Pharmacy Practice Introduction - 043442

Introduction: Pharmacy Practice
Chapter 1
Course outline
1. Introduction
2. The pharmacist as a health care professional
3. The Community Pharmacy
4. Hospital Pharmacy
5. Other areas of Pharmacy practice
6. Pharmacy health education
Introduction
• Over the past four or five decades, there has been a trend for pharmacy
practice
Moved away from its original focus on medicine supply towards a more
inclusive focus on patient care
oMoved from a compounder and supplier of pharmaceutical products
towards that of a provider of services and information
oUltimately, moved towards a provider of patient care
3
Introduction …
• Increasingly, the pharmacist’s task is to ensure that
oA patient’s drug therapy is appropriately indicated,
oThe most effective, the safest possible, and convenient for the patient
• Pharmacists take direct responsibility for individual patient’s medicine-

related needs
o This enables to uniquely contribute to the outcome of drug therapy and
patient’s QoL
4
Introduction …
• The practice of pharmaceutical care is new
Pharmacists may not adequately document, monitor and review the care
given
oHowever, accepting such responsibility is essential to the practice of
pharmaceutical care
oIn order to fulfill this obligation, the pharmacist needs to be

able to assume many different functions
5
What is pharmaceutical care?
• Pharmaceutical care is a patient-centered practice in which the practitioner
assumes responsibility for a patient's drug-related needs and is held
accountable for this commitment
o Pharmaceutical care practitioners accept responsibility for optimizing all of a patient's drug therapy,
to achieve better patient outcomes and to improve the quality of each patient's life
o This occurs with the patient's cooperation and in coordination with the
patient's other health care providers
6
Pharmaceutical care…
• The practitioner uses a rational decision-making process called the
Pharmacotherapy Workup to
o Make an assessment of the patient's drug-related needs,

o Identify drug therapy problems (DTP),
o Develop a care plan, and
o Conduct follow-up evaluations to ensure that all drug therapies are effective and safe
• Together, these steps are the patient care process
7
• Assess to determine if the following drug-related needs are being met:
• The medication is appropriate …… Unnecessary drug therapy or needs
additional drug therapy?
oThere is a clinical indication for each medication being taken
oAll of the patient's medical conditions that can benefit from drug therapy
have been identified
• The medication is effective…… ineffective drug, dosage too low?
8
oThe most effective drug product is being used
oThe dosage of the medication is sufficient to achieve the goals of therapy
• The medication is safe……ADR, dosage too high?

oThere are no ADRs being experienced
oThere are no signs of toxicity
• The patient is compliant …… noncompliance?

oThe patient is willing and able to take the medications as intended
9
• If all of these criteria are met, then the patient's drug-related needs
are also being met at this time, and no drug therapy problems exist
oIn this case, it is the pharmaceutical care practitioner's responsibility

to do what is necessary in the care plan to ensure that the goals of
therapy for each medical condition continue to be achieved
10
• When the practitioner's assessment reveals that the above criteria are not
met, a DTP exists
• It is then the pharmaceutical care practitioner's responsibility to
o Resolve the DTP with and for the patient

o Assure that the goals of therapy are achieved by developing a care plan for each
medical condition and by conducting follow-up evaluations at appropriate times
o Prevent drug therapy problems whenever possible
11
• Therefore, pharmaceutical care is a professional practice that has evolved from
many years of research and development in the profession of pharmacy
• It is designed to complement existing patient care practices to make drug

therapy more effective and safe
• This practitioner is not intended to replace the physician, the dispensing

pharmacist, or any other healthcare practitioner
oRather, the pharmaceutical care practitioner is a new patient care provider
within the healthcare system
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• The need for this practitioner results from
oMultiple practitioners writing prescriptions for a single patient, often
without coordination and communication;
oThe large number of medications and overwhelming amount of drug

information presently available to patients;
oPatients playing a more active role in the selection and use of
medications;
14
• An increase in the complexity of drug therapy;
• An increase in self-care through alternative and complementary

medicine;
• A high level of drug-related morbidity and mortality which results

in significant human and financial costs
15
• It is expected that the practitioner who will practice pharmaceutical care as a
primary role and full-time career is the pharmacist
• The pharmacist is equipped with a minimum of 5/6 years of academic

