Introduction

Pharmaceutical care is an aspect of pharmacy that focuses on improving the quality of life of patients through responsible provision of medication-related care.¹ In the hospital setting, this has been quite productive, but with some challenges such as limited time for patient education, staffing, and even proactively involved in deciding the right treatment for the patient.² These limitations have contributed to challenges such as polypharmacy, medication non-adherence, drug therapy problems, and rising rates of chronic disease mismanagement.

Pharmaceutical care in the hospital setting is important. Having pharmacists as part of the hospital team means the doctors do not have to make decisions about how patients receive their medications alone, as the pharmacists can offer expert guidance helping patients get maximum benefit and minimum harm from their treatment.² Whether it is choosing the safest drug for a patient with multiple health conditions, adjusting doses, or finding better alternatives, pharmacists can help improve patient’s outcomes. 

This article aims to shine the light on pharmaceutical care in hospital settings, and how it can enhance patient safety and outcome. 

Evolution of Pharmacy Practice in Hospital Settings

Pharmacy practice in the hospital setting has evolved. From the traditional role of compounding and window dispensing with little to no interaction with the patients, barely acting on orders via prescription from the physician to being advisors. 

Initially, the primary roles of hospital pharmacists were limited to compounding and distributing medications, to ensure safe dispensing practices. These responsibilities were crucial in maintaining drug quality and patient safety, but they did not fully capitalize on the pharmacists’ potential to contribute to direct patient care and improved therapeutic outcomes.³ 

As healthcare began shifting toward more patient-centered and outcome-focused care, the need for pharmacists to take on a more active role became important, as we had more recorded drug-related morbidity and mortality.³ This is where the concept of clinical pharmacy and later pharmaceutical care started to take root. In the 1990s, Hepler and Strand emphasized the pharmacist’s responsibility for the patient’s therapeutic outcomes, not just the medications they receive.⁴

With this, pharmacy education evolved. It prepared pharmacists to do more than dispense – they procure, prepare, deliver, administer medications, monitor drug therapies, influence prescribing, participate in human resources and training, and counsel patients directly.⁵ This has resulted in pharmacists playing a crucial role in managing chronic illnesses, preventing medication errors, and improving the overall quality of care and life.³

This evolution transformed how pharmacists are viewed in hospitals today: not just as dispensers, but as vital members of the healthcare team working to ensure better health outcomes for every patient.

What is Pharmaceutical care?

“The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life,” is how Hepler and Strand explained pharmaceutical care.⁴

This working definition of pharmaceutical care is interpreted in diverse ways across different regions, making challenges to implementing pharmaceutical care unique.³

The role of Pharmacists in the Hospital

Although the services offered by pharmacists working in the hospital may differ across regions, depending, they can offer clinical services such as;³

• Obtaining medication history 
• Taking up preceptor roles
• Inpatient medication supply
• Drug and therapeutics committee
• Reporting adverse drug reactions
• Patient counselling and education
• Medication review, reconciliation and recommendations
• Extemporaneous preparation in the appropriate dosage forms

Obtaining medication history

Aside from the patient's demographics, their subjective data also involves medical, social, and medication history. Prescription and nonprescription drugs are considered. For this history, pharmacists obtain this information by conducting interviews with patients/caregiver, and reviewing medical records. This is because they have the expertise and experience to scrutinize drug orders.

It is important to obtain medication history, as it guides drug therapy for an in-patient/out-patient.⁶

Preceptors roles

Pharmacists in the hospital are on a defined career trajectory, making them suitable to assume the role as educator for pharmacy students/residents. It is a vital part of the pharmacy profession, as they bridge the gap between what is taught in school as theory and what is practised by serving as mentors.⁷

Inpatient medication supply

Medication procurement and supply is another responsibility of the pharmacists in the hospital setting. This is important as the pharmacists have the experience and skill to source for medications of best quality, procure them and have them stored in appropriate conditions which are safe for the patients.

