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Hilgarth H, Wichmann D, Baehr M, Kluge S, Langebrake C. Clinical pharmacy services in critical care: results of an observational study comparing ward-based with remote pharmacy services. Int J Clin Pharm 2023; 45:847-856. [PMID: 37029858 PMCID: PMC10366025 DOI: 10.1007/s11096-023-01559-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/15/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Pharmacists are essential team members in critical care and contribute to the safety of pharmacotherapy for this vulnerable group of patients, but little is known about remote pharmacy services in intensive care units (ICU). AIM We compared the acceptance of pharmacist interventions (PI) in ICU patients working remotely with ward-based service. We evaluated both pharmacy services, including further information on PI, including reasons, actions and impact. METHOD Over 5 months, a prospective single-centre observational study divided into two sequential phases (remote and ward-based) was performed on two ICU wards at a university hospital. After a structured medication review, PI identified were addressed to healthcare professionals. For documentation, the national database (ADKA-DokuPIK) was used. Acceptance was used as the primary endpoint. All data were analysed using descriptive methods. RESULTS In total, 605 PI resulted from 1023 medication reviews. Acceptance was 75% (228/304) for remote and 88% (265/301; p < 0.001) for ward-based services. Non-inferiority was not demonstrated. Most commonly, drug- (44% and 36%) and dose-related (36% and 35%) reasons were documented. Frequently, drugs were stopped/paused (31% and 29%) and dosage changed (31% and 30%). PI were classified as "error, no harm" (National Coordinating Council for Medication Error Reporting and Prevention [NCC MERP] categories B to D; 83% and 81%). The severity and clinical relevance were at least ranked as "significant" (68% and 66%) and at least as "important" for patients (77% and 83%). CONCLUSION The way pharmacy services are provided influences the acceptance of PI. Remote pharmacy services may be seen as an addition, but acceptance rates in remote services failed to show non-inferiority.
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Affiliation(s)
- Heike Hilgarth
- Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Baehr
- Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Langebrake
- Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Stem Cell Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Wang Y, Rao Y, Yin Y, Li Y, Lin Z, Zhang B. A bibliometric analysis of global trends in the research field of pharmaceutical care over the past 20 years. Front Public Health 2022; 10:980866. [PMID: 36324463 PMCID: PMC9618714 DOI: 10.3389/fpubh.2022.980866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/30/2022] [Indexed: 01/25/2023] Open
Abstract
Pharmaceutical care is essential in building up the basics of public health and clinical care. A comprehensive understanding of global status in the field of pharmaceutical care is necessary for directing its research frontiers and future trends. Therefore, this study aims to make a bibliometric analysis to track the development of pharmaceutical care research worldwide during the past two decades. The publications regarding pharmaceutical care were culled from the Web of Science Core Collection (WoSCC). Countries, institutions, authors, journals, references, and keywords in this field were visually analyzed by using VOSviewer (version 1.6.17) and CiteSpace (Version 5.8.R3). As a result, 3,597 publications (3,177 articles and 420 reviews) were obtained. The annual yields grew more than three times in the past two decades, from 54 records in 2002 to 379 papers in 2021. The United States played the leading role in this research from multiple aspects, including publication (n = 1,208), citations (n = 28,759), funding agencies, and collaboration worldwide. The University of Sydney in Australia was the most contributed institution with the greatest number of publications (n = 112) in pharmaceutical care research. Hersberger KE from the University of Basel was the most productive author (n = 40). Chen TF from the University of Sydney was the author who owed the highest H-index of 19 and most citations (n = 1,501). They both significantly impacted this field. American Journal of Health System Pharmacy produced the most publications, while Pharmacotherapy had the highest IF (IF2020 = 4.705) in this field. Clusters networks of co-cited references and keywords suggested that clinical pharmacy is an essential theme in pharmaceutical care. Terms of medication safety and critical care recognized by burst analysis of keywords also hint at the recent attention on clinical pharmacy. The present bibliometrics analysis may provide a comprehensive overview and valuable reference for future researchers and practitioners in the research field of pharmaceutical care.
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Affiliation(s)
- Yu Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yifei Rao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yuling Yin
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yaolei Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Zhijian Lin
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
- Center for Pharmacovigilance and Rational Use of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Bing Zhang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
- Center for Pharmacovigilance and Rational Use of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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3
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Gemmechu WD, Eticha EM. Factors influencing the degree of physician-pharmacists collaboration within governmental hospitals of Jigjiga Town, Somali National Regional State, Ethiopia, 2020. BMC Health Serv Res 2021; 21:1269. [PMID: 34819071 PMCID: PMC8611947 DOI: 10.1186/s12913-021-07301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Collaboration is the way to deliver the desired health outcome for the patients or service users in the healthcare. Inter-professional collaboration can improve medication safety, patient outcome and minimize healthcare costs. This study aimed to explore the degree of collaboration and factors influencing collaboration between physicians and pharmacists within the public hospitals of Jigjiga town, Somali National Regional State, Ethiopia, 2020. METHODS A cross-sectional study qualitative was conducted among 149 participants in the two governmental hospitals of the Jigjiga town with a response rate of 79.87%. The collaborative working relationship model and the physician-pharmacist collaborative instrument with three main exchange domains (trustworthiness, role specification, and relationship initiation) and collaborative care items were used. An independent sample t-test was used to compute the differences of the mean scores of physician-pharmacist collaborative instrument domains and collaborative care. Separate multiple regression was employed to assess factors influencing collaborative care for pharmacists and physicians. RESULTS This study showed that pharmacists reported higher mean of collaborative care (10.66 ± 4.75) than physicians (9.17 ± 3.92). The multiple regression indicated that area of practice influence both professionals' collaborative practice. A significant association between collaborative care and the two PPCI domains (trustworthiness and relationship initiation for the physicians; role specification and relationship initiation for pharmacists) was established. CONCLUSIONS The study showed that the collaboration between the physicians and pharmacists was sub-optimal and the exchange variables had a significant influence on their collaboration. RECOMMENDATION Physicians and pharmacists need to exert more efforts to enhance this collaboration. Further qualitative study might be needed to search for factors affecting, barriers and how to develop collaborative practice.
