Clinical Pharmacy in 2011!

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Clinical Pharmacy in 2011! Good day friends. I have not written for a long time but I felt like writing today in response to Sri Bhagavan's call. We have started doing patient counseling with this year's batch of III year students in our dispensary. I do not know about other colleges but in our college it is a challenge to find the time to train the students. Both I and my students- we are full of enthusiasm, but we do not find the time. Anyway, we started. This is what I did. In introductory classes I told them what patient counseling means. Then I took them to the pharmacy in our dispensary and made them enter all the brand names, corresponding generic names and categories. I told them to learn them well. Then for each category, I told them how to do counseling. Now we started to do counseling; they are at the present observing me and other senior scholars do counseling. Later they will do it themselves. We are also giving height- weight counseling. To diabetic people, we are giving counseling based on a prepared brochure. My feeling is that the patients are appreciating our presence. They happily take our brochure and go home. Another field of activity is, we are taking out II year Pharm D students to King George Hospital once in a week. We trained them since last year to do brochure based counseling to Diabetics. They are doing it well now. This year they will spend time in hospital understanding prescriptions also. Last month I attended a workshop on experiential learning by Pharm D students in Mysore JSS college. To put it in a nutshell, it was impressed upon all of us, by the international speakers, that most of the learning by Pharm D students happens through experiencing rather than through class room learning. It was also impressed upon me that we must go beyond patient counseling. I am wondering whether we can start adverse drug reaction monitoring with the help of M.Pharm students. A few colleagues pointed out that doctors may not like this activity. But my own experience with doctors in KGH is that they are friendly and cordial. I am now a member of the ethics committee of KGH also. The doctors listen to my opinion and I feel proud that I am able to contribute something on that platform also. I find that there are some points, like CDSCO guidelines on clinical trials and some points about pharmacoeconomics that I am able to give to the committee. I invite opinions on whether adverse drug monitoring can be a worthwhile activity or not. How can we plan to make it a success? Vijaya Ratna

About the Author

Prof. J. Vijaya Ratna's picture

Dr. Vijaya Ratna Jayanthi serving Andhra University College of Pharmaceutical Sciences as Chairman, Pharmaceutical Technology Department.

Dr. J. Vijaya Ratna did her B.Pharm (1977), M.Pharm (1979), PGDAS (1981) and Ph.D (1998) at Andhra University Campus and won "M.L. Khorana Gold Medal" for standing University FIRST in graduation.


Siva Mavuduru's picture

Respected madam I heard about the patient counsilleing from my friends they enjoyed it and they are lucky to have your guidance, adverse drug monitoring is great idea madam.

Prof. J. Vijaya Ratna's picture

Siva Ganesh, Thank you. I am looking forward to a discussion on carrying out ADR monitoring in hospitals, on this platform. I am looking for ideas from young people and from people with experience. Vijaya Ratna

Balaji's picture

Respected Vijayaratna Madam, I am very happy to meet you in recently got registered in this site.My self DBSS Balaji studied in Yalamarthy pharmacy college (Andhra University) (2005-2009) Now i am doing PharmD (Post Bacculaureate)(2009-2012) now in Internship in Sri Adichunchanagiri college of pharmacy (RGUHS) near Bangalore. As per my studies going through i can tell ADR monitoring is one of the important clinical pharmacy service and makes a big difference in hospitals if Physicians are accepting the ADR Reporting and documentation it will be easier to monitor the adverse drug reactions. ADR Reporting will be done my some ADR scales like WHO Scale,Naranjo Scale etc. I will be happy to be a part of this type of discussions. Thanking you Madam DBSS Balaji PharmD Intern Department of Clinical Pharmacy SACP


Sandhya Sravya malla's picture

Firstly i would like to congratulate for your initiation of such beneficial activities mam.The activities started by you are really neccesary as patient counselling is very good in a pharmacist's point of view as well as that of the patient's. ADVERSE DRUG MONITORING is also very brilliant thought that will boost up your activities.this will help the patients to be aware of the usage of the drugs... All the best mam!!! PHARMA WARRIORS

Archana Bansode's picture

It's a great work mam, please continue it .... with ADR monitoring.... we always read the name's of adr's 0f drug's while studying p'cology but many times don't give that much of attention to it ..... but by ur work this will get totally change
Sirisha Pingali's picture

Madam, this time i will squeeze my time and attend the patient counseling section. I have not attended any of such sections in my B.Pharm. So definitely i am looking forward to learn patient counseling. Adverse drug reaction monitoring is great initiation indeed. I feel it is our responsibility as pharmacist to ensure public about this. Definitely i'll drive my batch mates to attend this section. Thank you for sharing views!

Sirisha Pingali

Viswanadha Institute of Pharmaceutical Sciences.

Prof. J. Vijaya Ratna's picture

Dear Sirisha Yes, ADR is a good thing. But we must plan well and do it well. I am looking for comments from people who have done it already. I want to learn from their experiences. Vijaya Ratna
Shouvik's picture

can u pls upload a copy of pamphlet wich u distribute amoung ur patients by ur pharmacist students. it will help us in learning that what things do u communicate while patient counselling. and madam pls also tell that who is doing such kind of litreture work in ur it done by the students only or u ppl r taking the help from doctors?


