CP-022 Nationally agreed standards for ward pharmacy services – how are we doing?

BackgroundWard pharmacists are required for the active implementation of therapeutic drug monitoring (TDM). This epidemiological study verified whether Japanese ward pharmacists contribute to improving the TDM implementation proportions of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents using the large health insurance claims database.MethodsThe patients who received intravenous anti-MRSA agents from April 2012 to March 2017 were enrolled. We defined ward pharmacy service as the “drug management and guidance fee” and/or “inpatient pharmaceutical services premium”. In addition, implementation of TDM was identified by “the specific drug treatment management fee”. We compared the proportions of TDM implementation for vancomycin (VCM), teicoplanin (TEIC), and arbekacin (ABK) in the ward and non-ward pharmacy service groups. To avoid confounding, the propensity score method was employed. Moreover, the clinical variables affecting TDM implementation in each anti-MRSA agent were analyzed by using a multiple logistic regression model.ResultsThe following number of patients were included in the study: VCM (n = 2138), TEIC (n = 596), and ABK (n = 142). After propensity score matching, the proportions of TDM implementation for VCM and TEIC were higher in the ward pharmacy service group than in the non-ward pharmacy service group (VCM: 69.2% vs 60.3%, TEIC: 51.4% vs 34.7%), while no significant difference was observed for ABK (21.2% vs 23.1%). As independent clinical variables affecting TDM implementation for VCM and TEIC, several clinical variables, including ward pharmacy services, were extracted. In contrast, no clinical variables were extracted for ABK.ConclusionsWe found that the ward pharmacy service is associated with the active implementation of TDM for anti-MRSA agents, such as VCM and TEIC.

BackgroundPatient’s awareness and satisfaction towards ward pharmacy services may influence perception towards effectiveness and safety of drugs, affecting medication adherence and clinical outcome. Nevertheless, studies on local ward pharmacy services were lacking. This study evaluated awareness, expectation and satisfaction of ward pharmacy services among patients in medical wards and determined their association with demographic characteristics.MethodsThis was a cross-sectional study using self-administered questionnaire conducted in medical wards of fourteen Perak state public hospitals from September to October 2020. In-patients aged ≥18 years old were included. The validated questionnaire had four domains. The student’s t-test, one-way analysis of variance (ANOVA) and multiple linear regression were was employed to evaluate the association between patients’ demographic characteristics with their awareness, expectation and satisfaction towards ward pharmacy services.Results467 patients agreed to participate (response rate = 83.8%) but only 441 were analysed. The mean age of the patients was 54.9 years. Majority was male (56.2%), Malay (77.3%), with secondary education (62.9%), rural resident (57.1%) and reported good medication adherence (61.6%). The mean awareness score was 49.6 out of 60. Patients were least aware about drug-drug interaction (3.85 ± 1.15) and proper storage of medications (3.98 ± 1.06). Elderly patients (β = − 2.82, P < 0.001) obtained lower awareness score. Patients with tertiary education (β = 3.87, P = 0.001), rural residents (β = 3.65, P < 0.001) and with good medication adherence (β = 2.55, P = 0.002) had higher awareness score. The mean expectation score was 44.0 out of 50. The patients had higher expectation to encounter a polite ward pharmacist (4.51 ± 0.56). Patients with tertiary education (β = 1.86, P = 0.024), rural residents (β = 1.79, P = 0.001) and with good medication adherence (β = 1.48, P = 0.006) demonstrated higher expectation. The mean satisfaction score was 43.6 out of 50. The patients had high satisfaction in language used (4.45 ± 0.57) and level of knowledge demonstrated (4.41 ± 0.62) by the ward pharmacists. Patients with tertiary education (β = 2.16, P = 0.009), rural residents (β = 1.82, P = 0.001) and with good medication adherence (β = 1.44, P = 0.009) demonstrated higher satisfaction, while elderly patients (β = − 1.17, P = 0.031) had lower satisfaction towards ward pharmacy services.ConclusionThere was a high level of awareness, expectation and satisfaction towards ward pharmacy services in public hospitals of Perak, Malaysia.

In UK hospitals, traditional ward pharmacy services involve pharmacists visiting their wards once or twice a day each weekday. However, to provide a more patient orientated ward pharmacy service, we developed the Imperial Model of Ward Pharmacy. This is based on pharmacists seeing every drug chart every other day, allowing increased focus towards patients' needs on other days. To assess the impact of the Imperial Model of Ward Pharmacy on the prevalence of new medication orders that have not been screened by pharmacists, and doses omitted due to medication being unavailable. We conducted an uncontrolled before-and-after study on eight medical wards. In each phase, we collected data on the number and prevalence of active medication orders that had not been screened by a pharmacist at the point of data collection, and the number and prevalence of regular doses documented as being omitted due to drug unavailability, or for which the administration record was left blank. The prevalence of unscreened medication orders reduced from 7.6 % of 1,433 orders to 4.1 % of 1,495 orders (p = 0.0002; Chi square test). There was no change in the prevalence of dose omissions (1.4 % in each phase of the study). This is a practical way to move to a more patient-focused service without affecting the safety of the service provided.

