Differing clinical pharmacy service models: Quantitative and qualitative analysis of nurse perceptions of support from pharmacists

Perceptions and expectations of health professionals regarding hospital pharmacy services and the roles of hospital pharmacists: A qualitative systematic review and meta-synthesis

Background

Pharmacists have become increasingly integrated within the interprofessional hospital team as their scope of practice expanded in recent decades. However, limited research has explored how the roles of hospital pharmacists are perceived by other health professionals.

Aim/Objectives

To identify what is known about the perceptions of hospital pharmacists' roles and hospital pharmacy services held by non-pharmacist health professionals.

Methods

A systematic literature search was conducted in August 2022 in MEDLINE, Embase, and CINAHL to identify peer-reviewed articles published between 2011 and 2022. Title/abstract and full-text screening, by two independent reviewers, identified eligible articles. Inclusion criteria included qualitative studies in hospital settings that reported perceptions regarding the roles of hospital pharmacists held by non-pharmacist health professionals. Data were extracted using a standardised extraction tool. Collated qualitative data underwent inductive thematic analysis by two independent investigators to identify codes, which were reconciled and merged into over-arching themes through a consensus process. Findings were assessed to measure confidence using the GRADE-CERQual criteria.

Results

The search resulted in 14,718 hits. After removing duplicates, 10,551 studies underwent title/abstract screening. Of these, 515 underwent full-text review, and 36 were included for analysis. Most studies included perceptions held by medical or nursing staff. Hospital pharmacists were perceived as valuable, competent and supportive. At an organisational level, the roles of hospital pharmacists were perceived to benefit hospital workflow and improve patient safety. Roles contributing to all four domains of the World Health Organization's Strategic Framework of the Global Patient Safety Challenge were recognised. Highly-valued roles include medication reviews, provision of drug information, and education for health professionals.

Conclusion

This review describes the roles hospital pharmacists performed within the interprofessional team, as reported by non-pharmacist health professionals internationally. Multidisciplinary perceptions and expectations of these roles may guide the prioritisation and optimisation of hospital pharmacy services.

Economic evaluation of a collaborative model of pharmaceutical care in an Irish hospital: cost-utility analysis

Background: A complex, collaborative pharmaceutical care intervention including medication review and reconciliation demonstrated a statistically significant reduction in the prevalence of discharge medication error and improved quality of prescribing for hospitalised adults.  This study sought to assess the cost-effectiveness of this intervention. Methods: A cost-utility analysis was undertaken using a decision-analytic framework. The evaluation was undertaken from the Health Service Executive's perspective, the payer for primary and secondary care settings. Direct costs associated with managing hypothetical harm consequent to intercepted discharge medication error and consequences in terms of quality-adjusted life years loss were key input parameters. Analysis was structured within a decision tree model in Microsoft Excel® populated with consequences as utilities, estimated costs using macro- and micro-costing approaches, and event probabilities generated from the original study. Incremental analysis, one-way and probabilistic sensitivity analyses were performed. Results: The results of analysis for the base-care demonstrated that the intervention dominated standard care with an incremental cost-effectiveness ratio of -€36,537.24/quality-adjusted life year, indicating that the intervention is less costly and more effective. The one-way and probabilistic sensitivity analyses both demonstrated that the intervention dominated standard care. The model was relatively robust to variation in input parameters through one-way sensitivity analysis. The cost of discharge medication error and effect parameters relating to standard care were most sensitive to change. Discussion: The analysis demonstrated the cost-effectiveness of a complex pharmaceutical intervention which will support decision-making regarding implementation. This is the first cost-utility analysis of a complex, collaborative pharmaceutical care intervention, adding to the scant evidence-base in the field.

Overcoming Barriers in Nurse-Pharmacist Collaborations on Wards - Qualitative Expert Interviews with Nurses and Pharmacists

Purpose

Interprofessional collaboration in healthcare is an essential element in promoting patient safety. However, little research is available on the collaboration between nurses and pharmacists. To optimize processes, mutual understanding is needed, which can be gained by examining the perspectives of those collaborating professional groups. We aimed to identify barriers to the interprofessional collaboration of nurses and pharmacists as well as preconditions and solution strategies to devise approaches for optimizing teamwork in inpatient settings.

