist

Norvic International Hospital, Thapathali

Kathmandu, Nepal