Prof. J. Vijaya Ratna's picture

Dear Shouvik Thank you. The pamplet was initiated by me and I compiled the initial item. But over the last three years, my colleagues like Eswar Kumar and many of our students also worked on its literature, style and presentation. Two such students are Suresh Kumar and Santosh. Santosh actually kept it in his blogs on patient counseling. But again over the last two three years, at least three doctors have appreciated it and made some suggestions. And we always incorporated the suggestions of the doctors. The latest suggestion was from endocrinilogist DR. Subrahmanyam to shift Papaya from "eat very little" to "eat moderately in salads'. So now we are incorporating that suggestion, by pointing with a pen. When we go for the next print, we will incorporate the suggestion. I will ask one of my students to upload it. May be Sirisha Pingali can take up that job. Vijaya Ratna
Ph. Bhagavan P S RPh's picture

Good to see your blog. Good initiation and I appreciate the enthusiasm. Well, let me share some of my experience wrt Counseling and ADR. One should not harp on the patient to counsel. Counseling should happen very casually while talking to the patient / his attendant. It should not appear to be an activity separate from the dispensing, billing and cash collection, unless the issue warrants confidentiality and privacy. ADR is a sensitive issue. No doctor however appreciative he is in open, will be trying to evade and if necessary sabotage the process when his identity is getting exposed on record. Doctors with due regards, are highly egoistic creatures and and are not amenable for any enforceable system / regulation. Hundreds of ADRs are occurring every day and each one is covered up under the guise of Idiosyncrasy without being documented and investigated. A typical situation had arisen while I was in hospital service. I was the Member secretary to the hospital P T C. I raised an A D R that had occurred in the O P D. I placed before the PTC the complete drug profile pertaining to the said ADR. However, I had taken care not bring in the identification of the doctor and the patient. The issue was c losed without discussion as no doctor was willing to comment. Hence ADR monitoring and follow up activity is a very sensitive issue not relished by any doctor and hence should be done after taking the doctors into confidence and only if the management mandates and supports the system. Thank you

Bhagavan P.S. B Pharm

Rtd. Dy Dir.(Pharmacy),Govt of Karnataka, India
Prof. J. Vijaya Ratna's picture

Sir Thank You for your response. I am really suspecting the same issue that you have pointed out. I am wondering whether there is any way in which I can "depersonalize" the ADR issue and present it to the doctors so that they will accept it. Actually if we can generate material on ADRs of drugs, I think it should be seen as beneficial to everyone in the long run. Are there any other ways in which we can collect information on ADR? What if we arrange for a weekly meeting with a doctor by our M.Pharm students, asking them if there are any ADRs that week? Is it likely to work out? Please give your suggestion, Sir. Vijaya Ratna
Ph. Bhagavan P S RPh's picture

Thank you for considering my view. In this regard, I wish to share my experience in the Mc Gann District Hospital (a Govt hospital), Shimoga - Karnataka where I was working as Graduate Pharmacist.Now it has become a teaching hospital. I had just reported for duty on being transferred from Wenlock District hospital, Mangalore. I had no friends in this hospital and District Surgeon, Resident Medical Officer and the Pharmacists were the only professional contacts. My assignment was to establish an IV fluids manufacturing unit in the hospital under Hospital pharmacy program. Since not much of workload was on me the district Surgeon and the RMO used to assign me some sundry jobs related to drugs and drugs stores including verification of ward and unit indents. During the course of my job, I had few occasions to discuss with him on the pricing of drugs, budget management, rational use of drugs, drug storage facility etc. The hospital was holding clinical meeting for doctor every month. One day while I was discussing an issue with the District surgeon a doctor came to remind the District Surgeon on the Clinical meeting. The District Surgeon immediately obliged him and requested all all doctor to come in for the meeting. I got up and requested the District Surgeon to permit me to leave. Immediately he looked at me and said 'No', you sit and join us and introduced me to all the doctors and asked them whether they have any objection for my presence. There was no negative voice and he said that I would be attending all clinical meetings. First meeting I sat through quietly and in the second meeting after they concluded there part of discussion I sought permission from the District Surgeon to express my views. I took the lead from the same pathophysiology which they were discussing and spoke about the medication: some being given hospital drugs, some being asked to buy from outside etc.. Finally I placed before them my view that there is a need to study the issue as it helps in clinically evaluating the efficacy of the drugs. There was a good response and one of the physician volunteered to permit me to study all the case sheets in his units. Like wise my relation with the doctors improved and I got all the support from them. Bottomline: Instead of creating a new road, lets use the existing road, improve it and take them along by creating a feeling that it is they who are taking us along with them!

Bhagavan P.S. B Pharm

Rtd. Dy Dir.(Pharmacy),Govt of Karnataka, India
Ph. Bhagavan P S RPh's picture

Madam, I entered your old blog with interaction we had on it while I was wildely browsing for information and write ups on various types of clin ical support system available. After goimg through the entire chain of discussion under your blog I wish to bring it to your notice that the RTI is thought of being another threat by the doctors that it could be used against them. I rised this issue in the Bangalore PVP seminar organized by the IPC jointly with an NGO. But could not get any response.

I think you need to rise this issue in some right forum to know the safeguards available.

Thank you

Bhagavan P.S. B Pharm

Rtd. Dy Dir.(Pharmacy),Govt of Karnataka, India

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