Effective Communication Between Physician and Pharmacist: Dr. G Praveen Kumar

EFFECTIVE
COMMUNICATION
BETWEEN PHYSICIAN
AND PHARMACIST
by,
Dr. G Praveen Kumar
Assistant Professor,
Department of Pharmacy practice,
C.L. Baid Metha College of Pharmacy.
Incharge-Drug Information Centre & Patient Counseling,
VHS(voluntary health care) hospital, Adayar, Chennai
PHARMACIST
ADMIN
PHYSICIANS PATIENTS
• Chemists or druggists,
• healthcare professionals who
practice in pharmacy, the field of
health sciences focusing on safe and
effective medication use.
• The role of the pharmacist is "lick,
stick, and pour" dispensary
• "lick & stick the labels, count the
pills & pour liquids"
NATIONAL
GUIDELINES
PHYSICIAN
ADMIN
PATIENTS
PARAMEDICS
• Examine
• Diagnose
• Treat
• Prescribe
• Dispense (sometimes)
MONITORING
• Counsel TEAM
WARD
• Follow up ROUNDS
GOVERNING
BOARDS
PYHSICIAN & PHARMACIST RELATIONSHIP
Pharmacist
• Looks special but actually not

Physician
LOOKS SIMPLE BUT SPECIAL

(SPECIALITY)
DEVELOPMENT OF PROFESSION
Physicians Pharmacist
• MBBS • D.Pharm
• MD • B.Pharm/M.Pharm
• DM • Pharm.D
• Clinical pharmacists work directly with
doctors, other health professionals, and
patients to ensure that the medications
prescribed for patients contribute to the
best possible health outcomes.
Roles of a clinical pharmacist
• Assess the status of the patient’s health
problems and determine whether the
prescribed medications are optimally meeting
the patient’s needs and goals of care.
• Evaluate the appropriateness and effectiveness
of the patient’s medications.
• Recognize untreated health problems that
could be improved or resolved with
appropriate medication therapy.
• Follow the patient’s progress to determine the
effects of the patient’s medications on his or
her health.
• Consult with the patient’s doctors and
other health care providers in selecting the
medication therapy that best meets the
patient’s needs and contributes effectively
to the overall therapy goals.
• Advise the patient on how to best take his
or her medications.
• Support the health care team’s efforts to
educate the patient on other important
steps to improve or maintain health, such
as exercise, diet, and preventive steps like
immunization.
But still the fight never got over……….
Mode of communication?
Prescribing Guidelines
• Part 1: The process of rational treatment
• Part 2: Selecting your P-drugs
• Part 3: Treating your patients
• Part 4: Keeping up-to-date

Part 1: The process of rational treatment
• Step 1: Define the patient's problem

• Step 2: Specify the therapeutic objective
(What do you want to achieve with
the treatment? )
• Step 3: Verify the suitability of your P-
treatment Check effectiveness and
safety
• Step 4: Start the treatment
• Step 5: Give information, instructions and
warnings
• Step 6: Monitor (and stop?) treatment
Part 2: Selecting your P-drugs
i Define the diagnosis (pathophysiology)
ii Specify the therapeutic objective
iii Make an inventory of effective groups
iv Choose a group according to criteria
efficacy safety suitability cost
Group 1
Group 2
Group 3
v Choose a P-drug
efficacy safety suitability cost
Drug 1
Drug 2
Drug 3
Conclusion: Active substance, dosage form, Standard
dosage schedule, Standard duration.
Part 3: Treating your patients
Part 4: Keeping up-to-date
“Knowledge is of two kinds. We know a

subject ourselves, or we know where we
can find information upon it.”
-Samuel Johnson (1709-1784)
Martindale’s The Extra Pharmacopoeia is an excellent reference book
with detailed drug information on most active substances and chemicals.
Avery’s Drug Treatment is a more specialized book, appropriate for

prescribers with a special interest in clinical pharmacology.
Pharmacist contribution?
• Prescription audit/monitoring
• Drug information
• Patient counselling
Prescription audit….
• Medication errors
• Almost everyone in the modern world takes
medication at one time or another
• Most of the time medications are beneficial
• But some occasion they do harmful effects (side
effects) which is adverse drug events
• But sometimes the harm is caused by an error in
prescribing or dispensing or administration of
medication
Types - Responsibilities
• PRISCRIBING ERRORS - physicians
• TRANSCRIBING ERRORS – pharmacist/nurses
• DISPENSING ERRORS – pharmacist/ physicians
• ADMINISTRATION ERRORS – nurses/patients

