Beruflich Dokumente
Kultur Dokumente
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Introduction
• More pharmacists currently work in the community sector
than in any other part of the pharmaceutical industry
– relief pharmacists, or
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The past role of the community pharmacist
• Wherever there are civilised societies
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The past role of the community pharmacist...
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• Pharmacy has a long history.
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The earliest historical record for the preparation of drugs
comes from Babylonia, circa 2600 BC, where clay tablets were
inscribed with the description of an illness, a formula for the
preparation of the remedy and an incantation to impart or
enhance the healing quality of the medication.
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• Specialisation first occurred early in the 9th century in the
civilised world around Baghdad,
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• Physicians often both prepared and prescribed medicines
• Not until well into the 19th century was the distinction
between
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• Pharmacy first became legally separated from medicine in
1231 AD in Sicily and southern Italy.
• This paved the way for further legislation defining the role of
apothecary, the development of the first official
pharmacopoeia (the Ricettario Florentino published in
Florence in 1498).
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• The establishment of the College de Pharmacie in France in
1777 and the eventual formation of the Pharmaceutical
Society of Great Britain in 1841 (Taylor & Harding, 2001).
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Today’s community pharmacist
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Essential services
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1. Repeat dispensing
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2. Adverse drug reaction reporting
– Both hard copies (the yellow pages in the back of the BNF)
and electronic versions (implemented in 2002 and
available at www.mhra.gov.uk) of the yellow card are
currently in use. 14
• ‘black triangle drugs’ (noted as such in the BNF; these are
drugs that have received market authorisation in the last 2
years) for which any suspected ADRs should be reported
• Members of the public are now able to use this scheme, both
online and
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3. Patient counselling
• This involves giving advice to patients on how to use their
prescribed medications, often used as an informal method of
checking on how patients are coping with their medications.
– timing of medications,
– side-effects or
– Many people hold firmly to the misconception that ‘natural is good’, which
suggests, incorrectly, that
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Responding to symptoms...
• In this situation the community pharmacist needs to draw on an
extensive group of skills:
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7. Signposting
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8. Disposal of unwanted medications
• The aims of this service are:
– to reduce the incidence of accidental poisoning in the home,
and the risk of medications being diverted to individuals they
were not intended for
– to reduce the risk to the public caused by medicines disposed of
unsafely
– to reduce the environmental impact of unsafe disposal.
– Patients are requested to return unused medicines to the
community pharmacy for safe disposal in destruction of old
pharmaceuticals (DOOP) bins, which are then collected by a
pharmaceutical waste disposal company.
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9. Clinical governance
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• This is a large area that affects every aspect of the pharmacist’s
role and is characterised by:
– audit – defined as
• an important review of current practice,
• revision of any part of practice which does not give the best
standards of care for patients, and
• integration of new procedures for improving these standards
– continuing professional development
– staff development programmes
– development and implications of standard operating
procedures (SOPs) within the community pharmacy setting
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Other services
Retailing
– Most community pharmacists are also business people.
Substance misuse
Health screening
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1. Smoking cessation clinics
• These clinics have been developed in order to reduce the number
of minor consultations with GPs, helping to reduce their workloads.
• The pharmacist can then assess the needs of the patient and carry
out peak flow measurements,
which are a useful measure for the patient to see how their
lung function improves the longer they do not smoke.
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2. Minor ailments schemes
• These were also created in order to reduce minor consultations for
GPs in order to
analgesics for cold and flu symptoms, and pain relief, cough
mixtures, etc.
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• In this way patients are provided with symptomatic relief
from a minor ailment,
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3. Substance misuse
• Patients with a drug dependency (e.g. heroin, amphetamines or
painkillers) can be started on a programme of withdrawal.
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• Pharmacists must undergo training to be able to prescribe on
a patient group directive (PGD) form.
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5. Advice to residential and care homes
• Community pharmacies can supply residential homes with
medication in weekly dispensing trays and monitored
dosage systems.
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• Community pharmacists are often closely involved with
reviewing these medications and provide advice to home
staff and carers
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6. Health screening
• Services for monitoring blood cholesterol, blood sugar and
blood pressure
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Health screening...
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Summary of the areas where a pharmacist can
involve in public health through community
pharmacy
• Drug and nutrition counseling
• Use of OTC and prescribed medicines
• Family planning
• Pregnancy and infant care
• Immunization
• Sexually transmitted disease counseling
• Toxic agents control
• Health and safety
• Control of accidental injures
• Prevention of smoking, alcoholism, and drug abuse
• Environmental protection
• Weight control program
• Poising and cancer detection
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The future of the community pharmacist
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Future Cont…
• Pharmacist become more integral within the health care
system.
• Paying attention toward the patient health, general wellness,
counseling, and drugs related matter.
• Medication therapy management (MTM): teaching clinical
services that pharmacist can provide for patients/ to increase
patient health outcome and decrease costs of health care
system.
