News of medicine and pharmacy
Pharmacy information systems manage medical information, svyazannoy medication and use of drugs for the treatment of patients. Due to the nature of the tasks and requirements to pharmaceutical information, pharmacy was one of the first among the health services who find themselves in significant gains from the development of medical Informatics and applications of computers in health care. Today computerized information systems are part of the fabric of pharmacy, in hospitals, and in a city network. In this Chapter, we review the basics of pharmacy, will discuss how the principles of medical Informatics impact on the functions of pharmacies and consider the possible development of a computerized pharmacy information systems in the future.
For many years the pharmaceutical industry was considered as profession-oriented products associated with collecting, extraction and preparation of medicinal ingredients in order to create the final dosage form suitable for administration to the patient. A gradual transfer of function of preparation of drugs for pharmaceutical companies has changed the role of the pharmacist; modern pharmaceutical practice includes the functions are oriented towards the patient and on the dispensing of medicines, and can be characterized as the management of the use of drugs. Management of a drug defined as “a conglomerate of knowledge, assessments, judgments, procedures, skills, controls and ethics to ensure optimal safety and efficacy the prescription and use of drugs” .
Ideally, the management of the use of drugs implies the observation of the therapeutic substance from the moment of its appearance in the health care system until its removal from the body of the patient, or destruction. The process of medication can be divided into the following stages (see also Fig. 10.1.
1. Diagnosis: identify the patient’s disease.
2. The study drug-patient history: a clarification of previous drug appointments the patient’s drug allergies and adverse reactions.
3. The purpose of the drug: definition of drug therapy, can cure the patient’s disease and not in contradiction with his drug history.
4. Product selection: selecting a particular medical product that satisfies the purpose.
5. Holiday: holiday of the medical product.
6. Consultation: providing the patient information on the correct use of medicines risk from the use and possible side effects.
7. Reception: the reception of drugs by the patient.
8. Observation. observation of the patient taking the drugs, with the aim of establishing the effectiveness of drug therapy and to identify signs of adverse reactions.
In addition, the pharmacy staff consults with other health professionals on the use of drugs. These consultations build on the achievements of pharmacology – the science of the properties, use and effects of drugs. Please note that pharmacists, doctors, other health professionals and patients interact at all stages of the process of medication and strive to ensure that drug therapy is beneficial, and not harmful to the health of patients. Pharmacy business includes a large number of functions related to the treatment and performed in a variety of conditions. We can distinguish the following four types of pharmaceutical activity: hospital pharmacy, ambulatory (community) pharmacy, pharmacotherapy and pharmaceutical services information.
Fig. 10.1. After the doctor put the patient the diagnosis, pharmacists, nurses and patients involved in other steps of the process of medication starting from selection of appropriate drugs before their admission, and status monitoring of patients. 10.1.1. Hospital pharmacy.
A large part of the interaction of physicians with pharmaceutical services takes place in hospitals. The main task of hospital pharmacies is to dispense products by destinations (recipes) doctors. This role of the holiday can be characterized by the words “to give the right medicine to the right patient at the right time”. On receiving the prescription the pharmacist [Because of differences in the distribution of responsibilities among pharmacy workers in Russia and the United States some of the functions that the original assigned farmacevt, in Russia performed by pharmacists.- Approx. transl.] checks the correctness of filling, and evaluates it in the context of available information on the current drug therapy of the patient. A significant component of this work is the analysis of the previous medicinal appointments and clinical information to identify potential interactions between medications and food allergies and other sensitivities to medications that can have a negative impact on the patient. If the pharmacist finds a problem, he consults with the treating physicians of the patient to develop the most appropriate course of action. Once the recipe is approved, the medicine that satisfy the requirements for treatment of the patient and not in conflict with the state of his body, or it is selected in the warehouse (e.g. tablets, capsules, etc.) or manufactured (for example as a solution for intravenous infusion). The recipe, as the drug was released, recorded in the leaf of the medicinal prescriptions of the patient, and the medication is sent to the nurse for administration to the patient.
There are two different approaches to the implementation of the function of dispensing drugs. Under the old approach, still practised in many hospitals, pharmacy releases multiple doses of the medication to the patient. The medication is sent in the labeled container in nurse’s station in the amount required for the full course of treatment of the patient. This conventional method minimizes the amount of registration of dispensing drugs in a pharmacy, but has several potential problems, including the lack of demand of the medication, wrong medication, and illegal leakage of drugs.
When you vacation as a single dose the drug is packaged, labeled and released for the post of nurses in a quantity equal to one dose – one tablet or one dose of injection. A pharmacy sends to every nurse truck, which is many doses of the cure as it is required for a given period – usually one day (Fig. 10.2). This approach significantly reduced the uselessness of the drug and provides better control over the medical treatment of the patient, as the prescription can be cancelled immediately. On the other hand, increased registration of dispensing drugs; the drug sheet assignment of the patient should be reviewed and updated whenever you release a new dose of medication. However, if you have a computerized system for handling sheets of medicinal appointments and print labels on the bags with doses, amount of extra work decreases and more than kompensiruet benefits.
The function of dispensing drugs and in connection with this function of hospital pharmacy performs many other works. She is responsible for the purchase of medicines, the provision of information for inclusion in the account to pay for the treatment, and also conducts certain types of registration that are required by the applicable legal acts. Hospital pharmacy together with a pharmaceutical and therapeutic Committee develops the forms of medicines – the documents that specify which drugs should be stored in the pharmacy stock and what are the restrictions on the use of these drugs.
Finally, the hospital pharmacy can provide a range of specialist services to doctors and patients. For example, she often gathers and evaluates published information about drugs and distributes this information within the framework of the program of improvement of qualification or upon request. The hospital pharmacy can also perform more complex functions related to drug therapy, for example to the computation of optimal doses of medication for particular patients or to consult physicians regarding the validity of the therapeutic decisions.
10.1.2. Utilities (outpatient) pharmacies.
Outpatient pharmacy performs basically the same function. and hospital pharmacy, but in a more open and complex environment in which she had much less control over the process of application of the drugs (Fig.10.3). Outpatients, in contrast to the hospitalized, unable to choose which pharmacy they go to. The patient can be treated in different occasions, by several doctors, each might not be aware of what medications prescribed by other doctors. Further, patients can receive long courses of drug therapy aimed at treatment of chronic diseases. In the hospital the number of patients is relatively small and limited to the number of beds (95% of hospitals has 500 beds). In contrast, the outpatient pharmacy can provide medication to 3000-5000 patients simultaneously.
The main objective of the outpatient pharmacies, and hospital, is a holiday of drugs according to recipes of doctors. By submitting this function, the pharmacist conducts a professional assessment of the assigned drug therapy in relation to the contraindications and drug interactions. Most outpatient pharmacies currently leads the accounting sheets of the medicinal appointments for your regular clients. In addition, pharmacists outpatient pharmacies serve to educate clientele and give her advice. They are among the most accessible health professionals, are the customers more trust and thus are in an ideal position to distribute to patients information on the potential side effects of medications and drug interactions. Often they call with General questions of a medical nature, and thus they are for patients as a gateway to the healthcare system.