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Smith SE, Nei AM. Defining the "ideal state": A primer on critical care pharmacy practice models. Am J Health Syst Pharm 2024; 81:796-811. [PMID: 38741290 DOI: 10.1093/ajhp/zxae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE Critical care pharmacists (CCPs) have been clearly established as value-added members of the interprofessional team, and their contributions positively impact patient outcomes in the intensive care unit (ICU). Despite this, not every critically ill patient in the US receives care from a CCP and the model through which CCPs practice is variable, which has important implications. The purpose of this primer is to review current CCP models and discuss elements of the optimal CCP practice model. SUMMARY Current CCP practice models are defined, including the drug processing and dispensing model, clinical pharmacy specialist model, integrated pharmacy generalist model, and hybrid model, as well as unit-based vs service-based models. The optimal CCP practice model considers the Triple Domain of CCP workload, which includes direct patient care, indirect patient care, and professional service. Elements of the ideal CCP practice model including 24/7/365 CCP services, unit- vs service-based models, prescriptive authority, operational support, and CCP-to-patient ratio are discussed. Other vital elements include dedicated offline time, use of appropriate workload metrics, development of career ladders, opportunities for professional development, and providing wellness resources. The ideal CCP practice model must also be considered through the lens of the patient and medical team, the CCP, the institution, and professional organizations. Strategies for optimizing current CCP practice models are provided, and application of optimal CCP practice model elements is explored through 5 case studies. CONCLUSION The optimal CCP practice model includes multiple elements and incorporates the viewpoints of patients, providers, CCPs, institutions, and professional organizations; this model will increase access of all ICU patients to CCPs, enhance the scope of CCP cognitive services, and ensure the economic sustainability of CCP practice while establishing CCP involvement in activities outside of patient care and in professional service.
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Affiliation(s)
- Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Andrea M Nei
- Department of Pharmacy, Mayo Clinic Hospital-Rochester, Rochester, MN, USA
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Al‐Jazairi A, Hijazi H, Samarkandi H, Akhras N, Devol E, Hamasni I. What is the ideal clinical pharmacy practice model? A satisfaction comparative study. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Abdulrazaq Al‐Jazairi
- Pharmaceutical Care at King Faisal Specialist Hospital and Research Center (KFSH&RC) Riyadh Saudi Arabia
| | - Hala Hijazi
- Staff‐Clinical Pharmacist, KFSH&RC Riyadh Saudi Arabia
| | | | - Nathem Akhras
- Cardiology, Consultant Clinical Pharmacist, Cardiology KFSH&RC Riyadh Saudi Arabia
| | - Edward Devol
- Biostatistics, Epidemiology & Scientific Computing KFSH&RC Riyadh Saudi Arabia
| | - Ibrahim Hamasni
- Pharmaceutical Care, Clinical Pharmacist (Nephrology) at King Faisal Specialist Hospital (KFSH&RC) Riyadh Saudi Arabia
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3
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Martin RD. Leveraging telecommuting pharmacists in the post-COVID-19 world. J Am Pharm Assoc (2003) 2020; 60:e113-e115. [PMID: 32839136 DOI: 10.1016/j.japh.2020.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/19/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022]
Abstract
In response to the coronavirus disease 2019 (COVID-19) pandemic, many industries, including pharmacy, rapidly expanded the use of telecommuting workers to assure business continuity and address social distancing needs. Advances in electronic health records and telepharmacy over the past 2 decades enabled pharmacy leaders to easily adapt their practice models to allow for telecommuting alternatives during the pandemic. While these changes were generally intended to be part of the short-term response, the sustained expansion of telecommuting within the pharmacy profession merits further exploration. Documented experience with telepharmacy and telehealth indicate a wide array of clinical and operational pharmacist activities that could be conducted by telecommuters. In addition, experience with telecommuters in other industries suggests potential benefits ranging from improving pharmacists' work-life balance to mitigating postpandemic financial burden. Health care organizations should consider integrating part-time telecommuter pharmacists into contemporary practice models to address other frontline issues and facilitate ongoing expansion of clinical pharmacy services to meet emerging patient needs.
