EFFECTIVE COMMUNICATION

BETWEEN PHYSICIAN AND PHARMACIST

by,

Dr. G Praveen KumarAssistant Professor,

Department of Pharmacy practice,C.L. Baid Metha College of Pharmacy.

Incharge-Drug Information Centre & Patient Counseling,VHS(voluntary health care) hospital, Adayar, Chennai

PHARMACIST

PHYSICIANS PATIENTSADMIN

NATIONAL

GUIDELINES

• Chemists or druggists,• healthcare professionals who

practice in pharmacy, the field of health sciences focusing on safe and effective medication use.

• The role of the pharmacist is "lick, stick, and pour" dispensary

• "lick & stick the labels, count the pills & pour liquids"

PHYSICIAN

PARAMEDICS

WARD ROUNDS

ADMIN

GOVERNING

BOARDS

MONITORING TEAM

PATIENTS

• Examine • Diagnose • Treat • Prescribe • Dispense (sometimes)• Counsel• Follow up

PYHSICIAN & PHARMACIST RELATIONSHIP

Pharmacist

• Looks special but actually not

Physician

LOOKS SIMPLE BUT SPECIAL(SPECIALITY)

DEVELOPMENT OF PROFESSION

Physicians• MBBS• MD• DM

Pharmacist• D.Pharm• B.Pharm/M.Pharm• Pharm.D

• Clinical pharmacists work directly with doctors, other health professionals, and patients to ensure that the medications prescribed for patients contribute to the best possible health outcomes.

Dispensing

Manufacturing

Clinical

Roles of a clinical pharmacist

• Assess the status of the patient’s health problems and determine whether the prescribed medications are optimally meeting the patient’s needs and goals of care.

• Evaluate the appropriateness and effectiveness of the patient’s medications.

• Recognize untreated health problems that could be improved or resolved with appropriate medication therapy.

• Follow the patient’s progress to determine the effects of the patient’s medications on his or her health.

• Consult with the patient’s doctors and other health care providers in selecting the medication therapy that best meets the patient’s needs and contributes effectively to the overall therapy goals.

• Advise the patient on how to best take his or her medications.

• Support the health care team’s efforts to educate the patient on other important steps to improve or maintain health, such as exercise, diet, and preventive steps like immunization.

But still the fight never got over……….

Mode of communication?

Prescribing Guidelines

• Part 1: The process of rational treatment

• Part 2: Selecting your P-drugs

• Part 3: Treating your patients

• Part 4: Keeping up-to-date

Part 1: The process of rational treatment

• Step 1: Define the patient's problem • Step 2: Specify the therapeutic objective

(What do you want to achieve with the treatment? )

• Step 3: Verify the suitability of your P- treatment Check effectiveness and safety

• Step 4: Start the treatment • Step 5: Give information, instructions and

warnings • Step 6: Monitor (and stop?) treatment

Part 2: Selecting your P-drugs

i Define the diagnosis (pathophysiology) ii Specify the therapeutic objective iii Make an inventory of effective groups iv Choose a group according to criteria efficacy safety suitability cost Group 1 Group 2 Group 3 v Choose a P-drug efficacy safety suitability cost Drug 1 Drug 2 Drug 3 Conclusion: Active substance, dosage form, Standard dosage schedule, Standard duration.

Part 3: Treating your patients

Part 4: Keeping up-to-date

“Knowledge is of two kinds. We know a subject ourselves, or we know where we can find information upon it.”

-Samuel Johnson (1709-1784)Martindale’s The Extra Pharmacopoeia is an excellent reference book with detailed drug information on most active substances and chemicals.

Avery’s Drug Treatment is a more specialized book, appropriate for prescribers with a special interest in clinical pharmacology.

Pharmacist contribution?

• Prescription audit/monitoring• Drug information• Patient counselling

Prescription audit….

• Medication errors • Almost everyone in the modern world takes

medication at one time or another • Most of the time medications are beneficial • But some occasion they do harmful effects (side

effects) which is adverse drug events• But sometimes the harm is caused by an error in

prescribing or dispensing or administration of medication

Types - Responsibilities

• PRISCRIBING ERRORS - physicians

• TRANSCRIBING ERRORS – pharmacist/nurses

• DISPENSING ERRORS – pharmacist/ physicians

• ADMINISTRATION ERRORS – nurses/patients

Parts of prescription

• Name, address, telephone of prescriber • Date • Drugs• Name/I.D no., age & gender of patient • Signature or initials of prescriber

Legibility

• Poor Physician handwriting

Drugs with similar namesChlorpromazine -

ChlorpheniramineCarbamazepine - CarbimazoleClotrimazole - Co-trimaxazoleCetirizine - CinnarizineMebendazole - MetronidazoleBetadine - Betnovate

Doctors are legally obliged to write clearly Tab.Dimol & Tab.Divalin Tab.Amoxil & Tab.Daonil

(REF: WHO prescriber guidelines page 67)

Drug name and dosage form

• Brands differ as same as the sarees brands– Especially in India

• Use only generic names in the Prescription• Use brands only if needed…

Dosage forms

• Tablet• Capsule• Injection• Nebulizer• Infusion• Eye Drops• Ear Drops• Nasal Drops • Transdermal Patches