preparation that focuses on pharmacology, pharmacotherapy, and
pharmaceutical care practice
16
The Language of Practice
• The ability to use precise language appropriately in practice will directly reflect
upon your level of competency and confidence
• Pharmaceutical care practitioners use the same practice vocabulary as the

other health sciences (medicine, nursing, and dentistry)
o Common meanings facilitate communication between practitioners
• Terms such as assessment, care plan, and follow-up evaluation are used by all
healthcare practitioners in the same way
17
The Language of Practice…
• Since the practitioner focuses his/her attention on the patient's
drug-related needs, it is necessary to introduce terminology not
currently used in medicine and nursing
oThis includes drug therapy problem, medication experience, and
drug-related needs to name just a few
18
The Practitioner and the Patient Form a Practice
• Pharmaceutical care practice includes a qualified practitioner, a
patient in need, and the work that occurs between them
oAll of the work focuses on the patient
oAlthough you will collaborate with the patient's other providers and
care-givers to ensure that he/she receives coordinated care in an
efficient manner, your responsibility is to the patient
19
The Practitioner and the Patient Form a Practice…
 Your primary and unique responsibility on the healthcare team is to
manage all of the patient's pharmacotherapy
Prescription medications, OTC products, herbal remedies, nutritional
supplements, traditional medicines, and any other products the patient
may take for therapeutic purposes
o To treat medical conditions, to prevent illnesses, and to improve the
patient's QoL
20
Pharmacotherapy Workup
A structured, rational thought process for making clinical decisions
The systematic thought process
What makes a practitioner qualified to do his or her work is the application of a

unique knowledge base and set of clinical skills using a systematic thought
process to
o Assess the needs of a patient,
o Identify and resolve problems, and
o Prevent problems from occurring
21
Pharmacotherapy Workup…
• This unique knowledge base is focused on pharmacology, pharmacotherapy,
and pharmaceutical care practice
o The practitioner identifies, resolves, and prevents drug therapy problems
22
Pharmacotherapy Workup…
• The Pharmacotherapy Workup
o Is a logical thought process that guides work and decisions as the clinician
assesses the patient's drug-related needs and identifies DTP
o Also organizes the interventions that need to be made on the patient's behalf
o Establishes appropriate parameters to evaluate at follow-up and allows the

practitioner to contribute uniquely to the patient's care
23
The Pharmacotherapy Workup…
 Helps to fulfill the practitioner's primary responsibility to determine if a
patient's drug therapy is appropriately indicated, effective, and safe and to
determine if the patient is being compliant
24
Requirements for the Pharmaceutical Care Practitioner
 Understand your responsibilities

 Develop a therapeutic relationship with each patient
 Apply the Pharmacotherapy Workup to make rational drug therapy decisions
 Learn the patient care process
 Acquire an appropriate pharmacotherapeutic knowledge base
 Develop clinical skills
 Understand practice standards and ethical considerations
 Document all care provided
25
Seven star Pharmacist concept
• The concept of the seven-star pharmacist, introduced by WHO
• sees the pharmacist as a
oCaregiver,
oCommunicator, Policy statement on
oDecision-maker, Good Pharmacy
oTeacher, Education Practice
oLife-long learner,
oLeader and manager plus researcher
26
Seven star Pharmacist…
• Caregiver: Pharmacists provide caring services
oThey must view their practice as integrated and continuous with
those of the healthcare system and other health professionals
oServices must be of the highest quality
27
• Decision-maker:
The appropriate, efficacious, safe and cost-effective use of resources
should be the foundation of the pharmacist’s work
At the local and national levels, pharmacists play a role in setting
medicines policy
o Achieving this goal requires the ability to evaluate, synthesize data and
information and decide upon the most appropriate course of action
28
• Communicator:
oThe pharmacist is in an ideal position to provide a link between prescriber
and patient, and to communicate information on health and medicines to
the public
oHe or she must be knowledgeable and confident while interacting with

other health professionals and the public
oCommunication involves verbal, non-verbal, listening and writing skills
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• Manager
Pharmacists must be able to manage resources (human, physical and
financial) and information effectively
o They must also be comfortable being managed by others, whether by an
employer or the manager/leader of a healthcare team
Pharmacists assume greater responsibility for sharing information about

medicines and related products and ensuring their quality
30
• Life-long learner
It is impossible to acquire in pharmacy school all the knowledge and experience needed
to pursue a life-long career as a pharmacist
The concepts, principles and commitment to life-long learning must begin while
attending pharmacy school and must be supported throughout the pharmacist’s career
Pharmacists should learn how to keep their knowledge and skills up to date
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• Teacher
The pharmacist has a responsibility to assist with the education and
training of future generations of pharmacists and the public
Participating as a teacher not only imparts knowledge to others, it

