Pharmacy informatics Information: technology and automation Information technology and automation significantly impact the delivery of hospital pharmacy services. Almost all pharmacy services are supported in some way by these systems. The impact of technology on pharmacy services has also resulted in the need for pharmacists to develop skills and in many cases specialize in this practice area in order to optimally support these systems. Due to the number of opportunities for medication errors and drug diversion in the ‘medication use process, many companies have developed automated systems to ensure the accurate dispensation and administration of medications as well as prevent diversion. Pharmacy related automation is represented by a wide variety of systems. They include: robots (cartfill, IV and syringe compounding, retail prescription vial fill, and delivery), automated dispensing machines (ADMSs), carousels, drug repackaging/barcoding machines, and IV infusion smart pumps, to name a few,Pharmacy informatics Pharmacy informatics has been defined as “the use and integration of data, Information, knowledge, technology, and automation in the medication use process for the purpose of Improving health outcomes.” Medical informatics deals with the storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem-solving and decision-making. Health-care Informatics is the umbrella term for all health-related disciplines and pharmacy's related discipline is commonly called either pharmacy informatics or pharmacoinformatics. It is impossible to consider that any individual can keep up with the flood of information that is being created concerning the safe and appropriate use of medications in humans. information technology is, therefore, required to manage these data efficiently and effectively, Pharmacy information systems have been and continue to be the leading clinical medication systems for performing such tasks as identifying drug-drug interactions, avoiding drug food interactions, drug-disease state monitoring, and detecting overdosing or under-dosing of medications, to name a few, Pharmacy informaticists come from a wide variety of backgrounds and include professionals ranging from non-clinical information technology programmers to pharmacy technicians and pharmacists. Most individuals in this field have "knowledge of computer systems, medication-use processes, safety issues, clinical management of medications, drug distribution, and administration, and have developed extensive expertise in using technology to support these activities.” ‘The pharmacy information systems should perform the following activities: « Inpatient and outpatient order entry, management, and dispensing + Inventory and purchasing management + Reporting (utilization, workload, financial) * Clinical monitoring + Manufacturing and compounding * Intervention management * Medication administration : Se topic to other systems (pharmacy automation, CPOE, EHR, financial, ec.) * Pricing, charging, and billing.and health systems include drug data. om pharmacy practice specific information systems such as atient pharmacy information systems, to systems that affect Practitioners and. the care, Of patients. e. B, administration record (eMAR), EimPuterized provider order entry (CPOE), and lectronic health records (EHRs), In addition, drug library utilization benchmart machines, Y databases are also found within smart infusion pumps, drug King databases, ADMs, and drug repackaging/bar-coding Pharmacy drug data are e "qually important within financial systems such as the charge data master (CDM) for hospital financial billing. Medication management technologies Computerized Prescriber/provider Onder Entry (CPOE); As a. profession, pharmacists have adopted technology at a much faster rate than other clinical professions. Electronic health record (EHR): An EHR is an “electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staf across more than one health care organization.” The data contained within the EHR are inclusive of medication (prescribing, dispensing, administration, monitoring). yyElectronic medication administration recard (eIMAM) pharmacies ave able to With the development of pharmacy information syste Preserve and update patient medication profiles electronically lnstead of maintaining handwritten medication lists. Ihe ability t@ maintain such Iists of ‘medications within the pharmacy information system also fed to the practice of pharmacy printing the “profiled” medication lists for use as MANS, Through clinical system integration and real-time electronic communication, MANls are How belng Provided in a completely electronic format (eMAR). This has allowed caregivers such as nurses to immediately view ordered medications on a computer, The eMAK can also be used to communicate location af products, provide adininistvation Information, and document medication administration, Automated dispensing machines (ADMs) ‘AOMs are decentralized and located in various areas such as hospital patient care units, surgical suites, procedural areas, emergency departments, and clinics. ADMs are similar to automated teller machines (ATMs). However, instead of money, ADMs ensuré controlled access to medications by requiring users to provide personal Identification in order to access the contents. Most of these systems utilize bio- identification or fingerprint technology for controlling medication