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Affiliation(s)
- Workineh Diriba Gemmechu
- College of Medicine and Health Science, School of Medicine, Jigjiga University, Jigjiga, Ethiopia
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4
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Lumb PD, Adler DC, Al Rahma H, Amin P, Bakker J, Bhagwanjee S, Du B, Bryan-Brown CW, Dobb G, Gingles B, Jacobi J, Koh Y, Razek AA, Peden C, Shrestha GS, Shukri K, Singer M, Taylor P, Williams G. International Critical Care-From an Indulgence of the Best-Funded Healthcare Systems to a Core Need for the Provision of Equitable Care. Crit Care Med 2021; 49:1589-1605. [PMID: 34259443 DOI: 10.1097/ccm.0000000000005188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Philip D Lumb
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Bombay, India
| | | | | | - Bin Du
- Peking Union Medical College, Beijing, China
| | | | - Geoffrey Dobb
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | | | | | - Younsuck Koh
- University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Carol Peden
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Khalid Shukri
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | | | - Phil Taylor
- World Federation of Intensive and Critical Care (WFICC)
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Toukhy A, Fayed S, Sabry N, Shawki M. The Impact of an Established Pharmaceutical Care Pathway on Drug Related Problems in an Intensive Care Unit. Am J Med Sci 2021; 362:143-153. [PMID: 33745978 DOI: 10.1016/j.amjms.2021.03.007] [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: 08/20/2020] [Revised: 01/19/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence of drug related problems (DRPs) in intensive care units (ICU) is higher compared to any other wards in the hospital, requiring a structured pathway to ensure optimum detection of DRPs. The study aimed to evaluate the impact of implementing a pharmaceutical care pathway on the detection and management of DRPs in an ICU. METHODS The study was conducted in a general ICU and included three phases: tool preparation phase included the development of a core measures reference pathway and daily working scenario flow-charts, a control phase where the patient files and pharmacists' case assessment notes were retrospectively reviewed to detect the rate of DRPs before pathway implementation and a prospective phase similar to the control phase but with the implementation of the new pathway. The number and classification of DRPs and required core measures in the control and implementation phases were documented. RESULTS Using the new pathway, the detection of unmet core measures increased from 7.3% in the control phase to 99% in the implementation phase (p-value <0.001). The prevalence of unidentified DRPs/1000 patients' service days decreased from 98.1 in the control phase to 27.08 in the implementation phase (p-value <0.001). However, there was no significant difference between the phases regarding mortality rate and length of ICU stay. CONCLUSIONS The implementation of a unified pharmaceutical care pathway improved the detection of DRPs in ICU patients.
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Affiliation(s)
- Asia Toukhy
- Clinical Pharmacy Department, Al Haram Hospital, Giza, Egypt
| | - Said Fayed
- Anesthesia and Intensive Care Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Nirmeen Sabry
- Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Giza, Egypt.
| | - May Shawki
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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Beks H, Namara KM, Manias E, Dalton A, Tong E, Dooley M. Hospital pharmacists' experiences of participating in a partnered pharmacist medication charting credentialing program: a qualitative study. BMC Health Serv Res 2021; 21:251. [PMID: 33740978 PMCID: PMC7980669 DOI: 10.1186/s12913-021-06267-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Medication-related errors are one of the most frequently reported incidents in hospitals. With the aim of reducing the medication error rate, a Partnered Pharmacist Medication Charting (PPMC) model was trialled in seven Australian hospitals from 2016 to 2017. Participating pharmacists completed a credentialing program to equip them with skills to participate in the trial as a medication-charting pharmacist. Skills included obtaining a comprehensive medication history to chart pre-admission medications in collaboration with an admitting medical officer. The program involved both theoretical and practical components to assess the competency of pharmacists. METHODS A qualitative evaluation of the multi-site PPMC implementation trial was undertaken. Pharmacists and key informants involved in the trial participated in an interview or focus group session to share their experiences and attitudes regarding the PPMC credentialing program. An interview schedule was used to guide sessions. Transcripts were analysed using a pragmatic inductive-deductive thematic approach. RESULTS A total of 125 participants were involved in interviews or focus groups during early and late implementation data collection periods. Three themes pertaining to the PPMC credentialing program were identified: (1) credentialing as an upskilling opportunity, (2) identifying the essential components of credentialing, and (3) implementing and sustaining the PPMC credentialing program. CONCLUSIONS The PPMC credentialing program provided pharmacists with an opportunity to expand their scope of practice and consolidate clinical knowledge. Local adaptations to the PPMC credentialing program enabled pharmacists to meet the varying needs and capacities of hospitals, including the policies and procedures of different clinical settings. These findings highlight key issues to consider when implementation a credentialing program for pharmacists in the hospital setting.
