Effective communication between physician and pharmacist.

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Effective communication between physician and pharmacist.

  1. 1. EFFECTIVE COMMUNICATION BETWEEN PHYSICIAN AND PHARMACIST by, Dr. G Praveen Kumar Assistant Professor, Department of Pharmacy practice, C.L. Baid Metha College of Pharmacy. Incharge-Drug Information Centre & Patient Counseling, VHS(voluntary health care) hospital, Adayar, Chennai
  2. 2. PHARMACIST ADMIN PHYSICIANS PATIENTS • Chemists or druggists, • healthcare professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use. • The role of the pharmacist is "lick, stick, and pour" dispensary • "lick & stick the labels, count the pills & pour liquids" NATIONAL GUIDELINES
  3. 3. PHYSICIAN ADMIN PARAMEDICS • • • • • • • Examine Diagnose Treat Prescribe Dispense (sometimes) Counsel Follow up PATIENTS MONITORING TEAM WARD ROUNDS GOVERNING BOARDS
  4. 4. PYHSICIAN & PHARMACIST RELATIONSHIP
  5. 5. Pharmacist • Looks special but actually not
  6. 6. Physician LOOKS SIMPLE BUT SPECIAL (SPECIALITY)
  7. 7. DEVELOPMENT OF PROFESSION Physicians • MBBS • MD • DM Pharmacist • D.Pharm • B.Pharm/M.Pharm • Pharm.D
  8. 8. • Clinical pharmacists work directly with doctors, other health professionals, and patients to ensure that the medications prescribed for patients contribute to the best possible health outcomes.
  9. 9. Roles of a clinical pharmacist • Assess the status of the patient’s health problems and determine whether the prescribed medications are optimally meeting the patient’s needs and goals of care. • Evaluate the appropriateness and effectiveness of the patient’s medications. • Recognize untreated health problems that could be improved or resolved with appropriate medication therapy. • Follow the patient’s progress to determine the effects of the patient’s medications on his or her health.
  10. 10. • Consult with the patient’s doctors and other health care providers in selecting the medication therapy that best meets the patient’s needs and contributes effectively to the overall therapy goals. • Advise the patient on how to best take his or her medications. • Support the health care team’s efforts to educate the patient on other important steps to improve or maintain health, such as exercise, diet, and preventive steps like immunization.
  11. 11. But still the fight never got over……….
  12. 12. Mode of communication?
  13. 13. Prescribing Guidelines • Part 1: The process of rational treatment • Part 2: Selecting your P-drugs • Part 3: Treating your patients • Part 4: Keeping up-to-date
  14. 14. Part 1: The process of rational treatment • Step 1: Define the patient's problem • Step 2: Specify the therapeutic objective • Step 3: • Step 4: • Step 5: • Step 6: (What do you want to achieve with the treatment? ) Verify the suitability of your Ptreatment Check effectiveness and safety Start the treatment Give information, instructions and warnings Monitor (and stop?) treatment
  15. 15. Part 2: Selecting your P-drugs i Define the diagnosis (pathophysiology) ii Specify the therapeutic objective iii Make an inventory of effective groups iv Choose a group according to criteria efficacy safety suitability cost Group 1 Group 2 Group 3 v Choose a P-drug efficacy safety suitability cost Drug 1 Drug 2 Drug 3 Conclusion: Active substance, dosage form, Standard dosage schedule, Standard duration.
  16. 16. Part 3: Treating your patients
  17. 17. Part 4: Keeping up-to-date “Knowledge is of two kinds. We know a subject ourselves, or we know where we can find information upon it.” -Samuel Johnson (1709-1784) Martindale’s The Extra Pharmacopoeia is an excellent reference book with detailed drug information on most active substances and chemicals. Avery’s Drug Treatment is a more specialized book, appropriate for prescribers with a special interest in clinical pharmacology.
  18. 18. Pharmacist contribution? • Prescription audit/monitoring • Drug information • Patient counselling
  19. 19. Prescription audit…. • Medication errors • Almost everyone in the modern world takes medication at one time or another • Most of the time medications are beneficial • But some occasion they do harmful effects (side effects) which is adverse drug events • But sometimes the harm is caused by an error in prescribing or dispensing or administration of medication
  20. 20. Types - Responsibilities • PRISCRIBING ERRORS - physicians • TRANSCRIBING ERRORS – pharmacist/nurses • DISPENSING ERRORS – pharmacist/ physicians • ADMINISTRATION ERRORS – nurses/patients
  21. 21. Parts of prescription • • • • • Name, address, telephone of prescriber Date Drugs Name/I.D no., age & gender of patient Signature or initials of prescriber
  22. 22. Legibility • Poor Physician handwriting
  23. 23. Drugs with similar names Chlorpromazine - Chlorpheniramine Carbamazepine - Carbimazole Clotrimazole - Co-trimaxazole Cetirizine - Cinnarizine Mebendazole - Metronidazole Betadine - Betnovate Doctors are legally obliged to write clearly Tab.Dimol & Tab.Divalin Tab.Amoxil & Tab.Daonil (REF: WHO prescriber guidelines page 67)
  24. 24. Drug name and dosage form • Brands differ as same as the sarees brands – Especially in India • Use only generic names in the Prescription • Use brands only if needed…
