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Amir M, Zehra A, Munawar R, Gul W, Fatima T, Khan Y, Jaffery R, Babar ZUD. Economic evaluation of clinical pharmacy service using integrated health system in tertiary care hospital. Expert Rev Pharmacoecon Outcomes Res 2024; 24:533-539. [PMID: 38362677 DOI: 10.1080/14737167.2024.2319593] [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: 05/06/2022] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Clinical pharmacy services are the specialized practices of pharmacists to provide pharmaceutical care. All these activities are documented as pharmacist interventions to avoid medication errors which occur during prescribing, dispensing, and administration. The purpose of this study is to conduct an economic analysis of the pharmacist interventions using integrated health system. RESEARCH DESIGN AND METHODS A retrospective study was conducted in a tertiary care hospital. Pharmacist interventions were analyzed by an independent pharmacist. Cost-saving and cost avoidance analyses were carried out for drug-related interventions. Economic analysis was performed and tabulated both in PKR and USD. RESULTS Out of 1330 interventions, 1250 (95%) interventions were accepted and changed the prescription upon the physician-pharmacist consultation while 71 (5%) were not accepted. Interventions related to prescribing and duplication errors were the highest of all (30 and 29% respectively). Pharmacist interventions were recorded with a 95% acceptance rate. Cost analysis showed that pharmacist interventions saved around 105,115.88 US dollars. CONCLUSION Clinical pharmacy services provided by integrated health system are a cost saving program. The cost saved per intervention for our study is around USD 37 which is more than another similar study which quoted USD 30.35 per intervention.
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Affiliation(s)
- Muhammad Amir
- Department of Pharmacy Services, Lady Reading Hospital-MTI, Peshawar, Pakistan
| | - Ale Zehra
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabya Munawar
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Wajiha Gul
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Tehreem Fatima
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Younas Khan
- Department of Pharmacy Services, Lady Reading Hospital-MTI, Peshawar, Pakistan
| | - Razia Jaffery
- Department of Pharmacy Practice, Salim Habib University, Karachi, Pakistan
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Salimnejad S, Schultheis JM, Wolcott MD, Mando-Vandrick JD, Yang S, Lee HJ, Kram BL. Simulation-Based Training to Improve Clinical Pharmacist Self-Efficacy in the Management of a Rapidly Decompensating Patient. J Pharm Pract 2023; 36:1118-1124. [PMID: 35418269 DOI: 10.1177/08971900221088784] [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] [Indexed: 11/17/2022]
Abstract
Background: The optimal training method to prepare pharmacists as an integral rapid response team or cardiopulmonary arrest responders is poorly described. This study assessed the utility of simulation-based training (SBT) as a training technique for clinical pharmacists. Objective: This study aimed to determine if attending SBT is associated with an improvement in self-efficacy. Methods: This single-center, prospective, interventional cohort study offered three simulations to clinical pharmacists over the course of seven months at a 957-bed quaternary care academic medical center. Pharmacists who participated in at least one simulation were categorized in the intervention group and were compared to pharmacists who did not attend a simulation. All participants were asked to complete a 19-question self-efficacy survey in the form of a 100-point scale, a 15-question multiple-choice knowledge assessment, and a perception survey in the form of 4-point Likert scale administered at baseline and following the conclusion of the SBT. Results: Forty-four clinical pharmacists participated; 20 in the intervention group and 24 in the control group. Median change in self-efficacy score improved significantly in the intervention group compared to the control group (14.3 vs 2.3, P = .009). Median change in perception score improved significantly (2 vs 0, P = .046). Knowledge score did not change significantly from baseline. Conclusion: Simulation-based training improved clinical pharmacist self-efficacy and perceptions in the care of rapidly decompensating patients. These findings support SBT as a viable modality of training clinical pharmacists for the management of rapidly decompensating patients.
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Affiliation(s)
| | | | - Michael D Wolcott
- Division Of Primary Care, High Point University School of Dental Medicine, High Point, NC, USA
| | | | - Siyun Yang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Bridgette L Kram
- Department of Pharmacy, Duke University Hospital, Durham, NC, USA
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Rubbo B, Saville C, Dall'Ora C, Turner L, Jones J, Ball J, Culliford D, Griffiths P. Staffing levels and hospital mortality in England: a national panel study using routinely collected data. BMJ Open 2023; 13:e066702. [PMID: 37197808 DOI: 10.1136/bmjopen-2022-066702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES Examine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups. DESIGN Retrospective observational study of routinely available data. SETTING AND PARTICIPANTS 138 National Health Service hospital trusts that provided general acute adult services in England between 2015 and 2019. OUTCOME MEASURE Standardised mortality rates were derived from the Summary Hospital level Mortality Indicator data set, with observed deaths as outcome in our models and expected deaths as offset. Staffing levels were calculated as the ratio of occupied beds per staff group. We developed negative binomial random-effects models with trust as random effects. RESULTS Hospitals with lower levels of medical and allied healthcare professional (AHP) staff (e.g, occupational therapy, physiotherapy, radiography, speech and language therapy) had significantly higher mortality rates (rate ratio: 1.04, 95% CI 1.02 to 1.06, and 1.04, 95% CI 1.02 to 1.06, respectively), while those with lower support staff had lower mortality rates (0.85, 95% CI 0.79 to 0.91 for nurse support, and 1.00, 95% CI 0.99 to 1.00 for AHP support). Estimates of the association between staffing levels and mortality were stronger between-hospitals than within-hospitals, which were not statistically significant in a within-between random effects model. CONCLUSIONS In additional to medicine and nursing, AHP staffing levels may influence hospital mortality rates. Considering multiple staff groups simultaneously when examining the association between hospital mortality and clinical staffing levels is crucial. TRIAL REGISTRATION NUMBER NCT04374812.
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Affiliation(s)
- Bruna Rubbo
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
| | - Chiara Dall'Ora
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
| | - Lesley Turner
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jane Ball
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - David Culliford
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
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Iqbal MJ, Mohammad Ishaq G, Assiri AA. Connecting Pharmacists and Other Health Care Providers (HCPs) towards Drug Therapy Optimization: A Pharmaceutical Care Approach. Int J Clin Pract 2023; 2023:3336736. [PMID: 36713950 PMCID: PMC9867584 DOI: 10.1155/2023/3336736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Pharmaceutical care services offered by pharmacists rationalize drug therapy, improve patient quality of life, and save patients' lives. This study was designed to optimize patient drug therapy through pharmaceutical care services offered by a pharmacist in consultation with other health care providers (HCPs) at a tertiary care hospital. METHODS This descriptive study was conducted to assess the role and effectiveness of pharmacists in optimizing drug therapy outcomes. The study was carried out at an internal and pulmonary medicine unit of a tertiary care hospital in Srinagar, Jammu and Kashmir, India, with a total of 50 health care providers (HCPs) (24 doctors, 16 nurses, and 10 pharmacists). A total of 182 patients (males and females) of all age groups were recruited into the study over a period of nine months. Patient-specific pharmaceutical care plans initiated by the pharmacist based on drug therapy-related needs and problems were used to address and optimize drug therapy outcomes in consultation with other HCPs. RESULTS A total of 388 drug-related problems (DRPs) with an average of 2.29 DRPs per patient were identified, for which 258 pharmaceutical care plans as interventions were proposed, out of which 233 (90.31%) were accepted and implemented. Preassessment and postassessment by HCPs on services rendered by the pharmacist showed a positive change in attitude among HCPs with respect to their endorsement and acceptance of the pharmacist's services in providing direct patient care. CONCLUSIONS Pharmaceutical care services offered by pharmacists helped in optimizing drug therapy and patient care.
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Affiliation(s)
- Mir Javid Iqbal
- Department of Pharmaceutical Sciences, College of Pharmacy, Northeastern University, Boston, USA
| | - Geer Mohammad Ishaq
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, India
| | - Abdullah A. Assiri
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia
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Bassett E, Frantzen L, Zabel K. Evaluation of Pharmacist Renal Dose Adjustments and Planning for Future Evaluations of Pharmacist Services. Hosp Pharm 2021; 56:416-423. [PMID: 34720140 DOI: 10.1177/0018578720918363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Clinical pharmacy services are known to improve patient outcomes. Pharmacists contribute to patient care in the acute care setting in multiple ways, including providing advice and information to patients and the health care team, performing medication histories to prevent waste and support medication adherence, analyzing the cost-effectiveness of medications, and ensuring patient safety through patient monitoring and medication review. Specific clinical pharmacist services include managing intravenous to oral medication adjustments, renal dose adjustments, and performing pharmacokinetic dosing of medications, among others. Many of these clinical services are performed daily but are not evaluated for clinical quality or compliance with policies. Evaluating these clinical services may provide a multitude of benefits to pharmacy departments, health systems, and patients. Methods: The purpose of this study was to evaluate pharmacist use and percent compliance of a renal dose adjustment policy upon initial order verification and discharge. This was completed through retrospective chart review to determine if dose adjustments were made appropriately and descriptive statistics were used to establish pharmacist compliance. Those orders that were inappropriately adjusted were analyzed for trends that could lead to possible policy improvements or pharmacist education opportunities. The completed evaluation also led to the development of an evaluation system that can be utilized to routinely assess clinical pharmacist services. Conclusions: The results of this study are being used to develop and support future clinical service evaluations, inspire process improvements, and improve patient outcomes and pharmacist accountability.