• Ex:
- Australia: Austrian government for conducting comprehensive
home medicines reviews
- UK: pharmacist additional training
- USA: pharm D, 2 year residency for pharmacist
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• ‘Priorities for Action’ developed in 2004 by the Department of
Health, Social Services and Public Safety (DHSSPS) for the UK
and Northern Ireland,
made a priority of ‘Working for Healthier People’,
giving a budget commitment to developing the role of the
community pharmacist further,
modernising and improving services,
promoting integrated working across primary, secondary
and community sectors and improving efficiency and
performance.
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• Priorities for Action has endorsed the development of a medicines
management service in order to start making full use of community
pharmacists’ skills (DHSSPS, 2006).
• Areas where community pharmacy can contribute to the medicines
management agenda include:
– ongoing medication review
– improving patient understanding and use of prescribed medication
– developing care programmes and services for ‘at risk’ patient groups
– protocols for patient counselling and self medication
– health promotion and multidisciplinary research
– audit and drug utilisation review.
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• It is also important to note the substantial role pharmacists play in
providing prescribing support.
• In this context, pharmacists work at different levels:
– individual practice,
– local health and social care group, and
– health and social services board.
• These pharmacists also contribute to the medicines management agenda.
Examples of the key areas of involvement include:
– prescribing analysis and feedback
– formulary development and maintenance
– review and management of repeat prescribing processes
– medication review.
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• Work is also under way to develop prescribing policies across the primary–
secondary care interface, and across the whole of the pharmaceutical
sector, developing opportunities for pharmacist prescribing allied to the
Crown Report (1999).
• Pharmacy practice has been evolving to meet the needs of a
contemporary healthcare system.
• The modern role of the community pharmacist is well articulated in the
Report of the Joint Working Party on the Future Role of the Community
Pharmaceutical Service, published in 1992 (Hawksworth & Chrystyn, 1992).
• In addition, a major and ongoing initiative by the RPSGB – ‘Pharmacy in a
New Age’, started in 1995 – seeks to set out what pharmacy does and can
offer, supported by information technology, education and training, audit
and research.
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Steps of dispensing a prescription in a
community pharmacy:
• Receiving the prescription: At this stage, communication and
interaction with the pharmacy staff take place
• Reading and checking of prescription
- patient’s name and address
- age of patient if under 12 years
- name, dose and quantity of medicine
- Date
- prescriber’s name and address
- signature of prescriber
- legality
• Collection of medicine: care in selecting appropriate
medicine, strength, and dosage form.
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Cont…
Label production: Details to be included on label:
• patient’s name
• date of dispensing
• name of pharmacy
• name of medicine
• strength
• dosage form
• quantity dispensed
• dose with clear instructions
• cautionary labels.
• Rechecking Recheck that the prescription and the
medicine prepared are consistent
• Handing over the medicine: The pharmacist explains
to the patient when and how to take the medication.
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Code of ethics
• Moral ‘’the conduct of individuals in any society is governed by the
environment controls on the one land and social customs and duties on
the other”
• Code of ethics = code of moral principles= science of moral
• Governments restricts the practice of the pharmacy to who's qualified
under regulatory requirement and grant them privileges necessarily
denied to other.
• In return, government expects the pharmacist to recognize his
responsibilities and fulfill their professional obligations honorably and with
due regard for the well being of the society.
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Factors influencing health promotion activities
in community pharmacies
Positive factors
Environment within the pharmacy
Health promotion
Access to parts of the pharmacy
Communication skills of community pharmacy
Negative factors
Lack of resource materials
Lack of space
Lack of privacy
Inappropriate time management of the pharmacy
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Communication with patient
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Communication process
• Understanding needs of individual: (e.g. social problem
associated with occurrence of acne may impact differently on
individuals).
• Professional Relationship building: friendliness, Preserve
confidentiality.
• Non-verbal communication and body language :
Close conversational distance, Direct eye contact, forward leaning
posture, Smiling, voice tone
• Questioning and listening: Use effective questions by asking
open questions to obtain information that is necessary, Ask only
one question at a time, Encourage patient participation, Practice
active listening.,
• Responding and explaining: Place the most important
points at the beginning of the communication session, Give specific
instructions, Simplify complicated messages. Give care to Patient
characteristics such as speech defect
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Counseling in the community pharmacy setting
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References
1. British Society for the History of Pharmacy (2007). www.bshp.org
(accessed 5 March 2007).
2. CIPPET – Centre for Inter-Professional Postgraduate Education and
Training; www.pharmacy.rdg.ac.uk/ cippet (accessed 5 March 2007).
3. CPPE – Centre for Pharmacy Postgraduate Education –
www.cppe.manchester.ac.uk
4. Crown Report (1999). Review of Prescribing, Supply and Administration
of Medicines. Final report. www.jcn.co.uk/pdf/crownreport2.pdf
(accessed 5 March 2007).
5. Department of Health (2007). Patient Group Directions
http://www.dh.gov.uk/en/Policyandguidance/
Emergencyplanning/DH_4069610 (accessed 5 March 2007).
6. DHSSPS (2006). Priorities for Action. Department of Health and Social
Services and the Pharmaceutical Service for Northern Ireland.
www.dhsspsni.gov.uk/
7. pfa_2007–08.pdf (accessed 5 March 2007).
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THANK YOU
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