INTRODUCTION AND COMMUNITY PHARMACY MANAGEMENT

UNIT1INTRODUCTION AND COMMUNITYPHARMACY MANAGEMENT1

2COMMUNITY PHARMACY: BASIC PRINCIPLESANDCONCEPTS1.1 COMMUNITY PHARMACY1.1.1 DefinitionThe main responsibilities of a community pharmacy include compounding,counseling, and dispensing of drugs to the patients with care, accuracy, andlegality along with the proper procurement, storage, dispensing anddocumentation of medicines. The community pharmacist must be a qualifiedand pertinent with sound education, skills and competence to deliver theprofessional service to the community.A community pharmacist should(i)have a sound background of pharmaceutical care, pharmacotherapy,and health promotion.(ii)have good communication skills with patients and other healthcareproviders.(iii)maintain a high degree of standard in products, services, andcommunication.(iv)record and maintain his documents in order.“In short community pharmacy is the drug use, control and effectiveapplication of knowledge of ethics, that assures optimal drug safety in thedistribution and use of medicines and hence, it ensures maximum well-being ofpatients while they are on drug therapy.”Community Pharmacy is defined broadly to include all those establishmentthat are privately owned and whose function, in varying degrees is to servesocieties needs for both drug product and pharmaceutical service. It is thebranch of pharmacy that deals with different aspects of patient care, dispensingof drugs and advising patient on the safe and rational drug use.1.1.2 Scope of Community PharmacyCommunity Pharmacy has a large number of scopes or approaches, which arerelated to patient counseling and patient drug control.1.1.2.1 Drug information about their actionBesides proper understanding of the biological and physical science,community pharmacy also provides grasp on chemistry, pharmacology,toxicology, routes of administration, stability and other information regardingdrugs.

CHAPTER 1INTRODUCTIONANDCOMMUNITY PHARMACY The community pharmacy is an excellent institute and an educationallaboratory for physician and pharmacist carrying out an obligation to providenecessary and fully authoritative information on drug. Community pharmacyacquires the knowledge by personal and individual contacts with the physicianbut also from the pharmacy and therapeutic committee. Community pharmacyalso ensures the pharmaceutical quality of drugs and dispensing of drugs andalso responsible in selection of a suitable product in the market.1.1.2.2 Drug utilizationCommunity pharmacy helps to develop charging policies for pharmaceuticalservices. It should also be able to implement an adequate system for stock andinventory control. Community pharmacy also decides the proper regimen ofdrug to the patient. It also gives the knowledge to how to administer the drug tothe patient.Stock control reports on prescription and controlled drugs dispensed, drugpurchases, inspection and improvement in operation and such other aspectwhich demand attention.1.1.2.3 Drug distributionConsiderable quantities of drugs are localized physically outside the pharmacy.It is necessary to have control for internal distribution of drugs for patients. Thepatients who are hospitalized may require intensive drug therapy, controlledprocedures which will allow rapid rechecks of drug source and quality. Thepotentialities of automated dispensing at the wards level bring further emphasisto establishment of correct controls for drug distribution in this situation.1.1.2.4 Drug selectionIn the field of community pharmacy the ‘rational drug therapy’ plays aimportant role for the selection of drugs which will be given to the patients toencounter the disease. It is defined as the use of an appropriate, efficacious, safeand cost-effective drug given for the right indication, in the right dose and atright interval of time and for the right duration of time (Dosage regimen).It involves various type of activities like(a) Adoption of essential drugs concept(b) Training of health professionals (counseling of health in Rational DrugTherapy/ Rational Drug Use)(c) Maintenance of data based on clinical guidelines3

4COMMUNITY PHARMACY: BASIC PRINCIPLESANDCONCEPTS(d) Consumer education and regulatory strategies if the Rational Drug Use(RDU) is not proper it leads to illness, adverse drug reactions (ADRs),increase cost of medication and treatment to the patient.It is also known as “Essential Drug Concept” (EDC).1.1.2.5 Patient counseling and evaluatingDialogues between patients and physicians regarding the indication, proper useand potential adverse effects of non-prescription drugs (NPDs) should bedifferent as compared, when if the physician has written the prescription. In theera, the cost considerations are greater than ever, NPDs should be consideredand referred when appropriate, as alternatives to prescription drugs.Fig. 1.1 Pharmacists involved in patient counseling1.1.3 Role and Responsibilities of Pharmacist(I) Central Pharmacists ResponsibilitiesA. Dispensing area1. Ensures that established policies and procedures are followed.2. Checks for the accuracy of doses prepared(a) Intravenous admixtures(b) Unit dose3. Provides for proper drug control(a) Ensures that drugs are stored and dispensed properly (eg.Investigational drugs)(b) Ensure that all state and federal drug laws are followed4. Ensure that good techniques are used in compoundingintravenous admixtures and extemporaneous preparations

