Clinical Pharmacy Concepts and Interprofessional Relationship

What is Clinical pharmacy?

Clinical pharmacy may be defined as the science and practice of rationale use of medications, where the pharmacists are more oriented towards the patient care rationalizing medication therapy, promoting health , wellness of people. It is the modern and extended field of pharmacy.
It is also a discipline that embodies the application and development (by pharmacist) of scientific principles of pharmacology, toxicology, therapeutics, and clinical pharmacokinetics, pharmacoeconomics, pharmacogenomics and other allied sciences for the care of patients.( American college of clinical pharmacy).
Clinical pharmacy in the academic arena is that area within the pharmacy curriculum dealing with patient care, with particular emphasis on drug therapy. In practice, clinical pharmacy is patient- oriented and includes not only the dispensing of the required medications, both prescribed and patient selected. Also the pharmacist gives information to the physicians and other health professionals on all matters pertaining to drugs and their dosage forms. It is the philosophy of safe, and appropriate drug usage in patients.

Functions of Clinical Pharmacists

Therapeutic drug monitoring: Monitor drug therapy for safety and efficacy.
Drug information– Provides drug information to doctors, health professionals, public and patients.
Medication errors– Medication-related Problems• Untreated indications, Improper drug selection, Subtherapeutic dosage, Medication Failure to receive, Medication Overdosage, Adverse drug reactions, Drug interactions, Medication use without indication.
Patient drug profiles– Interview patients for drug history and counseling.
Teaches in pharmacy and medical schools.
Conducts clinical research
Recommends treatments for mild and limiting diseases,

Many specialized clinical services are available now but not limited to general surgery, ambulatory care, solid organ transplantation, pediatric and adult oncology and hematology, nephrology, pediatrics, infectious disease, internal medicine, adult surgical/medical ICU, neonatology/pediatric ICU, cardiology, pharmacokinetics, parenteral nutrition, pain management, therapeutic drug monitoring, drug information, anticoagulation services, and investigational drugs services.

Clinical pharmacy

Clinical pharmacy comprises a set of functions that promote the safe, effective and economic use of medicines for individual patients. Clinical pharmacy process requires the application of specific knowledge of pharmacology, pharmacokinetics, pharmaceutics and therapeutics to patient care

Pharmaceutical care

The need to focus on outcomes of medicines use rather than dwelling only on the functions of clinical pharmacy became apparent. Hepler and Strand, 1990 defined pharmaceutical care as the ‘responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life’.
Also pharmaceutical care is a co-operative, patient-centred system for achieving specific and positive patient outcomes from the responsible provision of medicines. The practice of clinical pharmacy is an essential component in the delivery of pharmaceutical care.

Definitions of Clinical Pharmacy and Pharmaceutical Care

The two ideas of clinical pharmacy and pharmaceutical care are firmly related. Of the two, the clinical pharmacy has been around the longest and the term is broadly utilized. Curiously, a drug specialist is not a part of this definition, and in principle, any health care expert could give pharmaceutical care unlike clinical pharmacy. Hepler around then was hospital clinical pharmacist, based at the college. Be that as it may, Strand later deﬁned pharmaceutical care as a style of pharmacy practice with the patient at the center, and she focuses on community pharmacy.
The principle contrast between the two ideas is the beneficiary; in clinical pharmacy, the doctors are the essential common beneficiary. He gets all the data about the utilisation of the drugs from the pharmacist; though from the pharmaceutical care point of view, the patient is the fundamental recipient of the pharmacist decisions and behaviours.
Also clinical pharmacy is not synonymous with a hospital pharmacy. There are two purposes behind this. To begin with, the hospital pharmacy includes a lot more extensive range of activities, for example, producing, quality control, supply, procurement, and systems administration. Second, the clinical pharmacy can likewise be practiced by community pharmacists.

DRUG SELECTION AND RESPONSE

Drugs are selected based on characteristics of the drug (eg, efficacy, safety profile, route of administration, route of elimination, dosing frequency, cost) and of the patient (eg, age, sex, other medical problems, likelihood of pregnancy, ethnicity, other genetic determinants). Risks and benefits of the drug are also assessed; every drug poses some risk.
Response to a drug depends partly on the patient’s characteristics and behaviours (e.g, consumption of foods or supplements; adherence to a dosing regimen; differences in metabolism due to age, sex, race, genetic polymorphisms, or hepatic or renal insufficiency), coexistence of other disorders, and use of other drugs.

What Is Interprofessional Collaboration in Healthcare?

The World Health Organization defines Interprofessional Collaboration in Healthcare as “multiple health workers from different professional backgrounds working together with patients, families, carers (caregivers), and communities to deliver the highest quality of care.”
Interprofessional collaboration is about more than data sharing and efficient communication between health care professionals. It requires all care team members to engage with the patient and with each other, and it requires leaders to put their egos aside for the good of the patient.
Effective interprofessional collaboration promotes the active participation of each discipline in patient care, where all disciplines are working together and fully engaging patients and those who support them, and leadership on the team adapts based on patient needs. It fosters respect for the disciplinary contributions of all professionals.

