Construct validation of an instrument to measure patient satisfaction with pharmacy services in Nigerian hospitals

BACKGROUND

Patient satisfaction is a multidimensional construct that reflects the type and quality of service provided by healthcare providers, how well it is delivered, and the extent to which the expectations and needs of patients are met. As a performance measure, patient satisfaction has been defined as the personal evaluation of health care services and providers.

OBJECTIVE

To develop a patient satisfaction scale, that could be used to assess the quality of pharmacy services provided in Nigerian hospitals and to determine the construct validity of the scale with a view to identifying the factors that may be considered relevant to the target users.

METHODS

The questionnaire was a 35-item inventory titled "Patient Satisfaction Survey (PSS)". This study was carried out in three university teaching hospitals located in Southwestern Nigeria. The patient satisfaction survey instrument (PSS) was administered on 506 clinic outpatients who patronised the hospital pharmacies. Participation in the study was voluntary with appropriate informed consent. Ethical approval was obtained for this study from the Medical and Ethics Committee of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC).

RESULTS

Patients with post secondary education were in the majority with a frequency of 224 (44.3%) subjects. This was followed by a frequency of 116 (22.9%) for those with secondary education. Eighty-seven (17.2%) of those included in the main study had primary education 64 (12.7%) did not receive any formal education. Fifteen (3%) out of the 506 sampled did not indicate their level of education.

CONCLUSION

This study developed a scale to measure patient satisfaction with pharmaceutical services in selected Nigerian university teaching hospitals. The final 25 item scale presents significant and stable coefficients of correlation and yielded six derived dimensions of patient satisfaction.

[Process management in the hospital pharmacy for the improvement of the patient safety]

OBJECTIVES

To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality.

MATERIAL AND METHODS

In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced.

RESULTS

The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence.

CONCLUSIONS

The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality.

Medication problems are frequent and often serious in a Danish emergency department and may be discovered by clinical pharmacists

INTRODUCTION

Transferring a patient from one health-care sector to another implies a risk of medication errors. It is of interest to evaluate whether a specialist in clinical pharmacy is beneficial for the patients in the emergency departments (ED). The aim of the present study was to report the incidence, categories and seriousness of medication problems discovered by clinical pharmacists in an ED and to evaluate if it is possible for pharmacists to identify those groups of patients who are most at risk of medication problems.

MATERIAL AND METHODS

A pharmacist reviewed the patient files in the ED. If the pharmacists provided any kind of recommendations, a note was made describing the problem and a suggestion for a solution. After the study period, two medical specialists reviewed the files and rated the suggestions according to four levels of importance.

RESULTS

A total of 1,696 patient files were reviewed after excluding patients who had received no medication. A total of 420 pharmacist notes were written, corresponding to 25% of all the included admissions. 47% of the pharmaceutical suggestions were considered serious. Increasing age and one drug as opposed to 2-9 drugs were associated with serious recommendations. In the multivariate analysis, only age above 70 years remained of significance for the identification of patients with a risk of a serious medication problem.

CONCLUSION

A considerable amount of serious pharmaceutical problems were found in the ED. These problems had not been observed by the physicians and they were especially prevalent among the elderly and patients who were only prescribed a single drug.

FUNDING

The Amgros research foundation financed salaries for the independent specialists who reviewed the patient files.

TRIAL REGISTRATION

not relevant.

Taking the risk. Despite meningitis outbreak, some hospitals have little choice but to rely on compounding pharmacies

In the wake of a deadly meningitis outbreak tied to a compounding pharmacy, many hospitals will still have to use such facilities because they have no alternative for hard-to-obtain drugs. "I don't think we would stop buying from compounding pharmacies, but it will cause people to strengthen evaluations of what they are buying," says Alison Apple, left, of Methodist Healthcare, Memphis, Tenn.

Use of a general level framework to facilitate performance improvement in hospital pharmacists in Singapore

OBJECTIVE

To evaluate the acceptability and validity of an adapted version of the General Level Framework (GLF) as a tool to facilitate and evaluate performance development in general pharmacist practitioners (those with less than 3 years of experience) in a Singapore hospital.

METHOD

Observational evaluations during daily clinical activities were prospectively recorded for 35 pharmacists using the GLF at 2 time points over an average of 9 months. Feedback was provided to the pharmacists and then individualized learning plans were formulated.

RESULTS

Pharmacists' mean competency cluster scores improved in all 3 clusters, and significant improvement was seen in all but 8 of the 63 behavioral descriptors (p ≤ 0.05). Nonsignificant improvements were attributed to the highest level of performance having been attained upon initial evaluation. Feedback indicated that the GLF process was a positive experience, prompting reflection on practice and culminating in needs-based learning and ultimately improved patient care.

CONCLUSIONS

The General Level Framework was an acceptable tool for the facilitation and evaluation of performance development in general pharmacist practitioners in a Singapore hospital.

Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand

This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation.