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Affiliation(s)
| | | | - Katie Zabel
- HealthEast St. Joseph's Hospital, St. Paul, MN, USA
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Saadah LM, Khan AH, Syed Sulaiman SA, Bashiti IA. Maximizing acceptance of clinical pharmacy recommendations to reduce length of hospital stay in a private hospital from Amman, Jordan. BMC Health Serv Res 2021; 21:937. [PMID: 34496856 PMCID: PMC8424814 DOI: 10.1186/s12913-021-06966-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Clinical pharmacy interventions (CPI) usually require prior medical authorization. Physicians approve 80% of CPI and reject 20%. If pharmacists show that physicians should authorize all 100% CPI, the profession will step closer to a fully independent prescriber status. This study used an artificial neural network (ANN) model to determine whether clinical pharmacy (CP) may improve outcomes associated with rejected CPI. Method This is a non-interventional, retrospective analysis of documented CPI in a 100-bed, acute-care private hospital in Amman, Jordan. Study consisted of 542 patients, 574 admissions, and 1694 CPI. Team collected demographic and clinical data using a standardized tool. Input consisted of 54 variables with some taking merely repetitive values for each CPI in each patient whereas others varying with every CPI. Therefore, CPI was consolidated to one rejected and/or one accepted per patient per admission. Groups of accepted and rejected CPI were compared in terms of matched and unmatched variables. ANN were, subsequently, trained and internally as well as cross validated for outcomes of interest. Outcomes were length of hospital and intensive care stay after the index CPI (LOSTA & LOSICUA, respectively), readmissions, mortality, and cost of hospitalization. Best models were finally used to compare the two scenarios of approving 80% versus 100% of CPI. Variable impacts (VI) automatically generated by the ANN were compared to evaluate the effect of rejecting CPI. Main outcome measure was Lengths of hospital stay after the index CPI (LOSTA). Results ANN configurations converged within 18 s and 300 trials. All models showed a significant reduction in LOSTA with 100% versus 80% accepted CPI of about 0.4 days (2.6 ± 3.4, median (range) of 2 (0–28) versus 3.0 ± 3.8, 2 (0–30), P-value = 0.022). Average savings with acceptance of those rejected CPI was 55 JD (~ 78 US dollars) and could help hire about 1.3 extra clinical pharmacist full-time equivalents. Conclusions Maximizing acceptance of CPI reduced the length of hospital stay in this model. Practicing Clinical Pharmacists may qualify for further privileges including promotion to a fully independent prescriber status.
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Affiliation(s)
- Loai M Saadah
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia. .,Department of Clinical Pharmacy, Ibn Al Haytham Hospital, Amman, Hashemite Kingdom of Jordan. .,Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences University Pharmacy, 11931, Amman, Hashemite Kingdom of Jordan.
| | - Amer H Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Iman A Bashiti
- Department of Clinical Pharmacy, Ibn Al Haytham Hospital, Amman, Hashemite Kingdom of Jordan.,Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences University Pharmacy, 11931, Amman, Hashemite Kingdom of Jordan
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Bednall R, White S, Mills E, Thomson S. Validation of a hospital clinical pharmacy workforce calculator: A methodology for pharmacy? Int J Clin Pract 2021; 75:e13932. [PMID: 33305382 DOI: 10.1111/ijcp.13932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/08/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The benefits of clinical pharmacy services are established within hospital practice but staff numbers required for service delivery are not well described and staffing levels vary. The need for a consistent, objective method of determining staffing levels was recognised at a UK University Hospital and a Clinical Pharmacy Workforce Calculator (CPWC) was developed. OBJECTIVE To develop the Activity Standard (AS) for pharmaceutical care and establish the reliability of the CPWC across acute hospital settings in UK. SETTING Acute hospital in-patient clinical pharmacy services on medical and surgical wards. METHOD Using the World Health Organisation's Workload Indicators of Staffing Need (WISN) methodology, a two-round Delphi study was undertaken. This developed the Activity Standard for pharmaceutical care and identified the staff-time unavailable for clinical work. Consenting panel members then tested the CPWC, calculating the staff required for three scenarios to determine whether it could be reliably used by different operators. RESULTS Thirty-six participants consented to participate. Data were returned from 22 (61%) of whom 20 (56%) supplied analysable data. Consensus was achieved on the tasks required for pharmaceutical care delivery, the mean time each takes, how frequently they should be completed and the time unavailable for clinical work for each grade of staff. The CPWC calculates staffing requirements using these data. Eleven participants (55%) tested the CPWC and analysis of responses demonstrated that 30 of 33 (91%) calculations were accurately completed. DISCUSSION This study defined the WISN Activity Standard for UK pharmaceutical care delivery to hospital inpatients and showed content validity for the CPWC in acute medical and surgical hospital settings. Different operators used the CPWC reliably and applied it to local sites. CONCLUSION The CPWC offers hospital pharmacy managers a useful tool to negotiate adequate staffing to deliver pharmaceutical care. Its development methodology could be applied widely in pharmacy practice.
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Affiliation(s)
- Ruth Bednall
- Royal Stoke University Hospital, United Hospitals of North Midlands, Newcastle-under-Lyme, UK
| | - Simon White
- School of Pharmacy & Bioengineering, Keele University, Newcastle-under-Lyme, UK
| | | | - Susan Thomson
- Royal Stoke University Hospital, United Hospitals of North Midlands, Newcastle-under-Lyme, UK
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Lanier C, Moss J, Tunney R, Baird R, Kelly K. Clinical Pharmacy Practice Patterns Among North Carolina Rural Hospitals. J Pharm Pract 2019; 34:279-286. [PMID: 31422734 DOI: 10.1177/0897190019866325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Rural hospitals are isolated without adequate funding needed to provide for clinical services offered at larger health systems. The purpose of this study is to determine the clinical pharmacy services available and desired by rural hospitals in North Carolina. METHODS This prospective, cross-sectional, survey was distributed to a cohort of rural pharmacy directors and managers at rural hospitals across North Carolina. Data collected pertained to characteristics of the hospital and pharmacy, pharmacy director, clinical services, and responder impressions on their ability to maintain or enhance clinical services. Responses were summarized utilizing descriptive statistics and free-responses were coded for similar themes. RESULTS Seventeen respondents (32.6%) completed the survey. Clinical activities varied, as did characteristics of the hospitals and staff. Improved patient care is the primary reason why hospital pharmacies expand their clinical participation (46.7%). Pharmacy directors believed growth of clinical activities was a long-term goal while reporting regulations, staff, and finances as barriers to growth. CONCLUSION Clinical pharmacy services vary in NC rural hospitals. Directors exhibit a willingness to expand clinical responsibilities. Rural hospital pharmacy directors desire pharmacists to be active clinically in patient care, but face barriers in reaching that goal.
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Affiliation(s)
- Cameron Lanier
- 233484Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
- 385561Harnett Health System, Dunn, NC, USA
| | - Jason Moss
- 233484Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
- 385561Harnett Health System, Dunn, NC, USA
| | - Robert Tunney
- 233484Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
- Vidant Health, Greenville, SC, USA
| | | | - Kim Kelly
- 233484Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
- 385561Harnett Health System, Dunn, NC, USA
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Newsome AS, Smith SE, Jones TW, Taylor A, Van Berkel MA, Rabinovich M. A survey of critical care pharmacists to patient ratios and practice characteristics in intensive care units. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1163] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Andrea S. Newsome
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
- Department of Pharmacy; Augusta University Medical Center; Augusta Georgia
| | - Susan E. Smith
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
| | - Timothy W. Jones
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
| | - Ashley Taylor
- Department of Clinical and Administrative Pharmacy; The University of Georgia College of Pharmacy; Athens Georgia
- Department of Pharmacy; Augusta University Medical Center; Augusta Georgia
| | | | - Marina Rabinovich
- Department of Pharmacy and Clinical Nutrition; Grady Health System; Atlanta Georgia
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Thomson C, Gunther M, Macek P. Clinical Pharmacists in Correctional Facilities: A Literature Review and Future Directions. JOURNAL OF CORRECTIONAL HEALTH CARE 2019; 25:201-213. [DOI: 10.1177/1078345819852044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Mary Gunther
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Peter Macek
- Alberta Health Services, Edmonton, Alberta, Canada
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Feih J, Peppard WJ, Katz M. Pharmacist involvement on a rapid response team. Am J Health Syst Pharm 2019; 74:S10-S16. [PMID: 28213382 DOI: 10.2146/ajhp160076] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The effect of a pharmacist on a rapid response team (RRT) was investigated. METHODS This study evaluated 234 patients before and 157 patients after pharmacist involvement on an RRT. The primary outcome was time to medication administration, with a goal turnaround time of less than 30 minutes. Secondary outcomes included most frequently used medications, readmissions to the intensive care unit (ICU) within 48 hours, number of rapid responses that resulted in ICU admission, length of hospital stay, and survival to hospital discharge. Additionally, pharmacist interventions were tracked in the postinterventional group. RESULTS The preinterventional group screened 326 rapid response events, of which 234 were included for analysis; during the postinterventional phase, 256 rapid response events were evaluated, of which 157 were included. The primary outcome, median time to medication administration from central pharmacy, was lower in the postinterventional group compared with the preinterventional group (32.0 minutes versus 64.5 minutes, p = 0.004). ICU admission rates following rapid response were not significantly different between the two groups. Additionally, there were no significant differences between rates of medical emergency and survival to hospital discharge. The most common medications administered were metoprolol and naloxone. Pharmacists provided documentation for 90 of 157 (57%) patient cases. In the 90 cases with documentation, 18 (20% of patients) had documented pharmacist interventions, including dosing assistance for 8 cases (44% of interventions). CONCLUSION The addition of a pharmacist to an RRT reduced time to medication administration, helped improve medication accessibility, and helped optimize medication selection and dosing.