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Dunn RL, Cho JC, Parmentier BL. Acute Care Pharmacy Practice: A Perspective for Pharmacy Students, Residents, and Other Health-Care Providers. J Pharm Pract 2020; 33:350-355. [DOI: 10.1177/0897190018816262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To describe the acute care setting with a specific focus on acute care pharmacy practices. Summary Acute care is the sector of health care where time-sensitive episodes of illness are managed. Acute care pharmacy practice includes both hospital and clinical pharmacists serving, in a variety of domains, as medication experts and authority on patient-centered medication therapy. Pharmacists serving in this area can have a beneficial impact on patient care and the health-care system. Conclusion: The demand for acute care services is likely to grow as the population continues to grow and age. Pharmacists are key members of interdisciplinary teams in the acute care setting.
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Affiliation(s)
- Rebecca L. Dunn
- Department of Clinical Sciences, Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, TX, USA
| | - Jonathan C. Cho
- Department of Clinical Sciences, Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, TX, USA
| | - Brittany L. Parmentier
- Department of Clinical Sciences, Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, TX, USA
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5
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Newsome AS, Anderson D, Gwynn ME, Waller JL. Characterization of changes in medication complexity using a modified scoring tool. Am J Health Syst Pharm 2020; 76:S92-S95. [PMID: 31586396 DOI: 10.1093/ajhp/zxz213] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The purpose of this study was to characterize dynamic changes in medication regimen complexity over time in critically ill adults and to validate a modified version of the medication regimen complexity-intensive care unit (MRC-ICU) scoring tool. SUMMARY A single-center, retrospective, observational chart review was conducted with a primary aim of assessing changes in medication regimen complexity over time, as measured by both the 39-item MRC-ICU scoring tool and a modified version (the mMRC-ICU) containing just 17 items. Secondary aims included validation of the mMRC-ICU and exploration of relationships between medication regimen complexity and ICU length of stay (LOS), inpatient mortality, and patient acuity. Adults admitted to a medical ICU from November 2016 through June 2017 were included. The medication regimens of a total of 130 patients were scored in order to test, modify, and validate the MRC-ICU and mMRC-ICU tools. The modified tool was validated by evaluating correlation of mMRC-ICU scores with MRC-ICU scores and with patient outcomes including patient acuity, ICU LOS, and inpatient mortality. mMRC-ICU scores were collected at 24 and 48 hours after admission and at ICU discharge to evaluate changes over time. Significant changes in medication regimen complexity over time were observed, with the highest scores observed at 24 hours after admission. CONCLUSION Medication regimen complexity may provide valuable insights into pharmacist activity and resource allocation. Further validation of the MRC-ICU and mMRC-ICU scoring tools in other critically ill populations and at external sites is required.
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Affiliation(s)
- Andrea Sikora Newsome
- College of Pharmacy, University of Georgia, Augusta, GA, and Department of Pharmacy, Augusta University Medical Center, Augusta, GA
| | - Daniel Anderson
- Department of Pharmacy, Emory Healthcare, Atlanta, GA, and College of Pharmacy, University of Georgia, Augusta, GA
| | - Morgan E Gwynn
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC
| | - Jennifer L Waller
- Department of Population Health Sciences, Division of Biostatistics and Data Science, Augusta University, Augusta, GA
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Newsome AS, Smith SE, Olney WJ, Jones TW. Multicenter validation of a novel medication-regimen complexity scoring tool. Am J Health Syst Pharm 2020; 77:474-478. [PMID: 34086844 DOI: 10.1093/ajhp/zxz330] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The MRC-ICU, a novel regimen complexity scoring tool, provides an objective measure of medication regimen complexity in critically ill patients. The MRC-ICU may have the ability to evaluate the impact of critical care pharmacists on patient outcomes but requires further validation. The objective of this study was to confirm the external validity of the MRC-ICU scoring tool at multiple institutions and intensive care unit (ICU) settings. METHODS This was a multicenter, prospective, observational study. The electronic medical record was reviewed to collect patient demographics and patient outcomes, and the medication administration record was reviewed to collect MRC-ICU scores at 24 hours, 48 hours, and ICU discharge. Validation was performed by assessing convergent and divergent validity of the score. Spearman rank-order correlation was used to determine correlation. RESULTS A total of 230 patients were evaluated across both centers in both medical ICUs and surgical ICUs. Differences between the original center and the new site included that total number of orders (29 vs 126; P < 0.001) and total number of medication orders (17 vs 36; P < 0.001) were higher at the new site, whereas the original site had higher overall MRC-ICU scores (14 vs 11; P = 0.004). The MRC-ICU showed appropriate convergent validity with number of orders and medication orders (all P < 0.001) and appropriate divergent validity with no significant correlation found between age, weight, or gender (all P > 0.05). CONCLUSIONS External validity of the MRC-ICU has been confirmed through evaluation at an external site and in the surgical ICU population. The MRC-ICU scoring tool requires prospective evaluation to provide objective data regarding optimal pharmacist use.