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Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong, Victoria, Australia.
| | - Kevin Mc Namara
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | - Andrew Dalton
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Erica Tong
- Alfred Health, Prahran, Victoria, Australia
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AbuRuz S, Jaber D, Basheti I, Sadeq A, Arafat M, AlAhmad M, Said A. Impact of pharmacist interventions on drug-related problems in general surgery patients: a randomised controlled trial. Eur J Hosp Pharm 2020; 28:e72-e78. [PMID: 32661104 DOI: 10.1136/ejhpharm-2020-002206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/07/2020] [Accepted: 06/08/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The inappropriate use of medications is harmful and is a common issue in hospitalised patients. Patients hospitalised in general surgery wards are usually at high risk for drug-related problems (DRPs). This randomised controlled trial aimed to explore the value of a pharmaceutical care service conducted in general surgery wards in the identification and reduction of DRPs in comparison with standard medical care. METHODS This study was conducted in general surgery wards including abdominal, cardiovascular, vascular, endocrine, orthopaedic and oncological surgeries at one of the largest teaching hospitals in Jordan over a period of 6 months. Recruited patients were randomised into intervention or control groups. Clinical pharmacists assessed patients' DRPs and submitted recommendations to resolve the identified DRPs in the intervention group. RESULTS Patients in the intervention group (n=63) and the control group (n=60) had a mean age of 55±14.4 years, with 52.0% being women. A total of 1062 DRPs were identified, with a mean of 8.6±3.6 per patient (intervention group, 8.65±4.2; control group, 8.62±2.6; p=0.56). The commonly identified DRPs included safety (20.2%) and efficacy (19.0%) issues. The acceptance rate for pharmacists' recommendations by physicians was very high (90%) with a good DRP correction rate of 58.9% during patients' hospital stay. The value of pharmaceutical care was significantly reflected in the achievement of the therapeutic outcomes and prevention of morbidity (resolved/improved or prevented) of 68.2% (24.2%+44%) in the intervention group compared with 19.2% (12.4%+6.8%) in the control group (p<0.001). CONCLUSIONS This study shows that DRPs are common among general surgery patients in Jordan, especially those related to drug safety and efficacy. Pharmacists' recommendations contributed substantially to resolving most of the identified DRPs and had a significant impact on improving medications used in general surgery patients.
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Affiliation(s)
- Salah AbuRuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates .,Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Deema Jaber
- Department of Clinical Pharmacy, School of Pharmacy, Zarqa University, Zarqa, Amman, Jordan
| | - Iman Basheti
- Department of Clinical Pharmacy and Therapeutics, Applied Science University, Amman, Jordan
| | - Aya Sadeq
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Mosab Arafat
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Mohammad AlAhmad
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Amira Said
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
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Nasir BB, Gezahegn GT, Muhammed OS. Degree of physician-pharmacist collaboration and influencing factors in a teaching specialized hospital in Ethiopia. J Interprof Care 2020; 35:361-367. [PMID: 32619158 DOI: 10.1080/13561820.2020.1777953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several studies have found that physician-pharmacist collaboration improves medication therapy outcomes. This study aimed to measure the degree of physician-pharmacist collaboration in Ethiopia, to identify associated factors, and to determine barriers to their collaboration. A cross-sectional study was conducted among 299 health professionals (246 physicians and 53 pharmacists) in Tikur Anbessa Specialized Hospital, Ethiopia. The Collaborative Working Relationship Model and the Physician-Pharmacist Collaborative Instrument (PPCI) with three main exchange characteristics (trustworthiness, role specification, and relationship initiation), and collaborative care items were used. Barriers to collaboration and areas that need further collaboration were assessed. Multiple regression was used to assess influencing factors. This study revealed that, in Ethiopia, physicians had higher PPCI mean scores on collaborative care items (4.22 ± 1.35) compared to pharmacists (3.25 ± 0.86). Areas of practice and relationship initiation were the two influencing factors for collaboration among pharmacists. But for physicians, age, areas of practice, educational qualification, role specification, and trustworthiness were the factors associated with collaboration. Lack of face-to-face communication and fragmentation of care were the common barriers. However, the vast majority of members of both professions believed that collaboration should be developed in their future practice. Their current collaboration seems suboptimal, and exchange characteristics, which reflect interactions between the practitioners, had a significant influence on their collaboration in addition to other factors.