Abbreviations CFX CIPROFLAOXACINNFX NORFLOXACINNFR NIFEDIPINE RETARDMF METFORMIN

MMF MYCOPHENOLATE MOFETILCAT CALCIUMCCT COMMON COLD

CCM CALCIUM CITRATE MALEATE

CPZ CHLORPROMAZINECBZ CARBAMAZEPINEABZ ALBENTAZOLECTZ CETRIZINE DF DERIPHYLLINDCF DICLOFENACDEC DIETHYLCARBAZINEGM GENTAMYCIN CM CHLORAMPHENICOLANT ANTACIDAST ATORVASTATINSBT SALBUTAMOLSMT SALMETROL

Dosage strength and frequency

• ng/mg/µg• OD/BD/1/2tablets• Half tablet/capaules

– Entricoated/sustained release• Decimals

– O.5/.5– 150/1.50

• Duration – 3 === days/weeks– antibiotics

Never use unofficial abbreviations – or invent your own abbreviations – it is not safe to do so.

Prescription audit/monitoring

• Legibility• Use generic names only• Mention the full details of every drug• Avoid unofficial abbreviations• Avoid “Repeat all”• Avoid “Double dosing”

Drug information services

• “The Drug Information Centre is a service offered through Pharmacy department which provides advice and act as a referral service by directing the best available resource to respond to query or concern.”

What kind of information?

1. New Drug or its Product Information/ Identification

2. Availability 3. Contraindications/Safety4. Adverse Drug Reactions/Drug Interactions5. Efficacy/Treatment/Choice of drug6. Pregnancy/Lactation/Pediatrics7. Drug Profile/Indications/Dosage/

Pharmacokinetic information8. Toxicology9. Counselling information

Resources….

• Primary resources: Research papers/Journal

articles/Case reports.

• Secondary resource: abstracts, review

articles, indexing services such as DRUGDEX,

Drug Information Database and abstracting

MEDLINE, MICROMEDIX, etc…

• Tertiary resources: Text books on various

aspects of drug use & practical guidelines.

• Micromedex• FDA website• Medscape • webMD• Drugs.com(dr

ug interaction checker)

• Who guidelines

• EBSCO journal services

Patient counselling

“It is the physicians or pharmacist’s responsibility to ensure the patient receives

the required information for the quality use of medicine.

Counselling implies the communication of information that would encourage therapeutic

outcome”

You can organize a patient counseling Event – to develop professional practice skills.

• Hypertension Dietary changes – Reduce sodium, Reduce alcohol, Eat more fruits and vegetablesRegular aerobic exercise – Walking, runningWeight loss – Eat less

• Diabetes – Less Carbohydrate, Fat and more fiber food

Physical activity – Walking, cyclingNo smoking, Alcohol intakeSulfonyl ureas – Glibenclamide 15-30 mts before food others taken with meal

Storage of medicines

• Proper storage of medication ensures efficacy, stability and safety.

• Room temperature - 15⁰C - 30⁰C• Cool – 8⁰C - 25⁰C• Cold - 2⁰C - 8⁰C• Warm - 30⁰C - 40⁰C• Excessive heat – Any temp. above 40⁰C

Potency & Temperature for storage of Vaccines

Vaccine Temperature Potency maintained for

Oral Polio (OPV) -20⁰C4⁰C to 8⁰C

1 Year3 months

Bacillus Calmette Guerine (BCG)

4⁰C to 8⁰C 1 Year

Diphtheria, Pertusis, Tetanus (DPT)

4⁰C to 8⁰C 2 Years

Measles 0⁰C to 2⁰C 2 Years

Typhoid (TAB) 4⁰C to 8⁰C 8 months

Tetanus toxoid (TT)Hepatitis B

4⁰C to 8⁰C 4 Years

Patient information leaflets

How to overcome the barrier?

PHARMACY AND THERAPEUTIC COMMITEE

THE PHARMACY AND THERAPEUTICS COMMITTEE IS A POLICY FAMING AND

RECOMMENDING BODY TO THE MEDICAL STAFF AND THE ADMINSTRATION OF HOSPITAL ON MATTERS RELATED TO

THERAPEUTIC USE OF DRUGS.

HOSPITAL FORMULARY

• Hospital Formulary is a continually revised compilation of pharmaceuticals including

important ancillary information that reflects the current clinical judgment of the medical

staff.

Contents…

• Introductory information- Acknowledgement, List of abbreviations, Intended usage of the formulary manual

• Basic information of the drug – Generic name, – dosage form, – strength – Indications – Pharmacological action – Precautions – Side effects – Dosage – form, – frequency Instructions – Drug interactions

• Supplementary information on each drug– Price – Regulatory category – Storage guidelines – Patient counselling information– Brand names

• Formulas for various diagnostic stains, diagnostic aids

• Table of common Lab-values

Size of the formulary

• It is sufficiently small in size so that it could be easily carried by clinicians, nurses etc, in the pockets of their uniform or lab coats.

• The hospitals may determine their own size of the formulary.

• Join together to create a better therapeutic outcome.

• For queries contact:DRUG & POISON INFORMATION CENTRE

Department of Pharmacy PracticeC.L. Baid Metha College of Pharmacy

• www.clbaidmethacollege.com Go-to “DIC Request Form”

Aware….

Stay Tuned to the

Developing Technology.

We TREAT

And Let“GOD” Heals...

Thanks To the Almighty GOD (Jesus Christ)

& to all….

For details mail to :praveen.pharmd@gmail.com.