10. The elements of pharmaceutical care for individual patients, taken together, describe comprehensive pharmaceutical care, the delivery of which requires an ongoing, covenantal relationship between the pharmacist and the patient. The pharmacist must use his clinical judgement to determine the level of pharmaceutical care that is needed for each patient. Examples of situations which call for comprehensive pharmaceutical care include:

- Patients who are particularly vulnerable to adverse effects because they are physiologically compromised (e.g. infants; the elderly; those with kidney, liver or respiratory failure)

- Patients with medical conditions that require ongoing evaluation and manipulation of drug therapy to achieve optimal results (e.g. diabetes mellitus; asthma; hypertension; congestive heart failure).

- Patients who are taking multiple medication thereby placing them at higher risk for complex drug-drug or drug-disease interactions and for drug-food interactions.

- Patients requiring therapy with drugs that can be extremely toxic, especially if they are dosed, administered or used improperly (e.g. cancer chemotherapeutic agents, anticoagulants, parenteral narcotics.

- Patients whose acute illnesses can become life threatening if the prescribed medications are ineffective or used improperly (e.g. certain infections, severe diarrhoea).

Pharmaceutical Care For Individual Patients

11. The following are the various actions that comprise the application of pharmaceutical care to individuals. If undertaken, in whole or in part, they will result in added value to drug therapy by making a positive contribution to the safe and cost effective use of drugs, leading to positive outcomes and improved health care.

- Obtain and maintain medication records and relevant health information, if they do not already exist. This information is essential to assess individualized drug therapy.

- Identify, evaluate and assess:

(i) drug related problems (side effects; drug interactions; improper drug use);
(ii) symptoms described by patients;
(iii) self-diagnosed conditions;

and decide whether pharmacist action is appropriate or collaboration with other health professionals is needed.

- Initiate or modify drug/non drug therapies by:

(i) independent action (drugs that can be provided by pharmacists without a prescription; non drug therapies, e.g. life style changes, medical devices); and

(ii) collaborative action (always for medically prescribed drugs).

- Prepare and supply medication for use (including selection of drug products, prescription assessment, dispensing, compounding, packaging, labelling)

- With prescriber and/or patient, as the case may be. - set goals of therapy

- Design and implement pharmaceutical care plan (education, counselling)

- Monitor for therapeutic outcomes and take appropriate follow up actions (begin the pharmaceutical care cycle again)

Pharmaceutical Care For The Community

12. Pharmacists individually and as a profession have important roles to play in positively influencing drug policy, drug use and outcomes as well as other aspects of health care. In many instances this will be through collaboration with other health professionals at a community level.

(a) Participate in the formulation of drug policy including drug regulation

(b) Develop guidelines and criteria for formularies

(c) Collaborate with other health care professionals to develop treatment guidelines

(d) Design and monitor procurement and drug distribution systems, including storage and disposal (e.g. country wide, local, institutional)

(e) Formulate and manufacture quality medications within pharmacy practice

(f) Serve as a source of objective drug information: establish poison and drug information systems, e.g. poison and drug information centres

(g) Initiate and undertake research in e.g. pharmacotherapeutics including clinical trials; pharmacoepidemiology; pharmacy practice; health economics; and evaluate and document the results of such research in order to improve all aspects of pharmaceutical care.

(h) Educate all health professionals who participate in pharmaceutical care

(i) Develop, evaluate and document pharmaceutical care practices

(j) Participate in health screening (e.g. diabetes, cholesterol)

(k) Participate in health promotion and education (e.g. the proper use of medication; smoking cessation; immunization; prevention of drug abuse; hygiene; family planning; AIDS prevention)

(l) Develop professional standards and audit procedures

(m) Establish and maintain an appropriately qualified pharmacy workforce.