Clinical pharmacists work at both multi-disciplinary team (MDT) level and in a number of specialities including intensive care, haematology, oncology, psychiatry, paediatrics, microbiology and clinical trials. The pharmaceutical model of care in place is known as the PACT model1 and it focuses on ensuring medication reconciliation is carried out at the point of admission and discharge to ensure the safe transition of patients in and out of the Hospital. Medication reconciliation is the process of ensuring that a patient is prescribed the most accurate list of medications a patient was taking prior to arriving in/leaving the Hospital and correcting any discrepancies identified. In addition, this model of care enables Clinical Pharmacists to collaboratively prescribe medications on the inpatient kardex to ensure the prompt resolution of medication discrepancies. Clinical Pharmacists will often participate in ward rounds and attend multidisciplinary team meetings where they offer their pharmaceutical expertise. Pharmacists visit patients at ward level and are involved in many aspects of patient care including drug usage review, promotion of safe, effective and economic medication use, patient and staff education, research, therapeutic drug monitoring, and other ward based clinical activities. Some of our Clinical Pharmacists see patients in the Atrial Fibrillation Clinic and will advise on the choice of drug/dosing/interactions as well as providing counselling to patients newly commenced on DOACs (blood thinners).
This clinic is the first of its kind in Ireland.
1. Grimes TC, Deasy E, Allen A, O'Byrne J, Delaney T, Barragry J, et al. Collaborative pharmaceutical care in an Irish hospital: uncontrolled before-after study. BMJ Qual Saf. 2014;23(7):574-83.