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Affiliation(s)
- Joel Feih
- Cardiovascular Intensive Care Unit, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - William J Peppard
- Surgical Intensive Care Unit, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - Michael Katz
- Medical Intensive Care Unit, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
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Cho US, Song YJ, Jung YM, Choi KS, Lee E, Lee E, Han MK. Effects of Medication Reconciliation and Cost Avoidance Analysis by Clinical Pharmacists in a Neurocritical Care Unit. JOURNAL OF NEUROCRITICAL CARE 2018. [DOI: 10.18700/jnc.180064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Flanagan PS, Barns A. Current perspectives on pharmacist home visits: do we keep reinventing the wheel? INTEGRATED PHARMACY RESEARCH AND PRACTICE 2018; 7:141-159. [PMID: 30319952 PMCID: PMC6171762 DOI: 10.2147/iprp.s148266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The scope of clinical pharmacy services available in outpatient settings, including home care, continues to expand. This review sought to identify the evidence to support pharmacist provision of clinical pharmacy services in a home care setting. Seventy-five reports were identified in the literature that provided evaluation and description of clinical pharmacy home visit services available around the world. Based on results from randomized controlled trials, pharmacist home visit interventions can improve patient medication adherence and knowledge, but have little impact on health care resource utilization. Other literature reported benefits of a pharmacist home visit service such as patient satisfaction, improved medication appropriateness, increased persistence with warfarin therapy, and increased medication discrepancy resolution. Current perspectives to consider in establishing or evaluating clinical pharmacy services offered in a home care setting include: staff competency, ideal target patient population, staff safety, use of technology, collaborative relationships with other health care providers, activities performed during a home visit, and pharmacist autonomy.
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Affiliation(s)
- Priti S Flanagan
- Pharmacy Community Programs, Lower Mainland Pharmacy Services, Langley, BC, Canada,
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada,
| | - Andrea Barns
- Pharmacy Community Programs, Lower Mainland Pharmacy Services, Langley, BC, Canada,
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Sidhu S, Gorman SK, Slavik RS, Ramsey T, Bruchet N, Murray S. Positive and Negative Impacts of a Continuing Professional Development Intervention on Pharmacist Practice: A Balanced Measure Evaluation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 37:215-222. [PMID: 29140819 DOI: 10.1097/ceh.0000000000000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Evaluations of behavior change interventions aimed at improving professional practice are increasingly focused on impacts at the practice and patient outcome levels. Many of these evaluations assume that if the intended changes occur, the result represents an improvement. However, given the systemic nature of clinical practice, a change in one area can produce changes in other areas as well, some of which may adversely affect the patient. Balancing measures are used to determine whether unintended consequences of an intervention have been introduced into other areas of the system. The aims of this study were to evaluate the impact of behavior change intervention-based continuing professional development (CPD) on pharmacist interventions (resolution of drug therapy problems-DTPs) and resolution of quality indicator DTPs and knowledge change for urinary tract infections (UTI) and pneumonia. As a balancing measure, we aimed to determine whether delivery of behavior change interventions targeting pneumonia and UTI practice results in a negative impact on other important pharmacist interventions, specifically the resolution of heart failure DTPs. METHODS A quasiexperimental study was conducted at a Canadian health authority that evaluated the impacts of an 8-week multifaceted behavior change intervention delivered to 58 ward-based pharmacists. The primary outcome was change in proportion of UTI and pneumonia DTPs resolved from the 6-month preintervention to 6-month postintervention phase. Secondary outcomes were changes in proportion of UTI and pneumonia quality indicator DTPs resolved, knowledge quiz scores, and proportion of quality indicator DTPs resolved for heart failure as a balancing measure. RESULTS A total of 58 pharmacists were targets of the intervention. The proportion of resolved UTI and pneumonia DTPs increased from 17.8 to 27.2% (relative risk increase 52.8%, 95% confidence interval [CI] 42.8-63.6%; P < 0.05). The proportion of resolved UTI and pneumonia quality indicator DTPs increased from 12.2% to 18.2% (relative risk increase 49.9%, 95% CI 34.5-67.0%; P < 0.05). Resolved heart failure DTPs decreased from 14.3 to 8.5% (RRR 40.4%, 95% CI 33.9-46.2%; P < 0.05). Thirty-six pharmacists completed the pre- and post-quiz. Scores increased from 11.3/20 ± 3.2/20 to 14.8/20 ± 2.9/20 (P < 0.05). DISCUSSION CPD using a multifaceted behavior change intervention improved pharmacist behavior and knowledge for UTI and pneumonia. However, these improvements may be offset by reduced interventions for other disease states, such as heart failure. Strategies to mitigate the unintended effects on other professional behaviors should be implemented when delivering CPD focused on changing one aspect of professional behavior.
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Affiliation(s)
- Sukhjinder Sidhu
- Sidhu: Pharmacy Department, Fraser Health Authority, Surrey, British Columbia, Canada. Gorman and Slavik: Interior Health Pharmacy Services, Faculty of Pharmaceutical Sciences, University of British Columbia, Kelowna, British Columbia, Canada. Ramsey: Pharmacy Department, Nova Scotia Health Authority, College of Pharmacy, Dalhousie University, Victoria General Hospital, Halifax, Nova Scotia, Canada. Bruchet: Interior Health Pharmacy Practice Residency Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Kelowna, British Columbia, Canada. Murray: Kelowna General Hospital Pharmacy Department, Kelowna, British Columbia, Canada
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Blassmann U, Morath B, Fischer A, Knoth H, Hoppe-Tichy T. [Medication safety in hospitals : Integration of clinical pharmacists to reduce drug-related problems in the inpatient setting]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1103-1110. [PMID: 30022237 DOI: 10.1007/s00103-018-2788-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Drug-related problems (DRPs) are a significant and often preventable cause for morbidity and mortality. Hospitalization is associated with a high risk for DRPs, especially due to a lack of information transfer at transitions of care. At the same time, interventions during inpatient treatment usually require a change in drug therapy and additionally increase the risk of DRPs. Thereby, DRPs can occur at all levels of the medication process and can be caused by different groups of professionals. One way to improve medication safety in hospitals is to integrate clinical pharmacists into the medication process.According to available data, the integration of a clinical pharmacist in multi-professional teams during admission, hospitalization and discharge can significantly reduce DRPs, costs and increases efficacy of drug therapy. In addition, drug supply with unit-dose systems in combination with digitalization of the medication process can achieve an improvement in medication safety. Improvement in continuity of medical care through a structured medication review and seamless transmission of medically relevant information upon discharge contribute to a significant reduction of hospital readmissions and emergency admissions due to ABPs, as well as health costs. With a university education, the hospital pharmacist specialized in clinical pharmacy is the only professional group that can comprehensively support the physician in the field of drug therapy.
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Affiliation(s)
- Ute Blassmann
- Krankenhausapotheke, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
| | - Benedict Morath
- Krankenhausapotheke, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,Kooperationseinheit Klinische Pharmazie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Andreas Fischer
- Klinik-Apotheke, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Holger Knoth
- Klinik-Apotheke, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Torsten Hoppe-Tichy
- Krankenhausapotheke, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,Kooperationseinheit Klinische Pharmazie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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16
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Curry LA, Brault MA, Cherlin E, Smith M. Promoting integration of pharmacy expertise in care of hospitalized patients with acute myocardial infarction. Am J Health Syst Pharm 2018; 75:962-972. [PMID: 29752256 DOI: 10.2146/ajhp170727] [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] [Indexed: 02/02/2023] Open
Abstract
PURPOSE The substantive integration of pharmacists into quality-improvement initiatives aimed at improving the care of hospitalized patients with acute myocardial infarction (AMI) is described. METHODS A 2-year, mixed-methods, interventional study was conducted in 10 U.S. hospitals, directed at promoting the use of evidence-based strategies and fostering domains of hospital organizational culture associated with lower risk-standardized mortality rates (RSMRs) for patients with AMI. The adoption of 5 evidence-based strategies associated with reducing RSMRs for AMI was measured at baseline, 12, and 24 months. Data were collected via face-to-face interviews conducted at each hospital. Ethnographic observations were conducted at baseline and 18 months. RESULTS Significant changes in the use of evidence-based strategies were observed over the 2-year study period (p = 0.02), with the mean number of strategies used per hospital increasing from 2.4 at baseline to 3.9 at 24 months. Innovative approaches for integrating pharmacotherapy and pharmacy practice expertise included information technology solutions, targeted rounding for patients with AMI, medication-bridging programs, and education of patients with AMI. CONCLUSION A mixed-methods interventional study in 10 hospitals examined the substantive integration of pharmacists into quality-improvement initiatives aimed at improving the care of patients with AMI. The investigation revealed the ability of this integration to meet clinical challenges by generating novel, feasible solutions that were tailored for specific hospital contexts. Inclusion of pharmacists strengthened relationships across disciplines and allowed pharmacists to become routinely embedded in broader quality efforts.
