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Canning ML, Barras M, McDougall R, Yerkovich S, Coombes I, Sullivan C, Whitfield K. Defining quality indicators, pharmaceutical care bundles and outcomes of clinical pharmacy service delivery using a Delphi consensus approach. Int J Clin Pharm 2024; 46:451-462. [PMID: 38240963 DOI: 10.1007/s11096-023-01681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/28/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Clinical pharmacy quality indicators are often non-uniform and measure individual activities not linked to outcomes. AIM To define a consensus agreed pharmaceutical care bundle and patient outcome measures across an entire state health service. METHOD A four-round modified-Delphi approach with state Directors of Pharmacy was performed (n = 25). They were asked to rate on a 5-point Likert scale the relevance and measurability of 32 inpatient clinical pharmacy quality indicators and outcome measures. They also ranked clinical pharmacy activities in order from perceived most to least beneficial. Based upon these results, pharmaceutical care bundles consisting of multiple clinical pharmacy activities were formed, and relevance and measurability assessed. RESULTS Response rate ranged from 40 to 60%. Twenty-six individual clinical pharmacy quality indicators reached consensus. The top ranked clinical pharmacy quality indicator was 'proportion of patients where a pharmacist documents an accurate list of medicines during admission'. There were nine pharmaceutical care bundles formed consisting between 3 and 7 activities. Only one pharmaceutical care bundle reached consensus: medication history, adverse drug reaction/allergy documentation, admission and discharge medication reconciliation, medication review, provision of medicines education and provision of a medication list on discharge. Sixteen outcome measures reached consensus. The top ranked were hospital acquired complications, readmission due to medication misadventure and unplanned readmission within 10 days. CONCLUSION Consensus has been reached on one pharmaceutical care bundle and sixteen outcomes to monitor clinical pharmacy service delivery. The next step is to measure the extent of pharmaceutical care bundle delivery and the link to patient outcomes.
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Affiliation(s)
- Martin Luke Canning
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, QLD, 4032, Australia.
| | - Michael Barras
- Princess Alexandra Hospital, Woolloongabba, Australia
- The University of Queensland, Woolloongabba, Australia
| | - Ross McDougall
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, QLD, 4032, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research, Casuarina, Australia
- Queensland University of Technology, Brisbane, Australia
| | - Ian Coombes
- The University of Queensland, Woolloongabba, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Clair Sullivan
- The University of Queensland, Woolloongabba, Australia
- Digital Metro North, Herston, Australia
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2
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Coombes I, Donovan P, Bullock B, Mitchell C, Noble C. Can a novel constructivist theory-informed feedback intervention reduce prescribing errors ? A pre-post study. BMC Med Educ 2023; 23:150. [PMID: 36882779 PMCID: PMC9993618 DOI: 10.1186/s12909-023-04095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT Medical interns (interns) find prescribing challenging and many report lacking readiness when commencing work. Errors in prescribing puts patients' safety at risk. Yet error rates remain high, despite education, supervision and pharmacists' contributions. Feedback on prescribing may improve performance. Yet, work-based prescribing feedback practices focus on rectifying errors. We aimed to explore if prescribing can be improved using a theory-informed feedback intervention. METHODS In this pre-post study, we designed and implemented a constructivist-theory informed prescribing feedback intervention, informed by Feedback-Mark 2 Theory. Interns commencing internal medicine terms in two Australian teaching hospitals were invited to engage in the feedback intervention. Their prescribing was evaluated by comparing errors per medication order of at least 30 orders per intern. Pre/baseline (weeks 1-3) were compared with post intervention (weeks 8-9). Interns' baseline prescribing audit findings were analysed and discussed at individualised feedback sessions. These sessions were with a clinical pharmacologist (Site 1) and a pharmacist educator (Site 2). RESULTS Eighty eight intern's prescribing over five 10-week terms was analysed from two hospitals. The frequency of prescribing errors significantly reduced at both sites after the intervention, across all five terms (p < 0.001).There were initially 1598 errors in 2750 orders (median [IQR] 0.48 [0.35-0.67] errors per order) and after the intervention 1113 errors in 2694 orders (median [IQR] 0.30 [0.17-0.50] errors per order). CONCLUSION Our findings suggest interns' prescribing practices may improve as a result of constructivist -theory learner centred, informed feedback with an agreed plan. This novel intervention, contributed, to a reduction in interns' prescribing errors. This study suggests new strategies for improving prescribing safety should include the design and implementation of theory-informed feedback interventions.
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Affiliation(s)
- Ian Coombes
- School of Pharmacy, University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102 Australia
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Butterfield Street, Brisbane, QLD 4029 Australia
| | - Peter Donovan
- Clinical Pharmacology. Royal Brisbane and Women’s Hospital, Butterfield St, Herston, QLD 4029 Australia
- School of Medicine, University of Queensland, Herston, QLD 4029 Australia
| | - Brooke Bullock
- Advanced Pharmacist. Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD 4215 Australia
| | - Charles Mitchell
- School of Pharmacy, University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102 Australia
| | - Christy Noble
- Clinical Learning and Assessment Lead, Academy for Medical Education, Medical School, The University of Queensland, Herston, QLD 4006 Australia
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3
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McCourt E, Harper N, Butnoris M, Friend R, Dekker K, Ayre J, Tai B, Pelecanos A, Stowasser D, Coombes I, Dunn T, Donovan P. The effect of Computerised Physician Order Entry on prescribing errors: an interrupted time-series study at a secondary referral hospital in Australia. Int J Med Inform 2022; 165:104829. [DOI: 10.1016/j.ijmedinf.2022.104829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/08/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
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Brown NJ, Doran E, Greenslade JH, Lukin B, Cottrell N, Jaramillo F, Coombes I, Donovan P, Cullen L. Retrospective study of the prevalence and characteristics of adverse drug events in adults who present to an Australian emergency department. Emerg Med Australas 2022; 34:547-554. [PMID: 34973155 DOI: 10.1111/1742-6723.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/17/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the burden, on the ED, of harm from unintentional adverse drug events (ADEs) in the community. METHODS A retrospective, observational study of 936 randomly selected presentations to a level 6 ED at a principal referral hospital in Brisbane, Australia, in November 2017. Clinical records were screened by a pharmacist, who identified suspected ADEs. All suspected ADEs and a random selection of presentations without ADEs were reviewed by an expert panel, which classified, by consensus: occurrence and type of ADE, contribution of ADE to presentation, severity of harm and preventability of presentation. Medication-related ED presentations (ADE-Ps) and potential ADEs were, respectively, defined as presentations directly attributable to an ADE, and medication events that occurred but did not cause the ED presentation. Descriptive data analysis was performed. RESULTS The median (interquartile range) age of patients was 40 (27-58) years, with 49.7% (95% confidence interval [CI] 46.5-52.9) being male. The prevalences of ADE-Ps and potential ADEs were 9.2% (95% CI 7.5-11.3) and 5.0% (95% CI 3.8-6.6), respectively. The severity of harm was classified as 'death or likely permanent harm' in 4.7% (95% CI 0.2-9.1) of ADE-Ps, 'temporary harm' (89.5%, 95% CI 83.1-96.0) and 'minimal or no harm' (5.8%, 95% CI 0.9-10.8). Most (79.1%, 95% CI 70.5-87.7) ADE-Ps were preventable. CONCLUSIONS There is a high burden on emergency care because of unintended medication harm in the community. Interventions to reduce such harm are likely to require a co-ordinated primary, acute and public healthcare response. The high proportion of presentations with potential ADEs indicates opportunity for harm mitigation in the ED.
