Pharmacy Practice (24) Clinical Pharmacy (Part-3)= Clinical Review, Ward Round & Pharmaceutical Care
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Solution Pharmacy will cover this syllabus of medicinal chemistry 01 for B.Pharmacy 4th semester
MEDICATION CHART REVIEW
1. It is a fundamental responsibility of a pharmacist to ensure the appropriateness of medication orders.
2. It serves as starting point for other clinical pharmacy activities (medication counselling, TDM, DI and ADR).
3. Organizing information according to medical problems (e.g., disease) helps breakdown a complex situation into its individual parts.
Goals
1. To optimize the patient's drug therapy.
2. To prevent or minimize drug related problems/medication errors.
Procedure
1. The patients' medical record should be reviewed in conjugation with the medication administration record.
2. Recent consultations, treatment plans and daily progress should be taken into account when determining the appropriateness of current medication order and planning each patient’s care.
3. All current and recent medication orders should be reviewed.
COMPONENTS OF MEDICATION ORDER REVIEW INCLUDE:
1. Checking that medication order is written in accordance with legal and local requirements.
2. Ensuring that the medication order is comprehensible and unambiguous, that appropriate terminology is used and that drug name are not abbreviated. Annotate the chart to provide clarification as required.
3. Detecting orders for medication to which the patient may be hypersensitive /intolerant.
4. Ensuring that medication order is appropriate with respect to:
(a) The patient's previous medication order.
(b) Patient's specific considerations e.g., disease state, pregnancy.
(c) Drug dose and dosage schedule, especially with respect to age, renal function and liver function.
(d) Route, dosage form and method of administration.
5. Checking complete drug profile for medication duplication, interactions or incompatibilities.
6. Ensuring that administration times are appropriate e.g., with respect to food, other drugs and procedures.
7. Checking the medication administration record to ensure that all ordered medications have been administered.
8. Ensuring that the drug administration order clearly indicates the time at which drug administration is to commence.
9. Special considerations should be given especially in short course therapy as in antibiotics and analgesics. Ensuring appropriate therapy monitoring is implemented. Ensuring that all necessary medication is ordered. ex. premedication, prophylaxis. Reviewing medication for cost effectiveness.
Identification of drug related problems:
(a) Untreated indication.
(b) Inappropriate drug selection.
(c) Sub-therapeutic dose.
(d) Adverse drug reaction.
(e) Failure to receive drug.
(f) Drug interactions.
(g) Drug use without indication.
(h) Over dosage.
Medication Chart Endorsement:
1. Another important goal of treatment chart review is to minimize the risk of medication errors that might occur at the level of prescribing and/or drug administration.
2. A medication error is any preventable error that may lead to inappropriate medication use or patient harm.
3. To prevent potential morbidity and mortality associated with these errors, pharmacists should systematically review the medication chart and write annotations on the chart where the medication orders are unclear.
E-Mail for official and other work - [email protected]
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