Emergency Department and Hospital Treatment of Asthma
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Asthma is one of the most frequently treated problems in emergency departments and hospitals. Over the last 10 years, several excellent clinical trials have redefined the optimal approach to treating acute, severe asthma. Both in the emergency department and in the hospital, frequent doses of inhaled β 2 -agonists and systemic corticosteroids are the cornerstones of treatment. In either setting, theophylline therapy adds no or minimal benefits. Inhaled anticholinergics add to the efficacy of the initial dose only of inhaled β 2 -agonist in the emergency department. Pharmacists should help ensure optimal treatment in acute care settings via protocols as well as routine patient monitoring and drug use evaluation. Improving long-term prevention of asthma should also be addressed by careful patient education and treatment protocols. Serving on a case management team is one excellent approach of helping patients with asthma. Providing pharmaceutical care for asthmatics is a rewarding experience that can dramatically improve clinical outcomes, including a reduced need for emergency and hospital treatment. Copyright © 1992 by W.B. Saunders CompanyKeywords:
Asthma management
The department of pharmacy in hospitals have stored up large supplies of human resources and accumulated a wealth of experience in pharmaceutical care practice.It is the responsibility for hospitals to participate in the clinical pharmacy education.Establishing a cooperative model between colleges and hospitals may contribute to the development of the clinical pharmacy education and the training of clinical pharmacists,and can promote the growth of the clinical pharmacy.
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Journal Article Impact of a clinical pharmacy research team on pharmacy resident research Get access Kari L. Olson, Pharm.D., Kari L. Olson, Pharm.D. Clinical Pharmacy Supervisor Clinical Pharmacy Cardiac Risk Service, Pharmacy Department, Kaiser Permanente Colorado (KPCO), Aurora, and Clinical Associate Professor, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora Search for other works by this author on: Oxford Academic Google Scholar Adriane N. Irwin, M.S., Pharm.D., Adriane N. Irwin, M.S., Pharm.D. Clinical Assistant Professor Oregon State University College of Pharmacy, Corvallis; at the time of writing, she was Clinical Pharmacy Research Fellow, Pharmacy Department, KPCO Search for other works by this author on: Oxford Academic Google Scholar Sarah J. Billups, Pharm.D., Sarah J. Billups, Pharm.D. Clinical Pharmacy Specialist Clinical Pharmacy Research Team (CPRT), Pharmacy Department, KPCO, and Clinical Assistant Professor, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Search for other works by this author on: Oxford Academic Google Scholar Thomas Delate, Ph.D., M.S., Thomas Delate, Ph.D., M.S. Clinical Pharmacy Research Scientist CPRT, Pharmacy Department, KPCO, and Clinical Instructor, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Search for other works by this author on: Oxford Academic Google Scholar Samuel G. Johnson, Pharm.D., Samuel G. Johnson, Pharm.D. Clinical Pharmacy Specialist Applied Pharmacogenomics, Pharmacy Department, KPCO, and Clinical Instructor, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Search for other works by this author on: Oxford Academic Google Scholar Deanna Kurz, Pharm.D., B.A., CCRP, Deanna Kurz, Pharm.D., B.A., CCRP Senior Project Manager CPRT, Pharmacy Department, KPCO Search for other works by this author on: Oxford Academic Google Scholar Daniel M. Witt, Pharm.D., FCCP, BCPS Daniel M. Witt, Pharm.D., FCCP, BCPS Professor (Clinical) and Vice Chair Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City; at the time of writing, he was Senior Manager, Clinical Pharmacy Research and Applied Pharmacogenomics, Department of Pharmacy, KPCO Address correspondence to Dr. Witt (dan.witt@pharm.utah.edu). Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 72, Issue 4, 15 February 2015, Pages 309–316, https://doi.org/10.2146/ajhp140214 Published: 15 February 2015
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The establishment of a clinical pharmacy education programme in the University of Tasmania, Australia, is described. Re-organization and integration of the pharmacy curriculum is outlined and generally agreed concepts of clinical pharmacy education are detailed. Description and objectives of a hospital-based Clinical Pharmacy Residency are presented and the broad scope of clinical pharmacy education is discussed.