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Affiliation(s)
- Nathan J Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Doran
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Jaimi H Greenslade
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bill Lukin
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Fabian Jaramillo
- Brisbane North PHN/Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ian Coombes
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.,Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Peter Donovan
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Clinical Pharmacology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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5
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Whitfield K, Coombes I, Denaro C, Donovan P. Medication Utilisation Program, Quality Improvement and Research Pharmacist-Implementation Strategies and Preliminary Findings. Pharmacy (Basel) 2021; 9:pharmacy9040182. [PMID: 34842809 PMCID: PMC8628968 DOI: 10.3390/pharmacy9040182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
Abstract
Judicious use of medicines that considers evidence-based practice, together with cost-effectiveness, is a priority for all health care organisations. We describe an initiative to lead a Medication Utilisation Program, incorporating medication quality improvement and research activities. In August 2020 an advanced pharmacist position was implemented to lead the Program. The purpose was to provide oversight and facilitate initiatives promoting medication optimisation to create sustainable change in practice. A strategic plan was developed with key performance indicators. A governance structure was implemented with relevant reporting mechanisms. Strategic planning and collaboration with medical, nursing and allied health professionals has seen the successful implementation of seven codesigned medication-use evaluations and eight quality improvement projects centred around patient safety, quality and value-based care. Several research studies have been designed with subsequent commencement of pharmacists enrolled in university Research Higher Degree programs. Cost containment initiatives have realised potential savings approximating AUD 250,000. Educational programs included protocol design, ethics approvals and report writing. Key success criteria for a Medication Utilisation Program include dedicated pharmacist resources, structured governance and reporting mechanisms. Alignment of study complexity with staff experience and interdisciplinary collaboration are also critical.
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Affiliation(s)
- Karen Whitfield
- Department of Clinical Pharmacology, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia;
- School of Pharmacy, University of Queensland, 20 Cornwall Street, Brisbane, QLD 4102, Australia;
- Correspondence:
| | - Ian Coombes
- School of Pharmacy, University of Queensland, 20 Cornwall Street, Brisbane, QLD 4102, Australia;
- Department of Pharmacy, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia
| | - Charles Denaro
- Department of Internal Medicine & Aged Care, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia;
- Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
| | - Peter Donovan
- Department of Clinical Pharmacology, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia;
- Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
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Paradissis C, Cottrell N, Coombes I, Scott I, Wang W, Barras M. Patient harm from cardiovascular medications. Ther Adv Drug Saf 2021; 12:20420986211027451. [PMID: 34367546 PMCID: PMC8317255 DOI: 10.1177/20420986211027451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Medication harm can lead to hospital admission, prolonged hospital stay and poor patient outcomes. Reducing medication harm is a priority for healthcare organisations worldwide. Recent Australian studies demonstrate cardiovascular (CV) medications are a leading cause of harm. However, they appear to receive less recognition as ‘high risk’ medications compared with those classified by the medication safety acronym, ‘APINCH’ (antimicrobials, potassium, insulin, narcotics, chemotherapeutics, heparin). Our aim was to determine the scale and type of medication harm caused by CV medications in healthcare. Methods A narrative review of adult (>16 years) medication harm literature identified from PubMed and CINAHL databases was undertaken. Studies with the primary outcome of measuring the incidence of medication harm were included. Harm caused by CV medications was described and ranked against other medication classes at four key stages of a patient’s healthcare journey. Where specified, the implicated medications and type of harm were investigated. Results A total of 75 studies were identified, including seven systematic reviews and three meta-analyses, with most focussing on harm causing hospital admission. CV medications were responsible for approximately 20% of medication harm; however, this proportion increased to 50% in older populations. CV medications were consistently ranked in the top five medication categories causing harm and were often listed as the leading cause. Conclusion CV medications are a leading cause of medication harm, particularly in older adults, and should be the focus of harm mitigation strategies. A practical approach to generate awareness among health professionals is to incorporate ‘C’ (for CV medications) into the ‘APINCH’ acronym. Plain language summary
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Affiliation(s)
- Chariclia Paradissis
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Coombes
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Scott
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - William Wang
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Barras
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
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7
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Freeman CR, Scott IA, Hemming K, Connelly LB, Kirkpatrick CM, Coombes I, Whitty J, Martin J, Cottrell N, Sturman N, Russell GM, Williams I, Nicholson C, Kirsa S, Foot H. Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial. Med J Aust 2021; 214:212-217. [DOI: 10.5694/mja2.50942] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Ian A Scott
- Princess Alexandra Hospital Brisbane QLD
- Transitional Research Institute University of Queensland Brisbane QLD
| | - Karla Hemming
- Institute of Applied Health Research University of Birmingham Edgbaston United Kingdom
| | - Luke B Connelly
- Centre for the Business and Economics of Health University of Queensland Brisbane QLD
| | | | - Ian Coombes
- University of Queensland Brisbane QLD
- Royal Brisbane and Women's Hospital Brisbane QLD
| | - Jennifer Whitty
- University of Queensland Brisbane QLD
- Norwich Medical School University of East Anglia Norwich United Kingdom
| | - James Martin
- Institute of Applied Health Research University of Birmingham Edgbaston United Kingdom
| | | | | | - Grant M Russell
- Monash University Melbourne VIC
- Southern Academic Primary Care Research Unit Monash University Melbourne VIC
| | | | - Caroline Nicholson
- University of Queensland Brisbane QLD
- Mater‐UQ Centre for Primary Healthcare Innovation Mater Health Services Brisbane QLD
| | - Sue Kirsa
- Centre for Medicine Use and Safety Monash University Melbourne VIC
- Monash Health Melbourne VIC
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Coombes I, Markwell A, Kubler P, Redmond AM, McGurk G, Roberts JA. Principles of ethical prescribing for self and others: hydroxychloroquine in the COVID-19 pandemic. Aust Prescr 2020; 43:76-77. [PMID: 32675906 PMCID: PMC7358057 DOI: 10.18773/austprescr.2020.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ian Coombes
- Royal Brisbane and Women's Hospital, Brisbane.,The University of Queensland, Brisbane.,Queensland Clinical Senate, Queensland Health, Brisbane
| | - Alexandra Markwell
- Royal Brisbane and Women's Hospital, Brisbane.,The University of Queensland, Brisbane.,Queensland Clinical Senate, Queensland Health, Brisbane
| | - Paul Kubler
- Royal Brisbane and Women's Hospital, Brisbane.,The University of Queensland, Brisbane.,Queensland Clinical Senate, Queensland Health, Brisbane
| | - Andrew M Redmond
- Royal Brisbane and Women's Hospital, Brisbane.,The University of Queensland, Brisbane.,Queensland Clinical Senate, Queensland Health, Brisbane
| | - Gordon McGurk
- Royal Brisbane and Women's Hospital, Brisbane.,The University of Queensland, Brisbane.,Queensland Clinical Senate, Queensland Health, Brisbane
| | - Jason A Roberts
- Royal Brisbane and Women's Hospital, Brisbane.,The University of Queensland, Brisbane.,Queensland Clinical Senate, Queensland Health, Brisbane
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9
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Bullock B, Donovan PJ, Mitchell C, Whitty JA, Coombes I. The impact of a Post-Take Ward Round Pharmacist on the Risk Score and Enactment of Medication-Related Recommendations. Pharmacy (Basel) 2020; 8:pharmacy8010023. [PMID: 32093405 PMCID: PMC7151687 DOI: 10.3390/pharmacy8010023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 01/31/2020] [Accepted: 02/14/2020] [Indexed: 11/16/2022] Open
Abstract
There is a scarcity of published research describing the impact of a pharmacist on the post-take ward round (PTWR) in addition to ward-based pharmacy services. The aim of this paper was to evaluate the impact of clinical pharmacists' participation on the PTWR on the risk assessment scores of medication-related recommendations with and without a pharmacist. This includes medication-related recommendations occurring on the PTWR and those recommendations made by the ward-based pharmacist on the inpatient ward. A pre-post intervention study was undertaken that compared the impact of adding a pharmacist to the PTWR compared with ward-based pharmacist services alone. A panel reviewed the risk of not acting on medication recommendations that was made on the PTWR and those recorded by the ward-based pharmacist. The relationship between the risk scores and the number and proportion of recommendations that led to action were compared between study groups. There were more medication-related recommendations on the PTWR in the intervention group when a pharmacist was present. Proportionately fewer were in the 'very high and extreme' risk category. Although there was no difference in the number of ward pharmacist recommendations between groups, there was a significantly higher proportion of ward pharmacist recommendations in the "very high and extreme" category in those patients who had been seen on a PTWR attended by a pharmacist than when a pharmacist was not present. There were a greater proportion of "low and medium" risk actionable medication recommendations actioned on the PTWR in the intervention group; and no difference in the risk scores in ward pharmacist recommendations actioned between groups. Overall, the proportion of recommendations that were actioned was higher for those made on the PTWR compared with the ward. The addition of a pharmacist to the PTWR resulted in an increase in low, medium, and high risk recommendations on the PTWR, more very high and extreme risk recommendations made by the ward-based pharmacist, plus an increased number of recommendations being actioned during the patients' admission.