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Affiliation(s)
- Beshir Bedru Nasir
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getahun Tigistie Gezahegn
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Oumer Sada Muhammed
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Cvikl M, Sinkovič A. Interventions of a clinical pharmacist in a medical intensive care unit - A retrospective analysis. Bosn J Basic Med Sci 2020; 20:495-501. [PMID: 32070269 PMCID: PMC7664781 DOI: 10.17305/bjbms.2020.4612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/08/2020] [Indexed: 12/01/2022] Open
Abstract
Several studies demonstrated a significant decrease in prescription errors, adverse drug events, treatment costs and improved patient outcomes, when a clinical pharmacist (CP) was a full member of a multidisciplinary team in the intensive care unit (ICU). Our aim was to evaluate the activities of a CP, included in a 12-bed medical ICU team of a university hospital in the course of several months. We conducted a retrospective analysis of all the CP’s interventions from March 2017 to November 2017, carried out and documented after reviewing and discussing patients’ medical data with the treating ICU physicians. We identified four main categories of CP’s interventions: pharmacotherapy adjustments to kidney function (PAKF category), drug-drug interactions (DDIs category), therapeutic monitoring of drugs with narrow therapeutic index (TDM category), and drug administration by the nasogastric tube (NGT category). During the study period, 533 patients were admitted to the medical ICU. The CP reviewed the medical data of 321 patients and suggested 307 interventions in 95 patients. There were 147 interventions of the PAKF category, 57 interventions of the TDM category, 30 interventions of the NGT category, and 22 interventions of the DDIs category. Fifty-one interventions were unspecified. The majority of all interventions (203/307) were related to antimicrobial drugs. ICU physicians completely accepted 80.2% of the CP’s suggestions. We observed that regular participation of the CP in the medical ICU team contributed to more individualized and improved pharmacological treatment of patients. Therefore, ICU teams should be encouraged to include CPs as regular team members.
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Affiliation(s)
- Maja Cvikl
- Central Pharmacy, University Medical Centre Maribor, Maribor, Slovenia
| | - Andreja Sinkovič
- Department of Medical Intensive Care, University Medical Centre Maribor, Maribor, Slovenia
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Newby B. Expanding the role of pharmacy technicians to facilitate a proactive pharmacist practice. Am J Health Syst Pharm 2019; 76:398-402. [DOI: 10.1093/ajhp/zxy065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
This study describes a change in pharmacy practice to expand pharmacy technician roles to allow dispensing without a pharmacist check, thereby enhancing the pharmacist role in direct patient care.
Summary
In an effort to optimize patient care with limited resources, we set out to change our pharmacy practice model. We transferred duties that did not require clinical judgment in the dispensary from the pharmacist to the regulated technician. The transferred roles included order entry, order entry verification, and final check of medications and preparations. The changes in roles were well received by the pharmacy staff. The pharmacist practice changed from a reactive process, where the pharmacist waited for orders to be sent to the pharmacy, to a proactive process where the pharmacist collaborated directly with patients and the health care team. The pharmacists were able to provide daily medication therapy management for every inpatient in the new practice model compared with only reactive targeted care in the former practice model. Implementation of the new practice model at our site led to a reduction in time for medications to be delivered to the patient and reduced pharmacy-related medication errors.
Conclusion
A new pharmacy practice model was successfully implemented whereby the pharmacy technician roles were expanded to the point where they perform all the distribution roles in the dispensary. This, in turn, allowed a change in the pharmacist role, which was focused on daily proactive direct patient care and medication therapy management.
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Affiliation(s)
- Brandi Newby
- Neonatal and Pediatric Pharmacy, Surrey Memorial Hospital, BC, Canada
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Cross VJ, Parker JT, Law Min MCYL, Bourne RS. Pharmacist prescribing in critical care: an evaluation of the introduction of pharmacist prescribing in a single large UK teaching hospital. Eur J Hosp Pharm 2018; 25:e2-e6. [PMID: 31157059 PMCID: PMC6457156 DOI: 10.1136/ejhpharm-2017-001267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the introduction of pharmacist independent prescribing activity across three general critical care units within a single large UK teaching hospital. To identify the prescribing demographics including total of all prescriptions, number prescribed by pharmacists, reason for pharmacist prescription, range of medications prescribed, pharmacist prescribing error rate and the extent of pharmacist second 'clinical check'. METHODS Retrospective evaluation of e-prescribing across all general critical care units of a single large UK teaching hospital. All prescribing data were downloaded over a 1-month period (May to June 2016) with analysis of pharmacist prescribing activity including rate, indication, therapeutic class and error rate. RESULTS In total, 5374 medicines were prescribed in 193 patients during the evaluated period. Prescribing pharmacists were available on the units on 60.4% (58/96) of days, during their working hours and accounted for 576/5374 (10.7%) of medicines prescribed in 65.2% (126/193) of patients. The majority (342/576) of pharmacist prescriptions were for new medicines. Infections, central nervous system, and nutrition/blood were the top three British National Formulary (BNF) therapeutic categories, accounting for 63.4% (349/576) of all pharmacist prescriptions. The critical care pharmacist prescribing error rate was 0.18% (1/550). CONCLUSIONS Pharmacist independent prescribers demonstrated a high degree and wide-ranging scope of prescribing activity in general critical care patients. Pharmacists contributed a significant proportion of total prescribing, despite less than full service coverage. Prescribing activity was also safe with a very low error rate recorded.