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Affiliation(s)
- Leslie A Curry
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT .,Yale Global Health Leadership Institute, Yale University, New Haven, CT
| | - Marie A Brault
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.,Yale Global Health Leadership Institute, Yale University, New Haven, CT
| | - Emily Cherlin
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.,Yale Global Health Leadership Institute, Yale University, New Haven, CT
| | - Marie Smith
- University of Connecticut School of Pharmacy, Storrs, CT
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17
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Lombardi N, Wei L, Ghaleb M, Pasut E, Leschiutta S, Rossi P, Troncon MG. Evaluation of the implementation of a clinical pharmacy service on an acute internal medicine ward in Italy. BMC Health Serv Res 2018; 18:259. [PMID: 29631587 PMCID: PMC5891983 DOI: 10.1186/s12913-018-2988-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Successful implementation of clinical pharmacy services is associated with improvement of appropriateness of prescribing. Both high clinical significance of pharmacist interventions and their high acceptance rate mean that potential harm to patients could be avoided. Evidence shows that low acceptance rate of pharmacist interventions can be associated with lack of communication between pharmacists and the rest of the healthcare team. The objective of this study was to evaluate the effect of a structured communication strategy on acceptance rate of interventions made by a clinical pharmacist implementing a ward-based clinical pharmacy service targeting elderly patients at high risk of drug-related problems. Characteristics of interventions made to improve appropriateness of prescribing, their clinical significance and intervention acceptance rate by doctors were recorded. METHODS A clinical pharmacy intervention study was conducted between September 2013 and December 2013 in an internal medicine ward of a teaching hospital. A trained clinical pharmacist provided pharmaceutical care to 94 patients aged over 70 years. The clinical pharmacist used the following communication and marketing tools to implement the service described: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis; Specific, Measurable, Achievable, Realistic and Timely (SMART) goals; Awareness, Interest, Desire, Action (AIDA) model. RESULTS A total of 740 interventions were made by the clinical pharmacist. The most common drug classes involved in interventions were: antibacterials for systemic use (11.1%) and anti-parkinson drugs (10.8%). The main drug-related problem categories triggering interventions were: no specific problem (15.9%) and prescription writing error (12.0%). A total of 93.2% of interventions were fully accepted by physicians. After assessment by an external panel 63.2% of interventions (96 interventions/ per month) were considered of moderate clinical significance and 23.4% (36 interventions/ per month) of major clinical significance. The most frequent interventions were to educate a healthcare professional (20.4%) and change dose (16.1%). CONCLUSIONS To our knowledge this is the first study evaluating the effect of a structured communication strategy on acceptance rate of pharmacist interventions. Pharmaceutical care delivered by the clinical pharmacist is likely to have had beneficial outcomes. Clinical pharmacy services like the one described should be implemented widely to increase patient safety.
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Affiliation(s)
- Nicola Lombardi
- Department of Pharmacy, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK.
| | - Li Wei
- Department of Pharmacy Practice and Policy, University College London School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX, UK
| | - Maisoon Ghaleb
- School of Life and Medical Science, Department of Pharmacy, Pharmacology & Postgraduate Medicine, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Enrico Pasut
- Department of Pharmacy, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330-33100, Udine, Friuli Venezia Giulia, Italy
| | - Silvia Leschiutta
- Department of Pharmacy, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330-33100, Udine, Friuli Venezia Giulia, Italy
| | - Paolo Rossi
- Division of Internal Medicine, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330 - 33100, Udine, Friuli Venezia Giulia, Italy
| | - Maria Grazia Troncon
- Department of Pharmacy, Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330-33100, Udine, Friuli Venezia Giulia, Italy
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18
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Trinh HT, Nguyen HTL, Pham VTT, Ba HL, Dong PTX, Cao TTB, Nguyen HTH, Brien JA. Hospital clinical pharmacy services in Vietnam. Int J Clin Pharm 2018; 40:1144-1153. [PMID: 29627872 DOI: 10.1007/s11096-018-0633-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/31/2018] [Indexed: 12/01/2022]
Abstract
Background Clinical pharmacy is key to the quality use of medicines. While there are different approaches in different countries, international perspectives may inform health service development. The Vietnamese Ministry of Health introduced a legal regulation of clinical pharmacy services in December 2012. Objective To describe the services, and to explore reported barriers and facilitators in implementing clinical pharmacy activities in Vietnamese hospitals after the introduction of Vietnamese Ministry of Health legal regulation. Setting Thirty-nine hospitals in Hanoi, Vietnam, including 22 provincial and 17 district hospitals. Method A mixed methods study was utilized. An online questionnaire was sent to the hospitals. In-depth interviews were conducted with pairs of nominated pharmacists at ten of these hospitals. The questionnaire focused on four areas: facilities, workforce, policies and clinical pharmacy activities. Main outcome measure Proportion of clinical pharmacy activities in hospitals. Themes in clinical pharmacy practice. Results 34/39 (87%) hospitals had established clinical pharmacy teams. Most activities were non-patient-specific (87%) while the preliminary patient-specific clinical pharmacy services were available in only 8/39 hospitals (21%). The most common non-patient-specific activities were providing medicines information (97%), reporting adverse drug reactions (97%), monitoring medication usage (97%). The patient specific activities varied widely between hospitals and were ad hoc. The main challenges reported were: lack of workforce and qualified clinical pharmacists. Conclusion While most hospitals had hospital-based pharmacy activities, the direct patient care was limited. Training, education and an expanded work forces are needed to improve clinical pharmacy services.
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Affiliation(s)
- Hieu T Trinh
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia. .,Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.
| | - Huong T L Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Van T T Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Hai L Ba
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Phuong T X Dong
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Thao T B Cao
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Hanh T H Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Jo-Anne Brien
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
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19
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Hensler D, Richardson CL, Brown J, Tseng C, DeCamp PJ, Yang A, Pawlowski A, Ho B, Ison MG. Impact of electronic health record-based, pharmacist-driven valganciclovir dose optimization in solid organ transplant recipients. Transpl Infect Dis 2018; 20:e12849. [PMID: 29360250 DOI: 10.1111/tid.12849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 10/11/2017] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prophylaxis with valganciclovir reduces the incidence of cytomegalovirus (CMV) infection following solid organ transplant (SOT). Under-dosing of valganciclovir is associated with an increased risk of CMV infection and development of ganciclovir-resistant CMV. METHODS An automated electronic health record (EHR)-based, pharmacist-driven program was developed to optimize dosing of valganciclovir in solid organ transplant recipients at a large transplant center. Two cohorts of kidney, pancreas-kidney, and liver transplant recipients from our center pre-implementation (April 2011-March 2012, n = 303) and post-implementation of the optimization program (September 2012-August 2013, n=263) had demographic and key outcomes data collected for 1 year post-transplant. RESULTS The 1-year incidence of CMV infection dropped from 56 (18.5%) to 32 (12.2%, P = .05) and the incidence of breakthrough infections on prophylaxis was cut in half (61% vs 34%, P = .03) after implementation of the dose optimization program. The hazard ratio of developing CMV was 1.64 (95% CI 1.06-2.60, P = .027) for the pre-implementation group after adjusting for potential confounders. The program also resulted in a numerical reduction in the number of ganciclovir-resistant CMV cases (2 [0.7%] pre-implementation vs 0 post-implementation). CONCLUSIONS An EHR-based, pharmacist-driven valganciclovir dose optimization program was associated with reduction in CMV infections.
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Affiliation(s)
| | | | | | | | | | - Amy Yang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anna Pawlowski
- Northwestern Medicine Enterprise Data Warehouse, Chicago, IL, USA
| | - Bing Ho
- Divisions of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael G Ison
- Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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20
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Elsadig H, Weiss M, Scott J, Laaksonen R. Exploring the challenges for clinical pharmacists in Sudan. Int J Clin Pharm 2017; 39:1047-1054. [PMID: 28823049 DOI: 10.1007/s11096-017-0521-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/02/2017] [Indexed: 11/24/2022]
Abstract
Background Clinical pharmacy practice in hospitals is a new role for pharmacists in Sudan. Pharmacists have to face the challenge of moving from their traditional roles within the pharmacy premises to new roles on the wards with direct contact with patients and other healthcare professionals. Objectives To explore the role and challenges facing the clinical pharmacists of Sudan. Settings Two of the main government hospitals in Sudan and an online survey. Method This study applied a two phase mixed method, a focus group discussion and a survey. A FGD was conducted with the clinical pharmacists in two of the main government hospitals in Sudan. This was followed by an on-line survey among the clinical pharmacists of Sudan. Main outcome measure The role of the clinical pharmacists of Sudan and the challenges facing clinical pharmacy practice. Results Four pharmacists participated in the focus group and 51 out of 140 pharmacists (34%) completed the on-line survey. The roles that were perceived by the majority of pharmacists as part of their duties in hospitals in Sudan were identifying drug-related problems (100%, n = 51), providing drug-related information to healthcare professionals by (96%, n = 47), and educating patients about their medicines (96%, n = 48). The pharmacists identified a number of obstacles that hindered their progress in practice. These obstacles were related to the pharmacists themselves, the lack of senior clinical pharmacists for leadership, the environment they were working in and the training they had received in clinical pharmacy. Conclusion The new clinical pharmacists in Sudan faced several challenges that need to be overcome in order to move forward in their clinical practice. To do so they will require support from pharmacy educational institutions, other healthcare professionals and the healthcare institutions they are working within.