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Affiliation(s)
- Brooke Bullock
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Herston QLD 4029, Australia
- School of Pharmacy, University of Queensland, Woolloongabba QLD 4102, Australia
- Medical Education Unit, Gold Coast Hospital and Health Service, Southport QLD 4215, Australia
- Correspondence: ; Tel.: +61-421-787-754
| | - Peter J Donovan
- Faculty of Medicine, University of Queensland, Herston QLD 4006, Australia
- Department Clinical Pharmacology, Royal Brisbane and Women’s Hospital, Herston QLD 4029, Australia
| | - Charles Mitchell
- School of Pharmacy, University of Queensland, Woolloongabba QLD 4102, Australia
| | - Jennifer A Whitty
- School of Pharmacy, University of Queensland, Woolloongabba QLD 4102, Australia
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Ian Coombes
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Herston QLD 4029, Australia
- School of Pharmacy, University of Queensland, Woolloongabba QLD 4102, Australia
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10
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Snoswell CL, Flor M, Tessier C, Ratanjee S, Hale A, Matthews A, Nissen L, Coombes I. Accuracy checking of dispensed medications by a pharmacy technician: a hospital case study. AUST HEALTH REV 2019; 44:410-414. [PMID: 31771746 DOI: 10.1071/ah18267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/21/2019] [Indexed: 11/23/2022]
Abstract
Medication order accuracy checking is an integral and time-consuming component of the current Australian pharmacist's role. However, the pharmacy profession internationally has moved towards separating the checking task into two parts: a clinical check performed by the registered pharmacist and a technical accuracy check delegated to an appropriately trained pharmacy technician. This case study demonstrates that in an Australian hospital pharmacy context, appropriately trained pharmacy technicians have the potential to be more proficient and time efficient than pharmacists when undertaking accuracy checking of dispensed medications.
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Affiliation(s)
- Centaine L Snoswell
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia. ; and School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Qld 4102, Australia; and Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Brisbane, Qld 4102, Australia; and Corresponding author.
| | - Melynda Flor
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia.
| | - Cameron Tessier
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia.
| | - Sunita Ratanjee
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia.
| | - Andrew Hale
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia. ; and School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Qld 4102, Australia; and School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Qld 4059, Australia.
| | - Andrew Matthews
- Society of Hospital Pharmacists of Australia, PO Box 1774, Collingwood, Vic. 3066, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Qld 4059, Australia.
| | - Ian Coombes
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia. ; and School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Qld 4102, Australia; and School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Qld 4059, Australia.
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11
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Bullock B, Coombes I, Mitchell C, Donovan P, Whitty JA. A systematic review of the costs and cost-effectiveness of clinical pharmacists on hospital ward rounds. Expert Rev Pharmacoecon Outcomes Res 2019; 19:551-559. [PMID: 31305172 DOI: 10.1080/14737167.2019.1643089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: There is a lack of good quality economic evidence for the inclusion of pharmacists on hospital ward rounds in addition to, or as an alternative to, traditional ward-based clinical pharmacy services. There has been no systematic review of the cost or cost-effectiveness of pharmacists attending and contributing on ward rounds. Areas covered: A literature search was conducted in Medline, Embase, Cochrane, and CINAHL and reported in accordance with the PRISMA guidelines in May 2019. As well, a search using Google Scholar and a targeted hand search were undertaken. Studies that reported any estimate of the cost or cost-effectiveness were included if pharmacist participation on inpatient hospital ward rounds was the predominant focus of the intervention. The identified studies were subsequently screened by three reviewers who extracted data on their clinical and economic design. A bias assessment was completed using the ROBINS-I tool. Expert opinion: Seven studies were identified investigating a clinical pharmacist's inclusion on hospital ward rounds where there was a cost estimated. However, none were deemed to be a full economic evaluation and all were found to be open to a serious risk of bias. Future evaluations should include a comparator group and investigate the cost and cost savings of the service, alongside their clinical outcomes.
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Affiliation(s)
- Brooke Bullock
- Pharmacy Department, Royal Brisbane and Women's Hospital , Brisbane , Australia.,School of Pharmacy, University of Queensland , Brisbane , Australia.,Medical Education Unit, Gold Coast Hospital and Health Service , Australia
| | - Ian Coombes
- Pharmacy Department, Royal Brisbane and Women's Hospital , Brisbane , Australia.,School of Pharmacy, University of Queensland , Brisbane , Australia
| | - Charles Mitchell
- School of Medicine, University of Queensland , Brisbane , Australia
| | - Peter Donovan
- School of Medicine, University of Queensland , Brisbane , Australia.,Department Clinical Pharmacology, Royal Brisbane and Women's Hospital , Brisbane , Australia
| | - Jennifer A Whitty
- School of Pharmacy, University of Queensland , Brisbane , Australia.,Health Economics group, Norwich Medical School, University of East Anglia , Norwich , UK
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12
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Bullock B, Donovan P, Mitchell C, Whitty JA, Coombes I. The impact of a pharmacist on post-take ward round prescribing and medication appropriateness. Int J Clin Pharm 2019; 41:65-73. [PMID: 30610543 PMCID: PMC6394496 DOI: 10.1007/s11096-018-0775-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Abstract
Background Medication communication and prescribing on the post-take ward round following patient admission to hospital can be suboptimal leading to worse patient outcomes. Objective To evaluate the impact of clinical pharmacist participation on the post-take ward round on the appropriateness of medication prescribing, medication communication, and overall patient health care outcomes. Setting Tertiary referral teaching hospital, Brisbane, Australia. Method A pre-post intervention study was undertaken that compared the addition of a senior clinical pharmacist attending the post-take ward was compared to usual wardbase pharmacist service, with no pharmacist present of the post-take ward round. We assessed the proportion of patients with an improvement in medication appropriateness from admission to discharge, using the START/STOPP checklists. Medication communication was assessed by the mean number of brief and in-depth discussions, with health care outcomes measured by comparing length of stay and 28-day readmission rates. Main outcome measures: Medication appropriateness according to the START/STOPP list, number and type of discussions with team members and length of stay and readmission rate. Results Two hundred and sixty patients were recruited (130 pre- and 130-post-intervention), across 23 and 20 post-take ward rounds, respectively. Post-intervention, there was increase in the proportion of patients who had an improvement medication appropriateness (pre-intervention 25.4%, post-intervention 36.9%; p = 0.004), the number of in-depth discussions about patients’ medication (1.9 ± 1.7 per patient pre-intervention, 2.7 ± 1.7 per patient post-, p < 0.001), and the number relating to high-risk medications (0.71 ± 1.1 per patient pre-intervention, to 1.2 ± 1.2 per patient post-, p < 0.05). Length of stay and 28-day mortality were unchanged. Conclusion Clinical pharmacist participation on the post-take ward round leads to improved medication-related communication and improved medication appropriateness but did not significantly improve health care outcomes.
