Pharmaceutical care responsibilities

Hepler CD and Strand LM (1990) Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 47(3) 533-543... 

Pharmaceutical care (PC) is defined by Hepler and Strand (1990) as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient s quality of life . PC involves three major functions on behalf of... 

FDA, Report to the FDA Commissioner From the Task Force on Risk Management. Managing the Risks From Medical Product Use Creating a Risk Management Framework, Food and Dmg Administration, Rockville, MD, May 1999 (http //www.fda.gov/oc/tfrm/riskmangement.pdf). Hepler, C.D. and Strand, L.M., Opportunities and responsibilities in pharmaceutical care. Am. J. Pharm. Educ., 53,15S, 1989. 

The pharmacist is responsible for preparing a pharmaceutical care plan for this patient and must include the issues listed in Table A3.1. 

The advent of pharmaceutical care has ushered in a new era of pharmacy practice based on a clear description of a pharmacist s patient care responsibilities and contributions to society. Before the era of pharmaceutical care, pharmacists engaged in professional activities often defined merely by a drug or disease state of interest. This potpourri of pharmacy activities previously referred to as a practice was inconsistent with the systems of care used by all other health care professions. This chapter presents and discusses... 

Before analyzing the interrelated systems of pharmaceutical care, a brief overview of this new professional practice will be helpful. The landmark pharmaceutical care article published in 1990 creafed the theoretical constructs for the responsible provision of drug therapy. This article set the foundation for the development of a new professional practice. Through efforts aimed at moving from theory into application, the definition of fhis new professional practice emerged. A pharmaceutical care practice then is defined as a practice in which the practitioner takes responsibility for all of a patient s drug-related needs and is held accountable for this commitment. ... 

Because there has not been a consistent, systematic, and rational medication use process, it is necessary to first describe the purpose of fhis systematic medication use process and then establish a new professional practice by clearly delineating the scope and domain of fhis practice. Defining the scope and domain of practice are essential to clarify how pharmaceutical care practitioners can address a problem better than other individuals or professions. The scope of pharmaceutical care is drug therapy problems and the domain is the practice environment in which a practitioner assumes responsibility for a patient s drug-related needs and is held accountable for this commitment. 

All health care professions have a specific philosophy of care. The four componenfs of fhe philosophy for pharmaceutical care are (1) the statement of social need, (2) a patienf-cenfered need for meeting the social need, (3) the development of a fherapeutic relationship to care for another human being, and (4) a description of fhe practitioner s specific responsibilities. A philosophy of practice is a sef of values thaf guide behaviors. This philosophy defines the rules, roles, relationships, and responsibilities of the practitioner. 

To address the social need of drug-related morbidity and mortality based on a patient-centered approach that is built on the establishment of a therapeutic relationship, there must be clearly defined practitioner responsibilities. In pharmaceutical care, the practitioner is responsible for all drug-related needs of a patient. As discussed in detail in the next section, this means that a practitioner seeks to ensure that all therapies are appropriately indicated and that all medical conditions of a patient are appropriately treated, and that all therapies in use are effective, safe, and convenient for the patient. 

The scope of pharmaceutical care is drug therapy problems, defined as any aspect of a patient s drug therapy that is interfering with a desired, positive patient therapeutic outcome.Before the advent of pharmaceutical care, there was no evidence of a consistent and systematic patient care process applied to the use of medications therefore, pharmaceutical care practitioners responsibilities are to ensure that therapeutic outcomes are achieved and to identify, resolve, and prevent drug therapy problems that hinder achievment of desirable therapeutic outcomes. 

The patient care process clearly describes how a pharmaceutical care practitioner fulfills responsibilities outlined in the philosophy of care. The fhree sfeps in the patient care process are assessment, care plan, and evaluation. These three steps are continuous, or may be viewed as being cyclical in nature. The initial assessment helps the practitioner formulate a care plan in concert with the patient, and follow-up evaluation includes documenfation of acfual patienf oufcomes, leading back to assessment of new drug-relafed needs. 

Identifying, resolving, and preventing drug therapy problems are the central focus of a practitioner s patienf care responsibilities. The pharmaceutical care practitioner learns to fulfill fhis patienf care responsibility better than any other health care professional. Table 15.1 presents a classification of drug therapy problems. 

Evaluation is defined as the practitioner s determination of the patient s outcome and clinical status at planned intervals. Evaluation represents accountability in the definition of a pharmaceutical care practice. This accoxmtability is witnessed at the patient level by the practitioner assuming responsibility for finding out exactly what happens to the patient in the medication use process and documenting these results or outcomes. 

Patient satisfaction and quality of life are the two most common methods of measuring the humanistic outcomes of care. Improvements in patients quality of life have not been consistently demonstrated however, there is evidence that many of these studies purporting to provide pharmaceutical care were in fact disease state management or specific drug-focused programs in which pharmacists did not assume responsibility for all of the patients drug therapy treatment goals. 

Mission statement. Without a statement of mission, there is no clear definition of the purpose to guide practitioners through their daily duties and responsibilities. The following is an example of describing the service as part of the mission for a pharmaceutical care practice ... 

In pharmaceutical care, pharmacists knowledge, skills, and capabilihes are the same as in clinical pharmacy however, their athtudes and values differ. The shift from clinical pharmacy to pharmaceuhcal care focuses more attenhon on the profession, and pharmacists begin to assume responsibility for the outcome of medicahon therapy. ... 

The supplies of food, clothing, housing, and numerous other amenities provided by the commission have been well documented in Charles Stille s official report of 1866 and ninety years later in Maxwell s contemporary history of the organization. The commission s role in pharmaceutical care, however, has not received adequate attention. In fact. Maxwell dismisses its pharmaceutical activities. Explaining that the early shortages of dmgs experienced by many regiments early in the war arose from internal requisition problems that were the military s responsibility and not due to any real de-... 

Before discussing the military aspects of pharmaceutical care, it is a significant fact that the Southern war for independence would tax the resources of the region to its limit and beyond. The Confederacy understood that it had a dual responsibility to care not only for its... 

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