Clinical pharmacist: humanization and safety of care

The clinical pharmacist, already present in many Anglo-Saxon countries, has arrived in Italy. This role is introduced in the ward next to the medical staff to completely take care of patient and his own clinical workflow, helping to remarkably improve the quality of his therapy.

The clinical pharmacist takes its origin when the pharmacist and doctor skills split in 1267. But its role was defined only 600 years later when production and distribution of drugs activities were separated.

In the U.S., in fact, in the ’80s the clinical pharmacy was instituted in order to integrate and complete patient care. The doctor diagnoses the disease and the pharmacist prescribes the drugs most suitable for each single individual, taking in charge of all the responsibilities.

Clinical pharmacist has arrived in Europe from overseas around the ’90s, its slowly spread is due to increased attention to medical error. In fact, according to current statistics, 39% of errors are made in pre-admission, 12% at the transcript of the recipe, in logistics11% and the remaining 38% during administration of drugs. 40% of those errors actually arrive to the patient.

The clinical pharmacist has as a main goal to improve the correct use and the right administration of drugs. It is an important role because it supports the doctor in terms of drugs and economical consultant as also legal advice (reimbursement of the drug, patient monitoring and optimization of inventory management). Responsibilities on pharmaceutical decision change depending on the country.  In USA and Great Britain pharmacist responds personally to any mistakes while in Germany and Italy the physician is always accountable for any errors.

In England the clinical pharmacist exists since several years, its role within the hospital is recognized and well defined, although there are always teething problems during introduction, explains Dr. Marco Bravi, clinical pharmacist in England for ten years, three of them at the Diana Princess of Wales Hospital Grimsby.

There the “consultant pharmacist” is established with specific tasks such as:

- meeting with clinicians to define drugs hand over

- discussing the therapeutic approaches with the head physician, the ward director and the economical superintendency

- handing over drugs to nurses

- handing over drugs to patients

- continuously monitoring the medical staff activities (medical records, dosages, transcriptions)

- ensuring that national guidelines are followed in the choice of drug

The goal is the patient centrality, eliminating the possibility of error by offering the patient a reliable and excellent service.

In Italy, the first hospital that has experienced the clinical pharmacist was the San Giovanni Battista Molinette in Turin in late 2005.
Dr. Francesco Cattel, pharmacist in the hospital, said that the project began with a business plan including the introduction of two pharmacists: one in the emergency department and another in the department of nephrology and transplantation.

The objective of the project  was to include the figure of the pharmacist in the departments rather than wards, alongside doctors and nurses to establish a permanent contact with the patient.

To date there are six pharmacists in seven departments: Onco-hematology, emergency, surgery, medicine, anesthesia and intensive care, rehabilitation. A single pharmacist can move from one department to another as needed.

According to Dr. Cattel there are still ideas to improve and further develop the figure of the clinical pharmacist, as for example to allow to sign the patient’s medical records for complete traceability of the therapy, or  institutionalizing the forms of contract related to this new role.
Nevertheless, the Molinette obtained a great benefit from this experience: a reduction by 40% the cost of medicines and 70% the cost of errors (Ref. “quotidianosanità.it” – February 18, 2011) was obtained.

For this reason about a year ago, a project began, promoted by the Ministry of Health in collaboration with the SIFO, entitled: “The pharmacist’s Department as a means of preventing errors in treatment and implementation of government policies in Clinical Oncology. ”

Five Italian hospitals have been selected as main centers for an experimental project in which the pharmacist was supported by a tutor or a pharmacist manager already working in the field of onco-hematology.

The centers are:

- San Giovanni Battista, Molinette, Torino

- IOV (Istituto Oncologico Veneto), Padova

- San Vincenzo, Taormina

- A.O.U. Consorziale Policlinico, Bari

- A.O.U. Ospedali Riuniti, Ancona

The experience demonstrated how important  is this role  and to train qualified personnel within the different structures, as stated in the case of Ancona hospital.
Since July 2010, in fact, at the University Hospital of Ancona Dr. Guglielmi Sabrina was responsible for  the project and brings with her a positive feedback on her experience from a clinical and human aspect. The safety of drug treatment, the monitoring of adverse events, the appropriateness of therapy and the continuous contact with the patient are the aspects that have significantly characterized the experience of Dr. Guglielmi.

Her role within the departments was to help physicians activity  and to guarantee clinical and psychological support to the patients, focusing mostly on Counseling ( advising patients on the right therapy to follow at  home).

The main benefits reached are:

- optimizing the management of drugs  in the department

- increasing from 46%  to 79% compliance of registered patients (respectively in the departments of oncology and hematology, for the period 2007-2010 in accordance with the requirements of the register  “AIFAonco”)

- substantial reimbursement by pharmaceutical companies to AOU Ospedali Riuniti based on cost sharing and Payment by result.

Following the great success of the project   in the different Italian hospitals, a post-graduate specialization course on clinical pharmacist was established at the Faculty of Pharmacy in the University of Bari.

In England, said Dr.Bravi, special courses  are organized and promoted by the hospitals. It is necessary to attend them to work as a clinical pharmacist

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