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Affiliation(s)
- B Bullock
- Pharmacy Department, Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, QLD, 4029, Australia. .,School of Pharmacy, University of Queensland, Pharmacy Australia Centre of Excellence, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia. .,Medical Education Unit, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD, 4215, Australia.
| | - P Donovan
- School of Medicine, University of Queensland, Level 5, Building 69, St Lucia, QLD, 4072, Australia.,Department Clinical Pharmacology, Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, QLD, 4029, Australia
| | - C Mitchell
- School of Medicine, University of Queensland, Level 5, Building 69, St Lucia, QLD, 4072, Australia
| | - J A Whitty
- School of Pharmacy, University of Queensland, Pharmacy Australia Centre of Excellence, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia.,Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - I Coombes
- Pharmacy Department, Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Rd, Herston, QLD, 4029, Australia.,School of Pharmacy, University of Queensland, Pharmacy Australia Centre of Excellence, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
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13
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Murphy K, Coombes I, McMillan S, Wheeler AJ. Clozapine and shared care: the consumer experience. Aust J Prim Health 2018; 24:455-462. [PMID: 30452883 DOI: 10.1071/py18055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/13/2018] [Indexed: 11/23/2022]
Abstract
Clozapine is a high-risk medication with restrictions that may increase consumer treatment burden. Shared care may improve access, reduce burden and promote primary care management. However, knowledge about the consumer experience of clozapine treatment within a shared-care setting has not been previously reported to the authors' knowledge. The aim of this study was to explore the consumer experience within the shared-care setting. This mixed-methods study examined consumers' experiences with a clozapine shared-care program in an urban setting in Queensland, Australia. Eligible consumers (n=35) participated in a semi-structured interview, including a survey. Analysis was descriptive and thematic. Ten (28.6%) consumers participated. Survey results found a strong belief in the necessity for clozapine, with a low level of reported treatment burden and minimal adverse effects. Four themes were identified from the interviews: (i) understanding of illness and recovery; (ii) positive outcomes of treatment; (iii) acceptance of treatment burden; and (iv) communication pathways. Participants reported positive experiences in the clozapine shared-care program, citing clozapine's efficacy and the GP relationship as key benefits, however communication between clinicians and consumers must be enhanced to reduce risk of suboptimal treatment and adverse drug events.
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Affiliation(s)
- Kate Murphy
- Royal Brisbane and Women's Hospital, Bowen Bridge Road and Butterfield Street, Herston, Qld 4029, Australia
| | - Ian Coombes
- Royal Brisbane and Women's Hospital, Bowen Bridge Road and Butterfield Street, Herston, Qld 4029, Australia
| | - Sara McMillan
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia
| | - Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia
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14
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Hale A, Merlo G, Nissen L, Coombes I, Graves N. Cost-effectiveness analysis of doctor-pharmacist collaborative prescribing for venous thromboembolism in high risk surgical patients. BMC Health Serv Res 2018; 18:749. [PMID: 30285744 PMCID: PMC6167876 DOI: 10.1186/s12913-018-3557-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background Current evidence to support cost effectiveness of doctor- pharmacist collaborative prescribing is limited. Our aim was to evaluate inpatient prescribing of venous thromboembolism (VTE) prophylaxis by a pharmacist in an elective surgery pre-admission clinic against usual care, to measure any benefits in cost to the healthcare system and quality adjusted life years (QALYs) of patients. Method A decision tree model was developed to assess cost effectiveness of pharmacist prescribing compared with usual care for VTE prophylaxis in high risk surgical patients. Data from the literature was used to inform decision-tree probabilities, utility, and cost outcomes. In the intervention arm, a pharmacist prescribed patient’s regular medications, documented a VTE risk assessment and prescribed VTE prophylaxis. In the usual care arm, resident medical officers were responsible for prescribing regular medications, and for risk assessment and prescribing of VTE prophylaxis. The base scenario assessed the cost effectiveness of a pre-existing pre-admission clinic pharmacy service that takes on a collaborative prescribing role. The alternative scenario assessed the benefits of introducing a pre-admission clinic pharmacy service where previously there had not been one. Probabilistic sensitivity analysis was conducted to explore uncertainty in the model. Results In both the base-case scenario and the alternative scenario pharmacist prescribing resulted in an increase in the proportion of patients adequately treated and a decrease in the incidence of VTE resulting in cost savings and improvement in quality of life. The cost savings were $31 (95% CI: -$97, $160) per patient in the base scenario and $12 (95% CI: -$131, $155) per patient in the alternative scenario. In both scenarios the pharmacist-doctor prescribing resulted in an increase in QALYs of 0.02 (95% CI: -0.01, 0.005) per patient. The probability of being cost effective at a willingness to pay off $40,000 was 95% in the base scenario and 94% in the alternative scenario. Conclusion Delegation of the prescribing of VTE prophylaxis for high risk surgical patients to a pharmacist prescriber in PAC, as part of a designated scope of practice, would result in fewer cases of VTE and associated lower costs to the healthcare system and increased QALYs gained by patients. Trial registration Pre admission clinic study registered with ANZCTR-ACTR Number ACTRN12609000426280.
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Affiliation(s)
- Andrew Hale
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Road, Herston, Brisbane, 4029, Australia.
| | - Greg Merlo
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, 4059, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Level 9, Q Block Room, 911, Brisbane, 4000, Australia
| | - Ian Coombes
- Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Road, Herston, Brisbane, 4029, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, 4059, Australia
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Myers B, Mitchell C, Whitty JA, Donovan P, Coombes I. Prescribing and medication communication on the post-take ward round. Intern Med J 2017; 47:454-457. [PMID: 28401716 DOI: 10.1111/imj.13280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/14/2016] [Accepted: 09/10/2016] [Indexed: 11/28/2022]
Abstract
Gaps in communication between medical officers and poor planning are associated with prescribing errors and may result in patient harm. This study describes medication communication on post-take ward rounds (PTWR). Over 6 weeks on 24 PTWR, 130 patients, prescribed 1244 medications, were observed. Of these, 811 (65%) medications were discussed, with 249 discussions (relating to 126 medications) being 'in-depth'. Of 191 planned medication-related actions, 38 (20%) were not implemented by the end of the PTWR and 21 (11%) by time of discharge from hospital. This study suggests that the level of medication communication and subsequent actions are suboptimal. Processes to improve this situation should be explored.
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Affiliation(s)
- Brooke Myers
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.,Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Charles Mitchell
- Centre for Safe and Effective Prescribing, University of Queensland, Brisbane, Queensland, Australia
| | - Jenny A Whitty
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Peter Donovan
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ian Coombes
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
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16
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Murphy K, Coombes I, Moudgil V, Patterson S, Wheeler A. Clozapine and concomitant medications: Assessing the completeness and accuracy of medication records for people prescribed clozapine under shared care arrangements. J Eval Clin Pract 2017; 23:1164-1172. [PMID: 28471043 DOI: 10.1111/jep.12743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 12/18/2022]
Abstract
RATIONALE, AIM, AND OBJECTIVE The objective of the study is to assess the completeness and accuracy of medication records held by stakeholders (secondary care, general practice, and community pharmacy) for clozapine consumers managed in a shared care programme. METHODS This was an exploratory, descriptive study examining secondary and primary care medication records in a large, urban, public mental health service setting in Queensland, Australia. Consumers (18-65 years old) prescribed clozapine under shared care management with capacity to consent were eligible (n = 55) to participate. Information from medication and dispensing records was used by a pharmacist to compile a best possible medication history for each consumer. Discrepancies were identified through reconciliation of stakeholder records with the history. Discrepancies were defined as an omission, addition, or administration discrepancy (difference in dose, frequency, or clozapine brand). RESULTS Thirty-five (63.6%) consumers consented for records to be reviewed. Overall, 32 (91.4%) consumers had at least 1 discrepancy in their records with a mean of 4.9 discrepancies per consumer. Of 172 discrepancies, 127 (73.8%) were omissions. Primarily, concomitant medicines were omitted in 19/35 (54%) of secondary care records while clozapine was omitted in 13/32 (40.6%) of community pharmacies records. CONCLUSIONS Discrepancies were highly prevalent in the shared care medication records of clozapine consumers of this service. Where there is incomplete and inaccurate medication information, there is a risk of suboptimal clinical decision making, increasing the likelihood of adverse drug events. This study demonstrates a need for improved documentation and timely access to accurate and complete medication records for shared care stakeholders. Expanding the pharmacist's role in this setting could improve medication accuracy in documentation and related communication.
