Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic

Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey

BACKGROUND

There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres.

AIM

To describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs.

METHOD

We conducted a multicentre, cross-sectional electronic survey inviting one pharmacy professional response per UK ECMO centre. We collated information on workforce, service provision, and pharmaceutical care activities provided by pharmacy teams in adult CCUs with an ECMO service.

RESULTS

The survey response rate was 90.9%: representatives of 10/11 tertiary hospitals providing ECMO services responded. Median critical care pharmacist to critical care bed was 1:12.1 (IQR: 1:9.4-1:14.9). Most centres (90.0%) did not meet national standards for pharmacy professionals to critical care bed staffing ratios for weekday services. Total critical care beds covered by the critical care pharmacy team varied across the UK: median (IQR) - 45 (37-80) beds. Two centres funded pharmacist time for ECMO activity, and one centre funded a pharmacy technician post. Median peak ECMO activity was 4 ECMO patients in a single day (IQR: 3-5). Most respondents reported reduced pharmacy service at weekends compared to weekday, with limited on-site support.

CONCLUSION

Most responding ECMO centres in the UK reported pharmacy staffing ratios below nationally agreed critical care standards. There was high variability in clinical pharmacy services to ECMO patients over 7 days.

The Medicines Optimisation Innovation Centre: a dedicated centre driving innovation in medicines optimisation-impact and sustainability

BACKGROUND

Sub-optimal medicines use is a challenge globally, contributing to poorer health outcomes, inefficiencies and waste. The Medicines Optimisation Innovation Centre (MOIC) was established in Northern Ireland by the Department of Health (DH) in 2015 to support implementation of the Medicines Optimisation Quality Framework.

AIM

To demonstrate how MOIC informs policy and provides support to commissioners to improve population health and wellbeing.

SETTING

MOIC is a regional centre with multidisciplinary and multi-sector clinical expertise across Health and Social Care and patient representation.

DEVELOPMENT

Core funded by DH, MOIC has a robust governance structure and oversight programme board. An annual business plan is agreed with DH. Rigorous processes have been developed for project adoption and working collaboratively with industry.

IMPLEMENTATION

MOIC has established partnerships with academia, industry, healthcare and representative organisations across Europe, participating in research and development projects and testing integrated technology solutions. A hosting programme has been established and evaluation and dissemination strategies have been developed.

EVALUATION

MOIC has established numerous agreements, partnered in three large EU projects and strengthened networks globally with extensive publications and conference presentations. Informing pathway redesign, sustainability and COVID response, MOIC has also assisted in the development of clinical pharmacy services and antimicrobial stewardship in Europe and Africa. Northern Ireland has been recognised as a 4-star European Active and Healthy Ageing Reference Site and the Integrated Medicines Management model as an example of best practice in Central and Eastern Europe.

CONCLUSION

MOIC has demonstrated considerable success and sustainability and is applicable to health systems globally.

Improving the pragmatic usefulness of the scoring matrix for the Consolidated Framework for Implementation Research (CFIR). A proposal for a more frequency-based approach: The CFIR-f

The Consolidated Framework for Implementation Research (CFIR) is a well-established framework for systematically identifying key factors influencing the implementation of programs. To enhance the classification of existing CFIR definitions, as well as its +2/-2 scoring system, this study incorporated the views of relevant experts to: i) improve how themes are scored; and ii) utilise more information regarding the frequency with which themes are identified. This structured, frequency-based approach to the CFIR's scoring process has been trialled as the CFIR-frequency (CFIR-f). Researchers thematically analysed semi-structured interview data from four groups of policy and program experts (N = 24) delivering two family-based therapies in New South Wales (NSW), Australia. Themes identified by less than 50% were excluded from further analysis. Themes identified by 50% or more of expert participants in the four groups were classified as enablers or barriers using clearly defined criteria. Each theme was allocated a score according to how many experts identified it as an enabler or barrier, and then mapped back onto the latest adaptation of the CFIR comprising 67 constructs. The CFIR-f successfully determined three enablers of, and six barriers to, implementation. Enablers included the family-based therapy programs, therapist training and participant monitoring systems. Barriers included referral, data collection and staffing difficulties, NSW adaptation issues and the suitability and safety of the programs for Aboriginal families. The same enablers and barriers were identified using both the CFIR-f and the original scoring approach, and the identified themes were successfully mapped to almost all CFIR constructs (65/67). This paper proposes a more frequency-based approach to CFIR's scoring process (the CFIR-f). By specifically utilising the frequency with which these barriers and enablers are identified, the CFIR-f engenders a list of ranked themes that service providers and policymakers can use to inform their decisions about program modification and implementation.