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Remmington C, Cameron L, Hanks F, Liang YH, Barrow L, Coxhead R, Mehta R, Bhudia N, Lyster H, Cooke S, Gilmartin J, Lee P, Sloss R, McKenzie C. Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey. Int J Clin Pharm 2024; 46:854-861. [PMID: 38551749 DOI: 10.1007/s11096-024-01719-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/27/2024] [Indexed: 07/30/2024]
Abstract
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.
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Affiliation(s)
- Christopher Remmington
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK.
| | - Lynda Cameron
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Fraser Hanks
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Ya-Hui Liang
- Pharmacy Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Linda Barrow
- Pharmacy Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Ruth Coxhead
- Pharmacy Department, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Reena Mehta
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Nisha Bhudia
- Pharmacy Department, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas, NHS Foundation Trust, London, UK
| | - Haifa Lyster
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Pharmacy Department, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas, NHS Foundation Trust, London, UK
| | - Sarah Cooke
- Pharmacy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James Gilmartin
- Pharmacy Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Phillisa Lee
- Pharmacy Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rhona Sloss
- Pharmacy Department, Barts Health NHS Trust, London, UK
| | - Cathrine McKenzie
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Department of Pharmacy and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Medicine, University of Southampton, National Institute for Health and Care Research (NIHR), Biomedical Research Centre, Perioperative, and Pharmacy and Critical Care, Southampton and NIHR Wessex Applied Research Collaborative (ARC), Southampton, UK
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Berger V, Reeh M, Scherer M, Härterich S, Möller S, Wansing EMA, van der Linde A, Langebrake C. Enhancing drug therapy in ostomy patients: Best practice recommendations for medication management. PLoS One 2024; 19:e0305047. [PMID: 38843261 PMCID: PMC11156294 DOI: 10.1371/journal.pone.0305047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Ostomy surgery is a common procedure that poses various challenges for patients and healthcare professionals. There are numerous guidelines addressing different ostomy-related problems (ORPs) and supporting an interdisciplinary approach for ostomy care, but evidence-based literature for optimizing drug therapy after ostomy surgery is lacking. AIM To investigate and characterize typical ORPs in relation to drug therapy and provide best practice recommendations from a pharmaceutical point of view. METHODS Patients with an ileo- or colostomy were consecutively enrolled in a prospective, interventional monocentric cohort study during hospitalization, with particular attention to medication. A clinical pharmacist assessed DRPs by performing level 3 medication reviews and patient interviews. Pharmacists' interventions (PIs) were evaluated by two senior clinical pharmacists and documented in DokuPIK (Documentation of Pharmacists' Interventions in the Hospital). Following interdisciplinary discussions, physicians either accepted or rejected the proposed changes in drug therapy. Comparisons were made between ileostomy and colostomy patients regarding type and extent of PIs. RESULTS Out of the 80 patients included in the cohort, 54 (67.5%) had an ileostomy and 26 (32.5%) a colostomy. In this study, 288 PIs were documented (234 ileostomy vs. 54 colostomy), of wich 94.0% were accepted and implemented by the physicians. The most common reason for PIs in both subgroups (29.6% ileostomy vs. 26.1% colostomy) was a missing drug although indicated (e.g. no loperamide, but high stoma output). The proportion of PIs associated with the ostomy was higher in ileostomy patients (48.3% ileostomy vs. 31.5% colostomy; p = 0.025). Typical ORPs were extracted and analyzed as case studies including recommendations for their respective management and prevention. CONCLUSION This study highlights the importance of clinical pharmacists being a part of interdisciplinary teams to collaboratively improve ostomy care and patient safety. Especially ileostomy patients are more vulnerable for ORPs in the context of drug therapy and need to be monitored carefully.
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Affiliation(s)
- Vivien Berger
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Reeh
- Department of General, Abdominal, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Härterich
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Möller
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Annika van der Linde
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Langebrake
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mehta R, Onatade R, Vlachos S, Sloss R, Maharaj R. The association of a critical care electronic prescribing system with the quality of patient care provided by clinical pharmacists - a prospective, observational cohort study. Int J Med Inform 2023; 177:105119. [PMID: 37311293 DOI: 10.1016/j.ijmedinf.2023.105119] [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: 12/30/2022] [Revised: 04/26/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the strong face validity of electronic prescribing (EP), the empiric data in support of improved patient safety is sparse. The objective of this study was to compare the clinical significance of pharmacist contributions between an established EP and paper-based prescribing (PBP) system in the intensive care unit (ICU) to understand the EP impact on the quality of patient care. MATERIALS AND METHODS We conducted a prospective longitudinal study in two 18-bed ICUs; one with EP and the other, PBP. Pharmacist contributions were analysed over three months. Demographic, clinical and adjunctive intervention data were also collected. A multilevel ordinal logistic regression model was used and patients were followed up for 28 days. The primary outcome was the distribution of clinical significance levels of pharmacist contributions. RESULTS There were 303 patients admitted to the ICU between April 1st and June 30th 2018. EP was used in 171 patients and PBP in 132 patients. 1658 contributions were analysed. There were 14.9% highly clinically significant contributions with EP compared to 44.6% with PBP. The EP group had lower odds (OR 0.05, 95% CI 0.02-0.12) for a higher clinical significance contribution compared to the PBP group, but this changed over the admission and differed between groups, with decreasing odds of a higher-level clinical contribution for each additional admission day with PBP (OR 0.57, 95%CI 0.42-0.78). CONCLUSION This study showed a significant difference in the distribution of pharmacist contributions made over time, with clinical significance levels remaining stable in the EP group at low severity, as opposed to PBP which were initially high and then gradually decreased in severity over time. This contemporaneous controlled study found that the EP system required less significant input both in the severity and frequency of pharmacist contributions to maintain patient safety.