BackgroundIn the University Hospital Basel (UHB) as well as in many other Swiss hospitals the ward pharmacies are managed by nursing teams according to a survey conducted by the Swiss...

A sentence, as has been suggested before in this study, consists of one or more elements, each consisting of one or more than one word. We have mentioned the subject as an important element, because it denotes the person or thing about whom (which) a statement is made. The other basic elements, as they are now sometimes called,1 are the verb, the object(s) and the complement(s). Although these are called basic (or major) elements, it does not follow that no sentence can be complete without them. In fact it is very seldom that they are all present in a sentence in PC. Carlton (see op. cit. chapter II) divides them into mandatory (subject and verb) and optional basic elements (objects and complement), and defines the mandatory ones as “those that are found in every sentence” and the optional ones as “those that may or may not be used in combination with other basic elements.” This is certainly not the state of affairs in PC. In this text we find at least one verb in practically all sentences; the subject is not expressed in about 200 main clauses in A and in about 130 main clauses in B. There are also sentences in which we find no basic elements at all. Those without a finite verb are sometimes called elliptical sentences.

This study was conducted based on a questionnaire survey addressed to physicians and nurses, who were in direct contact with pharmacists on their wards, in order to explore and stratify the factors contributing to the improvement of physicians’ and nurses’ satisfaction with the pharmacists’ ward pharmacy services. The participants were physicians and nurses working in wards of Tokyo Teishin Hospital who had given their consent to participate. The questionnaire asked the pharmacists to respond to seven questions regarding their ward pharmaceutical services and their overall evaluation. The customer satisfaction (CS) analysis showed that, for physicians, the priority improvement areas were participation in discussion rounds and conferences and participation in team medicine; for nurses, in addition to these points, confirmation of prescription content and monitoring of drug effects and side effects were priority points. Factor analysis showed that three factors were extracted for physicians and two factors for nurses, and they were categorized into several clusters. The CS analysis showed that both physicians and nurses desired more active involvement of pharmacists in discussion rounds and team care, and different factors were extracted for physicians and nurses, suggesting that the evaluation of ward pharmacy services differed between occupations.

BackgroundIntegration of pharmacists into multidisciplinary teams has been shown to have a positive effect in several clinical, pharmaceutical and financial indicators. Literature on the oncology setting and in non-teaching facilities...

Pharmacists' impact on individual patient care is difficult to measure especially the contribution made by clinical pharmacy ward visits. This study set out to determine what activities pharmacists actually undertook on a clinical pharmacy ward visit and compare this with the usual method of measuring clinical pharmacist performance, self-reported pharmacist interventions. Observational analysis was carried out on 16 pharmacists providing a ward clinical pharmacy service in four acute hospitals. Percentage of pharmacist interventions recorded. A total of 34 wards were visited during the study which included both medical and surgical specialties. Average time spent per patient was less than two minutes for most pharmacists and three-quarters of the pharmacists checked over 80% of patient drug charts. Interventions represented 68% of pharmacist activities on the wards but on questioning the pharmacists reported that they would record only 31% of those interventions. Comparison of the interventions the pharmacists stated they would record with an historical sample of recorded interventions from the four hospitals showed a similar pattern in each intervention category. However, pharmacists were more likely to record interaction type interventions and less likely to record interventions on incomplete/illegal prescriptions, which were regarded as routine practice. Pharmacists reported they would record less than one-third of interventions observed. If recorded pharmacist interventions continue to be used the main source of evidence of outputs of clinical pharmacy service, a better way of capturing this data needs to be developed.

Ward pharmacy services are widely provided in hospitals throughout the United Kingdom. The objective of this study was to compare the efficiency of once daily with twice daily ward visits. Over a two week period, eight matched wards — four providing a twice daily service and four a once daily service — were assessed in three areas: time taken to provide the service, clinical pharmacy activity, and supply of non-stock items. A total of 120 ward pharmacy visits occurred during the 10 day study period. The mean total daily ward visit time was 55 minutes in the twice daily group compared with 40 minutes in the once daily group, a difference of 15 ± 7.6 minutes/ward/day. Pharmacists in the once daily group spent 52 per cent of time on clinical pharmacy activities and recorded 169 prescription monitoring incidents (PMIs). In comparison, pharmacists in the twice daily group spent proportionally less time on clinical pharmacy activities (42 per cent) and recorded significantly fewer PMIs (107). The proportion of non-stock items originating from the ward pharmacy service was similar in both groups. This study found a once daily ward pharmacy service more efficient than a twice daily service, saving an average of 15 minutes/ward/day.

