DEFINITION:

Clinical pharmacy is defined as the branch of pharmaceutical science dealing with the utilization
of pharmacist knowledge, skills, and judgments related to biomedical and pharmaceutical sciences to
prove the safety, the cost, and the precision of the drug usage in the patient care.

Clinical pharmacy may be defined as the science and practice of rational use of medications, where the
pharmacists are more oriented towards patient care rationalizing medication therapy promoting health,
wellness of people. It is the new and extended field of pharmacy.

Clinical pharmacists often work in collaboration with physicians, nurse practitioners, and other
healthcare professionals.

Status of clinical pharmacy

In developed countries like the United States of America, Canada ... Clinical Pharmacy has already taken
good shape. In Nepal, it is in the infancy stage. The role of the retail pharmacist is viewed by many
people as simply transferring pills from a large bottle to a small one - counting tablets, typing labels and
calculating the price. Much of his time is seen as devoted to routine merchandising of cosmetics, shaving
supplies, stationery, and other commodities that have little or no relation to health care.

There is still a need to develop the concept of clinical pharmacy. Today there is 'drug-explosion' and
'information explosion' in relation to the drugs. On one hand there is the development of newer and
more effective drugs, and on other hands their potential hazards of side effects are on rising. First, there
is little time for doctor-patient dialogue as the doctor usually has too short time to spend with each
patient. Many a time, doctors prescribe patients by excessive and wrongful use of drugs. More and more
people fall into latrogenesis (drug-induced diseases) and misuse of drugs. Also, there is an increase in
"self-medication" by the patients. These have led to the development of "Clinical Pharmacy.”

SCOPE OF CLINICAL PHARMACY:

Clinical pharmacy has emerged as one of the latest branches of pharmacy in the 21st Century. It is
where pharmacists deal with various aspects of patient care, dispensing of drugs and advising patients
on the safe and rational use of drugs. It can also be explained as a part of the pharmacy in which the
clinical pharmacist provides patient care that optimizes the use of medication and promotes health,
wellness, and disease prevention. It doesn’t restrict the role of a pharmacist merely to good
manufacture practices, easy procurement, proper preparation, distribution and control of drug
products. Besides, it also comprises functions necessary to discharge a particular set of social
responsibilities related to the appropriate therapeutic use of drugs in the aspects like prescribing,
dispensing and administrating drugs, documenting professional services, direct patient involvement,
Reviewing drug use, Education, Consultation and Counseling.
Goals of Clinical Pharmacy

Function of clinical pharmacist/ clinical pharmacy

1. Preparation of patient medication history:

Any hypersensitivity or allergies to specific drugs observed in the past, any particular drug or
food habits, drug dependence, or intoxication with chemicals due to occupational hazards, all of
which are likely to interfere with the therapy. This will help in saving physicians time and efforts
and thus will result in a faster and more accurate selection of drug therapy.

