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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]