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The Primary Goal Of The On-site Pharmacy Department At Any Large Acute Hospital Is To Guarantee That Patients May Get The Appropriate Medication At The Appropriate Time Via A System That Is Both Effective And Cost-effective. The Majority Of Chemists Today Agree That Their Role Has Expanded To Include Using Their Knowledge Of Pharmaceuticals To Help Maximise Drug Efficacy And Reduce Drug Toxicity . The Practise Of Clinical Pharmacy Is Characterised By Chemists’ Concern For The Outcome Of Treatment In A Particular Patient, Which Has Grown In The Uk Over The Past Thirty Years. This Concern Has Given Rise To The Concept Of Pharmaceutical Care , Which Describes The Role Of The Pharmacist In Patient Care.
The Diversity Of Pharmacy Practise Generally Seen Across Our Hospitals Is Reflected In The Fact That Clinical Pharmacy Is Not Practised In A Uniform Manner In Uk Hospitals. For Instance, There Are Differences In The Input That Pharmacists Have On Patient Care. In Certain Hospitals, Ward-based Pharmacists Serve As Important Members Of The Clinical Team, While In Others, A Pharmacist May Visit The Wards Irregularly  To Review Medication Records And Advance Formulary Policies.
This Lack Of Consistency Pertains Not Just To Clinical Pharmacy But Also To Almost All Aspects Of Pharmacy Services, Including Intravenous Additive Services, Discharge Planning Services, And Many Others. This Diversity Has Been Allowed To Flourish Since There Is No Central Authority Within The Profession Or The Department Of Health. The Services Offered By Each Major Hospital Have Evolved In A Manner Favoured By Its Pharmacy Staff. Strong Leaders Have Developed Their Own Service Philosophies That Range From Patient-oriented To Supply-oriented. They Have Often Shown More Interest In Promoting The Hospital’s Pharmacy Than In Informing Their Coworkers About Service Improvements. This Means That Any Patient Benefits From New Service Delivery Methods Developed In One Hospital Could Not Be Felt Right Away By Other Pharmacy Departments. If Pharmacists Adopted A More Open Approach To Disseminating And Promoting Developments, The Implementation Of Evidence-based Improvements In Pharmacy Practise May Be Sped Up.
The Work Of Two Chemists Led To The Development Of Clinical Pharmacy Practise In The Uk. In Aberdeen, Graham Calder  Pioneered A New Position For Chemists On Hospital Wards. To Ensure Safe Prescribing, They Started Reviewing The Medication Orders On The Wards Here. John Baker, Based At Westminster Hospital, Introduced The Formulary Concept And Created The Role Of The Pharmacist As A Part Of The Prescribing System At The Same Time Period, The Late 1960s . Throughout The 1960s And 1970s, Several More Hospitals Adopted These Significant Modifications To Pharmacy Practise. The Pharmacist’s Presence On The Ward Was The Revolutionary Aspect Of These Developments. This Made It Possible For Certain Pharmacy Professionals To Participate Actively In The Clinical Team, A Practise That Is Now Widespread. Cousins & Luscombe Have Provided A Detailed Account Of The Evolution Of Clinical Pharmacy From Ward Pharmacy .
Because They Have The Necessary Therapeutic Knowledge And Often Interact With Prescribers, Clinical Chemists Are In A Position To Influence Hospital Doctors’ Prescribing. Two Main Strategies Have Been Used By Hospitals To Influence Prescribing. These Include The Creation Of Hospital Policies On The Prescription Process And The Post-graduate Training Of Certain Chemists To Enhance Their Therapeutic Skills And Clinical Process Knowledge.
The Majority Of Hospitals Have A Hospital Formulary And A Statement Of Prescribing Policy That Permits The Use Of Approved Names Rather Than Brand Names When Writing Prescriptions. It Has Been Shown That Formularies Enhance Prescribing And Cut Costs. A Working Group Of The Drug & Therapeutics Committee Was Charged With Producing A Formulary At St James’ Hospital, Leeds . It Was The Responsibility Of The Clinical Pharmacy Service To Make Sure That Prescribing Complied With These Formulary Recommendations. After Many Years Of Overspending On Drugs, The Implementation Of The Formulary Policy Led To An Underspend. When A Limited Drugs List Was Implemented At A London Teaching Hospital, Baker And Others Reported A Similar Experience . They Discovered That Between 1978 And 1985, Drug Expenditures Decreased Consistently, Which They Attributed To The Implementation Of A Policy On The Use Of Medications. The Policy’s Use Of Clinical Pharmacists To Monitor Compliance With The Agreed Selection Of Medicines Was A Key Component. This Process Included Ongoing Conversations Between Prescribers And Chemists Who Encouraged Prescribers To Do Their Own Self-evaluations And Peer Reviews. Implementing A Restricted Drugs Policy Has Also Been Found To Be A Successful Method Of Limiting The Adoption Of New Drugs . In The 1980s, The Majority Of Large Hospitals Published Formularies . Multiple Issues With The Implementation Of The Formulary Process Were Discovered In A Report On The Implementation Of Hospital Formularies In 1986 . These Included A Lack Of Adaptability, Infrequent Updates, And A Lack Of Feedback To Prescribers On Drug Use.
Despite These Worries, The Government Supported The Formulary Approach To Controlling Drug Spending In 1988 . A Health Circular Sent To All Hospital Managers In 1988 Outlined The Goals Of A Formulary Management System. To Provide Good Value For Money From Medicines, They Were Advised To Implement Clinical Pharmacy Services. To “Control Access To Drugs, To Audit Prescribing, And To Maximise Clinical Benefit To Patient At Least Cost” Were Identified As The Three Main Benefits.
