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The Profession of Pharmacy Paradigm Publishing Inc Chapter Topics Origins of pharmacy practice The pharmacy workplace of today Evolution of the pharmacists role Roles and responsibilities of the pharmacist and pharmacy technician ID: 715155

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Slide1

The Profession of Pharmacy

Chapter Topics

Origins of pharmacy practice

The pharmacy workplace of today

Evolution of the pharmacist’s role

Roles and responsibilities of the pharmacist and pharmacy technicianEducational requirements of the pharmacist and pharmacy technician

Learning Objectives

Describe the cultural origins of pharmacy and their impact on the profession.

Discuss the four stages of development of the pharmacy profession in the twentieth century.

Differentiate the major roles and responsibilities of the pharmacist and pharmacy technician.

Understand the educational and licensing requirements of the pharmacist and pharmacy technician.

Differentiate among various pharmacy workplace environments.

Origins of Pharmacy

Early Civilizations

Sickness was thought to be a curse.

Medicinal preparations were combined with magic, chants, and rituals.

Preparations were made from plants, animals, and minerals.

Clay tablets more than 5,000 years old found in Mesopotamia listed medicinal preparations.

These provided the basis for the modern-day formulary.

Origins of Pharmacy

(continued)

Traditional Eastern medicine

Relies on plant products and healing modalities. Some are used in Western culture today (such as ginseng).

Hippocrates

This Greek physician thought that disease had a physical explanation.

Pharmacy

is derived from Greek word

pharmakon

, meaning drug or remedy.

He is the Father of Modern Medicine.

Galen

This Greek physician studied the effect of herbs on the body.

Galenical

pharmacy is the practice of creating medicinal extracts from plants.He is the Father of Modern Pharmacy.

Origins of Pharmacy

(continued)

Early Arabic civilizations identified pharmacists as qualified healthcare professionals.

In eleventh and twelfth century Europe, apothecaries and professional guilds were developed.

They oversaw chemist and pharmacist apprenticeships.

They led to universities and professional organizations and, later, state boards.

During the Renaissance, alchemy was on the rise, scientific thinking was on the decline.

During seventeenth century’s Scientific Revolution, many new scientific terms developed with Greek and Latin roots.

Origins of Pharmacy

(continued)

During the 1800s, pharmacists were more recognized as healthcare providers; physicians still operated most apothecaries.

Major cities in Europe had their own drug lists or pharmacopeia.

Martindale: The Extra Pharmacopoeia

still a useful reference today.

Native Americans combined herbal medicine with chants and prayers for healing.

Origins of Pharmacy

(continued)

In the

ninteenth

century, the medicine and pharmacy professions separated.

Pharmacists became the owners of apothecaries.

United States Pharmacopeia (USP)

, a formulary of drug standards, was developed in 1820.

American Pharmacists Association (

APhA

) formed in 1852 to address adulteration of imported drugs.

Community pharmacy focused on compounding herbs and chemicals.

In early twentieth century, pharmaceutical manufacturing became dominant.

By the 1950s, pharmacists compounded less, and pharmacy practice became more scientific.

Modern-Day Pharmacy Practice

Many new drugs are developed annually to keep up with medical advances.

As the population ages, an increasing number of prescriptions are expected.

To meet increasing demands on pharmacists, more pharmacy schools are opening; technician roles are expanding.

The Pharmacy Workplace

Community Pharmacies

Also called

retail pharmacies

Employ the majority of pharmacists and pharmacy technicians

perated by pharmacists who hold a BS or

PharmD

degree

ivided into a restricted prescription area and a front-end area

Types of Community Pharmacies

Independent pharmacies

A pharmacist (or a small group of pharmacists) owns the pharmacy.

Decisions are made at the store level.

More attention and time is spent on customer service.

Most compounding is done in these, and some specialize in compounding.

Chain pharmacies

Corporations own and operate chain pharmacies.

Decisions are made at the corporate level.

They dispense large volumes.

Technicians and automation are heavily used in chains.

Examples include: Walgreens, CVS,

Walmart

, and Kroger.

Types of Community

Pharmacies

(continued)

Franchise pharmacies

One pharmacist owns a franchise.

Sometimes they are called apothecaries, which sell only medication and health-related products.

More personalized health care is provided here.

An example is Medicine Shoppe International.

Mail-order pharmacies

A centralized operation mails large volumes of prescriptions.

Patients have no direct contact with the pharmacy.

Examples include Medco and Express Scripts.

Institutional Pharmacies

A pharmacy associated with any organized healthcare delivery system is called

institutional

Hospital pharmacies are the most common examples.

Institutional pharmacists will have a BS or

PharmD

degree.