offers an opportunity for the practitioner to gain new knowledge and
to fine-tune existing skills
32
Leader: The pharmacist is obligated to assume a leadership position in the
overall welfare of the patient and the community
o In multidisciplinary (e.g., team) caring situations
o In areas where other healthcare providers are in short supply or non-existent
Leadership involves compassion and empathy as well as vision and the ability
to make decisions, communicate, and manage effectively
33
• Researcher
The pharmacist must be able to use the evidence base (e.g., scientific,
pharmacy practice, health system) effectively in order to advise on the
rational use of medicines in the healthcare team
By sharing and documenting experiences, the pharmacist can also

contribute to the evidence base with the goal of optimizing patient care
and outcomes
34
 As a researcher, the pharmacist is able to increase the accessibility of
unbiased health and medicines-related information to the public
and other healthcare professionals
35
Pharmacy practice changes
• Thus, the knowledge base of pharmacy graduates is changing
oAs the graduates move into practice, so pharmacy practice itself
will change, to reflect the new knowledge base
oHowever, pharmacists already in practice were mainly educated

on the basis of the old paradigm of pharmaceutical product focus
36
Pharmacy practice changes…
• To contribute effectively to the new patient-centered
pharmaceutical practice, . . . .
Pharmacists must have the opportunity to acquire the new knowledge

and skills required for their new role
oTo do this, they must become life-long learners, one of the roles of the
new pharmacist
37
• In developing and industrialized countries alike, efforts to provide healthcare
like pharmaceutical care are facing new challenges
• The challenges include

oThe rising costs of healthcare,
oLimited financial resources,
oInefficient health systems,
38
• Challenges (2)
oShortage of human resources in the healthcare sector,
oThe huge burden of disease, and
oThe changing social, technological, economic and political environment
which most countries face
39
Major concerns
1. Access to medicines of assured quality remains a major concern
worldwide
One-third of the world’s population do not yet have regular access to
essential medicines
For many people, the affordability of medicines is a major constraint

oPatients purchase 50%–90% of medicines paid for out-of-pocket . . . .
. in countries with developing and transitional economies  The burden
falls most heavily on the poor
40
Major concerns …
2. The logistical aspects of distribution represents another
challenge
Often seen as the pharmacist’s traditional role, especially in
health institutions
Moreover, in many developing countries 10%–20% of sampled

medicines fail quality control tests
41
Major concerns…
• Therefore, a statement on ensuring the quality and safety of
medicinal products was jointly signed by FIP and the IFPMA in 2000
Its common goal is to protect the well-being of patients in all parts of the
world by ensuring that all medicinal products are of good quality and
proven safety and efficacy
IFPMA = International Federation of Pharmaceutical

Manufacturers Associations
FIP = International Pharmaceutical Federation
42
Major concerns…
3. Another major challenge is ensuring that medicines are used
rationally
• This requires
• Patients receive medications appropriate to their clinical needs
• In doses that meet their own individual requirements for an
adequate period of time, and at the lowest cost to them and their
community
43
Major concerns…
• However, rational use of medicines remains the exception
rather than the rule
• For those people who do receive medicines,

o More than half of all prescriptions are incorrect and more than
half of the people involved fail to take them correctly
44
Major concerns…
4. The increase in the global spread of antimicrobial resistance is also a major
public health problem
• A recent report by WHO revealed findings of up to

o90% resistance to original first-line antibiotics such as ampicillin and
cotrimoxazole for shigellosis,
o70% resistance to penicillin for pneumonia and bacterial meningitis,
o98% resistance to penicillin for gonorrhoea, and
o70% resistance to both penicillins and cephalosporins for hospital-acquired SA
infections
45
Who should collaborate?
• In 2000, the FIP Council adopted a statement declaring
Pharmacists are ready to collaborate actively with physicians,

