Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5995_Библиотеки_им_академика_М_И_Перельмана.pdf
123
Prescribed Medication Order and Communication Skills
Communication with Patients
Patient last opportunity for interaction with pharmacist for verbal and printed directions
on how to take medications properly. Verbal explanation is particularly important,
when patient has low educational level to understand directions for use. Pharmacists
can improve medication adherence of patients’ to take medications in a recommended
way by using effective communication (Table 15.2).
Speaking slowly and avoiding the use of medical term is important. It has been
observed that many doctors deal with the patient just like child and so start speaking in
a louder voice; this might be grasped as an abusive to some patients. Loudly speaking
should be avoided, as noticeable mark of social disgrace stigma may be associated with
low health literacy. Change in tone can have noxious effects; may cause the development
of a false understanding.
Provide information to patients based on their individual prescription history through
personalized reports. Educate patients on their disease state and on the treatment plan,
which healthcare professional is going to follow. Advice the patients in the management
of their diseased condition and also help physicians in addressing complex medication
therapy questions. If a patient is taking two or more medications prescribed by different
providers, make aware the patient to fatal dangerous drug interactions, if any.
Next, pharmacists should specifically clarify from patients for any queries about their
prescriptions in a simple sentence. “What questions do you have?” is more effective
phrasing than “Do you have any questions?”
Pharmacists should keep their message simple and should focus on what is intention
of the patient to know in order to take the drug in a prescribed manner.
Finally, use the “teach-back” method which is crucially important. It is a quick
way for healthcare professional members and others to check how well patients have
understood the instruction provided. The response from the patient, gives the feedback
to pharmacist how the message is being received and comprehended or explanation
provided through communication needs modification to provide better understanding.
Follow this method with each patient, irrespective of education level.
Table 15.2: Effective verbal communication, provided by pharmacist
What pharmacist can do?
Speak slowly with clarity Slowing down the pace of the speech, provide clear wording.
Focus on need of patient, which patient wants to know.
Avoid the use of medical
terminology
Instead of saying “hyperlipidemia,” for high cholesterol, use the simple
sentence, ‘what is cholesterol level in your blood?’
Use an adult tone Instead of directing “Discontinue medication if associated with rapid
fluctuations in blood pressure,” suggest the patient “stop the medicine,
if the bottom number of blood pressure is become below 45.”
Simple language In place of asking “Do you have any questions?”, say “What questions
do you have?”
Solicit questions effectively
and consistently
In place of asking “Do you have any questions?”, say “What questions
do you have?”
Focus on two or three Simple and effective, and related with therapy
Take a feedback Make a judgement about the patient’s understanding, such as saying,
“Mr. Ashok, can you tell me how you would take this medication?”
124
Textbook of Pharmacy Practice
Salient points of teach-back method are:
• Usesimplelanguageandrequestthepatienttoexplainback,intheirownwords,
whatwasdiscussed.
• Usenon-shamingopen-endedquestions.Thesearequestionsthatcannotbeanswered
withasimple‘yes’or‘no’,andinsteadrequirethepatienttoelaboratetheirpoints.
• The responsibilityto explain and ensure understanding lie on clinician and
pharmacist.Botharegenuineprovidertogiveinstructions.
• Repeattheprocessuntilyouaresureaboutthecompleteunderstandingofkeypoints
bythepatient.Ifakeypointseemstobeunclear,rephraseorrewordtheinformation,
ratherthanjustrepeatingtheinformationasalreadypresented.
• Patientsshouldbereformed,ifrequired.
EXERCISE
Multiple ChoiCe Questions
Tick mark the appropriate choice
1. English word 'communication' has been originated from which Latin word?
(a) Communicate (c) Compute
(b) Communicare (d) Computer
2. Which type of word is generally not used in verbal communication with patient?
(a) Technical (c) Easy
(b) Simple (d) Local language
short Questions
3. What does the word ‘prescription’ indicate? Explain.
4. What are communication skills? Classify them. Explain each of them.
long Questions
5. What is prescription? Explain the various parts of prescription.
6. Explain the communication of pharmacist with patients and prescriber.
Answer to MCQs
1. (b) 2. (a)
UNIT
IV
16. Budget Preparation and its Implementation
17. Clinical Pharmacy
18. Over-the-Counter (OTC) Medications
127
Chapter
Budget Preparation
and its Implementation
Budget is a banking document or quantifiable description, made ready to project future
income and expenses for the purpose of accomplishing the specific desirable outcome.
