PTC, Drug Information Services, Patient Counseling & Education
This unit covers the advisory and educational roles of the pharmacist. It includes the Pharmacy and Therapeutics Committee (organization, functions, and formulary policies), Drug Information Services (sources, computerized databases, poison information), Patient Counseling (steps and special cases), education and training programs in hospitals, the code of ethics for community pharmacy, and prescription interpretation with communication skills.
Syllabus & Topics
- 1Pharmacy and Therapeutics Committee (PTC): PTC (also called Drug and Therapeutics Committee — DTC): advisory committee that serves as the organizational LINK between medical staff and pharmacy department. Organization: (1) Chairman: senior physician (usually Chief Medical Officer). (2) Secretary: Chief Pharmacist/Director of Pharmacy. (3) Members: physicians (from major departments — medicine, surgery, pediatrics), pharmacists, nurses, administrator, infection control officer. (4) Meetings: typically quarterly (minimum). (5) Minutes documented and circulated. Functions: (1) Develop and maintain hospital formulary. (2) Establish drug use policies. (3) Evaluate drug use (DUE — Drug Use Evaluation). (4) Review ADR reports. (5) Develop antimicrobial stewardship program. (6) Cost containment strategies. (7) Education on rational drug use.
- 2PTC Policies: (1) Drugs into formulary: formal process — request by physician → literature review by pharmacy → PTC evaluation (efficacy, safety, cost, therapeutic advantage over existing drugs) → vote → approved/rejected → communicated to medical staff. Non-formulary requests: case-by-case approval by PTC chair with justification. (2) Inpatient prescription policy: generic prescribing preferred, therapeutic substitution policy (PTC-approved interchange of therapeutically equivalent drugs), drug use restrictions (antibiotics — infectious disease approval required for certain drugs). (3) Outpatient prescription policy: prescription format, maximum quantities, refill policies. (4) Automatic Stop Order (ASO): policy that automatically discontinues certain drug orders after a specified time unless renewed by prescriber. Examples: antibiotics (7-14 days), narcotics (48-72 hours), anticoagulants (variable). Purpose: prevent unnecessary prolonged therapy, encourage prescriber reassessment. (5) Emergency drug list: standardized list of drugs that must be available immediately in crash carts, emergency room, ICU — maintained and checked by pharmacy.
- 3Drug Information Services (DIS): DIS: specialized service providing accurate, unbiased, evidence-based drug information to healthcare professionals, patients, and the public. Drug information center: dedicated facility within hospital pharmacy staffed by drug information pharmacists. Functions: (1) Answer drug information queries. (2) Publish drug bulletins/newsletters. (3) Formulary management support. (4) ADR monitoring. (5) Medication error prevention. (6) Drug use evaluation. Poison Information Center: provides emergency information on poisoning management — identification, symptoms, treatment (antidotes), decontamination procedures. National Poisons Information Centre (NPIC), AIIMS, New Delhi — 24/7 helpline.
- 4Drug Information Sources: Three levels: (1) PRIMARY sources: original research articles in peer-reviewed journals. Examples: New England Journal of Medicine (NEJM), The Lancet, JAMA, British Journal of Pharmacology. Most current, but requires critical appraisal. (2) SECONDARY sources: indexing/abstracting services that organize and reference primary literature. Examples: MEDLINE/PubMed (NLM), EMBASE, International Pharmaceutical Abstracts (IPA), Cochrane Library. Used to SEARCH for relevant primary literature. (3) TERTIARY sources: textbooks, compendia that summarize information from primary sources. Examples: Goodman & Gilman’s (pharmacology), Remington’s (pharmacy), AHFS Drug Information, Martindale’s Extra Pharmacopoeia, Drug Facts and Comparisons, Physician’s Desk Reference (PDR), pharmacopoeias (IP, BP, USP). Computerized services: online databases (PubMed, Micromedex, UpToDate, Lexicomp), clinical decision support systems, drug interaction checkers.
- 5Patient Counseling: Patient counseling: process of providing medication information, education, and support to patients and caregivers to promote optimal medication use. Steps: (1) Introduce yourself as the pharmacist. (2) Verify patient identity and medication. (3) Assess patient’s existing knowledge (‘What has your doctor told you about this medication?’). (4) Provide information: drug name and purpose, dose and schedule, route of administration, expected duration, common side effects and how to manage, storage instructions, what to do if dose is missed. (5) Use open-ended questions to verify understanding (‘Can you tell me how you will take this medication?’). (6) Address questions/concerns. (7) Provide written materials (patient information leaflets). (8) Document counseling provided. Special cases requiring pharmacist: (1) New prescriptions. (2) Chronic disease medications (diabetes, hypertension). (3) Narrow therapeutic index drugs. (4) Drugs with complex administration (inhalers, insulin pens, eye drops). (5) Elderly patients (multiple medications, confusion). (6) Pediatric caregivers. (7) Pregnant/lactating women. (8) Patients with poor adherence history.
