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1 M.S.Umashankar et al. / Journal of Pharmacy Research 2017,11(3), Review Article Available online through ISSN: Review on Benefits of Clinical Pharmacy Services and Discussion of Current Scenario in Indian Healthcare System M.S.Umashankar* 1, K.S.Lakshmi 2, A.Bharath Kumar 3, A.Porselvi 4 SRM College of Pharmacy, SRM University, Kattankulathur,Tamil Nadu,India. Received on: ; Revised on: ; Accepted on: ABSTRACT Clinical Pharmacy is a health science discipline in which Pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention. To achieve desired therapeutic goals, the clinical pharmacist applies evidence based therapeutic guidelines, evolving sciences, emerging technologies, and relevant legal, ethical, social, cultural, economic, and professional Principles. The clinical pharmacist is trained in clinical pharmacy practice and comprehensive medication management and educating the Patient about the importance of strict adherence to the medication schedule and thus enhance patient compliance.pharmacy Practice integrates the Pharmaceutical sciences with the professional roles of Pharmacists.It includes areas such as clinical pharmacy, pharmaceutical care, health promotion and education, social Pharmacy,health informatics,pharmacoepidemiology and Pharmacy education.clinical Pharmacist must have a Doctor of Pharmacy degree and M.Pharm in PharmacyPractice degree responsible for Practice in clinical level.using of current updated therapeutic guidelines about the disease and drug is acceptable to promote and solve the health care issues in community.the clinical Pharmacy development is currently infant in Indian health care settings and proper awareness is needed to uplift the services in practice. In abroad countries it was well stabilized and well promoted by the health care communities.promoting Proper awareness about the clinical Pharmacy services is needed.in future we hope that these services will promote the better patient care in India. KEY WORDS: Health informatics,pharmacoepidemiology,health care. INTRODUCTION Clinical pharmacy has emerged as one of the latest branches of pharmacy in 21st Century.It is where pharmacists deal with various aspects of patient care includes dispensing of drugs and advising patients on the safe and rational use of drugs.the clinical pharmacist provides patient care that optimizes the use of medication and promotes health,wellness and disease prevention.professional skills and ethics guides the optimal safety in the distribution and use of medicine. Hence ensures the patient s maximum wellbeing during the drug therapy. It doesn t restrict the role of a pharmacist merely to good manufacture practices,easy Procurement,proper Preparation, distribution and control of drug products. In addition, it also comprises functions necessary to discharge a particular set of social responsibilities related to proper therapeutic use of drugs in the aspects like prescribing,dispensing and administrating drugs,documenting Professional services,direct Patient involvement,reviewing drug use,education, consultation and counselling. Pharmacy Practice integrates the Pharmaceutical sciences with the professional roles o Pharmacists.It includes areas such as clinical pharmacy, pharmaceutical care, health promotion and education, social pharmacy,health informatics, Pharmacoepidemiology and Pharmacy education.pharmacists comprises the third larg-est healthcare professionals in the world and pharmacy profession has been evolv-ing steadily over the last decade in India [1]. The Pharmacists have extended their role from dispensing to pharmaceutical care by maximizing the benefits of medications and their safety. With the increase in work related activities directly or indirectly influences the work delivery. *Corresponding author. M.S.Umashankar SRM College of Pharmacy, SRM University, Kattankulathur.Tamil Nadu.India. Fig 1 : Clinical Pharmacist role in community

2 M.S.Umashankar et al. / Journal of Pharmacy Research 2017,11(3), Innovations in clinical pharmacy is the most recent and radical approach towards medication and therapeutics, wherein the patient is provided with a whole new array of medication services and support.the pharmacist performs the clinical pharmacy services, apart from other non clinical and drug distributive services like both patient oriented and product oriented.awareness has come on the medical side and the day is not far off in practicing this system of clinical pharmacy in the hospitals of India. Modern clinical pharmacy practice in the hospital service has its roots in the mid 1960s. However Pharmacists have been practicing what is now called clinical pharmacy.responding to symptoms appropriately and advising the patients on the correct use of their medicines also come under the basic clinical functions. However until recently there was reluctance on the part of the medical professionals to accept that pharmacists having a clinical role. Clinical pharmacists are frequently granted patient care privileges by collaborating physicians and/or health systems that allow them to perform a full range of medication decision-making functions as part of the patient s health care team.clinical pharmacy is the branch of pharmacy in which pharmacists provide patient care that optimizes the use of medication and promotes health,wellness and disease prevention [2]. Intiation of Clinical Pharmacy Practice Professional in Indian and Abroad Internationally Particularly in the countries like the US, Canada, Australia etc clinical pharmacists have extensive education in the biomedical, pharmaceutical, socio behavioural and clinical sciences.many clinical pharmacists also choose to become Board Certified through the