Actually, budgeting is the foundation for planning, organizing, directing and controlling
the financial activities of the organization. It is important for financial forecasting, for
predicting an organization’s financial future by assessing historical performance data,
such as revenue, cash flow, expenses, or sales. The budgeting is essential to set up specific
goals for future activities and to perform systematic comparison of actual results with
the financial desired goals.
Definition: Intermsofhospitalpharmacy,budgetisdefinedasatoolthroughwhich
hospitaladministration/management or governingbodies can evaluatethe various
hospitalactivitiesinrelationshiptotheproposedplan,representedinfinancialterms.
FUNCTIONS OF BUDGETING
The well-known functions of budgeting are:
• Budgetdetailsareusedbyanaccountablepersontoevaluatetheeconomicfeasibility
andpracticabilityoftheproposal.
• Theprimaryfunctionofbudgetingistoensuretheavailabilityofsufficientfundsin
ahospitalorganizationtomeetitsgoals.
• Tomonitorthehospitalentirefinancialoperations.
• Ingeneral,itevaluatestheincomeandexpenditureandalsomonitortheinflowand
outflowoffunds.Toactinaccordancetoit,everydepartmentmakeitsownreport
oftheirvariousactivitiesalongwithexpenditureandreporttofinancesection.
• Toestimatethecostofcompletingidentifiedobjectivesintheproposal.
• Budgetingprovidesfinancialroadmapfortheupcomingperiod;ifallgoesasper
intendedplan,itshowshowmuchshouldbeearnedandspentonparticularitems.
CATEGORIES OF BUDGETS
Budgets are generally separated into two categories:
• Short-term budget: This type of budget is prepared for a period less than a year
for actual implementation and it has a practical value.
• Long-term budget: This type of budget is prepared for long-term planning of the
organization. In this case, budget is prepared normally for a period of 5 to 10 years.
16
128
Textbook of Pharmacy Practice
DIVISIONS OF BUDGET
• Income or revenue account statements: Revenue indicates the total amount of money
generated before taking out any expenses. “Income”, on the other hand, is equal to
revenues minus the costs of carrying out business, such as depreciation, interest,
taxes, and other expenses.
Total income must be calculated after the implementation of the budgeting
system. Hospital pharmacy or accounts department keeps the account of cost of
pharmaceuticals/drugs distributed on daily, or weekly, or monthly or annual basis
to the patients in the hospital.
Following information are included under these accounts:
± Numberofprescriptions/medicalordersreceivedperday.
± Numberofprescriptionsdispensedbyeachpharmacistperday.
± Numberofworkinghoursperday.
± Costofmedicationperpatientperday.
± AveragedrugcostperOPD/clinicvisitofpatient.
± Averageemployee’ssalarycostperprescription.
± Averagesupplycostperrequisitioninaday.
Other sources of income: Other sources should also be considered to calculate the
income. For example:
± Grantsorsubsidyprovidedtopublicorgovernmentalhospitalsbygovernment
± Fundsobtainedthroughdonation,peopleofthesocietyorcommunitydonateto
charitabletrusthospitals
± Fund receivedfrom the owner if medical professionalsin privately owned
hospitals,whichareusuallyproprietaryinnature.
± Income,whichoccurredthroughinvestmentinsharetogetneedfulprofitbythe
peopleincommunityincorporatehospitals.
± Incomefrominterestoninvestingtheunusedfundstoearntheinterest.Thismay
beutilizedorusedforhospitaloperationandcountedinthesourceofincome.
± Othermiscellaneousoperatingincomeshouldalsobeconsidered.Forexample,
incomesfromcanteen,whichareobtainedfromthesupplyoflunch/dinnerto
employeesand patients and sale ofscrap items (e.g. silver obtained from old
X-rayfilms).
• Expenditure accounts: Expenditure accounts represent a payment done either in cash
or credit to purchase items or services. It is essential for making budget statement.
Administrative and general expenses, professional care of patients, outpatient and
emergency expenses and miscellaneous expenses are a part of expenditure accounts.
The expense budget also includes employee’s salaries, supplies, and other various
expenses.
Expenditure accounts can be explained as:
± Salaries and wages: Theseincludethesalariesoftotalnumbersoftechnicaland
non-technicalstaff.Listofcompletestaffmemberscomprisepermanent,temporary,
contractualandsupportingstaffondailywages.
