The role of the pharmacist has been evolving worldwide for over a century whereby there has been a shift from
purely compounding roles in 1900 with extension of roles to medication therapy management in 2003.
Globally, pharmaceutical care has been evolving with the recognition of Medication Therapy Management
(MTM. This evolution is an ongoing process globally with various countries at different levels of practice.
In the hospital pharmacy practice, the various roles of a pharmacist are intertwined with the success of each
heavily relying on the other.
Clinical pharmacy practice at KUTRRH
The importance of clinical pharmacy in the hospital
• Evaluating medication therapy and making appropriate recommendations to patients orhealth practitioners.
• Conducting Medication Therapy Management which includes medication review and reconciliation as well as counseling of a patient on medication use.
• Providing evidence-based information and advice about the safe and effective use of medications.
• Recognizing untreated health conditions that could be managed with medication therapy.
• Monitoring patient progress with medications and making relevant recommendations to change medications.
• Therapeutic drug monitoring of various medications especially those with narrow therapeutic windows.
• Pharmacovigilance; monitoring and reporting adverse effects and poor-quality medicines.
• Conducting clinical trials and carrying out observational and retrospective research as which can help influence institutional, regional, and national policies.
• Training of Pharmacist Interns and Pharmacy students on provision of pharmaceutical.
Inpatient clinical pharmacy practice atthe hospital
It involves the attendance of ward rounds and review of the patient treatment sheets to identify and mitigate any drug related problems such as:
• Drug-drug and drug- food interactions
• Drug contraindications
• Drug dose adjustments
• Alternate drug choices that are safer, cost effective and most appropriate for optimal patient outcomes
• Carrying out pharmacovigilance to prevent or mitigate adverse drug reactions as well as documentation of the same
• Advising other health care workers on the appropriate use and administration of drugs
• Patient education on any change in their medications and on adherence upon discharge
Endocrinology Medication Therapy Management Clinic
The endocrinology Medication Therapy Management(MTM) clinic at KUTRRH operates every Monday afternoon and targets all patients visiting the clinic on that day. Medication Therapy Management (MTM) is a group of patient-centered, pharmacist-provided,collaborative services that focus on medication appropriateness, effectiveness, safety, and adherence with the goal of ensuring the best therapeutic outcomes for patients.
Medication therapy management services offered include performing a comprehensive medication review
to identify, resolve and prevent medication related
problems such as therapeutic duplication, drug interactions and adverse/side effects; providing counseling
on medication to enhance patients’ understanding and appropriate use of their medications; monitoring and
evaluating a patients’ response to therapy to include safety and effectiveness of their medication; documenting the pharmaceutical care delivered and communication to the patients’ primary care providers.
Oncology Targeted Bedside Medication Therapy Management
Medication therapy management services offered include performing comprehensive counseling on medication the patient is on and the expected side effects
to enhance patients’ understanding and appropriate
use of their medications, identification, and mitigation side effects as well as other drug related problems
such as poor adherence with communication with the primary doctor.
Others include monitoring and evaluating a patients’ response to therapy to include safety and effectiveness of their medication, dispensing post chemotherapy medications and an average of 20% of the patients were experiencing adverse drug reactions that warranted interventions.
Expected Outcomes from the Interventions
Expected outcomes from the pharmacy interventions include appropriate drug use, increased patient adherence with prescribed drug therapies, reduced risk of adverse events associated with drugs, and reduced need for other costly medical services with overall reduction in healthcare expenditure.