Impact of the pharmacist on a multidisciplinary team in an antimicrobial stewardship program: a quasi-experimental study

BACKGROUND

Antimicrobial stewardship programs (ASP) have been implemented to promote rational use of antimicrobial drugs. Multidisciplinary teams are needed to form effective committees.

OBJECTIVE

Assess the impact of ASP, with and without the presence of a pharmacist, in a cardiology hospital in Brazil.

METHODS

The program started with an infectious disease (ID) physician, and after 22 months, a pharmacist started to work in the ASP team. We present data related to: stage 1-before the program implementation; stage 2-with the ID physician; and stage 3 with the inclusion of a pharmacist. Analysis was made by segmented regression of time series.

RESULTS

After the start of ASP there was a significant reduction of consumption of all antimicrobials. The pharmacist contributed to the significant reduction in consumption of fluoroquinolones, clindamycin and ampicillin/sulbactam and in increase in total cephalosporins use in stage 3. Adherence rate to the ASP team recommendations was 64.1%. There was a significant reduction of 69% in hospital antibiotics costs.

CONCLUSION

A non-expensive ASP in a limited resource country resulted in reductions in antimicrobial consumption and costs. The multidisciplinary team contributed to maximize the impact of interventions.

Dispensing medications at the hospital upon discharge from an emergency department

Although most health care services can and should be provided by their medical home, children will be referred or require visits to the emergency department (ED) for emergent clinical conditions or injuries. Continuation of medical care after discharge from an ED is dependent on parents or caregivers' understanding of and compliance with follow-up instructions and on adherence to medication recommendations. ED visits often occur at times when the majority of pharmacies are not open and caregivers are concerned with getting their ill or injured child directly home. Approximately one-third of patients fail to obtain priority medications from a pharmacy after discharge from an ED. The option of judiciously dispensing ED discharge medications from the ED's outpatient pharmacy within the facility is a major convenience that overcomes this obstacle, improving the likelihood of medication adherence. Emergency care encounters should be routinely followed up with primary care provider medical homes to ensure complete and comprehensive care.

Acceptance and importance of clinical pharmacists' LIMM-based recommendations

OBJECTIVE

The objective of this study was to evaluate the quality of the clinical pharmacy service in a Swedish hospital according to the Lund Integrated Medicine Management (LIMM) model, in terms of the acceptance and clinical significance of the recommendations made by clinical pharmacists.

METHOD

The clinical significance of the recommendations made by clinical pharmacists was assessed for a random sample of inpatients receiving the clinical pharmacy service in 2007. Two independent physicians retrospectively ranked the recommendations emerging from errors in the patients' current medication list and actual drug-related problems according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant).

RESULTS

The random sample comprised 132 patients (out of 800 receiving the service). The clinical significance of 197 recommendations was assessed. The physicians accepted and implemented 178 (90%) of the clinical pharmacists' recommendations. Most of these recommendations, 170 (83%), were ranked 3 (somewhat significant) or higher.

CONCLUSION

This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists' recommendations further demonstrates the effectiveness of the process.

Hospitalists, pharmacy collaborate on throughput

Pace of Care, a multidisciplinary initiative at Memorial Health Care System in Chattanooga, TN, has improved patient throughput and cut length of stay. The case management department was redesigned and the staff increased. Case managers and nursing staff hold rounds in each patient's room and discuss the plan of care and anticipated discharge. The hospitalists and pharmacy collaborate with case management on moving patients through the continuum of care.

Approaches to the management of agents used for the treatment of multiple sclerosis: consensus statements from a panel of U.S. managed care pharmacists and physicians

BACKGROUND

Multiple sclerosis (MS) is a chronic, disabling, and costly disease with several treatment options available; however, there is variability in evidence-based clinical guidelines. Therefore, payers are at a disadvantage when making management decisions without the benefit of definitive guidance from treatment guidelines.

OBJECTIVE

To outline approaches for the management of agents used to treat MS, as determined from a group of U.S. managed care pharmacists and physicians.

METHODS

A modified Delphi process was used to develop consensus statements regarding MS management approaches. The panel was composed of experts in managed care and included 8 pharmacy directors and 6 medical directors presently or previously involved in formulary decision making from 12 health plans, 1 specialty pharmacy, and 1 consulting company. These decision makers, who have experience designing health care benefits that include MS treatments, provided anonymous feedback through 2 rounds of web-based surveys and participated in 1 live panel meeting held in December 2010. Consensus was defined as a mean response of at least 3.3 or 100% of responses either "agree" or "strongly agree" (i.e., no panelist answered "disagree" or "strongly disagree") on a 4-item Likert scale (1=strongly disagree, 2=disagree, 3=agree, 4=strongly agree).

RESULTS

After 3 phases, these managed care representatives reached consensus on 25 statements for management of patients with MS. Consistent with managed care principles, this group of managed care experts found that health plans should consider efficacy, effectiveness, and safety, as well as patient preference, when evaluating MS therapies for formulary placement. Cost and contracting should be considered if efficacy and safety are judged to be comparable between agents.

