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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5739_Библиотеки_им_академика_М_И_Перельмана.pdf
Pharmacy Practice158
river. Both know roughly the direction in which it is flowing
but the first one is provided with a proper guidelines and
the other with nothing. Former will be able to reach his
destination as soon as possible while latter will have to rely
upon judgments to avoid obstacles.
3. The usual budget proposals are annually prepared, but it
can vary from 3 to 5 years duration to take into account
long-term planning. A proper budgeting system facilitates
the hospital administration to take right decision according
to the local needs, requirements, and the order of priorities.
ISOLISOL
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TED KEY POINTSTED KEY POINTS
TED KEY POINTSTED KEY POINTS
TED KEY POINTS
• Budget preparation is an essential and crucial function for
hospital management due to the continuous changes in the
reimbursement system, increasing costs, and the increased
competition among hospitals.
• HALMA described “Budget as an instrument through which
hospital administration, management at the departmental
levels and the governing board can review the hospital’s
services in relationship to a prepared plan in a comprehen-
sive and integrated form expressed in financial terms.”
• Best practices in setting and managing healthcare organiza-
tion budgets include:
i. Using comparative benchmarks
ii. Setting accurate, high performance department budgets
iii. Establishing a culture of accountability
iv. Managing expenses
v. Monitoring variances and requiring corrective action
plans
vi. Employing a balanced scorecard.
• Each budget is classified into the following three divisions:
i. Income accounts
ii. Expenditure accounts
iii. Equipment and construction budget
• Income (or revenue) accounts: A commonly used method
for determining the income may be the maintenance of
daily, weekly, monthly or annual accounts to get the total
cost of the pharmaceuticals issued to various patient services
as well as to special services departments.
Budget Preparation and Implementation 159
• The expense accounts: Fixed expenses generally remain
fixed or same at all levels.
• Salaries and wages: This includes salaries and wages of:
i. Pharmacists
ii. Assistants
iii. Clerks
iv. Others.
• Purchase expenses: This account should include the cost of
prescriptions (excluding those intended for outpatient)
purchased from an outside pharmacy in case the hospital
does not have its own pharmacy.
• Budgeting is an essential tool in the process of planning
and control and is an instrument of forecast to achieve
objectives.
PRAPRA
PRAPRA
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CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONS
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1. Define hospital budget.
2. List of out important parts of a budget.
3. Explain about the revenue accounts in the hospital.
4. Explain about the income accounts in the hospital.
5. What are different sources of income to meet the operating
emphasizing in a hospital?
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1. How is the budget prepared in hospital pharmacy?
2. Explain the role of a pharmacist in budget preparation and
implementation.
3. Mention the best practices in setting and managing health-
care organization budget.
4. Explain the various divisons of a budget.
LL
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ong Answer Tong Answer T
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1. Define hospital budget. What are the various steps involved
in the preparation of a budget?
2. Explain the process of implementation of budget.
Pharmacy Practice160
Objective TObjective T
Objective TObjective T
Objective T
ype Questionsype Questions
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1. Generally, income of the hospital pharmacy is limited to:
A. Sale of drugs to in-patients
B. Ambulatory patients
C. Departments of hospital
D. All of the above
2. Budget is divided into ___ divisions.
A. 3 B. 5
C. 2 D. 7
3. Academic hospital budgets should be set to obtain at least
_____ opening budget target.
A. 2–6% B. 3–5%
C. 2–4% D. 5–7%
4. Salary and wages of the staff include salary of:
A. Pharmacists B. Assistants
C. Clerks and others D. All of the above
5. The usual budget proposals are ______ prepared, but in
vary from ____ years duration to take into account long-
term planning.
AnswersAnswers
AnswersAnswers
Answers
1. D 2. A 3. B 4. D 5. Annually, 3–5 years
The pharmacy services can be broadly classified as clinical,
hospital and community pharmacy services based on the point
of service. The clinical pharmacy services are done in a clinic
for inpatients and OPD patients. For example, the activities
like ward rounds, safety, drug information services, poison
center, patient counseling and education along with discharge
medication.