Methods

We recruited pairs of collaborating nurses and pharmacists from different hospitals in German-speaking countries and conducted qualitative expert interviews by phone with each of them individually. Transcribed interviews were assessed using qualitative content analysis.

Results

We conducted 12 interviews each with the collaborating nurses and pharmacists. The most frequently mentioned barriers to optimal collaboration were "skepticism due to perception as controller" (reported mainly by pharmacists), "organizational implementation", and "limited (possibilities of) presence" (reported by both professional groups). A solution strategy proposed to overcome such barriers was "explaining added value". This added value was found in "clinical-pharmaceutical activities as complement by additional perspective" and "reducing workload in tasks distant from the patient".

Conclusion

Nurses, pharmacists and hospital management should recognize the added value of intensifying their collaboration regarding patient-related services. A combination of logistical and clinical-pharmaceutical activities should be established at the level of drug application since interviewees endorsed collaboration. A stepwise process must be anticipated to address existing barriers, including some redefinition of professional roles.

Practice and experience in the teaching system of clinical pharmacy laboratory in the post-epidemic era: A review

Out of the global outbreak of COVID-19, clinical pharmaceutical therapeutic analytical-teaching laboratories underwent an increasing number of digitally-led teaching research. A teaching system working online and offline to monitor medicinal drugs was explored and established using a clinical pharmaceutical therapy through a drug concentration monitoring laboratory within a comprehensive tertiary hospital. Meanwhile, laboratory access training and standards of laboratory biosafety management system were also strictly implemented, improving the technical operation and daily management. Moreover, a new, significant, and efficient teaching mode was set up based on vocational training needs for efficient and professional learning. The learning results are enforced to have dynamic checks accomplished using stage-oriented assessment. Moreover, the questionnaire survey results, especially during independent learning ability and laboratory skills training, reveal that teachers and students have commented positively on the new teaching mode. Hereon, a clinical pharmaceutical teaching system during the Post-Epidemic Era was elaborated to provide a unique teaching mode and experience dedicated to teaching and scientific research in clinical therapeutic drug monitoring laboratory.

Teamwork in Health Care Services Delivery in Nigeria: A Mixed Methods Assessment of Perceptions and Lived Experiences of Pharmacists in a Tertiary Hospital

Background

Lack of teamwork is the bane of weak and ineffective health care systems in many countries. This study examined the perceptions and lived experiences of pharmacists working in a Nigerian government-owned (public) multispecialty tertiary hospital regarding teamwork in their workplace.

Methods

A sequential explanatory mixed methods study using phenomenological approach of inquiry, was conducted among pharmacists with experience in multidisciplinary health care provision in a public tertiary hospital in Nigeria. Questionnaires with 16 close-ended questions based on a Likert scale, which scored from strongly disagree (1) to strongly agree (5), were administered. The mean (M) scores were determined using SPSS Version 20; M ≥ 3.00 indicated agree, while M < 3.00 disagree. Subsequently, focus group discussions were conducted, and the audio recorded responses transcribed and subjected to thematic analysis using NVivo 11.

Results

Some participants (50%) had worked for 5–10 years in the hospital’s Department of Pharmacy, 25% (11–20 years), and 16.7% (21–30 years). Participants agreed that effective teamwork leads to positive patient outcomes (M = 3.67) and is in the public’s interest (M = 4.25). However, they disagreed that their workplace supports teamwork (M = 2.33), effective interprofessional collaborative practices exist in the hospital (M = 1.08), and their remuneration reflects their worth to the organization (M = 2.33). Doctors’ dominance and claim of ownership of patients, allied professionals’ attitudes and ignorance of pharmacists’ roles, salary disparity, poor communication, and defective leadership style among others were identified as impediments to teamwork.

Conclusion

The hospital pharmacists demonstrated positive disposition towards teamwork, and agreed that effective teamwork would improve health care delivery. However, they identified some factors that hinder interprofessional teamwork in the hospital. Principles and practices of teamwork should be incorporated into the curriculum of each discipline; interdisciplinary collaborative practices, health system structure, institutional policies and leadership should be strengthened to enhance teamwork.

