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Decentralized Pharmacy Services PHCL 471 Nouf Aloudah.

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Presentation on theme: "Decentralized Pharmacy Services PHCL 471 Nouf Aloudah."— Presentation transcript:

1 Decentralized Pharmacy Services PHCL 471 Nouf Aloudah

2 Decentralized Pharmacy Services Hospital pharmacy departments are responsible for the safe and effective use of drugs and drug products within the institution Pharmacy personnel perform functions that relate to drug distribution and drug information in striving toward this objective Decentralized pharmacy services have proven over long period of time to be an important action plan to achieve safe and effective use of drugs for patients 2

3 Decentralized Pharmacy Services Since the mid 1960s, hospital pharmacy services have evolved to meet these needs, frequently by decentralizing operations and staff in order to provide clinical services and more efficient and less error prone medication system A decentralized pharmacy is an area located in the patient care parts of a hospital from which pharmacy personnel work and provide pharmacist clinical services and drug distribution service 3

4 Decentralized Pharmacy Services Hospital pharmacies historically have been centralized departments A s hospital increased in size from bed facilities to bed institutions, there has been a tendency to locate the central pharmacy away from inpatient care areas Decentralized pharmacies have been an effective method for bringing pharmacy services closer to the patients and professional staff 4

5 Decentralized Pharmacy Services The safe and effective use of drugs requires clinically competent pharmacist, system, and services to deal with all patient care areas in cooperation with physician and nurses A decentralized service component maximize pharmacists communications and contributions to the professional staffs and the patient 5

6 Decentralized Pharmacy Services A completely decentralized pharmacy staff puts pharmacists and drug close to the end users and facilitates the provision of necessary drugs and drug information in an effective manner The rationale for providing proactive pharmaceutical services is discussed today in conjunction with the alternative centralized and decentralized approaches to providing these services 6

7 Decentralized Pharmacy Services Patient needs Nurse needs Physician needs And pharmacy needs 7

8 Decentralized Pharmacy Services Patient needs Hospital medication system have been reported to have an 8-20 % medication error rate Medication errors are defined as wrong patient, wrong drug, wrong dose, wrong route and wrong time 8

9 Decentralized Pharmacy Services Patient needs Complications in patients resulting from drug use are 1. Adverse drug reaction, 5-30% of patients 2. Prolonged hospitalization from adverse drug reaction 3. Drug modifying laboratory tests 4. Drug inducing blood dyspraxia 5. Drugs affecting liver function tests 6. And drug interaction and teratology 9

10 Decentralized Pharmacy Services Patient needs Medication prescribing errors with regard to safe or effective dosage regimens, ambiguous and incomplete orders, inadequate laboratory test monitoring, and misinterpretation of meaning of serum drug level have been reported 10

11 Decentralized Pharmacy Services Patient needs Pharmacist dispensing from a central pharmacy has resulted in a high rate errors Prolonged delays in receiving initial doses Significant drug complications Extended hospital stays Increased expense New drugs and drug delivery system technologies will be more complicated and more potent with high risks of toxicity 11

12 Decentralized Pharmacy Services Nursing needs Plays a major role in the hospital medication system The nurse may order drugs from the pharmacy, prepare and reconstitute doses for administration, administer medications, record each drug administered, keep additional records for the controlled drug received and administered, and maintain drug floorstock Without adequate pharmacy support, the nurse would have to be knowledgeable about drug storage, dosage forms and strengths, the effect of each drug administered, and the safety of drugs IV administered….. As a result a great deal of nursing time is required for medication related activities! 12

13 Decentralized Pharmacy Services Nursing needs Generic drug names, therapeutic interchange of drug products, variable dosage depending upon the drugs salt form, more dangerous drugs such as oncology agents …. just examples of continuing area of confusion and potential errors! Registered nurse shortage, high staff turnover … make it very difficult to maintain a consistently experienced and a drug knowledgeable nursing staff 13

14 Decentralized Pharmacy Services Nursing needs A centralized pharmacy services frequently leads to many unanswered drug related questions by a busy nurse A decentralized pharmacy service more readily provides the drug related activities and drug information support to the nurse when needed 14

15 Decentralized Pharmacy Services Physician needs The physician diagnoses the patient medical problem and then prescribe a plan of therapy The prescribing of drugs is frequently a critical aspect of inpatient care Drug complications illustrate the physicians need for general and specific clinical drug information Pharmacist can reduce costly drug reactions and quicken the discharge of the patient from a hospital 15

16 Decentralized Pharmacy Services Physician needs Medical services representatives, Physician Desk Reference, journal articles, textbooks, drug data, professional conferences are the usual sources of physician drug information Theses sources are inadequate in meeting when it relates to complex patients with multiple healthcare problems and multiple drug regimens Pharmacist who practice in patient care areas can provide clinical drug knowledge and experience to help physician mange their patients drug therapy 16

