Clinical pharmacists are licensed pharmacists with specialized advanced education and training who provide comprehensive medication management and related care for patients in all health care settings. Clinical pharmacists also work in collaboration with other providers to deliver comprehensive medication management that optimizes patient outcomes.
The clinical pharmacist’s standards of practice comprises the following components:
1. Review of Prescription
Pharmacists are experts of medicines and should use their knowledge to ensure patient receives appropriate medication and that the medication is safe, effective and cost effective.
- All demographic data and allergy status data (including nature of allergies) is recorded accurately and completely on the Electronic Prescribing and Medicines Administration (EPMA) chart.
- Clinically screens each newly prescribed medicine or where a dose has changed. This will also include viewing the prescription against Trust protocols, policy and guidance and against national guidance as appropriate.
- Inappropriate medication is discussed with relevant member of the healthcare team, documented on Rio and the issue resolved. Pharmacist to leave as unverified on EPMA until resolved.
- Appropriate endorsements made (on paper chart /EPMA and added to Rio (e.g. whether patient uses a compliance).
2. Monitoring of Treatment
Clinical pharmacists will monitor parameters relating to the effect of the body on drug metabolism and additionally the effect of drugs on the body. The overall aim is to ensure the safe and appropriate use of medication.
- Review or verify blood status via ZTAS/DMS/CPMS system prior to ordering clozapine.
- Review and monitoring of high risk drugs (e.g. clozapine, lithium, anticoagulants, insulin) where necessary.
- Review Conflict Log on EPMA Inpatient charts.
- Evaluating the effectiveness, safety, and affordability of each medication.
3. Supply of Medication
Supply of medication to the patient is one of the core roles of pharmacy. Access to medicines needs to be rapid, continuous but also safe.
- Supply of medication for requested items only. (Technicians can only order those medicines that have been clinically screened by a pharmacist) indicated by green pen on paper charts and a tick symbol on EPMA Inpatient charts.
- Short-term leave TTAs and Discharge TTAs ordered only when requested by ward.
- Compliance aids only dispensed when deemed absolutely essential.
4. Patient Counselling and Education
Whenever appropriate, pharmacy staff will counsel patients about their medication, either individually or in organized groups. Pharmacy staff are often well positioned to give patients advice on the correct use of their medication. They can assist in the assessment of patients who are most likely not to comply with their medication regime.
- Facilitating the supply of patient information leaflets.
5. Medicines Information (MI)
Healthcare professionals will be provided with information on any aspect of drug therapy.
- Only urgent MI enquiries to be answered.
Self-administration allows the patient to acquire a greater level of autonomy and independence which is an important aspect of the care process. However, it is time consuming for both nursing and pharmacy staff.
- Encourage doctors to indicate self-administered medicines using the “Medicines Management” box on EPMA.
7. Follow-up Evaluation
The clinical pharmacist performs follow-up evaluations in collaboration with other members of the health care team to continually assess patient outcomes by:
- Coordinating with other providers to ensure that patient follow-up and future encounters are aligned with the patient’s medical and medication-related needs;
- Revisiting the medical record to obtain updates on the clinical status of the patient and then meeting with the patient/caregivers to obtain an updated medication history to identify, assess, and document any new medication-related needs or problems;
- Conducting ongoing assessments and refining the plan of care to optimize medication therapy and ensure that individual goals are achieved; and
- Monitoring, modifying, documenting, and managing the plan of care in collaboration with the patient/caregivers and his/her other health care providers.