Pharmacists are integral part of healthcare system. Duties and Importance of pharmacist is less understood but role of pharmacist is indispensable from discovery to rational use of drugs. Pharmacist role is not acknowledged by some governments and policy makers and this lead to commonplace irrational use of drugs; both through prescription and self medication.
We are providing role and responsibilities of pharmacists as per pharmacy regulations and drugs laws in India. If strictly implemented these can improve patient well-being and treatment outcomes to a great degree.
Pharmacist Role In Dispensing and Hospital Pharmacy
Pharmacy Practice Regulations
Let us see role of pharmacist in pharmacy practice as per pharmacy practice regulations 2015.
As per pharmacy Practice Regulation Chapter 3 Pharmaceutical care include
A Registered Pharmacist shall review the patient record and each prescription presented for supply for the purpose of promoting therapeutic appropriateness by indentifying :
(i) Over utilization or under utilization
(ii) Therapeutic duplication
(iii) Drug-disease interactions
(iv) Drug-drug interactions
(v) Incorrect drug dosage or duration of drug treatment
(vi) Drug-allergy interactions
(vii) Correlation of availability of drugs (to avoid artificial shortage of drugs)
(viii) Clinical abuse/misuse
Note : upon recognizing any of the above, the Registered Pharmacist shall take appropriate steps to avoid or resolve the problem that shall, if necessary, include consultation with the Registered Medical Practitioner.
Duties of registered pharmacist as per chapter 4 of pharmacy practice regulations 2015
Role and Duties Of Registered Pharmacist
1. Dispensing/Supply of Drugs:
(a) The various activities of dispensing (prescription assembly) like removal of drugs from the packing, filling the prescription etc. may be performed under the super-vision of a registered pharmacist by any person who has been trained to perform these activities. However, the actual dispensing of drugs to patients shall only be performed by the Registered pharmacist after due verification of the prescription filled by others.
(b) A Registered pharmacist shall undertake a pharmaceutical assessment of every prescription presented for dispensing. For the purpose of the act, pharmaceutical assessment is defined as the point at which Registered pharmacist applies his knowledge to establish the safety, quality, efficacy and rational use of drugs treatments specified by a prescriber.
(c) Patient confidentiality shall be maintained at all times.
(d) Appropriate information shall be provided to the patient or the care giver and, where possible, understanding of this information should be checked.
(e) For all prescriptions handled by the pharmacy:
(i) Patient details shall be checked and confirmed;
(ii) Pharmaceutical assessment shall be made;
(iii) Proper documentation shall be maintained.
(f) Assessment of the prescription should include but not be limited to assessment of whether :
(i) The prescription is legally valid.
(ii) The prescription includes an appropriate dosage form and appropriate route of administration.
(iii) Prescription is appropriate to the patient’s condition.
(iv) Duration of treatment is correct.
(v) Prescription is appropriate according to patient’s para-meters (age, weight etc.) and previous medication.
(vi) Prescription is compatible with other medications.
(vii) Prescription is consistent with formulary and guidelines, if any.
(viii) Possibility of side effects and ad-verse drug reactions exist.
(x) Potential for misuse and inappropriate use of the medicines in prescription by patient exists.
(xi) Prescription is complying with labeling requirements.
(g) Compounding, dispensing and labeling of required drug products should ensure that
(i) The drug product matches the prescription.
(ii) The drug product has not expired.
(iii) The drug product is appropriately compounded (if necessary), packed and labeled appropriately.
(iv) The accuracy of dispensing is checked by Registered Pharmacist.
(v) Proper documentation is made.
(h) Delivery of the drug product to the patient/carer is done in such a way as to ensure that:
(i) The Registered pharmacist hands over the drug to the patient/carer.
(ii) Appropriate information on drugs is provided to the patient/ carer.
2. Pharmacist role for promotion of rational drug use:
To promote rational use of drugs, the pharmacist shall involve himself in activities such as:
(i) Preparation of formularies both at the hospital level and at state/ national levels.
(ii) Critical assessment of promotional materials prepared by the drug companies.
(iii) Dissemination of evaluated information through authorized sources.
(iv) Updating the knowledge of drugs through continuing education programmmes and also to organize educational programmes for health professionals.
v) Preparation and dissemination of patient information leaflets.
3. Pharmacist role in Patient counselling :
(a) Upon receipt of a prescription (prescription drug order) and following a review of the patient’s record, a Registered Pharmacist shall personally initiate discussion of matters that will enhance or optimize drug therapy with each patient or care given of such patient. Such discussion shall be in person, whenever practicable or by telephone and shall include appropriate elements of patient counseling. Such elements may include the following :
(i) Name and description of the drugs
(ii) The dosage form, dose, route of administration, and duration of drug therapy
(iii) Intended use of the drug and expected action
(iv) Special directions and precautions for the drug
(v) Common severe side effects or adverse effects or interactions and therapeutic contraindications that may be encountered, including their avoidance, and the action required if they occur ;
(vi) Techniques for self monitoring drug therapy
(vii) Proper storage of the drugs
(viii) Prescription refill information
(ix) Action to be taken in the event of a missed dose
(x) To ensure rational use of drugs
Note: The pharmacist shall not be required to counsel a patient or caregiver when the patient or caregiver refuses such consultations.