Parts of prescription
• Name, address, telephone of prescriber

• Date
• Drugs
• Name/I.D no., age & gender of patient
• Signature or initials of prescriber
Legibility
• Poor Physician handwriting

Drugs with similar names
Chlorpromazine - Chlorpheniramine
Carbamazepine - Carbimazole
Clotrimazole - Co-trimaxazole
Cetirizine - Cinnarizine
Mebendazole - Metronidazole
Betadine - Betnovate
Doctors are legally obliged to write clearly
Tab.Dimol & Tab.Divalin
Tab.Amoxil & Tab.Daonil
(REF: WHO prescriber guidelines page 67)
Drug name and dosage form
• Brands differ as same as the sarees brands
– Especially in India
• Use only generic names in the Prescription
• Use brands only if needed…
Dosage forms
• Tablet
• Capsule
• Injection
• Nebulizer
• Infusion
• Eye Drops
• Ear Drops
• Nasal Drops
• Transdermal Patches
Abbreviations
CFX CIPROFLAOXACIN
NFX NORFLOXACIN
NFR NIFEDIPINE RETARD
MF METFORMIN
MMF MYCOPHENOLATE MOFETIL
CAT CALCIUM
CCT COMMON COLD
CCM CALCIUM CITRATE MALEATE
CPZ CHLORPROMAZINE
CBZ CARBAMAZEPINE
ABZ ALBENTAZOLE
CTZ CETRIZINE
DF DERIPHYLLIN
DCF DICLOFENAC
DEC DIETHYLCARBAZINE
GM GENTAMYCIN
CM CHLORAMPHENICOL
ANT ANTACID
AST ATORVASTATIN
SBT SALBUTAMOL
SMT SALMETROL
Dosage strength and frequency
• ng/mg/µg
• OD/BD/1/2tablets
• Half tablet/capaules
– Entricoated/sustained release
• Decimals
– O.5/.5 Never use
unofficial
– 150/1.50 abbreviations
– or invent
• Duration your own
– 3 === days/weeks abbreviations
– it is not safe
– antibiotics to do so.
Prescription audit/monitoring
• Legibility
• Use generic names only
• Mention the full details of every drug
• Avoid unofficial abbreviations
• Avoid “Repeat all”
• Avoid “Double dosing”
Drug information
services
• “The Drug Information Centre is a service
offered through Pharmacy department
which provides advice and act as a referral
service by directing the best available
resource to respond to query or concern.”
What kind of information?
1. New Drug or its Product Information/
Identification
2. Availability
3. Contraindications/Safety
4. Adverse Drug Reactions/Drug Interactions
5. Efficacy/Treatment/Choice of drug
6. Pregnancy/Lactation/Pediatrics
7. Drug Profile/Indications/Dosage/
Pharmacokinetic information
8. Toxicology
9. Counselling information
Resources….
• Primary resources: Research papers/Journal

• Micromedex articles/Case reports.
• FDA website
• Medscape • Secondary resource: abstracts, review
• webMD
• Drugs.com(d articles, indexing services such as DRUGDEX,
rug
interaction Drug Information Database and abstracting
checker)
MEDLINE, MICROMEDIX, etc…
• Who
guidelines
• EBSCO
• Tertiary resources: Text books on various
journal aspects of drug use & practical guidelines.
services
Patient counselling
“It is the physicians or pharmacist’s
responsibility to ensure the patient receives
the required information for the quality use of
medicine.
Counselling implies the communication of
information that would encourage
therapeutic outcome”
You can organize a patient counseling Event – to

develop professional practice skills.
• Hypertension Dietary changes – Reduce
sodium, Reduce alcohol, Eat more fruits
and vegetables
Regular aerobic exercise – Walking, running
Weight loss – Eat less
• Diabetes – Less Carbohydrate, Fat and

