afams eo 001.02 pharmacy practice (dari) 01/09/2013

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EO 001.02 Pharmacy Practice(Dari)

01/09/2013

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Importance of Lesson(Dari)

• Pharmacy Technicians serve as Pharmacist extenders however, they may only perform some activities of a Pharmacist.

• Therefore, Pharmacy Technicians must be aware of these activities that require a Pharmacist.

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Overview EO 001.02(Dari)

• Understanding roles and responsibilities:– Pharmacist

– Pharmacy Technician

• Description of Pharmacy Practice Settings

• Lesson Review

• Scenarios (not graded)

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Pharmacist Roles/ Responsibilities Dari

• Provision of pharmacy services (Clinical);

• Provision of dispensing services;

• Managing use of Under Control/ Controlled Medications;

• Managing the use of medical materials;

• Pharmacy operations; and• Pharmacy administration.

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Pharmacy Services (Clinical)Dari

Clinical Pharmacy

“ …patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.”

“…it blends a caring orientation with specialized therapeutic knowledge, experience and judgment...”

American College of Clinical Pharmacy

• Due to the requirement for professional judgment and therapeutic knowledge only Pharmacists can provide clinical services.

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Pharmacist Clinical Activities:• Ensures safe and effective use of

medications – Determines and resolves any

medication therapy problems • drugs without indications;

• medical conditions for which no therapy is prescribed;

• therapy inappropriate for medical condition;

• incomplete immunization record;

• inappropriate dose, dosage form, duration, schedule, route of administration, method of administration;

• therapeutic duplication;

• medication allergies; and

• clinically significant drug-drug, drug-disease, drug-nutrient, or drug-laboratory test interactions.

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Pharmacist Clinical Activities:• Provides responses to requests for

drug information from patients, physicians and nurses.

• Provide patient discharge medication teaching upon request.

• Report medication errors and adverse drug reactions to the medical team.

• Inform and provide education to hospital staff.

• Document clinical activities in patient chart.

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Pharmacy Dispensing Services Dari

Dispensing:

• The preparation of a drug or device referred to in a prescription and taking steps to ensure the pharmaceutical and therapeutic suitability of a drug or device for its intended use and taking steps to ensure its proper use.• Government of British Columbia Canada

Prescription:

• A written or verbal order from a Doctor

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Pharmacist Dispensing Activities:

• Assess a prescription for suitability of medication selected for a patient’s disease state, appropriateness dose, and frequency of dosing, therapy duration, medication duplication and drug-drug interaction.

• Contacts Physician for questions about prescriptions.

• Contacts the prescribing Physician for known contraindications and drug interactions on medications that have been requested

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Pharmacist Dispensing Activities:

• Oversee Pharmacy Technician filling of a prescription.

• Provide medication information and advice to physician and nursing staff.

• Provide consultation and advice regarding medications for patients.

• Ensures appropriate packaging of medication.

• Ensures adequate supply of medication to match with requirements.

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Under Control/ Controlled Medications

DariManagement of Under Control/

Controlled Medications:

• Under Control/ Controlled medications have the potential for abuse or addiction and therefore, must be kept in a separate locked area to prevent unauthorized removal from the pharmacy department.

• Pharmacists are responsible for ensuring policies related to Under Control/ Controlled Medications are followed and reports completed. • Including: receipt, storage, issue and

disposal.

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Managing Medical MaterialsDari

Medical Materials (Class VIII):

– Militaries require supplies to be effective. Supplies can be classified as rations (Class I), ammunition(Class V), vehicles (Class VII)….

– Class VIII – Medical and Dental material.

– Pharmacist’s extent of responsibility depends on location. Pharmacists must ensure the proper receipt, accounting, storage, transfer and issue of medical supplies under their control:

» Hospital: Drugs, pharmaceutical gels/ creams….

» Warehouse: drugs, pharmaceutical gels/ creams, bandages, crutches, x-ray machines….y machines, blood pressure machines at Class VIII warehouses.

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Pharmacy OperationsDari

– The Chief of Pharmacy is responsible for the professional services and efficient management of all pharmacy operations.

» Enforcement of national, hospital and pharmacy policies by pharmacy staff.

» Management of pharmacy staff (e.g. administration staff, pharmacy technicians..). Proper staffing of clinical, dispensary and quartermaster positions.

» Liaising with other areas of the hospital (e.g Wards, Hospital Management, Emergency Department,..)

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Pharmacy Administration Pharmacists are responsible to the Chief

of Pharmacy for administrative accountability

Pharmacy technicians report to the Chief of Pharmacy through the pharmacist supervising their division.