Board of Pharmacy Specialties (BPS) which was organized in 1976 as an independent certification agency of APhA (American Pharmacists Association).A Pharmacist may become a Board Certified Pharmacotherapy Specialist (BCPS), a Board Certified Oncology Pharmacist (BCOP), Board Certified Nuclear Pharmacist (BCNP),Board Certified Nutrition Support Pharmacist (BCNSP), or a Board Certified Infectious Disease. India has launched Doctor of Pharmacy (PharmD) study program in the year 2008, and it has sprouted huge discussions about both, the program and the role of clinical pharmacists in the country. Before launching of the study program (i.e. PharmD), the role of a pharmacist in the nation was mostly considered to be dispensing/manufacturing/ marketing of the drugs and clinical pharmacy education was mostly given under the study program of Master of Pharmacy (M. Pharm) (Pharmacy Practice/Clinical Pharmacy). As a consequence, the concepts of clinical pharmacy services and PharmD services are slowly developing in India. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, nurse practitioners, and other healthcare professionals. Clinical pharmacy is a branch of pharmacy that involves the provision of patient care with the use of medications to optimize the health outcomes of patients. This includes promoting wellness and preventing disease.clinical pharmacy is defined as that area of pharmacy concerned with the science and practice of rational medications. Clinical pharmacists work with physicians, other health professionals, and patients to ensure that the medications prescribed for patients contribute to the best possible health outcomes. Clinical pharmacists practice in health care settings where they have frequent and regular interactions with physicians and other health professionals, contributing to better coordination of care.a clinical pharmacist can also be of value among the health care team in offering recommendations to the physician for an optimised medical treatment which is completely patient oriented.clinical Pharmacist is also responsible for educating the patient about the importance of strict adherence to the medication schedule and thus enhance patient compliance. Roles of a Clinical Pharmacist in Hospitals The goal of a clinical Pharmacist is to support to provide the best quality drug therapy for the patients. These may also include : Prescription monitoring Maximize drug efficiency Minimize drug toxicity and promote cost effectiveness Therapeutic drug monitoring of drugs with narrow therapeutic index Drug information services Patient services Patient counseling Improving patient compliance collecting past medical history Clinical Pharmacists should have capabilities to : Assess the status of the patient s health problems and determine whether the prescribed medications are optimally meeting the patient s needs and goals of care. Evaluate the appropriateness and effectiveness of the patient s medications.

3 M.S.Umashankar et al. / Journal of Pharmacy Research 2017,11(3), Recognize untreated health problems that could be improved or resolved with appropriate medication therapy. Follow the patient s progress to determine the effects of the patient s medications on his or her health. Consult with the patient s physicians and other health care providers in selecting the medication therapy that best meets the patient s needs and contributes effectively to the overall therapy goals. Advise the patient on how to best take his or her medications. Support the health care team s efforts to educate the patient on other important steps to improve or maintain health, such as exercise, diet, and preventive steps like immunization. Ward round participation It consist of group of health care members having physicians, pharmacists,nurses,medical students provide the information to during the rounds.the purpose includes improved understanding of patient s history, progress, clinical details, to provide the information on clinical aspects of patient s therapy and to improve discharge planning. Medical coding The codes are used in a variety of fields such as medicine, public health and medical informatics for statistical analysis, reimbursement schemes, Benefits of clinical Pharmacy services Provision of drug and poison information The various electronic databases and drug information softwares are used for the provision of unbiased and latest medicine/poison information in the western world.such softwares/databases give easy, quick and updated information about drugs/poisons.some examples include - MICROMEDEX,PubMed,MedScape,Drugs.com, Cochrane library. Medication history interview Accurate medication history of the patient is important to assess the medical concordance, rationale for the drugs prescribed previously, patient understanding toward medicines, evidence for drug abuse, patient acceptance for the treatment, documenting allergies and adverse drug reactions (ADRs), etc. Clinical review of details In clinical review, Pharmacists have to check the drug therapy to ensure that the patient is getting the most appropriate dose, dosage, dosage form,duration of therapy for their medical/disease state.the signs and symptoms of the patient, laboratory results [3,4], medical diagnoses and therapeutic goals with Indications/benefits of the medicine Duration of action Proper storage How to take the medication When and how long to take medication Information about ceased/new medication Special Precautions about the drug Common adverse drug reactions Action to be taken when a dose is missed Drugs and/or foods to be avoided Medical billing Medical billing is different from medical coding. It is the process of translation of healthcare service into billing claim. Medical transcription In simple