access. ADMs can charge and credit patients for medications removed on their behalf or returned if not administered. Some ADM are used for the floor-stocking of medications. ADMs support medication inventory management including placing orders for wholesaler replenishment based on the inventory on hand. in cases where medications are needed urgently, certain medications where permitted can be accessed via an “everride” function. This option is discouraged because it bypasses pharmacist review.delivery companies, 2009, a survey conducted by the Ai Concluded that 27.9% of hospitals ‘merican Society of Health-System Pharmacists were utilizing BCMA, BCMA assures that the ‘five tights’ are confirmed - right patient, right medication, right dose, right time, and right route,” Telepharmacy Telehealth is the use of communtcation and information technology to deliver health, health-care services, and information over large and small distances. While most People think of telehealth in relation to surgeries performed between countries using remote robotic control, telehealth can be delivered in the same room in which a Practitioner is standing. Consider that a diabetes educator can delegate the initial ion of the newly diagnosed patient with diabetes to a technology that is a multimedia program. This program can deliver ‘Age-specific, gender-specific, race- specific, and diagnosis-specific education in an interactive format that allows the Patient to comprehend and retain the educational material as effectively as a one-to- one interaction with a human educator, ‘Telepharmacy involves bringing care to patients when it is not feasible to have patients brought to the care setting. Using video conferencing, pharmacists are able to provide real-time patient counseling and manage a medication use system via remote control, Telepharmacy operations are proving to be a cost-effective method to render high-quality pharmacy services in underserved regions and can be a much-preferred alternative to physician/nurse/clerk dispensing options.lon (BCMA: BCMA Is the application of bar- lon process in order to improve the of medication administration. The ‘d by numerous other industries (grocery stores, sae tc.) to ensure highly accountable, safe services. In Sarchsted ree v the American Society of Health-System Pharmacists ‘at 27.9% of hospitals were utilizing BCMA. BCMA assures that the ‘five rights’ are confirmed — right patient, right medication, right dose, right time, and right route:” Im one study, the researchers found a 41.4% reduction in medication errors through the utilization of BCMA, The authors also found a 50.8% reduction of potential adverse drug events as well as a reduction of transcribing errors from 6.1% on non- BCMA units to 0.0% on patient care units that used the technology. Telepharmacy Telehealth is the use of communication and information technology to deliver health, health-care services, and information over large and small distances, While most people think of telehealth in relation to surgeries performed between countries using remote robotic control, telehealth can be delivered in the same room in which a practitioner is standing. Consider that a diabetes educator can delegate the initial education of the newly diagnosed patient with diabetes to a technology that is a multimedia program, This program can deliver age-specific, gender-specific, race- specific, and diagnosis-specific education in an interactive format that allows the patient to comprehend and retain the educational material as effectively as a one-to- ‘one interaction with a human educator, Telepharmacy involves bringing care to patients when it is not feasible to have patients brought to the care setting. Using video conferencing, pharmacists are able to provide real-time patient counseling and manage a medication use system via remote control. Telepharmacy operations are proving to be a cost-effective method to render high-quality pharmacy services in underserved regions and can be a much-preferred alternative to physician/nurse/clerk dispensing options.The Patient: Behavioral Determinants Patient factors Influencing behavior: eg. patient age and sex. The relationship between age, sex, and health is in part physiological and in part a social construct. Age and gender influence health experiences through life. Survey information related to age, sex, ilness, and drug use gives evidence to thls point. Older people tend to use health services more than younger people. While the elderly represent 12% of the population, they account for 34% of total pharmaceutical expenditures. . Drug factors Influencing patient behavior: Drug regimens can be complex. The complexity of a drug regimen often is measured In the total number of medications taken daily, number of daly doses, duration of treatment, the extent to which the regimen is tallored to daily routines, and the side-effect profile. Medications may require special behaviors, for example having to take 2 dose 1 hr before or 2 hr after a ‘meal, avolding foods that are common in the diet, taking doses three or more times in 2 day, refrigerator storage, or skill in administration. In addition, Just learning the name of the drug prescribed, purpose of the drug, proper dose, when to begin taking it, frequency of dosing, and when to stop treatment is complex. Environmental factors Influencing patient behavior: choice and control; pharmacy