Chief of Pharmacy is responsible for the disciplining of pharmacy staff members.

Pharmacy Accountant is responsible for maintaining accurate records of medications, equipment and consumables for the Pharmacy Department. Works closely with other members of the Pharmacy Department and the hospital Finance Officer to support the department’s needs

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Check on Learningآموزش ارزیابی

Question:

• What are the six areas of responsibility for a pharmacist?

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Check on Learningآموزش ارزیابی

Answer:

1. Provision of pharmacy services (Clinical);

2. Provision of dispensing services;

3. Managing use of Under Control/ Controlled Medications;

4. Managing the use of medical materials;

5. Pharmacy operations; and

6. Pharmacy administration.

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Pharmacy Technician Roles/ Responsibilities

DariRemember:• Pharmacy Technicians

serve as Pharmacist extenders however, they may only perform some activities of a Pharmacist.

• Let’s look at the 6 areas of a pharmacist’s responsibilities and where Pharm Techs fit in.

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Clinical Pharmacy

“ …patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.”

“…it blends a caring orientation with specialized therapeutic knowledge, experience and judgment...”

American College of Clinical Pharmacy

• Due to the requirement for professional judgment only Pharmacists can provide clinical services.

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Professional judgment:

“…a process used to reach a well-reasoned conclusion that is based on the relevant facts and circumstances available at the time of the conclusion. A fundamental part of the process is the involvement of individuals with sufficient knowledge and experience.”

American Accounting Association

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Therapeutic Knowledge• knowledge required for the evaluation,

selection, use, monitoring, advice, education and/or recommendations related to appropriate drugs to assist in the:

(a) management of individual patient’s symptoms and disease states, and / or,

(b) identification, management and/or resolution of drug-related problems.

NAPRA Canada

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Therapeutic knowledge does not include information and basic knowledge related to: (Technical Questions)(a) principles related to communication, collaboration, professionalism, ethics or legal aspects of pharmacy practice

(b) drug distribution systems

(c) basic pharmacology (i.e. mechanism of action, uses and customary doses of common drugs and drug classes)

(d) basic pharmaceutics (i.e. drug contents, dosage forms, stability and physical compatibility, pharmaceutical calculations)

(e) principles and practices related to patient safety

(g) principles and practices related to pharmacy management

NAPRA Canada

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Question: True or False?

Since only pharmacists can perform clinical services Pharmacy Technicians

cannot assist in completing these pharmacist duties?

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Question: True or False?

Since only pharmacists can perform clinical services Pharmacy Technicians

cannot assist in completing these pharmacist duties?

FALSE

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Pharmacy Services (Clinical)(Dari)

Pharmacy technicians, when helping Pharmacist to provide patient care can:

• ensure confidentiality when gathering, using or providing patient information

• recognize when a patient potentially requires assessment, clinical analysis or application of therapeutic knowledge and consult with the pharmacist in such instances.

• refer to the pharmacist patients who require assessment, clinical analysis or application of therapeutic knowledge.

• identify and refer to the pharmacist patients who have discrepancies between their current drug therapy and their recent or intended drug therapy.

• provide information that does not require application of therapeutic knowledge to patients requiring assistance in selecting non-prescription drugs and medical devices

• determine whether the prescription meets all legal requirements, and where it does not, notify the pharmacist

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How Pharm Techs can assist:

1. Answer questions that do not require professional judgment or therapeutic knowledge.

(Technical Questions)– A Physician asks at what temperature a

certain drug should be stored.

– A Physician asks if a certain drug is paid for by the ANA.

– A patient asks for the name of the drug they are taking.

– A patient asks what are the hours of the pharmacy.

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How Pharm Techs can assist Pharmacists:

2. When asked a question that requires professional judgment or therapeutic knowledge gather information to assist the pharmacist in answering the question.

– A Physician asks you what is the best medication to treat a patient’s high blood pressure.

– A Physician asks you if a certain drug could be causing a patient to have a certain side effect.

– A patient asks you for the reason why they are taking the medication.

* Do not answer the question but, get a Pharmacist.