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Affiliation(s)
- Verity J Cross
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - James T Parker
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Marie-Christine Y L Law Min
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Richard S Bourne
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
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Bourne RS, Shulman R, Tomlin M, Borthwick M, Berry W, Mills GH. Reliability of clinical impact grading by healthcare professionals of common prescribing error and optimisation cases in critical care patients. Int J Qual Health Care 2017; 29:250-255. [PMID: 28453820 DOI: 10.1093/intqhc/mzx003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 01/12/2017] [Indexed: 11/12/2022] Open
Abstract
Objective To identify between and within profession-rater reliability of clinical impact grading for common critical care prescribing error and optimisation cases. To identify representative clinical impact grades for each individual case. Design Electronic questionnaire. Setting 5 UK NHS Trusts. Participants 30 Critical care healthcare professionals (doctors, pharmacists and nurses). Intervention Participants graded severity of clinical impact (5-point categorical scale) of 50 error and 55 optimisation cases. Main Outcome Measures Case between and within profession-rater reliability and modal clinical impact grading. Methods Between and within profession rater reliability analysis used linear mixed model and intraclass correlation, respectively. Results The majority of error and optimisation cases (both 76%) had a modal clinical severity grade of moderate or higher. Error cases: doctors graded clinical impact significantly lower than pharmacists (-0.25; P < 0.001) and nurses (-0.53; P < 0.001), with nurses significantly higher than pharmacists (0.28; P < 0.001). Optimisation cases: doctors graded clinical impact significantly lower than nurses and pharmacists (-0.39 and -0.5; P < 0.001, respectively). Within profession reliability grading was excellent for pharmacists (0.88 and 0.89; P < 0.001) and doctors (0.79 and 0.83; P < 0.001) but only fair to good for nurses (0.43 and 0.74; P < 0.001), for optimisation and error cases, respectively. Conclusions Representative clinical impact grades for over 100 common prescribing error and optimisation cases are reported for potential clinical practice and research application. The between professional variability highlights the importance of multidisciplinary perspectives in assessment of medication error and optimisation cases in clinical practice and research.
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Affiliation(s)
- Richard S Bourne
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield S5 7 AU, UK
| | - Rob Shulman
- Pharmacy Department, University College Hospital NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK
| | - Mark Tomlin
- Departments of Pharmacy and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Rd, Southampton SO16 6YD, UK
| | - Mark Borthwick
- Departments of Pharmacy and Critical Care, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Will Berry
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7 EH, UK
| | - Gary H Mills
- Departments of Critical Care and Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield S5 7 AU, UK
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Ljubojević G, Miljković B, Bućma T, Ćulafić M, Prostran M, Vezmar Kovačević S. Problems, interventions, and their outcomes during the routine work of hospital pharmacists in Bosnia and Herzegovina. Int J Clin Pharm 2017; 39:743-749. [PMID: 28597173 DOI: 10.1007/s11096-017-0491-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
Background In the last 30 years, activities of hospital pharmacists have gone through significant changes. Pharmacists are increasingly involved in patient care. Objectives To explore drug-related and logistic problems, interventions, and their outcomes during routine everyday work of hospital pharmacists. Setting Institute for physical medicine and rehabilitation, Banja Luka, Bosnia and Herzegovina. Methods In the period of January 2013-October 2015 a prospective observational study was performed. Medical doctors, nurses, therapists, and patients addressed pharmacists, face-to-face or by telephone, with drug-related problems (DRPs) and/or logistic issues. Main outcome measure Type of DRP or logistic issue, intervention, outcome, initiator and time spent for solving the problem were documented for each consultation. Results Out of 1515 interventions, 48.8% were aimed at solving DRPs. The most common DRPs were the recommendation of a drug or dose and need for additional information about drugs. Drug price and supply were the most prevalent logistic issues. DRPs were more frequently initiated by medical doctors and required more time to solve the problem compared to logistic issues (Mann-Whitney U test, p ≤ 0.001, respectively). The acceptance rate of interventions to solve DRPs (83.7%) was lower compared to logistic issues (95.2%; p ≤ 0.001). Conclusions Hospital pharmacists were faced with an approximately equal number of DRPs and logistic issues during their routine everyday work. The overall acceptance rate of pharmacists' interventions was high, and the results of our study indicate that there is a need for more involvement of hospital pharmacists in Bosnia and Herzegovina in clinical activities. Impact on practice.
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Affiliation(s)
- Gordana Ljubojević
- Institute for Physical Medicine and Rehabilitation, Dr Miroslav Zotović, Banja Luka, Bosnia and Herzegovina
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, 11000, Serbia
| | - Tatjana Bućma
- Institute for Physical Medicine and Rehabilitation, Dr Miroslav Zotović, Banja Luka, Bosnia and Herzegovina
| | - Milica Ćulafić
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, 11000, Serbia
| | - Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sandra Vezmar Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, 11000, Serbia.