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Affiliation(s)
- Andrea Sikora Newsome
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA.,Department of Pharmacy, Augusta University Medical Center, Augusta, GA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA
| | - William J Olney
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA
| | - Timothy W Jones
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA
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Root L, Denke N, Johnson I, McFadden M, Wermers R. Applying Complexity Science as a DNP Quantum Leader. Nurs Adm Q 2020; 44:142-148. [PMID: 32134873 DOI: 10.1097/naq.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As Doctor of Nursing Practice (DNP) students and graduates begin to apply new knowledge in real-life situations, they are transforming their organizations. The impact of DNP projects is noted by measurable outcomes in diverse settings. This article presents 4 unique clinical/organizational examples of DNP projects. The authors have identified an application of complexity science and leadership theory in their practice changes. In addition, they share their thoughts and feelings as emerging leaders.
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Affiliation(s)
- Lynda Root
- Arizona State University Edson College of Nursing and Health Innovation, Phoenix (Drs Root and Denke and Ms McFadden); Colorado Center for Nursing Excellence, Denver (Dr Johnson); and Arizona State University, Phoenix (Dr Wermers)
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Newsome AS, Smith SE, Jones TW, Taylor A, Van Berkel MA, Rabinovich M. A survey of critical care pharmacists to patient ratios and practice characteristics in intensive care units. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1163] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Andrea S. Newsome
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
- Department of Pharmacy; Augusta University Medical Center; Augusta Georgia
| | - Susan E. Smith
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
| | - Timothy W. Jones
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
| | - Ashley Taylor
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
- Department of Pharmacy; Augusta University Medical Center; Augusta Georgia
| | | | - Marina Rabinovich
- Department of Pharmacy and Clinical Nutrition; Grady Health System; Atlanta Georgia
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9
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Newsome AS, Smith SE, Olney WJ, Jones TW, Forehand CC, Jun AH, Coppiano L. Medication regimen complexity is associated with pharmacist interventions and drug-drug interactions: A use of the novel MRC-ICU scoring tool. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1146] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Andrea Sikora Newsome
- Department of Clinical and Administrative Pharmacy; University of Georgia College of Pharmacy; Augusta Georgia
- Department of Pharmacy; Augusta University Medical Center; Augusta Georgia
| | - Susan E. Smith
- Department of Clinical and Administrative Pharmacy; University of Georgia College of Pharmacy; Augusta Georgia
| | - William J. Olney
- Department of Clinical and Administrative Pharmacy; University of Georgia College of Pharmacy; Augusta Georgia
| | - Timothy W. Jones
- Department of Clinical and Administrative Pharmacy; University of Georgia College of Pharmacy; Augusta Georgia
| | | | - Ah Hyun Jun
- Department of Pharmacy; Augusta University Medical Center; Augusta Georgia
| | - Lindsey Coppiano
- Department of Clinical and Administrative Pharmacy; University of Georgia College of Pharmacy; Augusta Georgia
- Department of Pharmacy; Augusta University Medical Center; Augusta Georgia
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10
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Gill TK, Thornton LM, Schroeder TR, Garrelts JC, Schminke BC, Utz KJ, Gerlach CT. Implementation and evaluation of a team-based pharmacy practice model in a community health system. Am J Health Syst Pharm 2019; 76:470-477. [DOI: 10.1093/ajhp/zxy082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
The development and implementation of a team-based pharmacy practice model is described.
Methods
In January 2016 a transition from a staff-specialist to a team-based pharmacy practice model was implemented. The overall goal of the model change was to enhance the pharmacist’s clinical roles and further integrate pharmacists into the healthcare team. Before implementation of the new staffing model, a formalized metric evaluation process was created. The aim of this metric evaluation was to gauge model success, determine areas of model revision, and objectively communicate pharmacist impact. Objective metrics were evaluated before implementation and 1 year after implementation. In addition, surveys were distributed to pharmacists, physicians, nursing and hospital administration before and after model implementation.
