CLINICAL PHARMACY IN RHODE ISLAND

The institution and development of clinical pharmacy in Rhode Island is described. The difficultires encountered in developing affiliations between the School of Pharmacy and the hospitals for the provision of Pharm. D courses and the eventual use of the clinical pharmacists is discussed     

EXPANDING THE CLINICAL COMPONENT OF PHARMACY EDUCATION IN SAUDI ARABIA

The clinical pharmacy component of Riyad College of Pharmacy curriculum was expanded from its present 4-credit h clinical pharmacy course to 18-credit h of clinical instructions in the pharmacy-core programme. In the final year of a 5-year programme, students may select clinical pharmacy as a professional option, thus receiving an additional 10-credit h of clinical instructions. The decision to expand the clinical component of the pharmacy curriculum was prompted by the need for patient-oriented pharmacy practitioners. The performance of graduates who had been rather briefly exposed to clinical pharmacy education led to this expansion.     

Clinical pharmacy in a South Indian teaching hospital

OBJECTIVE: To describe how clinical pharmacy is helping to improve medication use at a South Indian teaching hospital by addressing medication use problems, which are commonly encountered in India. SUMMARY: Clinical pharmacy is practiced in many countries and makes a significant contribution to improved drug therapy and patient care. India is a country with significant problems with medication use, but until recently Indian pharmacists have not been educated for a patient-care role. Postgraduate pharmacy practice programs have been established at 2 pharmacy colleges in South India as a result of a joint Indo-Australian program of cooperation. At a teaching hospital associated with the colleges, clinical pharmacy services such as drug information, medication counseling, drug therapy review, adverse drug reaction reporting, and the preparation of antibiotic guidelines are assisting clinicians to improve drug therapy and patient care. Seven hundred twenty-seven requests for drug information were received from July 1997 to February 2001, and 543 suspected adverse drug reactions were evaluated from November 1997 to February 2001. The most common drug classes causing adverse drug reactions were antibiotics, nonsteroidal antiinflammatory drugs, and antitubercular agents. Physician opinion and service utilization have also been surveyed: 82% of respondents had sought drug information from the Clinical Pharmacy Department and 71% of respondents had sought advice on individual patient management. The success of this program is raising awareness of clinical pharmacy among pharmacy educators elsewhere in India and has led to the introduction of clinical pharmacy services at other Indian hospitals.     

Pharmacotherapy and the primary care physician

Clinical pharmacy services and pharmacotherapy specialists did not begin in primary care settings. Rather, the initial interdisciplinary teams took root in large hospitals and tertiary medical center inpatient services during the middle 1960s. By the early 1970s, however, numerous papers appeared that described a unique and exciting practice model that incorporated primary care physicians and clinical pharmacists. The sole purpose of the interdisciplinary concept was to allow each member to contribute their own expertise to improve patient care. In my experience, primary care physicians have been eager to consult clinical pharmacists and other health professionals. I believe that the reason for this is a fundamental philosophy that distinguishes these physicians from other medical specialists. Ingrained in their philosophy are concepts such as continuity of care and care of the entire patient. The latter relates, not only to multiple organ systems, but also the spiritual and behavioral characteristics of the person. The primary care physician is also viewed as the coordinator for all health care services required by their patients. Most primary care physicians welcome others' expertise as long as they continue to be the health care coordinator for the patient. The health care structure of the United States continues to shift to ambulatory care. This will provide additional opportunities for the types of group models described in this article. After 20 years, the positive impact that physician and pharmacotherapist teams can have on drug therapy is being recognized on a broader scale. These models should continue to move from the academic laboratory to private group practice.(ABSTRACT TRUNCATED AT 250 WORDS)     

A TRIAL 24-HOUR PHARMACY INTRAVENOUS ADDITIVE SERVICE IN A TEACHING HOSPITAL

The problems of administering drugs by addition to intravenous infusions may be overcome in a number of ways. Some drugs may be injected slowly into the line of an intravenous infusion. Others may be provided as primary infusion solutions, or compounded by the Pharmacy as intravenous admixtures i.e. by providing a Pharmacy Intravenous Additive Service. This paper describes the introduction of a range of primary infusion solutions and a trial 24-hour Pharmacy Intravenous Additive Service. The place of such a service within the context of a total pharmacy service is discussed.     

The state of U.S. emergency care: a call to action for hospital pharmacists

The recent publication of the Institute of Medicine/Board on Health Care Services reports on the future of emergency care in the US health system has identified the main limitations of the care provided by emergency departments (EDs). Increased development of ED pharmacy services and increased involvement of pharmacists in the ED can contribute to improvements in shortcomings identified in the report. Pharmacy training programs must take the initiative to incorporate emergency care into their curricula to meet the predicted increase in demand for ED pharmacists. Pharmacy associations, administrators, and ED practitioners must direct research on the impact of the pharmacist in the ED.     