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21
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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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22
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Sharma M, Krishnamurthy M, Snyder R, Mauro J. Reducing Error in Anticoagulant Dosing via Multidisciplinary Team Rounding at Point of Care. Clin Pract 2017; 7:953. [PMID: 28484587 PMCID: PMC5406843 DOI: 10.4081/cp.2017.953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/10/2017] [Accepted: 03/17/2017] [Indexed: 11/23/2022] Open
Abstract
The incorporation of a clinical pharmacist in daily rounding can help identify and correct errors related to anticoagulation dosing. Inappropriate anticoagulant dosing increases the risk of developing significant bleeding diathesis. Conversely, inappropriate dosing may also fail to produce a therapeutic response. We retrospectively reviewed electronic medical records of 41 patients to confirm and analyze the errors related to various anticoagulants. A clinical pharmacist in an integrated rounding between the period of February 2016 and April 2016 collected this data. We concluded that integrated rounding improves patient safety by recognizing anticoagulant dosage error used for the purpose of prophylaxis or treatment. It also allows us to make dose adjustments based on renal function of the patient. We think that it is prudent for physicians to pay particular attention to creatinine clearance when dosing anticoagulants in order to achieve the intended dosing effect and reduce the risk of adverse drug events.
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Affiliation(s)
- Munish Sharma
- Department of Internal Medicine, Easton Hospital, Easton, PA, USA
| | | | - Richard Snyder
- Department of Nephrology, Easton Hospital, Easton, PA, USA
| | - James Mauro
- Department of Pharmacy, Easton Hospital, Easton, PA, USA
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23
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Maclaren R, Devlin JW, Martin SJ, Dasta JF, Rudis MI, Bond CA. Critical Care Pharmacy Services in United States Hospitals. Ann Pharmacother 2016; 40:612-8. [PMID: 16569803 DOI: 10.1345/aph.1g590] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Critical care pharmacy activities have been described as fundamental, desirable, and optimal, but actual services provided have not been evaluated. Objective: To characterize the type and level of pharmacy services provided to intensive care units (ICUs). Methods: A 38 question survey was sent in 2 consecutive mailings to all US institutions (N = 3238) with an ICU. Questions were categorized according to clinical, educational, administrative, and scholarly activities, with levels of services stratified as fundamental, desirable, or optimal. Results: Completed surveys were received from 382 (11.8%) institutions encompassing 1034 ICUs. Direct clinical pharmacy activities were provided at 62.2% of ICUs. The pharmacists in those programs attended rounds 4.4 ± 1.5 days/wk, mean ± SD, and had a workweek that consisted of patient care (43% of hours worked), drug distribution (26.2%), administration (12.6%), education (10.9%), and scholarly activities (7.3%). Fundamental clinical activities performed during at least 75% of patient ICU days were providing drug information, drug therapy evaluation, drug therapy intervention, and pharmacokinetic monitoring. Conducting inservices (92.8%), a fundamental service, was the only educational activity frequently provided. Most respondents were involved with at least one multidisciplinary committee, and 45.5% conducted scholarly activities. Desirable or optimal activities were not frequently provided across all service categories. Conclusions: Clinical pharmacists are directly involved as caregivers in nearly two-thirds of ICUs in the US. Although they provide a range of clinical and administrative services, involvement in educational and scholarly activities is variable. The level of services provided is consistent with the criteria deemed fundamental for improving patient care. Higher-order services are far less likely to be provided.
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Affiliation(s)
- Robert Maclaren
- Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
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24
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Dunn SP, Birtcher KK, Beavers CJ, Baker WL, Brouse SD, Page RL, Bittner V, Walsh MN. The role of the clinical pharmacist in the care of patients with cardiovascular disease. J Am Coll Cardiol 2016; 66:2129-2139. [PMID: 26541925 DOI: 10.1016/j.jacc.2015.09.025] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/08/2015] [Accepted: 09/14/2015] [Indexed: 01/30/2023]
Abstract
Team-based cardiovascular care, including the use of clinical pharmacists, can efficiently deliver high-quality care. This Joint Council Perspectives paper from the Cardiovascular Team and Prevention Councils of the American College of Cardiology provides background information on the clinical pharmacist's role, training, certification, and potential utilization in a variety of practice models. Selected systematic reviews and meta-analyses, highlighting the benefit of clinical pharmacy services, are summarized. Clinical pharmacists have a substantial effect in a wide variety of roles in inpatient and ambulatory settings, largely through optimization of drug use, avoidance of adverse drug events, and transitional care activities focusing on medication reconciliation and patient education. Expansion of clinical pharmacy services is often impeded by policy, legislation, and compensation barriers. Multidisciplinary organizations, including the American College of Cardiology, should support efforts to overcome these barriers, allowing pharmacists to deliver high-quality patient care to the full extent of their education and training.
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Affiliation(s)
- Steven P Dunn
- University of Virginia Health System, Charlottesville, Virginia.
| | - Kim K Birtcher
- University of Houston College of Pharmacy, Houston, Texas
| | | | - William L Baker
- University of Connecticut School of Pharmacy, Storrs, Connecticut
| | - Sara D Brouse
- UK HealthCare, University of Kentucky, Lexington, Kentucky
| | - Robert L Page
- University of Colorado School of Pharmacy, Denver, Colorado
| | - Vera Bittner
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
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25
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Scott MG, Scullin C, Hogg A, Fleming GF, McElnay JC. Integrated medicines management to medicines optimisation in Northern Ireland (2000–2014): a review. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2014-000512] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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El Hajji FWD, Scullin C, Scott MG, McElnay JC. Enhanced clinical pharmacy service targeting tools: risk-predictive algorithms. J Eval Clin Pract 2015; 21:187-97. [PMID: 25496483 DOI: 10.1111/jep.12276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This study aimed to determine the value of using a mix of clinical pharmacy data and routine hospital admission spell data in the development of predictive algorithms. Exploration of risk factors in hospitalized patients, together with the targeting strategies devised, will enable the prioritization of clinical pharmacy services to optimize patient outcomes. METHODS Predictive algorithms were developed using a number of detailed steps using a 75% sample of integrated medicines management (IMM) patients, and validated using the remaining 25%. IMM patients receive targeted clinical pharmacy input throughout their hospital stay. The algorithms were applied to the validation sample, and predicted risk probability was generated for each patient from the coefficients. Risk threshold for the algorithms were determined by identifying the cut-off points of risk scores at which the algorithm would have the highest discriminative performance. Clinical pharmacy staffing levels were obtained from the pharmacy department staffing database. RESULTS Numbers of previous emergency admissions and admission medicines together with age-adjusted co-morbidity and diuretic receipt formed a 12-month post-discharge and/or readmission risk algorithm. Age-adjusted co-morbidity proved to be the best index to predict mortality. Increased numbers of clinical pharmacy staff at ward level was correlated with a reduction in risk-adjusted mortality index (RAMI). CONCLUSIONS Algorithms created were valid in predicting risk of in-hospital and post-discharge mortality and risk of hospital readmission 3, 6 and 12 months post-discharge. The provision of ward-based clinical pharmacy services is a key component to reducing RAMI and enabling the full benefits of pharmacy input to patient care to be realized.
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Affiliation(s)
- Feras W D El Hajji
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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27
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Clinical pharmacy services that influence prescribing in the Western Pacific Region based on the FIP Basel Statements. Int J Clin Pharm 2015; 37:485-96. [DOI: 10.1007/s11096-015-0084-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/11/2015] [Indexed: 11/26/2022]
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Abstract
PURPOSE Rapid response teams (RRTs) have been developed to provide early therapy to patients with risk factors for cardiopulmonary arrest. We sought to investigate the role a pharmacist could have as a member of the RRT. METHODS Two pharmacists trained in critical care and emergency medicine proposed a pilot program to determine whether a pharmacist as a member of the RRT could help to optimize pharmacotherapy and facilitate medication administration. During response, 1 pharmacist was at the bedside with the RRT for patient evaluation, consult, chart review, and to facilitate medication administration. The responding RRT pharmacist collected patient demographics, medications administered, pharmacotherapy recommendations, and time commitment. RESULTS The pharmacists responded to 32 RRT alerts. A majority (65.6%) of patients required at least 1 medication, and a total of 45 medications were administered. The pharmacists performed 49 pharmacotherapy-related interventions in 21 patients. These included medication facilitation (15), dose (15) or therapy (8) recommendations, and adding (6) or discontinuing (5) a medication. The pharmacists spent a median time of 15 minutes (interquartile range [IQR] 15, range 2-70) for each RRT alert and a total of 612 minutes (10.2 hours). CONCLUSION With a minimal time commitment, pharmacists can be valuable members of the RRT.