  25. 25. Dosage forms • • • • • • • • • Tablet Capsule Injection Nebulizer Infusion Eye Drops Ear Drops Nasal Drops Transdermal Patches
  26. 26. Abbreviations CFX NFX NFR MF CIPROFLAOXACIN NORFLOXACIN NIFEDIPINE RETARD METFORMIN MMF MYCOPHENOLATE MOFETIL CAT CCT CALCIUM COMMON COLD CCM CALCIUM CITRATE MALEATE CPZ CBZ ABZ CTZ DF DCF DEC GM CM ANT AST SBT SMT CHLORPROMAZINE CARBAMAZEPINE ALBENTAZOLE CETRIZINE DERIPHYLLIN DICLOFENAC DIETHYLCARBAZINE GENTAMYCIN CHLORAMPHENICOL ANTACID ATORVASTATIN SALBUTAMOL SALMETROL
  27. 27. Dosage strength and frequency • ng/mg/µg • OD/BD/1/2tablets • Half tablet/capaules – Entricoated/sustained release • Decimals – O.5/.5 – 150/1.50 • Duration – 3 === days/weeks – antibiotics Never use unofficial abbreviations – or invent your own abbreviations – it is not safe to do so.
  28. 28. Prescription audit/monitoring • • • • • • Legibility Use generic names only Mention the full details of every drug Avoid unofficial abbreviations Avoid “Repeat all” Avoid “Double dosing”
  29. 29. Drug information services
  30. 30. • “The Drug Information Centre is a service offered through Pharmacy department which provides advice and act as a referral service by directing the best available resource to respond to query or concern.”
  31. 31. What kind of information? 1. New Drug or its Product Information/ Identification 2. Availability 3. Contraindications/Safety 4. Adverse Drug Reactions/Drug Interactions 5. Efficacy/Treatment/Choice of drug 6. Pregnancy/Lactation/Pediatrics 7. Drug Profile/Indications/Dosage/ Pharmacokinetic information 8. Toxicology 9. Counselling information
  32. 32. Resources…. • Primary resources: Research papers/Journal • • • • • Micromedex FDA website Medscape • webMD Drugs.com(d rug interaction checker) • Who guidelines • • EBSCO journal services articles/Case reports. Secondary resource: abstracts, review articles, indexing services such as DRUGDEX, Drug Information Database and abstracting MEDLINE, MICROMEDIX, etc… Tertiary resources: Text books on various aspects of drug use & practical guidelines.
  33. 33. Patient counselling
  34. 34. “It is the physicians or pharmacist’s responsibility to ensure the patient receives the required information for the quality use of medicine. Counselling implies the communication of information that would encourage therapeutic outcome” You can organize a patient counseling Event – to develop professional practice skills.
  35. 35. • Hypertension Dietary changes – Reduce sodium, Reduce alcohol, Eat more fruits and vegetables Regular aerobic exercise – Walking, running Weight loss – Eat less • Diabetes – Less Carbohydrate, Fat and more fiber food Physical activity – Walking, cycling No smoking, Alcohol intake Sulfonyl ureas – Glibenclamide 15-30 mts before food others taken with meal
  36. 36. Storage of medicines • Proper storage of medication ensures efficacy, stability and safety. • Room temperature - 15⁰C - 30⁰C • Cool – 8⁰C - 25⁰C • Cold - 2⁰C - 8⁰C • Warm - 30⁰C - 40⁰C • Excessive heat – Any temp. above 40⁰C
  37. 37. Potency & Temperature for storage of Vaccines Vaccine Temperature Potency maintained for Oral Polio (OPV) -20⁰C 4⁰C to 8⁰C 1 Year 3 months Bacillus Calmette Guerine (BCG) Diphtheria, Pertusis, Tetanus (DPT) 4⁰C to 8⁰C 1 Year 4⁰C to 8⁰C 2 Years Measles 0⁰C to 2⁰C 2 Years Typhoid (TAB) 4⁰C to 8⁰C 8 months Tetanus toxoid (TT) Hepatitis B 4⁰C to 8⁰C 4 Years
  38. 38. Patient information leaflets
  39. 39. How to overcome the barrier?
  40. 40. PHARMACY AND THERAPEUTIC COMMITEE THE PHARMACY AND THERAPEUTICS COMMITTEE IS A POLICY FAMING AND RECOMMENDING BODY TO THE MEDICAL STAFF AND THE ADMINSTRATION OF HOSPITAL ON MATTERS RELATED TO THERAPEUTIC USE OF DRUGS.
  41. 41. HOSPITAL FORMULARY • Hospital Formulary is a continually revised compilation of pharmaceuticals including important ancillary information that reflects the current clinical judgment of the medical staff.
  42. 42. Contents… • Introductory information- Acknowledgement, List of abbreviations, Intended usage of the formulary manual • Basic information of the drug – Generic name, – dosage form, – strength – Indications – Pharmacological action – Precautions – Side effects – Dosage – form, – frequency Instructions – Drug interactions
  43. 43. • Supplementary information on each drug – Price – Regulatory category – Storage guidelines – Patient counselling information – Brand names • Formulas for various diagnostic stains, diagnostic aids • Table of common Lab-values
  44. 44. Size of the formulary • It is sufficiently small in size so that it could be easily carried by clinicians, nurses etc, in the pockets of their uniform or lab coats. • The hospitals may determine their own size of the formulary.
  45. 45. • Join together to create a better therapeutic outcome.
  46. 46. • For queries contact: DRUG & POISON INFORMATION CENTRE Department of Pharmacy Practice C.L. Baid Metha College of Pharmacy • www.clbaidmethacollege.com Go-to “DIC Request Form”
  47. 47. Aware…. Stay Tuned to the Developing Technology.
  48. 48. We TREAT And Let “GOD” Heals...
  49. 49. For details mail to : praveen.pharmd@gmail.com. Thanks To the Almighty GOD (Jesus Christ) & to all….

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