b) Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pharmacy Functions and responsibilities of clinical pharmacist, Drug therapy monitoring Medication chart review, clinical review., pharmacist intervention Ward round participation, Medication history and Pharmaceutical care. Dosing pattern and drug therapy based on Pharmacokinetic & disease pattern

1. Clinical Pharmacy
Mr. Ravinandan A P
Asst. Prof.
Department of Pharmacy Practice
Sree Siddaganga College of Pharmacy
Tumkur, Karnataka

2. Presentation Outlines…………………….
1. Introduction to Clinical Pharmacy
2. Concept of clinical pharmacy
3. Functions and responsibilities of clinical pharmacist
4. Drug therapy monitoring
5. Medication chart review
6. Clinical review
7. Pharmacist intervention
8. Ward round participation
9. Medication history
10.Pharmaceutical care.
11.Dosing pattern and drug therapy based on Pharmacokinetic & disease
pattern

3. Introduction to Clinical Pharmacy
• Clinical pharmacy practice is concerned with the promotion of
safe, effective and economical drug therapy.
• Clinical pharmacy is a branch of pharmacy that involves the
provision of patient care with the use of medications to
optimize the health outcomes of patients.
• This includes promoting wellness and preventing disease.
• The practice of clinical pharmacy embraces pharmaceutical
care philosophy.
• Furthermore it combines patient care with specialized
therapeutic knowledge about the use of medications.

4. • Clinical pharmacy is defined as the “services provided
by pharmacist to promote rational drug therapy that is
safe, appropriate and cost effective.”
• Clinical pharmacy is the branch of pharmaceutical science.
• Why clinical pharmacy is required?
• Increased number of pharmaceuticals / drugs in the market
• Increase in patients numbers
• Increase in co-morbidities (presence of more than 2 diseases)
• Increase in the rate of hospitalization (Morbidity)
• Increase in the rate of death (Mortality)
• Complex treatment
• Prescription contain more drug related problems
• Doctors are too busy to explain about the medicines to patients.

5. Concept Of Clinical Pharmacy
• The emergence and need of clinical pharmacy as a form of practice
has been attributed to the poor medicines control systems that
existed in hospitals during the early 1960s
• Although provoked by similar hospital centered problems, the
nature of the professional response differed between the USA and
the UK.
• Medication safety may have been the branch but clinical pharmacy
in the 1980s grew because of its ability to promote cost-effective
medicines used in hospitals.
• Clinical pharmacy thereby emerged from the presence of
pharmacists in these patient areas and their interest in promoting
safer medicines use.

6. Concept Of Clinical Pharmacy
• Clinical pharmacists practice in all health care settings and
utilize in-depth knowledge of medications and disease
states to manage medication therapy as part of a multi
professional team.
• Clinical pharmacists are responsible and accountable for
medication therapy and patient outcomes.
• They are a primary source of scientifically valid information
on the safe, appropriate, and cost-effective use of
medications.
• It encourages pharmacists and support staff to shift their focus
from a just product-oriented role towards more direct
engagement with patients and the problems they encounter
with medicines.

7. Functions and Responsibilities of Clinical
Pharmacist
Compound and dispense
prescription
Conduct medication history
interview
Explain how to use medicines
Explain how to select medicines
for doctors
Monitor drug therapy
Conduct patient education
Conduct patient counselling
Drug information services
Identify, document and
reporting adverse drug reactions
(ADRs)
Prepare treatment guidelines
Involve in education and training
activities
Participate in research activities
Improving medication
adherence
Avoid drug related problems

8. Functions and Responsibilities of Clinical
Pharmacist
• The principle activities of a clinical pharmacist include:
• Consulting: Analyzing therapies, advising health care
practitioners on the correctness of drug therapy and providing
pharmaceutical care to patients both at hospital and at community
level.
• Selection of drugs: Defining "drug formularies" or "limited lists of
drugs" in collaboration with hospital doctors, general practitioners
and decision makers.
• Drug information: Seeking information and critically evaluating
scientific literature; organizing information services for both the
health care practitioners and the patients.