Several factors related to vancomycin-induced nephrotoxicity (VIN) have not yet been clarified. In the present study, we used Japanese big data to investigate novel factors and their high-risk combinations that influence VIN. We employed a large Japanese electronic medical record database and included patients who had been administered intravenous vancomycin between June 2000 and December 2020. VIN was defined as an increase in serum creatinine ≥0.5mg/dL or 1.5-fold higher than the baseline. The outcomes were: (1) factors affecting VIN that were identified using multiple logistic regression analysis, and (2) combinations of factors that affect the risk of VIN according to a decision tree analysis, which is a typical machine learning method. Of the 7306 patients that were enrolled, VIN occurred in 14.2% of them (1035). A multivariate analysis extracted 22 variables as independent factors. Concomitant ramelteon use (odds ratio 0.701, 95% confidence interval 0.512-0.959), ward pharmacy service (0.741, 0.638-0.861), duration of VCM < 7days (0.748, 0.623-0.899) and trough concentrations 10-15 mg/L (0.668, 0.556-0.802) reduce the risk of VIN. Meanwhile, concomitant piperacillin-tazobactam use (2.056, 1.754-2.409) and piperacillin use (2.868, 1.298-6.338) increase the risk. The decision tree analysis showed that a combination of vancomycin trough concentrations ≥20 mg/L and concomitant piperacillin-tazobactam use was associated with the highest risk. We revealed that the concomitant ramelteon use and ward pharmacy service may decrease the risk of VIN, while the concomitant use of not only piperacillin-tazobactam but also piperacillin may increase the risk.

A questionnaire was drawn up to ascertain junior doctors' satisfaction with the ward pharmacy service in the Hammersmith and Queen Charlotte's special health authority, London. The questionnaire was designed for face to face interviews lasting not more than 10 minutes. The interviews were taped and the interviewer was not known to the doctors. The survey took place in January, 1992. Forty three out of 135 senior house officers, registrars and senior registrars employed by the special health authority were randomly selected for interview and 26 (60 per cent) of these were seen. Eighty five per cent of doctors thought the service was better than average and most doctors were satisfied with aspects of the service such as prescription monitoring, advice received from and friendliness of ward pharmacists. Only one doctor rated the service as worse than that in other hospitals in which he had worked. Fifteen doctors suggested increased liaison or contact between ward pharmacists and doctors would make the service better. A number of issues have been raised concerning the service which have been addressed and we intend to repeat the survey in the future.

FIGO good practice recommendations for reducing preterm birth and improving child outcomes.

Rationale: Integration of guidelines for severe asthma (SA) management into electronic medical records (EMRs) may greatly enhance asthma care and outcomes. Objectives: We aimed: 1) to develop an algorithm to identify SA patients in primary care EMRs using pan-Canadian standardized data elements and decision support that prompts adherence with best practice guidelines and 2) to develop EMR data standards for SA for use primarily by specialists. Methods: A draft algorithm and list of elements were prepared, based upon the Canadian Thoracic Society criteria for suspected SA, Pan-Canadian Respiratory Standards Initiative for Electronic Health Records (PRESTINE) Asthma and Chronic Obstructive Pulmonary Disease (COPD) Working Group Report and published SA registries. Using a modified Delphi process, a working group (WG) of 18 experts voted on algorithm steps, elements and data definitions. Consensus was defined a priori as ≥ 60%. The algorithm, data elements and definitions were revised based on external stakeholder review. Measurements and Main Results: The WG devised a 4-step algorithm to identify SA and identified minor revisions to PRESTINE Core asthma elements necessary for the algorithm. PRESTINE Core asthma elements were deemed Core for SA. The WG identified 108 Core and 48 Optional elements for SA. Of those, 26 Core elements and 15 Optional elements were unique to SA. Conclusions: An algorithm has been proposed that will identify SA patients in primary care EMRs based upon PRESTINE Core asthma elements. This initiative has also identified SA EMR elements for use primarily by specialists.

BackgroundWithin the framework of the Austrian healthcare reform, a publicly funded project with the aim of resolving medication related problems (MRPs) by means of inhospital clinical pharmacy services (CPS) was...

A Monte Carlo simulation study evaluated the effects of a simulated ‘good’ or ‘poor’ ward care setting, pharmacy, laboratory and phlebotomy service on the resulting precision of control of serum tobramycin concentrations in a representative (theoretical) patient receiving the drug. The ward care (precise dose administration and recording of times given) and the pharmacy (precise dosage preparation) played significant roles in achieving precise serum concentrations whereas laboratory (assay precision) and the phlebotomy service (precise labelling of blood specimen times) were considerably less important. However, use of a simulated ‘smart’ infusion pump contributed most to therapeutic precision.