17 Decentralized Pharmacy Services Pharmacist needs In centralized pharmacy the time is devoted to dispensing duties, professional relationship with the nurse, physician and others are limited In decentralized environments: the pharmacist is able to relate directly to a patents drug therapy needs as a result of easy access to the patient, nurse, physician Initial doses for new order can be provided quickly Drug information questions can be answered quickly Pharmacist can develop expertise for particular patient areas… and more! 17

18 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Pharmacist practicing in hospitals have been active in developing new pharmaceutical services and systems (unit dose distribution system, patient medication profile, drug information services, pharmacist participating in patient care areas, clinical pharmacokinetics) directed toward reducing the problems associated with drug use 18

19 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Characteristic of a pharmacist clinical practice in decentralized pharmacy are: Patient care round Participating in teaching rounds by providing drug information upon physician request or by pharmacist initiation which usually result in improving in the patient\s treatment plan 19

20 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Characteristic of a pharmacist clinical practice in decentralized pharmacy are: Patient interviews Drug history information that obtained orally Prescription and OTC drugs, drug allergy, attitude about drug as to which worked or did not work Previous patient drug therapy problems, attitude and misconceptions as to what drugs worked or did not work are identified 20

21 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Characteristic of a pharmacist clinical practice in decentralized pharmacy are: Patient medication therapy monitoring Safe and effective drug therapy is determined by reviewing medication charts Drug administered, pertinent laboratory tests, and patients diagnosis and medical condition Changes in drug therapy, actual and potential drug therapy problems are communicated to the physician 21

22 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Characteristic of a pharmacist clinical practice in decentralized pharmacy are: Physician inquiry Physician initiated and general drug information questions are answered by the pharmacist 22

23 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Characteristic of a pharmacist clinical practice in decentralized pharmacy are: Nurse Inquiry Nurse initiated questions about patient drug therapy, general drug information, and drug orders are answered by the pharmacist 23

24 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Characteristic of a pharmacist clinical practice in decentralized pharmacy are: Drug Information The physician and pharmacist initiate a drug information questions involving a patients drug therapy problems requiring a search of the available literature for information in order to provide a response The answer should result in safer and more effective drug therapy 24

25 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Characteristic of a pharmacist clinical practice in decentralized pharmacy are: Cardiopulmonary Arrest Emergency Participation The pharmacist is a member of the hospitals cardiopulmonary resuscitation team and participates by providing drug therapy assistance and the needed drugs 25

26 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Characteristic of a pharmacist clinical practice in decentralized pharmacy are: Pharmacist regulated drug therapy services Special services such as anticoagulation, dosing of drugs in patients with compromised renal status, drugs affecting the blood and liver, amioglycoside dosing, pain control, nutrition support, and aminophyllin therapies 26

27 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Characteristic of a pharmacist clinical practice in decentralized pharmacy are: Clinical pharmacokinetics Schedules the appropriate time for drug levels to help ensure that test results are usable. Consultation services using the serum drug level and kinetic knowledge can be provided to modify the dose and/or dosing interval to prevent toxicity and ensure therapeutic efficacy 27

28 Decentralized Pharmacy Services Services And Expected Patient Benefits Of A Decentralized Pharmacy Characteristic of a pharmacist clinical practice in decentralized pharmacy are: Drug usage evaluation Special drug case studies are conducted and educational programs provided to the medical, nursing, and pharmacy staff by the pharmacist Targeted incorrect and inappropriate drug prescription of physician should be corrected via educational programs Cost and cost reductions of drug therapy can be defined and documented 28

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30 Decentralized Pharmacy Services Pharmacist performance characteristics Pharmacists who practice in a decentralized pharmacy environment are able to greatly expand their professional knowledge ad skills in the areas of patient service, teaching, and research bec. Of the greater opportunities for clinical experience To be successful: Commitment to high standard patient care services Clinical knowledge and skills Commitment to lifelong learning Initiative; self accountability and productivity Specialization or concentration of time and energy into selected areas of clinical drug use 30

31 Decentralized Pharmacy Services What departmental organizational plan or structure is the most effective in providing services to meet patient, nurse, and physical drug related needs? Drug distribution system that maximize the use of nonpharmacists in the inpatient drug distribution system of the hospital Unit dose system are more just providing double checks, reducing medication errors and eliminating the drug waste seen in multiple dose systems, it allows the pharmacist to delegate many of the nonprofessional drug distribution tasks to technician and still maintain the necessary responsibility and supervision, that resulted in more pharmacist time for clinical services Patient drug profiles associated with unit dose system also can provide a record that become the basis for the pharmacists patient drug therapy monitoring system 31