environment Effects of provider: patient interaction on patient behavior; The relationship between patient and health- ‘care provider has been studied much more extensively between patient and doctor than between patient ‘and pharmacist. Research using observation, audio-transcriptions, and Interventions suggests that both physician-patient interactions and pharmacist-patient interactions are related to patient behavlors and Outcomes, Patients use three main sources of information when making decisions about their illness and treatment: their personal experience with the illness and various treatments; information obtained from family, friends, and the larger culture; and thelr interaction with health professionalsPatient Communication Communication if livalved not re ene sats of information, ideas, thoughts, and feelings. tt alt ee ord, but also what is conveyed through infection, vocal a spe be lon, body posture, and other behavioral responses, Keon ‘ard communicating more effectively, pharmacists must understand lunication process. The goal ofall communication is understanding, For one person to understand a message composed by another, the receiver must do more than recognize the words used in the message by the sender, Effective communication occurs only when the meaning of a message Is held in common by the participants. Effective communication should involve patient empowerment in the health care- Patient relationship. Patient empowerment posits that since patients are the ones who experience the consequences of both having and treating their illness, they have the right to be the primary decision makers regarding their medical condition, Outline of a Patient Empowerment Program 1. Health care professional assess current status (physical, emotional, cognitive, etc.) + Review patient's actual self-care practices + Reviews patient's recommended self-care practices 2. Health care professional provides relevant medical Information += Describes various treatment options * Reviews costs and benefits for each option 3. Health care professional acknowledges patient's responsibilty for self-care + Helps patient clarity personal values specific to thelr illness ‘+ Helps patient assess level of personal responsibility for their care + Helps patient select treatment goals 4. Patient identities barriers and strengths related to achieving self-care + Assesses medical barriers and sources of support + Assesses life/social barriers and sources of support 5. Patient assumes problem-solving responsibility * Develops skills to optimize support eg, communication and assertiveness skills to enhance support from family and friends; Increases support networks) + Identifies potential barriers + learns strategies/skills to overcome barriers (eg, negotiation, self-care agreements and plans, conflict resolution) 6, Patient establishes plan with assistance from provider 7. Patient carriers out plan 8. Patient and provider evaluate and review plan using problem-solving mode!Patient adherence/ patient compliance This concept of compliance in healthcare can be viewed broadly as it heey » instructions concerning diet, exercise, rest, return appointments, and tl fe use of medications. It is in discussions concerning drug therapy that the designation patient compliance is used most frequently. Many terms such as compliance, adherence, and persistence are used interchangeably, but there are differences between them. ‘Adherence can be defined as “the extent to which a patient’s behavior corresponds with the recommendations of a healthcare provider.” When viewed in this context, adherence and compliance are synonyms and can be substituted for one another. Adherence with therapy implies an understanding of how the medication is to be used, as well as a positive behavior in which the patient is motivated sufficiently to use the prescribed treatment in the manner intended. It also implies that the patient perceives self-benefit and a positive outcome associated with the prescribed treatment, such as enhanced daily functioning and well-belng. Some have recommended the use of the terms adherence or concordance rather than the designation compliance; however, the latter term continues to be the most widely accepted and used. Patient persistence & non-adherence Persistence Is a similar concept to adherence but can be defined as “the duration of time from initiation to discontinuation of therapy.” Persistence to a regimen is maintained as long as the patient does not exceed the permissible gap (the time frame for which a patient may discontinue medication without experiencing an adverse outcome). Patients can “demonstrate persistence with a given regimen while not being adherent to that regimen if they continue to take some medication but not in the prescribed manner. Some patients make a conscious decision to deviate from the prescribed regimen (i.e,, intentional non-adherence). However, many patients intend to take their medication according to instructions and may even be unaware that their use differs from what the prescriber intended. The term patient non-adherence implies that the patient is at fault for the inappropriate use of medication. While this may often be the case, the physician and pharmacist may not have provided the patient with adequate instructions in a manner that the patient understands.Patient adherence/ patient compliance This concept of compliance in healthcare