Some pharmacists will have an MBA and some will have completed a postgraduate residency.

Technicians typically must be certified and have experience to work in institutional pharmacies.

Types of Institutional Pharmacies

Hospital pharmacies

About 25% of pharmacists work in hospitals.

They prepare unit-dose systems, IV medications, and floor stock.

Many pharmacy technicians work in a “clean room.”

Types of Institutional

Pharmacies

(continued)

Long-term care facilities

Extended-care facility (ECF) or nursing home

Medical and residential care is provided to older or disabled adults.

Skilled-care facility (SCF)

Around-the-clock nursing care is provided.

Medications may come from

either an

in-house pharmacy or a community pharmacy.

Home healthcare systems

Patient care services are provided at patient’s home.

Hospice care is provided for patients who are terminally ill.

Types of Institutional

Pharmacies

(continued)

Managed-care or HMO

Centralized outpatient clinics and some hospitals

Clinic pharmacies and off-site pharmacies

Minimal cash or insurance transactions

Nuclear pharmacy

Compounds and dispenses sterile radioactive pharmaceuticals

In the Know: True or False

A community pharmacy is also called a retail pharmacy.

rueSome independent pharmacies specialize in compounding.

rue

Decisions are made at the store level in a chain pharmacy.

alse

A hospital pharmacy mails large volumes of prescriptions.

false© Paradigm Publishing, Inc.Slide20

Development of Pharmacy in the Twentieth Century

Traditional Era

The traditional era extended into the 1920s.

Pharmacists compounded more than 80% of prescriptions from natural sources.

Ingredients and doses were tailored to patients.

Pharmacists packaged, labeled, and dispensed medications.

Pharmacists-in-training served as apprentices rather than studying at universities.

Limited formal education focused on

galenical

pharmacy and

pharmacognosy

Scientific Era

The pharmaceutical industry emerged in the 1950s.

Many new drugs and dosage forms were developed.

Drugs were less expensive and better quality than what individual pharmacists could compound.

Pharmacists became merchants of factory-made products.

To keep up with scientific advances, pharmacy schools added pharmacology to their curriculum.

By 1960, a five-year BS degree was required to become a pharmacist.

Clinical Era

The clinical era started in the mid-1960s.

Pharmaceutics was added to pharmacy school curricula.

Training shifted too much toward basic science and too far away from pharmacy practice.

Pharmacists were not fully utilized, did routine tasks, and dispensed medications.

Until 1969, it was not considered ethical for a pharmacist to label medication vials with the drug name or counsel patients.

Clinical Era

(continued)

The Millis Commission report came out in 1975.

“Pharmacists for the Future”

Defined pharmacy as a knowledge-based profession

Emphasized the clinical role of pharmacists

The Millis Commission led to new emphasis on clinical or patient-oriented pharmacy.

Pharmacists became dispensers of drug information.

Clinical Era

(continued)

More colleges adopted a six-year

PharmD

degree program.

Pharmacy schools added pharmacokinetics, biochemistry, therapeutics, and pathophysiology to curricula.

Laboratories moved from the schools to more patient-oriented practice settings.

Interdisciplinary experiences with physicians and residents became standard in pharmacy schools.

Pharmaceutical Care Era

The pharmaceutical care era began in 1990.

Further development of the Millis Commission

Coined by Dr. Charles

Hepler

and Dr. Linda Strand

Expanded pharmacy to include ensuring positive outcomes for drug therapy

Patient-oriented focus in the hospital began to move to the community pharmacy and ambulatory clinics.

Patient counseling and medication monitoring became more accepted by physicians and consumers.

Pharmaceutical Care Era

(continued)

Medication therapy management (MTM) was integrated into pharmacy curriculum.

Recommending less costly medications

Identifying potential drug-drug interactions

Identifying potential adverse reactions

Counseling patients on adherence to therapy

MTM recognized by insurance companies providing reimbursement to pharmacists

In the Know: Short Answ

In the traditional era, most prescriptions were __________ by the pharmacist.

compounded

The Millis Commission led to an emphasis on what type of pharmacy practice?

clinical

Medication therapy management (MTM) is a key component of ______________.

pharmaceutical care

Pharmacist Responsibilities: Traditional vs. Current Roles

The product-oriented practice focused on compounding.

A patient-oriented practice focuses on counseling and monitoring.