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ABSTRACT Background Subacute aged‐care inpatients usually have multiple risk factors for adverse medication events. There is evidence that clinical pharmacy services can improve their medication management. Aim To describe clinical pharmacy services, pharmacist and pharmacy technician staffing levels, and pharmacy technician roles in the subacute aged‐care inpatient setting. Method A pre‐piloted online survey was e‐mailed to directors of pharmacy listed in the Society of Hospital Pharmacists of Australia Directory of Hospital Pharmacy Services 2011. The survey included items about the hospital, number of full‐time equivalent (FTE) pharmacists and pharmacy technicians providing clinical and medication distribution services to subacute aged‐care beds, clinical pharmacy services provided, and tasks undertaken by pharmacy technicians. Results 31 evaluable responses were received (estimated response rate 25%). 11 (36%) respondents provided a comprehensive clinical pharmacy service to most subacute aged‐care inpatients at least 5 days/week; 8 (26%) respondents were unable to provide a basic clinical pharmacy service. The number of subacute aged‐care beds per 1 FTE pharmacist (20–128 beds) and pharmacy technician (15–630 beds) was highly variable. Pharmacy technicians predominantly assisted with distribution of medicines (restocking ward imprest and individual patient supply) and infrequently assisted with clinical pharmacy tasks. Conclusion Clinical pharmacy service provision to subacute aged‐care inpatients was suboptimal at most participating hospitals. Increased FTE pharmacists would be needed to consistently deliver comprehensive clinical pharmacy services. Expanding pharmacy technicians' roles could support the provision of clinical pharmacy services.
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The clinical pharmacy component of Riyad College of Pharmacy curriculum was expanded from its present 4-credit h clinical pharmacy course to 18-credit h of clinical instructions in the pharmacy-core programme. In the final year of a 5-year programme, students may select clinical pharmacy as a professional option, thus receiving an additional 10-credit h of clinical instructions. The decision to expand the clinical component of the pharmacy curriculum was prompted by the need for patient-oriented pharmacy practitioners. The performance of graduates who had been rather briefly exposed to clinical pharmacy education led to this expansion.
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In mid-2014, I received an email from Dina Kamowa, a previous student in the Clinical Pharmacy Program at the University of Queensland (UQ), regarding an opportunity to undertake two teaching assignments of up to 5 weeks duration with the Pharmacy Department at the College Of Medicine (CoM), University of Malawi, in January 2015 and 2016. Funding was provided by a German non-government organisation (GIZ – refer https://www.giz.de/en/worldwide/germany.html), to support the clinical teaching. After completing the Masters in Clinical Pharmacy in 2012, Dina Kamowa was given the responsibility to integrate a clinical pharmacy course into the pharmacy curriculum at the CoM, and to organise clinical placements for students at the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. It was with great pleasure that I accepted this offer with the support of the School of Pharmacy at UQ. The results expected for the initial teaching assignment in my contract provided me with daunting challenges. Staff and students of the Pharmacy Department at CoM, and staff and interns of the hospital pharmacy at QECH, were to be trained in the provision of clinical pharmacy services. Procedures for the future provision of clinical pharmacy services at QECH and for the teaching of pharmacy students and staff in the practice of clinical pharmacy were to be established. A further expectation was that the project would contribute to an improvement in efficacy and safety of pharmacotherapy at QECH, and a reduction in costs of pharmacotherapy by promoting rational drug use. Historically, pharmacy at QECH has been run by technicians and has been centred on procurement and supply of medicines and sundries. The pharmacy staff did not venture beyond the walls of the pharmacy. Nurses were solely responsible for ordering, storage and administration of medicines and sundries in the wards. Despite having qualified pharmacists at QECH since 2010, the service delivery remained unchanged. My first task on arrival was to visit the pharmacy department at QECH to find relevant cases to discuss in class. Visiting the wards was an eye-opening experience: they were full of young people with human immunodeficiency virus, tuberculosis, malaria and sepsis. Many error-prone, unsafe, inefficient and wasteful medication and sundry management practices were identified during my ward visits with students and interns. Problems included a lack of expiry dates on products, many different strengths and brands of tablets mixed together, no stock rotation, poor labelling, issues with storage and administration of medicines, and the presence of excess stock. Theft was also rife and stock outs were all too frequent. Toward the end of my initial teaching assignment, the findings were shared with the key stakeholders, who were all supportive of strategies to improve medicine management as a critical first step in the development of clinical pharmacy services at QECH. At this time, I was faced with a dilemma: return to Australia until my next teaching assignment a year later, or should I at least try to support initiatives