Pharmaceutical Care

“The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.”

• Hepler & Strand 1989
• Opportunities and Responsibilities in pharmaceutical care

Acts of Commission

Idiosyncratic causes

Acts of Omission

• misreads
• wrong dosing
• wrong drug

prescribing, dispensing, & medication administration errors

adverse reactions to meds

absence of individual / profession to assume responsibility for pt. medication outcomes

ex: 90 day follow up on a new depression medication

John Morgan

He was a physician and pharmacist

1821 Philadelphia College of Pharmacy

William Proctor

• first professor of practical pharmacy
• editor of American Journal of Pharmacy
• started APhA - 1852

Univ of Southern California

• frequent dramatic changes in practice
• spurred by advances in technology, by economic alterations, and by legislation.
• Between 1860 - 1990s, the profession’s orientation has moved from manufacturing, to compounding, to distribution, to a more clinical role and finally to pharmaceutical care
• Often initiated by others outside of the profession

one automated location takes and fills orders for many locations which are then mailed to pts

mostly maintenance meds

prescriptions are read and processed at another location using computers

scanned scrips read at off location sites, typed, and filled if necessary and sent back to original location

• Increase extent that:
• 1) health-system pharmacists help inpatients achieve the best use of medications
• 2) health-system pharmacists help non-hospitalized patients achieve the best use of medications
• 3) health-system pharmacists actively apply evidence-based methods to improve medication therapy
• 4) pharmacy depts have a significant role in improving the safety of medication use
• 5) health systems apply technology to improve safety
• 6) pharmacy depts can engage in public health initiatives in their communities

• obtain medical histories
• medication reconciliation
• ~ dif. btwn home and hospital medications
• medication monitoring
• provide discharge medication counseling

manage medication therapy in collaborations w/ other health care professionals

provide medication counseling

provision of care using evidence-based medicine

involved in the development and use of drug-therapy protocols

routine medication orders reviewed by pharmacist prior to administration of 1st dose

certified pharmacy technicians

ASHP-accredited residency training

• use of bar coded medication
• use of bar coded medication administration to patients
• use of computerized prescriber order entry system

• brown bag
• diabetes clinics
• smoking cessation
• -- ashville project --

doing the very best for the patient within the context of pharmaceutical care

• patient-centered
• non-coercive

do no harm

• altruism---concern for welfare of others
• equality---having the same rights, privileges or status
• freedom---capacity to exercise choice
• justice---upholding moral and legal principles
• truth---faithfulness to fact or realityhuman dignity---inherent worth and uniqueness of an individual

• Economic argument
• Health Outcome argument
• Profession argument