“Clinical pharmacy is the branch of pharmacy in which
clinical pharmacists provide direct patient care that optimizes
the use of medication and promotes health, wellness, and
disease prevention”.
“Clinical pharmacists care for patients in all health care
settings but the clinical pharmacy movement initially began
inside hospitals and clinics”. Clinical pharmacists often work
in collaboration with physicians, physician assistants, nurse
practitioners, and other healthcare professionals. Clinical
pharmacists can enter into a formal collaborative practice
agreement with another healthcare provider, generally one or
more physicians that allow pharmacists to prescribe
medications and order laboratory tests.
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i. Check the status of the patient’s health problems and
monitor the prescribed medications that they meet the
patient’s needs and goals of care.
ii. Check the appropriateness and effectiveness of the
patient’s medications.
Clinical Pharmacy
17
Pharmacy Practice162
iii. Recognize untreated health problems which can be
resolved with appropriate medication or therapy.
iv. Follow the patient’s progress to determine the effects of the
patient’s medications on his or her health.
v. Consult with the patient’s physicians and other healthcare
providers in selecting the medication therapy.
vi. Advise the patient regarding administration of medica-
tions.
vii.Educate the patient on other important steps to improve or
maintain health, such as exercise, diet, and preventive steps
like immunization.
RESPONSIBILITIES OF CLINICAL PHARMARESPONSIBILITIES OF CLINICAL PHARMA
RESPONSIBILITIES OF CLINICAL PHARMARESPONSIBILITIES OF CLINICAL PHARMA
RESPONSIBILITIES OF CLINICAL PHARMA
CISTCIST
CISTCIST
CIST
A clinical pharmacist has solid clinical training and is well-
versed in pharmaceutical therapy. Their major responsibilities
are:
i. Develop clinical pharmacy programs according to
policies and regulations.
ii. Review records of patients to determine the appropriate-
ness of medication therapy.
iii. Evaluate patient’s condition to ensure all issues.
iv. Identify untreated health problems and refer patients to
appropriate physicians.
v. Develop effective medication plans that minimize the
risk of adverse side-effects.
vi. Check the dosages, medication substances administered.
vii. Advise on the correct administration of drugs.
viii. Assess the results of pharmaceutical treatments.
ix. Collaborate with healthcare professionals to ensure
optimal patient care.
x. Keep accurate documentation of medication plans and
patient progress.
DRUG THERAPY MONITORINGDRUG THERAPY MONITORING
DRUG THERAPY MONITORINGDRUG THERAPY MONITORING
DRUG THERAPY MONITORING
Drug therapy monitoring is an ongoing process in which
pharmacists actively review patients’ records, identify and
resolve drug therapy problems such as adverse drug events
(ADEs) and communicate with prescribers when problems
Clinical Pharmacy 163
occur. Pharmacists educate patients and their caregivers about
potential adverse effects and work with patients to ensure
adherence to therapy and attainment of therapeutic goals.
Following are the three steps of monitoring:
1. Educate patients about their therapy, potential adverse
effects, and actions to take if problems occur.
2. Regularly assess patients’ drug therapy. Check that
patients take their medications as prescribed, proactively
identify and resolve ADEs as they occur, and assess
therapeutic effectiveness.
3. Adjust drug therapy as needed based on patient status.
TDM service depends on team work between nurses, doctors,
pharmacist, scientist and technical staff. The clinical pharmacist
should provide advice to medical staff on the appropriate use
and timing of TDM and assist with the interpretation of results.
In addition, the pharmacists are involved in:
i. Initial selection of drug regimen, which involves decisions
about drug choice, dose, dosing interval, route of
administration and dosage form of the drug, keeping
in mind various factors such as sex, age, body weight,
race, etc.
ii. Adjustment of the dosage regimen based on TDM results
and the patients clinical response.
iii. Dose adjustment for patients on hemodialysis or
peritoneal dialysis.
