Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa

How much time do nurses in Norwegian emergency departments spend on different work tasks with and without a clinical pharmacist present-a time and motion study

BACKGROUND

The emergency department (ED) is a demanding work environment where nurses undertake a variety of clinical and administrative tasks, including medication-related tasks. The integration of a clinical pharmacist into the ED team represents a complex intervention with potential implications for nurses' distribution of work time, particularly concerning medication-related tasks. This study examined the distribution of work time among ED nurses and assessed the impact of a clinical pharmacist's presence on this distribution, with an emphasis on medication-related work tasks.

METHODS

A direct observational time and motion study was conducted to evaluate the work time distribution of nurses in three Norwegian EDs, applying the Work Observation Method By Activity Timing (WOMBAT) methodology. Time distributions were measured for non-medication-related tasks, medication-related tasks, standby and movement, both in the absence and presence of a clinical pharmacist in the same ED.

RESULTS

A total of 298 h of nursing work time were observed, comprising 138 h without pharmacists present and 160 h with pharmacists present. In the absence of a pharmacist, nurses spent 62.7% of their time on non-medication-related tasks, 34.7% on standby and movement, and 3.3% on medication-related tasks. The introduction of a clinical pharmacist did not significantly change the overall distribution of nurses' work time, although some variations were noted across the EDs.

CONCLUSION

ED nurses in three Norwegian EDs dedicated only 3.3% of their work time to medication-related tasks. The presence of clinical pharmacists did not substantially affect the distribution of nurses' work time.

Improving the provision of clinical pharmacy services in low- and middle-income countries: a qualitative study in tertiary health facilities in Tanzania

Background

The provision of clinical pharmacy services (CPS) in low- and middle-income countries is still low. The reported challenges in providing CPS include healthcare structures, public policies, resources, workforce, culture and education inequalities. This study aimed to explore the strategies to improve the provision of CPS in tertiary health facilities in Tanzania.

Methods

This study was conducted between August and September 2021. We adopted an exploratory qualitative study to conduct 14 in-depth interviews with hospital administrators and 10 focus group discussions (FGDs) with healthcare providers. A purposeful sampling technique was used to recruit 97 participants, including 45 pharmacists, 31 medical doctors and 21 nurses across five tertiary healthcare institutions. Of those, 14 hospital administrators participated in 14 IDIs and 83 healthcare workers divided into 10 FGDs. Analysis was done using a qualitative thematic approach.

Results

The study identified several strategies that fall under four major themes: (i) strengthen preservice training by reviewing the Bachelor of Pharmacy training curriculum to include clinical pharmacy components; (ii) improve continuing professional training through regular provision of on-job training to pharmacists; (iii) revise the scope of work for pharmacists to include CPS provision in the job description; and (iv) improve operational environment by ensuring availability of guidelines, policies, and adequate number of pharmacists and good inter-professional communication skills.

Conclusions

This study's findings highlight that improving CPS provision requires strengthening pharmacists' training, scope of work and operational environment. The latter calls for multifaceted engagement from pharmacists, training institutions, policymakers, regulatory bodies and health systems for sustainable progress.

Exploring interprofessional collaboration in the intensive care unit

Background

Critical care units require an interprofessional management approach to optimise patients' health. Clinical education and training delivered in remote healthcare settings are vital for fostering interprofessional collaboration (IPC) among health science students for future team functioning.

Objectives

Our study explored the IPC among clinicians in the intensive care unit (ICU) setting at two South African decentralised clinical training facilities to understand the existing collaborative practices that students are exposed to during their clinical training.

Method

A qualitative study design, utilising semi-structured interviews, was used to gather information on the experiences of 40 purposively selected participants working in the ICU settings at the two clinical sites. Data collected from the interviews were transcribed verbatim and thematically analysed.

Results

Four major themes were identified from the data, namely, scope-of-practice dispute, teamwork disruption, organisational obstacles and future aspirations.