Roles and Responsibilities

of the Pharmacist

Gathering information on medical, medication, and allergy histories

Reviewing medication doses and screening for duplicate therapies

Counseling patients

Screening patients for chronic diseases

Educating patients on self-management of diseases

Monitoring for drug interactions

Screening patients for minor illnesses

Roles and Responsibilities

of the Pharmacist

(continued)

Assisting and supporting patients to quit smoking

Providing recommendations regarding OTC medications, vitamins, herbs, and supplements

Providing drug information to other healthcare professionals

Providing advice about home healthcare supplies and medical equipment

Monitoring drug response in chronic diseases

Monitoring the safe use of controlled substances

Vaccinating high-risk patients

Site-Specific Pharmacist Responsibilities

Community pharmacy

Compounding both

nonsterile

and sterile medications

Packaging medications for nursing homes

Independent pharmacy

Identifying unmet needs in the community; offering new services

Hiring and supervising employees

Evaluating insurance contracts

Reconciling unpaid insurance claims

Maintaining and ordering inventory

Selling non–healthcare-related merchandise

Managing the overall retail operation

Site-Specific Pharmacist Responsibilities

(continued)

Institutional pharmacy

Entering physician’s orders

Preparing medications and IVs

Providing drug information

Recommending drug formulary changes

Educating nurses

Developing policies and procedures

Dispensing investigational and hazardous drugs

Providing medications to hospital units

Site-Specific Pharmacist Responsibilities

(continued)

Clinical specialists in large teaching hospitals

Accompanying physicians on morning rounds

Providing advice on appropriate medication use

Monitoring patients for adverse effects or drug interactions

Educating patients on medications prior to discharge

Site-Specific Pharmacist Responsibilities

(continued)

Home healthcare

Preparing medications and IVs for home use

Consulting

Reviewing medical and medication records monthly

Managed-care

Working with primary-care physicians to help control chronic diseases

Educating patients, monitoring and adjusting medications

Educational Requirements for Pharmacists

Pharmacy school admission requirements

Two years of pre-pharmacy

Calculus, chemistry, physics, microbiology, and biology

Pharmacy College Admission Test (PCAT)

On-site interview

Prior pharmacy experience advisable

Educational Requirements for Pharmacists

(continued)

Doctor of Pharmacy programs

Four year program

Challenging coursework

Practice experiences in community and hospital settings interspersed throughout curriculum

Fourth year spent in various practice settings

Licensing Requirements for Pharmacists

Graduating from an accredited college of pharmacy

Passing a state board examination

Serving an internship under a licensed pharmacist

Continuing education required for renewal

Traditional Pharmacy Technician Responsibilities

Answering the phone

Stocking the inventory

Operating the cash register

Site-Specific Pharmacy Technician Responsibilities

Community Pharmacy

Greeting patients presenting or picking up prescriptions

Entering patient and prescription information into a computerized database

Assisting the pharmacist in filling, labeling, and recording prescriptions

Operating the pharmacy cash register

Stocking and inventorying prescription and OTC medications

Billing and resolving inventory claims

Site-Specific Pharmacy Technician Responsibilities

(continued)

Hospital

Preparing sterile and hazardous products

Delivering, stocking, and inventorying medications

Operating manual or computerized robotic dispensing machinery

Pharmacy technicians play a valuable role in reducing the risk of medication errors.Slide42

Site-Specific Pharmacy Technician Responsibilities

(continued)

Long-term care

Repackaging drugs in unit dose carts labeled for each patient

Delivering medications to the nursing home

Conducting inspections of medications on nursing stations

Rather than work independently, the pharmacy technician works under the direction of the supervising pharmacist.Slide43

In the Know: True or False

A pharmacy technician may enter allergy information into the computer database.

true

A pharmacy technician may counsel patients on over the counter medications.

false

A pharmacy technician may override drug interaction alerts when entering prescriptions.

false

Roles and Responsibilities Compared

Pharmacy Technician

Assumes routine functions that used to be performed by pharmacists

Gives work completed to the pharmacist for final check

Is held accountable to the pharmacist for the accuracy of medications dispensed

Pharmacist

Does more patient-care activities, less dispensing activities

Oversees the technician’s work and provides the final check

Is ultimately accountable for the accuracy of medications dispensed

Educational Requirements for Pharmacy Technicians

Technician training programs

Programs strive to prepare students for the certification exam.

Many are hospital based, some are offered in community colleges and technical schools.

Topics include medical terminology, pharmacology, dispensing procedures, sterile compounding, aseptic technique, pharmacy laws and regulations, pharmacy calculations, and communications.

Educational Requirements for Pharmacy Technicians

(continued

)

Pharmacy Technician Certification Exam

The Pharmacy Technician Certification Board (PTCB) offers this exam.

Many employers require that technicians be certified initially or within a certain time period after hiring.

Specialized Training Programs for Pharmacy Technicians

Sterile compounding

Program from Accreditation Council for Pharmacy Education (ACPE)

Nonsterile

compounding

Program from the Professional Compounding Centers of America (PCCA)