The core of pharmacists’ contribution to appropriate prescribing and medi-cation use is made whilst undertaking near-patient clinical pharmacy activities.
Prescription monitoring
The core of
pharmacists’ contribution to appropriate prescribing and medi-cation use is
made whilst undertaking near-patient clinical pharmacy activities. Checking
and monitoring patients’ prescriptions on hospital wards is frequently the
starting point for this process and on most hospital wards the prescription
card and clinical observation charts (temperature, pulse rate, blood pressure,
and so on) are typically kept at the end of the patient’s bed. This allows the
clinical pharmacist to interact with the patient whilst reviewing the contents
of the prescription.
The prescription is
reviewed for medication dosing errors, appropriateness of administration route,
drug interactions, prescription ambiguities, inappropriate prescribing and many
other potential problems. Formal assessments of prescription charts in
hospitals have shown that there are wide variations in the quality of
prescribing and pharmacists are able to identify and resolve many clinical
problems. Patients can be questioned on their medication histories, including
allergies and intoler-ances, efficacy of prescribed treatment, side-effects and
adverse drug reactions (ADRs). The routine presence of medical and nursing
staff on the ward allows the pharmacist to communicate easily with other
mem-bers of the healthcare team who value the prescription-monitoring service
that clinical pharmacists provide.Patients’ notes are also accessible, to
enable the pharmacist both to check important information that may affect their
healthcare and to record details of any clinical pharmacy input made.
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