Conclusion

Participants believed that a lack of professional regard by medical doctors and an inadequate understanding of the role of other professionals impeded appropriate referral practice and collaborative team functioning. Under-exposure to interprofessional education (IPE) at an undergraduate level and the pervasive medical hierarchy were perceived as a primary attributable cause of this phenomenon. Moreover, the coronavirus disease 2019 (COVID-19) pandemic and persistent staff shortages purportedly obstructed potential opportunities to collaborate in multidisciplinary meetings. Participants believed that improving undergraduate IPE and compulsory multidisciplinary meetings to promote communication would improve team functioning in these clinical settings.

Clinical Implications

Undergraduate IPE is a feasible approach to improve collaborative care in ICUs to achieve better patient outcomes.

Getting time and building trust: unveiling the systemic, relational, and personal factors influencing clinical pharmacy service implementation in South Africa, a qualitative study

BACKGROUND

While multidisciplinary teams with clinical pharmacists improve medication use and outcomes, their integration in South Africa faces limitations. A lack of dedicated positions and healthcare professionals' misunderstanding restrict ward activities and hinder full collaboration, limiting their potential to optimize patient care. This study addresses a gap by exploring how perceived healthcare professionals' understanding of clinical pharmacists' roles impacts their motivation and service implementation. Understanding these dynamics, particularly in resource-constrained settings, is crucial for optimizing integration and healthcare delivery.

METHODS

Adopting a constructivist approach, this qualitative study was conducted using focus group discussions. Through purposive sampling clinical pharmacists were recruited across South Africa's public healthcare sector. A semi-structured guide based on previous findings explored how the perceived understanding around clinical pharmacy impacts service delivery and work motivation. Transcripts were analyzed using thematic analysis, guided by the Self-Determination Theory framework. Thematic analysis employed an inductive approach, following an initial preliminary analysis of open and selective coding to develop a coding framework.

RESULTS

Clinical pharmacists (n = 16) reported various challenges impacting service implementation and motivation. Two main themes were identified: (1) Time: Dedicated ward time is crucial for both the proper implementation of clinical services, as well as the clinical pharmacists' motivation; and (2) Trust: Clinical pharmacists experience a lack of trust amongst healthcare professionals in the value of clinical pharmacy services. The themes illustrated mechanisms at work at three levels: systemic (lack of dedicated positions), inter-relational (healthcare professional's misconceptions), and personal (thwarted autonomy).

CONCLUSIONS

Systemic challenges, like the absence of official positions present the biggest obstacle, affecting support, scope of practice, and healthcare professional interactions. While systemic changes are crucial for full integration of clinical pharmacists, in resource-constrained settings fostering autonomous motivation is equally important. This study emphasizes the need for a multi-faceted approach, including policy changes, international collaboration, interprofessional education, and interventions to empower clinical pharmacists for proactive service delivery. By addressing these interconnected challenges, healthcare systems can leverage the full potential of clinical pharmacists, ultimately improving healthcare delivery and patient outcomes.

How Do Pharmacists Distribute Their Work Time during a Clinical Intervention Trial?-A Time and Motion Study

Emergency departments (EDs) handle urgent medical needs for a diverse population. Medication errors and adverse drug events pose safety risks in the ED. Clinical pharmacists, experts in medication use, play a crucial role in identifying and optimizing medication therapy. The aim of this study was to investigate how clinical pharmacists introduced into the ED interdisciplinary teams distribute their work time. In a time and motion study, we used the Work Observation Method By Activity Timing (WOMBAT) to observe pharmacists in two Norwegian EDs. The pragmatic approach allowed pharmacists to adapt to ED personnel and patient needs. The pharmacists spent 41.8% of their work time on medication-related tasks, especially those linked to medication reconciliation, including documenting medication-related issues (16.2%), reading and retrieving written information (9.6%), and obtaining oral information about medication use from patients (9.5%). The remaining time was spent on non-medication-related tasks (41.8%), and on standby and movement (17.4%). In conclusion, ED pharmacists spent 42% of their work time on medication-related tasks, predominantly medication reconciliation. Their relatively new role in the interdisciplinary team may have limited their broader clinical impact. Relative to other ED healthcare professionals, ED pharmacists' goal remains to ensure accurate patient medication lists and appropriate medication use.