regulatory authorities and other health professionals. . .
oIn efforts to combat antimicrobial resistance and to participate in public
information campaigns on this
46
Who should collaborate? (2)
Key components for accessible, sustainable, affordable and equitable health
care system ensuring the efficacy, safety and quality of medicines are ……
oPublic health interventions, pharmaceutical care, rational medicine use
and effective medicines supply management
It is clear that pharmacy has an important role to play in the health
sector reform process
47
Who should collaborate?(3)
• To do so, however, the role of the pharmacist needs to be redefined and
reoriented
Pharmacists have the potential to improve therapeutic outcomes
and patients’ QoL within available resources
oMust position themselves at the forefront of the healthcare system
The movement towards pharmaceutical care is a critical factor in
this process
Pharmacists also have a vital contribution to patient care through managing drug
therapy and concurrent non-prescription or alternative therapies
48
• Thus, over the past 40 years, the pharmacist’s role has expanded
from that of compounder and dispenser to one of “drug therapy
manager”
• This involves responsibilities to ensure

Quality products are selected, procured, stored, distributed, dispensed
and administered
oAll these contribute to the health of patients, and not to their harm
49
• Therefore, the scope of pharmacy practice now includes
oPatient-centered care with all the cognitive functions of counseling,
oProviding drug information and monitoring drug therapy,
oTechnical aspects of pharm’cal services. . . . . MSM
• These are expansion of existing roles and adoption of new roles

previously considered beyond the scope of traditional pharmacy practice
50
• The new approach has been given the name pharmaceutical care
o“Pharmaceutical care is the responsible provision of drug therapy for
the purpose of achieving definite outcomes that improve a patient’s
QoL” (Hepler and Strand, 1990)
• In adopting this definition in 1998, the FIP added one significant amendment:
“achieving definite outcomes that improve or maintain a patient’s QoL”.
51
Pharmacist as a Healthcare Professional
Chapter 2
Learning objectives
 By the end of this session, students will be able to:-
• Understand roles of pharmacists in healthcare
• Understand evolution of professional pharmacy practice
• Identify concepts of profession and professionalism
• Understand relationships of pharmacy profession with other healthcare

professions
53
Overview: What is health?
Health is a broad concept and it is the most important human resource
“Health is a state of complete physical, mental and social well-being, not
merely the absence of disease or infirmity” . . . . (WHO, 1946)
54
What is health? (2)
 Over years, WHO has revised its definition
• “Health is the extent to which an individual or group is able, on the one hand, to
realize aspirations and satisfy needs; and, on the other hand, to change or cope with
the environment
• Health is, therefore, seen as a resource for everyday life, not an object of
living; it is a positive concept emphasizing social and personal resources,
as well as physical capacities.” (WHO, 1984)
55
What is health? (3)
 There is no single definition that unifies the perceptions about health
 Our understanding of it depends on the many different contexts in which life

is lived and health is perceived
• Health is a human right and access to healthcare, including essential medicines,

is a derived right
• Health is essential for sustainable economic and social development
• Health is thus a very precious resource
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Roles of pharmacists in healthcare
 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
• The range of effective medications has broadened
• “Life-style medicines” – treatments for ailments like baldness, dry skin,
wrinkles or erectile dysfunction– are being marketed
57
Roles of pharmacists (2)
 Increasingly medicines can be purchased in new settings, and are
handled by non-pharmacists
• Compounding has been largely replaced by the commercial manufacture of
nearly all formulations
• Medicines can be bought in supermarkets, in drug stores or at markets
• They can also be obtained by mail order or over the internet, they are sold by
medical practitioners and dispensed by computerized dispensing machines
58
 Under these circumstances it is pertinent to ask the following questions:
• Do we still need pharmacists?
• What is the value of pharmacy services?
 Professions exist to serve society

• Hence, the mission of the pharmacy profession must address the needs of
society and individual pts
• At one time, the acts of deciding on drug therapy and implementing it were
relatively simple, safe and inexpensive
59
 The physician prescribed and the pharmacist dispensed. . . . (Traditional
method)
• Substantial evidences showed that this traditional method is no longer
appropriate to ensure
• Safety, effectiveness and adherence to drug therapy
• Plus, the consequences of medicine-related errors are costly in terms

of hospitalizations, physician visits, laboratory tests and remedial
therapy
60
 In developed countries, 4%–10% of all hospital inpatients experience an
adverse drug reaction
• Mainly due to the use of multiple drug therapy, especially in the elderly and
patients with chronic diseases
• ADR is the 4th–6th leading cause of death and is estimated to cost up to $130
billion per year in USA
• In the UK it accounted for £466 million in 2004
61
 In 1998, FIP published a statement of Professional Standards on
Medication Errors
• The statement makes recommendations to improve safety in the
• Manufacturing,
• Ordering,
• Labeling,
• Dispensing,
• Administration, and
• Use of medicines
62
 Pharmacists are well positioned to assume responsibility for the
management of drug therapy
• Because of their
• Extensive academic background
• Traditional role in preparing and providing medicines and informing
patients about their use
• Thus, the pharmacy profession has a responsibility to identify new