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Affiliation(s)
- Kate Murphy
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Ian Coombes
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Vikas Moudgil
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Susan Patterson
- Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Amanda Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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17
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Shanika LGT, Jayamanne S, Wijekoon CN, Coombes J, Perera D, Mohamed F, Coombes I, De Silva HA, Dawson AH. Ward-based clinical pharmacists and hospital readmission: a non-randomized controlled trial in Sri Lanka. Bull World Health Organ 2017. [PMID: 29531414 PMCID: PMC5840627 DOI: 10.2471/blt.17.198366] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To assess if a ward-based clinical pharmacy service resolving drug-related problems improved medication appropriateness at discharge and prevented drug-related hospital readmissions. Method Between March and September 2013, we recruited patients with noncommunicable diseases in a Sri Lankan tertiary-care hospital, for a non-randomized controlled clinical trial. The intervention group received usual care and clinical pharmacy service. The intervention pharmacist made prospective medication reviews, identified drug-related problems and discussed recommendations with the health-care team and patients. At discharge, the patients received oral and written medication information. The control group received usual care. We used the medication appropriateness index to assess appropriateness of prescribing at discharge. During a six-month follow-up period, a pharmacist interviewed patients to identify drug-related hospital readmissions. Results Data from 361 patients in the intervention group and 354 patients in the control group were available for analysis. Resolutions of drug-related problems were higher in the intervention group than in the control group (57.6%; 592/1027, versus 13.2%; 161/1217; P < 0.001) and the medication was more appropriate in the intervention group. Mean score of medication appropriateness index per patient was 1.25 versus 4.3 in the control group (P < 0.001). Patients in the intervention group were less likely to be readmitted due to drug-related problems (44 patients of 311 versus 93 of 311 in the control group; P < 0.001). Conclusion A ward-based clinical pharmacy service improved appropriate prescribing, reduced drug-related problems and readmissions for patients with noncommunicable diseases. Implementation of such a service could improve health care in Sri Lanka and similar settings.
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Affiliation(s)
| | | | | | - Judith Coombes
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Dhineli Perera
- Department of Pharmacy, Austin Health, Melbourne, Australia
| | - Fahim Mohamed
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ian Coombes
- School of Pharmacy, University of Queensland, Brisbane, Australia
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18
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Affiliation(s)
- Ian Coombes
- The Society of Hospital Pharmacists of Australia; Melbourne Australia
| | - Kristin Michaels
- The Society of Hospital Pharmacists of Australia; Melbourne Australia
| | - Michael Dooley
- The Society of Hospital Pharmacists of Australia; Melbourne Australia
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19
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Dooley M, Coombes I, Michaels K, Duggan C, Bates I. Why pharmacists need advanced practice specialist residences: the UK-Australia story. J Pharm Pract Res 2017. [DOI: 10.1002/jppr.1364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michael Dooley
- The Society of Hospital Pharmacists of Australia; Melbourne Australia
| | - Ian Coombes
- The Society of Hospital Pharmacists of Australia; Melbourne Australia
| | - Kristin Michaels
- The Society of Hospital Pharmacists of Australia; Melbourne Australia
| | | | - Ian Bates
- University College London School of Pharmacy; London UK
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20
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Galbraith K, Coombes I, Matthews A, Rowett D, Bader LR, Bates I. Advanced pharmacy practice: aligning national action with global targets. J Pharm Pract Res 2017. [DOI: 10.1002/jppr.1333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kirsten Galbraith
- Postgraduate Studies and Professional Development Unit; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Melbourne Australia
- Domain Lead Advanced Competency; FIP Education, Monash University; Melbourne Australia
| | - Ian Coombes
- Royal Brisbane and Women's Hospital; Brisbane Australia
- Federal Vice President; The Society of Hospital Pharmacists of Australia; Melbourne Australia
| | - Andrew Matthews
- Workforce Transformation; The Society of Hospital Pharmacists of Australia; Melbourne Australia
| | - Debra Rowett
- Drug and Therapeutics Information Service; Repatriation General Hospital; Adelaide Australia
- Australian Pharmacy Council; Canberra Australia
| | - Lina R. Bader
- Division of Pharmacy Practice and Policy; School of Pharmacy; University of Nottingham; Nottingham UK
| | - Ian Bates
- FIP Education Development; FIP Collaborating Centre; University College London School of Pharmacy; London UK
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21
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Shanika LGT, Wijekoon CN, Jayamanne S, Coombes J, Coombes I, Mamunuwa N, Dawson AH, De Silva HA. Acceptance and attitudes of healthcare staff towards the introduction of clinical pharmacy service: a descriptive cross-sectional study from a tertiary care hospital in Sri Lanka. BMC Health Serv Res 2017; 17:46. [PMID: 28100204 PMCID: PMC5241951 DOI: 10.1186/s12913-017-2001-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 01/11/2017] [Indexed: 12/01/2022] Open
Abstract
Background Multidisciplinary patient management including a clinical pharmacist shows an improvement in patient quality use of medicine. Implementation of a clinical pharmacy service represents a significant novel change in practice in Sri Lanka. Although attitudes of doctors and nurses are an important determinant of successful implementation, there is no Sri Lankan data about staff attitudes to such changes in clinical practice. This study determines the level of acceptance and attitudes of doctors and nurses towards the introduction of a ward-based clinical pharmacy service in Sri Lanka. Methods This is a descriptive cross-sectional sub-study which determines the acceptance and attitudes of healthcare staff about the introduction of a clinical pharmacy service to a tertiary care hospital in Sri Lanka. The level of acceptance of pharmacist’s recommendations regarding drug-related problems (DRPs) was measured. Data regarding attitudes were collected through a pre-tested self-administered questionnaires distributed to doctors (baseline, N =13, post-intervention period, N = 12) and nurses (12) worked in professorial medical unit at baseline and post-intervention period. Results A total of 274 (272 to doctors and 2 to nurses) recommendations regarding DRPs were made. Eighty three percent (225/272) and 100% (2/2) of the recommendations were accepted by doctors and nurses, respectively. The rate of implementation of pharmacist’s recommendations by doctors was 73.5% (200/272) (95% CI 67.9 – 78.7%; P < 0.001). The response rate of doctors was higher at the post-intervention period (92.3%; 12/13) compared to the baseline (66.7%; 8/12). At the post-intervention survey 91.6% of doctors were happy to work with competent clinical pharmacists and accepted the necessity of this service to improve standards of care. The nurses’ rate of response at baseline and post-intervention surveys were 80.0 and 0.0% respectively. Their perceptions on the role of clinical pharmacist were negative at baseline survey. Conclusions There was high acceptance and implementation of clinical pharmacist’s recommendations regarding DRPs by the healthcare team. The doctors’ views and attitudes were positive regarding the inclusion of a ward-based pharmacist to the healthcare team. However there is a need to improve liaison between clinical pharmacist and nursing staff. Trial registration Sri Lanka Clinical Trials Registry SLCTR/2013/029 Date: 13 September 2013; retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2001-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lelwala Guruge Thushani Shanika
- Department of Allied Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura Kotte, Sri Lanka. .,South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka.