Results
At 1-year postimplementation, the pharmacist:patient bed ratio decreased from 1:87 to 1:47, the number of rounds/huddles with pharmacist attendance increased by 63% to 80 per week, and the number of clinical interventions and new clinical consultations increased from 57 to 62 and from 12 to 16 per day, respectively. Nonformulary medication use also decreased from 1.77 to 0.623 per 1000 patient days, and compliance with therapeutic initiatives increased from 77%to 91%. Overall, 72% of pharmacist survey responses indicated satisfaction with the model change.
Conclusion
A team-based pharmacy practice model was designed and successfully implemented over a 3-year period. Data analysis revealed improvements in clinical and operational endpoints and enhanced pharmacist, physician, and nursing satisfaction.
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Bryant R, Chaar B, Schneider C. Differing clinical pharmacy service models: Quantitative and qualitative analysis of nurse perceptions of support from pharmacists. Int J Nurs Stud 2018; 86:90-98. [DOI: 10.1016/j.ijnurstu.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/31/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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12
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Tran T, Taylor SE, Hardidge A, Mitri E, Aminian P, George J, Elliott RA. The Prevalence and Nature of Medication Errors and Adverse Events Related to Preadmission Medications When Patients Are Admitted to an Orthopedic Inpatient Unit: An Observational Study. Ann Pharmacother 2018; 53:252-260. [DOI: 10.1177/1060028018802472] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Medication errors commonly occur when patients move from the community into hospital. Whereas medication reconciliation by pharmacists can detect errors, delays in undertaking this can increase the risk that patients receive incorrect admission medication regimens. Orthopedic patients are an at-risk group because they are often elderly and use multiple medications. Objective: To evaluate the prevalence and nature of medication errors when patients are admitted to an orthopedic unit where pharmacists routinely undertake postprescribing medication reconciliation. Methods: A 10-week retrospective observational study was conducted at a major metropolitan hospital in Australia. Medication records of orthopedic inpatients were evaluated to determine the number of prescribing and administration errors associated with patients’ preadmission medications and the number of related adverse events that occurred within 72 hours of admission. Results: Preadmission, 198 patients were taking at least 1 regular medication, of whom 176 (88.9%) experienced at least 1 medication error. The median number of errors per patient was 6 (interquartile range 3-10). Unintended omission of a preadmission medication was the most common prescribing error (87.4%). There were 17 adverse events involving 24 medications in 16 (8.1%) patients that were potentially related to medication errors; 6 events were deemed moderate consequence (moderate injury or harm, increased length of stay, or cancelled/delayed treatment), and the remainder were minor. Conclusion and Relevance: Medication errors were common when orthopedic patients were admitted to hospital, despite postprescribing pharmacist medication reconciliation. Some of these errors led to patient harm. Interventions that ensure that medications are prescribed correctly at admission are required.
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Affiliation(s)
- Tim Tran
- Austin Health, Heidelberg, VIC, Australia
- Monash University, Parkville, VIC, Australia
| | | | | | | | | | | | - Rohan A. Elliott
- Austin Health, Heidelberg, VIC, Australia
- Monash University, Parkville, VIC, Australia
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13
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Vest TA, Carrasquillo MA, Morbitzer KA, Cruz JL, Eckel SF. Evaluation of a comprehensive, integrated, medical service-based pharmacy practice model. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tyler A. Vest
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina; Chapel Hill North Carolina
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; Chapel Hill North Carolina
| | - Michelle A. Carrasquillo
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina; Chapel Hill North Carolina
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; Chapel Hill North Carolina
| | - Kathryn A. Morbitzer
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; Chapel Hill North Carolina
| | - Jennifer L. Cruz
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina; Chapel Hill North Carolina
| | - Stephen F. Eckel
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina; Chapel Hill North Carolina
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; Chapel Hill North Carolina
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14
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LeBras M, Maruyama A, Stacey D, Tataru A, Dalen D, Harbin M, Leung TS, Mihic T, Su G, Louie S. Are Decentralized Pharmacy Services the Preferred Model of Pharmacy Service Delivery within a Hospital? Can J Hosp Pharm 2015; 68:168-71. [PMID: 25964690 DOI: 10.4212/cjhp.v68i2.1444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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15
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Clinical pharmacy services that influence prescribing in the Western Pacific Region based on the FIP Basel Statements. Int J Clin Pharm 2015; 37:485-96. [DOI: 10.1007/s11096-015-0084-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/11/2015] [Indexed: 11/26/2022]