opportunities for pharmacy practice
63
Evolution of professional pharmacy practice
 Evidence shows that people have been treating themselves with
medicinal substances for as long as the species Homo sapiens has been in
existence
• Humans have always used plant, animal and mineral substances

• Not only as foods or food complements but instrumentally to alleviate
distress and cure illnesses
64
Evolution of pharmacy practice (2)
 The roots of pharmacy are first established in the ancient Sumerians
(modern day Iraq) from about 4000 B.C.
• The practitioners typically combined the roles of priests,
pharmacists/herbalists and physicians
• Although their approach was not necessarily scientific as in modern terms,
there is little doubt of its utility to their communities
• They were aware of the ability of opium to relieve pain
65
 Similar progress took place in other parts of Asia and Africa at and after
that time
• E.g., the early Aryans invaded Northern India in around 1500 BC and
Ayurveda (literally, the science of life) initially stemmed from that period
• This early form of pharmacopeia remains central to Ayurvedic medicine
66
Traditional Chinese Medicine (TCM)
• Has a similarly important heritage
• Has been passed on by word of mouth
• The oldest book of Chinese medical theory, the Huangdi Neijing or

‘Yellow Emperor’s Inner Canon’, dates from around 2000 years ago
67
 Early European thinking about the causes of health and ill-health
was linked to that of ancient Egypt about 5,000 years ago
• People appear to have believed that disease was caused by malignant

demons
• Such supernatural explanations of human suffering persisted through

into Greek civilization
68
 But by the 6th century BC, Hippocratic Corpus treatises marked the beginnings
of a rational, evidence based, approach
• This continued on into Roman medicine and to the work of Galen (the first
century philosopher and physician)
• Galen was the first to clearly define a drug as a substance that acts
on or in the body to bring about a functional change
69
 Thereafter, Arabian powers (early Islamic period) played a significant role
in preserving and further developing Galenical principles and medicines
• E.g., The word alcohol is of Arabic origin, and probably originally meant
‘the essence’ or spirit in the sense of an active ingredient
• Arguably, the first recognizable ‘apothecary’s store’ of the post-Roman era

was established in Baghdad in the 8th century
70
 A key point to stress is that the existence of pharmacy as a discrete
occupational and professional entity has always been linked to
• The regulation of medicines supply and use
• The maintenance of defined standards of practice
• A core element of the contribution of modern pharmacists, like that of
their medieval predecessors, relates to risk limitation
71
12th – 18th centuries
• Development of the work of monasteries as proto-hospitals and
dispensaries alongside in countries like Spain and Netherlands
• Increasingly specialized drug and spice vendors

• The vendors eventually became established as apothecaries
72
12th- 18th Centuries (2)
• Germany and Hungary had relatively sophisticated regulations governing
the role of the apothecary by around the 1500s
• The basic principles included a clear separation between the tasks of

physicians and pharmacists
• The predominant role of the apothecaries in France in the 1700s was to

make medicines for individual patients according to physicians’
prescriptions
73
 Royal declaration definitively separated French apothecaries from grocers
and spicers in 1777
• Transforming the apothecaries into ‘pharmaciens
 The detailed events leading to the creation of the profession of pharmacy . .

. as it is currently constituted across the world . . . differed from nation to
nation and region to region
74
19th Century
• Progress relevant to the ongoing evolution of medicines, pharmacy and
pharmacy practice have made
• The further introduction of laws and regulations relevant to medicines
supply and drug quality
• The establishment of new professional bodies like the development of

specialized educational institutions and more comprehensive
disciplinary and allied mechanisms within pharmacy
• Early modern pharmaceutical industry began to be capable of

generating well packaged medicines of consistently high quality
75
20th century
• FIP was able to hold its first scientific Congress in Hague (1913)
• Fundamental changes in the communities served by pharmacists

everywhere
• Global demographic and epidemiological transition and its social

impacts, including the introduction of universally accessible
healthcare systems
76
20th century (2)
• Emergence and expansion of the modern pharmaceutical industry
• Evolution of community and hospital pharmacies
• Beginning of the current century pharmaceutical sector