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Affiliation(s)
- Christine M Groth
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA
| | - Nicole M Acquisto
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
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Benavides S, Rambaran KA. Pharmacy technicians: Expanding role with uniform expectations, education and limits in scope of practice. J Res Pharm Pract 2014; 2:135-7. [PMID: 24991621 PMCID: PMC4076926 DOI: 10.4103/2279-042x.128141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sandra Benavides
- Department of Pharmacy Practice, Nova Southeastern University, Fort Lauderdale, USA E-mail:
| | - Kerry Anne Rambaran
- Department of Pharmacy Practice, Nova Southeastern University, Fort Lauderdale, USA E-mail:
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Brook-Barclay L, Delaney CL, Scicchitano M, Quinn S, Spark JI. Pharmacist influence on prescribing in peripheral arterial disease (PIPER). Vasc Med 2014; 19:118-124. [DOI: 10.1177/1358863x14523064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to determine the association between a specialist clinical pharmacist working in collaboration with medical staff and prescribing in peripheral arterial disease (PAD). A retrospective cohort study was conducted comparing the influence of a dedicated clinical pharmacist on two samples of patients admitted to a single vascular surgery unit in either 2007 (control group) prior to implementation of a comprehensive clinical pharmacy service or 2009 (comparison group) post implementation. Data were obtained via review of medical records and electronic reports. A total of 685 patients were identified, resulting in 964 admissions. The patient to pharmacist ratio decreased from 62 to 33 patients per day in 2009. More patients were initiated on an antiplatelet (OR 4.6, 95% CI 2.26 to 9.53, p<0.001) and statin (OR 3.4, 95% CI 1.97 to 6, p<0.001) in 2009 compared to 2007. Risk factor modification increased in 2009, resulting in action being taken more often for HbA1c>7% (OR 3.45, 95% CI 1.64 to 7.27, p=0.001), total cholesterol >4 mmol/L in females (OR 14.5, 95% CI 2.67 to 78.6, p=0.002) and blood pressure above target (OR 1.9, 95% CI 1.01 to 3.73, p=0.05) when a comprehensive clinical pharmacist service was available. There was a non-significant reduction in mortality (18.7% (65) to 14.2% (46), p=0.13) and cardiovascular outcomes (5.5% (19) to 4.3% (14), p=0.44) within 12 months of discharge. In conclusion, prescribing of evidence-based medication for PAD and risk factor modification increased with a comprehensive clinical pharmacist service. This study provides important insight into optimising treatment in this patient group and how a pharmacist can be a helpful addition to the multidisciplinary team.
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Affiliation(s)
- Laura Brook-Barclay
- Flinders Medical Centre, Bedford Park, SA, Australia
- School of Pharmacy, University of South Australia, Adelaide, SA, Australia
| | - Christopher L Delaney
- Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders University, Bedford Park, SA, Australia
| | | | | | - James I Spark
- Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders University, Bedford Park, SA, Australia
- Repatriation General Hospital, Daw Park, SA, Australia
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Anderegg SV, Demik DE, Carter BL, Dawson JD, Farris K, Shelsky C, Kaboli P. Acceptance of recommendations by inpatient pharmacy case managers: unintended consequences of hospitalist and specialist care. Pharmacotherapy 2013; 33:11-21. [PMID: 23307540 DOI: 10.1002/phar.1164] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVE To determine whether recommendations made by pharmacists and accepted by hospital physicians resulted in fewer postdischarge readmissions and urgent care visits compared with recommendations that were not implemented. DESIGN Prospective substudy of pharmacist recommendations. SETTING Tertiary care academic medical center and private community-based physician practices and community pharmacies. PATIENTS A total of 192 patients aged 18 years or older who were a subsample of a randomized, prospective study, who were admitted with a previous diagnosis of one of nine cardiovascular or pulmonary diseases or diabetes mellitus or had received oral anticoagulation therapy and who were discharged to community-based care provided by private physicians and community pharmacists. MEASUREMENTS AND MAIN RESULTS Pharmacy case managers performed evaluations for patients and made recommendations to inpatient physicians. Patients received drug therapy counseling, a drug therapy list, and a wallet card at discharge. Data were collected from patients and private physicians for 90 days after discharge. Pharmacy case managers made 546 recommendations to inpatient physicians for 187 patients (97%). Overall, 260 (48%) of the 546 recommendations were accepted. The acceptance rate was lower for patients who had an urgent care visit compared with the other patients (33.6% vs 52.2%, p=0.033). High acceptance rates were noted for updating the record after medication reconciliation (36 patients [78%]) and when there was an actual allergy (2 [100%] of 2 patients) or medication error (2 [100%] of 2 patients). Physicians were less likely to accept recommendations related to drug indications (p<0.001), drug efficacy (p=0.041), and therapeutic drug and disease state monitoring (p=0.011). Recommendations made for patients with a relatively greater number of drugs were also less likely to be accepted (p=0.003). CONCLUSION Recommendations to reconcile medications or address actual drug allergies or medication errors were frequently accepted. However, only 48% of all recommendations were accepted by inpatient physicians, and there was no impact on health care use 90 days after discharge. This study suggests that recommendations by pharmacy case managers were underused, and the low acceptance rate may have reduced the potential to avoid readmissions.
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Affiliation(s)
- Sammuel V Anderegg
- Department of Pharmacy, University of Kansas Medical Center, Kansas City, Kansas, USA
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Neville HL, Chevalier B, Daley C, Nodwell L, Harding C, Hiltz A, MacDonald T, Skedgel C, MacKinnon NJ, Slayter K. Clinical benefits and economic impact of post-surgical care provided by pharmacists in a Canadian hospital. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2013; 22:216-22. [DOI: 10.1111/ijpp.12058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 06/19/2013] [Indexed: 11/29/2022]
Abstract
Abstract
Objective
Clinical pharmacists improve the quality of patient care by reducing adverse drug events (ADEs), length of stay and mortality. This impact is currently not well described in surgery. The objective was to evaluate clinical and economic outcomes after clinical pharmacist services were added to two general surgical wards in an adult hospital.
Methods
This was a prospective, observational study. All clinical interventions to resolve drug therapy problems were documented and assessed for severity, value and the probability of preventing an ADE. Cost avoidance was calculated using two methods: by avoiding additional days in hospital (CA$3593/ADE) or additional hospital costs ($7215/ADE). Two clinical pharmacy specialists and the surgical care pharmacist independently categorized the interventions; disagreements were resolved by consensus.
Key findings
The pharmacists made 1097 interventions in 6 months with a 98% acceptance rate by surgical staff. Half of the interventions were rated significant for severity (561, 51.1%) and value (559, 51.0%). One-quarter of the interventions had a 40% or greater probability of preventing an ADE (270, 24.6%). Cost avoidance was estimated to be $0.68–1.36 million or $617–1239 per intervention. Pharmacists avoided an additional 867 days in the hospital for surgical patients.
Conclusion
The pharmacist's role in the management of the drug therapy needs of the post-surgical patient has the potential to improve clinical and patient outcomes and avoid healthcare costs. The inclusion of clinical pharmacists in surgical wards may result in $7 in savings for every $1 invested.
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Affiliation(s)
| | | | - Chris Daley
- Multi-Organ Transplant Program, Capital Health, Halifax, NS, Canada
| | - Lisa Nodwell
- Pharmacy Services, Capital Health, Halifax, NS, Canada
| | | | - Anne Hiltz
- Pharmacy Services, Capital Health, Halifax, NS, Canada
| | | | - Chris Skedgel
- Atlantic Clinical Cancer Research Unit, Capital Health, Halifax, NS, Canada
| | | | - Kathryn Slayter
- Pharmacy Services, Capital Health, Halifax, NS, Canada
- Faculties of Medicine and Health Professions, Dalhousie University, Halifax, NS, Canada
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Somers A, Robays H, De Paepe P, Van Maele G, Perehudoff K, Petrovic M. Evaluation of clinical pharmacist recommendations in the geriatric ward of a Belgian university hospital. Clin Interv Aging 2013; 8:703-9. [PMID: 23807844 PMCID: PMC3686245 DOI: 10.2147/cia.s42162] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the type, acceptance rate, and clinical relevance of clinical pharmacist recommendations at the geriatric ward of the Ghent university hospital. Methods The clinical pharmacist evaluated drug use during a weekly 2-hour visit for a period of 4 months and, if needed, made recommendations to the prescribing physician. The recommendations were classified according to type, acceptance by the physician, prescribed medication, and underlying drug-related problem. Appropriateness of prescribing was assessed using the Medication Appropriateness Index (MAI) before and after the recommendations were made. Two clinical pharmacologists and two clinical pharmacists independently and retrospectively evaluated the clinical relevance of the recommendations and rated their own acceptance of them. Results The clinical pharmacist recommended 304 drug therapy changes for 100 patients taking a total of 1137 drugs. The most common underlying drug-related problems concerned incorrect dose, drug–drug interaction, and adverse drug reaction, which appeared most frequently for cardiovascular drugs, drugs for the central nervous system, and drugs for the gastrointestinal tract. The most common type of recommendation concerned adapting the dose, and stopping or changing a drug. In total, 59.7% of the recommendations were accepted by the treating physician. The acceptance rate by the evaluators ranged between 92.4% and 97.0%. The mean clinical relevance of the recommendations was assessed as possibly important (53.4%), possibly low relevance (38.1%), and possibly very important (4.2%). A low interrater agreement concerning clinical relevance between the evaluators was found: kappa values ranged between 0.15 and 0.25. Summated MAI scores significantly improved after the pharmacist recommendations, with mean values decreasing from 9.3 to 6.2 (P < 0.001). Conclusion In this study, the clinical pharmacist identified a high number of potential drug-related problems in older patients; however, the acceptance of the pharmacotherapy recommendations by the treating physician was lower than by a panel of evaluators. This panel, however, rated most recommendations as possibly important and as possibly having low relevance, with low interrater reliability. As the appropriateness of prescribing seemed to improve with decreased MAI scores, clinical pharmacy services may contribute to the optimization of drug therapy in older inpatients.
