community pharmacy

Actions of community pharmacists in society Procurement of medicines that are suitable for human consumption Storage of medicines in appropriate conditions (temperature, humidity, cleanliness, stock monitoring)

Dispensing of medicines chosen by patient or as pharmacist-recommended products or on presentation of a prescription Compounding and ensuring quality of compounded products

Patient medication review, advise patients on use of medicines and participate in adverse drug reaction reporting Ensuring rational and safe use of medicines by patients, developing care plans and collaborating with prescribers to establish a therapeutic plan, implement it and monitor patient outcomes

Monitoring of self-care, responding to symptoms and identifying cases warranting referral Point-of-care testing Health promotion and promotion of healthy lifestyles (nutrition, physical activity, smoking cessation)

Ensuring safe disposal of unwanted or expired Medicines Participating in national health service schemes to provide social pharmacy services

Other responsibilities: nutritional supplements, special foods (e.g. food for diabetic people)disability and mobility aids (e.g. wheelchairs, walking aids), oxygen supplies and ventilation equipment, veterinary medicines.

Organisation of a community Pharmacy Personnel present: managing pharmacist, pharmacists, pharmacy technicians, sales personnel. Staff management includes 1. identifying training needs and providing appropriate training, 2. management to develop a team approach, 3. continuing professional development of professional personnel

Premises: areas available for dispensing, storage of medicines, patient counselling, health promotion Equipment: dispensing equipment, diagnostic equipment for point-of-care testing (e.g. blood pressure measurement, blood testing, urinalysis)

Documentation and information: registers to be kept at the pharmacy, IT-supported systems for documentation of pharmacist actions and for maintaining pharmacy patient profiles, drug information sources (books and electronic access).

Dispensary area Area should be spacious and designed in such a way as to promote communication between pharmacist and patient. Space should be available for patient advice and counselling in privacy. Consultation areas should provide for space to carry out point-of-care testing.

Adequate facilities for dispensing must be provided – cleanable floor and surfaces, adequate fixtures and fittings, clean refrigerator with appropriate temperature monitoring and control, clean sink, logical layout of stock and a natural workflow.

Storage of medicines Sufficient storage space to store medicines in a dry place Temperature control of areas where medicines are stored Prescription-only medicines not accessible to the public Area available to store medicines that require controlled access Stock rotation, monitoring of expiry dates and systems to ensure that medicines are not damaged Pricing

Legislation Pharmacists practising at the pharmacy are registered with a registering body. Process of community pharmacy practice is controlled by legislation.

Legislation classifies medicines according to:  category of medicines that may be sold from other outlets (such as drugstores) not only pharmacies (e.g. general sales list, in countries where this is permitted)  category of medicines that may be sold after being recommended by pharmacists (over the counter drugs).  category of medicines that require a prescription

 category of medicines that are controlled (e.g. buprenorphine, diamorphine, fentanyl, methadone). Pharmacy services must be available for 24 hours, 7 days a week. Rosters are issued for night- time service and for service on Friday and public holidays.

Clinical governance Clinical governance relates to a commitment to continuously improve the quality of professional services provided and maintain standards of practice. It involves development of 1.quality standards 2.audit 3. training and development of personnel 4. staff management 5. monitoring of clinical effectiveness.

Quality standards include the development of standard operating procedures for processes that are carried out in a community pharmacy and the implementation of audit processes

Provision of patient-focused services from community pharmacies Repeat dispensing: pharmacists dispense medicines as a repeat prescription as directed by prescriber. Supplementary pharmacist prescribing: pharmacist prescribes medicines according to an agreed protocol with prescriber.

Pharmacist prescribing: pharmacist may prescribe medicines that are designated as pharmacist prescription drugs as long as he or she has the required competency to do so (competency is based on pharmacist skills and patient characteristics presented).

Electronic transmission of prescriptions from prescriber or secondary care interface to community pharmacy. Electronic patient records: pharmacy keeps patient records which are treated as confidential and where access is limited to authorised staff.

Through these records the pharmacy has a history of medicines that are taken by the patient and other relevant data. These data may be shared with prescribers and with secondary care interfaces. Medicines management services: pharmacist medication review, medicines use review, chronic medication monitoring.

Pharmacist consulting rooms: where patients can discuss their health issues and drug therapy issues with pharmacists in privacy. Provision of enhanced services (e.g. preparation of extemporaneous preparations which require a dedicated area that is run according to established quality systems), dispensing of special items (e.g. gluten-free food) and provision of home deliveries.

Practice summary Community pharmacy practice requires management skills and involves continuing education and development of personnel. Setting up and maintaining a community pharmacy requires consideration of physical aspects of storage and handling of medicines as well as quality aspects.

Documentation of processes carried out in the pharmacy is essential. Quality systems are required to ensure good standards and to promote the value of patient-focused services offered from community pharmacies. The development of patient-focused pharmacy services and the orientation of pharmacist actions towards individual patient care enhance the practice of pharmaceutical care in the community.

Community pharmacy practice should be undertaken in collaboration with other health professionals and with pharmacy institutions in other settings to ensure Continuous care as the patient is transferred from one setting to another.

True or False nutritional supplements is the Responsibility of nurse not pharmacist ( T or F ) pharmacy keeps patient records which are treated as confidential and where access is limited to authorised staff ( T or F )

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Quiz next week 5 Marks 20 minutes Last 4 lectures (including this one) 2 T & F questions (with correction) 2 multiple choice questions. 1 short answer question! BE ON TIME!! ABSENTEES WILL NOT RETAKE THE QUIZ!