• The care of the pharmacist around pharmaceuticals for the benefit
of the patient
• Clinical Pharmacy and Pharmaceutical Care
77
20th century (3)
• Clinical pharmacy became the foundation for the development of
pharmaceutical care
• Clinical pharmacy started to play a role in community pharmacies in
Scandinavia and the Netherlands in the early1980s
• Little written evidence
78
 Pharmacists’ organizations in other countries slowly became aware

of the new professional development known as pharmaceutical care
• The community pharmacy section of FIP started discussing importance of
pharmaceutical care in 1993
• Subsequently issued a statement of Professional Standards about

it in 1998
79
 Thus in the 1990s, most community pharmacists’ organizations in

Europe started looking at pharmaceutical care as the (strategic) future
for the profession
80
81
New Dimensions of Pharmacy Practice
Pharmaceutical care
• A ground-breaking concept in the practice of pharmacy which emerged in the
mid-1970s
• It stipulates that all practitioners should assume responsibility for the
outcomes of drug therapy in their patients
• includes emotional commitment to the welfare of patients

• Accepting such responsibility is essential to the practice of pharmaceutical care
82
New Dimensions of Pharmacy Practice. . .
Evidence-based pharmacy
• In an increasingly complex healthcare environment,
• it has become difficult to compare the effectiveness of different
treatments
• Healthcare interventions - should not based on opinion or individual

experience alone
• Scientific evidence, from good quality research, is used as a guide
83
New Dimensions of Pharmacy Practice. .
Evidence-based pharmacy (2)

• Ensure that –
• people can access medicines or pharmaceutical advice easily and in a
way and at a time and place of their own choosing
• Help patients to become accurately informed
• by offering unbiased relevant evidence-based information and by
pointing to reliable sources
84
Chronic patient care – HIV/AIDS
• Throughout history, the world has never faced a health challenge like
the HIV/AIDS pandemic
• Pre-service and ongoing training of pharmacists in providing HIV/AIDS

prevention, care and treatment is essential
• Adherence to chronic HIV/AIDS care and treatment is one of the key areas
where pharmacists need to be involved
85
Self-medication
• Providing an advice on self-medication is one of the responsibilities of
pharmacists
• There should be a need of guidance to pharmacists, patients and the

industry regarding
• the safe and effective use of non-prescription medicines
86
 Pharmacies are open all day, are convenient for most people to get to and
there is no need for an appointment to see the pharmacist
 All this makes pharmacies the natural first port of call for help with common
ailments
 Pharmacists have the expertise to advise both on the choice of medicines and
their safe and effective use
87
 QA of pharmaceutical care services
• Quality assurance
• is set of activities that are carried out to monitor and improve
performance so that the health care provided is as effective and as safe
as possible”
(Quality Assurance Project, 1993)
88
 Quality assurance can also be defined as
• “All activities that contribute to defining, designing, assessing,
monitoring, and improving the quality of healthcare”
• These activities can be performed as part of the accreditation of

pharmacies, supervision of pharmacy health workers, or other efforts
to improve the performance and the quality of health services
89
 The Quality Assurance Project of USA lists four core principles which
have emerged to guide quality assurance in health care:
1. Focus on the client (patient)
2. Focus on systems and processes
3. Focus on measurement
4. Focus on teamwork
90
Pharmacovigilance
• A structured process for the monitoring and detection of adverse drug
reactions (ADRs) in a given context
• adverse effects may not always be readily identified and so are not
monitored systematically
91
 Medicine-related problems, once detected,
• need to be assessed, analyzed, followed up and communicated to the focal
person
 Pharmacovigilance includes the dissemination of such information
 Pharmacists have an important contribution to make post-marketing

surveillance and pharmacovigilance
92
The Pharmacy Practice Activity Classification
 A. Ensuring appropriate therapy and outcomes
• Ensuring appropriate pharmacotherapy
• Ensuring patient’s understanding/adherence to his or her treatment plan
• Monitoring and reporting outcomes
 B. Dispensing medications and devices

• Processing the prescription or medicine order
• Preparing the pharmaceutical product
• Delivering the medication or device
93
The Pharmacy Practice Activity Classification (2)
 C. Health promotion and disease prevention
• Delivering clinical preventive services
• Surveillance and reporting of public health issues
• Promoting safe medication use in society
 D. Health systems management