Benefits of Interprofessional Collaboration in Healthcare

Why is interprofessional collaboration essential? Because when you create a collaborative culture (and put communication strategies and technology in place to support that culture), you:

1. Improve patient care and outcomes

A patient walks into the emergency department (ED) complaining of chest pains. An ED doctor checks him out, followed by a cardiologist, who orders some tests and waits on the results from the radiologist, who confirms what both doctors suspected: the patient is having a heart attack.
After having emergency surgery, the patient spends a day in the ICU, where a team of nurses care for him in 12-hour shifts, before transferring him to a cardiac unit, where he meets his new team of rotating nurses. Each morning throughout his stay, a hospitalist (or perhaps his primary care doctor) stops by during rounds. So does the cardiologist, and since the patient has diabetes and COPD, an endocrinologist and pulmonologist. Depending on the patient’s recovery and lifestyle, physical therapists, dieticians, and social workers might even get involved.
Each of these people has a unique perspective and valuable insights about the patient. They notice different symptoms and consider different possibilities. Together, they have a more comprehensive, holistic view of the patient. But these people are rarely, if ever, in the same room. At best, they share data via EHR, but they often lack a way to communicate directly in real-time.
Along with care team meetings, many hospitals now encourage team-based, patient-centered rounds that include the primary doctor, bedside nurse, specialized physicians, and any other relevant team members. This helps to foster both patient-centered care and interprofessional collaboration in healthcare.
It also helps to have hospital communication technology that lets care teams communicate and collaborate seamlessly and securely on the go or at the point of care — via text, voice, or video.

2. Reduce medical errors

In healthcare, communication gaps can have costly consequences — from missed symptoms to misdiagnoses to medication errors. In fact, medical errors cause 250,000 deaths each year. According to Johns Hopkins, it’s the third leading cause of death in the U.S.
It’s easy to see how accidents can happen, with multiple doctors prescribing multiple medications, and numerous nurses delivering those medications. EHR notes can help, but clinical communication is vital. That means having a group conversation, looping in a pharmacist for some interprofessional collaboration, and ensuring nurses have all the information they need to treat patients safely.
Studies have shown that interprofessional collaboration in healthcare can help to reduce preventable adverse drug reactions, decrease mortality rates, and optimize medication dosages.

3. Start treatment faster.

Much of healthcare is a waiting game. Patients wait for physicians, while physicians wait for other physicians to provide consultations, or for radiology to send back lab results.
Communication delays frustrate patients and waste valuable time, giving conditions time to worsen. That’s why the Joint Commission continually lists “improve staff communication” and “get important test results to the right staff person on time” as a National Patient Safety Goal.
Again, interprofessional collaboration bridges the gaps. So does clinical communication technology. It keeps care team members connected (so they can reach out to that physician who hasn’t entered notes into the EHR) and automates alerts (so they receive text messages when critical lab results come in). Overall a care team collaboration platform delivers the right information to the right people at the right time via secure messaging, voice, or video.

4. Reduce inefficiencies and healthcare costs.

Interprofessional collaboration in healthcare helps to prevent medication errors, improve the patient experience (and thus HCAHPS), and deliver better patient outcomes — all of which can reduce healthcare costs. It also helps hospitals save money by shoring up workflow redundancies and operational inefficiencies.
By improving the interprofessional collaboration model between its nurses and physicians, one hospital cut its fall rate in half, decreased average length-of-stay by 0.6 days, increased annualized bed turn by 20 percent, and increased discharges before noon by 20 percent — according to a Robert Wood Johnson Foundation study of 20 hospitals. At another hospital in the study, interprofessional collaboration significantly improved surgical start times and prevented delays that led to 700 wasted hours over the previous four years.

5. Improve staff relationships and job satisfaction

Every health profession has its own subculture, knowledge base, and philosophy. When you add power structures, some members’ voices get prioritized over others. That’s not good for the patient or for staff morale.
Interprofessional collaboration levels the playing field and acknowledges that everyone plays a vital role on the care team. That sense of community and camaraderie can also boost staff retention and recruitment.

Four Core Competencies

The core competencies and sub-competencies feature the following desired principles: patient and family centered (hereafter termed “patient centered”); community and population oriented; relationship focused; process oriented; linked to learning activities, educational strategies, and behavioral assessments that are developmentally appropriate for the learner; able to be integrated across the learning continuum; sensitive to the systems context and applicable across practice settings; applicable across professions; stated in language common and meaningful across the professions; and outcome driven.

Competency 1 Work with individuals of other professions to maintain a climate of mutual respect and shared values. (Values/Ethics for Interprofessional Practice)

Competency 2 Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations. (Roles/Responsibilities)

Competency 3 Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease. (Interprofessional Communication)

Competency 4 Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable. (Teams and Teamwork)

38 developed competencies for interprofessional practice in four domains

Values and Ethics,
Roles and Responsibilities,
Interprofessional Communication, and
Teams and Teamwork.

Interprofessional Education for Health Professions

Effective collaboration begins early, as providers are being educated. The Institute of Medicine in 2010 recommended that nurses should be educated with doctors and other health professionals both as students and later. The Interprofessional Education Collaborative has recommended that all future health professionals should be taught to:

Assert values and ethics of interprofessional practice by placing patient interests at the center of health care delivery, and embracing the cultural diversity and differences within health care teams;
Leverage the unique roles and responsibilities of interprofessional partners to appropriately assess and address the health care needs of patients and populations served;
Communicate with patients, families, communities and other health professionals; and
Perform effectively in various team roles to deliver patient- or population-centered care that is safe, timely, efficient, effective and equitable.

ANTECEDENT CONDITIONS NEEDED FOR COLLABORATION BETWEEN PROVIDERS

Close proximity
Time to interact
Appropriate clinical knowledge
Receptiveness to collaboration
Interest in each other’s professional responsibilities
Active discussion of patient care issues
Demonstrated respect for one another
Trust in each other’s competence

COMMON OBSTACLES TO COLLABORATION

Boundary or turf concerns
Communication breakdown
Power issues
Lack of trust in another’s competence
Practice sites distance from one another

FIVE STAGES IN COLLABORATIVE WORKING RELATIONSHIP

Stage 0 – Professional Awareness
Stage 1 – Professional Recognition
Stage 2 – Exploration and Trial
Stage 3 – Professional Relationship Expansion
Stage 4 – Commitment to the collaborative working relationship