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Clinical Pharmacy is an area of ​​Pharmacy that focuses on the application of pharmaceutical knowledge to improve patient health. Clinical pharmacists work in the evaluation, prescription and monitoring of pharmacotherapy, with the aim of ensuring the safety, efficacy and effectiveness of drug treatment.

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Clinical pharmacy had its origins at the beginning of the 1960th century, in the United States. However, it was only from the XNUMXs onwards that this area began to gain greater relevance, with the development of new medicines and technologies. It began to be practiced in hospitals, where pharmacists began to take a more active role in patient care. Currently, clinical pharmacy is also practiced in clinics, offices, community pharmacies and other healthcare settings.

Pharmacists in the UK play a crucial role in ensuring the appropriate and effective use of medicines for patients in hospitals. In recent decades, there has been a significant expansion of the role of the pharmacist, going beyond simply dispensing medicines to include pharmaceutical care. The latter focuses on the effectiveness of the treatment and the reduction of side effects.

The development of clinical pharmacy in the UK has resulted in different service models. A survey of these services in the United Kingdom in 1994 confirmed this diversity. The lack of an authoritative body of evidence to support clinical pharmacists' claims has hampered the adoption of successful local initiatives in mainstream services. However, there is a strong belief among pharmacists that clinical pharmacy improves patient care and resource use. This was recognized by the Department of Health, which issued guidance to hospital managers on the clinical and economic benefits that could be achieved by implementing clinical pharmacy services.

The concept of “pharmaceutical care” gained prominence in the pharmaceutical scene during the 90s, introduced in the USA by Heppler and Strand. Defined as the “responsible provision of drug therapy with the aim of achieving defined outcomes that improve the patient's quality of life”, it was quickly incorporated into the Royal Pharmaceutical Society's good practice guidelines in the United Kingdom. Although the term has become common among pharmacists, its adoption has not been questioned regarding its suitability for the UK healthcare system, leading to criticism about the unquestioning acceptance of a concept developed in a very different healthcare environment.

Clinical Pharmacist

The essential role played by clinical pharmacists within hospital institutions covers a range of multifaceted activities that are vital to the quality of patient care.

Clinical pharmacy is a crucial area in healthcare and the clinical pharmacist plays a multifaceted and fundamental role within this field. This professional is the foundation of patient-centered care, prioritizing not only the effectiveness of medications, but also the safety and well-being of those under care.

These activities exemplify the commitment of clinical pharmacists to ensuring optimized and personalized drug therapy, contributing significantly to the safety and effectiveness of treatment.

Some of the main activities of the clinical pharmacist in hospital institutions:

• Detailed patient history:

It allows you to understand the patient's medical history, pre-existing conditions and specific needs, helping to personalize drug therapy.

• Medication reconciliation:

Ensures that the patient's medication list is accurate and up-to-date, preventing medication errors and reducing the risk of errors in the medication process.

• Analysis of medical prescriptions:

It goes beyond simply following the prescription, considering factors such as dosage, routes of administration and necessary adjustments based on the patient's clearance.

• Dose adjustment considering patient clearance:

It allows the dose of the medication to be adapted to the patient's body's ability to metabolize it, ensuring efficacy and safety.

• Identification of possible incompatibilities between medications:

Prevents adverse reactions or decreased effectiveness of therapy due to negative interactions between different medications.

• Identification of therapeutic duplications:

Prevents unnecessary or duplicate use of medications, optimizing therapy and reducing the risk of side effects.

• Identification of possible harmful drug interactions:

Benefits: Protects against interactions that could interfere with treatment, compromising effectiveness or causing adverse effects.

• Pharmaceutical interventions and greater proximity to the medical team

They allow immediate adjustments to therapy, ensuring a collaborative and coordinated approach to the safety and effectiveness of patient treatment.

• Identifying and reporting allergies

Identifying and reporting allergies helps avoid prescribing or administering medications that could trigger serious allergic reactions, promoting patient safety. Communicating allergies clearly and accurately to the healthcare team reduces the risk of errors in prescribing or administering medications, preventing potentially dangerous situations.

• Analysis of laboratory test results

Personalization of therapy, adjusts doses and medications according to the patient's needs based on their laboratory tests. Early detection of problems: Identifies complications or negative trends in the patient's health.

Reducing risks, avoiding adverse reactions to medications, adjusting doses according to physiological response; maximizing effectiveness ensures that the therapy achieves the desired objectives. And interdisciplinary collaboration contributes to an integrated treatment plan.

• Education for patients and families upon hospital discharge

Helps and guides patients and family members to understand the prescribed medications, their purposes, doses and possible side effects, ensuring correct adherence to treatment after discharge, giving the patient greater understanding of drug therapy.

Effective education can decrease the likelihood of returning to the hospital due to complications caused by misunderstanding or inappropriate administration of medications, reducing hospital readmissions. Enjoy and read more about readmissions: "Unraveling Hospital Readmission".