for improvement in the interim? What chance of success would there be once I returned to Australia? Following my visit, a proposal was submitted to GIZ and approved. The project was titled ‘A multidisciplinary approach to quality improvement in medication and sundry management at Queen Elizabeth Central Hospital - a pilot study’. This involved the introduction of a ward pharmacy service and an imprest system for stock management in two pilot wards at QECH. Baseline data were collected to determine stock holdings and the utilisation of medicines and sundries. Ward A kept a total of 98 medicines, of which 34% were in date, 15% were out of date and 51% had no expiry date. Ward B kept 70 medicines, of which 12% were out of date and 42% had no expiry date. Progress was slow and by the time of my second teaching assignment the project had not been implemented. The project was launched and partially implemented during the second teaching assignment in January 2016 in conjunction with a weekend Medication Safety Workshop. Excess stock was removed from the pilot wards, all medicines had expiry dates stipulated and a ward pharmacy and imprest system was introduced. The ongoing implementation and evaluation of the project proved challenging. The planned evaluation of the project and final report to GIZ due in July 2016 have not been forthcoming. Despite ongoing requests for updates, it is uncertain whether the strategies introduced in January 2016 have been sustained. While the project had not gone to plan, barriers to progress can be complex and the evolution of pharmacy practice takes time. I subsequently developed an online module on Medication Management and Safety, also funded by GIZ, which continues to raise awareness of the issues of medication safety in Malawi. I am very grateful to GIZ, Dina Kamowa, the staff and students at CoM, the pharmacists at QECH and the School of Pharmacy at UQ for the opportunity to contribute to the development of clinical pharmacy in Malawi. Despite the challenges, the teaching assignments were a rewarding and humbling experience.
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looking after residents in these settings have a significant degree of influence on the use of these medicines for BPSD (1).Therefore, it is imperative to understand how staff within this sector view the risks and benefits of using antipsychotics for BPSD, for example through theory-based attitude questionnaires.The aim was to develop, validate, and pilot a theory-based tool to measure care-staff views about the use of antipsychotics in dementia.Method: An 81-item questionnaire, the Antipsychotics in Dementia Attitude Questionnaire (ADAQ-v1), was constructed based on the Theory of Planned Behaviour (2) by modifying an existing, but incomplete Dutch questionnaire (3).Eleven staff in two UK care homes were recruited for content validity with the resultant second version (ADAQ-v2) pilot tested with a further 18 care-home staff to generate the finalised version (ADAQ-vf).The content validity index (CVI) was calculated for each item of ADAQ-v1 (4).Principal Component Analysis (PCA) and Cronbach's alpha were used to determine the validity and reliability of ADAQ-v2.The study received approval from the University's Ethics Committee (UREC 19/38).Main outcome measures: To develop and determine the psychometric properties of the ADAQ questionnaire.Results: A total of 21 from 81 items of ADAQ-v1 had an item CVI (I-CVI) \0.78 and were deleted, based on feedback 12 items were reworded and reduced to 5 items and 6 questions added leaving ADAQ-v2 with 59 items.The PCA for ADAQ-v2 showed 47 items with a factor loading C0.5 and KMO [0.5, with the remaining nine items deleted and retained 3 demographic questions.Cronbach's alpha showed high internal consistency (a = C0.6)within the 47 items.Thus, the finalised draft ADAQ-vf contained 50 items including 3 demographic questions.Conclusion: A validated and theory-oriented tool was developed to measure staff attitudes towards the use of antipsychotics in residents with BPSD.The questionnaire can be used by health and social care professionals to gauge the views of staff caring for residents with dementia in care homes.
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Clinical pharmacy as an emerging subject is a major development of hospital pharmacy services.Japan is a developed country,of which the pharmacy education developed rapidly.Japan has accumulated rich experience in the field of clinical pharmacy education.Based on analysis of social demand for clinical pharmacy professionals,we summary the features of Japanese clinical pharmacy training objectives,training model and curriculum,with expectations of being helpful for clinical pharmacy education and training reform in China.
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Objective: To understand the clinical pharmacists' views and suggestions on clinical pharmacy education.Methods: Questionnaires were posted to survey the status of clinical pharmacy in Guangdong,the views and suggestions of clinical pharmacists to clinical pharmacy education,and the results were statistically analyzed.Results: 42 hospitals answered our survey and clinical pharmacy was carried out in their hospitals.They agreed that the original model of partial chemical pharmacy education should be changed,the proportion of biomedical and clinical pharmacy courses ought to be increased and the time for pharmacy practice have to be extended.Conclusion: Clinical pharmacy education should be reformed to train clinical pharmacy professionals who can meet the clinical needs.
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