Paradigm Publishing Inc 1 The Profession of Pharmacy

© Paradigm Publishing, Inc.

1 The Profession of Pharmacy © Paradigm Publishing, Inc.

Chapter Topics Origins of pharmacy practice The pharmacy workplace of today Evolution of the pharmacist’s role Roles and responsibilities of the pharmacist and pharmacy technician • Educational requirements of the pharmacist and pharmacy technician • • © Paradigm Publishing, Inc.

Learning Objectives • Describe the cultural origins of pharmacy and their impact on the profession. • Discuss the four stages of development of the pharmacy profession in the twentieth century. • Differentiate the major roles and responsibilities of the pharmacist and pharmacy technician. • Understand the educational and licensing requirements of the pharmacist and pharmacy technician. • Differentiate among various pharmacy workplace environments. © Paradigm Publishing, Inc.

Origins of Pharmacy Early Civilizations • Sickness was thought to be a curse. • Medicinal preparations were combined with magic, chants, and rituals. • Preparations were made from plants, animals, and minerals. • Clay tablets more than 5, 000 years old found in Mesopotamia listed medicinal preparations. – These provided the basis for the modern-day formulary. © Paradigm Publishing, Inc.

Origins of Pharmacy (continued) Traditional Eastern medicine • Relies on plant products and healing modalities. Some are used in Western culture today (such as ginseng). Hippocrates • This Greek physician thought that disease had a physical explanation. • Pharmacy is derived from Greek word pharmakon, meaning drug or remedy. • He is the Father of Modern Medicine. Galen • This Greek physician studied the effect of herbs on the body. • Galenical pharmacy is the practice of creating medicinal extracts from plants. • He is the Father of Modern Pharmacy. © Paradigm Publishing, Inc.

Origins of Pharmacy (continued) • Early Arabic civilizations identified pharmacists as qualified healthcare professionals. • In eleventh and twelfth century Europe, apothecaries and professional guilds were developed. – They oversaw chemist and pharmacist apprenticeships. – They led to universities and professional organizations and, later, state boards. • During the Renaissance, alchemy was on the rise, scientific thinking was on the decline. • During seventeenth century’s Scientific Revolution, many new scientific terms developed with Greek and Latin roots. © Paradigm Publishing, Inc.

Origins of Pharmacy (continued) • During the 1800 s, pharmacists were more recognized as healthcare providers; physicians still operated most apothecaries. • Major cities in Europe had their own drug lists or pharmacopeia. • Martindale: The Extra Pharmacopoeia is still a useful reference today. • Native Americans combined herbal medicine with chants and prayers for healing. © Paradigm Publishing, Inc.

Origins of Pharmacy (continued) • In the ninteenth century, the medicine and pharmacy professions separated. • Pharmacists became the owners of apothecaries. • United States Pharmacopeia (USP), a formulary of drug standards, was developed in 1820. • American Pharmacists Association (APh. A) formed in 1852 to address adulteration of imported drugs. • Community pharmacy focused on compounding herbs and chemicals. • In early twentieth century, pharmaceutical manufacturing became dominant. • By the 1950 s, pharmacists compounded less, and pharmacy practice became more scientific. © Paradigm Publishing, Inc.

Modern-Day Pharmacy Practice • Many new drugs are developed annually to keep up with medical advances. • As the population ages, an increasing number of prescriptions are expected. • To meet increasing demands on pharmacists, more pharmacy schools are opening; technician roles are expanding. © Paradigm Publishing, Inc.

The Pharmacy Workplace Community Pharmacies Institutional Pharmacies Independent pharmacies Hospital pharmacies Long-term care facilities Chain pharmacies Home healthcare systems Franchise pharmacies Managed-care pharmacy services Mail-order pharmacies Nuclear pharmacies © Paradigm Publishing, Inc.

Community Pharmacies • Also called retail pharmacies • Employ the majority of pharmacists and pharmacy technicians • Operated by pharmacists who hold a BS or Pharm. D degree • Divided into a restricted prescription area and a front-end area © Paradigm Publishing, Inc.