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Katada Y, Nakagawa S, Minakata K, Odaka M, Taue H, Sato Y, Yonezawa A, Kayano Y, Yano I, Nakatsu T, Sakamoto K, Uehara K, Sakaguchi H, Yamazaki K, Minatoya K, Sakata R, Matsubara K. Efficacy of protocol-based pharmacotherapy management on anticoagulation with warfarin for patients with cardiovascular surgery. J Clin Pharm Ther 2017; 42:591-597. [PMID: 28503837 DOI: 10.1111/jcpt.12560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/20/2017] [Indexed: 01/21/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Anticoagulation therapy with warfarin requires periodic monitoring of prothrombin time-international normalized ratio (PT-INR) and adequate dose adjustments based on the data to minimize the risk of bleeding and thromboembolic events. In our hospital, we have developed protocol-based pharmaceutical care, which we called protocol-based pharmacotherapy management (PBPM), for warfarin therapy. The protocol requires pharmacists to manage timing of blood sampling for measuring PT-INR and warfarin dosage determination based on an algorithm. This study evaluated the efficacy of PBPM in warfarin therapy by comparing to conventional pharmaceutical care. METHODS From October 2013 to June 2015, a total of 134 hospitalized patients who underwent cardiovascular surgeries received post-operative warfarin therapy. The early series of patients received warfarin therapy as the conventional care (control group, n=77), whereas the latter received warfarin therapy based on the PBPM (PBPM group, n=68). These patients formed the cohort of the present study and were retrospectively analysed. RESULTS The indications for warfarin included aortic valve replacement (n=56), mitral valve replacement (n=4), mitral valve plasty (n=22) and atrial fibrillation (n=29). There were no differences in patients' characteristics between both groups. The percentage time in therapeutic range in the first 10 days was significantly higher in the PBPM group (47.1%) than that in the control group (34.4%, P<.005). The average time to reach the steady state was significantly (P<.005) shorter in the PBPM group compared to the control group (7.3 vs 8.6 days). WHAT IS NEW AND CONCLUSION Warfarin therapy based on our novel PBPM was clinically safe and resulted in significantly better anticoagulation control compared to conventional care.
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Affiliation(s)
- Y Katada
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - S Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - K Minakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M Odaka
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - H Taue
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Y Sato
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - A Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Y Kayano
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - I Yano
- Department of Pharmacy, Kobe University Hospital, Kobe, Japan
| | - T Nakatsu
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Sakamoto
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Uehara
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - H Sakaguchi
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Yamazaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - R Sakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Matsubara
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
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15
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Al-Jumaili AA, Al-Rekabi MD, Doucette W, Hussein AH, Abbas HK, Hussein FH. Factors influencing the degree of physician-pharmacist collaboration within Iraqi public healthcare settings. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 25:411-417. [PMID: 28181318 DOI: 10.1111/ijpp.12339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 11/28/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Medication safety and effectiveness can be improved through interprofessional collaboration. The goals of this study were to measure the degree of physician-pharmacist collaboration within Iraqi governmental healthcare settings and to investigate factors influencing this collaboration. METHODS This cross-sectional study was conducted in Al-Najaf Province using the Collaborative Working Relationship Model and Physician-Pharmacist Collaborative Instrument (PPCI). Four pharmacists distributed paper surveys with a 7-point Likert scale to a convenience sample of physicians and pharmacists working in seven public hospitals and two outpatient clinics. The questionnaire (in English) covered individual (demographics, practising years and academic affiliation), context (practice setting) and PPCI characteristics (trustworthiness, role specification and relationship initiation) in addition to collaborative care items: one for pharmacists and one for physicians. Separate multiple regressions were used to assess the association of the factors with collaborative care for physicians and for pharmacists. KEY FINDINGS Seventy-seven physicians and 86 pharmacists returned usable surveys (81.5% response rate). The majority of physicians were male (84%), while the majority of pharmacists were female (58%). The mean age of the physicians was (37.99 years) older than that of the pharmacists (30.35 years). The physicians had a longer period of practice (11.32 years) than pharmacists (5.45 years). Most (90%) of the providers were practising in hospitals. Pharmacist academic affiliation was significantly associated with collaborative care. The pharmacist and physician regressions indicated significant (P < 0.05) associations between collaborative care and two PPCI domains (role specification and relationship initiation for physicians; role specification and trustworthiness for pharmacists). CONCLUSIONS This study focused on physician-pharmacist collaboration within hospitals, and it was the first study measuring interprofessional collaboration in Iraq. The results showed there is physician-pharmacist collaboration within Iraqi hospitals and exchange characteristics had significant influence on this collaboration.
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Affiliation(s)
- Ali Azeez Al-Jumaili
- The University of Iowa College of Pharmacy, Health Service Research Division, Iowa City, IA, USA
| | | | - William Doucette
- The University of Iowa College of Pharmacy, Health Service Research Division, Iowa City, IA, USA
| | - Ahmed H Hussein
- Faculty of Pharmacy, Humanity Studies University College, Al-Najaf, Iraq
| | - Hayder K Abbas
- Faculty of Pharmacy, Humanity Studies University College, Al-Najaf, Iraq
| | - Furqan H Hussein
- Faculty of Pharmacy, Humanity Studies University College, Al-Najaf, Iraq
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16
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Swieczkowski D, Mogielnicki M, Merks P, Gruchala M, Jaguszewski M. Pharmaceutical services as a tool to improve outcomes in patients with cardiovascular diseases. Int J Cardiol 2016; 222:238-241. [PMID: 27497101 DOI: 10.1016/j.ijcard.2016.07.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/28/2016] [Indexed: 01/23/2023]
Abstract
Despite the presence of effective and safe pharmacotherapy, and availability of multidimensional non-pharmacological treatment, the overall rate of major adverse cardiovascular outcomes remains still unsatisfactory. The clinical pharmacy activities and pharmaceutical care available in the community pharmacy settings have a significant impact on outcomes in cardiovascular patients, e.g. adherence, the level of blood pressure, total cholesterol or patients' health literacy. Pharmaceutical care in patients diagnosed with cardiovascular diseases remains beneficial both to the patients and the entire health care system. However, the prediction of results of pharmacists' interventions is particularly difficult and random. Many factors contribute to outcomes of community pharmacy services, e.g. time spent with the patients or quality of communication between patients and healthcare professionals. The most important issue in delivering effective pharmaceutical care is to develop an evidence-based model. Globally, the development of interprofessional collaboration between physicians and pharmacists, and preparing more sophisticated pharmacoeconomics analyses in the scope of pharmaceutical care are the next step in the improvement of advanced pharmaceutical services. Further research, particularly based on real data on this highly interesting topic is needed and recommended.
