1. Career Path of Tertiary Care Hospital Pharmacist
Suphat Subongkot, Pharm.D., BCPS, BCOP
Associate Professor
Faculty of Pharmaceutical Sciences
Khon Kaen University
Khon Kaen, Thailand
Maharat Nakhonratchasima Hospital, Feb 3, 2019 Thailand

2. Outline Introduction How do we go beyond dispensing
Medication therapy and patient care
Pharmacist’s Role to Provide Patient Care
What choices are there on the pharmacy career path?

3. Introduction Example of Medication Therapy and Patient Care
You have arrived for your 8-hour pharmacist shift when the new orders come from the Intensive Care Unit (ICU).
The patient is being admitted with a diagnosis of acute coronary syndrome (ACS).

4. Introduction Example of Medication Therapy and Patient Care (cont.)
A 75 year-old Asian male had substernal chest pain (“Feels like an elephant sitting on my chest”), radiating down his left arm for about 6 hours, calls 119, and was brought to the hospital.

5. Introduction Example of Medication Therapy and Patient Care (cont.)
His past medical history includes hypertension, type 2 diabetes mellitus, hyperlipidemia, and cigarette smoking (35 pack-years).

6. Introduction Example of Medication Therapy and Patient Care (cont.)
The medications continued from home were
Lisinopril 5 mg daily
Metoprolol 12.5 mg twice daily
Gluburide 5 mg bid
Metformin 850 mg bid
Rosiglitazone 4 mg bid
Lovastatin 10 mg qd

7. Introduction Example of Medication Therapy and Patient Care (cont.)
The medications added were
Enoxaparin 30 mg twice daily
Nitroglycerine IV 5 mcg/min and titrated to relief chest pain
Clopidogrel 300 mg once and then 75 mg daily
Antacid prn
Mg(OH)2 prn
Acetaminophen prn

8. Question 1: What should you do as a pharmacist-in-charge?
A. Inform an incoming next-shift pharmacist to fill the prescription for this patient B. Make sure the orders are filled accurately C. Make sure the orders are filled accurately and are sent to the ICU D. Make sure the orders are filled accurately and are sent to the ICU immediately E. Not sure

9. Introduction Example of Medication Therapy and Patient Care (cont.)
As the pharmacist, you quickly make sure the orders are filled accurately and are sent to the ICU by a runner.

10. Part 1: How do we go beyond dispensing

11. Revolution in Pharmacy
Transformation of a Profession

12. Reflections on US Clinical Pharmacy
Year
Activities
1960’s
The rise of clinical pharmacy
1962
The University of Kentucky Drug Information Center
1966
Opening day: The UCSF Ninth Floor Project
Drug use control
1967
The development of total parenteral nutrition

13. Reflections on Clinical Pharmacy
Year
Activities
1976
The Mills Commission
The path leading to specialization in pharmacy: Creating the Board of Pharmaceutical Specialties
1979
The founding of American College of Clinical Pharmacy
Clinical pharmacists as principal investigators: Then and now
1985
The ASHP Hilton Head Conference

14. Reflections on Clinical Pharmacy
Year
Activities
1986
Clinical pharmacodynamics of high-dose methotrexate in ALL
1988
Clinical pharmacy practice in the Veterans Health Administration
1989
The AACP Commission to implement change in pharmaceutical education
The contribution of pharmaceutical care to clinical pharmacy
2002
Pharmacist-administered immunization

15. Reflections on Clinical Pharmacy
Year
Activities
2003
The Medicare Modernization Act of 2003 and medication therapy management
2005
Residency training: Catalyst for change

16. Evolution of Asian Clinical Pharmacy
Year
Activities
1997
The first East Asia Conference on Developing Clinical Pharmacy Practice and Clinical Pharmacy Education (EACDCPPE) was held in America in 1997
2003
When the third conference was held in Japan in 2003, the title of the conference was changed to Asian Conference on Clinical Pharmacy (ACCP). This opened the conference to more Asian countries; also the subject of clinical pharmacy was strengthened

17. Evolution of Minimum Requirement of Pharmacist Education in Thailand
Year
Minimum Requirement
3 years (Certificate in Pharmacy)
3 years (Diploma in Pharmacy)
4 years (B.S. Pharm)
5 years (B.S. Pharm)
5 years (B.S. Pharm) with Elective subjects

18. Evolution of Minimum Requirement of Pharmacist Education in Thailand
Year
Minimum Requirement
5 years (B.S. Pharm) with Subspecialty
5 years (B.S. Pharm) with Subspecialty and 6 years (Pharm.D)***
From 2552
6 years (Pharm.D)
From 2548
Residency/Fellowship Program Started
*** Transition Period; some schools offered only the B.S. or the Pharm.D degree; many schools offered both degrees, with the Pharm.D considered an advanced degree