CHAPTER 1INTRODUCTIONANDCOMMUNITY PHARMACY 5. Provides for proper record keeping and billing(a) Patient-medication records(b) Extemporaneous compounding records(c) Intravenous admixture records billing(d) Investigational-drug records(e) Reports (eg. Monthly workload report)6. Maintains professional competence, particularly in knowledge ofdrug stability and incompatibilities.7. Ensures that new personnel are trained properly in the policiesand procedures of the dispensing area.8. Co-ordinates the activities of the area with the available staff tomake the best possible use of personnel and resources.9. Keeps the dispensing area neat and orderly.10. Communicates with all pharmacy staff regarding newdevelopment in the area and assists in employee evaluations.11. Provides drug information as necessary to the pharmacy, medicaland nursing staffs.12. Co-ordinates the overall pharmaceutical needs of the patients careareas with the dispensing area (eg. Delivery schedules).B. Patient-care area1. Supervision of drug administration.(a) Reviews and interprets each unit doses and intravenous (IV)admixture medication order to ensure that it is enteredaccurately into the unit-dose or IV- admixture system.(b) Reviews each patients drug administration form periodicallyto ensure that all doses are being administered and chartedcorrectly.2. Reviews all doses missed, reschedule the doses as necessary andsigns all drugs not given notices.3. Ensures that new drug administration forms are transcribedaccurately for continuity of drug therapy and that drug charges areassessed correctly.(a) Confirms periodically that administered doses are notedcorrectly on the patient chart.5

6COMMUNITY PHARMACY: BASIC PRINCIPLESANDCONCEPTS(b) Ensures that records for administered narcotics are keptcorrectly and that the physician is informed of all automaticsstop orders.(c) Ensures that proper drug administration techniques are used.(d) Acts as liaison between the pharmacist, the nursing andmedical staffs.(e) Communicates with nurses and physicians concerningmedication administration problems.(f) Periodically inspects the medication area on the nursing unitsto ensure that adequate levels of floor stocks drugs and supplyare maintained.(g) Ensure that order supportive services performed from thedispensing area as required.(h) Ensure that the other supportive services performed by thedepartment of pharmacy are carried out correctly.(i) Co-ordinate all pharmacy services on the nursing unit level.(j) Ensure that the medication area is neat and orderly.(k) Ensure that proper security is maintained in the medicationarea to prevent pilferage.C. Direct patient careIdentifies drug brought into the hospital by patients.Obtain patient medication histories and communicates all pertinentinformation to the physician.1. Assists in drug-product and entity selection.2. Assists the physician in selecting dosage regimens and schedulesand then assigns drug administration times for these schedules(pharmacokinetic service).3. Monitors patient s’ total drug therapy for(a) Effectiveness/ ineffectiveness(b) Side-effects(c) Toxicities(d) Allergic drug reactions(e) Drug interaction(f) Appropriate therapeutic outcomes

CHAPTER 1INTRODUCTIONANDCOMMUNITY PHARMACY 4. Counsels patients on(a) medication to be self administered in the hospital(b) Discharge medications5. Participates in cardiopulmonary emergencies by(a) Procuring and preparing the drug required.(b) Charting all medications given.(c) Performing cardiopulmonary resuscitation, if necessary.D. General responsibilities1. Provides education to(a) Pharmacists, pharmacy externs, clerks, students, residents andother students.(b) Nurses and nursing students.(c) Physicians and medical students.2. Provides drug information to physicians, nurses and other healthcare personnel.(II) Ambulatory Pharmacists ResponsibilitiesA. Dispensing area1. Ensure that established policies and procedures are followed2. Checks for the accuracy in the work of supportive personnel3. Ensure that proper techniques are used in extemporaneouscompounding4. Maintenance of adequate record keeping and billing(a) Patient medication records(b) Investigational drug records(c) Outpatients billing(d) Reports(e) Prescription files5. Maintains professional competence6. Ensure that new personnel are trained properly in the policies andprocedures of the ambulatory pharmacy.7. Co-ordinate the activities of the area with available staff to makethe best use of personnel and resources.8. Keeps the ambulatory pharmacy area neat and orderly at all times.7

8COMMUNITY PHARMACY: BASIC PRINCIPLESANDCONCEPTSB. Patient care area1. Inspects the medication areas in the nursing unit periodically toensure an adequate supply of stock drugs and their proper storage.2. Identifies the drugs brought into the clinic by patients.3. Obtains patients medication histories and communicates pertinentinformation to the physician.4. Assists in drug-product entity selection.5. Assists the physician in selecting dosage regimens and schedules.6. Monitors the patients total drug therapy for:(a) Effectiveness(b) Side-effects(c) Toxicities(d) Allergic drug reactions(e) Drug interactions(f) Appropriate patient outcomes7. Counsels patients on the proper use of their medications.8. Prepare medications for intravenous administration.9. Provides medication and/or supply for patient home care.C. General responsibilities1. Provides drug information necessary to pharmacy, medicals andnursing staffs.2. Co-ordinates overall pharmaceutical needs of the ambulatoryservice area.3. Provides adequate drug controls(a) Ensures that the drugs areInvestigational-drug storage).handledproperly(b) Ensures that all state and federal laws are followed4. Maintains professional competence in area.5. Participates in cardiopulmonary emergencies by(a) Procuring and preparing the drug required.(b) Charting all medications given.(c) Performing cardiopulmonary resuscitation, if necessary.(eg.