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Information Pharm Techs can gather to assist Pharmacists in answering clinical questions:

1. Patient name

2. Patient age

3. Physician name and contact number

(if applicable)

4. What is the question?

5. Drug name, dose and frequency

(if applicable)

6. Side effect(s) being experienced

(if applicable)

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Pharmacy Dispensing ServicesDari


1. Receive, verify, complete and provide medications to patients under Pharmacist supervision.

2. Provide information to patients or healthcare professionals as directed by the Pharmacist.

3. Compound medications when required.

4. Follow ANA, MEDCOM and hospital policies and procedures.

5. Educate patients on using home care devices (e.g inhalers…)

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Under Control/ Controlled Medications

DariHow Pharm Techs can assist

Pharmacists:* Follow policies:

1. Ensure all Under Control/ Controlled Medication prescriptions are recorded in the perpetual inventory log;

2. Conduct monthly inventory counts under supervision of a disinterested officer;

3. Report any stock discrepancies to a Pharmacist immediately;

4. Ensure all Under Control/ Controlled Medications are stored properly; and

5. Under Control/ Controlled medications are only given to authorized personnel or to patients with valid prescription;

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Managing Medical MaterialDari


1. Keep pharmacy dispensary shelves well stocked.

2. When working in the Quartermaster Storeroom: identify and complete paperwork.

3. Properly receive ordersa. Verify completeness of order;

b. Check expiry dates and condition of medications); and

c. Put order away ensuring medications expiring first are placed at the front.

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Managing Medical MaterialDari


4. Maintain cleanliness of Pharmacy;

5. Monitor temperature controlled environments (ie. Room temperatures,

fridge temperatures);

6. Identify/ remove expiring and unserviceable medications;

7. Build and maintain operational medical kits;

8. Recommend changes/ improvements to procedures;

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Pharmacy OperationsDari


1. Obey all pharmacy procedures;

2. Perform tasks assigned by Pharmacists;

3. Verify pharmacy procedures are in effect on wards;

4. Notify superiors when policies and procedures are not being followed;

5. Identify unsafe working practices; and

6. Ask questions when unsure.

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Pharmacy AdministrationDari


1. Attend all pharmacy department meetings;

2. Be on time for work;

3. Conduct handover with on coming Pharm Tech staff;

4. Prepare reports correctly; and

5. Assist in the training of new Pharm Techs.

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Pharmacy Practice SettingsDari

Sites you will see in ANA:

1. Hospital inpatient dispensary;

2. Hospital wards (Clinical Pharmacists)

3. Outpatient dispensary

(e.g. Polyclinic)

4. Quartermaster storeroom; and

5. Class VIII warehouse.

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AFAMSKandahar Regional Hospital

Gardez Regional Hospital

Herat Regional Hospital

Mazar-e Sharif Regional Hospital

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Hospital Inpatient DispensaryDari

• Although some outpatient prescriptions are filled at an inpatient dispensary the majority of prescriptions are for inpatients.

• Outpatients: patients not admitted to hospital.

• E.g. Patients treated in emergency room but, no further hospital treatment required.

• E.g. Patients discharged from hospital but, present to pharmacy dispensary with prescription.

• Inpatients: patients admitted to a ward in the hospital.

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Hospital Inpatient DispensaryDari

• Each hospital ward requests medications from the Hospital Inpatient Dispensary based on prescriptions (orders) written by Physician’s for their inpatients.

• Medications are then sent up to the wards based on the Physician’s orders.

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Hospital Wards Dari

On Wards Clinical Pharmacists: • review Physician orders and assess them for

medication product selection, dosage regimen, effective dose administration and drug therapy monitoring services.

• prevent, detect, and resolve medication-related problems and make appropriate-based medication therapy recommendations.

Emergency Medication Cabinets:• Contain medications required quickly by

Physicians.

• Verified and monitored by Pharm Techs.

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Outpatient DispensaryDari

• Example: Polyclinic pharmacy. • Similar to Civilian pharmacy

practice.

• Outpatients or their family members present with prescription(s) to be filled.

• Medications are then provided with education on how to take the medication and possible side effects.

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Quarter Master StoreroomDari

• Stores medications for Dispensary.

• Orders and receives medications for Dispensary from NMH Warehouse or Forward Supply Depot.

* Does not provide medications to patients.

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Class VIII WarehouseDari

National Class VIII Supply

Warehouse• Provides medical supplies to NMH

Warehouse and Forward Supply Depots (FSD).

NMH Warehouse and FSD• Stores and supplies medical supplies

(including medications) to NMH, Regional Hospitals, Kandaks…

* Does not provide medications to patients.

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ReviewDari

What type of information can Pharm Techs gather to assist Pharmacists in answering clinical questions?

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ReviewDari

What type of information can Pharm Techs gather to assist Pharmacists in answering clinical questions?

1. Patient name

2. Patient age

3. Physician name and contact number

(if applicable)

4. What is the question?

5. Drug name, dose and frequency

(if applicable)

6. Side effect(s) being experienced

(if applicable)

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ReviewDari

• Differentiate between outpatients and inpatients. Insert Dari

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ReviewDari

• Outpatients: patients not admitted to hospital.