Types of Community Pharmacies • Independent pharmacies – – A pharmacist (or a small group of pharmacists) owns the pharmacy. Decisions are made at the store level. More attention and time is spent on customer service. Most compounding is done in these, and some specialize in compounding. • Chain pharmacies – – – Corporations own and operate chain pharmacies. Decisions are made at the corporate level. They dispense large volumes. Technicians and automation are heavily used in chains. Examples include: Walgreens, CVS, Walmart, and Kroger. © Paradigm Publishing, Inc.

Types of Community Pharmacies (continued) • Franchise pharmacies – One pharmacist owns a franchise. – Sometimes they are called apothecaries, which sell only medication and health-related products. – More personalized health care is provided here. – An example is Medicine Shoppe International. • Mail-order pharmacies – A centralized operation mails large volumes of prescriptions. – Patients have no direct contact with the pharmacy. – Examples include Medco and Express Scripts. © Paradigm Publishing, Inc.

Institutional Pharmacies • A pharmacy associated with any organized healthcare delivery system is called institutional. • Hospital pharmacies are the most common examples. • Institutional pharmacists will have a BS or Pharm. D degree. • Some pharmacists will have an MBA and some will have completed a postgraduate residency. • Technicians typically must be certified and have experience to work in institutional pharmacies. © Paradigm Publishing, Inc.

Types of Institutional Pharmacies • Hospital pharmacies – About 25% of pharmacists work in hospitals. – They prepare unit-dose systems, IV medications, and floor stock. – Many pharmacy technicians work in a “clean room. ” © Paradigm Publishing, Inc.

Types of Institutional Pharmacies (continued) • Long-term care facilities – Extended-care facility (ECF) or nursing home • Medical and residential care is provided to older or disabled adults. – Skilled-care facility (SCF) • Around-the-clock nursing care is provided. – Medications may come from either an in-house pharmacy or a community pharmacy. • Home healthcare systems – Patient care services are provided at patient’s home. – Hospice care is provided for patients who are terminally ill. © Paradigm Publishing, Inc.

Types of Institutional Pharmacies (continued) • Managed-care or HMO – Centralized outpatient clinics and some hospitals – Clinic pharmacies and off-site pharmacies – Minimal cash or insurance transactions • Nuclear pharmacy – Compounds and dispenses sterile radioactive pharmaceuticals © Paradigm Publishing, Inc.

In the Know: True or False • A community pharmacy is also called a retail pharmacy. true • Some independent pharmacies specialize in compounding. true • Decisions are made at the store level in a chain pharmacy. false • A hospital pharmacy mails large volumes of prescriptions. false © Paradigm Publishing, Inc.

Development of Pharmacy in the Twentieth Century Traditional Era Scientific Era Clinical Era Pharmaceutical Care Era © Paradigm Publishing, Inc.

Traditional Era • The traditional era extended into the 1920 s. • Pharmacists compounded more than 80% of prescriptions from natural sources. • Ingredients and doses were tailored to patients. • Pharmacists packaged, labeled, and dispensed medications. • Pharmacists-in-training served as apprentices rather than studying at universities. • Limited formal education focused on galenical pharmacy and pharmacognosy. © Paradigm Publishing, Inc.

Scientific Era • The pharmaceutical industry emerged in the 1950 s. – Many new drugs and dosage forms were developed. – Drugs were less expensive and better quality than what individual pharmacists could compound. • Pharmacists became merchants of factory-made products. • To keep up with scientific advances, pharmacy schools added pharmacology to their curriculum. • By 1960, a five-year BS degree was required to become a pharmacist. © Paradigm Publishing, Inc.

Clinical Era • The clinical era started in the mid-1960 s. • Pharmaceutics was added to pharmacy school curricula. • Training shifted too much toward basic science and too far away from pharmacy practice. • Pharmacists were not fully utilized, did routine tasks, and dispensed medications. – Until 1969, it was not considered ethical for a pharmacist to label medication vials with the drug name or counsel patients. © Paradigm Publishing, Inc.

Clinical Era (continued) • The Millis Commission report came out in 1975. – “Pharmacists for the Future” – Defined pharmacy as a knowledge-based profession – Emphasized the clinical role of pharmacists • The Millis Commission led to new emphasis on clinical or patient-oriented pharmacy. • Pharmacists became dispensers of drug information. © Paradigm Publishing, Inc.

