Clinical pharmaceutical recommendation is proposal of patient’s medication change. It is provided to the attending physician. CP recommendation is made after detailed study of patient’s medication record and obtaining all necessary information from patient’s healthcare documentation.
Initial control of patient’s medication, admission of the patient to the clinical pharmacist’s care (should be done short after admission of the patient to the ward). Patient's pharmacotherapy is graded as low, medium or high risk in the context of current health state of the patient and planned interventions. Identification of the drug related risk factors that are possible causes of current adverse effects or may be causes of future adverse effects during the in-hospital stay or after discharge. The aim is prevention or early identification of drug related problems. If patient is in high risk, recommendation with plan for pharmacotherapy adjustment is provided to the attending physician.
Repeated control of patient’s medication to evaluate the CP intervention effectiveness. This procedure may also serve as the control of medication on the discharge. Repeated controls may also have only preventive purpose in case of long hospitalization. The frequency of repeated controls depends on initial risk stratification, on type of the ward (acute/after-care, ICU/standard) and medical field (e. g. internal medicine/surgery).
Consultation with the attending physician. The clinical pharmaceutical care is always provided in cooperation with the attending physician, with the knowledge of health state of the patient and planned medical interventions.
Patient education. Attending physician is always informed about patient education activities of CP.
Competences of clinical pharmacist
CP is part of various interdisciplinary teams: antibiotic stewardship, palliative care, acute pain service, positive drug list formulation etc. CP actively participates on education of other health care specialists and formulation of local pharmacotherapy guidelines. Clinical pharmaceutical services may be provided in inpatient, outpatient and home-care setting. Pharmacist with specialization in the field of clinical pharmacy is authorized to manage clinical pharmacy department.
As clinical pharmaceutical care does not need to be provided in the pharmacy Czech Professional Society of Clinical Pharmacy recommends that CP departments are pharmacy-independent. CP departments should not be involved in economic issues of the pharmacy as this is possible conflict of interests. Some healthcare facilities in the Czech Republic do not have pharmacy and have CP departments.
President of the Czech Professional Society of Clinical Pharmacy
Department of Clinical Pharmacy
Hospital Na Bulovce
Budínova 67/2, 180 81, Prague
tel.: +420 266 084 104
Board member of Czech Society of Clinical Pharmacy responsible for foreign affairs
Jan Miroslav Hartinger
Department of Clinical Pharmacology and Pharmacy
General University Hospital in Prague
Na Bojišti 1, 128 08, Prague
tel.: +420 224 964 135