24/04/2015

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Optimization of the prescription in collaboration with the

physician:the role of the clinical

pharmacist

CLINICAMP IV

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What will it be all about ?

• A few slides to introduce the topic … (not a conference !)

• Interactive discussion over the main points of interests to the participants, to identify

where can the clinical phamacist be active and efficient in collaboaration with the physicians

which are the favouring conditions

which are the difficulties and bottlenecks

• Obtaining the most important "Take Home Messages"

CLINICAMP IV

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Who are we?

• Morning session: • Celine Vanwetter, Pharmacist, Grand Hôpital de Charleroi• Ludo Willems, Hospital Pharmacist, UZ Gashuisberg• Jean-Daniel Hecq, Hospital Pharmacist, CHU Dinant-Mont-Godinne• Paul M. Tulkens, MD, Université catholique de Louvain

• Afternoon session• Celine Vanwetter, Pharmacist, Grand Hôpital de Charleroi• Benoit Boland, MD, Cliniques St-Luc, Bruxelles• Nele Vermeulen, Pharmacist, O.L.Vrouw, Aalst• Paul M. Tulkens, MD, Université catholique de Louvain

CLINICAMP IV

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Why should MDs and pharmacists talk together ?

• The MD is responsible for the patient, for the diagnostic, and for the main decision(s) of the type of treatment

• The Pharmacist has the knowledge of the drugs and should deliver therapy and not only drugs…

• Together, they can improve the treatment of the patient if

• The MD is convinced that he/she will get an expert opinion from the pharmacist

• The pharmacist understands the clinical situation and the clinical choices that are applicable to the individual patient

CLINICAMP IV

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What can the clinical pharmacist bring to the team ?• Knowledge of the drugs (old as well as novel …)

• what about the pathology of the patient ?• which class of drugs, which mode of administration, which advantages and

disadvantages, which available generics, …• what about guidelines (local, national, international) for first lien treatments

and for alternatives… • Knowledge of pharmacokinetics for optimization of use

• loading dose, schedule of administration (once daily / continuous infusion …), monitoring, dose adaptation, …

• Knowledge of interactions (drug-drug, drug-food) and risks to individual patients• Practical knowledge of administration routes and procedures (including route

switches)• Access to consumption data and assessment of actual use vs. what is

recommended in guidelines (audits)• Price and other economical aspects (the best for your money)

CLINICAMP IV

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An algorithm of pharmacist activities welcomed by MDs

CLINICAMP IV

Know how to do a correct and useful medication history… but perhaps even more (e.g. intervene to optimize the chronic therapy)

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An algorithm of pharmacist activities welcomed by MDs

CLINICAMP IV

Base you pharmaceutical opinion on undisputable evidence !

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Evidence-based medicine is not only for the Minister…

CLINICAMP IV

Base you pharmaceutical opinion on undisputable evidence

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An algorithm of pharmacist activities welcomed by MDs

CLINICAMP IV

The good patient is the one that leaves the hospital not to come back !

medical

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Other involvements of a pharmacist

• Electronic / Paper files: write your pharmaceutical opinion• Local formulary (intranet): participate and deliver:

• Product information • Guidelines: empirical, documented and prophylactic treatment

• START/STOPP of drugs (e.g., geriatry)• Susceptibility-based rational choices (e.g., antibiotics)• Helping in declarations of side-effects (e.g., all new drugs)• Technical information for therapy administration (all drugs)• Potential savings (for Social Security as well as for patients). • Presence to answer questions (the doctor does not wait !)

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Now, let us start the Discussion …• What are you doing and do it well ?• What are your interactions with• the young doctors …• the older doctors …• the nurses …• the formulary committee (CPM/MFC)• the medical direction …• Your colleagues at the central pharmacy …

• What are your problems ?• What could / should be improved ?• How can the SPF/FOD help ?

CLINICAMP IV