POSTGRADUATE STUDIES IN CLINICAL PHARMACY AT THE UNIVERSITY OF ASTON

The development and philosophy of the 2-year course in Pharmaceutical Sciences leading to the degree of Master of Science which was founded in the University of Aston in 1970 is outlined. This includes a survey of course content together with examples of the types of project studied. The subsequent changes to a modular structure and concurrent introduction ofl-year courses leading to a Postgraduate Diploma and a Diploma in Clinical Pharmacy (Dip. Clin. Pharm.) in 1977 and 1978 respectively are also given.     

Executive summary: The Virginia Commonwealth University pharmacy practice transformation conference

Pharmacy practice transformation was the focus of an invitational conference held in June 2011 to address the current status of the practice of pharmacy in Virginia and elucidate the consensus on future directions from pharmacists across the commonwealth. The series of presentations provided visionary perspectives on the role that pharmacists can have in the collaborative management of patients with chronic disease states, the optimal pharmacy practice model for direct patient care delivery in acute care settings, and payment for pharmacists' cognitive services, such as medication therapy management (MTM). The discussion groups were structured to have conference participants first identify future goals for pharmacy practice and then consider strategies to achieve these goals. The conference concluded with a consensus development dialogue that revealed the priorities as well as the strategies that needed to be employed to move the profession toward its goals.     

Development of a Canadian family medicine pharmacy practice experience programme

Faculties of Pharmacy in Canada must currently provide students with at least 16 weeks of structured pharmacy practice experience. In recent years, the College of Pharmacy at Dalhousie University in Halifax, Nova Scotia, Canada has been developing more practice experience sites in non-institutional settings. One of these is at the Department of Family Medicine at Dalhousie University. This paper describes the development and expansion of clinical pharmacy services in the Family Medicine Clinics, provided by one of the College's clinical faculty members. With those services in place, the clinical pharmacist was ready to begin precepting pharmacy students at the Family Medicine Clinics. A proposal for a family medicine pharmacy practice experience programme was written, accepted and piloted in 1994-95. Following the success of that initial trial, the programme has continued and expanded over the years. Evaluation from the programme participants indicates that experience allows the pharmacy student to successfully complete programme objectives and gain an appreciation for working with other health care professionals to optimize patient care. The Family Medicine Clinics also appreciate the contributions made by the pharmacy students and value the interaction between students training in pharmacy and residents in family medicine.     

Differing clinical pharmacy service models: Quantitative and qualitative analysis of nurse perceptions of support from pharmacists

BackgroundIn the last decade interdisciplinary teamwork and collaboration are increasingly favoured as strategies to improve healthcare delivery. The need for collaboration is especially evident in acute care medical-surgical wards of hospitals. Doctors, nurses, pharmacists, doctors and other healthcare professionals work in shifts to provide a multiplicity of services to a rapidly changing caseload of patients.Traditionally, pharmacists have been assigned to a ward or wards for which they provided all clinical services. An alternative clinical pharmacy service model which aligns pharmacists with medical teams is being introduced into Australian hospitals. This newer model, teambased pharmacy, is intended to provide better clinical services overall to patients, but the effect on the working relationship between pharmacists and nurses has not been examined.ObjectiveTo compare nurses’ perceptions of the pharmacist’s role, collaboration with and support for nurses for two models of clinical pharmacy: wardbased pharmacy and teambased pharmacy.DesignQuantitative and qualitative analysis of survey data from nurses.Settings and participantsA total of 90 nurses from five acute-care wards located in two tertiary hospitals in Sydney, Australia participated in the survey.MethodsStatistical comparison of quantitative data from Likert-type questionnaire, and qualitative thematic analysis of nurses’ written responses to an open-ended question.ResultsThe qualitative data analysis indicated that the team-based pharmacy clinical service model, resulted in a perceived increase in nursing workload and a decreased collaboration with pharmacists. These findings were corroborated by the quantitative data analysis findings of statistically significant perceived reductions in collaboration.ConclusionsEfforts to align pharmacists with medical teams by replacing the traditional ward-based pharmacy model with an alternative model resulted in a perceived reduction in collaboration with and support for nursing teams.Evaluation of the impact of new pharmacy service models should involve all health professionals contributing to the safe and effective use of medicines.Intervention is recommended to provide resources to satisfy nurses’ needs for information and education about medication for hospitals that operate team-based clinical pharmacy services.     