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Affiliation(s)
- Annemie Somers
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium.
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Rattanarojsakul P, Thawesaengskulthai N. A medication safety model: a case study in Thai hospital. Glob J Health Sci 2013; 5:89-101. [PMID: 23985110 PMCID: PMC4776851 DOI: 10.5539/gjhs.v5n5p89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 11/12/2022] Open
Abstract
Reaching zero defects is vital in medication service. Medication error can be reduced if the causes are recognized. The purpose of this study is to search for a conceptual framework of the causes of medication error in Thailand and to examine relationship between these factors and its importance. The study was carried out upon an in-depth case study and survey of hospital personals who were involved in the drug use process. The structured survey was based on Emergency Care Research Institute (ECRI) (2008) questionnaires focusing on the important factors that affect the medication safety. Additional questionnaires included content to the context of Thailand's private hospital, validated by five-hospital qualified experts. By correlation Pearson analysis, the result revealed 14 important factors showing a linear relationship with drug administration error except the medication reconciliation. By independent sample t-test, the administration error in the hospital was significantly related to external impact. The multiple regression analysis of the detail of medication administration also indicated the patient identification before administration of medication, detection of the risk of medication adverse effects and assurance of medication administration at the right time, dosage and route were statistically significant at 0.05 level. The major implication of the study is to propose a medication safety model in a Thai private hospital.
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Reta A, Dashtaei A, Lim S, Nguyen T, Bholat MA. Opportunities to Improve Clinical Outcomes and Challenges to Implementing Clinical Pharmacists into Health Care Teams. Prim Care 2012; 39:615-26. [DOI: 10.1016/j.pop.2012.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rutter V, Wong C, Coombes I, Cardiff L, Duggan C, Yee ML, Wee Lim K, Bates I. Use of a general level framework to facilitate performance improvement in hospital pharmacists in Singapore. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2012; 76:107. [PMID: 22919083 PMCID: PMC3425922 DOI: 10.5688/ajpe766107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/30/2012] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the acceptability and validity of an adapted version of the General Level Framework (GLF) as a tool to facilitate and evaluate performance development in general pharmacist practitioners (those with less than 3 years of experience) in a Singapore hospital. METHOD Observational evaluations during daily clinical activities were prospectively recorded for 35 pharmacists using the GLF at 2 time points over an average of 9 months. Feedback was provided to the pharmacists and then individualized learning plans were formulated. RESULTS Pharmacists' mean competency cluster scores improved in all 3 clusters, and significant improvement was seen in all but 8 of the 63 behavioral descriptors (p ≤ 0.05). Nonsignificant improvements were attributed to the highest level of performance having been attained upon initial evaluation. Feedback indicated that the GLF process was a positive experience, prompting reflection on practice and culminating in needs-based learning and ultimately improved patient care. CONCLUSIONS The General Level Framework was an acceptable tool for the facilitation and evaluation of performance development in general pharmacist practitioners in a Singapore hospital.
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Scullin C, Hogg A, Luo R, Scott MG, McElnay JC. Integrated medicines management - can routine implementation improve quality? J Eval Clin Pract 2012; 18:807-15. [PMID: 21504517 DOI: 10.1111/j.1365-2753.2011.01682.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Previous service development work in the area of integrated medicines management (IMM) has demonstrated clear quality improvements in a targeted group of patients within a hospital in Northern Ireland. In order to determine whether this programme could be transferable to routine practice and thereby assess its generalizability, research has been carried out to quantify the health care benefits of incorporating the concept of IMM as routine clinical practice. METHOD The IMM programme of care was delivered to all eligible patients (subject to inclusion criteria) across two hospital sites in Northern Ireland during normal pharmacy opening hours. All patients were followed up for a period of 12 months from their time of hospital admission. All patient data were collected using the custom-designed Electronic Pharmacist Intervention Clinical System at each stage of their hospital journey, that is, admission, inpatient stay and discharge. RESULTS Patients who received the IMM service benefited from a reduced length of hospital stay on their reference admission (1.42 days; P = 0.020) as well as a reduced length of stay during the first rehospitalization (5.86 days; P = 0.013). There was also a trend of a reduced number of readmissions and a longer time to readmission during the 12-month follow-up period. Potential significant opportunity cost savings were demonstrated as well as a significant improvement in medication appropriateness (discharge vs. reference admission). CONCLUSIONS The IMM programme of care has proven to be transferable to routine hospital care within two hospitals in Northern Ireland. It is anticipated that this current research will further inform the development of IMM as routine clinical practice across Northern Ireland and beyond.
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Affiliation(s)
- Claire Scullin
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Lasak-Myall T, Peters MJ, Mlynarek M. Opportunity for Pharmacy Intervention on an Urban Teaching Hospital Rapid Response Team: A Pilot Study. J Pharm Technol 2012. [DOI: 10.1177/875512251202800305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The role of a rapid response team (RRT) or medical emergency team is to bring the expertise of specialists trained in critical care to patients on general medicine and surgical wards who are rapidly deteriorating and to treat them accordingly. The involvement of pharmacists on cardiopulmonary resuscitation teams has been reported. However, the role of a pharmacist member of an RRT has not been extensively researched. Objective: To identify the role of a pharmacist on an RRT and categorize types of pharmacist interventions during cardiopulmonary resuscitation and initial patient assessments. Methods: This pilot study documented interventions made by the pharmacist on our RRT over a 1-month period. The pharmacist assisted the RRT with evaluations of patients during assessments and cardiopulmonary resuscitations and provided specialized medical information based on our current organizational standards of practice. Results: The pharmacist attended 34 consultations and 8 resuscitations during cardiopulmonary arrests. There were 96 interventions made during 34 RRT assessments—2.6 interventions per assessment. The most common interventions were treatment recommendations (29%), dosing recommendations (15%), and procuring medications for emergent use (12%). In both the treatment and dosing categories, antibiotic recommendations were the most common. Conclusions: The pharmacist member of the RRT had the opportunity for intervention on every patient seen by the team. The most common areas for intervention are treatment and dosing recommendations involving antibiotics, as well as providing and preparing emergent medications.
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Affiliation(s)
- Tracey Lasak-Myall
- TRACEY LASAK-MYALL PharmD BCPS, Clinical Specialist—Neurosurgical Critical Care, Henry Ford Hospital, Detroit, MI
| | - Michael J Peters
- MICHAEL J PETERS RPh BCPS, Clinical Specialist—Medical Intensive Care, Henry Ford Hospital
| | - Mark Mlynarek
- MARK MLYNAREK RPh BCPS, Clinical Specialist—Surgical Intensive Care, Henry Ford Hospital
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Gallagher RM, Gallagher HC. Improving the working relationship between doctors and pharmacists: is inter-professional education the answer? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2012; 17:247-57. [PMID: 21088991 DOI: 10.1007/s10459-010-9260-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 11/06/2010] [Indexed: 05/12/2023]
Abstract
Despite their common history, there are many cultural, attitudinal and practical differences between the professions of medicine and pharmacy that ultimately influence patient care and health outcomes. While poor communication between doctors and pharmacists is a major cause of medical errors, it is clear that effective, deliberate doctor-pharmacist collaboration within certain clinical settings significantly improves patient care. This may be particularly true for those patients with chronic illnesses and/or requiring regular medication reviews. Moreover, in hospitals, clinical and antibiotic pharmacists are successfully influencing prescribing and infection control policy. Under the new Irish Pharmacy Act (2007), pharmacists are legally obliged to provide pharmaceutical care to their patients, thus fulfilling a more patient-centred role than their traditional 'dispensing' one. However, meeting this obligation relies on the existence of good doctor-pharmacist working relationships, such that inter-disciplinary teamwork in monitoring patients becomes the norm in all healthcare settings. As discussed here, efforts to improve these relationships must focus on the strategic introduction of agreed changes in working practices between the two professions and on educational aspects of pharmaceutical care. For example, standardized education of doctors/medical students such that they learn to prescribe in an optimal manner and ongoing inter-professional education of doctors and pharmacists in therapeutics, are likely to be of paramount importance. Here, insights into the types of factors that help or hinder the improvement of these working relationships and the importance of education and agreed working practices in defining the separate but inter-dependent professions of pharmacy and medicine are reviewed and discussed.
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Affiliation(s)
- Ruth M Gallagher
- Trinity College Dublin/Health Services Executive Specialist Training Programme, Department of Public Health & Primary Care, Trinity College Centre for Health Sciences, Adelaide & Meath Hospital, Tallaght, Ireland
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Renet S, Rochais É, Bussières JF, Lebel D, Tanguay C, Bourdon O. [Prioritization of healthcare programs by pharmacy students from France and from Quebec, according to the perceived impact of a decentralized pharmacist]. ANNALES PHARMACEUTIQUES FRANÇAISES 2012; 70:94-103. [PMID: 22500961 DOI: 10.1016/j.pharma.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/29/2011] [Accepted: 01/05/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Healthcare decision makers need to establish priorities and their decisions must be justified. However, few data is available on the prioritization process of the healthcare programs that should benefit from decentralized pharmacists. PATIENTS AND METHODS The main objective was to prioritize healthcare programs according to the perceived impact of a decentralized pharmacist for outpatient and inpatient clienteles. The secondary objective was to compare the prioritization made by pharmacy students from two Quebec universities and from one French university. Two different approaches were developed (perceived impact according to three indicators and according to the global impact). RESULTS The majority of healthcare programs with a high evidence based literature quality score (5/6 outpatient programs and 5/8 inpatient programs) were highly prioritized by at least two out of three cohorts. The median rank that was attributed for each healthcare program was significantly different between the three cohorts for 8/17 (47%) of outpatient programs and for 10/18 (56%) of inpatient programs. DISCUSSION A higher rank was attributed to healthcare programs when the evidence based literature quality score was high. The prioritization was also influenced by the difference in pharmaceutical practice between France and Quebec (e.g. sterilization and medical devices in France). CONCLUSIONS This study presented two approaches for the prioritization of healthcare programs that should benefit from a decentralized pharmacist, according to students from France and from Quebec.