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Affiliation(s)
- Damian Swieczkowski
- First Department of Cardiology, Medical University of Gdansk, Debinki 7, 80-211 Gdansk, Poland; Department of Pharmaceutical Technology, Faculty of Pharmacy, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, dr. A. Jurasza 2, 85-089 Bydgoszcz, Poland
| | - Mariusz Mogielnicki
- Oceanic - Research and Development Laboratory, Łokietka 58, 81-736 Sopot, Poland
| | - Piotr Merks
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, dr. A. Jurasza 2, 85-089 Bydgoszcz, Poland
| | - Marcin Gruchala
- First Department of Cardiology, Medical University of Gdansk, Debinki 7, 80-211 Gdansk, Poland
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Debinki 7, 80-211 Gdansk, Poland.
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17
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Langebrake C, Ihbe-Heffinger A, Leichenberg K, Kaden S, Kunkel M, Lueb M, Hilgarth H, Hohmann C. Nationwide evaluation of day-to-day clinical pharmacists' interventions in German hospitals. Pharmacotherapy 2015; 35:370-9. [PMID: 25884525 DOI: 10.1002/phar.1578] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY OBJECTIVE To describe and evaluate the extent and diversity of nationwide data from clinical pharmacists' interventions (PIs) in German hospitals. DESIGN Retrospective analysis. DATA SOURCE The ADKA-DokuPIK German database, a national anonymous self-reported Internet-based documentation system for routine PIs as well as for medication errors reported by German hospital pharmacists. MEASUREMENTS AND MAIN RESULTS Data sets from ADKA-DokuPIK entered between January 2009 and December 2012 were analyzed descriptively. A total of 27,610 PIs were entered, mainly by ward-based clinical pharmacists (82.5%). Most of the PIs were performed on surgical wards (37.8%), followed by anesthesiology/intensive care unit/intermediate care unit and internal medicine. The most prevalent therapeutic subgroup that was the trigger for the PIs was antibacterials for systemic use (13.9%), followed by antithrombotic agents, analgesics, drugs for acid-related disorders, and agents acting on the renin-angiotensin system. About a quarter of interventions (23.4%) were performed due to inappropriate use of drugs, followed by use of a wrong dose or administration interval (22.1%), resulting in the most frequently taken actions of change of dose, change of drug, and drug stopped/paused (withheld). Altogether, the implementation rate of the PIs was 85.5%. Underlying medication errors were predominantly classified as "error, no harm" according to the National Coordinating Council for Medication Error Reporting and Prevention. CONCLUSION For the first time in a European country, our findings show the scope of clinical pharmacist involvement in patient care in daily clinical practice and demonstrate the usefulness and importance of their proactive interventions in the prevention of hazards and risks for hospital inpatients.
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Affiliation(s)
- Claudia Langebrake
- Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Johansen ET, Haustreis SM, Mowinckel AS, Ytrebø LM. Effects of implementing a clinical pharmacist service in a mixed Norwegian ICU. Eur J Hosp Pharm 2015; 23:197-202. [PMID: 31156848 DOI: 10.1136/ejhpharm-2015-000751] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/13/2015] [Accepted: 11/02/2015] [Indexed: 11/04/2022] Open
Abstract
Objectives An unacceptably high proportion of patients admitted to intensive care units (ICUs) develop drug-related problems (DRPs). DRPs might cause harm and increase costs and length of stay. The implementation of a clinical pharmacist service has been shown to detect a high number of DRPs and contributes effectively to solving these across different healthcare systems. However, this has not been prospectively studied in a mixed tertiary Norwegian ICU. Methods During a 12-month period from October 2012, a clinical pharmacist was dedicated to review medications 3 h daily (Monday to Friday). DRPs were reported at the ICU conference and included advice by the pharmacist for each case. All DRPs were categorised and the clinical impact was documented for later analysis. Drug-related questions from the staff were categorised and answered. Results 363 of 549 patients admitted to the ICU received medication reviews. 641 DRPs were detected in 194 of these patients (mean 1.8 DRPs per patient, range 0-25). Too high a dose, significant drug interactions and unnecessary or inappropriate drugs were among the most frequently detected DRPs. 87% of advice given by the pharmacist was accepted or taken into consideration. Typical questions from the nursing staff were related to drug preparation, generic equivalents and drug administration. Questions from doctors were most frequently related to drug dosage, efficiency and adverse effects. Conclusions The addition of a dedicated clinical pharmacist to the ICU team improves the quality and safety of medication in a mixed Norwegian ICU.
