The Roles and Responsibilities of Clinical Pharmacists in Hospital Settings

Clinical pharmacists (CPs) play a crucial role in hospital settings by providing patient-centered care and improving medication outcomes. CPs use various tools such as medication reviews, medicine reconciliation, patient counseling, and drug monitoring to identify and resolve drug-related problems. CPs are also involved in the implementation of evidence-based guidelines and standards to improve the quality of care and patient outcomes. These competencies required by CP in hospital settings include knowledge of all pharmaceutical sciences. They must also have excellent communication skills, be able to work as part of a multidisciplinary team, and possess the ability to critically evaluate and apply research findings. CPs assess the effectiveness of interventions with quality of life, health-related quality of life, medication adherence, clinical outcome, drug utilization, readmission rate, qualityadjusted life year, cost-effectiveness, hospital length of stay, patient satisfaction, and incidence of adverse drug events. In conclusion, the role of CP in hospital settings is essential for improving patient outcomes and ensuring safe and effective medication use. They play a critical role in the healthcare team by providing pharmaceutical care, utilizing evidence-based practices, and advocating for patients. CPs are well-positioned to make a significant impact on the quality of care and patient outcomes in hospital settings.

Internal medicine wards play a crucial role in providing healthcare services to a substantial number of patients. These wards primarily handle chronic or multiple diseases, making pharmacotherapy a fundamental approach for the majority of patients. The significance of clinical pharmacy services becomes particularly evident in these settings due to various factors, such as the coexistence of multiple diseases, advanced age, severe illnesses, or polypharmacy, all of which emphasize the importance of rational drug use. In patient populations with complex treatment regimens, especially those with specific healthcare needs, the likelihood of encountering drug-related problems increases, posing challenges to healthcare professionals in achieving desirable health outcomes. To address these challenges, clinical pharmacists (CPs) offer a range of essential services within the internal medicine ward. These services encompass pharmaceutical care, medication management, comprehensive medication review, medication reconciliation, patient education, and counseling, all aimed at improving treatment outcomes for patients admitted to the ward. The value and effectiveness of these services have been extensively discussed in the academic literature and validated through numerous clinical studies. Clinical pharmacists working in the internal medicine service are expected to demonstrate strong competence in managing various conditions, including diabetes, cardiovascular diseases, renal failure, liver failure, gastrointestinal diseases, chest diseases, and hematological diseases. In addition to their clinical expertise, CPs have a critical responsibility to ensure the rational use of medications and effectively apply their extensive knowledge of drugs in the clinical setting. By integrating these services into the daily healthcare routine and strengthening the role of the clinical pharmacist within the healthcare team, the overall effectiveness of patient treatment can be significantly enhanced.

Irrational use of antimicrobial agents has led to the emergence of antimicrobial resistance. The Infectious Diseases Society of America and The Centers for Disease Control and Prevention recommend that a clinical pharmacist with infectious diseases training should participate in the antimicrobial stewardship teams. Several authors stated that antimicrobial stewardship effectively reduces inappropriate antimicrobial use, cost, and hospital stays. Prospective audits and feedback can reduce the inappropriate use of antimicrobials. Clinical pharmacists may help orient the healthcare team on selecting appropriate antimicrobial agents, administration routes, dosing, treatment discontinuation, monitoring for toxicities, and therapeutical drug monitoring. Clinical pharmacists are important members of antimicrobial stewardship in the inpatient and outpatient settings. Antimicrobial stewardship pharmacists should have a role that includes designing and implementing antimicrobial stewardship interventions, measuring outcomes and relevant data, and management strategies. The participation of pharmacists in antimicrobial stewardship programs may increase compliance with guideline recommendations of antimicrobial therapies and improve adherence and response to treatment. Clinical pharmacist recommendations can also help prevent medication errors, such as missing or incorrect medications, inappropriate dosing, drug-drug interactions, or inadequate renal and hepatic function adjustment. This book chapter highlights the roles of an infectious disease-trained clinical pharmacist in the infectious diseases ward.

Intensive care units (ICUs) have a highly complex structure in terms of both diseases and medications used in treatment. Therefore, the management of ICU patients is possible with a multidisciplinary team. With their evolving skills and roles, clinical pharmacists have become indispensable parts of the ICU team. This section reviews ICU-specific issues such as the control of delirium, sedation, pain, stress ulcer prophylaxis, venous thromboembolism prophylaxis, sepsis, septic shock, prevention of drug-related problems (DRPs), healthcare-associated infections, and literature on the roles of clinical pharmacists. The studies carried out in the ICU are mainly within the scope of medication cost savings, DRPs, medication management, and compliance with the guidelines on various issues. In conclusion, it has been emphasized that including clinical pharmacists in the ICU team has improved many issues affecting DRPs, treatment costs, and patient health outcomes.