Clinical Era (continued) • More colleges adopted a six-year Pharm. D degree program. • Pharmacy schools added pharmacokinetics, biochemistry, therapeutics, and pathophysiology to curricula. • Laboratories moved from the schools to more patientoriented practice settings. • Interdisciplinary experiences with physicians and residents became standard in pharmacy schools. © Paradigm Publishing, Inc.

Pharmaceutical Care Era • The pharmaceutical care era began in 1990. – Further development of the Millis Commission – Coined by Dr. Charles Hepler and Dr. Linda Strand – Expanded pharmacy to include ensuring positive outcomes for drug therapy • Patient-oriented focus in the hospital began to move to the community pharmacy and ambulatory clinics. • Patient counseling and medication monitoring became more accepted by physicians and consumers. © Paradigm Publishing, Inc.

Pharmaceutical Care Era (continued) • Medication therapy management (MTM) was integrated into pharmacy curriculum. – – – Recommending less costly medications Identifying potential drug-drug interactions Identifying potential adverse reactions Counseling patients on adherence to therapy MTM recognized by insurance companies providing reimbursement to pharmacists © Paradigm Publishing, Inc.

In the Know: Short Answer • In the traditional era, most prescriptions were _____ by the pharmacist. compounded • The Millis Commission led to an emphasis on what type of pharmacy practice? clinical • Medication therapy management (MTM) is a key component of _______. pharmaceutical care © Paradigm Publishing, Inc.

Pharmacist Responsibilities: Traditional vs. Current Roles The product-oriented practice focused on compounding. A patient-oriented practice focuses on counseling and monitoring. © Paradigm Publishing, Inc.

Roles and Responsibilities of the Pharmacist • Gathering information on medical, medication, and allergy histories • Reviewing medication doses and screening for duplicate therapies • Counseling patients • Screening patients for chronic diseases • Educating patients on self-management of diseases • Monitoring for drug interactions • Screening patients for minor illnesses © Paradigm Publishing, Inc.

Roles and Responsibilities of the Pharmacist (continued) • Assisting and supporting patients to quit smoking • Providing recommendations regarding OTC medications, vitamins, herbs, and supplements • Providing drug information to other healthcare professionals • Providing advice about home healthcare supplies and medical equipment • Monitoring drug response in chronic diseases • Monitoring the safe use of controlled substances • Vaccinating high-risk patients © Paradigm Publishing, Inc.

Site-Specific Pharmacist Responsibilities • Community pharmacy – Compounding both nonsterile and sterile medications – Packaging medications for nursing homes • Independent pharmacy – – – – Identifying unmet needs in the community; offering new services Hiring and supervising employees Evaluating insurance contracts Reconciling unpaid insurance claims Maintaining and ordering inventory Selling non–healthcare-related merchandise Managing the overall retail operation © Paradigm Publishing, Inc.

Site-Specific Pharmacist Responsibilities (continued) • Institutional pharmacy – Entering physician’s orders – Preparing medications and IVs – Providing drug information – Recommending drug formulary changes – Educating nurses – Developing policies and procedures – Dispensing investigational and hazardous drugs – Providing medications to hospital units © Paradigm Publishing, Inc.

Site-Specific Pharmacist Responsibilities (continued) • Clinical specialists in large teaching hospitals – Accompanying physicians on morning rounds – Providing advice on appropriate medication use – Monitoring patients for adverse effects or drug interactions – Educating patients on medications prior to discharge © Paradigm Publishing, Inc.

Site-Specific Pharmacist Responsibilities (continued) • Home healthcare – Preparing medications and IVs for home use • Consulting – Reviewing medical and medication records monthly • Managed-care – Working with primary-care physicians to help control chronic diseases – Educating patients, monitoring and adjusting medications © Paradigm Publishing, Inc.

Educational Requirements for Pharmacists Pharmacy school admission requirements • Two years of prepharmacy – Calculus, chemistry, physics, microbiology, and biology • Pharmacy College Admission Test (PCAT) • On-site interview • Prior pharmacy experience advisable © Paradigm Publishing, Inc.