more fiber food
Physical activity – Walking, cycling
No smoking, Alcohol intake
Sulfonyl ureas – Glibenclamide 15-30 mts
before food others taken with meal
Storage of medicines
• Proper storage of medication ensures
efficacy, stability and safety.
• Room temperature - 15⁰C - 30⁰C
• Cool – 8⁰C - 25⁰C
• Cold - 2⁰C - 8⁰C
• Warm - 30⁰C - 40⁰C
• Excessive heat – Any temp. above 40⁰C
Potency & Temperature for storage of
Vaccines
Vaccine Temperature Potency maintained for
Oral Polio (OPV) -20⁰C 1 Year
4⁰C to 8⁰C 3 months
Bacillus Calmette 4⁰C to 8⁰C 1 Year
Guerine (BCG)
Diphtheria, Pertusis, 4⁰C to 8⁰C 2 Years
Tetanus (DPT)
Measles 0⁰C to 2⁰C 2 Years
Typhoid (TAB) 4⁰C to 8⁰C 8 months
Tetanus toxoid (TT) 4⁰C to 8⁰C 4 Years

Hepatitis B
Patient information leaflets
How to overcome
the barrier?
PHARMACY AND THERAPEUTIC COMMITEE
THE PHARMACY AND THERAPEUTICS

COMMITTEE IS A POLICY FAMING AND
RECOMMENDING BODY TO THE MEDICAL
STAFF AND THE ADMINSTRATION OF
HOSPITAL ON MATTERS RELATED TO
THERAPEUTIC USE OF DRUGS.
HOSPITAL FORMULARY
• Hospital Formulary is a continually revised

compilation of pharmaceuticals including
important ancillary information that reflects
the current clinical judgment of the medical
staff.
Contents…
• Introductory information- Acknowledgement, List
of abbreviations, Intended usage of the formulary
manual
• Basic information of the drug
– Generic name,
– dosage form,
– strength
– Indications
– Pharmacological action
– Precautions
– Side effects
– Dosage – form,
– frequency Instructions
– Drug interactions
• Supplementary information on each drug
– Price
– Regulatory category
– Storage guidelines
– Patient counselling information
– Brand names
• Formulas for various diagnostic stains,
diagnostic aids
• Table of common Lab-values
Size of the formulary
• It is sufficiently small in size so that it could
be easily carried by clinicians, nurses etc, in
the pockets of their uniform or lab coats.
• The hospitals may determine their own size

of the formulary.
• Join together to create a better therapeutic
outcome.
• For queries contact:
DRUG & POISON INFORMATION CENTRE
Department of Pharmacy Practice
C.L. Baid Metha College of Pharmacy
• www.clbaidmethacollege.com
Go-to “DIC Request Form”
Aware….
Stay Tuned
to the
Developing
Technology.
We TREAT
And Let
“GOD”
Heals...
For details mail to :
[email protected].
Thanks To the Almighty GOD

(Jesus Christ)
&
to all….

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EFFECTIVE

• Looks special but actually not

LOOKS SIMPLE BUT SPECIAL

• Part 1: The process of rational treatment

• Part 2: Selecting your P-drugs

• Part 3: Treating your patients

• Part 4: Keeping up-to-date

• Step 1: Define the patient's problem

“Knowledge is of two kinds. We know a

Avery’s Drug Treatment is a more specialized book, appropriate for

• PRISCRIBING ERRORS - physicians

• TRANSCRIBING ERRORS – pharmacist/nurses

• DISPENSING ERRORS – pharmacist/ physicians

• ADMINISTRATION ERRORS – nurses/patients

• Name, address, telephone of prescriber

• Poor Physician handwriting

• Primary resources: Research papers/Journal

You can organize a patient counseling Event – to

• Diabetes – Less Carbohydrate, Fat and

Typhoid (TAB) 4⁰C to 8⁰C 8 months

Tetanus toxoid (TT) 4⁰C to 8⁰C 4 Years

THE PHARMACY AND THERAPEUTICS

• Hospital Formulary is a continually revised

• The hospitals may determine their own size

Thanks To the Almighty GOD

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