• Managing the practice
• Managing medications throughout the health system
• Managing the use of medications within the health system
• Participating in research activities
• Engaging in interdisciplinary collaboration
94
95
Pharmacy Prct …
 The role of the pharmacist takes different forms in various parts of
the world
 The pharmacist’s involvement with pharmaceuticals can be in
• Research and development,
• Formulation, manufacturing, quality assurance
• Licensing, marketing, distribution, storage, supply, information management,

dispensing, monitoring or education
96
Pharmacy Prct …
Pharmacists practice in a wide variety of settings:-
• Community pharmacy (in retail and other healthcare settings),
• Hospital pharmacy (in all types of hospital from small local hospitals to
large teaching hospitals),
• Pharmaceutical industry
• In academia
• In health service administration, in research, in international health and
in nongovernmental organizations (NGOs)
97
Levels of practice
 Pharmacy practice takes place at different levels
 The ultimate aim of activities at all the levels is to benefit patients by

improving and maintaining their health
98
Levels of practice . . .
 Activities at individual patient level
• Comprise all aspects of providing and managing a patient’s drug
therapy
• Pharmaceutical care, including clinical pharmacy services
• Decisions are made on issues of pharmaceutical care and triage

• Prioritization of care, patient follow-up and therapeutic outcome
monitoring
99
Levels of practice . . .
At the level of supply management
• In community and hospital pharmacy such as manufacture,
compounding, procurement and distribution of medicines
At the level of an institution

• Formularies, STGs and medicines utilization reviews
100
Levels of practice and decision-making. . .
At the system level
• (e.g., at national, federal, state or district level)
• Activities:
• Planning, management, legislation, regulation and policy
• Development of standards of practice and mandates for pharmacy
• Development of national medicines policies
101
Levels of practice and decision-making. . .
 Community and population level
• Health Information, education and communication to promote public
health
• Provision of medicines information,
• Research,
• Dissemination of new information,
• Education and training of staff, consumer groups, community-based
organizations and health system researchers
102
103
What is Profession?
 The word “profession” means “to testify on behalf of ” or “to stand for”
something
 Members of a profession profess their fundamental commitment to serving
society
• Professionals promise to provide their clients with knowledge and
solve a specific range of human problems
• Thus, pharmacists profess to be experts on drug therapy and Promise

to help people make the best possible use of drugs
104
Attributes of Profession
 A profession involves specialized, intellectual learning
• Used to render a particular service either by
• Guiding or advising others, or Practicing an art
105
Attributes ….
 Altruism
 Honesty and integrity
 Respect for others
 Professional presence
 Dedication and commitment to excellence
 In terms of . . .
• Knowledge and skills
• Desire to learn
• Dependability
• Punctuality
106
Professionalism: On Your Rotations
Dress professionally
• First impression is visual
• White coat
• ID card/badge
• Groomed fingernails
• No fake nails allowed at medical center
• Avoid inappropriate “skin” showing
• Avoid strong perfumes, lotions, cologne
• Avoid sandals
107
Attitudes & Behaviors
• Positive attitude
• Respectful
• Address all medical professionals (attendees, preceptors, etc) and
patients, by their title
• Dr….
• Mr., Mrs., Miss,. Ms.
108
Use title unless told otherwise
• Everyone “doctor”
• Even if okay to use first name, use Dr. _____ in front of patients
Prepare in advance
• Know rotation topic
• Review therapeutics, pharmacology, etc. texts
 Pharmacist representative
• No guessing in patient care
109
Professionalism: On Your Rotations (5)
“Be” the Pharmacist
• Maintain this mindset
• Have a sense of ownership
Benefit of having someone oversee your work

• You don’t know everything (never will)
• Learn from your preceptors (model)
110
 Be punctual
 Be a good listener (active listening)
 Take responsibility for your work & actions
• Accountability
 Take initiative
 Be the professional learner
111
Pearls for your Rotations (2)
 Useful Drug Information Resources
• Pocket References
 Drug Information Handbook (Charles Lacy)

• Specialties (geriatrics, pediatrics, etc)
• PDA/phone versions
112
Professionalism: With Healthcare Teams
Keep the goal in mind
• Patient care & optimal therapeutic outcomes
Keep “perspective” in mind

