How to set up a pharmacist clinic

After securing support from interdisciplinary sectors, the next step to setting up a pharmacy is to determine the details of how the clinic would function. Here, we explain this process before using the TVGH pharmacist clinic as an example.

Key concepts

While setting up pharmacist clinics, consider:

• Manpower rotations
• Pharmacist credentials
• Services
• Service methods
• Service duration and frequency

The TVGH anticoagulation clinic model

Manpower rotation. There are 7 pharmacists at the clinic, 2 clinics per week. In every clinic, there is 1 full-time pharmacist and 1 PRN (Pro re neta) pharmacist. In each clinic time, there are at most 7 patients. If there are more than 7 patients the PRN pharmacists will report to the clinic to assist the full-time pharmacist.

Credentials

Pharmacists need to work as a clinical pharmacist in cardiovascular, cardiovascular surgery and neuro-department for more than 1 year. After which, they must enroll in a weekly training program facilitated by the current anticoagulant clinic team. Finally, they must pass a 16-hour clinic internship to become independent pharmacists of the anticoagulation clinic.

Service and service methods

TVGH anticoagulation clinic focuses on patient prescribed with warfarin or non-vitamin K antagonist oral anticoagulants (NOAC). Services include providing initial use pharmacy education and follow-ups, adverse drug reaction management and bridging suggestion, anticoagulation counselling, management of INR deviation and many others.

Pharmacists need to make sure the anticoagulant regiment is appropriate, and all medication are in good condition. They must also keep good medical records and manage patient lifestyle to control their weight. Lab data management is also part of their responsibility.

At TVGH, the initial referral is always a face-to-face interview. Follow-ups can be done in the clinics or over the phone. Though face-to-face sessions are more productive, it is not as flexible as telephone follow-ups. You need to have a healthy balance of both formats.

Service times and frequency. Warfarin and NOACs related initial referrals are always 60 minutes. The follow-up appointment will only take 30 minutes. Each follow-up must be within 3 months of the previous session as physicians carry out lab tests every 3 months.

Share and learn:

• Are there anticoagulation clinics in your country? Do they offer other services?