| | - Chandrani Nirmala Wijekoon
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura Kotte, Sri Lanka
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Judith Coombes
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Ian Coombes
- University of Queensland, Brisbane, Australia.,Royal Brisbane Hospital, Brisbane, Australia
| | - Nilani Mamunuwa
- South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka
| | - Andrew Hamilton Dawson
- South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Hithanadura Asita De Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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22
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Mulvogue K, Roberts JA, Coombes I, Cottrell N, Kanagarajah S, Smith A. The effect of pharmacists on ward rounds measured by the STOPP/START tool in a specialized geriatric unit. J Clin Pharm Ther 2016; 42:178-184. [PMID: 27981600 DOI: 10.1111/jcpt.12489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/13/2016] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The STOPP/START tool has been validated to assess elderly patients for potentially inappropriate prescribing. This study aimed to assess the effect of inclusion of a pharmacist on a physician-led ward round on potentially inappropriate prescribing in hospitalized elderly patients. METHODS This was an observational study of prescribing for patients using the STOPP/START tool at three points during hospital stay; admission to hospital, on transfer to the specialized geriatric unit and on discharge from hospital. Data were collected over 4 months pre- and post-introduction of a pharmacist to a physician-led ward round. Demographic and clinical data, including total number of medications and STOPP/START criteria met, were collected. The mean number of STOPP/START criteria at each time-point was compared for pre- and post-introduction of a pharmacist using a Mann-Whitney U-test. The mean number of criteria for each time-point within each group was compared using a paired Student's t-test. RESULTS AND DISCUSSION The demographic characteristics of the participants in the pre- and post-intervention groups were similar. The post-intervention group had numerically less STOPP/START criteria, mean 1·18 (1·37) compared to the pre-intervention group 1·50 (1·41), P = 0·07 at discharge. The pre-intervention group had no significant change in the criteria from admission 1·78 (1·57) to geriatric unit transfer 1·72 (1·54) (P = 0·37); however, there was a significant decrease from geriatric unit transfer 1·72 (1·54) to discharge 1·50 (1·41) (P = 0·02). The post-intervention group had a significant decrease from hospital admission 2·30 (1·91) to geriatric unit transfer 1·59 (1·60) (P < 0·01) and again to discharge 1·18 (1·37) (P < 0·01). WHAT IS NEW AND CONCLUSION Pharmacist participation on the ward round in a specialized geriatric unit resulted in a numerical improvement in prescribing quality as measured by the STOPP/START tool.
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Affiliation(s)
- K Mulvogue
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia
| | - J A Roberts
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia.,Burns, Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - I Coombes
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia
| | - N Cottrell
- Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia
| | - S Kanagarajah
- Geriatric Evaluation and Management Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - A Smith
- Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia.,School of Pharmacy, University of Otago, Dunedin, New Zealand
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23
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Davies K, Mitchell C, Coombes I. THE ROLE OF OBSERVATION AND FEEDBACK IN ENHANCING PERFORMANCE WITH MEDICATION ADMINISTRATION. J Law Med 2015; 23:316-321. [PMID: 26939498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Legislation in Queensland such as the Health (Drugs and Poisons) Regulation 1996, the national registration competency standards set by the Nursing and Midwifery Board of Australia, and the Continuing Professional Development Registration Standards made pursuant to the Health Practitioner Regulation National Law define expected standards of practice for nurses. The Framework for Assessing Standards for Practice for Registered Nurses, Enrolled Nurses and Midwives, released in July 2015, includes the principles for assessing standards but not the methods. Local policies and procedures offer specific requirements founded on evidence-based practice. Observation of clinical practice with the provision of immediate descriptive feedback to individual practitioners has been associated with improved performance. This column describes the role of regular observation and individual feedback on medication administration as a strategy to enhance performance and patient care.
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24
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Affiliation(s)
- Ian Coombes
- Department of Pharmacy; Royal Brisbane and Women's Hospital; Brisbane Australia
- School of Pharmacy; University of Queensland; Brisbane Australia
| | - Judith Coombes
- School of Pharmacy; University of Queensland; Brisbane Australia
- South Asian Clinical Toxicology Research Collaboration; University of Peradeniya; Peradeniya Sri Lanka
| | - Andrew Dawson
- Sydney Medical School; University of Sydney; Sydney Australia
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25
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Stacey SR, Coombes I, Cardiff L, Wainwright C, Whitfield KM. Using the General Level Framework to guide training and development needs of pharmacists working in paediatrics. J Pharm Pract Res 2015. [DOI: 10.1002/jppr.1140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sonya R. Stacey
- Queensland Children's Medical Research Institute; The University of Queensland; St Lucia Australia
- School of Pharmacy; The University of Queensland; St Lucia Australia
- Royal Children's Hospital; Children's Health Queensland Hospital and Health Service; Herston Australia
| | - Ian Coombes
- School of Pharmacy; The University of Queensland; St Lucia Australia
- Royal Brisbane and Women's Hospital; Metro North Hospital and Health Service; Herston Australia
| | - Lynda Cardiff
- Medication Services Queensland; Queensland Health; Bowen Hills Australia
- School of Clinical Sciences; Queensland University of Technology; Gardens Point Australia
| | - Claire Wainwright
- Queensland Children's Medical Research Institute; The University of Queensland; St Lucia Australia
- Royal Children's Hospital; Children's Health Queensland Hospital and Health Service; Herston Australia
| | - Karen M. Whitfield
- School of Pharmacy; The University of Queensland; St Lucia Australia
- Royal Brisbane and Women's Hospital; Metro North Hospital and Health Service; Herston Australia
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Jackson S, Martin G, Bergin J, Clark B, Halstead P, Rowett D, Stupans I, Galbraith K, Yeates G, Nissen L, Marty S, Gysslink P, Kirsa S, Coombes I, Matthews A, Deans K, Sorimachi K. Advanced practice: a survey of current perspectives of Australian pharmacists. J Pharm Pract Res 2015. [DOI: 10.1002/jppr.1097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Shane Jackson
- Advanced Pharmacy Practice Framework Steering Committee Deakin Australian Capital Territory Australia
| | - Grant Martin
- Australian Association of Consultant Pharmacy Fyshwick, Australian Capital Territory Australia
| | - Jennifer Bergin
- Australian College of Pharmacy Fyshwick, Australian Capital Territory Australia
| | - Bronwyn Clark
- Australian Pharmacy Council Canberra, Australian Capital Territory Australia
| | - Peter Halstead
- Australian Pharmacy Council Canberra, Australian Capital Territory Australia
| | - Debra Rowett
- Australian Pharmacy Council Canberra, Australian Capital Territory Australia
| | - Ieva Stupans
- Council of Pharmacy Schools: Australia and New Zealand Inc. Sydney, New South Wales Australia
| | - Kirstie Galbraith
- Council of Pharmacy Schools: Australia and New Zealand Inc. Sydney, New South Wales Australia
| | - Gilbert Yeates
- Pharmaceutical Defence Limited Hawthorn, Victoria Australia
| | - Lisa Nissen
- Pharmaceutical Society of Australia Deakin Australian Capital Territory Australia
| | - Stephen Marty
- Pharmacy Board of Australia Melbourne Victoria Australia
| | - Paul Gysslink
- Professional Pharmacists Australia South Melbourne Victoria Australia
| | - Sue Kirsa
- The Society of Hospital Pharmacists of Australia Collingwood Victoria Australia
| | - Ian Coombes
- The Society of Hospital Pharmacists of Australia Collingwood Victoria Australia
| | - Andrew Matthews
- The Pharmacy Guild of Australia Barton Australian Capital Territory Australia
| | - Kerry Deans
- Advanced Pharmacy Practice Framework Steering Committee Deakin Australian Capital Territory Australia
| | - Kay Sorimachi
- Advanced Pharmacy Practice Framework Steering Committee Deakin Australian Capital Territory Australia
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Martin JH, Coombes I. Mortality from common drug interactions systems, knowledge and clinical reasoning to optimise prescribing. Intern Med J 2015; 44:621-4. [PMID: 25041768 DOI: 10.1111/imj.12473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/29/2014] [Indexed: 12/11/2022]
Affiliation(s)
- J H Martin
- Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Director of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Schools of Pharmacy and Medicine, The University of Queensland, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Translational Research Institute, Brisbane, Queensland, Australia; School of Health Sciences, Monash University, Brisbane, Queensland, Australia
