PHAR 5 LEC

CHAPTER 1 - INTRODUCTION
KEY TERMS AND DEFINITIONS: ACCREDITATION - Determination by an accrediting body that an eligible health care organization complies with the accrediting bodys applicable standard. INSTITUTIONAL PHARMACY PRACTICE - Includes the provision of distributional and clinical pharmacy services at a broad range of institutional settings including hospitals, longterm care, hospice, correctional facilities, and others. INTEGRATED HEALTH SYSTEMS - Integrate all care under the umbrella of a central organization, and often include inpatient/acute care, primary/outpatient care, long term care, home care and other patient-care settings. PRACTICE GUIDELINES - Tools that describe processes found by clinical trials or by consensus opinion of experts to be the most effective in evaluating and/or treating a patient with specific symptom, condition, or diagnosis, or that describe a specific procedure. PRACTICE MODEL - The operational structure that defines how and where pharmacists practice, including the type of drug distribution system used, the layout and design of a department, how pharmacists spend their time, practices functions and practice priorities. - The THREE (3) predominant practice model: 1. Drug-distribution centered model 2. Clinical pharmacist centered model 3. Patient-centered integrated model PRIVELAGING - The process by which an oversight body of a health care organization or other appropriate provider body, having reviewed an individual health care providers credentials and performance and found them satisfactory, authorizes that individual to perform a specific scope of patient care services within that setting. REGULATION - Governmental order having the force of LAW. SMART PUMPS - Infusion devices with clinical decision support software and drug libraries that perform a test of sonableness at the point of medication administration.

TYPES OF HOSPITALS [1] COMMUNITY HOSPITAL - Most common type - Designed to deal with an assortment of disease and injury. - Typically have emergency services for treating trauma and other imminent threats to health. - Also have inpatients that need surgical, intensive care, obstetrics, long term care, medical and other services. [2] SPECIALIZED HOSPITAL - Serve the needs of patients suffering from some particular disease, or affecting a specific organ system. [3] TEACHING HOSPITAL - Two missions: I. Serving patients needs II. Training future health care professionals [4] FOR-PROFIT HOSPITALS - Owned by corporations or groups of private investors. NON-PROFIT HOSPITALS - Do not seek a return of investment for owners. - Operate under religious, volunteer, community, or other voluntary patronages. [5] GOVERNMENT HOSPITALS - Owned or heavily supported by federal, state, county or other governmental entities. PHARMACYS ROLES: THE MEDICATION USE PROCESS [1] PRESCRIBING Privelaging Influence the prescribing of other health professionals [2] TRANSCRIBING - Is the process by which a prescribers written order is copied and either manually or electronically entered into pharmacy records Help find ways to minimize errors [3] DISPENSING - Act of physically transferring the drug product following review and approval of the prescription to the area responsible for administering the medication to the patient. [4] ADMINISTRATION - Typically managed by nurses Help improve the safety of medication administration by clearly labelling medications, using bar code systems and unit dose packaging. [5] MONITORING - Monitoring the patients response to the medication. Reviewing lab values.

PRACTICE MODELS - Most important factor - Determining the role and effectiveness of the pharmacy department [1] DRUG DISTRIBUTION-CENTERED MODEL - Pharmacists primarily distribute drugs and process new medication orders. - Pharmacists role is reactive, in that he/she responds to requests of physicians and nurses but rarely initiates major changes in therapy. - Not actively involved with the health care team. - Not accountable for health outcomes of the patients. [2] CLINICAL-PHARMACIST MODEL Two primary types of Pharmacist: I. Clinical Pharmacist - Chiefly involved in clinical activities associated with medical teams on the nursing units. - 1o: Assisting physicians and other health care professionals in avoiding and solving clinical problems exclusive of the distribution process II. Distributive Pharmacist - Spend most of their time in drug distribution, reviewing orders and verifying the accuracy of medication preparation by technicians. [3] PATIENT-CENTERD INTEGRATED MODEL - All pharmacists in the department accept responsibility for all elements of the medication-use process and therefore spend their tie on both clinical and distributive functions.

A pharmacotherapy plan should be developed for every patient. Pharmacists will need continuous training to practice pharmacy Institutional pharmacist will need to collaborate better with community pharmacists to coordinate care as patients transition form one practice setting to the next.

Practice will need to be interdisciplinary and team based. Medication preparation and distribution will need to be made more efficient with automation, centralization, and use of trained technicians. Pharmacists contributions to the medication-use process will be increasingly in direct patient care and less in medication distribution. Health information technology Pharmacists will need to justify their value because allocation of heath care resources will be heavily driven by metrics.