can be viewed broadly as it relates to instructions concerning diet, exercise, rest, return appointments, and the use of medications, It is in discussions concerning drug therapy that the designation patient compliance is used most frequently. Many terms such as compliance, adherence, and persistence are used interchangeably, but there are differences between them. Adherence can be defined as “the extent to which a patient’s behavior corresponds with the recommendations of a healthcare provider” When viewed in this context, adherence and compliance are synonyms and can be substituted for one another. Adherence with therapy implies an andentanding of haw the medication is to be , a5 well as a positive behavior in which the patient is motivated sufficiently to use the prescribed treatment in the manner intended. It also implies that the Patient perceives self-benefit and a positive outcome associated with the presabed treatment such as enhanced day functloning and wel-bere, Some peasant the ue ofthe terms adherence or concordance rather than the ecepted wide: /ever, the latter term continues to be the most widely Patient persistence & non-adherence Persistence is a similar concept to adherence but can be defined as “the duration of time from initiation to discontinuation of therapy.” Persistence to a regimen is maintained as long as the patient does not exceed the permissible gap (the time frame for which a patient may discontinue medication without experiencing an adverse outcome). Patients can -demonstrate persistence with a given regimen while not being adherent to that regimen if they continue to take some medication but not in the prescribed manner. Some patients make a conscious decision to deviate from the prescribed regimen (i.e., intentional non-adherence). However, many patients intend to take their medication according to instructions and may even be unaware that their use differs from what the prescriber intended. The term patient non-adherence implies that the patient is at fault for the inappropriate use Of medication. While this may often be the case, the physician and pharmacist may not have provided the patient with adequate instructions in a manner that the patient understands. Jie ieProfessional communications Communication is a vital skill, necessary for success in personal and professional settings. Pharmacists often serve as the guardians of appropriate drug therapy. Therefore, communicating effectively is key to reinforcing the value of the pharmacist within the healthcare system. Pharmacists communicate with a wide variety of healthcare professionals on a daily basis. The type of information that is communicated may be the same. However, the knowledge level and expectation of the audience dictate the delivery of the message. Regardless of knowledge or expertise, pharmacists cannot actively participate in Patient care unless they can communicate effectively Communicating with healthcare professionals: Verbal communications The most common verbal communications that pharmacists engage in Invalye responding to drug therapy questions and receiving verbal drug orders. Receiving drug-related questions A major challenge in cesponding to requests for drug therapy recommendations Is determining the unique situation that prompted the request. In addition to asking appropriate questions, itis Important to have strong listening skis Pharmacists should avoid all possible distractions when gathering background Information. If the Interaction isin person, the pharmacist may use non-verbal cues such as facial expressions, eye contact, and other forms of body language to interpret the requestor’ response to hs of her background questions, Racial and cultural differences are also important issues to consider during in-person Interactions. Communicating over the telephone is inherently more dificult, and in these situations pharmacists must be especially skiled in gathering background information. tt is very important to ask for cleriications when necessary to ensure a complete understanding of the situation. Table 1: The questions allow the pharmacist to formulate the most appropriate response.Table Questions to consider when collecting Pertinent background information What is the requestor’s name, profession, and affiliation? Does the question pertain to a specific patient? Dot have a clear understanding of the question or problem? Dol knowif the correct question is being asked? Do | know why the question is being asked? Dol understand the requestor’s expectations? Do know pertinent patient history and background information? Do | know what unique circumstances generated the question? Do | have insight about how the information | provide will actually be used? Written communications The most critical written communications between pharmacists and other healthcare professionals are undoubtedly the prescription, in community practice, and medication order, in institutional practice. Other important types of written communications, including documentation of patient care, electronic ‘communications, professionat correspondence, manuscripts for publication, and poster presentations are discussed in this section.S of ae S ~ Subjectve: Patents caren te SOAP/ SOAPEO note members should be characterizi O ~ Objective: Pati : Patient dat rad une Including age, sex, race, height, weight, vita signs, *Y and diagnostic tests, and physical exam findings aS ‘ i hea eae The pharmacist’s evaluation of therapeutic alternatives or ih the pate e a therapy problems which may define the necessity for al drugs Patient's regimen, evaluate the potential for drug Interactions, document the appropriateness of the drug regimen and/or evaluate the patient’ provious response to pharmacotherapy, P ~ Plan: The plan should include specific drug therapy recommendations (drug, dose, route, frequency, duration), monitoring parameters and the necessity for further studies or tests, SOAPEO note: The authors have expanded this methodology to Include two additional components, Education and Outcomes, Medication Therapy Management (MTM) The rules for MTM outline specific requirements for documentation of care. MIM is a structured form of pharmacist-managed care entailing at least an annual complete medication review followed by creation.of a medicatlon-related action plan (MAP), a patient-specific plan designed to provide the patient with a list of actions to complete in order to optimize thelr self-management. The MAP can also be used by patients to assess their progress over time. The MAP must be documented (ideally electronically) through the maintenance of a chronological, patient-specific record that allows for longitudinal patient evaluation and billing submission, Table 3 provides a detailed list of suggested documentation elements for MTM and the components of a MAP. The primary purpose of the extensive documentation required for MAP is to facilitate pharmacist communication with other healthcare professionals while resolving drug-related problems; the documentation is also designed to Improve outcomes, demonstrate the value of MTM services, and ensure legal complianceTable 3: Components of MTM documentation Prescription medications (current and discontinued) -Nonprescription medications (current and discontinued) -Dietary supplements (current and discontinued) -Medication-related actlon plan (MAP): -Patient name -Primary care physician (including name and phone number) Pharmacy (including pharmacist name and phone number) -Date prepared Action steps for patient Notes for patient Follow-up Information ara (possibly including SOAP or SOAPEO note with or without a cover +Education materials Correspondence with other healthcare professionals -Billing information Electronic communication: Electronic mail While the introduction of e-mail has greatly facilitated contact, this type of communication must be appropriately utilized in the professional environment. Professional e-communication should be utilized in situations where a face-to-face meeting or telephone (i.e., direct) communication would not communicate the message more effectively. Within this environment, e-mail should be for professional use only. Attention should be given to one’s chosen e-mail sign-on. When communicating by e-mail, it is important that any message may be elther saved or forwarded for viewing by others. Accordingly, close attention should be it, The subject line should clarify the intent of the message. should be concise but thorough enough to be understood. inted or shared, one should refrain from including confidential or controversial information, E-mail users are advised to compose professional communications with a word processing program inital, to factitate Epelling and grammar checks. All messages should end with 2 professional losing ‘and contain the individual's name, title, affiation, and contact information pald to content and forma The content of messages sI Given that messages may be pr When e-communication is utilized, it Is most appropriate to respond within the same business day, but a goal would be to respond in no longer than 24 hours.Fac Source of communication ebook and Twitter have recently become a popular Although access to soci 3 professional ineraton and pi ee neaate e mation dis one’s professional repuraiee ssemination, they could jeopardize Pharmacists Should always be vigilant to present themselves as trusted Rrovessionals. Therefore, all photos that are viewable to the publle should be eons in nature. Privacy settings should be carefully chosen so that Information not intended to be viewed by other professionals or patlents i not available on the Internet. A general guideline to follow is not to post anything online that would not be appropriate to send in a professional e-mail, Pharmacists should be careful to present themselves through social networking sites In the same manner that they represent themselves in the professional setting, Professional correspondence: Memoranda Most pharmacists will find a need to communicate with other healthcare providers via memos, whether or not they have administrative positions. Written memos are frequently used to communicate drug information, policy changes, or in the * evaluation/discipline of employees. Memos should be formal in format and should be addressed to a specific individual or group of individuals, whenever possible. ‘The format for a professional memorandum is included in Table 4, Table 4: Example of memo header. To: Jane A. Doe, PharmD, RPh Director of Pharmacy From: Samuel T. Smith, PharmD, RPh Pharmacy Manager Re: Staffing Patterns for Ambulatory Pharmacy Date: March 4, 2022Adverse Drug reactions (ADRs) ly for the past several decades. In 1961, only 656 st (OTC)) were marketed In the USA. By 1989 this 2011 well over 11 000 drugs were marketed In world’s new