Yemeni Physicians' Attitudes and Perceived Barriers Toward Ward-Based Clinical Pharmacist in Hospital Settings

Background

Clinical pharmacy services (CPSs) are still in their infancy in Yemen. Furthermore, pharmacists are not members of a multidisciplinary healthcare team, so their responsibilities are limited to drug dispensing and marketing. This study examines physicians' attitudes and perceived obstacles regarding the inclusion of clinical pharmacists in hospital medical wards.

Methods

A descriptive observational study was carried out using a validated, self-administered bilingual questionnaire. The study's questionnaire was conducted among physicians in three leading hospitals. Those hospitals were at the forefront of establishing clinical pharmacy units and embracing clinical pharmacy services. Data were analyzed using descriptive statistics.

Results

Sixty-five responses were included. Our data results indicated that physicians believed the most important contributions for clinical pharmacists to improve patient care were "attending medical rounds", followed by "order review". About 75% of physicians showed positive attitudes toward the clinical pharmacist role. However, more than 70% of physicians believed that clinical pharmacists should leave patient care to other healthcare professionals and focus on drug products. Not enough clinical pharmacist staff working in the health center was considered the top perceived barrier (83.1%), followed by "clinical pharmacist responsibilities were not clearly defined" and "clinical pharmacist recommendations are not properly documented".

Conclusion

Strategies to expand clinical pharmacy services in Yemen should focus on several key areas. Protocols must be established to clearly outline the collaboration between clinical pharmacists and physicians. Additionally, fostering inter-professional relationships is crucial to overcoming resistance and increasing awareness and understanding of CPS adoption among healthcare team members.

Development of service standards and manpower calculation criteria for hospital clinical pharmacies in South Korea: a survey-based study

BACKGROUND

After the revision of the Korean Pharmaceutical Affairs Act, the certification of specialized pharmacists is scheduled to be legally recognized in 2023. Considering that the specialized pharmacist certification was developed based on the working model of hospital clinical pharmacists, it is necessary to establish standards for clinical pharmacists in hospitals and to calculate appropriate manpower. Through this study, we aim to establish practical standards for clinical pharmacists and propose a method for calculating staffing levels based on an investigation of actual workloads.

METHODS

This survey-based study consisted of two phases. In the first phase, a literature review was conducted to establish standards for clinical pharmacy services, and tasks in relevant literature were classified to identify clinical pharmacy service tasks that are applicable to the practice of Korean hospitals. Additionally, a preliminary survey was conducted to investigate the essential tasks. In the second phase of the investigation, a multicenter survey was conducted targeting pharmacists in facilities with more than 1,000 beds to explore their perceptions and actual workloads related to tasks.

RESULTS

According to the standards for clinical pharmacists in Korea, clinical pharmacy services consist of a total of 23 tasks, of which 16 have been identified as essential tasks. Essential tasks accounted for 93% of the total tasks in clinical pharmacy services. The average full-time equivalent (FTE) through workload calculation was 2.5 ± 1.9 for each field, while the FTE allocated to actual practice was 2.1 ± 1.6. The distribution of each type of clinical pharmacy service was as follows: 77% for medication therapy management, 13% for medication education, 8% for multidisciplinary team activities, and 3% for medication use evaluation.

CONCLUSION

This study identified essential tasks common to clinical pharmacy services across different healthcare institutions. However, the FTE of clinical pharmacists in actual practice was insufficient compared to the required amount. In order to establish and expand clinical pharmacy services in a hospital, it is necessary to ensure an adequate workforce for essential tasks.