• E.g. Patients treated in emergency room but, no further hospital treatment required.

• E.g. Patients discharged from hospital but, present to pharmacy dispensary with prescription.

• Inpatients: patients admitted to a ward in the hospital.

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ReviewDari

In your own words define Professional judgment:

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ReviewDari

In your own words define Professional judgment:

“…a process used to reach a well-reasoned conclusion that is based on the relevant facts and circumstances available at the time of the conclusion. A fundamental part of the process is the involvement of individuals with sufficient knowledge and experience.”

American Accounting Association

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Questions?Dari

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Scenarios (Assessment)Dari

Formative Assessment:

• Not marked

• Used to assess the students understanding of lectures material.

• Instructors will ask the questions to the class as a whole. Group discussion amongst the students is encouraged to answer the questions.

• Instructor will provide a debrief after each scenario question to highlight reasons why response was correct or incorrect.

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Scenario OneDari

You are working as a Pharm Tech in a Hospital Dispensary. The Pharmacist is talking to the Quarter Master just outside of the pharmacy.

The phone rings and you answer it.

A physician has called. They state, “I have a question about clarithromycin.”

What do you do?

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Scenario OneDari

Possible Answer:

• Ask the Physician for their question.

Examples:

“Yes Doctor, what is your question?”

Or

“Yes Doctor, how may I help you?”

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Scenario One ContinuedDari

Question 1:

The Physician asks:

“Does clarithromycin suspension have to be stored in the fridge?

1. Can you answer the question or do you need to get the Pharmacist?

2. Why?

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Question 1:

The Physician asks:

“Does clarithromycin suspension have to be stored in the fridge?

1. Can you answer the question or do you need to get the Pharmacist?

2. Why?

Answer:

Yes, you can answer the question since it does not require professional judgment. The answer is in the drug monograph.

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Question 2:

The Physician says:

“Thank you for the information. If you have another minute I have another question? ”

“The patient is also taking the drug atorvastatin is there a drug interaction with clarithromycin?”

1. Can you answer the question?

2. Why?

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Answer:

No, you cannot answer this question since it requires the professional judgment of a Pharmacist. Though a reference textbook will state there is a drug-drug interaction the Pharmacist must assess using relevant facts (textbook) and circumstances (reason for the atorvastatin, reason for the clarithromycin, length of therapy…) whether or not the interaction is serious and ways to minimize any effect.

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Since you cannot answer the question, what can you do to help the Pharmacist?

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Inform the Physician the Pharmacist cannot come to the phone right away but, you can gather some information for the Pharmacist and they will phone back once they can.

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1. Write down the question.

2. Physician’s name and contact number.

3. Patient name

4. Drug name, dose and frequency (both drugs)

5. Additional info if possible:a. Reasons for each medication.

b. When each medication was started.

c. How long will the patient be taking each medication.

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Scenario TwoDari

You are working at the Polyclinic Dispensary. A patient asks if the medication they just started could be causing them have muscle pain. The Pharmacist is presently talking to another patient.

You look in the reference book and see no mention of the drug causing patients to feel tired.

Do you provide this information to the patient?

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Scenario TwoDari

No, you cannot provide this information to the patient. Professional judgment is required since there are many circumstances involved.

i) Is the patient on another medication that could be causing the side effect or a drug-drug interaction.

ii) Is it an expected side effect that is short term or could be minimized slowly increasing the dose.

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Scenario Two ContinuedDari


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Inform the patient the Pharmacist cannot come to see them right away but, you can gather some information to help the Pharmacist when they come over.

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1. Write down the question.

2. Patient’s name

3. Drug name, dose and frequency (both drugs)

4. Additional info if possible:a. Any other medications the patient is

taking.

b. When each medication was started.

c. Why they are taking each medication.

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Questions?Dari

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Handouts For Next ClassDari

For Next Class Read First Three Documents:

(Instructor to Provide Handouts)

1. Afghan Medicine Law (Drugs Law) 2006

2. National Medicine Policy 2003

3. Counter Narcotics Drug Law 2005

4. National Licensed Drug List 2007

5. Afghanistan Regulation on Manufacture and Importation of Medicines and Medical Equipment 2006

6. Afghanistan Regulation on Retail Pharmacy

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afams eo 001.02 pharmacy practice (dari) 01/09/2013

Documents

clinical services

significant drugdrug

proper use

intended use

drug information

document clinical activities

effective use of medications

adverse drug reactions