by,by,

Dr. G Praveen KumarDr. G Praveen KumarAssistant Professor, Assistant Professor,

Department of Pharmacy practice,Department of Pharmacy practice,

C.L. Baid Metha College of Pharmacy.C.L. Baid Metha College of Pharmacy.

Incharge-Drug Information Centre & Patient Counseling,Incharge-Drug Information Centre & Patient Counseling,

VHS(voluntary health care) hospital, Adayar, ChennaiVHS(voluntary health care) hospital, Adayar, Chennai

“PRAISE BE TO THE ALMIGHTY GOD”

Definition

GPP is the practice of pharmacy that responds to the needs of the people who use the pharmacists’ services to provide optimal, evidence-based care.

PHYSICIANS PATIENTSADMIN

NATIONALNATIONAL

GUIDELINESGUIDELINES

Requirements of good pharmacy practice

• The core of pharmacy activity is to help patients make the best use of medicines, through; – the supply of medication and other health-care products

of assured quality– the provision of appropriate information and advice to the

patient – administration of medication– the monitoring of the effects of medication use– the promotion of rational and economic prescribing, as

well as dispensing

• GPP requires that the objective of each element of pharmacy service is relevant to the patient, is clearly defined and is effectively communicated to all those involved.

• Multidisciplinary collaboration(TEAM WORK) among health-care professionals is the key factor for successfully improving patient safety.

ROLES OF PHARMACIST IN GPP

• Prepare, obtain, store, secure, distribute, administer, dispense and dispose of medical products

• Provide effective medication therapy management• Maintain and improve professional performance• Contribute to improve effectiveness of the health-

care system and public health

.…..WE ALREADY DID/DOING IT……..

PYHSICIAN & PHARMACIST RELATIONSHIP

PHARMACIST

LOOKS SPECIAL BUT ACTUALLY NOT

PHYSICIAN

LOOKS SIMPLE BUT SPECIAL

(SPECIALITY)

HOW TO OVERCOME THIS?

ANS: SPECIALITY PHARMACIST

A STEP FORWARD…..

PHARMACIST(dispensing) MUST GETS SPECIALIZED IN;

•Drug information services•Medication error•Patient counselling

DRUG INFORMATION SERVICES

• Services which cover the activities of specially trained individual to provide accurate, unbiased, factual information in response to patient oriented drug problems that are received from health care professionals.

• “The Drug Information Centre is a service offered through Pharmacy department which provides advice and act as a referral service by directing the best available resource to respond to query or concern.”

Simple logic….

“Knowledge is of two kinds. We know a subject ourselves, or we know where we can find information upon it.”

-Samuel Johnson (1709-1784)

Resources of DI

• Primary resources: Research papers/Journal articles/Case

reports.

• Secondary resource: abstracts, review articles, indexing

services such as DRUGDEX, Drug Information Database

and abstracting MEDLINE, MICROMEDIX, etc…

• Tertiary resources: Text books on various aspects of drug

use & practical guidelines.

Updated resources

• Micromedex• FDA website• Medscape • webMD• Drugs.com(drug interaction checker)• Who guidelines• EBSCO journal services

What kind of information?

1. New Drug or its Product Information/Identification

2. Contraindications/Safety

3. Adverse Drug Reactions/Drug Interactions

4. Efficacy/Treatment/Choice of drug

5. Pregnancy/Lactation/Pediatrics

6. Drug Profile/Indications/Dosage/Pharmacokinetic information

7. Toxicology

8. Counselling information

MEDICATION ERRORS...

• Almost everyone in the modern world takes medication at one time or another

• Most of the time medications are beneficial • But some occasion they do harmful effects (side effects)

which is adverse drug events• But sometimes the harm is caused by an error in prescribing

or dispensing or administration of medication

TYPES…

• PRISCRIBING ERRORS• TRANSCRIBING ERRORS• DISPENSING ERRORS • ADMINISTRATION ERRORS

PRISCRIBING ERRORS

• PHYSICIAN– WRONG DRUG OF CHOICE– WRONG DOSE– WRONG UNITS– WRONG FREQUENCY– WRONG DURATION

TRANSCRIBING ERRORS

• PHARMACIST– WRONG ENTRY– WRONG TIME OF ENTRY– MISSING INFORMATION

DISPENSING ERRORS

• PHARMACIST– Wrong assumption of prescription reading– Wrong dispensing of drugs/dose/dosage form/quantity– Look alike and sound alike drugs– Fail to give proper information to patients– Time factor

ADMINISTRATION ERRORS

• Missing drugs• Wrong route of administration• Wrong entry• Wrong reporting

PATIENT COUNSELING…..

