Injibara Health Science and Business College

of Department Pharmacy

Pharmacy Practice I for 4th year pharmacy

students

By: Gizachew A.(B.Pharm)

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 Course contents
• Introduction to pharmacy practice
•Community pharmacy 
•Hospital pharmacy 
•Other areas of pharmacy practice 

• Pharmacy health education

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 Introduction
 Pharmacy is the health profession
– that links the health science with the chemical science
and
– it is charged with ensuring the safe and effective use of
medicines
 Pharmacists are health care professionals who use their
expertise in medicine to help people understand
– what the medications they are taking,
– how they will help, and how they will react

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 Pharmacy Practice
 Pharmacy Practice is the discipline within Pharmacy that
involves developing the professional roles of the pharmacist.
 Pharmacy Practice is vital, since it facilitates and enables
pharmacists to fully exploit their substantial knowledge and
expertise in areas such as pharmacology, pharmaceutics, and
therapeutics within a clinical context.
 It can also be described as application of the knowledge and
skill to actual patient care
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 Pharmacy Practice Aim
 The practice of pharmacy aimed at providing and promoting
the best use of drugs and other health care services and
products, by patients and members of the public.
 The application of unique knowledge and skills of the
pharmacist to improve the health of the people
 It requires that the welfare of the patient is the pharmacist's
prime concern at all times.

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Evolution of professional pharmacy practice
Ancient era (beginning to 1600)
 Use leaves, mud and cool water

 Were priests, pharmacists and physicians

After the fall of roman empire were division of pharmacy

and medicine; three major advances in this era
1. Formulary- documentation of knowledge

2. Dosage form of drugs

3. Pharmacy shops ( in baghdad AD 762) 6

Empiric (experience) era (1600 to 1940)
 Pharmacopeias were regulatory tool for pharmacists

 Hospitals started- Benjamin frankline hospital 1751

 In 1821- the Philadelphia college of pharmacy was founded

Industrialization era (1940 to 1970)

• 1950s- large scale manufacturing of medicinal products by the
pharmaceutical industry
• Introduction of prescription only legal status for most therapeutic
agents
• Limited the role of pharmacists to compounding, dispensing and
labeling of fabricated products 7
Patient care era (1970 to present)
• A more patient-oriented practice and

• Developed the concept of clinical pharmacy

• This marked the beginning of a period of rapid transition

Characterized by
• An expansion and integration of professional functions
• Increased professional diversity and

• Closer interaction with physicians and other health care

professionals
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• By the early 1990s the Pharmaceutical care model was adopted

• The model emphasize that the role of the pharmacist involves

“The responsible provision of drug therapy for the purpose of

achieving definite outcomes that improve or maintain a patient's
quality of life.“
The future pharmacy
 Research in the era of biotechnology

 Recombinant DNA technology

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• Pharmacists are currently recognized as drug experts
• Whose role is to work in collaboration with
• Patients
• Physicians and
• Other health care professionals
 To optimize medication management to produce
positive health outcomes

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 The Pharmacy Profession
Is pharmacy a true profession? Yes
• Because it assists the public and individuals make the best
usage of medications and fulfils the basic feature of a
profession.
 Characteristics of Profession:
– Specializing in knowledge
• Rigorous training and schooling, problem-solving skills

– Providing essential services to the society

– High degree of self-control of behavior
– Codes, oaths, commitment statements, etc
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 The Pharmacy Profession

 Medicinal therapy is the most frequently used form of

treatment intervention in any health practice setting.
Its use has grown dramatically as the population has
aged, the prevalence of chronic disease has increased,
new infectious diseases have emerged and the range of
effective medications has broadened.

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 The Pharmacy Profession

 The physician prescribed and the pharmacist dispensed.

 However, there is substantial evidence to show that the traditional

method of prescribing and dispensing medication is no longer
appropriate to ensure safety, effectiveness and adherence to drug
therapy.
The consequences of medicine-related errors are costly in
terms of hospitalizations, physician visits, laboratory tests
and remedial therapy.
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 Clinical Pharmacy

 Clinical pharmacy is defined as that area of pharmacy concerned

with the science and practice of rational medication use.
– It is all those services provided by a pharmacist in an attempt to promote rational
drug therapy

 It includes all the services performed by pharmacists practising

in hospitals, community pharmacies, nursing homes, home-based
care services, clinics and any other setting where medicines are
prescribed and used.
 The term “clinical” does not necessarily imply an activity
implemented in a hospital setting.
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 How Does Clinical Pharmacy Differ
From Pharmacy?
 The discipline of pharmacy embraces the knowledge on synthesis,
chemistry and preparation of drugs

 Clinical pharmacy is more oriented to the analysis of population needs

with regards to medicines, ways of administration, patterns of use and
drugs effects on the patients.