The Pharmacy Profession Believed That It Was Their Duty To Promote The Formulary Approach . And As Part Of Their Training, Clinical Pharmacists Who Are Supported By Drug Information Pharmacists Have Used Them As A Teaching Tool For Junior Doctors.
The Development Of Information Systems That Provide Details On Drug Use By Prescribers Inside The Hospital Has Aided In The Audit Of The Impact Of Formularies . A Lengthy Study Reported By Feely  Shown The Need Of A Continuous Reinforcement Of The Formulary Message By An Active Sales Staff, Clinical Chemists.
This Investigation Was Conducted At Two Hospitals In Ireland. Clinical Pharmacologists And Chemists Actively Promoted And Actively Marketed The Introduction Of A Hospital Formulary At One Facility. Without Any Active Promotion, A Similar Formulary Was Introduced At A Second Hospital.
Prospectively, The Effects Of The Formularies In The Two Hospitals Were Compared With Regard To The Cost Of Drugs And The Calibre Of Prescribing. Feedback On Prescribing Practise, Peer Comparisons, And Drug Information Were The Interventions Used At The Hospital With Active Promotion.
Drug Prices Remained Constant Throughout The Intervention Period, Although The Prescription Of Generic Drugs Rose And Third-generation Cephalosporins Were Used Less Inappropriately. Drug Costs Rose During The Same Time Period In The Comparative Hospital With The Same Formulary But No Interventions.
The Improvements In Prescribing Were Not Maintained And Drug Costs Rose During The Third Year Of The Study, When No Interventions Were Implemented In Either Hospital. Because Chemists Serve As The “In-house” Sales Force And Are In Direct Competition With The Pharmaceutical Industry, The Results Highlight The Need For Ongoing Reinforcement Of The Promotional Messages Required To Establish Good Prescribing Practise.
|1.||Hospital PharmacyDefinition, scope, national and international scenarioOrganizational structureProfessional responsibilities, Qualification and experience requirements, job specifications, workload requirements and inter-professional relationshipsGood Pharmacy Practice (GPP) in hospitalHospital Pharmacy Standards (FIP Basel Statements, AHSP)Introduction to NAQS guidelines and NABH Accreditation and Role of Pharmacists||6|
|2.||Different Committees in the HospitalPharmacy and Therapeutics Committee – Objectives, Composition, and functionsHospital Formulary – Definition, procedure for development and use of hospital formularyInfection Control Committee – Role of Pharmacist in preventing Antimicrobial Resistance||4|
|3.||Supply Chain and Inventory ControlPreparation of Drug lists – High Risk drugs, Emergency drugs, Schedule H1 drugs, NDPS drugs, reserved antibioticsProcedures of Drug Purchases – Drug selection, short term, long term, and tender/e-tender process, quotations, etc.Inventory control techniques: Economic Order Quantity, Reorder Quantity Level, Inventory Turnover etc.Inventory Management of Central Drug Store – Storage conditions, Methods of storage, Distribution, Maintaining Cold Chain, Devices used for cold storage (Refrigerator, ILR, Walk-in-Cold rooms)FEFO, FIFO methodsExpiry drug removal and handling, and disposal. Disposal of Narcotics, cytotoxic drugsDocumentation – purchase and inventory||14|
|4.||Drug DistributionDrug distribution (in- patients and out – patients) – Definition, advantages and disadvantages of individual prescription order method, Floor Stock Method, Unit Dose Drug Distribution Method, Drug Basket Method.Distribution of drugs to ICCU/ICU/NICU/Emergency wards.Automated drug dispensing systems and devicesDistribution of Narcotic and Psychotropic substances and their storage||7|
|5.||Compounding in Hospitals. Bulk compounding, IV admixture services and incompatibilities, Total parenteral nutrition||4|
|6.||Radio Pharmaceuticals – Storage, dispensing and disposal of radiopharmaceuticals||2|
|7.||Application of Computers in Hospital Pharmacy Practice, Electronic health records, Softwares used in hospital pharmacy||2|
|8.||Clinical Pharmacy: Definition, scope, and development – in India and other countriesTechnical definitions, common terminologies used in clinical settings and their significance such as Paediatrics, Geriatric,Anti-natal Care, Post-natal Care, etc.Daily Activities of Clinical Pharmacists: Definition, goal, and procedure ofWard round participationTreatment chart reviewAdverse drug reaction monitoringDrug information and poisons informationMedication historyPatient counsellingInterprofessional collaborationPharmaceutical Care: Definition, classification of drug related problems. Principles and procedure to provide pharmaceutical CareMedication Therapy Management, Home Medication Review||12|
|9||Clinical Laboratory Tests used in the evaluation of diseasestates – significance and interpretation of test resultsHaematological, Liver function, Renal function, thyroid function testsTests associated with cardiac disordersFluid and electrolyte balancePulmonary Function Tests||10|
|10||Poisoning: Types of poisoning: Clinical manifestations and AntidotesDrugs and Poison Information Centre and their services –Definition, Requirements, Information resources with examples, and their advantages and disadvantages||6|
|11||PharmacovigilanceDefinition, aim and scopeOverview of Pharmacovigilance||2|
|12||Medication Errors: Definition, types, consequences, and strategies to minimize medication errors, LASA drugs and Tallman lettering as per ISMPDrug Interactions: Definition, types, clinical significance of drug interactions||6|
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