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pharmacy is growing in popularity, and the University of
Chile offers a training program for pharmacists to become
Specialists in Clinical Pharmacy and Pharmaceutical Care
that is more patient and health-team focused and different
from the academically focused Master in Pharmaceutical
Science or Doctorate in Pharmacology.
PHARMACIST COMPETENCY
Statements have been developed to define the basic
competencies of pharmacists in a number of individual
countries and also by the International Pharmaceutical
Federation (28). In Chile, the results of the Pan American
Conference on Pharmaceutical Education proposal for
basic education and pharmacist competencies include
statements that apply to clinical pharmacists- specifi-
cally to document patient information and manage phar-
macotherapy and follow-up (29). Clinical pharmacist or
advanced and specialist practice competencies have also
been described and summarized (30). While the United
States has not compiled a single list of competencies for
practitioners, a statement describes a general framework
and there are training criteria for hospital pharmacists
completing residency training that form the foundation for
the knowledge and skills expected of a specialist practi-
tioner (31, 32). In the United Kingdom, the National Health
Service has competency statements for pharmacists and
also for specialized practitioners (33). This advanced to
consultant level framework (ACLF) defines level of advanced
practice (foundation, excellence, and mastery/consultant)
and the competencies required to practice at each level.
(34) Critical car e pharmacists have developed a peer eval-
uation process and career advancement program that
has resulted in the credentialing of a growing number of
practitioners (35). Candidates submit a
vida voce
and prac-
tice portfolio to provide evidence of their practice model
based on the ACLF competencies. Supporting references,
interviews, case-based discussions and peer reviews were
included in this rigorous process that serves as a model for
other specialty practices.
Health systems in many other countries have similarly
developed pharmacist competency statements.
WHAT I DO AS A CLINICAL PHARMACIST
As a critical care pharmacy specialist, it is difficult to
describe a typical day, but in general, I am occupied with
the elements of the pharmacist process of care throughout
my day. I consider myself to be responsible for all aspects of
medication management. Each day, I evaluate and assess
new patients, and update the progress of prior patients,
identify medication related problems and potential problems,
develop a problem list and plan of care for optimal dosing based
on renal and hepatic function, potential drug interactions, and
serum concentrations. I join multiprofessional rounds with
the critical care team and ensure implementation of the
medication plan by coaching medical residents in proper
order entry or by entering orders myself under a collabo-
rative practice agreement and document in the electronic
medical record (EMR). A large contribution to medication
management is to identify therapies that are no longer
needed, thus reducing cost and risk of adverse events
and maintaining antimicrobial stewardship programs in
conjunction with our infectious disease physicians and
pharmacist. I also monitor for achievement of quality
measures such as ensuring proper venous thromboembo-
lism prevention, appropriate use of stress gastritis preven-
tion medications, addition of aspirin for troponin elevations
related to coronary ischemia, and also by discussing need
for central lines and urinary catheters. I educate the team
on medication related issues and applicable literature on
rounds and in didactic discussions. I am always available
for emergency response and resuscitations and to answer
mediation-related questions.
For each new patient, a member of the pharmacy team will
compile a medication history from electronic records, from
the family, the patient, community physicians or pharma-
cies and document that in the EMR. I will then reconcile that
list to determine medication-related causes of admission
such as nonadherence or overdose and provide advice on
which medications to order to avoid withdrawal reactions
or other adverse events. While I have a more limited role in
verifying medication orders within the EMR and almost no
role in actual drug product dispensing, I serve as a liaison
with the technicians and pharmacists who are specialists
in parenteral products and distribution systems to ensure
that medications are present when needed. Nurses have the
enormous task of administering medications, and I facilitate
that process by assisting with intravenous compatibility
information and education on unfamiliar therapies.
Other aspects of my role include developing quality assess-
ment tools and evaluating data. The EMR is made more
efficient by proper design of ordering systems that are
efficient and facilitate achievement of quality measures
and selection of preferred therapies. I have significant
input into these ordering systems in the area of medication
therapy and monitoring. I also report adverse drug events.
Many adverse events or incidents are related to system-
level problems and I regularly advise on potential process
improvements in intravenous pumps programming, medi-
cation safety systems or other processes.
[CLINICAL PHARMACISTS: PRACTITIONERS WHO ARE ESSENTIAL MEMBERS OF YOUR CLINICAL CARE TEAM - Judith Jacobi, PharmD]