“It is the pharmacist’s responsibility to ensure the patient receives the required information for the quality use of medicine. Counselling implies the communication of

information that would encourage therapeutic outcome”

When there is a need?

• The patient is new to the pharmacy

• The medication is new to the patient or there is a change in strength from a previous prescription

• A prescription is for a child

• Where there is a lack of or inadequate directions for use

• A prescription for a drug with a narrow therapeutic index (methotrexate, warfarin, digoxin, phenytoin) or a prescription for a controlled drug.

• When a prescription is dispensed the pharmacist should be satisfied that the patient understands how to use the medication correctly.

• Counselling provides an opportunity for the pharmacist to discuss all aspects of the prescribed medicine with the patient (or the patient’s carer) to ensure the desired therapeutic effect is achieved.

Criteria…

• Language • Time • Knowledge• Surrounding• Terms/words used• Communication

– Appropriate– Voice tone– Volume

Counselling must be…

Listen to the patient Speak distinctly and clearly (Tailor cut speech) Use open ended questions

• What is the need for using this medication?”• When are you going to take the medication?”• What side effects might you experience?”• What will you do if that occurs?”• What will you do if you miss a dose?”

Regarding drugs….

• Name of medication (brand/generic), dose, dosage form, schedule

• List precautions: e.g., use sunscreen, avoid milk• How to administer (PO, IM etc.)(before/after food)• Special directions (storage, dilution)• Necessary lab tests

• GIVE WRITTEN INFORMATION TO PATIENT(if possible)

Exercise…

• Find the medication error on the following prescriptions ?• DYSLIPIDEMIA WITH HYPERTENSION

SL NO DRUGS DOSE ROA FREQUENCY DURATION

1. 1T.ATORVA

(Atorvastatin)10 mg iv 1-0-0 X 7 Days

1. 2T .ATEN

(Atenolol)50 mg P/O 1-0-0 X 7 Days

1. 3T. ENVAS

(Enalapril)2.5 mg P/O 0-0-1 X 7 Days

1. 4T.SORBITATE

(Isosorbide dinitrate )5 mg P/O 1-1-1 X 7 Days

1. 5INJ. Rantac

(Ranitidine)150 mg P/O 1-0-1 X 7 Days

1. 6T.Dolo

(Paracetamol)650 mg P/O 1-0-1 X 7 Days

• T.ATORVA-EZ(ATORVASTATIN+EZETIMIBE): It is given to reduce the cholesterol levels in the blood. It should be taken once daily in the night. It can cause abdominal discomfort, nausea, vomiting and flatulence.

• T.ATEN (ATENOLOL): It is given to lower the blood pressure. It is to be taken once daily in the morning after food. It can cause bradycardia, tiredness, cold extremities, dizziness, nausea and vomiting

• T.ENVAS (ENALAPRIL): It is given to lower the blood pressure and cardiac risk. Each drug should be taken once daily at bed time. It can cause headache, dizziness, cough, abdominal pain and nausea.

• T.SORBITATE (ISOSORBIDE DINITRATE): It is given to reduce cardiac risk. The tablet has to be taken 3 times a day. If tingling sensation is experienced with drug placed sublingually, the tablet should be holded under buccal pouch.

• T.RANTAC (RANITIDINE): It is given to reduce gastric irritation caused by other drugs. Take the tablet half an hour before food.

Counselling regarding life style modification.

• Do regular checkups – BP, Blood sugar level, ECG and Lipid profile

• Have a brisk walking at least for 30min /day• Take more of fruits, carbohydrates,• Reduce salt intake.• Avoid fat containing food. • Etc…

• Three tailors came to a city on the same day and went to live on the same street. The next morning one of them had a notice outside his door: “The best tailor in the city”.

• The morning after that the second tailor hung a bigger notice: “The best tailor in the world.”

• The third tailor was in a state of puzzle about what to do. How could he beat the “best tailor in the world?”

• Then a thought occurred to him and he smiled, “Yes, that would do!” The next morning a crowd gathered around the notice he had hung on his door, that said, “The best tailor in the street.”

• All that matters is what you are doing NOW to help people around you.

THE BEST TAILOR

We We TREATTREAT

ButBut

““GOD” GOD” Heals...Heals...

Stay Tuned to the

Developing Technology.

PROVEPROVE and then Proud to and then Proud to be a be a PHARMACISTPHARMACIST

Thanks To the Almighty GOD Thanks To the Almighty GOD (Jesus Christ) & to all….(Jesus Christ) & to all….