Educational Requirements for Pharmacists (continued) Doctor of Pharmacy programs • Four year program • Challenging coursework • Practice experiences in community and hospital settings interspersed throughout curriculum • Fourth year spent in various practice settings © Paradigm Publishing, Inc.

Licensing Requirements for Pharmacists • • Graduating from an accredited college of pharmacy Passing a state board examination Serving an internship under a licensed pharmacist Continuing education required for renewal © Paradigm Publishing, Inc.

Traditional Pharmacy Technician Responsibilities • Answering the phone • Stocking the inventory • Operating the cash register © Paradigm Publishing, Inc.

Site-Specific Pharmacy Technician Responsibilities • Community Pharmacy – Greeting patients presenting or picking up prescriptions – Entering patient and prescription information into a computerized database – Assisting the pharmacist in filling, labeling, and recording prescriptions – Operating the pharmacy cash register – Stocking and inventorying prescription and OTC medications – Billing and resolving inventory claims © Paradigm Publishing, Inc.

Site-Specific Pharmacy Technician Responsibilities (continued) • Hospital – Preparing sterile and hazardous products – Delivering, stocking, and inventorying medications – Operating manual or computerized robotic dispensing machinery © Paradigm Publishing, Inc. Pharmacy technicians play a valuable role in reducing the risk of medication errors.

Site-Specific Pharmacy Technician Responsibilities (continued) • Long-term care – Repackaging drugs in unit dose carts labeled for each patient – Delivering medications to the nursing home – Conducting inspections of medications on nursing stations © Paradigm Publishing, Inc. Rather than work independently, the pharmacy technician works under the direction of the supervising pharmacist.

In the Know: True or False • A pharmacy technician may enter allergy information into the computer database. true • A pharmacy technician may counsel patients on over the counter medications. false • A pharmacy technician may override drug interaction alerts when entering prescriptions. false © Paradigm Publishing, Inc.

Roles and Responsibilities Compared Pharmacy Technician Pharmacist • Assumes routine functions that used to be performed by pharmacists • Gives work completed to the pharmacist for final check • Is held accountable to the pharmacist for the accuracy of medications dispensed • Does more patient-care activities, less dispensing activities • Oversees the technician’s work and provides the final check • Is ultimately accountable for the accuracy of medications dispensed © Paradigm Publishing, Inc.

Educational Requirements for Pharmacy Technicians • Technician training programs – Programs strive to prepare students for the certification exam. – Many are hospital based, some are offered in community colleges and technical schools. – Topics include medical terminology, pharmacology, dispensing procedures, sterile compounding, aseptic technique, pharmacy laws and regulations, pharmacy calculations, and communications. © Paradigm Publishing, Inc.

Educational Requirements for Pharmacy Technicians (continued) • Pharmacy Technician Certification Exam – The Pharmacy Technician Certification Board (PTCB) offers this exam. – Many employers require that technicians be certified initially or within a certain time period after hiring. © Paradigm Publishing, Inc.

Specialized Training Programs for Pharmacy Technicians • Sterile compounding – Program from Accreditation Council for Pharmacy Education (ACPE) • Nonsterile compounding – Program from the Professional Compounding Centers of America (PCCA) • Nuclear pharmacy technician (NPT) – Online self-study plus on-the-job training © Paradigm Publishing, Inc.

State Board Requirements for Pharmacy Technicians • Requirements vary among the states • Licensing or registration requirements – High school diploma or GED – Criminal background check – Completion of a formal training program • Certification requirements – Successful completion of approved pharmacy technician exam – Attend continuing education programs to maintain certification © Paradigm Publishing, Inc.

Summary • The profession of pharmacy has evolved from preparing natural medications to dispensing synthetic medications. • The primary mission of pharmacy is to safeguard the public and help patients achieve favorable medication outcomes. • Pharmacists are highly educated, licensed professionals. • Pharmacists dispense medications, information, and counseling to patients. • Pharmacists provide drug information to healthcare professionals. • Pharmacy technicians are paraprofessionals who work under the direct supervision of pharmacists. • Formal training programs and certification are becoming more important for pharmacy technicians. • There is a great demand for pharmacists and pharmacy technicians. © Paradigm Publishing, Inc.