language, medical transcription is transcribing (typing) the doctor s reports from dictated audio files and transcribes the oral dictations and/or edits the reports. Pharmacovigilance The science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drugrelated problem.the Documentation,analysis and prevention of ADRs are needed for epidemiological studies and patient safety. Clinical research and drug development There are countless clinical research organizations present in the country. Pharmacists can play a role in enhancing patient participation in clinical trial research.skills needed to work clinical research organization include knowledge of statistical, medical and pharmacologic terms, pharmacovigilance, sincerity in documentation. Clinical pharmacy in primary care and community pharmacy The role of the community pharmacist involved in primary care has been undergoing change. In the late 1970s and early 1980s, developments in computerized medication surveillance within the Netherlands enabled pharmacists to react to prescriptions and detect inappropriate pharmacotherapy in community pharmacy sites.in the early 1990s, pharmaceutical care was introduced in community pharmacy practice, and emphasis was given to providing patientcentered care and documenting cognitive services [5,6].

4 M.S.Umashankar et al. / Journal of Pharmacy Research 2017,11(3), Clinical Pharmacist functions in hospital 10. Computer Skills: Pharmacist has excellent computer skills and can use software programs to take new orders, find drug information, and manage inventory, among other tasks. Fig 2 : Clinical Pharmacist functions The Pharmacist must possess following capabilities and skills : 1. Communication Skills: Pharmacist should have excellent communication skills and be able to speak on a professional level with peers and doctors, as well as in laymen s terms to patients. A great pharmacist is also able to communicate with people despite possible language barriers and other factors of diversity. 2. Interpersonal Skills: Pharmacist should have excellent interpersonal skills, as they deal with doctors, patients, and other staff on a daily basis [7]. 3. Leadership Skills: Pharmacist has strong leadership skills and is able to supervise the work of technicians and assistants. 4. Analytical Skills: Pharmacist has sharp analytical skills and can easily reach conclusions based on information presented by patients. 5. A Good Memory: Pharmacist has an excellent memory and is able to easily recall hundreds of drugs, side effects, and interactions. 6. Conscientiousness: Pharmacist pays close attention to detail and is conscious of everything they do on the job [8]. 7. Counseling Skills: Pharmacist is able to counsel patients on how their prescribed drugs work and what to expect while taking them. They act as educators to the public on how medications help the body. 8. Scientific Aptitude: Pharmacist has a solid background in science, including chemistry, biology, and biochemistry. They are able to employ skills learned in these classes in their everyday work and are also able to learn new scientific concepts easily. 9. Interest in Continuing Education: Pharmacist pursues continuing education opportunities not only because it is a requirement to maintain licensure, but also because they are interested in new research and developments in the industry. Some of the challenges of clinical Pharmacist in Practice : 1. Leadership: It is an important to initiate and sustain the wind of progressive changes.strong leadership is the foundation of any successful organization and qualities at all levels. 2. Innovations: When is the last time we initiated something news ideas in research and practice. 3. Clinical developments: In the scientific world where evidence based is the only communicable language, we must be more than just a commentator. Pharmacists should be looking across the boundaries and grab the opportunities to be hands-on in research. It is high time for us to be loud professionally otherwise we will always be the profession that has a history of rewarding clinical experience with management that does not reach any extraordinary potential. 4. Education and training: Professional training and education is a vital investment. Many efforts have been put forward and are still taking place in our local system. Clinical Pharmacy activities Before the Prescription Involvement in conduct of clinical trials; preparation of formularies and a source of drug information serve the ground. Clinical pharmacists can make decisions on drugs to be marketed, to be included in national/local formularies, which prescribing policies and treatment guidelines in the Practice. During the Prescription In India, the scope of clinical pharmacist is wide, extending from counseling and influencing the mindset of prescribers by pathological, pharmacological and pharmacoeconomic information. After the Prescription Counselling,Preparation of personalized formulation, drug use evaluation, outcome research, and pharmacoeconomic studies stand as the hall marks.the overall goal of a clinical Pharmacist is to promote appropriate use of medicines and devices so as to ensure maximum clinical safety and efficacy of medicines.this also includes monitoring the therapy course and the patient s compliance with therapy, minimizing the treatment expenditures borne by the national health systems and patients. Medication history interview Accurate medication history of the patient is important to assess the medical concordance, rationale for the drugs prescribed