Medication CharMedication Char
Medication CharMedication Char
Medication Char
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It is a fundamental responsibility of a pharmacist to ensure the
appropriateness of medication orders. It serves as starting point
for other clinical pharmacy activities (medication counseling,
TDM, DI, and ADR).
Organizing information according to medical problems
(example disease) helps breakdown a complex situation into
its individual parts.
1. To optimize the patients drug therapy.
2. To prevent or minimize drug-related problems/medica-
tion errors.
Pharmacy Practice164
The patient’s medical record should be reviewed in
conjugation with the medication administration record. Recent
consultations, treatment plans and daily progress should be
taken into account when determining the appropriateness of
current medication orders and planning each patient’s care.
All current and recent medication orders should be reviewed.
Components of Medication Order RComponents of Medication Order R
Components of Medication Order RComponents of Medication Order R
Components of Medication Order R
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i. Checking that medication order is written in accordance
with legal and local requirements.
ii. Ensuring that the medication order is comprehensible
and unambiguous, that appropriate terminology is used
and that drug names are not abbreviated. Annotate the
chart to provide clarification as required.
iii. Detecting orders for medication to which the patient may
be hypersensitive/intolerant.
iv. Ensuring that medication order is appropriate with
respect to:
a. The patient's previous medication order.
b. Patient’s specific considerations, e.g disease state,
pregnancy.
c. Drug dose and dosage schedule, especially with
respect to age, renal function, liver function.
d. Route, dosage form and method of administration.
v. Checking complete drug profile for medication duplica-
tion, interactions or incompatibilities.
vi. Ensuring that administration times are appropriate, e.g.
with respect to food, other drugs and procedures.
vii. Checking the medication administration record to ensure
that all ordered have been administered.
viii. Ensuring that the drug administration order clearly
indicates the time at which drug administration is to
commence.
ix. Special considerations should be given especially in short
course therapy as in antibiotics and analgesics.
x. Ensuring that the order is cancelled in all sections of
medication administration record when the drug therapy
is intended to cease.
Clinical Pharmacy 165
xi. If appropriate follow-up of any non-formulary drug
orders, recommending a formulary equivalent if required.
xii. Ensuring appropriate therapy monitoring is implemented.
xiii. Ensuring that all necessary medication is ordered, e.g.
premedication, prophylaxis.
xiv. Reviewing medication for cost effectiveness.
xv. Identification of drug-related problems.
CLINICAL REVIEWCLINICAL REVIEW
CLINICAL REVIEWCLINICAL REVIEW
CLINICAL REVIEW
Clinical review is one of the integral components of medication
review and should preferably be performed on a daily basis. It
is the review of the patients’ progress for the purpose of
assessing the therapeutic outcome. The therapeutic goal for
the specific disease should be clearly identified before the
review. The primary aims of the clinical review are to:
i. Assess the response to drug treatment.
ii. Evaluate the safety of the treatment regimen.
iii. Assess the progress of the disease and the need for any
change in therapy.
iv. Assess the need for monitoring, if any.
v. Assess the convenience of therapy (to improve com-
pliance).
WARD ROUND PARTICIPWARD ROUND PARTICIP
WARD ROUND PARTICIPWARD ROUND PARTICIP
WARD ROUND PARTICIP
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Ward rounds are the routine clinical rounds where the
healthcare providers visit the patients in the ward to assess
the progress of the health condition of the inpatients. The goal
of the ward round is to closely monitor the patient’s condition
and take immediate intervention to improve the patient
condition and avoid death.
The ward team comprises doctors, nurses and pharmacists
who work in a team with a common objective to ensure safe,
effective, economic and patient-friendly treatment with
knowledge inputs of each professional practice.