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Affiliation(s)
- S Renet
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec, H3T 1C5 Canada
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Perceived value of ward-based pharmacists from the perspective of physicians and nurses. Int J Clin Pharm 2012; 34:127-35. [PMID: 22210106 DOI: 10.1007/s11096-011-9603-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 12/22/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Clinical pharmacy in a hospital setting is relatively new in Sweden. Its recent introduction at the University Hospital in Uppsala has provided an opportunity for evaluation by other relevant professionals of the integration of clinical pharmacists into the health-care team. OBJECTIVES The objectives of this descriptive study were to evaluate the perceived value of wardbased clinical pharmacists from the perspective of hospital based physicians and nurses and to identify potential advantages and disadvantages related to the new inter professional collaboration. Another objective was to evaluate the experiences of general practitioners on receiving medication reports from ward-based clinical pharmacists. SETTING Two acute internal medicine wards at the University Hospital in Uppsala, where a previously reported randomized controlled trial investigating the effects of ward based clinical pharmacists on re-visits to hospital was undertaken. METHODS Data were collected by questionnaires containing closed- and open-ended questions. The questionnaires were distributed during the nine-month study period of the randomized controlled trial by an independent researcher to 29 hospital-based physicians and 44 nurses on the study wards and to 21 general practitioners who had received two or more medication reports. Answers were analysed descriptively for the closed-ended questions and by content analysis for the open-ended questions. MAIN OUTCOME MEASURE The main outcome measure was the physicians' and nurses' level of satisfaction with the new collaboration with clinical pharmacists, from a hospital and primary care perspective. RESULTS Seventy-six percent of the hospital-based physicians and 81% of the nurses completed the questionnaire. Ninety-five percent of the physicians and 93% of the nurses were very satisfied with the collaboration. Out of the 17 general practitioners (81%) that completed the questionnaire 71% wanted to continue to receive medication reports in a similar way in the future. Increased patient safety and improvements in patients' drug therapy were the main advantages stated by all three groups of respondents. Eighteen percent of the hospital-based physicians and 21% of the nurses thought that the collaboration had been time-consuming to certain or to a high extent. CONCLUSIONS The majority of the respondents, both GPs and hospital based physicians and nurses, were satisfied with the new collaboration with the ward based pharmacists and perceived that the quality of the patients' drug therapy and drug-related patient safety had increased.
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Shane R. Critical requirements for health-system pharmacy practice models that achieve optimal use of medicines. Am J Health Syst Pharm 2011; 68:1101-11. [PMID: 21642569 DOI: 10.2146/ajhp110058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Rita Shane
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Khalil H. A review of pharmacist recommendations in an aged care facility. Aust J Prim Health 2011; 17:35-9. [PMID: 21616022 DOI: 10.1071/py10044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 11/07/2010] [Indexed: 11/23/2022]
Abstract
The aim of this study was to analyse the types of and rationale for the clinical recommendations made by the pharmacist in a rural aged care facility to improve patient safety. The classes of drugs associated with the pharmacist's recommendations were also identified. A related aim was to determine their degree of acceptance by medical practitioners. A retrospective, cross-sectional study design was used to review 56 aged care residents' case notes over a 12-month period. The main outcome measures included: the types of and reasons for recommendations made by the pharmacist; classes of drugs associated with the pharmacist's recommendations; and the implementation rate of the pharmacist's recommendations by the medical practitioner. A total of 196 recommendations were made by the pharmacist to the residents' existing medications. The main types of recommendations were alteration to residents' monitoring (49%), discontinuation of drug treatment (19%) followed by initiation of drug treatment (17%). The main reasons for the recommendations were to reduce potential side-effects (45%), symptom control (32%) and to increase drug efficacy (19%). Analysis of medical practitioners' case notes estimated that 70% of the pharmacist's recommendations were being implemented by the residents' medical practitioner. This case notes analysis reinforces the importance of doctor-pharmacist collaboration in the management of residents' medications in aged care facilities.
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Affiliation(s)
- Hanan Khalil
- Department of Rural and indigenous Health, School of rural Health, Faculty of Medicine, nursing and Health Sciences, Monash University, Vic, Australia.
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Nurgat ZA, Al-Jazairi AS, Abu-Shraie N, Al-Jedai A. Documenting clinical pharmacist intervention before and after the introduction of a web-based tool. Int J Clin Pharm 2011; 33:200-7. [PMID: 21369961 DOI: 10.1007/s11096-010-9466-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 11/29/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop a database for documenting pharmacist intervention through a web-based application. The secondary endpoint was to determine if the new, web-based application provides any benefits with regards to documentation compliance by clinical pharmacists and ease of calculating cost savings compared with our previous method of documenting pharmacist interventions. SETTING A tertiary care hospital in Saudi Arabia. METHOD The documentation of interventions using a web-based documentation application was retrospectively compared with previous methods of documentation of clinical pharmacists' interventions (multi-user PC software). MAIN OUTCOME MEASURE The number and types of interventions recorded by pharmacists, data mining of archived data, efficiency, cost savings, and the accuracy of the data generated. RESULTS The number of documented clinical interventions increased from 4,926, using the multi-user PC software, to 6,840 for the web-based application. On average, we observed 653 interventions per clinical pharmacist using the web-based application, which showed an increase compared to an average of 493 interventions using the old multi-user PC software. However, using a paired Student's t-test there was no statistical significance difference between the two means (P = 0.201). Using a χ² test, which captured management level and the type of system used, we found a strong effect of management level (P < 2.2 × 10⁻¹⁶) on the number of documented interventions. We also found a moderately significant relationship between educational level and the number of interventions documented (P = 0.045). The mean ± SD time required to document an intervention using the web-based application was 66.55 ± 8.98 s. Using the web-based application, 29.06% of documented interventions resulted in cost-savings, while using the multi-user PC software only 4.75% of interventions did so. The majority of cost savings across both platforms resulted from the discontinuation of unnecessary drugs and a change in dosage regimen. Data collection using the web-based application was consistently more complete when compared to the multi-user PC software. CONCLUSIONS The web-based application is an efficient system for documenting pharmacist interventions. Its flexibility and accessibility, as well as its detailed report functionality is a useful tool that will hopefully encourage other primary and secondary care facilities to adopt similar applications.
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Affiliation(s)
- Zubeir A Nurgat
- Division of Pharmacy Services, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
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Garrelts JC, Gagnon M, Eisenberg C, Moerer J, Carrithers J. Impact of telepharmacy in a multihospital health system. Am J Health Syst Pharm 2010; 67:1456-62. [DOI: 10.2146/ajhp090670] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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47
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Society of Critical Care Medicine presidential address. Crit Care Med 2010; 38:1243-5. [PMID: 20404628 DOI: 10.1097/ccm.0b013e3181db3c2a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Bussières JF, Tollec S, Martin B, Malo J, Tardif L, Thibault M. Démarche pour la mise à niveau d’un secteur de soins pharmaceutiques : le cas de la néonatologie. ANNALES PHARMACEUTIQUES FRANÇAISES 2010; 68:178-94. [DOI: 10.1016/j.pharma.2010.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 03/10/2010] [Accepted: 03/17/2010] [Indexed: 11/16/2022]
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49
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Loewen P, Merrett F, Lemos JDE. Pharmacists' perceptions of the impact of care they provide. Pharm Pract (Granada) 2010; 8:89-95. [PMID: 25132875 PMCID: PMC4133061 DOI: 10.4321/s1886-36552010000200002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Accepted: 04/07/2010] [Indexed: 11/11/2022] Open
Abstract
Limitations on health care resources necessitate careful focus on activities that lead to the greatest improvement in patient outcomes. Despite the importance of aligning pharmacists’ time with activities deriving the most impact, there is a paucity of literature on the correlations between pharmacists’ perceptions of the impact of their activities, how they actually spend their time and how these align with published evidence of impacts on patient outcomes.
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Affiliation(s)
- Peter Loewen
- Faculty of Pharmaceutcial Sciences, University of British Columbia , and Regional Pharmacy Coordinator - Education & Research, VCHPHC Regional Pharmacy Services. Vancouver ( Canada )
| | - Faye Merrett
- Clinical pharmacist, Vancouver General Hospital. Vancouver ( Canada )
| | - Jane DE Lemos
- Regional Pharmacy Coordinator - Professional Practice, VCH-PHC Regional Pharmacy Services. Vancouver ( Canada )
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50
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Michaels AD, Spinler SA, Leeper B, Ohman EM, Alexander KP, Newby LK, Ay H, Gibler WB. Medication errors in acute cardiovascular and stroke patients: a scientific statement from the American Heart Association. Circulation 2010; 121:1664-82. [PMID: 20308619 DOI: 10.1161/cir.0b013e3181d4b43e] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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