± Expenses of supplies and materials: Chiefpharmacistortheaccountableperson
usuallypreparesthelistofsuppliesandmaterialsrequiredinhospitalalongwith
129
Budget Preparation and its Implementation
financialstatementshowingthecostofeachitemwiththehelpofthelastfinancial
budget.Itisnecessarytoshowtheactualcostofmaterials.
± Purchase expense: Purchaseexpenseisknowntoincludetheprescriptionscost,
filledfromanoutsourcepharmacy.
± Drugs/pharmaceuticals and other essential accessories: Thisexpenditureaccounts
includethecostsofdrugs/pharmaceuticalsdispensedattheprescriptioncounter
ofhospital. Italso takesinto accountof costof drugs,used inoutpatient and
emergencydepartments.
± Equipment and construction budget: Itisacapitalbudget,whichsumupthefuture
plansforpurchaseofhospitalequipmentsasperpresentscenario.Thismaybe
essentialtoincludeinbudgetforpurchasingofmodernequipment,remodeling
andreplacementofoldobsoleteequipmentandconstructionofbuilding.
± Miscellaneous supplies and expenses. Purchaseofglasswares,labels,stationary,
uniform,repairandmaintenance,etc. are included inmiscellaneousexpenses.
Properallianceofaccountdepartmentwithpharmacydepartmentisrequiredfor
themaintenanceoffinancialstatisticaldata.
Execution of a Budget
Execution of a budgeting requires certain parameters, which are as follows:
• Requirementofdifferentdepartmentsinthedepartment.
• Actualfundpositionasperfinancedepartmentofthehospital.
• Utilityofparticulariteminavariousdepartmentinahospital.
• Immediatearrangementsofmodernandadvancedequipment.
• Remodelingandreplacementofobsoleteequipment.
• Constructionorrenovationofhospitalbuilding.
• Drugcost.
• Productsquantity.
Advantages of Implementing the Budget
Implementing budget operation offers several advantages. These are as follows:
• Betterfinancialplanning.
• Mainfocusonmakingbetterbudgetarycontrol.
• Effectivelymanagethefinancialaspectsofthehospital.
• Uncoverthereasonsofoverexpenditure.
• Betterfocusonhospitalpriorities.
• Boostuptheefficiencyofstaffandothers.
Factors Affecting Budget
• Adjoininglocalenvironmentandcompulsion.
• Policiesofgoverningbody.
• Confidenceofhighestauthority.
• Capacityofhighestauthority.
Conclusion
The implementation of a realistic budget is a key for efficient operation of any hospital,
and is especially vital for survival of the small-sized hospital. Improved staff efficiency
130
Textbook of Pharmacy Practice
results in a level of high-quality healthcare, which in return results in financial outcome
for the hospital. As the budgeting identifies problems, uncover areas for improvement,
and concurrently allow administrators and managers to keep and reinforce excellence,
budgeting operation helps to accomplish this objective. Predicted budget also includes
the incentives given to departmental employees for outstanding performance in
providing quality service. The ultimate responsibility of forecasting a rational budget rest
with the hospital administration. Crucial factors in projecting a budget comprise sound
accounting principles, knowledge of services provided by other hospitals in adjoining
area, and the impact of frequent changing legislation regarding mandated services.
EXERCISE
Multiple ChoiCe Questions
Tick mark the appropriate choice
1. Which one of these is part of budget implementation?
(a) Actual fund position
(b) Requirement of various departments
(c) Cost and quantity of items
(d) All of the above
2. Components of budgets include __________
(a) Net profitable income
(b) Fixed or constant expenses for particular activity
(c) Flexible expenses for particular activity
(d) All of the above
short Question
3. Define the term ‘Budget’. Illustrate the advantages of planning the budget.
long Questions
4. Discuss the expenditure accounts in budget planning.
5. What is budget? Categorise them. Explain the various divisions of budget.
Answer to MCQs
1. (d) 2. (d)
131
Chapter
Clinical Pharmacy
INTRODUCTION
Clinical pharmacy is a discipline of pharmacy, dedicated to encourage the rational and
appropriate use of medicines and patient in the community healthcare.
According to American College of Clinical Pharmacy (ACCP), clinical pharmacists
and general registered pharmacists differ in the ability of clinical pharmacists to interact
with patients. They can propose specific drugs as well as patient specific drug dosage
form to improve patient wellness. Clinical pharmacist is involved in various activities
for better patient healthcare like:
• Drugmonitoring,whichmeasurestheamountsofcertaindrugstomakesurethe
safeandeffectivelevelofbloodlevel.ItisabbreviatedasTDM.
