Clinical Pharmacy: Definition, Scope and Activities

Clinical Pharmacy
Definition, Scope and

Activities
Definition
A health specialty in pharmacy which through

skills, activities and services provided to patients
and healthcare professionals promotes the safe,
effective and economic use of medicines.
Develops and promotes for the rational and

appropriate use of medicinal products and devices.
Hospitals, community pharmacies, nursing homes,
home – based care services, clinics – all the settings
where medicines are prescribed and used (OTC included).
Services and Scope–

Also known as clinical pharmacist practitioner provides
drug therapy management under the supervision of a
licensed physician who provides the written prescription
for the patients.
The drug therapy management includes – ordering,
changing, substituting therapies or ordering tests.

Functions
• Communication with healthcare professionals and patients regarding drug
therapy, wellness, and health promotion.
- Designing or modifying drug therapy, implementing, monitoring for rational
drug therapy.
- Counseling patients – disease condition; purpose, uses, effects of medication;
monitoring use of OTC, herbals or alternative medicine; use of administering
devices.
• Using the clinical data for optimization of therapy.
• Documentation of interventions and evaluate the outcomes.
• Training and education progs for all the healthcare practitioners and general
public.
Three levels - Before, during and after
prescription.
1. Before the prescription:

• Clinical trials
• Formulary preparation
• Drug information
• Clinical trials- Ethical committee
participation; study monitoring;
dispensation and preparation of
investigational drugs.
- Decisions on which drug deserve to be

marketed.
• Formularies- Inclusion of drug in the
national and local formularies.
2. During the prescription:
• Influence attitudes and priorities of
prescribers for rational therapy.
• Monitors, detects and prevents harmful drug
interaction, ADRs and medication errors
through prescription evaluation (case sheet
review).
• Therapeutic drug monitoring.
• Direct decisions in case of drug selection in
the over the counter medications.
3. After the prescription:
• Counselling.
• Preparation of personalized formulation viz;
unit dose, I.V preparations, investigational
drugs, etc.
• Drug use evaluation.
• Outcome research.
• Pharmacoeconomics studies.
• Check and improve the patients’ compliance
with their medications.
Activities of Clinical Pharmacists
• Patient interview
• Case-note review
• Medication chart review
• Ward round participation
• Patient counseling
• Therapeutic drug monitoring
• ADR monitoring
• Drug utilization evaluation
Patient Interview
• Carried out on a daily basis.
• Aim: Patients’ past medical history, past
medication history, social habits, allergies are
assessed.
• Important inputs given to the attending
physician that aid in the planning the present
therapeutic regimen.
• Compliance of patient is assessed.
Case note review
Involves:
• Review of patients clinical progress notes
• Discussion with other members of the health team
• Discussion with the patient
Information obtained evaluated for

• The clinical and pathophysiological condition treated
• Time frame of drug related effects
• The planned outcome of treatment
• Indication of an investigation and its need
Ward Round Participation
• Ward rounds with consultants/specialists
• Multi-disciplinary approach
• Medical and pharmacy students often present
Aim is to:
• Be present when prescribing decisions are made
• Provide information and advice relevant to
patients’ drug therapy – drug related reactions or
ADR
• Improve pharmacist’s own understanding of
therapy objectives
Medication Chart Review
• Correct patient identification
• Legibility of drug orders, generic name use,
dose
• Appropriate drug, dosage, route of
administration and duration of therapy
• Allergy documentation
• Additional directions for administration
• Drug interactions and duplications
• Legal requirements
Patient Counseling
• During admission and discharge
• May need to involve patient’s family
• Aim is that every patient should leave hospital knowing what
their medications are for and how to take them
• Compliance aids may be required eg. Written instructions,
medicine measures, tablet cutters
Attention to patients:
• With serious/unstable disease states
• Chronic diseases
• Co morbidities (mainly renal/hepatic) and multiple drugs
• Narrow therapeutic index drugs
• Special populations: Elderly, Paediatric , Pregnant, Lactating
mother
• Non-intentional non-compliers
Therapeutic Drug Monitoring
• Drugs with a narrow therapeutic index
Eg: Digoxin, theophylline, lithium, gentamicin, phenytoin etc.

• Drugs with a high incidence of adverse effects
• Difficult to define the therapeutic endpoint.
• Drugs associated with clinically significant interactions

• Diseases requiring constant monitoring (hepatic/renal
impairment, diabetes, obesity, burns, cystic fibrosis etc)
Education and Clinical Pharmacy
One of clinical pharmacist’s main roles
• Patient education
• Education of staff and students
• Informal or formal meetings, lectures
• Guidelines and protocols
• Newsletter
Activities of Clinical Pharmacy Department at the
Government Head Quarters Hospital, Ooty
Patient care
Education
• Ward
Clinicalround participation
Pharmacy newsletter
• Treatment chart review
Pharmacy Education
• Patient
Nursingcounseling
Education
Patient Education
• Poison information
• Adverse drug reaction monitoring
• Therapeutic drug monitoring
Limitations
• India scenario
Clinical pharmacy services not recognized in
the Indian hospitals.
Even Regulatory frameworks/guidelines
does not recognize the need of clinical
pharmacist.
• Migration of the CP to the industries or
other countries.
• Lack of industry oriented topics in
curriculum.

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Clinical Pharmacy

Definition, Scope and

A health specialty in pharmacy which through

Develops and promotes for the rational and

home – based care services, clinics – all the settings

where medicines are prescribed and used (OTC included).

Services and Scope–

drug therapy management under the supervision of a

licensed physician who provides the written prescription

for the patients.

The drug therapy management includes – ordering,

changing, substituting therapies or ordering tests.

• Communication with healthcare professionals and patients regarding drug

therapy, wellness, and health promotion.

- Designing or modifying drug therapy, implementing, monitoring for rational

- Counseling patients – disease condition; purpose, uses, effects of medication;

monitoring use of OTC, herbals or alternative medicine; use of administering

• Using the clinical data for optimization of therapy.

• Documentation of interventions and evaluate the outcomes.

1. Before the prescription:

- Decisions on which drug deserve to be

Information obtained evaluated for

Eg: Digoxin, theophylline, lithium, gentamicin, phenytoin etc.

• Drugs associated with clinically significant interactions

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