Serve in drug and therapeutics committees 

When it comes to deciding which medications and diagnostic tools should be available for patients, hospitals make those decisions by relying on a multidisciplinary team of healthcare professionals that includes pharmacists, physicians, nurses, microbiologists, lab scientists, radiologists, physiotherapists, etc.

Within this team, pharmacists play a major role. They are responsible for making sure the hospital adheres to its approved medication list (called a formulary), helping to develop treatment guidelines, and monitoring how medicines are used across the facility. Using both clinical experience and scientific data, they conduct drug use reviews and share information with the rest of the care team.⁸

Reporting adverse drug reactions.

Adverse drug reaction is “a response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease, or for modifications of physiological function.”⁹

About 3.5% of in-patient cases are as a result of adverse drug reactions (ADRs). It is the responsibility of the pharmacist to identify, assess, report and resolve them. This is also known as pharmacovigilance.¹¹

Patient counselling and education

Communicating medication information in a clear and concise manner to a patient is an important role of the hospital pharmacist. While carrying this role, the pharmacist takes time to explain the medications dispensed and how it relates to the diagnosis. Aside from this, possible side/adverse effects, dosage, frequency, duration of the medication are also explained. 

At this point, it is possible for the patients to have questions about their therapy. These questions are answered by the pharmacist. 

Medication review, reconciliation and recommendations

This role can be carried out during wardrounds, and during dispensing. Here, the pharmacist works with a list of patient’s medications (past and present), examines them for appropriateness to therapy, screens out and resolves errors, and offers interventions by providing evidence-based recommendations. 

Extemporaneous preparation in the appropriate dosage forms

Some medications do not come in the appropriate dosage forms, especially when dose, age, health state of the patient are considered. To achieve the appropriate dosage form, it is common to have pharmacists prepare the medications as needed. This role allows pharmacists provide access to medications for individuals with unique medical needs.¹²

These roles are possible because it involves medication use. In the hospital, medication use spans across different specialties, wards, etc with varied frequency, duration, route, and even dose. These medications need to be prescribed, appraised, dispensed and then administered to the patients with adequate information. 

How can Pharmaceutical Care enhance Patient safety and outcomes?

When patients are admitted in or visit the hospital, medication use is an important part of therapy. Medications can be poisons, courtesy of the dose, possible interactions (drug-drug, drug-food, drug-condition), duration, frequency, etc. This is why the hospital takes extra care to make sure the medications patients receive are safe, effective and improve therapeutic outcomes. This is where pharmaceutical care comes in.

Pharmaceutical care ensures that pharmacists do not just hand over medications, they are involved in the process of therapy, from prescribing to administration. They work with other healthcare professionals to ensure that the right medicine is given for the right condition, at the right dose and time with reduced cost to help improve health outcomes. 

Pharmaceutical care enhances patient’s safety and outcomes by ensuring;¹³

• Medications are assessed to identify drug therapy related problems.
• Care plans and therapeutic goals are developed to resolve drug therapy related problems.
• Patients are educated to ensure adherence and compliance to therapy regimen.
• Follow-up and monitoring of therapeutic outcomes. 

Summary

Pharmaceutical care is all about helping patients get the best results from their medications. In hospital settings, this means pharmacists do much more than simply hand out drugs. They work with doctors, nurses, and other healthcare professionals to make sure medications are safe, effective, and tailored to each person’s needs.

In the past, hospital pharmacists mainly focused on preparing and dispensing medicines (window dispensing era). They had little to no direct contact with patients. But as healthcare began to focus more on people, the pharmacist’s role expanded. This shift, especially after Hepler and Strand introduced the idea of pharmaceutical care in the 1990s, turned pharmacists into a key part of the healthcare team.

Today, hospital pharmacists are involved in many ways. They take medication histories, support pharmacy students as mentors, ensure the hospital has quality medicines in stock, and help decide which drugs should be used in treatment. They also report and help prevent adverse drug reactions.

Pharmaceutical care in the hospital setting allows patients to receive the right medicine, at the right dose, at the right time. This approach not only improves recovery and treatment outcomes but also reduces risks, and ensures healthcare is safer.