5 M.S.Umashankar et al. / Journal of Pharmacy Research 2017,11(3), previously,patient understanding toward medicines,evidence for drug abuse, patient acceptance for the treatment,documenting allergies and adverse drug reactions (ADRs), etc. Clinical review The patient is getting the most appropriate dose, dosage, dosage form, duration of therapy for their medical/disease state and correlate the signs and symptoms of the patient,laboratory results,medical diagnoses and therapeutic goals with the medication history for better patient care. Patient counselling The pharmacists may provide the information about current clinical condition/proceedings of the patient and educate him about the safe and appropriate use of medicines, thereby enhancing his therapeutic outcomes.generally, there are many questions in patient s mind about disease, drugs, lifestyle modifications, diet, treatment, duration of therapy and medical devices, e.g., metered dose inhalers for asthma patients or insulin pen for diabetics. The patient may be counselled/educated for the following points about the drugs by the Pharmacists : Generic name, brand name of the drug. Dosage. Indications/benefits of the medicine and expected action. Proper storage. How to take the medication. When and how long to take medication. Information about ceased/new medication. Special precautions about the drug. Common ADRs. Action to be taken when a dose is missed. Drugs and/or foods to be avoided. Role of clinical pharmacists in research Despite of being a highly populated country with numerous hospitals, contribution of clinical and epidemiological research by India is not remarkable in the world. For the current contribution, Indian physicians, nurses and other healthcare providers are playing more or less roles. Bioavailability/bioequivalence studies In simple words, bioavailability (BA) is the fraction of the administered drug available in the blood circulation while bioequivalence (BE) is the comparison bioavailabilities of two Pharmaceutical Products with same drug and dosage [9]. BA/BE studies are conducted for following important purposes Development and determination of dose and dosage form of a drug Quality control of drug products Development of new formulation of the existing drugs. Clinical pharmacists have unique expertise in medication dosing, side effects, and efficacy. Conservative estimates of medication errors and adverse drug events in ambulatory care found an annual rate of more than half a million adverse drug events, with an annual cost of almost $900 million. Team-based care that includes a clinical pharmacist is one way to help prevent some of these adverse drug events [10]. In addition, when clinical pharmacists are active members of the care team, they enhance efficiency by: Providing critical input on medication use and dosing. Working with patients to solve problems with their medications and improve adherence. Consulting with primary care team members about medication-related issues. Assisting with on boarding of new patients by reviewing medications and aligning treatment options to medication prescribing patterns of the new organization and primary care provider. Reviewing and providing assistance with patients on multiple medications (polypharmacy) to help to simplify medication regimens. Pharmacists careers include : Hospital Community Industrial Quality Academia Regulatory Marketing Research Publications International Clinical Pharmacy Societies European society of clinical pharmacy American society of health care pharmacist American college of clinical pharmacy Canadian college of clinical pharmacy The Community Clinical Pharmacist United kingdom Clinical Pharmacy association South African society of clinical Pharmacy

6 M.S.Umashankar et al. / Journal of Pharmacy Research 2017,11(3), Scope of clinical Pharmacy practice Education, training, experience, and awareness of practice standards and trends help create the practice model vision.the scope of pharmacy practice now includes patient-centred care with all the cognitive functions of counseling, providing drug information and monitoring drug therapy, as well as technical aspects of pharmaceutical services, including medicines supply management. Clinical pharmacists should be involved in activities directed to individual patients and more broadly to support the objectives of the national medicines policy,especially its quality use of medicines. The Practice of Pharmacy means the interpretation, evaluation, and implementation of Medical Orders and dispensing of Prescription drug orders Participation in drug and device selection; Drug Administration,Drug Regimen Review,the Practice of Tele pharmacy within and across state lines and Drug or Drug-related research.the provision of Patient Counselling, The provision of those acts or services necessary to provide Pharmacist Care in all areas of patient care, including Primary Care and Collaborative Pharmacy Practice and the responsibility for Compounding and Labelling of Drugs and Devices and proper and safe storage of Drugs and Devices, and maintenance of required records [11]. Clinical Pharmacy consist of all the services accomplished by pharmacists practicing in hospitals,community pharmacies, nursing homes, home-based care services, clinics and any other setting wherever medicines are prescribed and used. The term clinical does not necessarily suggest an action implemented only in a hospital settings. A clinical pharmacist has the unique mix of knowledge, skills, and abilities in addition to education, training and experience to function under a scope of practice. Research areas and types of research Types of research: Laboratory based Clinical research (Phase I,II, III) Practical based Educational Pharmacist research career include: Clinical research coordinator Clinical trial assistant Clinical site monitor Clinical research associate Project manager Data management Pharmacist research career