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Affiliation(s)
- Andrew Hale
- Pre Admission Clinic; Princess Alexandra Hospital; Wooloongabba Qld 4102
| | - Ian Coombes
- Royal Brisbane and Womens Hospital; Herston Qld 4006
| | - Lisa Nissen
- School of Clinical Sciences; Queensland University of Technology; Brisbane Qld 4000
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Affiliation(s)
| | | | | | - Yvonne M Allinson
- The Society of Hospital Pharmacists of Australia; PO Box 1774 Collingwood Vic. 3006
| | - Ian Coombes
- Royal Brisbane and Women's Hospital, School of Pharmacy; The University of Queensland; Brisbane Qld 4072
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Affiliation(s)
| | | | | | - Ian Coombes
- Medication Review, Queensland Health; Safe Medication Practice Unit; Herston Qld 4029
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Coombes I, Bates I, Duggan C, Galbraith KJ. Developing and Recognising Advanced Practitioners in Australia: An Opportunity for a Maturing Profession? Journal of Pharmacy Practice and Research 2015. [DOI: 10.1002/j.2055-2335.2011.tb00057.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ian Coombes
- Safe Medication Management UnitMedication Services Queensland, Queensland Health Bowen Hills Brisbane Qld 4006
| | - Ian Bates
- Global Education Taskforce, FIP Collaborating Centre London UK
| | - Catherine Duggan
- Professional Development and SupportRoyal Pharmaceutical Society for Great Britain London UK
| | - Kirstie J Galbraith
- Postgraduate Studies and Professional Development Unit, Faculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Vic. 3052
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Coombes I, Avent M, Cardiff L, Bettenay K, Coombes J, Whitfield K, Stokes J, Davies G, Bates I. Improvement in Pharmacist's Performance Facilitated by an Adapted Competency-Based General Level Framework. Journal of Pharmacy Practice and Research 2015. [DOI: 10.1002/j.2055-2335.2010.tb00517.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Karen Bettenay
- Medication Practitioner Development, Medication Services Queensland
| | - Judith Coombes
- School of Pharmacy; University of Queensland, and Princess Alexandra Hospital
| | | | | | - Graham Davies
- Pharmaceutical Science Division; King's College London
| | - Ian Bates
- The School of Pharmacy; University of London; London United Kingdom
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Wilkin M, McLachlan A, Coombes I. Cost shifting and the quality use of medicines. Aust Prescr 2015; 38:4-5. [DOI: 10.18773/austprescr.2015.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Hale A, Coombes I, Stokes J, Aitken S, Clark F, Nissen L. Patient satisfaction from two studies of collaborative doctor-pharmacist prescribing in Australia. Health Expect 2015; 19:49-61. [PMID: 25614342 DOI: 10.1111/hex.12329] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Pharmacist prescribing has been introduced in several countries and is a possible future role for pharmacy in Australia. OBJECTIVE To assess whether patient satisfaction with the pharmacist as a prescriber, and patient experiences in two settings of collaborative doctor-pharmacist prescribing may be barriers to implementation of pharmacist prescribing. DESIGN Surveys containing closed questions, and Likert scale responses, were completed in both settings to investigate patient satisfaction after each consultation. A further survey investigating attitudes towards pharmacist prescribing, after multiple consultations, was completed in the sexual health clinic. SETTING AND PARTICIPANTS A surgical pre-admission clinic (PAC) in a tertiary hospital and an outpatient sexual health clinic at a university hospital. Two hundred patients scheduled for elective surgery, and 17 patients diagnosed with HIV infection, respectively, recruited to the pharmacist prescribing arm of two collaborative doctor-pharmacist prescribing studies. RESULTS Consultation satisfaction response rates in PAC and the sexual health clinic were 182/200 (91%) and 29/34 (85%), respectively. In the sexual health clinic, the attitudes towards pharmacist prescribing survey response rate were 14/17 (82%). Consultation satisfaction was high in both studies, most patients (98% and 97%, respectively) agreed they were satisfied with the consultation. In the sexual health clinic, all patients (14/14) agreed that they trusted the pharmacist's ability to prescribe, care was as good as usual care, and they would recommend seeing a pharmacist prescriber to friends. DISCUSSION AND CONCLUSION Most of the patients had a high satisfaction with pharmacist prescriber consultations, and a positive outlook on the collaborative model of care in the sexual health clinic.
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Affiliation(s)
- Andrew Hale
- Princess Alexandra Hospital, Woolloongabba, Brisbane, Qld, Australia
| | - Ian Coombes
- Royal Brisbane and Womens Hospital, Brisbane, Qld, Australia
| | - Julie Stokes
- Medicines Regulation and Quality, Queensland Health, Brisbane, Qld, Australia
| | - Stuart Aitken
- Gold Coast Sexual Health Clinic, Miami, Qld, Australia
| | - Fiona Clark
- Gold Coast Sexual Health Clinic, Miami, Qld, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
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Stacey S, Coombes I, Wainwright C, Klee B, Miller H, Whitfield K. Characteristics of adverse medication events in a children's hospital. J Paediatr Child Health 2014; 50:966-71. [PMID: 25049060 DOI: 10.1111/jpc.12684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 11/29/2022]
Abstract
AIM To compare adverse medication events (AMEs) reported in children, via the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) coding with events reported via other data sources. METHOD AME reports were retrieved using codes Y40-Y59 and X40-X44 over 6 months. Patients' charts were manually reviewed to identify events associated with error and/or harm with medicines during a hospital admission. Medication name, group, error, harm and alert documentation were recorded. Clinical incidents and pharmacist interventions were reviewed for the same period. RESULTS Two hundred sixty-three events from January to June 2011 were recorded by ICD-10 coding in 180 patients. After duplicated, missing or unrelated events were excluded and 146 AMEs remained. In the same period, 117 AMEs were reported as incidents and 190 as pharmacist interventions. In total, 276 children with 447 events were reported via all sources. Little duplication between data sources was evident. In total, 158 events involved harm, with 135 of these from ICD-10 coding, 16 from incident reports and 2 pharmacist interventions (including 6 events from multiple sources). Error was involved in 3% of ICD10 reports, 97% of incidents and 100% of interventions. Only 14% of harm-related events from ICD-10 were documented on the medical record clinical alert. Chemotherapy accounted for 31% of harm-related events, antimicrobials 18%, corticosteroids 14% and narcotics 12%. CONCLUSION Of the harm-related events, 85% were documented via ICD-10 coding with few documented in other databases. Review of ICD-10-coded AMEs can provide valuable information to improve patient safety and quality.
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Affiliation(s)
- Sonya Stacey
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia; Royal Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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Noble C, Coombes I, Nissen L, Shaw PN, Clavarino A. Making the transition from pharmacy student to pharmacist: Australian interns' perceptions of professional identity formation. Int J Pharm Pract 2014; 23:292-304. [PMID: 25363500 DOI: 10.1111/ijpp.12155] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 08/25/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The experience of transitioning from university to practice influences professional identity formation. It is unclear how this transitioning experience influences pharmacy interns' professional identities. This study aims to examine pharmacy interns' perceptions of their transition from university to the workplace and the influence this had on their pharmacist identities. METHODS A qualitative approach using in-depth interviews was adopted for this study. Fifteen interns (community and hospital) from one school of pharmacy in Australia were interviewed. Questions were asked about the nature of their current intern role, their university experiences, how they saw themselves as pharmacists and their perceptions of the transition to practice. KEY FINDINGS The interns interviewed entered the workplace valuing patient-focused aspects of practice and contributing to patient care. The nature of work meant there were limited opportunities to enact these aspects of their professional identities. The interns were challenged by interactions with patients and doctors, and experienced difficulties reconciling this with their university-derived professional identities. Also, the interns lacked the confidence and strategies to overcome these challenges. Some were exploring alternative ways of being pharmacists. CONCLUSIONS This paper argues that graduates' experience of the transition to practice was challenging. This was due to nascent professional identities formed in university and a lack of workplace experiences enabling patient-centred practices. The interns' formation of professional identities was highly responsive to the context of work. To facilitate the development of Australian patient-centred pharmacy practice, supporting professional identity formation should be a focus within pharmacy education.