Health professionals' experience and perceived obstacles with managing patients' medication information in Norway: cross-sectional survey

BACKGROUND

Access to correct and up to date medication information is crucial for effective patient treatment. However, persistent discrepancies exist. This study examines the experiences and challenges health professionals encounter while utilizing current digital solutions in the Norwegian healthcare system to manage patients' medication information.

METHODS

A cross-sectional descriptive analysis using quantitative survey data was conducted to investigate how health professionals managed patients' medication information. Content analysis was used to analyze free-text responses concerning challenges they encountered when transferring medication information and to identify factors deemed necessary for implementing the Shared Medication List in Norway.

RESULTS

A total of 262 doctors and 244 nurses responded to the survey. A higher percentage of doctors (72.2%) expressed concerns regarding obtaining accurate and updated medication lists than nurses (42.9%), particularly for patients with polypharmacy (35.3%) or transitioning between primary and specialist care services (27.6%). The patient's verbal information was the main source for hospital doctors (17%) to obtain an overview of the patient's medication usage, while general practitioners (19%) and nurses (working in both primary and specialist care services, 28% and 27% respectively) predominantly relied on electronic prescriptions. Doctors, in particular general practitioners, reported carrying excessive responsibilities in coordinating with other health actors (84.8%) and managing patients' medication information. The vast majority of both doctors (84.4%) and nurses (82.0%) were in favor of a Shared Medication List. However, about a third of doctors (36.3%) and nurses (29.8%) expressed the need for a more balanced responsibility in updating and managing patients' medication information, while ensuring compatibility with existing digital systems.

CONCLUSIONS

Fragmented resources for medication information and unclear responsibilities were prevalent concerns among both professional groups. Doctors voiced more concern than nurses about the accuracy of patients' medication list. While both groups are positive about a shared medication list, successful implementation requires proactive training initiatives and clearer role clarification.

Current practices, gaps, and opportunities on the role of clinical pharmacists in cancer pain management: Perspectives from Nepal

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Assessing the accuracy and consistency of ChatGPT in clinical pharmacy management: A preliminary analysis with clinical pharmacy experts worldwide

BACKGROUND

ChatGPT conversation system has ushered in a revolutionary new era of information retrieval and stands as one of the fastest-growing platforms. Clinical pharmacy, as a dynamic discipline, necessitates an advanced comprehension of drugs and diseases. The process of decision-making in clinical pharmacy demands accuracy and consistency in medical information, as it directly affects patient safety.

OBJECTIVE

The objective was to evaluate ChatGPT's accuracy and consistency in managing pharmacotherapy cases across multiple time points. Additionally, input was gathered from global clinical pharmacy experts, and the agreement between ChatGPT's responses and those of clinical pharmacy experts worldwide was assessed.

METHODS

A set of 20 cases of pharmacotherapy was entered into ChatGPT at three different time points. Reliability analysis was performed using inter-rater reliability to measure the accuracy of the output generated by ChatGPT at each time point. Test-retest reliability was performed to measure the consistency of the output generated by ChatGPT across the three time points. Pharmacy expert performance was evaluated, and the overall results were compared.

RESULTS

ChatGPT achieved a hit rate of 70.83% at week 1, 79.2% at week 3, and 75% at week 5. The percent agreement between weeks 1 and 3 was 79.2%, whereas it was 87.5% between weeks 3 and 5, and 83.3% between weeks 1 and 5. In contrast, accuracy rates among clinical pharmacy experts showed considerable variation according to their geographic location. The highest agreement between clinical pharmacist responses and ChatGPT responses was observed at the last time point examined.

CONCLUSIONS

Overall, the analysis suggested that ChatGPT is capable of generating clinically relevant pharmaceutical information, albeit with some variation in accuracy and consistency. It should be noted that clinical pharmacy experts worldwide may provide varying degrees of accuracy depending on their expertise. This study highlights the potential of AI chatbots in clinical pharmacy.