 The focus of attention moves from the drug to the single patient or
population receiving drugs.
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 Goal Of Clinical Pharmacy

 To promote the correct and appropriate use of medicinal products

and devices.
 These activities aim at:

– Maximising the clinical effect of medicines

– Minimising the risk of treatment-induced adverse events

– Minimising the expenditures for pharmacological treatments.

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Clinical Pharmacy Requirements

Knowledge of Knowledge
nondrug of
therapy drug therapy

Therapeutic Knowledge
planning of
skills the disease
Patient
Drug care Knowledge of
laboratory
Information and diagnostic
Skills skills

Physical Communica
assessment
Patient
tion
skills skills
monitoring
skills 17
 Clinical Pharmacists

 Clinical pharmacists are practitioners who provide comprehensive

medication management and related care for patients in all health care
settings.
 They are licensed pharmacists with specialized advanced education and
training who possess the clinical competencies necessary to practice in
team-based, direct patient care environments.
 Participate as members of the health care team to provide high-quality,
coordinated, patient-centered care to ensure that individuals and
populations achieve the best possible outcomes from their medications.

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 Clinical Pharmacists

 Assess medication-related needs, evaluate medication therapy,

develop and implement plans of care, and provide follow-up
evaluation and medication monitoring in collaboration with other
members of the health care team.
• Interpret diagnostic and laboratory tests, identify the most
appropriate drug and nondrug therapies, and teach patients and
caregivers about medications and how to use them.

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 Clinical Pharmacists

 Work directly with doctors, other health care professionals, and

patients to ensure that the medications prescribed for patients
contribute to the best possible health outcomes as follows:-

• With physicians
• attend ward rounds and clinical meetings as a
member of the healthcare team.
• consults 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.

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 Clinical Pharmacists
• acts as an Auditor on physicians' prescribing habits
• Facilitates physician’s decision making
• developing & updating formularies, updating clinical
guidelines and conducting Pharmacoeconomic studies)

• With Nurses
• Provide nursing staff with adequate information about,
Medications and their therapeutic use, method of
administration, potential adverse effects, and different dosage.
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 Clinical Pharmacists
• With patients
• Provide direct patient care to the greatest extent possible in
both inpatient and outpatient settings.
• Are responsible for continuity of care for patients’
medication therapy, Pharmacists and pharmacy departments
should take a leadership role in developing and
implementing policies and procedures for admissions,
discharges, and transfers so that patients’ medication therapy
is well managed regardless of patient transitions across care
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settings
 Clinical Pharmacists
 Clinical pharmacist is a primary source of scientifically
valid information and advice on the best use of medications
emphasizes that the clinical pharmacist serves as an
objective, evidence-based source of therapeutic information
and recommendations at three different levels:-
 Before the prescribing process,
 During the prescribing process
 After the prescribing process
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 Clinical Pharmacists

1. Before the prescribing process

Development of prescribing policies and treatment
guidelines, Medication formularies
Provide medication information
Involved in clinical trials at different levels

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 Clinical Pharmacists
2. During the prescribing process

Influence the attitudes and priorities of prescribers in

their choice of correct treatments.
Monitors, detects and prevents medication related
problems.
The clinical pharmacist pays special attention to the
dosage of drugs which need therapeutic monitoring.

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 Clinical Pharmacists

3. After the prescribing process

Preparation of personalized formulation

Communicating and counseling patients.