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Affiliation(s)
- Christy Noble
- Medical Education Unit, Gold Coast Hospital and Health Service, Southport, Qld, Australia.,School of Medicine, Griffith University, Southport, Qld, Australia
| | - Ian Coombes
- Pharmacy Australia Centre of Excellence, School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia.,Department of Pharmacy, Royal Brisbane and Womens Hospital, Brisbane, Qld, Australia
| | - Lisa Nissen
- Pharmacy Australia Centre of Excellence, School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
| | - Paul N Shaw
- Pharmacy Australia Centre of Excellence, School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Alexandra Clavarino
- Pharmacy Australia Centre of Excellence, School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
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Angley M, Rigby D, Dowling HV, Coombes I, Criddle D, Dooley M, Driscoll SE, Jayasuriya PH, Kirsa SW, Tenni P, Bennett S, Vassarotti R. Advocating for Patients and the Pharmacist's Role in Primary Care. Journal of Pharmacy Practice and Research 2014. [DOI: 10.1002/j.2055-2335.2014.tb00004.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manya Angley
- Sansom Institute for Health Research; University of South Australia
| | | | | | - Ian Coombes
- Safe Medication Management Unit Medication Services Queensland Queensland Health
| | | | | | | | | | | | - Peter Tenni
- Clinical Pharmacy Training and Consulting
- Consultant Pharmacy Services
- Clinical Division, Medscope
- University of Tasmania
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Hale A, Gibbs H, Coombes I, Collins R, Maycock E, Nissen L. Pharmacist prescribing of venous thromboembolism prophylaxis in a surgical pre-admission clinic. Anaesth Intensive Care 2014; 42:519-520. [PMID: 24967768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Stacey SR, Coombes I, Wainwright C, Cardiff L, Whitfield K. What does advanced practice mean to Australian paediatric pharmacists? A focus group study. International Journal of Pharmacy Practice 2014; 23:141-9. [DOI: 10.1111/ijpp.12113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 03/02/2014] [Indexed: 11/26/2022]
Abstract
Abstract
Objectives
The aim of this study was to explore perceptions and attitudes of Australian paediatric pharmacists about advanced pharmacy practice and to identify suitable methods of assessment for this level of practice.
Methods
Four focus groups (with 31 participants) were held in 2012 with Australian hospital pharmacists who work with children. Written notes and audio recordings were used to produce verbatim transcriptions and extract themes.
Key findings
There was consensus across groups that formal recognition of advanced pharmacy practice was valuable to the profession and to individuals. Elements should include a strong grounding in clinical practice, commitment to education, research and service improvement outside the department and institution. A framework for career development should be used to describe the levels of practice leading to advanced practice. Assessment should involve multiple separate criteria, and incorporate direct observation, peer review and a professional portfolio. Postgraduate qualifications are desirable but not considered essential. Different knowledge and skills are required in paediatrics; however, the definition of advanced practice remains the same.
Conclusions
Recognition of advanced practice is valuable for the profession and for individuals. Multiple methods of assessment should be used. Specialty areas such as paediatrics can be defined and assessed similar to other specialties, with acknowledgement of the specific paediatric knowledge and skills required.
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Affiliation(s)
- Sonya R Stacey
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Qld, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
- Royal Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Qld, Australia
| | - Ian Coombes
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Qld, Australia
| | - Claire Wainwright
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Qld, Australia
- Royal Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Qld, Australia
| | - Lynda Cardiff
- Pharmacist Practitioner Development Unit, Medication Services Queensland, Brisbane, Qld, Australia
| | - Karen Whitfield
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
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Noble C, Coombes I, Shaw PN, Nissen LM, Clavarino A. Becoming a pharmacist: the role of curriculum in professional identity formation. Pharm Pract (Granada) 2014; 12:380. [PMID: 24644522 PMCID: PMC3955867 DOI: 10.4321/s1886-36552014000100007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 02/02/2014] [Indexed: 11/25/2022] Open
Abstract
Objective To understand how the formal curriculum experience of an Australian
undergraduate pharmacy program supports students’ professional identity
formation. Methods A qualitative ethnographic study was conducted over four weeks using
participant observation and examined the ‘typical’ student experience from
the perspective of a pharmacist. A one-week period of observation was
undertaken with each of the four year groups (that is, for years one to
four) comprising the undergraduate curriculum. Data were collected through
observation of the formal curriculum experience using field notes, a
reflective journal and informal interviews with 38 pharmacy students. Data
were analyzed thematically using an a priori analytical framework. Results Our findings showed that the observed curriculum was a conventional
curricular experience which focused on the provision of technical knowledge
and provided some opportunities for practical engagement. There were some
opportunities for students to imagine themselves as pharmacists, for
example, when the lecture content related to practice or teaching staff
described their approach to practice problems. However, there were limited
opportunities for students to observe pharmacist role models, experiment
with being a pharmacist or evaluate their professional identities. While
curricular learning activities were available for students to develop as
pharmacists e.g. patient counseling, there was no contact with patients and
pharmacist academic staff tended to role model as educators with little
evidence of their pharmacist selves. Conclusions These findings suggest that the current conventional approach to the
curriculum design may not be fully enabling learning experiences which
support students in successfully negotiating their professional identities.
Instead it appeared to reinforce their identities as students with a naïve
understanding of professional practice, making their future transition to
professional practice challenging.
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Affiliation(s)
- Christy Noble
- Medical Education Unit, Gold Coast University Hospital. Southport, & School of Pharmacy, The University of Queensland . Sta. Lucia, Qld ( Australia ).
| | - Ian Coombes
- School of Pharmacy, The University of Queensland , Sta. Lucia, Qld ( Australia ).
| | - Paul Nicholas Shaw
- School of Pharmacy, The University of Queensland , Sta. Lucia, Qld ( Australia ).
| | - Lisa M Nissen
- School of Pharmacy, The University of Queensland, Sta. Lucia & School of Clinical Sciences, Queensland University of Technology , Brisbane Qld ( Australia ).
| | - Alexandra Clavarino
- School of Pharmacy, The University of Queensland , Sta. Lucia, Qld ( Australia ).
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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. Am J Pharm Educ 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Noble C, O'Brien M, Coombes I, Shaw PN, Nissen L. Concept mapping to evaluate an undergraduate pharmacy curriculum. Am J Pharm Educ 2011; 75:55. [PMID: 21655409 PMCID: PMC3109809 DOI: 10.5688/ajpe75355] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/05/2011] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To explore a pharmacy school curriculum for opportunities for student engagement and to determine how these might shape student identity as pharmacists. METHODS The learning aims and objectives and methods of assessment from the curriculum of a bachelor of pharmacy (BPharm) program were collected and a concept map was generated. The concept map was interpreted using Barnett and Coates' curricular domains of knowing, acting and being. RESULTS The key concepts within the intended curriculum that were identified from the concept map were drugs, pharmacy, understanding, practice, and skills. Concepts such as patient and consumer, which would indicate a patient-centered approach to the curriculum, were limited. The main form of assessment used in the curriculum was multiple-choice and short-answer examinations. CONCLUSION There was an emphasis in the curriculum on student acquisition of knowledge and this was reinforced by the use of theoretical examinations. The content of the curriculum was drug-centered rather than patient-centered and the emergence of students' identity as pharmacists may be fragmented as a result.
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Affiliation(s)
- Christy Noble
- School of Pharmacy, The University of Queensland, Australia.
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Coombes I. GlaxoSmithKline Medal of Merit 2010. Journal of Pharmacy Practice and Research 2010. [DOI: 10.1002/j.2055-2335.2010.tb00568.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ian Coombes
- Safe Medication Management Unit, Medication Services Queensland, Queensland Health; Brisbane Queensland
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Wheeler A, Hale A, Jensen M, Coombes I, Stokes J, Stowasser D, Nissen L. Pharmacist prescribers. J Prim Health Care 2010; 2:72-73. [PMID: 20695075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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