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Archives of Pharmacy Practice
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ISSN 2045-080X Vol. 3, Issue 3, 2012
Clinical Pharmacy Practice: An Activity Based Definition For Pharmacy Students Of Developing
Countries
Muhammad Amir
Assistant Professor/Clinical Pharmacist, Ziauddin College of Pharmacy, Ziauddin University, Pakistan
Citation: Muhammad Amir. Clinical Pharmacy Practice: An Activity Based Definition For Pharmacy Students Of
Developing Countries. Archives of Pharmacy Practice. 2012; 3(3) 193-196.
A definition of clinical pharmacy based on the activities
Introduction might be more comprehendible. Definition provided by
European Society of Clinical Pharmacy (ESCP) has made a
Clinical pharmacy practice is relatively a new discipline in similar attempt and defines clinical pharmacy as “the
pharmacy practice in which the emphasis is transferred from activities and services of the clinical pharmacist to
products oriented to patient oriented practice.[1] However, the develop and promote the rational and appropriate use of
definition of clinical pharmacy or clinical pharmacy practice medicinal products and devices.” However, in elaborating
has not been universally standardized; hence different activities of clinical pharmacist, it has included non-
academic institutions and pharmaceutical societies have clinical activities such as dispensing and compounding
attempted to define it in their own perspectives.[2] In doing so, along with clinical activities.[7] Overlapping of clinical
the discipline “clinical pharmacy” now has numerous meanings activities with non-clinical activities may jumble up the
through out world. Few of the recognized definitions are as responsibilities of hospital pharmacist and clinical
follows: pharmacist. The intention of the presenting a new
Clinical Pharmacy is a health science discipline in which definition is not to disprove previous definitions rather to
pharmacists provide patient care that optimizes medication support them and extrapolate the concept of rational use
therapy and promotes health, wellness, and disease prevention. or quality use of drug for greater understanding. The
[3] article also tries to explain the clinical activities.
Clinical Pharmacy practice is the practice of pharmacy as a part Pharmaceutical care
of a multidisciplinary Irrespective of words used in the definitions mentioned
healthcare team directed at achieving QUM (Quality Use of above, the core of clinical pharmacy lies in the concept of
Medicines). [4] pharmaceutical care,[8] which is defined as, specific
activities and services through which an individual
Key words pharmacist cooperates with a patient and other
professionals in designing, implementing and monitoring
Adverse drug reactions, pharmacist, pharmacovigilance,
a therapeutic plan that will produce specific therapeutic
hospital, pharmacoeconomics
outcomes for the patient. [9] Thus such activities that
Manuscript History promote rational drug therapy are clinical pharmacy.[10]
Including such activities into the definition of clinical
th
Article Received on: 13 Feb 2012, pharmacy may increase its understanding.
st
Revised on: 1 May 2012
th
Approved for Publication:15 May 2012 Activities of clinical pharmacist
In developed countries, clinical pharmacists are
Corresponding Author
performing various activities depending upon the
Muhammad Amir available resources and healthcare system[11]. These
Assistant Professor/Clinical Pharmacist, Ziauddin College of activities ranges from prescription review to prescribing
Pharmacy, Ziauddin University, Pakistan drugs. Australian’s Society of Hospital Pharmacy
identifies ten such activities and named them “clinical
Email: mohd_amir80@hotmail.com activities”. [4] In order to simplify clinical activities are
classified into six which are as follows:
In developing countries where clinical pharmacy practice is 1-Patient Medication History
still in evolutionary phase, such definitions are hard to “It involves gathering and recording of information
comprehend for pharmacy students and practicing regarding past and present medications used by the patient
pharmacists. [5] Moreover, with no or litter clinical pharmacy through interview and reviewing of past medical records.”
practice, grasping terminologies such as quality use of drug,
rational use of drug or optimizations of drug is hard to Patient medication history is a recognized clinical
implement.[6] activity for clinical pharmacist. [12] Clinical pharmacist
193 | P a g e Archives of Pharmacy Practice Vol. 3, Issue 3, 2012
Archives of Pharmacy Practice
had being designated this responsibility because researches 3-Adverse Drug Reaction Management
has shown that pharmacist are more accurate. [13] The It involves prevention, detection, management and
practice for patient medication history includes three stages; documentation (reporting) of Adverse Drug Reactions
each stage has an objective and a methodology described in (ADRs).