Monitoring treatment response, check and improve
patients' compliance with their medications.
Medication use evaluation

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 Clinical Pharmacists
 Involved in all aspects of drug therapy to:

– ensure appropriate, safe, cost-effective care

– ensure problems requiring drug therapy are treated
– check appropriateness of medication

– check dose, dosage form, administration technique

– monitor effects of medication
• laboratory results

• patient-specific parameters

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 Activities of Clinical Pharmacists

The principle activities of a clinical pharmacist

include:
 Consulting: Analysing 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.
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 Activities of Clinical Pharmacists

 Drug information: Seeking information and critically

evaluating scientific literature; organising information services
for both the health care practitioners and the patients.
 Medication Review :Review medication chart, Review
medication history
 Attending Rounds
 Drug use studies and research
 Clinical trials
 Pharmacokinetics/ therapeutic drug monitoring:
Studying the kinetics of drugs and optimising the dosage.
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 Clinical Pharmacist Job description

1. In-Patient Care
2. Out-Patient Care

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 In Patient Care (Ward Pharmacist)

 Responsibilities of ward pharmacist

 Must be involved in medical rounds with the other health care
professionals and participates in developing a pharmaceutical care
plan
 Collecting and organizing patient-specific information
• Assures the Medication of choice for a particular patient
condition is ordered& Selects medication products that are
effective are cost-beneficial, and promote patient compliance.
• Determines Medication therapy compliance with protocols,
guidelines, or recommendations.
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 In Patient Care (Ward Pharmacist)

• Assures there are no contraindications for selected medication

products (e.g., allergy, history of severe adverse reaction).

• Recommends medication discontinuation or dosage alteration

when indicated.

• Identifies potentially significant drug- drug, drug-food, and

drug–disease interactions

• Obtains and uses clinical laboratory data to evaluate

appropriateness of Medication product selection and/or dosing
regimen. 32
 In Patient Care (Ward Pharmacist)

• Provides and evaluates Medication therapy orders for

appropriateness of dosage, route, interval, and duration
throughout patient's hospital course.
 Determining the presence of medication-therapy problems

 Summarizing patients’ health care needs.

 Specifying pharmacotherapeutic goals.

 Developing a pharmacotherapeutic regimen and corresponding

monitoring plan in collaboration with the patient and other health
professionals.
 Initiating the pharmacotherapeutic regimen. 33
 In Patient Care (Ward Pharmacist)

 Monitoring the effects of the pharmacotherapeutic regimen.

 Documenting pharmaceutical care plan on a specially designed

record.
 Answering Medication information queries to physicians &
other health professionals.
 Patient education and counseling.

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 In Patient Care (Ward Pharmacist)
 Providing in-service education for Pharmacy students ,intern
pharmacists, pharmacy staff ,pharmacy technicians and other
health professionals.
 Patient education and counseling.
– Verify that patients have sufficient understanding,
knowledge, and skill to follow their
pharmacotherapeutic regimens and monitoring plans.
– Provide information orally and use visual aids or
demonstrations to fill patients’ gaps in knowledge and
understanding.
– Document education and counseling on a specially
designed counseling record.
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 Outpatient care
 Clinical pharmacists working in outpatient clinics especially
that provide direct care to high-risk patients, including those
with severe diabetes, those on anticoagulants, renal
impairment and others.
 Responsibilities
• Medication reconciliation
• Monitor patients according to key indicators
• Adjust medication doses as necessary,
• Improve patient compliance
• Report medication errors
• Educate patients and providers about managing these conditions.
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 Clinical Pharmacy Practice Areas

• Ambulatory care • Nephrology

• Critical care • Obstetrics and gynecology
• Drug Information • Pulmonary disease
• Geriatrics and long –term care • Psychiatry
• Internal medicine and • Rheumatology
subspecialties • Nutrition
• Cardiology
• Pediatrics
• Endocrinology
• • Pharmacokinetics
Gastroenterology
• Infectious disease • Surgery
• Neurology

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 Pharmaceutical Care
 Pharmaceutical care is the direct, responsible provision of
medication-related care for the purpose of achieving definite
outcomes that improve a patient’s quality of life.
– A patient-centered, outcomes oriented pharmacy practice
– that requires the pharmacist to work in concert with the patient and the other
healthcare providers
 Those outcomes are:
1. cure of a disease;
2. elimination or reduction of symptoms;
3. arresting or slowing a disease process;
4. prevention of disease;
5. desired alterations in physiological processes, all with
minimum risk to patients.

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 Reading assignment

Development of pharmaceutical sector in

Ethiopia

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Thank you!!!

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