(b) The pharmacist shall maintain the records pertaining to drugs administered to the patients (drug card) that may be utilized for the evaluation of the drug therapy
(c) The pharmacist is authorized (as a Health care professional) to undertake process and outcome research, health promotion and education and provide health information. Also to undertake the Pharmaco-epidemiological studies.
(d) Pharmacies providing patient counselling shall have regard to the following:
i.Only Registered pharmacists are involved in counselling.
ii.Facilities are provided for confidential conversation and patient confidentiality is maintained.
iii.Patient information leaflets are provided.
iv.Proper documentation is made.
v.Unnecessary counselling should be avoided.
vi.Counselling for Patient’s Benefit: In every consultation, the benefit to the patient is of foremost importance. All registered pharmacists engaged in the case should be frank with the patient and his attendants.
vii.Punctuality in counselling: Utmost punctuality should be observed by a registered pharmacist in making themselves available for counselling.
Drugs And Cosmetics Act and Rules 1945
Condition of licences.—Licences in 1[Forms 20, 20A, 20B, 20F, 20G, 21 and 21B] shall be subject to the conditions stated therein and to the following general conditions:—
Pharmacist Role In Pharmaceutical Industry
Pharmacists are involved and responsible for wide area activities in industry. Pharmacists are involved in drug discovery process, drug safety studies, formulation of dosage forms, clinical trials, marketing and management. In industry where there is drug, there is pharmacist, this is true for India too. because pharmacists are skilled workforce and these responsibilities cannot be taken by other professionals.
Drug discovery to Drug launch is a high expertise process. Pharmacist are responsible for the research, from beginning to the formulation of final product. After drug is in market pharmacists are involved in quality control and testing of the batches.
Phd and Masters Pharmacists are involved in drug research and drug safety processes mostly. B. Pharm to Phd can be found involved in production, quality control and clinical trial fields. Pharmacy professionals with varied specilizations and MBA too are involved in marketing and management.
Pharmacist Role In Regulation
Pharmacists in administration should participate in formulating health and drug policies, particularly those on the selection, procurement and distribution of drugs.Pharmacists have roles in environmental health control and in control of the quality of food and of cosmetics and medical devices.
In view of the special knowledge and expertise of pharmacists, they should be given the responsibility at a senior level for the determination and implementation of policy on drugs and pharmacy manpower and for the drafting and administration of legislation.
Drug procurement and supply, and drug control, registration and enforcement, do not meet satisfactory standards. To achieve acceptable standards, pharmacists with suitable training should be appointed .
Pharmacist should control the distribution of drugs through licit and illicit channels, and as inspectors of the manufacture, importation, distribution and sale of drugs. They should keep watch on distribution of spurious, misbranded and adulterated drugs.
Government-employed pharmacists are responsible for drug management, which includes the selection of essential drugs, the determination of drug requirements, the procurement and distribution of drugs and their rational use, as well as the design and use of information systems. Also, they should collect and collate data required by their national government agencies and by international bodies.
Pharmacist Role In Health Promotion
The pharmacist should be involved in health promotion campaigns, on health topics. Pharmacists should be involved particularly on drug-related topics (e.g., rational use of drugs, alcohol abuse, tobacco use, discouragement of drug use during pregnancy, organic solvent abuse, poison prevention).
Pharmacists should participate in preventive healthcare campaigns. They can communicate drug information to prescribers, monitor patient compliance. Should test quality of drug available to public.
Pharmacist in India has important role in pharmaceutical industry. Pharmaceutical industry is not the concern. Role of pharmacist is neglected in the Healthcare industry, Healthcare programs and Health Management areas.
In the area of Healthcare, pharmacy practice regulations are not implemented on the ground. There is no protocol to evaluate the prescription and communicate with the prescriber. There is no limit to the patients to be dealt by pharmacist, which is necessary for proper counselling. There is no quality check by pharmacist of the drugs procured by the government agencies for dispensing. drugs are not evaluated during Storage for the stability and bio-availability. Pharmacist do not monitor patient compliance of the treatment. In India pharmacist are not allowed to intervene with non prescription drug to manage side effects and treatment outcomes. Proper training is also not provided to pharmacists in the area of clinical pharmacy practice.
In private medical stores there is rampant violations of drug and cosmetic act. Private medical stores thrives on the basis of bribes. Most Drug stores owners are non pharmacists, illegally they hire the pharmacist on rent for the certificate, while actual dispensing is done by non qualified person. Non qualified persons are not skilled enough to evaluate the prescription and counsel the patient and to intervene wherever necessary. At some places in the government sector dispensing is done by the non-pharmacist employees like nurses.
Pharmacist are not given role in drugs management and health management. At various places medical officers having zero knowledge of Pharmacy, quality control and inventory control, are appointed as pharmacy in charges. similarly pharmacists are not appointed in the committee which select the drugs for purchasing.
Governments also do not take significant Health Care program which involve pharmacist. pharmacist must be involved in health campaigns particularly related to the drugs information, compliance and rational use of drugs.
So it can be easily concluded that in India Healthcare sector need tremendous improvement in pharmacy practice sector.