Drug availabilty and use have risen steadih drugs (prescription and over-the-counter number had Increased to 8000 and by the USA. The USA drives drug development, with almost 45% of the ‘medicines originating In the USA. Since 2000, an average of 24 new molecular entities OF biological license applications (ie., new products marketed for the first time) have been approved each year In the USA. Physician office visits result in over 2.3 billion prescriptions or drug samples supplied annually, and although the US population grew bby 9% between 1999 and 2009, the number of prescriptions increased by 39%, The frequency of ADR, classifying ADR, risk factors for ADR, reporting requirements and hospital-based drug reaction monitoring, Drug development and its relations to ADR, Drug development: toxicokinetics and toxicodynamics, Drug development: Pharmacogenomics, postmarketing safety surveillance, pharmacoepidemiology and pharmacovigliance, International ADR-monitoring Definition of ADR and ADE Although there are many definitions of an ADR, an intemationally accepted description is that of the WHO: “A response to a drug that is noxious and unintended, and that occurs at doses normally used in humans for the prophylaxis, diagnosis, or therapy of disease or for the modification of physiological function. ” Notably, this definition tacitly excludes the failure of a drug to have its intended effect (ie., a therapeutic failure), and situations of drug abuse, drug overdose or poisonings. Itis important to distinguish an ADR from an adverse drug event (ADE). While the two terms have been used interchangeably, the differences are important. ‘An ADE js an injury resulting from taking a drug. ADEs encompass all steps that can go wrong with drug therapy including preventable mistakes in prescribing, administering, dispensing, monitoring, and documenting (that is, medication errors), and non-preventable ADRs. ‘That is, an ADR is the result of the intrinsic properties of the drug and cannot be prevented,Drug Interactions Many drug-related problems are caused by drug interactions 1. Food or certain dietary items influence the activity of a drug (ice., 2. Herbs or other ‘Natural products influence the activity of a drug, o drug-f00d interactions), or + Environmental chemicals or smoking Influence the activity of adr ug, OF 4-Adrug causes alterations of laboratory test results (he, drug-labs oratory test Interactions), oF 5. A drug causes undesired effects in atlents with certain disease states (i, drug-disease Interactions), For example, interaction of digoxin and warfarin can result in serious adverse events. These Interactions in which drug activity is decreased, resulting ina loss of elficacy, Digoxin and a diuretic often are given concurrently, heart failure, ‘and rationally so, In treating patients with congestive {tls well known that most diuretics can cause potassium depletion that, if uncorrected, could become excessive and lead to an increased action of digoxin and adverse events. The entrepreneurial and intrapreneurial pharmacist A community pharmacy owner is certainly an entrepreneur, activities occur in a community pharmacy. in addition, regularly occur within large and medium-sized corporations and organizations — defined by some as intrapreneurship. As the profession of pharmacy moves from a primarily independent ownership model of practice to a more employee-based profession, the opportunities for creative ventures within these corporate entities cannot be ignored, and a return to the entrepreneurial spirit in pharmacy practice provides limitless opportunities, and entrepreneurial entrepreneurial activitiesEntrepreneurship “one who undertakes an enterprise, one who es the risk of profit oF fos” The entrepreneur is defined as ‘owns and manages a business; a person who taki Another definition, an entrepreneur is "someone who starts their own busir especially when this involves seeing a new opportunity” In the marketing definition, “entrepreneur is an owner or manager of a business ‘who by risk, initiative, and innovation attempts to make a profit. These definitions and insights provide the underlying theme for this section- the entrepreneurial pharmacist is one who assumes risk, takes responsibility, looks for opportunity, is creative, and assumes a leadership role in the inception and evolution of a new pharmacy-related business concept. Entrepreneurial actions ‘Small business and entrepreneurship overlap, but are not the same. The ey diference isthe focus on growth and market planning, The following definitions to differentiate entrepreneurial ventures from small business ventures « Small business venture: “Any business that Is Independently owned and operated, act dominant in is field and does not engage In new marketing or innovative practices.” « Entrepreneurial venture: “A business whose principal goals are profitabilty and growsh and the business Is characterized by innovative stategte practice The following identified five strategic behaviors that best described entrepreneurial ventures: + Introduction of new products or services + Introduction of new methods of production * Opening new markets «+ Opening new sources of supply + Industrial reorganization Specific pharmacy-based ventures can be usad to iustrate each ofthese strategic Behaviors9/11/2024 Characteristics of entrepreneurs and intrapreneurs Entrepreneur Invapreneur “Works within an ‘gaat.