• Antimicrobial management – ​​Sterwardship Program

The management and control of antimicrobials, also known as stewardship, is one of the key positions where the clinical pharmacist stands out. These professionals lead efforts to ensure the appropriate use of these medications and collaborate with healthcare teams to ensure the judicious use of antibiotics, antivirals, and antifungals. Their involvement ranges from evaluating antibiotic prescriptions to recommending the most effective and targeted therapy for infectious diseases. They analyze the pharmacokinetics and pharmacodynamics of antibiotics and guide antibiotic de-escalation strategies, preventing the development of bacterial resistance, one of the main global health challenges. Ensuring that antimicrobials are used more precisely, increasing their effectiveness in combating infections and reducing the risk of therapeutic failures, avoiding unnecessary or prolonged use of antimicrobials, reducing the risks of side effects and adverse reactions in patients and saving hospital resources by avoiding prolonged or inappropriate treatments, directing medicines to where they are most needed, optimizing healthcare resources. Contributing to the reduction of hospital infections and the spread of resistant organisms, improving patient safety.

Providing education to healthcare professionals and patients on the rational use of antimicrobials, promoting a broader understanding of the importance of correct use of these medicines. Facilitating communication between different healthcare teams, including doctors, nurses and pharmacists, for more effective and coordinated use of antimicrobials.

These activities together provide comprehensive and personalized pharmaceutical care, promoting the safety and effectiveness of treatment, minimizing the risks of adverse events and maximizing benefits for the patient and placing the patient at the center of their care. With the necessary information, a cohesive medical and multidisciplinary team, with the aim of providing the patient with a positive experience with high added value.

 Participation in Hospital Committees

The active participation of clinical pharmacists in hospital committees, such as the Pharmacy and Therapeutics Committee, Infection Control Committee, Parenteral Nutrition Committee, Oncology Committee, among others, is vital, as participating in the committees this professional will enable greater safety and security. efficacy in patients' drug therapy. They collaborate with medical and multidisciplinary teams, contributing to the implementation of care protocols, such as pain protocol, VTE prophylaxis, antimicrobial surgical prophylaxis, pressure ulcers, falls, bronchoaspiration, among others, verifying compliance with institutional protocols and promoting assistance quality and safe.

Clinical Pharmacy Applications

• Assessment of patient pharmacotherapy to identify medication-related problems (MRPs). DRPs can be medication errors, drug interactions, drug allergies, among others.
• Reducing medication errors by identifying and correcting medication errors, which helps prevent adverse events.
• Improved treatment adherence, helping patients adhere to treatment, which improves clinical outcomes.
• Optimization of pharmacotherapy can improve the safety, efficacy and effectiveness of treatment.
• Pharmaceutical prescription as long as they have the appropriate authorization.
• Monitoring the patient's pharmacotherapy to ensure the safety, efficacy and effectiveness of the treatment.
• Pharmaceutical education of patients on the safe and effective use of medications.

Advantages for doctors:

• Improving patient safety, identifying and resolving DRPs, (Medication-Related Problems) contributing to the prevention of adverse events.
• Improving treatment effectiveness, helping doctors choose the most appropriate medications for each patient and monitor response to treatment.
• Reduction of the workload, as clinical pharmacists can take over some of the doctors' tasks, such as: adjusting medication doses for nephropathy patients, providing guidance and education to patients about their entire medication treatment, choosing the safest medication with better adherence and more comfortable dosage, among other actions, freeing them to focus on clinical care.

Advantages for patients:

• Better care by providing patients with more individualized and comprehensive care. Improving the quality of care, helping to improve the quality of care provided to patients. Identifying a drug interaction that the doctor had not noticed, which can prevent a serious adverse event.
• They help the patient develop a personalized treatment plan that meets their needs and preferences. For example, you might work with a heart failure patient to develop a treatment plan that includes medications, lifestyle changes, and emotional support.
• They monitor response to treatment to ensure the patient is receiving the correct treatment. For example, you can monitor the blood pressure of a patient with hypertension to ensure that treatment is controlling the condition.
• Provide support and education to patients to help them manage their disease effectively. For example, it can provide a cancer patient with information about how to deal with the side effects of treatment.
• They offer non-pharmacological advice to patients, addressing important issues such as smoking cessation, guidance to avoid self-medication, encouragement of healthy eating, recommendations to avoid drinking alcoholic beverages, encouragement to practice physical activities under medical supervision and suggestions to reduce excessive stress.
• They collaborate with the patient to manage a chronic illness, which can improve the patient's quality of life and reduce the risk of complications.
• They monitor response to treatment to ensure the patient is receiving the correct treatment. For example, you can monitor the blood pressure of a patient with hypertension to ensure that treatment is controlling the condition.
• They help patients save money when purchasing medicines. For example, helping a patient find pharmaceutical assistance programs that can help them pay for their medications.
• They help the patient improve their quality of life. For example, helping a patient with chronic pain find a medication or treatment that will reduce pain and improve their ability to function.
• They helped the patient live longer. For example, helping a patient with diabetes manage their condition, which can reduce the risk of serious complications such as heart disease, stroke and blindness.