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The pharmacist being an expert in the matters of drug should
be available for the ward round team to decide upon the matters
Pharmacy Practice166
of dosage regimens, formulary interpretations, ADR
monitoring, drug-drug interactions, drug-food interactions and
drug and poison information services.
The availability of pharmaceutical services definitely
enhances accuracy of treatment, patient safety and efficacy.
Duties of the Pharmacists in WDuties of the Pharmacists in W
Duties of the Pharmacists in WDuties of the Pharmacists in W
Duties of the Pharmacists in W
ard Rard R
ard Rard R
ard R
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i. The pharmacist in ward round take two rounds one with
the doctors and another one with himself alone.
ii. In the first ward round he follows the treatment given and
checks the formulary for the dose prescribed.
iii. Further he may also critically think any possible risk to the
patients due to drug administered.
iv. In the 2nd round the pharmacist tells the patients prior to
discharge and advice the patients regarding discharged
medication practice in the rounds. He also gives knowledge
about diet and exercise required for disease management.
MEDICAMEDICA
MEDICAMEDICA
MEDICA
TION HISTORTION HISTOR
TION HISTORTION HISTOR
TION HISTOR
YY
YY
Y
A medication history is the part of a pharmaceutical
consultation that identifies and documents allergies or other
serious adverse medication events, as well as information about
how medicines are taken currently and have been taken in the
past. It is the starting point for medicines reconciliation and
medication review. Discrepancies between the history recorded
by the medical team and that which the pharmacist elicits fall
into two categories: Intentional (where the medical team has
made a decision to alter the regimen) or unintentional (where
a complete record was not obtained). Discrepancies should be
clarified with the prescriber or referred to a more senior
pharmacist.
KEY COMPONENTS OF A MEDICAKEY COMPONENTS OF A MEDICA
KEY COMPONENTS OF A MEDICAKEY COMPONENTS OF A MEDICA
KEY COMPONENTS OF A MEDICA
TION HISTORTION HISTOR
TION HISTORTION HISTOR
TION HISTOR
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i. Introduce yourself to the patient and explain the purpose
of the consultation.
ii. Identify any allergies or serious adverse reactions and
record these on the prescription chart, care notes or patient
medication record.
Clinical Pharmacy 167
iii. Ascertain information about prescribed and non-
prescribed treatments from the patient’s recall medicines
in the patient’s possession referral letter (usually from the
patient’s primary care doctor) copy of prescriptions
issued or a repeat prescription list medical notes contact
with the appropriate community pharmacist or primary
care doctor.
iv. Ensure the following are recorded generic name of
medicine (unless specific brand is required) dose
frequency duration of therapy.
v. Ensure items such as inhalers, eye drops, topical medi-
cines, herbal and homeopathic remedies are included, as
patients often do not consider these as medicines.
vi. Ascertain the patient’s medication-taking behavior.
vii. Consider practical issues such as swallowing difficulties,
ability to read labels and written information, container
preferences, ordering or supply problems.
viii. Document the history in an appropriate format.
ix. Note any discrepancies between this history and that
recorded by other healthcare professionals.
x. Ascertain if these discrepancies are intentional (from
patient, nursing staff, medical staff or medical notes).
xi. Communicate non-intentional discrepancies to the
prescriber.
xii. Document any other important medication-related
information in an appropriate manner, e.g. implications
of chronic renal failure, dialysis, long-term steroid
treatment.
PHARMAPHARMA
PHARMAPHARMA
PHARMA
CEUTICAL CARECEUTICAL CARE
CEUTICAL CARECEUTICAL CARE
CEUTICAL CARE
Pharmaceutical care is a cooperative, patient-centered system
for achieving specific and positive patient outcomes from the
responsible provision of medicines. The practice of clinical
pharmacy is an essential component in the delivery of
pharmaceutical care. The delivery of pharmaceutical care is
dependent on the practice of clinical pharmacy but the key
feature of care is that the practitioner takes responsibility for a