A description and evaluation of an innovative rural rehabilitation programme in South Eastern Australia

Purpose.?To describe and evaluate the effectiveness of an innovative model of rehabilitation designed to meet the needs of a sparsely populated rural area in South Eastern Australia.

Method.?Five rural health services collaborated to establish a rehabilitation programme. Evaluation included comparing length of stay (LOS) and improvement in the Modified Barthel Index (BI) with the Victorian State average for Level 2 (non-specialist) rehabilitation. Surveys were conducted with staff, clients and carers in the programme.

Results.?An inpatient rehabilitation programme was successfully established through cooperation between five health services. Clients admitted to the programme improved functionally at least as well as the Victorian State average for similar client groups (BI change 26.5 compared with 22.3 points, p?<?0.001), with a shorter LOS (13.8 compared with 22.3 days) but more were discharged to residential aged care (16.1% compared with 6%).

Conclusions.?The programme was successful in meeting its stated aims. The model described could be adopted in rural areas sharing similar characteristics. Key enablers to the success of the programme included: collaboration between hospitals; a skilled and enthusiastic leader; recruitment of allied health staff; consistent medical leadership; access to training and support from a major regional rehabilitation centre; and access to funding to enable the programme to establish itself and demonstrate outcomes for clients.     

AWARENESS OF POTENTIAL DRUG INTERACTIONS WITH ANTICOAGULANTS

A survey by questionnaire returned by 180 individuals determined the awareness of doctors and medical students and pharmacists and undergraduate pharmacy students to the potential of drug interactions occurring in patients receiving anticoagulant drugs. Pharmacy students and hospital pharmacists were particularly well informed of the hazards of drug interactions; community pharmacists were less well informed. Hospital medical consultants, registrars and general practitioners were more aware of the hazards of interactions than medical students. The survey clearly shows the need for more education of doctors and pharmacists on drug interactions, especially those involving anticoagulant drugs.     

Hydration of patients treated with cisplatin: practical investigation and establishment of a protocol

BACKGROUND: Administration of cisplatin requires hyperhydration of the patient to prevent nephrotoxic effects of this molecule. MATERIALS AND METHODS: A survey done in different hospitals - university hospitals, general hospitals and cancer institutes--has shown a large variability in the hydration protocols. A multidisciplinary group was set up in our university hospital comprising oncologists, nephrologists and pharmacists. This group has developed a consensual local protocol from a bibliographic analysis (Medline) and from the personal experience of each member. CONCLUSION: This protocol was approved by our hospital's Committee of Drugs and Medical Devices.     

The involvement of pharmacists in professional and clinical audit in the UK: a review and assessment of their potential role

This review addresses the uptake and implementation of the principles of audit by community, hospital and health authority pharmacists. The pressures to audit professional services are discussed, as are the barriers to cooperation among pharmacists and between pharmacists and prescribes in primary care. The development of standards of professional practice is then described taking into account the particular difficulty in developing standards for health care workers who are geographically separated from other members of the primary care team and are in commercial competition with each other. The review identifies audit of professional services in both community and hospital pharmacy and of clinical services in the latter. The role of pharmacists employed by health authorities to advise them and general practitioners on the optimum use of the drug budget is described and their potential role for involvement in audit is discussed. The particular advantages that pharmacists in hospital and health authorities have in developing the specific aspect of clinical audit related to medicines usage (drug utilization review) is then described. The potential for pharmacists to contribute to clinical and management audit is discussed.     

Hidden on the ward: the abuse of children in hospitals

Hidden on the ward: the abuse of children in hospitals While there have been a small number of high profile cases of the abuse of children by hospital staff, there has been relatively little attention paid to the child protection issues for children staying in hospitals. Drawing on a conceptual framework from work on institutional abuse, we identify three types of abuse: physical and sexual abuse; programme abuse; and system abuse. Physical and sexual abuse can be perpetrated by medical professionals and hospital workers, it can be perpetrated by other children, or it can be perpetrated by the child's own parent(s). Research evidence from the United States of America (USA) suggests that the rate of abuse in hospitals is higher than in the family home. Programme abuse occurs when treatment and care falls below normally accepted standards. Recently, a tragic case of programme abuse concerned the unacceptably high death rate of babies undergoing heart surgery at Bristol Royal Infirmary. System abuse is the most difficult to define but concerns the way in which child health services fail to meet the needs of children. Recent reports have highlighted inadequate services for children and young people, lack of priority given to children's services, and geographical inequalities in the provision of services. Three crucial aspects in safeguarding children from abuse are highlighted: listening to children; the selection support and training of staff; and external systems of inspection, monitoring and standards. The recent British government agenda which has placed quality at the centre of National Health Service (NHS) developments are discussed. Only by addressing the abuse of children in hospital openly and honestly will effective child protection be possible.