Effective medication therapy management is essential in addressing pediatric pharmacotherapy's unique challenges, as pediatric patients are distinct from adults in terms of physiological and pharmacological characteristics. This management requires a multidisciplinary team to provide optimal care, with clinical pharmacists specializing in pediatrics playing a role in ensuring safe and effective medication use in this patient population. This chapter reviews clinical pharmacists' roles and responsibilities in these settings, including participation in interdisciplinary rounds, medication reconciliation and review, and patient counseling. In addition, this chapter investigates the essential knowledge required to fulfill the roles and responsibilities of clinical pharmacists in pediatric care settings, which include a basic understanding of common pediatric diseases and medications, clinical guidelines, tools used to provide clinical pharmacy services, identification and prevention of drug-related problems, and clinical competencies. Additionally, this chapter discusses the current evidence on the impact of clinical pharmacy services on outcomes such as medication errors, adverse drug events, and treatment efficacy in pediatric disease wards and the literature on the roles of clinical pharmacists in pediatric wards. Overall, this chapter emphasizes the critical importance of integrating clinical pharmacists as essential healthcare team members in pediatric disease wards to enhance the quality of care and improve patient outcomes.

The provision of healthcare to cardiology patients requires a multidisciplinary team, including a clinical pharmacist as a member, to ensure optimal medication management. In this chapter, the benefits and challenges of the presence of a clinical pharmacist as a team member in cardiology care are briefly presented from a general perspective. In addition, medication management and input of clinical pharmacists in the most common cardiovascular conditions (i.e., acute coronary syndrome, hypertension, pulmonary hypertension, heart failure, atrial fibrillation) are reviewed. The most prominent outcomes of the clinical pharmacists’ interventions are reduced drug-related problems, increased medication adherence, improved healthcare outcomes such as reduced blood pressure levels, and prevention of hospital readmissions. Also, leading cardiology guidelines as means of evidence-based pharmaceutical care are listed. Overall, this chapter aims to emphasize the importance of incorporating clinical pharmacists in cardiology healthcare teams to provide comprehensive care for patients.

Nutrition, as a fundamental process for sustaining health, is of paramount importance, particularly for individuals grappling with critical illnesses. The effective management of nutrition involves a collaborative effort from a diverse group of healthcare professionals, including doctors, dietitians, and clinical pharmacists, among others. Among these professionals, clinical pharmacists play a significant role in delivering nutrition and enhancing potential health outcomes within the healthcare team. In the pursuit of comprehensive patient care, clinical pharmacists are actively engaged in providing essential macro and micronutrients while diligently addressing any issues arising from nutritional products and medication usage in critically ill patients. Moreover, optimizing drug regimens for patients requiring parenteral or enteral nutrition yields substantial benefits for their overall survival. The administration of medications to individuals in need of Total Parenteral Nutrition (TPN) and Enteral Nutrition (EN) necessitates keen attention and skill. As leaders in drug administration processes for patients receiving nutritional support, clinical pharmacists assume a pivotal role, particularly in the administration of medications through enteral feeding tubes. This active involvement significantly contributes to the achievement of desired health outcomes, enhancing patient well-being and recovery. Given the indispensable contributions of clinical pharmacists, their inclusion within the multidisciplinary healthcare team is of paramount importance. By drawing upon their specialized pharmaceutical and clinical knowledge, clinical pharmacists are instrumental in the successful implementation of enteral and parenteral nutrition applications. Embracing this collaborative approach not only strengthens the efficacy of nutrition interventions but also augments the overall quality of patient care.

Cancer treatment includes various medications and therapies, both alone or in combination, such as surgery, radiotherapy, chemotherapy, hormone therapy and immunotherapy. During chemotherapy with different cytotoxic effects, the use of supportive medications (such as antiemetic, antidiarrheal medicines, and granulocyte colony-stimulating factors) can lead to polypharmacy. For this reason, it is necessary to provide clinical pharmacy services to prevent and solve drug-related problems (DRPs). On the other hand, since most cancer drugs are in the “hazardous drug” class, pharmacists have important duties in the preparation, administration, storage and disposal of wastes. In the mid-20th century, in line with these requirements in the field of oncology, pharmacists started visiting oncology clinics, new courses were added, and oncology pharmacy specialization emerged. In this section, we will discuss the role of the clinical pharmacist in the oncology clinic, as well as examine the steps of pharmaceutical care for the cancer patient.