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Affiliation(s)
- Reena Mehta
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK; Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | | | - Savvas Vlachos
- Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Cardio-Vascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rhona Sloss
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK; Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Ritesh Maharaj
- Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Health and Social Care Research, King's College London, London, UK; Department of Health Policy, London School of Economics & Political Science, London, UK
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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 2023:10.1007/s11096-023-01559-z. [PMID: 37029858 PMCID: PMC10366025 DOI: 10.1007/s11096-023-01559-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Cheng C, Walsh A, Jones S, Matthews S, Weerasooriya D, Fernandes RJ, McKenzie CA. 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. Int J Clin Pharm 2023; 45:293-303. [PMID: 36367601 PMCID: PMC9650667 DOI: 10.1007/s11096-022-01475-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Seven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls. AIM To optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability. SETTING A tertiary-referral teaching hospital, London, United Kingdom. DEVELOPMENT The seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed. IMPLEMENTATION The service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these. EVALUATION A prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical. The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34-1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome. CONCLUSION Seven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.
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Affiliation(s)
- C Cheng
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK.
- Institute of Pharmaceutical Sciences and Institute of Psychiatry, Psychology, Neurosciences Kings College London, London, SE1 9RT, UK.
| | - A Walsh
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK
| | - S Jones
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK
- Institute of Pharmaceutical Sciences and Institute of Psychiatry, Psychology, Neurosciences Kings College London, London, SE1 9RT, UK
| | - S Matthews
- Pharmacy Department, Medway NHS Foundation Trust, Gillingham, ME7 5NY, UK
| | - D Weerasooriya
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK
| | - R J Fernandes
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK
| | - C A McKenzie
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK
- Institute of Pharmaceutical Sciences and Institute of Psychiatry, Psychology, Neurosciences Kings College London, London, SE1 9RT, UK
- Pharmacy and Critical Care, University Hospital Southampton, Tremona Road, Southampton, S016 6YD, UK
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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] [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,*Correspondence: Zhijian Lin
| | - 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,Bing Zhang
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Althomali A, Altowairqi A, Alghamdi A, Alotaibi M, Althubaiti A, Alqurashi A, Harbi AA, Algarni MA, Haseeb A, Elnaem MH, Alsenani F, Elrggal ME. Impact of Clinical Pharmacist Intervention on Clinical Outcomes in the Critical Care Unit, Taif City, Saudi Arabia: A Retrospective Study. PHARMACY 2022; 10:pharmacy10050108. [PMID: 36136841 PMCID: PMC9498917 DOI: 10.3390/pharmacy10050108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Objectives: Clinical pharmacists are now playing a significant role in hospitals aiming to reduce medication errors, adverse drug reactions, and healthcare costs. Therefore, the main objective of this study was to assess the interventions provided by a clinical pharmacist in the intensive care unit at the King Faisal Hospital in Taif city. (2) Methods: For this single-center retrospective study, patients were included from December 2021 to May 2022. In the present study, all the interventions of clinical pharmacists made over six months were included. The Intensive care unit (ICU) ward was covered by three clinical pharmacists, and the interventions made were categorized into four groups: (1) interventions related to indications; (2) interventions regarding safety; (3) interventions regarding dosing, and (4) miscellaneous. Descriptive statistics was applied to evaluate the results in the form of frequencies and percentages. Analysis was performed using the statistical package SPSS 20.0. (3) Results: Overall, a total of 404 interventions were recommended for 165 patients during the six- month period of study. Among them, 370 interventions (91.5%) were accepted by physicians. Among all the interventions, the majority were suggested regarding ‘indication’ (45.7%), including the addition of drugs, drugs with no indications, and duplication. The acceptance rate of clinical pharmacist intervention was 98.5%. (4) Conclusions: This retrospective study shows that clinical pharmacists played a critical role in optimizing drug therapy which could subsequently help to prevent drug-related issues and lower drug costs. More research is needed to do a thorough cost-benefit analysis.