- 6Education & Training Programs: Role of hospital pharmacist in education: (1) Internal training: training pharmacy staff (new employees orientation, continuing education), nurses (medication administration techniques, IV compatibility, ADR recognition), medical students/residents (drug information, pharmacokinetics). (2) External training: pharmacy student internships (practical training), community health education programs, public awareness campaigns. Services to nursing homes/clinics: (1) Drug information support. (2) Formulary development assistance. (3) Medication review for residents. (4) Infection control guidance. (5) Staff training on drug handling. Code of ethics for community pharmacy: (1) Patient welfare is primary concern. (2) Maintain confidentiality of patient information. (3) Dispense only against valid prescription (Schedule H/H1). (4) Never dispense substandard/spurious drugs. (5) Provide unbiased drug information. (6) Maintain professional competence through continuing education. (7) Maintain proper records. (8) Professional behavior and appearance. Role in interdepartmental communication: pharmacist serves as drug information bridge between departments — communicating drug policies, formulary changes, drug interactions, recall information.
- 7Prescription Interpretation & Communication: Prescription: written order from authorized prescriber to pharmacist for dispensing medication to a patient. Components: (1) Prescriber information (name, qualifications, registration number, address). (2) Date. (3) Patient information (name, age, sex, address). (4) Superscription (Rx — ‘recipe’ = take thou). (5) Inscription (drug name — generic preferred, strength, dosage form). (6) Subscription (directions to pharmacist — quantity to dispense). (7) Signa/Transcription (directions to patient — Latin abbreviations: OD = once daily, BD/BID = twice daily, TDS/TID = thrice daily, QID = four times, SOS = if needed, ac = before food, pc = after food, hs = at bedtime). (8) Prescriber’s signature. Legal requirements: Schedule H drugs — prescription mandatory. Schedule H1 — additional record maintenance. Schedule X — special prescription format. Communication skills: (1) With prescribers: professional, evidence-based recommendations, respectful disagreement when needed (drug interaction alert, dose correction). (2) With patients: simple language (avoid jargon), use teach-back method, be empathetic, allow time for questions, culturally sensitive.
Learning Objectives
Exam Prep Questions
Q1. What is an Automatic Stop Order?
An Automatic Stop Order (ASO) is a hospital policy that AUTOMATICALLY discontinues certain drug orders after a predetermined time period unless the prescriber explicitly renews the order. Examples: Antibiotics: stop after 7-14 days. Narcotics/opioids: stop after 48-72 hours. Anticoagulants: stop per protocol.
Why? (1) Prevents unnecessary prolonged therapy (antibiotic resistance, opioid dependence). (2) Forces prescriber to REASSESS the patient’s condition. (3) Promotes rational drug use. The pharmacy sends a reminder to the prescriber before the auto-stop → prescriber can renew if therapy is still needed.
Q2. What is the difference between primary, secondary, and tertiary drug information sources?
Primary: ORIGINAL research — journal articles reporting original studies (clinical trials, case reports). Most current but takes time to find the right article. Example: NEJM clinical trial on a new drug.
Secondary: INDEXES/DATABASES that catalog primary literature — help you SEARCH for relevant articles. You don’t read secondary sources; you use them to FIND primary sources. Example: PubMed (search → get list of relevant articles).
Tertiary: COMPILED/SUMMARIZED information from multiple primary sources — textbooks, drug compendia. Most convenient but may be outdated. Example: Goodman & Gilman’s textbook.
For quick clinical decisions: use tertiary first → verify with primary if needed.
Q3. Why is the ‘teach-back’ method important in patient counseling?
Teach-back: after providing information, ask the patient to explain it back in their OWN words (“Can you show me how you will use this inhaler?”).
Why it matters: (1) Verifies UNDERSTANDING — patients often nod/agree without truly understanding. (2) Identifies GAPS — you can immediately clarify misunderstandings. (3) Improves RETENTION — actively recalling information strengthens memory. (4) Establishes CONFIDENCE — patient feels more prepared.
Studies show that patients forget 40-80% of medical information immediately. Teach-back reduces this information loss significantly and is recommended by WHO as the gold standard for patient education.