• Preceptors, attendees, residents, medical students, nurses, etc.
113
Professionalism: With Healthcare Teams (2)
 Be respectful
 “Pre-Round”
• Know your patient’s issues
• Know their labs, vitals, meds, etc
 Be resourceful
• If don’t know, look it up, and get RIGHT BACK to them
• Have a sense of “ownership” for your team and patients
114
Professionalism: With Healthcare Teams (3)
 You are the drug expert
• Be certain of your answers
• Team player
• Proactively identify medication-related ways you can contribute
• Pharmacokinetics
• ADRs
• Drug monitoring (efficacy and toxicity)
• Renal and hepatic impairment dosing
• Interview patients on medications taken before hospitalization
• Example: unusual bruising/bleeding  arthritis patient
115
Professionalism: With Your Patients
• Respect • Active listening
• Compassion • Remembering
• Concern for privacy • Patient’s perspective
• Empathy • Understanding
• Do not provide • Helpful
misinformation
Professionalism: With Your Peers
• Be supportive
• Help problem solve
• Bounce ideas off of each other
• Share experiences
117
Professionalism: With the Community
 Community service
• Volunteering (serving and helping others)
• Free Clinic Attending
• Brown bags: churches, civics groups
• Health Education events
• BP and DM screenings, influenza vaccines, etc
• Help local health care organizations
• “Be” the pharmacist
118
THANKS
119

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Introduction: Pharmacy Practice

oUltimately, moved towards a provider of patient care

• Pharmacists take direct responsibility for individual patient’s medicine-

oIn order to fulfill this obligation, the pharmacist needs to be

o Make an assessment of the patient's drug-related needs,

• Together, these steps are the patient care process

• The medication is effective…… ineffective drug, dosage too low?

• The medication is safe……ADR, dosage too high?

• The patient is compliant …… noncompliance?

oIn this case, it is the pharmaceutical care practitioner's responsibility

• It is then the pharmaceutical care practitioner's responsibility to

o Resolve the DTP with and for the patient

• It is designed to complement existing patient care practices to make drug

• This practitioner is not intended to replace the physician, the dispensing

oThe large number of medications and overwhelming amount of drug

• An increase in self-care through alternative and complementary

• A high level of drug-related morbidity and mortality which results

• The pharmacist is equipped with a minimum of 5/6 years of academic

• Pharmaceutical care practitioners use the same practice vocabulary as the

What makes a practitioner qualified to do his or her work is the application of a

o The practitioner identifies, resolves, and prevents drug therapy problems

o Establishes appropriate parameters to evaluate at follow-up and allows the

 Understand your responsibilities

oHe or she must be knowledgeable and confident while interacting with

oCommunication involves verbal, non-verbal, listening and writing skills

Pharmacists assume greater responsibility for sharing information about

Participating as a teacher not only imparts knowledge to others, it

By sharing and documenting experiences, the pharmacist can also

oHowever, pharmacists already in practice were mainly educated

Pharmacists must have the opportunity to acquire the new knowledge

• The challenges include

For many people, the affordability of medicines is a major constraint

Moreover, in many developing countries 10%–20% of sampled

IFPMA = International Federation of Pharmaceutical

• For those people who do receive medicines,

• A recent report by WHO revealed findings of up to

Pharmacists are ready to collaborate actively with physicians,

• This involves responsibilities to ensure

• These are expansion of existing roles and adoption of new roles

• Understand evolution of professional pharmacy practice

• Identify concepts of profession and professionalism

• Understand relationships of pharmacy profession with other healthcare

 Our understanding of it depends on the many different contexts in which life

• Health is a human right and access to healthcare, including essential medicines,

• Health is essential for sustainable economic and social development

• Health is thus a very precious resource

• Medicines can be bought in supermarkets, in drug stores or at markets

 Professions exist to serve society

• Plus, the consequences of medicine-related errors are costly in terms

• Thus, the pharmacy profession has a responsibility to identify new

• Humans have always used plant, animal and mineral substances

• They were aware of the ability of opium to relieve pain

• This early form of pharmacopeia remains central to Ayurvedic medicine

• Has been passed on by word of mouth

• The oldest book of Chinese medical theory, the Huangdi Neijing or

• People appear to have believed that disease was caused by malignant

• Such supernatural explanations of human suffering persisted through

• Arguably, the first recognizable ‘apothecary’s store’ of the post-Roman era

• Increasingly specialized drug and spice vendors