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Affiliation(s)
- Abdullah Althomali
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Ahmed Altowairqi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Afnan Alghamdi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Musim Alotaibi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | | | | | - Adnan Al Harbi
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Majed Ahmed Algarni
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Abdul Haseeb
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University, Kuantan 53100, Pahang, Malaysia
| | - Faisal Alsenani
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Mahmoud E. Elrggal
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
- Correspondence: or
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8
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Haas CE, Dick TB. Productivity, workload, and clinical pharmacists: Definitions matter. Am J Health Syst Pharm 2022; 79:728-729. [PMID: 35015815 DOI: 10.1093/ajhp/zxac003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Curtis E Haas
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA
| | - Travis B Dick
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA
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9
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Clinical pharmacists' interventions across German hospitals: results from a repetitive cross-sectional study. Int J Clin Pharm 2021; 44:64-71. [PMID: 34402022 PMCID: PMC8866273 DOI: 10.1007/s11096-021-01313-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022]
Abstract
Background Pharmacists’ interventions (PI) are suitable to improve medication safety and optimise patient outcome. However, in Germany, clinical pharmacy services are not yet available nationwide. Aim To gain prospective data on the extent and the composition of routine PI with special focus on intervention rates among German hospital pharmacists during two intervention weeks. Methods Within a repetitive cross-sectional study, clinical pharmacists documented all PIs on five days during a one-month period (intervention week) in 2017 and 2019 using the validated online-database ADKA-DokuPIK. Additionally, data regarding the supply structure/level of medical care, the extent of clinical pharmacy services and their professional experience were collected. All data were anonymised before analysis. Results In total, 2,282 PI from 62 pharmacists (2017) and 2578 PI from 52 pharmacists (2019) were entered. Intervention rate increased from 27.5 PI/100 patient days in 2017 to 38.5 PI/100 patient days in 2019 (p = 0.0097). Frequency of clinical pharmacy services on a daily basis significantly increased from 60% (2017) to 83% (2019). Reasons for PIs from the categories “drugs” (e.g. indication, choice, documentation/transcription) and “dose” were most common in both intervention weeks. The vast majority of underlying medication errors in both intervention weeks were categorised as “error, no harm” (80.3 vs. 78.6%), while the proportion of errors which did not reach the patient, doubled to 39.8% in IW-2019. Conclusion Regular and daily clinical pharmacy services become more established in Germany and clinical pharmacists are increasingly involved in solving drug related problems proactively and early during the medication management process.
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10
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Newsome AS, Murray B, Smith SE, Brothers T, Al-Mamun MA, Chase AM, Rowe S, Buckley MS, Murphy D, Devlin JW. Optimization of critical care pharmacy clinical services: A gap analysis approach. Am J Health Syst Pharm 2021; 78:2077-2085. [PMID: 34061960 PMCID: PMC8195049 DOI: 10.1093/ajhp/zxab237] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Andrea Sikora Newsome
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.,Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Brian Murray
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Todd Brothers
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, RI, and Department of Pharmacy, Roger Williams Medical Center, Providence, RI, USA
| | - Mohammad A Al-Mamun
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Aaron M Chase
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, and Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Sandra Rowe
- Department of Pharmacy, Oregon Health and Science University, Portland, OR, USA
| | - Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - David Murphy
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA, USA
| | - John W Devlin
- Northeastern University School of Pharmacy, Boston, MA, and Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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11
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Johnston K, Ankravs MJ, Badman B, Choo CL, Cree M, Fyfe R, Roberts JA, Xu J, Munro C. Standard of practice in intensive care for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Karlee Johnston
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Australian National University Medical School Garran Australia
- Canberra Hospital Garran Australia
| | - Melissa J. Ankravs
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Unit Royal Melbourne Hospital Parkville Australia
- Department of Medicine and Radiology Melbourne Medical School Royal Melbourne Hospital The University of Melbourne Parkville Australia
| | - Belinda Badman
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Princess Alexandra Hospital Metro South Health Service Brisbane Australia
| | - Chui Lynn Choo
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Services John Hunter Hospital New Lambton Heights Australia
| | - Michele Cree
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Queensland Children’s Hospital and Children’s Health Brisbane Australia
| | - Rachel Fyfe
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department and Intensive Care Unit Barwon Health Geelong Australia
| | - Jason A. Roberts
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Faculty of Medicine & Centre for Translational Anti‐infective Pharmacodynamics School of Pharmacy The University of Queensland Centre for Clinical Research The University of Queensland Brisbane Australia