Table
Table 1: Objective and methodology for Patient Clinical pharmacist carries out adverse drug reactions
Medication History (ADRs) management through patient counseling, profile
patient review and patient medication history. [15] ADRs
Stage Objective Procedure treatment is mainly a concern of physicians.
Before taking Create Step 1: Confirm the Prevention of ADRs
medication rapport patient’s identity. Clinical pharmacist play vital role in prevention of ADRs
history (Gaining Step 2: Pay regards. through history taking, monitoring and counseling.[16]
patient’s Step 3: Self introduction- History taking can reveals potential allergies, symptoms,
confidence) Name, position. suspected drugs etc. Monitoring of ADRs is carried out
Step 4: Reason of visit through lab review and clinical review, while counseling
and time required. could help to increase compliance, avoid drug interaction,
Step 5: Start taking and polypharmacy practice.
medication history of the Detection of ADRs
patient. Detection or identification of ADRs is challenging
Gather Step 6: Ask question with especially when co-morbid exist. Number of protocols had
During history information respect to form format. being suggested for ADR identifications. Clinical
taking pharmacist can use any of them, since they are very
similar to each other. Examples of such protocols are:
After history Documentati- Step 7: Express gratitude WHO, Narangos, European ABO system, Kram et,
taking on & analysis Step 8: Collect and Bayesian, Karch and Lasagna’s, French imputation
review past medical method.[17]
record. Treatment of ADRs
Step 9: Document The role of clinical pharmacist in treatment of ADRs is
essential data. very limited. Rarely, situation occurs where clinical
pharmacist treats ADRs.
2- Profile Patient Review Reporting of ADRs
It involves evaluation of patient and its medical chart by the ADRs are reported to related agencies such as FDA, CSM,
clinical pharmacist. etc. if classified as serious suspected ADRs. The report
It is often considered that medication review is a clinical should comprise of name of the reporter, an adverse
activity; however, it is not unless conducted along with the event, an identifiable patient and a suspect drug.
patients. Patient involvement is mandatory for the provision of
pharmaceutical care.[14] Term such as patient assessment, 4-Therapeutic Drug Monitoring (TDM)
profile review and medication review are used when It involves application of clinical pharmacokinetic for
evaluation is conducted only of patient, patient profile or monitoring drug efficacy and toxicities. The drugs that are
prescription, respectively. Hence, we used another term profile commonly monitored are gentamicin, amikacin,
patient review which involves all the three components. Profile tobramycin, vancomycin, carbamazapine, phenotoin,
patient review can be conducted in a manner shown in Table 2 valproic acid, lithium, theophylline, cyclosporine, digoxin,
Table 2: Objective and methodology for Patient Profile lidocaine, amitriptyline, nortriptyline and imipramine.
Review [18] The procedure of TDM comprises of six steps which
are:
Steps Review Objective
st 1. Ordering: Physician request for consultation for clinical
1 Patient history To check patient’s medical history, pharmacokinetic services
Step review present condition, allergies and 2. Sample taking: Biological sample is taken by the team
nd past medications. 3. Analysis of sample: Analysis of biological sample takes
2 Medication To evaluate medication in term of place in the laboratory
Step review prescribing error and clinical 4. Result issue: Laboratory issues the drug concentration
rd outcome. level result and notifies if it is sub-therapeutic to the
3 Laboratory test To recommend lab test to monitor clinical pharmacist.
Step review drug toxicity. 5. Interpretation of result: clinical pharmacist conduct the
To correlates abnormal lab test calculation with respect to results
th result with drug prescribed. 6. Action: With respect to calculation, dose adjustment are
4 Nursing chart To check whether the drug carried out.
Step review prescribed is administered at right In setting where clinical pharmacokinetic services exist,
time, way and dose.
194 | P a g e Archives of Pharmacy Practice Vol. 3, Issue 3, 2012
Archives of Pharmacy Practice
both laboratory and non laboratory based activities are the Clinical pharmacy practice which includes
responsibilities of clinical pharmacist. Clinical pharmacist collaborative agreement between the clinical
specializes in clinical pharmacokinetic services is pharmacist and physician allowing clinical
considered as clinical pharmacokinetic specialist.[19] pharmacist to prescribe medication is called
advance clinical pharmacy practice.
5-Drug Information Management
It involves appraisal, collection, utilization and presentation of References
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