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Pharmacist’s Roles 2 and Role 4

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Under Function C: Monitor patient progress and outcomes. The minimum national standards should be established for example, Pharmacists should consider patient diagnosis and patient-specific needs when assessing patient response to medicine therapy and intervene if necessary. We need to cooperate with physicians because a proper diagnosis is the key to success medication management. Also stated Pharmacists should document necessary clinical and patient data to assess and monitor medication therapy and to track patients’ therapeutic outcomes. Documentation is a vital process when performing medication reconciliation and practicing clinical services. Hospital Accreditation Criteria of
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Taiwan in Pharmacy Practice also states One: To follow up the consequence of drug therapy; to monitor, document, and report side effects of patients. Always keep documenting and therefore anyone can trace your thinking process and serves as a communication channel with other healthcare professionals.
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Two: Pay more attention to high alert drugs on dosing rate and dosage while administering or delivering to patients. Report to doctor if there is any drug-related issues. Some example of high alert medications are insulin, digoxin, inotropic agents, chemotherapy, etc.
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Three: To provide patients individualized essential drug information and counseling. Examples like handing out medication leaflets and providing brief or thorough patient counseling. Make sure they are effectively delivered to patients. According to 2011 updated version of Joint International Pharmaceutical Federation FIP and WHO guidelines on GPP. The role number 4 stated contribute to improve effectiveness of the health-care system and public health. Under Role number 4, function A stated Disseminate evaluated information about medicines and various aspects of self-care.
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Additional minimum national standards
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should be listed including: Pharmacists should ensure that the information provided to patients,other healthcare professionals and the public is evidence-based, objective, understandable, non-promotional, accurate and appropriate. Under the role number 4,
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And Function D stated: Provide information about medicines and health-related issues. Pharmacists should educate patients on how to evaluate and use web-based or other forms of health-care information including medicines information and strongly encourage them to be advised by a pharmacist regarding the information they find, particularly if obtained from the Internet.
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Another minimum standard for Function D: Pharmacists should assist patients and their care providers to obtain and critically analyze information to meet their individual needs. At clinical Pharmacy division in Taipei Veterans General Hospital, we provide clinical pharmacy services, drug information services, teaching and research. Next Let us share some experiences of clinical service with you. Let us introduce what are the areas that clinical services involve, such as Medical rounds and intervention,Prescription verification, Documentation and report ADR and Medication Error, Therapeutic drug monitoring (TDM), Individual drug evaluation services, Collaborative clinics, Pharmacist-managed clinics, Drug information services, Patient education First, let us talk about medical rounds and intervention.
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These are pictures showing our pharmacist joined various medical rounds, such as case meeting, resident round,resident round, attending round with gynecologic doctors. Our pharmacist participate various interdisciplinary meeting at psychiatric ward and case conference with physicians, residents, nurses, psychologist, and social workers. As a medical team member, clinical pharmacists also join the regular medical meeting,present case reports or share new medication information in ward meetings to other healthcare professionals. Next,Prescription verification At Taipei Veterans General Hospital, We implement Prescription verification system which Provide easy-browsing screen to access patient information, such as Admission note,vital signs, lab data, medical treatment and medication record. Pharmacists perform verifications right after physician prescribing based on multiple database.
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Our system Link to all drug information database, such as Hospital formulary,package inserts, drug guidelines, and all alert systems including drug-drug interactions, duplicated prescriptions, adjusting dose according to renal function, contraindication, allergy and ADR,pregnancy risk category, potential inappropriate medication for geriatric, etc. All chemotherapeutic prescriptions are on-line previewed since July 2008, New medication orders of inpatient since Mar 2011, and all outpatient prescriptions since Oct 2015. On-line Prescription Verification systems greatly help in an accurate and efficient manner. There are many intervention aspects while verifying a prescription, for example, the drug choice, indication, dosage, frequency, route, duration, drug-drug interaction, allergy checking, patient conditions, such as renal, liver function, etc.
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In addition, we measure the results of the medication error prevention from prescription verification service in 2016, we detected about 230 errors per month and nearly 25 errors for chemotherapy per month.

Ms Chao continues to explain Pharmacist’s role 2 from the GPP guideline. She will explain Function C and Function D.

pic * Role 2 Function C: Monitor patient progress and outcomes.

Minimum national requirement: Pharmacists should consider patient diagnosis and patient-specific needs when assessing patient response to medical therapy and intervene if necessary. Pharmacists should document necessary clinical and patient data to monitor medication therapy and track patients’ therapeutic outcomes.

  • Role 4 Function D: Provide information about medicines and health-related issues.

Minimum national requirement: Pharmacists should assist patients and their care providers to obtain and critically analyze information to meet their individual needs.

Next, we will see Pharmacist’s role 4, Contribute to improve effectiveness of the health-care system and public health. There are also 4 function in the guideline. We will focus on Function A and Function D. Please use the WHO GPP guideline PDF provided in the previous step as your reference to review the details on Role 4.

Finall, Ms Chao will share her experience of clinical service. Below are the items included inside clinical services.

CPS provided at TVGH:

  • Meetings and medical rounds. Pharmacists participate in the interdisciplinary meetings and resident rounds with physicians or other healthcare professionals.

  • Prescription verification. Pharmacists verify each prescription right after physicians write them. This is carried out using online prescription verification systems which greatly increase accuracy and efficiency.

Share and learn:

  • Are the same clinical pharmacy services (CPS) provided in the hospital you work at/visited?

  • If no, do you think these CPS should be adopted? Why?

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Good Pharmacy Practice: Introduction to Clinical Pharmacy Services

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