include: Clinical research coordinator Clinical trial assistant Clinical site monitor Clinical research associate Project manager Data management Types of clinical trials: Interventional Prevention Observational Diagnostic and screening potential solutions Medication outcomes and comparative effectiveness The assessment of relative drug effectiveness in the treatment of various disease states The department-based UCSF Medication Outcomes Center (MOC) performs research and conducts evidence based analyses 11 to assess the safety, efficacy, and costeffectiveness of medications. Analyzing the safety and coordination of drug monitoring and information resources. Pharmacoepidemiology Analysis. Pharmacokinetics and Pharmacodynamics The absorption, distribution, metabolism, and excretion of drugs by the body, and the effects of drugs on pathogens and diseases. Education research The department conducts research to determine, develop, and implement the most effective means of teaching how to deliver pharmacy care. This effort aims not only to improve the skills and knowledge of faculty and student pharmacists, but also to better educate patients and health care providers on topics such as effective use of medications, optimizing insurance coverage to costeffectively access therapies, and positive health behavior change [12]. To this end, department research explores: Global health : The availability and affordability of vital medicines in resource-poor nations, including barriers, bottlenecks, and other access problems. Health disparities : the causes and effects of unequal access to pharmaceutical services and medications, as well as

7 M.S.Umashankar et al. / Journal of Pharmacy Research 2017,11(3), Health policy analyses : evaluation of existing and proposed policies and campaigns to improve public health, including how to best convert research findings into public policy Pharmacoeconomics : economic analyses of pharmaceutical products. Pharmacogenomics and personalized medicine : The effective use of genetic testing to guide tailored drug choice and dosing, including issues around insurance coverage and applicability to diverse patient populations. Pharmacy practice models : New approaches to delivering pharmacy care to patients, including the education of health care providers and students. Health policy analyses existing and proposed policies and campaigns to improve public health, including how to best convert research findings into public policy [13]. Pharmacoeconomics It is a branch of science deals with economic analyses of pharmaceutical products and comparision of cost during the treatment. Pharmacy Practice Services care Targets Department Type of service Core purpose Teaching Hospitals and research Hospital pharmacy practice, teaching activities, drug Bring changes in the professional structure of pharmacy institutes supply management, drug selection, quantification, including education and training, specialization, career cost minimization and expiry drug disposal services structure and the roles of pharmacy 15 technicians Emergency Medicine (EM) Pharmacy Education, critical care, therapy Determine prevalence and characteristics of EM-related management and monitoring education opportunities for pharmacy students and residents. Community pharmacies Oral chemotherapy services, wellness services, Determine educational and training opportunities for cognitive memory screening, psychotherapy, community pharmacists, thereby improve patient-centred pharmacogenetic testing, health education, experiences that supplement their confidence, knowledge, concordance, counselling, medication therapy and skill in providing advanced pharmacy services management (MTM), follow-up and referral services Surgical department Cardiopulmonary resuscitation (CPR) Determine pharmacist participation on CPR teams in health care delivery organizations Regulatory scrutiny Drug Pricing Evaluate and monitor drug pricing through the use key metrics on cost savings achieved, maintenance costs, and other aspects of program involvement In-patient Pharmaceutical care Provision of pharmaceutical care, identification of drug therapy problems, prevention of adverse drug reactions and monitoring of drug therapy management Out-patient department Ambulatory care, patient education Assertively advancing ambulatory care practice, to achieve the national priorities of improving patient care, adherence, patient health, and affordability of care Pediatric department Pediatric care Provision of advanced pediatric care Intensive care units and oncology Palliative care services Introducing the concept of advanced practice roles in department pharmacy within the new integrated regionalized palliative care service Role of the Clinical Pharmacist Clinical pharmacists are the experts in the therapeutic use of medicines in the healthcare team and may perform various tasks including: Evaluating medication therapy and making appropriate recommendations to patients or health practitioners. Providing evidence-based information and advice about the safe and effective use of medications [14]. Recognizing untreated health conditions that could be managed with medication therapy. Monitoring patient progress with medications and making relevant recommendations to change Advising patients about the best way to take medications Assisting in direct care of patients in hospitals and surgeries [15]. Developing requirements for post registration continued professional development for governing bodies. Education and Training Clinical pharmacists are required to acquire higher education training in a recognized degree area to practice.the clinical pharmacist should includes biology,chemistry,pathology,pharmacology and sociobehavioral science.