9. • Formulation and preparation: Formulation and preparation of
medicinal products and devices according to acceptable standards
to meet specific patients' needs.
• Drug use studies and research: Drug use studies/
pharmacoepidemiology/ outcome research/
• Pharmacovigilance and vigilance in medicinal devices:
collecting data on drug therapies, their costs and patient outcome
through structured and scientific methods.
• Clinical Trials: Planning, evaluating and participating in clinical
trials.
• Pharmacoeconomic: Using the results of clinical trials and
outcome studies to determine cost- effectiveness evaluations.
• Dispensation & Administration: Dispensing and administration
of medicinal products and devices

10. Drug therapy monitoring
• On the health care team, the pharmacist is the key member who
provides ongoing drug therapy monitoring.
• Pharmacists have the skills and knowledge to perform and
embrace this role.
• Drug therapy monitoring is an ongoing process in which
pharmacists actively review patients’ records, identify and
resolve drug therapy problems such as adverse drug events
(ADEs), and communicate with prescribers when problems
occur.
• Pharmacists educate patients and their caregivers about
potential adverse effects and work with patients to ensure

11. • Drug therapy monitoring should be routine but is not always
done consistently or systematically.
• Medication monitoring is optimized by a team approach that
includes pharmacists.
Following are the three steps of monitoring:
1.Educate patients about their therapy, potential adverse effects,
and actions to take if problems occur. Make patients active
partners in their medication management and their own health
decisions.
2.Regularly assess patients’ drug therapy. Ensure that patients
take their medications as prescribed, proactively identify and
resolve ADEs as they occur, and assess therapeutic
effectiveness. Ensure that appropriate labs are done and
assessed.
3.Adjust drug therapy as needed based on information from the
monitoring process.

12. Medication chart review

13. SAMPLE MEDICATION CHART
This medication chart is just an example. Actual medications used for JM patients can vary significantly.
This example chart is provided by Cure JM Foundation. For more helpful tips & tricks visit www.curejm.org/fsn Contact Cure JM at
info@curejm.org or (760)487-1079.
MEDICATIONS MON
[DATE]
TUES
[DATE]
WED
[DATE]
THURS
[DATE]
FRI
[DATE]
SAT
[DATE]
SUN
[DATE]
AM PM AM PM AM PM AM PM AM PM AM PM AM PM
Orapred
(0.5ml/2x day)
CellCept
(2x day)
Previcid
(1x day at night)
Plaquenil
(1/2 tab, 1x day at night)
Viactiv
(2x day)
Mirilax
(1x per day as needed)
Other
Methotrexate
(Once per WEEK)

14. Medication chart review
• It is a fundamental responsibility of a pharmacist to ensure the
appropriateness of medication orders.
• It serves as starting point for other clinical pharmacy activities
( medication counselling, TDM, Drug information, and ADR).
• Organizing information according to medical problems ( example
disease) helps breakdown a complex situation into its individual
parts.
GOALS
• To optimize the patients drug therapy.
• To prevent or minimize drug related problems/medication errors.

15. Medication chart review- Procedure:
• The patients medical record should be reviewed in pairing
with the medication administration record.
• Recent consultations, treatment plans and daily progress
should be taken into account when determining the
appropriateness of current medication orders and planning
each patient’s care.
• All present and recent medication orders should be reviewed.

16. Components of medication order review
• Checking that medication order is written in accordance with legal
and local requirements.
• Ensuring that the medication order is understandable and
unambiguous, that appropriate terminology is used and that drug
name are not abbreviated. Annotate the chart to provide
clarification as required.
• Detecting orders for medication to which the patient may be
hypersensitive/intolerant.

17. •Ensuring that medication order is
appropriate with respect to:
1. The patient’s previous medication order.
2. Patient’s specific considerations e.g. disease state,
pregnancy.
3. Drug dose and dosage schedule, especially with
respect to age, renal function, liver function.
4. Route, dosage form and method of administration

18. Clinical review
• Clinical review is one of the important components of
medication review and should preferably be performed on a
daily basis.
• It is the review of the patients’ progress for the purpose of
assessing the therapeutic outcome.
• The therapeutic goal for the specific disease should be
clearly identified before the review.

19. GOALS of Clinical Review
The primary aims of the clinical review are to:
1. Assess the response to drug treatment.
2. Evaluate the safety of the treatment regimen.
3. Assess the progress of the disease and the need for any
change in therapy.
4. Assess the need for monitoring, if any.
5. Assess the convenience of therapy(to improve compliance).