32 Decentralized Pharmacy Services Advantages and disadvantages of a decentralized pharmacy services? Pharmacy departments are usually referred to as either centralized or decentralized this is oversimplification, because most decentralized pharmacy departments are a mix of centralized and decentralized functions Decentralized pharmacies frequently differ considerably in exactly what is decentralized and how The way services are provided may also vary from shift to shift, from weekday to weekend 32

33 Decentralized Pharmacy Services Advantages and disadvantages of a decentralized pharmacy services? Functions are New order review by the pharmacist First dose preparation Unit dose preparation of ongoing orders Unit dose checking by the pharmacist or trained technician IV order review by the pharmacist IV order preparation including admixture and total parenteral nutrition IV piggy back (PB) order reconstitution IVPB order review by the pharmacist IVPB order distribution to the patient Prescription filing for discharge and special inpatients Unit dose packaging 33

34 Decentralized Pharmacy Services Advantages and disadvantages of a decentralized pharmacy services? Functions are (cont) PK consults by the pharmacist Drug level order/or scheduling by the pharmacist Drug information questions directed to the pharmacist Responses to drug information questions Nonformulary drug request follow-up by the pharmacist Pharmacist –patient interviewing as needed Drug therapy regulation by the pharmacist Drug therapy monitoring by the pharmacist ADR monitoring by the pharmacist Pharmacy charge processing 34

35 Decentralized Pharmacy Services Advantages and disadvantages of a decentralized pharmacy services? These functions: some must be done by the pharmacist, others by technician or clerk Some requires the pharmacist to be outside the pharmacy Some nonpharmacist activities requires immediate supervision others not 35

36 Decentralized Pharmacy Services Advantages and disadvantages of a decentralized pharmacy services? What is the scope of the pharmacy services? What and when? 36

37 Decentralized Pharmacy Services Advantages of a decentralized pharmacy services 1. Drugs are immediately available for administration to the patient 2. Drug control and accountability are greater 3. Pharmacist communicate directly to the nurse and physician 4. There is more space for the pharmacy as a whole and flexibility in reallocating or designing existing space in the central pharmacy 5. Unique drug distribution systems are implemented to issue drugs to the nurse 37

38 Decentralized Pharmacy Services Advantages of a decentralized pharmacy services 6. Pharmacist review of the chart or talk with the patient is efficient 7. Drug information from the pharmacist is readily available to physician and nurses 8. Nursing time is reduced in drug distribution bec. More tasks are being performed by pharmacy personnel 9. Pharmacist drug therapy specialization by patient care area is accomplished more effectively as a result of focused clinical experience 10. Specialized pharmacist clinical services can be developed and efficiently provided 11. Pharmacists more readily perform clinical drug research and patient drug therapy quality assessment studies 38

39 Decentralized Pharmacy Services disadvantages of a decentralized pharmacy services 1. All clinical practice pharmacies must become proficient as supervision to work effectively with technicians 2. Pharmacist are usually responsible for both drug distribution and clinical services 3. Staffing flexibility id reduced when only one pharmacist with or without a technician is providing all inpatient pharmacy services for a specific patient car area when census level are significantly above or below normal 4. Unrealistic expectation from nursing and physician and excessive interruptions off the pharmacist and /or technician can reduce efficiency 5. Drug inventory control within the department is more complex because of multiple pharmacy location for the same drug, particularity infrequently prescribed drugs 39

40 Decentralized Pharmacy Services disadvantages of a decentralized pharmacy services 6. Communications within the pharmacy department are more difficult bec. the staff member practice in multiple physical location 7. More equipment is required 8. Patient acuity and resulting drug distribution work load may exceed the capacity of space and personnel in the small decentralized pharmacy units 9. Use of technology to automate and mechanize the drug distribution system component of pharmacy service will require more hardware and software 40

41 Decentralized Pharmacy Services Relative cost of a decentralized and decentralized pharmacy service Cost is very impartment part in hospital decision Cost is either patient benefits such as reduction in mortality, morbidity, and hospital patient days Also it is the equipment, facilities, and personnel 41

42 Decentralized Pharmacy Services Relative cost of a decentralized and decentralized pharmacy service Equipment and facilities Space, size, computer system Personnel Comparisons such as Centralized pharmacy services personnel cost per patient day and decentralized pharmacy services personnel cost per patient day and other can help 42

43 Decentralized Pharmacy Services Forces that interfere with decentralized pharmacy service Attitude ad behavior Pharmacy department Pharmacy time for information functions Legal requirements 43

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45 Any volunteers! Assignments Dermal fillers (previous lecture) Medication therapy management (MTM) programs Best Wishes! 45


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