19. Credentialing in Pharmacy
Education and Training
Education Program
Credential
Accrediting Agency
Entry level pharmacy education
B.S. or Pharm.D
Pharmacy Council (ACPE)
Continuing education
Certificate of Attendance
Certificate program
Certificate of Completion
Various agents, CPhT (ACPE)
Residency/Fellowship
Residency/Fellowship certificate
CPhT (ASHP, ACCP)

20. Importance of Medication to Patient Care
Between 44,000 and 98,000 patients die each year in hospitals due to medication errors
More than 1 million serious medication occur yearly
Patient Safety:
Achieving a New Standard of Care
Promoted comprehensive patient safety programs in all health care settings

21. Importance of Medication to Patient Care (cont.)
Example of medication errors
Administration of wrong drug
Drug overdoses
Overlooked drug interaction and allergies

22. Importance of Medication to Patient Care (cont.)
Consequences of medication errors
Longer admission
Higher total cost of care
One adverse drug event adds more than $2,000 on average to the cost of hospitalization

23. Importance of Medication to Patient Care (cont.)
About one-third to more than one-half of adverse events are preventable.
“Outcomes are improved when pharmacists are actively and directly engaged in direct patient care.”

24. Importance of Medication to Patient Care (cont.)
Because of concerns about patient safety and the quality of health care,
Pharmacists have unprecedented opportunities to increase their value and significance.

25. Part II: Medication therapy and patient care

26. The Future Vision of Pharmacy Practice: Joint Commission of Pharmacy Practitioners
Vision statement
Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes

27. Pharmacy Practice in 2015 The foundation of pharmacy practice
How pharmacists will practice
Working cooperatively with practitioners from other disciplines to care for patients
How pharmacy practice will benefit society

28. Component of Medication Therapy in Patient Care
The roles of the pharmacist are to
Prevent disease
Control symptoms of disease
Slow disease progression
Cure disease

29. Component of Medication Therapy in Patient Care
Domains of practice for a registered pharmacist
Area 1 (>50%): Assess Safe and Effective Pharmacotherapy and Optimized Therapeutic Outcomes
Area 2 (>30%): Assure Safe and Accurate
Preparation and Dispensing of Medications
Area 3 (>10%): Provide Health Care Information
and Promote Public Health

30. Component of Medication Therapy in Patient Care
Preventative Care
Evidence-based Medicine
Pharmacist’s Role to Provide Patient Care
Pharmaceutical Care
Patient Pharmacotherapy Assessment
Identification and Resolutions of Drug-related Problems
Developing a Care Plan and Goals of Therapy
Follow-up Evaluation

31. Part III: Pharmacist’s Role to Provide Patient Care

32. Patient-centered Care

33. Collaboration in Pharmaceutical Care Process
Therapeutic Outcomes
Federation International Pharmaceutique (FIP) 1998
American Society of Health System Pharmacy 1996

34. The Care Process
A continuous process structured according to the SOAP

35. Example: Pharmaceutical Care in Oncology

36. Developing a Care Plan and Goals of Therapy
Patient
Physician
Nurse
Pharmacist
Help clarify suspected toxicity of drug
Diagnosis
Prescribe medications
Give information on drug product selection, drug comparison, dosage regimen
Provide medication
Medication administration, blood sampling
Give information on drug administration, blood sampling
Monitor efficacy
Identify, solve and prevent DRPs
Good QOL

37. 7. Value of Clinical Pharmacy Services
ACCP summary
Over approximately 25 years
3 different ACCP task forces have reviewed 131 original articles regarding the clinical and economic value of pharmacists’ and economic value of pharmacist clinical services

38. Evidence of the Economic Benefit of Clinical Pharmacy Services: 1996–2000
(Pharmacotherapy 2003;23(1):113–132)

39. Criteria for Assessment of Type of Analysis

40. Setting of Economic Evaluation of Clinical Pharmacy Services

41. Type of Clinical Pharmacy Services

42. Method Used in Economic Evaluations

43. Benefit: Cost Ratios from Included Studies

44. Study Design

46. Question 2: Currently, pharmacists are certified in how many areas?
1 areas: Pharmacotherapy
2 areas: Pharmacotherapy, nuclear
3 areas: Pharmacotherapy, nuclear, oncology
> 4 areas
Not sure

47. Pharmacists Certified by the Board of Pharmacy Specialties
BPS 2016Annual Report

48. Benchmarking and Ability to Change and Innovate and Accelerate Performance
Career paths
Breadth versus depth
Consistent standard across and within specialities
Key points
General training
Advanced training
Career choice
Consistent and coherent standards for experience, knowledge and skills across profession

54. What choices are there on the pharmacy career path?

59. Continuing Professional Development (CPD)
Adaptation of Five Stage Cycle Used By FIP

66. Thank you for your attention!!