Advantages for healthcare institutions:

• Cost reduction, contributing to the reduction of healthcare costs, through the prevention of adverse events and optimization of medication use.
• Improved safety, improving the safety of patients and healthcare professionals.
• Improvement in the safety and quality of care for patients and healthcare professionals.

Contribution of Clinical Pharmacy

The influence of clinical pharmacists on medical prescriptions in hospitals is significant due to their therapeutic knowledge and frequent contact with prescribers.

Strategies such as hospital policy development and postgraduate training of individual pharmacists are used to influence improvements in prescribing and improve therapeutic skills, and they have an increasing role in educating patients about the correct use of medicines.

Implementation of formulary policies showed improvements in prescribing and cost reductions, although some challenges, such as lack of flexibility and insufficient feedback, were faced.

Despite recognized clinical and economic benefits of clinical pharmacy services, large-scale adoption of electronic prescribing systems is still a challenge despite the potential benefits. However, integration of these systems into electronic patient records is expected to improve patient safety.

Training programs have been instrumental in empowering clinical pharmacists, while their role in educating patients has the potential to improve appropriate medication use. Although there is recognition of the benefits, the role of pharmacists in the systematic quantification of drug-induced diseases is still limited.

Pharmaceutical Practice

Pharmaceutical practice has undergone a remarkable transformation in the last century, recognizing the profession's contribution to improving patient outcomes. The growing recognition of clinical pharmacy is reflected in national reports and important legislation, such as the Institute of Medicine (IOM) report 'To Err is Human', which highlighted the morbidity and mortality associated with medication errors.

Innovations over time have marked the evolution of clinical pharmacy, from the participation of pharmacists in hospital rounds to the establishment of medication management systems. Many significant milestones have been established, such as the creation of the University of Iowa Drug Information Service (IDIS), the Ninth Floor Pharmaceutical Services Project in San Francisco, CA, and the beginning of teaching about the safe and effective use of medications for medical students and residents.

The expansion of clinical pharmaceutical services in hospitals was notable from 1989 to 2006, being recognized as an effective strategy in reducing medication errors. In hospitals with large Medicare patient populations, clinical pharmacy services have been shown to directly reduce the rate of medication errors.

Legislation such as the Medicare Prescription Drug Improvement and Modernization Act of 2003 and reports from the IOM and National Quality Forum have recognized the authority and responsibility of pharmacists in managing drug therapies, driving the expansion of systems such as electronic prescribing and decision support. clinic.

Future-Proofing Your Wealth

Education continues to evolve to prepare future pharmacists to practice on interprofessional teams and use information technology to improve patient care. Interdisciplinary learning environments and educational innovations, such as 'classroom flipping', have proven fundamental in creating a workforce prepared for advanced clinical practice.

The future of clinical pharmacy is dynamic and promising. With technological advancement and the evolution of medical practices, clinical pharmacists are taking on more proactive roles, not only in educating patients about the correct use of medications, but also in the search for new therapeutic approaches.

Conclusion

The role of the clinical pharmacist is invaluable in the contemporary hospital setting. Their expertise, attention to detail and commitment to the patient not only ensure effective drug therapy, but also contribute significantly to the quality and safety of healthcare. The clinical pharmacist is the architect of patient-centered care, integrating science, technology and empathy to promote better health for all.

It is essential to continue imagining and propagating innovations in pharmaceutical practice to further advance the profession and the quality of patient care.

The clinical pharmacist is an essential member of the multidisciplinary healthcare team. Where your performance contributes significantly to improving the patient's health and quality of life, through more humanized care, for this, you must be at the bedside to practice a safe, economical and effective clinical pharmacy.

Learn more: Watch the free course Clinical Pharmacy Presentation *Registration on the platform required Opuspac University.

 

Bibliographic references

• Institute of medicine (IOM). To err is human: building a culture of safety in the health system. Washington, DC: National Academies Press; 2000.
• American College of Clinical Pharmacy (ACCP). The ACCP Position on Clinical Pharmacy Practice: 2023. J Clin Pharm Ther. 2023;48(3):336-345.
• World Health Organization (WHO). The role of the pharmacist in improving patient outcomes. Geneva: WHO; 2022.
• Bates DW, Leape LL, Cullen DJ, et al. Reducing the frequency of errors in medicine. Which Saf Health Care. 1998;7(2):185-191.
• Bardsley M, Jones M. The history of clinical pharmacy in the United States. Am J Hosp Pharm. 1995;52(10):1557-1567.