8 M.S.Umashankar et al. / Journal of Pharmacy Research 2017,11(3), CONCLUSION Clinical pharmacy practice have a significant role internationally to expand the role of a pharmacist well beyond the traditional roles of compounding and supplying drugs to roles more directly in caring for patients and providing medication consultation to Medical staff. This area of practice and its development still in infant stage in India. Need of an updated informations about the diseases and drugs information is supported for treating patient level problems in the community. We need to built advanced Pharmacy practice setups in every hospital in the country required to improve the standards of Pharmaceutical care and Pharmacy practioners should be actively engage delivery of high Quality Pharmaceutical care facilities in the clinical level. The proper cooperation from the health care communities in India is required. The development of such a patient benefit clinical services guidelines should be implemented in the hospitals.world wide we hope that in future the India will be one of the strengthened country for the clinical Pharmacy services towards the patient community. REFERENCES 1. ACCP (2008) The Definition of Clinical Pharmacy. Pharmacotherapy 28: Centers for Disease Control and Prevention: Division for Heart Disease and Stroke Prevention. Select features of state pharmacist collaborative practice laws. cdc.gov/ dhdsp/pubs/policy_resources.htm. Published December Updated July 16, Accessed October 6, Clinical community pharmacist.washington State Pharmacist Association website. wsparx.org/?page=ccp. Accessed October 10, North Carolina Administrative Code. Board of Pharmacy Pharmacy Rules. 21 NCAC Section.3100 Clinical Pharmacist Practitioner.North Carolina Board of Pharmacy website. Updated November McBane SE, Dopp AL, Abe A, et al.american college of clinical Pharmacy. Collaborative drug therapy management and comprehensive medication management Pharmacotherapy. 2015;35(4):e39-e50. doi: /phar The Asheville Project. theashevilleproject.net. Accessed October 10, Pai AK. Integration of a clinical community pharmacist position.emphasis on workflow design. J Am Pharm Assoc (2003). 2005;45(3): ACCP (2008) The Definition of Clinical Pharmacy. Pharmacotherapy 28: West J, Amey J, Knapton C, Illing S (2012) Clinical pharmacy in general practice Midlands Health Network. 10. ACCP (2012) Desired Professional Development Pathways for Clinical Pharmacists. American College of Clinical Pharmacy 33: e34-e West J, Amey J, Knapton C, Illing S (2012) Clinical pharmacy in general practice Midlands Health Network.SHPA (2005) Standards of Practice for Clinical Pharmacy. J Pharm Pract Res 35: Assemi M, Corelli RL, Ambrose PJ (2011) Development needs of volunteer pharmacy practice preceptors. Am J Pharm Educ 75: Clinical Pharmacy Defined (Pharmacotherapy 2008;28(6) : ). 14. American College of Clinical Pharmacy. Retrieved Bolt J, Semchuk W, Loewen P, Bell A, Strugari C (2015) A Canadian Survey of Pharmacist Participation during Cardiopulmonary Resuscitation. The Canadian Journal of Hospital Pharmacy 68: Source of support: nil ; Conflict of interest: None Declared