Central Clinical Services
1. Drug-Use evaluation:
Check if at minimum, drug-use patterns are analyzed and results are reported to a hospital committee.
2. In-service education:
Pharmacist presents continuing education to fellow employees (physicians, nurses, pharmacists, etc.) on a scheduled basis at least 4 times/year.
3. Drug information:
Provided only if a formal drug information service with specifically assigned pharmacist is available for questions. Does not required a physical location called drug information center.
4. Poison information:
Provided only if a pharmacist is available to answer toxicity and overdose questions on a routine basis with appropriate resources.
5. Clinical research:
Performed by pharmacist either as a principal investigator or co investigator. Pharmacist is likely to be (co-) author on a published paper. Do not check if activity is limited to investigational drug distribution or record keeping.
6. Drug safety:
Pharmacist(s) has specific time set aside each week to work on improving drug safety in the hospital.
Patient-Specific Clinical Pharmacy Services
7. ADR management:
Pharmacist evaluates potential ADR while the patient is hospitalized and appropriately follows through with physicians.
8. Pharmacokinetic consultation:
Provided only if at a minimum, the drug regimen, serum level, and patient's medical record is reviewed, and verbal or written follow-up is provided when necessary.
9. Drug therapy monitoring:
Provided only if a patient's medical record is reviewed, and verbal or written follow-up is provided when needed. Monitoring is ongoing and repeated, often on a daily basis. Do not check if drug orders are reviewed. Does not include pharmacokinetic consults, total parenteral nutrition (TPN) team, rounds, ADR management, or drug therapy protocol management.
10. Drug protocol management:
Pharmacist, under the order of a prescriber, requests laboratory tests if needed and initiates or adjusts drug dosage to obtain the desired therapeutic outcome (e.g., aminoglycoside or heparin dosing per pharmacy).
11. TPN team participation:
Pharmacist, at a minimum, reviews patient's medical records and/or provides written or verbal follow-up if needed.
12. Drug counseling:
Pharmacist provides counseling on drugs either during hospitalization or at time of discharge. Do not check if counseling involves solely review of label direction.
13.Cardiopulmonary resuscitation team participation:
Pharmacist is an active member of the CPR team attending most cardiac arrests when the pharmacist is present in the hospital.
14. Medical rounds participation:
Pharmacist rounds with a medical team at least 3 days/week, actively providing specific input.
15. Admission drug histories:
Pharmacist provides admission histories.
Types of clinical pharmacy services in ambulatory settings
1. Primary pharmaceutical care intervention:
Comprehensive patient assessment with review of drug therapy regimen for indication, efficacy and safety Identification of actual and potential drug therapy problems, preparation of care plans and therapeutic recommendations.
2. Patient teaching / Medication teaching and review of drug therapy regimens
Providing updated medication schedule to patient.
3. Medication reconciliation:
Performing a comprehensive medication history including all prescription, non-prescription and complementary and alternative medication use Documentation of full medication history in outpatient electronic chart Communicating medication changes to patients, other health care providers and community pharmacies
4. Referral of issue for team follow-up :
Re-directing and communicating patient care issues as appropriate to other members of the inter-professional team; may involve verbal and/or written communication.
5. Optimizing medication adherence:
Optimizing medication schedules to promote patient adherence taking into account cultural/lifestyle factors and medication-taking behavior Developing and implementing patient-specific adherence strategies and tools
6. Medical/drug information and advice:
Responding to drug information queries from patients and the inter-professional team Providing medical advice where appropriate, in collaboration with the inter-professional team
Assisting with drug coverage and reimbursement issues, Assisting with preparation of prescriptions,Updating community pharmacies with changes to drug therapy regimens
Collaborating with community pharmacist to manage adherence issues (e.g., blister packing)