Patient Safety in the Process of Pharmacotherapy Carried Out by Nurses-A Polish-Slovak Prospective Observational Study

Pharmacotherapy, i.e., the use of medicines for combating a disease or its symptoms, is one of the crucial elements of patient care. Nursing workloads in the pharmacotherapy process prove that nurses spend 40% of their work on the management of medications. This study was aimed at the determination and comparison of safety levels at the nurse-managed stage of the pharmacotherapy process in Poland and Slovakia by identifying the key risk factors which directly affect patient safety. The study involved a group of 1774 nurses, of whom 1412 were from Poland and 362 were from Slovakia. The original Nursing Risk in Pharmacotherapy (acronym: NURIPH) tool was used. The survey questionnaire was made available online and distributed to nurses. The Cronbach's alpha coefficient was 0.832. Nurses from Slovakia most often, i.e., for six out of nine factors (items: one, five, six, seven, eight, and nine), assessed the risk factors as "significant risk (3)", and Polish nurses most often, i.e., for as many as eight out of nine risk factors (items: one, two, three, four, five, six, seven, and nine), assessed the risk factors as "very significant (5)". It has been found that the safety of the pharmacotherapy process is assessed by Polish nurses to be much lower than by Slovak nurses.

Factors affecting physician implementation of hospital pharmacists' medication appropriateness recommendations in older adults

AIMS

Non-implementation of pharmacist recommendations by physician prescribers may prolong potentially inappropriate prescribing in hospitalised older adults, increasing the risk of adverse clinical outcomes. The aim of this study was to ascertain the key factors affecting physician prescriber implementation of pharmacists' medication appropriateness recommendations in hospitalised older adults.

METHODS

Semi-structured interviews were conducted with hospital pharmacists and physicians who provided care to older adults (≥65 years) in 2 acute university teaching hospitals in Ireland. Content analysis was employed to identify the key themes that influence physician prescriber implementation of pharmacist recommendations.

RESULTS

Fourteen interviews were conducted with 6 hospital pharmacists and 8 hospital physicians between August 2018 and August 2019. Five key factors were found to affect physician implementation of pharmacist recommendations: (i) the clinical relevance and complexity of the recommendation-recommendations of higher priority and those that do not require complex decision-making are implemented more readily; (ii) interprofessional communication-recommendations provided verbally, particularly those communicated face to face with confidence and assertion, are more likely to be implemented than written recommendations; (iii) physician role and identity-the grade, specialty, and personality of the physician significantly affect implementation; (iv) knowing each other and developing trusting relationships-personal acquaintance and the development of interprofessional trust and rapport greatly facilitate recommendation implementation; and (v) the hospital environment-organisational issues such as documentation in the patient notes, having the opportunity to intervene, and the clinical pharmacy model all affect implementation.

CONCLUSION

This study provides a deeper understanding of the underlying behavioural determinants affecting physician prescriber implementation of pharmacist recommendations and will aid in the development of theoretically-informed interventions to improve medication appropriateness in hospitalised older adults.

Behavioural changes in medication safety: Consequent to an action research intervention

AIM

To explore the extent to which action research assists developing medication safety behaviours among emergency medicine staff.

BACKGROUND

Health care staff involved in medication therapy are frequently required to implement progressive changes. To permanently improve medication safety, we must consider staff behaviour. This study utilizes action research to engage health care workers and engender behavioural changes.

METHOD

Two cycles of action research were implemented. Data were collected through pre- and post-medication safety surveys, unstructured interviews and field notes. Staff in the emergency department worked together to progress the study cycles.

RESULTS

The pre-evaluation phase revealed deficiencies in staff medication safety behaviour. Subsequent to the implementation of safety initiatives, pre- to post-evaluation comparison indicated significant improvement in medication safety behaviours. In response to qualitative reflection phase data in reflection, ward pharmacists were placed in the emergency department and anew policy on responding to medication error was developed. Analysed field notes revealed improved safe patient care, enhanced pharmaceutical knowledge and changes in the emergency department climate.

CONCLUSIONS

Through action research, this study introduced actions to improve medication safety behaviours in the emergency department. Staff involvement led to changed safety behaviours.

IMPLICATION FOR NURSING MANAGEMENT

This study advises nurse managers of the benefit of pharmacist-led medication therapy, interprofessional medication safety courses and active communication between front-line staff and managers regarding medication safety.