CONCLUSION

The consensus statements developed by a panel of managed care representatives provide some insight into decision making in formulary and utilization management of MS therapies.

Implementation of a peer review process to improve documentation consistency of care process indicators in the EMR in a primary care setting

BACKGROUND

Kaiser Permanente Colorado is a group model nonprofit HMO that provides health care services to more than 500,000 members. The Primary Care Clinical Pharmacy Services (PCCPS) department consists of 33 clinical pharmacy specialists (CPS), who are located in 19 primary care clinics.

OBJECTIVES

To develop and implement a peer review process to (a) improve the consistency of documentation of process indicators in the electronic medical record (EMR), (b) ensure compliance with existing standards, and (c) share best practices among PCCPS with varying geographical locations and practice styles.

METHODS

A committee was formed to undertake the peer review process. An audit tool consisting of yes/no questions was created to assess chart documentation by PCCPS and to provide feedback for improvement. Four sections were included in the evaluation tool: (a) content, (b) collaborative drug therapy management, (c) nonformulary reviews, and (d) pharmacy system documentation. Peer reviews occurred quarterly, and all CPS participated. Copies of reviews were distributed to PCCPS clinicians and their supervisors. Questions and inconsistencies regarding the process were identified by the peer review committee to provide feedback to the group to optimize reviews. After completion of each quarter's reviews, error rates were calculated by dividing the total number of "no" answers by the total number of PCCPS notes reviewed that quarter. A 2-tailed Fisher's exact test was used to compare the error rate at the last quarter of each year (2007 to 2010) with baseline (2007 Q1).

RESULTS

A total of 1,856 reviews were conducted between 2007 Q1 and 2010 Q2. Significant improvements in documentation were demonstrated over the first 12 months and sustained for the next 2.5 years. From 2007 Q1 to 2010 Q2, the rate of noncompliant elements decreased from 14.1% to 2.5% (P=0.001) in the content section and decreased from 31.3% to 8.3% (P less than 0.001) across all sections.

CONCLUSIONS

Over 3 years of follow-up, the peer review process was successful in improving the consistency of documentation by PCCPS and compliance with existing standards. The process was well received by participants. The peer review document is easily adaptable and can be updated to address changes in drug therapy management protocols and nonformulary medication reviews as needed. This process also allows for sharing of best practices among high-functioning PCCPS practitioners who otherwise could remain isolated.

Pharmacist-managed antimicrobial stewardship program for patients discharged from the emergency department

Positive outcomes of antimicrobial stewardship programs in the inpatient setting are well documented, but the benefits for patients not admitted to the hospital remain less clear. This report describes a retrospective case-control study of patients discharged from the emergency department (ED) with subsequent positive cultures conducted to determine whether integrating antimicrobial stewardship responsibilities into practice of the emergency medicine clinical pharmacist (EPh) decreased times to positive culture follow-up, patient or primary care provider (PCP) notification, and appropriateness of antimicrobial therapy. Pre- and post-implementation groups of an EPh-managed antimicrobial stewardship program were compared. Positive cultures were identified in 177 patients, 104 and 73 in pre- and post-implementation groups, respectively. Median time to culture review in the pre-implementation group was 3 days (range 1-15) and 2 days (range 0-4) in the post-implementation group (P = .0001). There were 74 (71.2%) and 36 (49.3%) positive cultures that required notification in the pre- and post-implementation groups, respectively, and the median time to patient or PCP notification was 3 days (range 1-9) and 2 days (range 0-4) in the 2 groups (P = .01). No difference was seen in the appropriateness of therapy. In conclusion, EPh involvement reduced time to positive culture review and time to patient or PCP notification when indicated.

Antimicrobial stewardship

Antimicrobial resistance is increasing; however, antimicrobial drug development is slowing. Now more than ever before, antimicrobial stewardship is of the utmost importance as a way to optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. This review describes the why, what, who, how, when, and where of antimicrobial stewardship. Techniques of stewardship are summarized, and a plan for implementation of a stewardship program is outlined.

High-tech approach to medication reconciliation saves time, bolsters safety at hospital in northern Virginia

Clinicians in the ED at Alexandria Inova Hospital in Alexandria, VA, have been able to streamline the medicine reconciliation process with the help of a new high-tech tool that retrieves a patient's medication history in a matter of minutes and transforms the data into a form that can automatically populate the patient's electronic medical record.The approach is facilitated by the regional health information exchange (HIE) organization, and will eventually be available to other providers in northern Virginia. Thus far, 80% to 90% of patients who have come through the ED have consented to have their medication history electronically retrieved. Eventually, administrators anticipate that the same approach will be used to share patient radiology studies, laboratory results, and other patient information across providers. Experts predict this practice will be commonplace among U.S. hospitals within five years, but they encourage hospital and ED administrators to take advantage of opportunities to leverage regional HIEs.