• Adverse drug reactionmonitoring,whichisprocessofcontinuous monitoring of
undesirableeffectlikelytobeassociatedwithuseofdrugs.
• In-servicetrainingprogrammefortheparamedicalstaff.
• Providingupdatefornewdrugsbygivingrecentdevelopment.
• Monitoringdrugtherapy,whichisprocessofdirectmeasurementofthephysiological
parameters related to therapeutic responses, such as lipid concentrations, blood
glucose,bloodpressure,etc.
SCOPE OF CLINICAL PHARMACY
Various types of the services are given by clinical pharmacists working in hospitals,
community pharmacies, nursing homes, home-based care services, other clinics and
any other setting where medicines are prescribed and used. These services comprise:
• Provisionfordruginformation
• Drugutilization
• Drugreviewandselection
• Managementofmedicationintherapy
• Formaleducationandtrainingprograms
• Diseasestatemanagement
Provision for Drug information: Itisoftenconsideredasthefirstclinicalpharmacy
function.Itisspecializedfacilitiesimpartedbypharmaciststoupdatetheknowledge
ofmedicinesuseamongthephysiciansandotherprescriberstoencouragerationaluse
17
132
Textbook of Pharmacy Practice
ofdrugsandreducethechancesofmedicationerrors.Italsoincludestheprovisionof
givinganswerinwrittenand/orverbalcommunicationinresponsetoaquerymadeby
healthcareprofessionals,patients,andpubliccommunityaboutdrugsanddrugtherapy.
Drug utilization:Clinicalpharmacistcontributessignificantlytosafeandresponsible
useof medicationsto justifyits inclusionin practiceto ensurethe patient’soverall
health.Theprimeaimsandobjectivesareintendedtohelpthedoctorinprescribing
andassessthepatient’sdrugtherapyinamoreeffectiveway.
Drug review and selection: Itincludesthestudyofdrugswiththeuseofsenseorgans
likeperceivingtheodour,shape,texture,etc.whereastheselectionofdrugsrevolves
aroundtheapproveddrugavailableinthemarket.Properdrugreviewandselectionof
drug,whichisencouragedbyclinicalpharmacytoimprovepatienttherapyoutcomes.
Management of medication in therapy:Clinicalpharmacistmayprovidefruitfuladvice
toimprovepatientsunderstandingoftheirhealthconditionandthepropermanagement
oftheirprescribedmedicationsandOTCmedicines.Thus,patientsafetyisboostup
withtheclarificationaboutmedicationrelatedissues.
Formal education and training programs:Clinicalpharmacistcanorganizetheeducational
programmeforparamedicalstaffs,andinternstoadvancetheirknowledgeregarding
thenewdiscoveryanddevelopment,productionanddistributionofdrugproductsand
relatedknowledge. Withappropriate education and training, clinical pharmacist can
improvemedicationuse,byparticipatinginwardround,andADRsreporting.
Disease state management: Clinicalpharmacistsmaycollaboratewithotherhealthcare
professionalin the management of chronicdiseases likediabetes, cancer,etc.The
numbersofsomemedication-relatedproblems,includingmedicationnon-adherencehas
beenminimizedbymanagementofdisease,whichresultedinloweredthehealthcare
costs.Hence,diseasemanagementisconsideredaprimegoalofclinicalpharmacists
inabroaderapproach.
RESPONSIBILITIES AND FUNCTIONS OF THE CLINICAL PHARMACIST
In healthcare system, clinical pharmacists are the knowledgeable persons, who has
better understanding about therapeutic use of drugs. Hence, he may perform various
functions to improve therapy outcome. These are:
• Tomakeappropriate suggestion to patientsor health professionals byassessing
medicationtherapy.
• Toencouragetheeffectiveandsafeuseofdrugbygivingevidence-basedinformation
aboutmedications.
• Toapplythemedicationrelatedknowledgetoevaluatetherelevanceofthedose,side
reactions,efficacyanddruginteractionsinthetreatmentplanforaspecificpatient.
Theclinicalpharmacistmaydiscussonanydrugrelatedissues,ifnecessary,tomake
relevantsuggestiontotheprescribingphysiciantoensuretheproperutilizationof
themedicationsforbetteroutcome.
• Makingawarenessaboutdiagnosis,untreatedhealthproblemsthatcanbehandled
withmedicationtherapy.
• Monitoringpatientprogresswith medicationsandmakingrelevantsuggestionto
changeifprogressisnotgoingindesireddirectionorsideeffectsarepredominating.