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16
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Waite LH, Heuser L, Williams PC, Winkler SR. Advanced clinical pharmacy services in a nonacademic community hospital. Am J Health Syst Pharm 2014; 71:989-90, 992-3. [DOI: 10.2146/ajhp130554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Laura H. Waite
- Department of Pharmacy Practice and Pharmacy Administration Philadelphia College of Pharmacy University of the Sciences Philadelphia, PA
| | - Lisa Heuser
- Department of Pharmacy Practice and Pharmacy Administration Philadelphia College of Pharmacy University of the Sciences Philadelphia, PA
| | | | - Susan R. Winkler
- Midwestern University Chicago College of Pharmacy Downers Grove, IL
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17
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Chapter 9: Staffing Levels and Structure for the Provision of Clinical Pharmacy Services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2013. [DOI: 10.1002/j.2055-2335.2013.tb00903.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Zaller ND, Yokell MA, Green TC, Gaggin J, Case P. The feasibility of pharmacy-based naloxone distribution interventions: a qualitative study with injection drug users and pharmacy staff in Rhode Island. Subst Use Misuse 2013; 48:590-9. [PMID: 23750660 DOI: 10.3109/10826084.2013.793355] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study analyzed qualitative data from a Rapid Policy Assessment and Response project to assess the feasibility of a potential pharmacy-based naloxone intervention to reduce opioid overdose mortality among injection drug users (IDUs). We conducted in-depth, semistructured interviews with 21 IDUs and 21 pharmacy staff (pharmacists and technicians). Although most participants supported the idea of a pharmacy-based naloxone intervention, several barriers were identified, including misinformation about naloxone, interpersonal relationships between IDUs and pharmacy staff, and costs of such an intervention. Implications for future pharmacy-based overdose prevention interventions for IDUs, including pharmacy-based naloxone distribution, are considered. The study's limitations are noted.
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Affiliation(s)
- Nickolas D Zaller
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA.
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19
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MacLaren R, Brett McQueen R, Campbell J. Clinical and financial impact of pharmacy services in the intensive care unit: pharmacist and prescriber perceptions. Pharmacotherapy 2013; 33:401-10. [PMID: 23468188 DOI: 10.1002/phar.1226] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
STUDY OBJECTIVE To compare pharmacist and prescriber perceptions of the clinical and financial outcomes of pharmacy services in the intensive care unit (ICU). DESIGN ICU pharmacists were invited to participate in the survey and were asked to invite two ICU prescriber colleagues to complete questionnaires. SETTING ICUs with clinical pharmacy services. METHODS The questionnaires were designed to solicit frequency, efficiency, and perceptions about the clinical and financial impact (on a 10-point scale) of pharmacy services including patient care (eight functions), education (three functions), administration (three functions), and scholarship (four functions). Basic services were defined as fundamental, and higher-level services were categorized as desirable or optimal. Respondents were asked to suggest possible sources of funding and reimbursement for ICU pharmacy services. RESULTS Eighty packets containing one 26-item pharmacy questionnaire and two 16-item prescriber questionnaires were distributed to ICU pharmacists. Forty-one pharmacists (51%) and 46 prescribers (29%) returned questionnaires. Pharmacists had worked in the ICU for 8.3 ± 6.4 years and devoted 50.3 ± 18.7% of their efforts to clinical practice. Prescribers generally rated the impact of pharmacy services more favorably than pharmacists. Fundamental services were provided more frequently and were rated more positively than desirable or optimal services across both groups. The percent efficiencies of providing services without the pharmacist ranged between 40% and 65%. Both groups indicated that salary support for the pharmacist should come from hospital departments of pharmacy or critical care or colleges of pharmacy. Prescribers were more likely to consider other sources of funding for pharmacist salaries. Both groups supported reimbursement of clinical pharmacy services. CONCLUSION Critical care pharmacy activities were associated with perceptions of beneficial clinical and financial outcomes. Prescribers valued most services more than pharmacists. Fundamental services were viewed more favorably than desirable or optimal services, possibly because they occurred more frequently or were required for safe patient care. Substantial inefficiencies may occur if pharmacy services disappeared. Considerable support existed for funding and reimbursement of critical care pharmacy services.
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Affiliation(s)
- Robert MacLaren
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, USA.
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20
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Russett F. Recent Publications on Medications and Pharmacy. Hosp Pharm 2012. [DOI: 10.1310/hpj4704-317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.
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Affiliation(s)
- Flint Russett
- Department of Pharmacy, St. Francis Health Center, Topeka, Kansas
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