2. Rational prescription :
The clinical pharmacist can suggest the physician and help him in selecting the right drug.
3. Bioequivalence and generic equivalence of pharmaceutical formulations:
Several factors influence the bioavailability of drugs from the dosage forms. Selection of proper
drug therapy based on bioequivalence studies on different dosage forms of the same drug
moiety.
4. Patient monitoring :
Observes the signs and symptoms that indicate the need for or reaction to drugs. A clinical
pharmacist who knows correct route of administration, the signs and symptoms of overdosages,
contraindications, desired effects, undesired effects, and side effects can help in monitoring the
drug therapy for safety and efficiency, a necessity with the increasing applications of potent and
toxic chemicals and drugs.
5. Adverse drug reactions and drug interactions :
The clinical pharmacist:
  Can compile and process data using computers and make it available to the medical
staff.
 May suggest an alternate therapy if applicable
 Identify drug effect modifications due to interactions with several foods, alcohol,
smoking, environmental chemicals, as well as due to pregnancy.
6. Drug diagnostic test inferences
7. Intravenous admixtures
8. Drug Information Specialist:
A clinical pharmacist is an expert on drugs that may operate a drug information service. Through
effective utilization and retrieval of clinical drug literature, the pharmacist can actively
communicate drug information. He can help during medical emergencies by providing
immediate information on antidotes in case of poisoning or overdosing.
9. Retail pharmacy stores :
Many OTC drugs have the potential to interact with prescription drugs. A clinical pharmacist at
retail drug stores can maintain patient drug profiles, family drug profiles and family records
based upon which the pharmacist can counsel the patient each time while filling the
prescription. He can determine the patient's responses to drug therapy and help him in the
selection and use of OTC drugs.
10. .Discharge counseling and patient compliance :
The compliance to drug therapy can be improved several times by educating and counseling the
patient at the time of discharge from the hospital or while dispensing the prescription at the
retail counter. The patient may be made aware of the purpose of the medication, proper mode
of administration, dosage schedule and storage conditions. He may be told of any potential
adverse or side effects to expect and any food or activities to be avoided during therapy.
11. Clinical research and continuing education program :
The clinical pharmacist can participate in an evaluation program on investigational drugs. He can
help in conducting clinical trials based on sound principles of biostatistical methods of
evaluation. He can also develop training programs for pharmacists, nurses, and interns.
 Pharmaceutical care

“Pharmaceutical care is the direct, responsible provision of medication-related care to achieve

definite outcomes that improve a patient’s quality of life.” Such as:
 Cure of the Disease • Elimination or reduction of symptoms • Arrest or slowing of a
disease process • Prevention of disease or symptoms.

It can be distinguished from the clinical pharmacy as shown in the table below.

MEDICATION HISTORY:
Taking medication histories can be difficult. Many patients don’t manage their medications, and many of
those who do struggle with drug names, doses, and indications. Using a standardized method for taking
medication histories is vital to minimizing errors. Here are ten steps to do so:

Step 1: Introduce yourself to patients and ask for permission to discuss their home medications.
If there are guests in the room, offer to come back later instead of asking whether it’s ok to speak in
front of others. This takes the burden off of patients and gives them an easy avenue to decline
discussing their medications in front of guests.

Step 2: Check each patient’s name and date of birth.

Step 3: Ask whether they came to the hospital from their home or a facility, if you’re uncertain.
Frequently, patients coming from a nursing home or other care facility will have a W-10 form that can be
used to obtain their current medications.

Step 4: Ask whether they manage their medications or if someone helps them.
Before spending a significant amount of time trying to obtain a medication history from patients
unfamiliar with their medications, ask if someone assists them. For example, many patients have family
members who set up their medication boxes. It may also be a good idea to inquire about a visiting nurse
who assists with their medications.
Step 5: Ask about the name, strength, dose, route, and frequency of their medications.
This question may be overwhelming for patients on many different medications, so encourage them to
start anywhere they remember. Although it may be tempting to read their current medication list and
ask whether it’s correct, there’s much room for error in this method. Instead, try promoting the patient
by asking, “Do you take any medications to lower your cholesterol?”

Step 6: Ask about OTC products, vitamins, and any medications taken less often.
Aspirin is an important medication that patients might forget to mention.

Step 7: Ask about inhalers, injectables, creams/ointments, eye drops, ear drops, nasal sprays, patches,
and medication samples.
Patients often associate the word “medication” with pills, so prompting them with other dosage forms
can remind them of medications they might have missed.

Step 8: Ask which pharmacy/pharmacies they use and inquire about allergies.

Step 9: Thank them and ask whether they have any questions.
Using the phrase “I have the time” has been proven to increase a patient’s willingness to ask questions.

Step 10: Evaluate the medication history obtained against at least one additional source.
The sources should contain the same medication names, strengths, dosages, routes, and frequencies.
Any discrepancies should be further investigated. Some examples of secondary sources are previous
medication lists, prescription bottles, pharmacy records, and insurance records.