- Departments of Pharmacy and Intensive Care Medicine Royal Brisbane and Women’s Hospital Brisbane Australia
| | - Jessica Xu
- Critical Care Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Pharmacy Department Fiona Stanley Hospital Perth Australia
| | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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Integrating a pharmacist into an anaesthesiology and critical care department: Is this worthwhile? Int J Clin Pharm 2019; 41:1491-1498. [PMID: 31595449 DOI: 10.1007/s11096-019-00909-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 09/09/2019] [Indexed: 01/25/2023]
Abstract
Background Operating rooms and Intensive Care Units are places where an optimal management of drugs and medical devices is required. Objective To evaluate the impact of a dedicated pharmacist in an academic Anaesthesiology and Critical Care Department. Setting This study was conducted in the Anaesthesiology and Critical Care Department of Grenoble University Hospital. Method Between November 2013 and June 2017, the drug-related problems occurring in three Intensive Care Units and their corrections by a full-time clinical pharmacist were analyzed using a structured order review instrument. Pharmaceutical costs in the Anaesthesiology and Critical Care Department were analyzed over a 7 year period (2010-2016), during which automated dispensing systems and recurrent meetings to review indications of medications and medical devices were implemented in the department. Main outcome measure Analysis of two issues: correcting drug-related problems and containing pharmaceutical costs. Results A total of 324 drug-related problems were identified. The most frequent problem concerned anti-infective agents (45%), and this was mainly due to the over-dosage of drugs (30%). Dosage adjustments were the most frequent interventions performed by the pharmacist (43%). Over the 7 year period, pharmaceutical costs decreased by 9% (€365,469), while the care activity of the department increased by 55% (+ 12,022 surgical procedures and + 1424 admissions in the ICU). Conclusion Integrating a pharmacist into the Anaesthesiology and Critical Care Department was associated with interventions to correct drug-related problems and containing pharmaceutical costs. Pharmacists should play a central role in such medical environments, to optimize the use of drugs and medical devices.
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Rennie T, Anguuo L, Corkhill N, Mubita M, Hunter CJ. A robust tool for recording pharmacist's interventions in a low-resource setting. Eur J Intern Med 2019; 65:e11-e12. [PMID: 31079935 DOI: 10.1016/j.ejim.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Timothy Rennie
- School of Pharmacy, University of Namibia, 340 Mandume Ndemufayo Avenue, Private Bag 13301, Windhoek, Namibia.
| | - Liisa Anguuo
- School of Pharmacy, University of Namibia, 340 Mandume Ndemufayo Avenue, Private Bag 13301, Windhoek, Namibia
| | - Nicola Corkhill
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Pharmacy Department, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK
| | - Mwangana Mubita
- School of Pharmacy, University of Namibia, 340 Mandume Ndemufayo Avenue, Private Bag 13301, Windhoek, Namibia
| | - Christian John Hunter
- School of Medicine, University of Namibia, 340 Mandume Ndemufayo Avenue, Windhoek, Namibia
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Prospective survey-based study on the categorization quality of hospital pharmacists’ interventions using DokuPIK. Int J Clin Pharm 2019; 41:414-423. [DOI: 10.1007/s11096-019-00785-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
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Bourne RS, Shulman R, Jennings JK. Reducing medication errors in critical care patients: pharmacist key resources and relationship with medicines optimisation. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:534-540. [PMID: 29314430 DOI: 10.1111/ijpp.12430] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/24/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medication errors are the most common type of medical errors critical care patients experience. Critical care units utilise a variety of resources to reduce medication errors; it is unknown which resources or combinations thereof are most effective in improving medication safety. OBJECTIVES To obtain UK critical care pharmacist group consensus on the most important interventions/resources that reduce medication errors. To then classify units that participated in the PROTECTED UK study to investigate if there were significant differences in the reported pharmacist prescription intervention type, clinical impact and rates according to unit resource classification. METHODS An e-Delphi process (three rounds) obtained pharmacist consensus on which interventions/resources were most important in the reduction of medication errors in critical care patients. The 21 units involved in the PROTECTED UK study (multicentre study of UK critical care pharmacist medicines interventions), were categorised as high-, medium- and low-resource units based on routine delivery of the final Top 5 interventions/ resources. High and low units were compared according to type, clinical impact and rate of medication interventions reported during the PROTECTED UK study. KEY FINDINGS Consensus on the Top 5 combined medication error reduction resources was established: advanced-level clinical pharmacist embedded in critical care being ranked most important. Pharmacists working on units with high resources made significantly more clinically significant medicines optimisations compared to those on low-resourced units (OR 3.09; P = 0.035). CONCLUSIONS Critical care pharmacist group consensus on the most important medication error reduction resources was established. Pharmacists working on high-resourced units made more clinically significant medicines optimisations.
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Affiliation(s)
- Richard S Bourne
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Rob Shulman
- Pharmacy Department, University College Hospital NHS Foundation Trust, London, UK
| | - Jennifer K Jennings
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
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