APTI ijopp - Indian Journal of Pharmacy Practice

APTIIndian J. Pharm. Pract. 1(2), Jan-Mar, 2009Clinical pharmacy practice in psychiatryChristopher P AldermanDirector, Pharmacy Department and Clinical Pharmacist (Psychiatry)Repatriation General Hospital, Daw Park, SOUTH AUSTRALIAAddress for Correspondence: chris.alderman@rgh.sa.gov.auInvited ArticleijoppAn evolution of pharmacy practicepatients. The movement to 're-professionalisation' ofIn an evolutionary process that has spanned several pharmacy involved practitioners accepting1decades, many pharmacists in primary and secondary responsibility and accountability for their input into thecare settings have shifted their focus from medication patient care process. 8supply functions (largely in the form of compounding A concept that is gaining increasing currency andand dispensing) to assisting other clinical staff with the credibility in relation to the role of clinical pharmacists inmanagement of patients and their drug therapy. This promoting optimal outcomes for patients is theclinical pharmacy practice began in the 1960s, when contribution of these practitioners in the facilitation of9hospital pharmacists began visiting the wards of quality use of medicines (QUM). QUM has been definedhospitals to check drug charts and proactively initiate as exhibiting three key componentsmedication supply without the need for prescriptions to judicious selection of therapeutic management options2,3be sent to the pharmacy. This practice allowed(considering the place of medicines in treating illnesspharmacists to establish a presence at the point of patientand maintaining health, and recognising the possibilitycare, in daily contact with doctors and nurses, andthat there may be better ways than medicine to managea particular situation)position themselves to offer advice and assistance withselection of a suitable medication, if a medicine is3, 4matters relating to drug therapy.considered necessary. This will involve considerationIn the context of ward pharmacy, pharmacists soonof the characteristics of the individual patient, thebecame involved in roles that included activities such as5clinical condition, risks and benefits associated withrecording patients' medication history and thetreatment options, the dosage and duration ofqualitative review of orders on patients' medicationtreatment, co-existing conditions, other therapies,6charts. These practitioners were starting to assume a rolemonitoring considerations, and costs for thethat helped to guide and inform prescribing, allowingindividual, the community and the health system as a7them to function as a part of a multidisciplinary team. whole.Although the re-engineering of pharmacy practice to a safe and effective use of medications toward-based model facilitated these changes, other achieve optimal health outcomes through monitoring,drivers also contributed. Rationing of public health funds minimizing misuse, over-use and under-use of medicreatedchanges for the hospital sector, so that only the cations, and ensuring that the patient or their carer havemost acutely ill patients were admitted to hospital, for the knowledge and skills to solve problems related toexample. This in turn meant that the acuity and the use of their medication(s).complexity of inpatient care progressively increased. The QUM framework extends the pharmaceutical careAdvances in pharmacotherapy led to the discovery and model and provides a mechanism for integrating clinicalwidespread implementation of entirely new drug pharmacists into the broader health care environment.treatment approaches for many clinical problems,It has the potential to address the issues that the moreprofession-specific pharmaceutical care model raisedcreating a rapid expansion in the scope of informationin terms of the integration of pharmacists into theabout the clinical applications for these drugs, theirhealthcare team. It also facilitates the routineadverse effects and drug interactions and the need forincorporation of pharmaceutical care as a component ofindividualisation of dosage to accommodate the needs ofemerging service delivery programs in hospitals, agedcareand primary health care settings and health careIndian Journal of Pharmacy Practiceteams. It is important, therefore, that the uniqueReceived on 12/03/2009Accepted on 12/03/2009 © APTI All rights reservedcontribution of clinical pharmacists that results from the1