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Affiliation(s)
- Elisabeth T Johansen
- Hospital Pharmacy of North Norway Trust, University Hospital of North Norway, Tromsø, Norway
| | - Stine M Haustreis
- Hospital Pharmacy of North Norway Trust, University Hospital of North Norway, Tromsø, Norway
| | - Ann S Mowinckel
- Hospital Pharmacy of North Norway Trust, University Hospital of North Norway, Tromsø, Norway
| | - Lars M Ytrebø
- Critical Care Unit, University Hospital of North Norway and Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
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19
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Bourne RS, Whiting P, Brown LS, Borthwick M. Pharmacist independent prescribing in critical care: results of a national questionnaire to establish the 2014 UK position. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2015; 24:104-13. [PMID: 26420309 DOI: 10.1111/ijpp.12219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Clinical pharmacist practice is well established in the safe and effective use of medicines in the critically ill patient. In the UK, independent pharmacist prescribers are generally recognised as a valuable and desirable resource. However, currently, there are only anecdotal reports of pharmacist-independent prescribing in critical care. The aim of this questionnaire was to determine the current and proposed future independent prescribing practice of UK clinical pharmacists working in adult critical care. METHODS The questionnaire was distributed electronically to UK Clinical Pharmacy Association members (closed August 2014). KEY FINDINGS There were 134 responses to the questionnaire (response rate at least 33%). Over a third of critical care pharmacists were practising independent prescribers in the specialty, and 70% intended to be prescribers within the next 3 years. Pharmacists with ≥5 years critical care experience (P < 0.001) or worked in a team (P = 0.005) were more likely to be practising independent prescribers. Pharmacists reported significant positives to the use of independent prescribing in critical care both in patient care and job satisfaction. Independently, prescribing was routine in: dose adjustment for multi-organ failure, change in route or formulation, correction prescribing errors, therapeutic drug monitoring and chronic medication. The majority of pharmacist prescribers reported they spent ≤5% of their clinical time prescribing and accounted for ≤5% of new prescriptions in critical care patients. CONCLUSIONS Most critical care pharmacists intend to be practising as independent prescribers within the next 3 years. The extent and scope of critical care pharmacist prescribing appear to be of relatively low volume and within niche prescribing areas.
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Affiliation(s)
- Richard S Bourne
- Department of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul Whiting
- Department of Anaesthesia and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lisa S Brown
- Department of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mark Borthwick
- Critical Care, Departments of Pharmacy and Critical Care, Oxford University Hospitals NHS Trust, Oxford, UK
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20
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Shulman R, McKenzie CA, Landa J, Bourne RS, Jones A, Borthwick M, Tomlin M, Jani YH, West D, Bates I. Pharmacist's review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK). J Crit Care 2015; 30:808-13. [PMID: 25971871 DOI: 10.1016/j.jcrc.2015.04.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose was to describe clinical pharmacist interventions across a range of critical care units (CCUs) throughout the United Kingdom, to identify CCU medication error rate and prescription optimization, and to identify the type and impact of each intervention in the prevention of harm and improvement of patient therapy. MATERIALS AND METHODS A prospective observational study was undertaken in 21 UK CCUs from November 5 to 18, 2012. A data collection web portal was designed where the specialist critical care pharmacist reported all interventions at their site. Each intervention was classified as medication error, optimization, or consult. In addition, a clinical impact scale was used to code the interventions. Interventions were scored as low impact, moderate impact, high impact, and life saving. The final coding was moderated by blinded independent multidisciplinary trialists. RESULTS A total of 20517 prescriptions were reviewed with 3294 interventions recorded during the weekdays. This resulted in an overall intervention rate of 16.1%: 6.8% were classified as medication errors, 8.3% optimizations, and 1.0% consults. The interventions were classified as low impact (34.0%), moderate impact (46.7%), and high impact (19.3%); and 1 case was life saving. Almost three quarters of interventions were to optimize the effectiveness of and improve safety of pharmacotherapy. CONCLUSIONS This observational study demonstrated that both medication error resolution and pharmacist-led optimization rates were substantial. Almost 1 in 6 prescriptions required an intervention from the clinical pharmacist. The error rate was slightly lower than an earlier UK prescribing error study (EQUIP). Two thirds of the interventions were of moderate to high impact.
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Affiliation(s)
- R Shulman
- University College London Hospitals NHS Foundation Trust, Pharmacy, London, NW1 2BU, United Kingdom.
| | - C A McKenzie
- Institute of Pharmaceutical Sciences, Kings College London, London, SE1 9NH, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, Pharmacy and Critical Care, London, SE1 7EH, United Kingdom
| | - J Landa
- Guy's and St Thomas' NHS Foundation Trust, Pharmacy and Critical Care, London, SE1 7EH, United Kingdom
| | - R S Bourne
- Sheffield Teaching Hospitals NHS Foundation Trust, Pharmacy, Sheffield, S5 7AU, United Kingdom
| | - A Jones
- Guy's and St Thomas' NHS Foundation Trust, Pharmacy and Critical Care, London, SE1 7EH, United Kingdom
| | - M Borthwick
- Oxford University Hospitals NHS Trust, Pharmacy, Oxford, OX3 7LE, United Kingdom
| | - M Tomlin
- University Hospitals Southampton NHS Foundation Trust, Pharmacy, Southampton, SO16 6YD, United Kingdom
| | - Y H Jani
- University College London Hospitals NHS Foundation Trust, Pharmacy, London, NW1 2BU, United Kingdom; UCL School of Pharmacy, London WC1N 1AX, United Kingdom
| | - D West
- UCL School of Pharmacy, London WC1N 1AX, United Kingdom
| | - I Bates
- UCL School of Pharmacy, London WC1N 1AX, United Kingdom
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