Need to develop a legal and ethical base for pharmaceutical care

Impact of a pediatric clinical pharmacist in the pediatric intensive care unit

OBJECTIVE

To study the impact of a clinical pharmacist in a pediatric intensive care unit. The goals of the study were to determine the type and quantity of patient care interventions recommended by a clinical pharmacist and to specifically examine cost savings (or loss) that resulted from clinical pharmacist recommendations.

DESIGN

A prospective case series.

SETTING

Ten-bed pediatric intensive care unit in a university-affiliated children's hospital.

PATIENTS

All patients admitted to the pediatric intensive care unit during the study period.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

During the 24-wk study period, the pediatric clinical pharmacist documented all interventions that occurred during her shift. She rounded with the pediatric intensive care unit team approximately two times a week and reviewed medication lists daily. Drug acquisition costs were used to calculate drug cost savings. Demographic information was collected on all the patients in the pediatric intensive care unit during the study period. There were 35 recommendations per 100 patient days. The most common interventions were dosage changes (28%), drug information (26%), and miscellaneous information (22%). The average time spent per day by the clinical pharmacist in the pediatric intensive care unit was 0.73 hrs or 0.02 full-time equivalent. The total cost direct savings for the study period was $1,977. Extrapolated to direct cost savings per year, the total amount saved was $9,135/year or 0.15 full-time equivalent. Indirect savings from educational activities, avoidance of medication errors, and optimization of medical therapies represent an additional nonquantifiable amount.

CONCLUSION

We conclude that a clinical pharmacist is an important and cost-effective member of the pediatric intensive care unit team.

Pharmaceutical care management: a modern approach to providing seamless and integrated health care

Institutional pharmaceutical services have widely evolved over the past 20-30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualized patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients' hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today's health-care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health-care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.

Methods to assess the economic outcomes of clinical pharmacy services

Studies that demonstrate the clinical and economic burden of drug misadventures have been published. The economic burden of drug misadventures likely exceeds $100 billion annually in the United States alone. Clinical pharmacy services (CPS) have been shown to reduce negative clinical outcomes and costs of drug therapy. Pharmacy practitioners and pharmacy managers need to demonstrate the impact of CPS at the local level and present the value to financial decision-makers to gain support for implementation, continuation, and/or expansion of those services. The basic model of an economic evaluation includes measurement of both costs and consequences of a service and of an alternative for comparison. Strategies for economic assessments include the generalization from previously published literature, use of modeling techniques, and measurement of actual costs and consequences of an existing service. Guidelines for conducting an economic assessment are widely available. Pharmacy practitioners and managers should use these methods of assessing economic outcomes of CPS and, at the same time, develop relationships and skills to effectively communicate the value of those services so as to ensure long-term success.

Pharmacists' perceptions of a set of pharmaceutical care practice standards

OBJECTIVE

This study assessed pharmacists' perceptions of the feasibility and relevance of a set of community-based pharmaceutical care practice standards.

DESIGN

Practice standards generated in a Delphi study were rated for feasibility of implementation and relevance to improving therapeutic outcomes by a randomized sample of 315 pharmacists on two 7-point Likert-type scales. These ratings were compared with assessments by Delphi panel experts.

RESULTS

Pharmacists judged many of the standards favorably; however, Kruskal-Wallis ANOVA revealed that they were less confident in the standards' feasibility of implementation and relevance to improving patient outcomes than were the Delphi panel experts.

CONCLUSION

Pharmacists appear ready to accept a majority of the practice standards used in this study. The lower ratings by respondent pharmacists may be indicative of apprehension about embracing a new practice paradigm and a belief that the provision of pharmaceutical care services has a limited impact on therapeutic outcomes.