20. Pharmacist intervention
• The role of pharmacist has been diversified from dispensing
medications to patient care, patient counselor, health care
educator, and community service to clinical practice
• Interventions by the pharmacists have always been considered
as a valuable input by the health care community in the patient
care process by reducing the medication errors, rationalizing
the therapy and reducing the cost of therapy.
• “Pharmaceutical intervention” as a recommendation initiated
by a pharmacist in response to a drug-related problem in an
individual patient occurring in any phase of the medication
process

21. Objective Need for pharmacist interventions
•
Reduce healthcare utilization and cost
• Provide evidence based information
• Provide what types of pharmacist interventions increase medication adherence,
and reduce healthcare utilization, and by how much
Importance of Pharmacist intervention
• Decreasing health care cost and utilization
• Medication adherence / patient compliance
• Patient education
• Effective communication & establishing patient relationships
• Medication therapy management
• Being a member of a healthcare team

22. Ward round participation
• Ward rounds are the routine clinical rounds where the
healthcare providers visit the patients in the ward to
assess the progress of the health condition of the
inpatients.
• The doctor led ward rounds comprises of the unit of
medicine or any other specialty where in professor,
associate professors, assistant professors, senior
residents, postgraduates and interns along with
pharmacists and nurses observe the patient's condition
and assess to decide further therapeutics for the patients.

24. Goals of the ward round participation
• The goal of the ward round is to closely monitor the
patient's condition and take immediate intervention to
improve the patient condition and avoid death.
• The doctors are visiting all the patients admitted in their
unit in an order beginning from intensive care unit.
• Here also there is documented case reports to remind
the case history of the patients who quickly updates and
is able to change the strategies of treatments.

25. Role of Pharmacist in Ward Round
Participation
• The pharmacist being an expert in the matters of drug should be
available for the ward round team to decide upon the matters of dosage
regimens, formulary interpretations, ADR monitoring, Drug-drug
interactions, Drug-food interactions and drug and poison information
services.
• The availability of pharmaceutical services definitely enhances
accuracy of treatment, patient safety and efficacy.
Objectives of the ward round participation
• The ward team comprises of doctors, nurses and pharmacists who
work in a team with a common objective to ensure safe, effective,
economic and patient friendly treatment with knowledge inputs of each
professional practice.

26. Medication history
• A medication history is a detailed , accurate and complete account
of all prescribed and non-prescribed medications that a patient had
taken or is currently taking prior to a initially institutionalized or
ambulatory care .
• It provides valuable insights in to patient’s allergic tendencies ,
adherence to pharmacological and non-pharmacological treatments
and self medication with complementary and alternative medicines .
• Interviewing a patient in collecting the data medical history is called
medication history interview.

27. • The pharmaceutical care is defined as “The responsible
provision of drug therapy for the purpose of achieving definite
therapeutic outcomes that improve the patients quality of life”
These outcomes are :
• Cure of the disease
• Elimination or reduction of patient`s symptomology
• Arresting or slowing of a disease process
Pharmaceutical Care

28. Basic Elements of Pharmaceutical Care
1. Patient oriented
2. Both acute and chronic problems addressed
3. Stress on prevention of drug related problems
4. Documented system on patients record need and
care.
5. Offering continuous care in systematic way.
6. Taking help of other health care providers in
integrating the care provided.
7. Highly accountable and responsible
8. Emphasis on optimizing patients health quality of life.

29. Function of pharmacist to perform
1. Collection of patient data.
2. Identification of problems.
3. Establishing outcome goals through a good
therapeutic plan
4. Evaluating treatment alternatives, by monitoring and
modifying therapeutic plan.
5. Individualising drug regimens.
6. Monitoring outcomes.

30. Dosing pattern and drug therapy based on
Pharmacokinetic & disease pattern
In this part pharmacist is responsible to record and use
different parameters which are useful in patent care like-
Drug Clearance
Drug Elimination
Volume of Distribution
The Half-Life
Dosing Variations
Oral Availability
Pharmacodynamics
Pharmacogenetics
Saturable Drug Metabolism
Protein Binding
PH and Pharmacokinetics
Dosing and Age
Drugs in Pregnancy
Drug Interactions
Drug Transport

31. Thank
You