Electronic Clinical Progress Notes as Performance Indicators in Clinical Pharmacy: A Validation Study

BackgroundThe Health Information and Quality Authority (HIQA) in Ireland are currently promoting and guiding the development of key performance indicators and minimum data sets to monitor health care quality. A...

Background Integration of clinical pharmacists into multidisciplinary Mental Health Hospital-in-the-Home teams is increasing but little is known about the medication safety contribution these pharmacists make.AimTo evaluate whether clinical pharmacist involvement in a Mental Health Hospital-in-the-Home service improved medication safety key performance indicators.Method Medical records were retrospectively reviewed of all patients admitted to 2 Western Australian Mental Health Hospital-in-the-Home services from September to November 2015.Site 1 was a 16-bed service incorporating a clinical pharmacist as part of its multidisciplinary team.Site 2was a similarly structured 18-bed service but without clinical pharmacist involvement. The primary outcome measure was completion of medication safety key performance indicators obtained from the Western Australian Government Pharmaceutical Review Policy and mental health-specific best practice guidelines. ResultsKey performance indicators from Site 1 (n = 75 records), which incorporated a clinical pharmacist, demonstrated significantly (p < 0.001) higher rates of completion of medication reconciliation [65 (87%) versus 17 (29%)], accurate adverse drug reaction list [73 (97%) versus 34 (58%)], accurate discharge medication list [51 (74%) versus 18 (45%)], accurate medication profile [74 (99%) versus 40 (68%)] and medication chart review [74 (99%) versus 0 (0%)] than Site 2 (n = 59). ConclusionIntegrating a clinical pharmacist into a Mental Health Hospital-in-the-Home program significantly improved achievement of medication safety key performance indicators.

BackgroundThe MedBridge study, with the aim of evaluating the effects of comprehensive medication reviews performed by ward-based clinical pharmacists on elderly patients’ healthcare consumption, started in February 2017. A secondary...

Key performance indicators (KPIs) are quantifiable measures of quality. There are no published, systematically derived clinical pharmacy KPIs (cpKPIs). A group of hospital pharmacists aimed to develop national cpKPIs to advance clinical pharmacy practice and improve patient care. A cpKPI working group established a cpKPI definition, 8 evidence-derived cpKPI critical activity areas, 26 candidate cpKPIs, and 11 cpKPI ideal attributes in addition to 1 overall consensus criterion. Twenty-six clinical pharmacists and hospital pharmacy leaders participated in an internet-based 3-round modified Delphi survey. Panelists rated 26 candidate cpKPIs using 11 cpKPI ideal attributes and 1 overall consensus criterion on a 9-point Likert scale. A meeting was facilitated between rounds 2 and 3 to debate the merits and wording of candidate cpKPIs. Consensus was reached if 75% or more of panelists assigned a score of 7 to 9 on the consensus criterion during the third Delphi round. All panelists completed the 3 Delphi rounds, and 25/26 (96%) attended the meeting. Eight candidate cpKPIs met the consensus definition: (1) performing admission medication reconciliation (including best-possible medication history), (2) participating in interprofessional patient care rounds, (3) completing pharmaceutical care plans, (4) resolving drug therapy problems, (5) providing in-person disease and medication education to patients, (6) providing discharge patient medication education, (7) performing discharge medication reconciliation, and (8) providing bundled, proactive direct patient care activities. A Delphi panel of hospital pharmacists was successful in determining 8 consensus cpKPIs. Measurement and assessment of these cpKPIs will serve to advance clinical pharmacy practice and improve patient care.

Introduction: Chinese hospitals still face various barriers to implementing pharmaceutical care. The quantitative instrument for measuring these barriers in China is scarce. This study aims to develop and validate a scale for measuring barriers to providing pharmaceutical care in Chinese hospitals from the perspective of clinical pharmacists. Methods: The scale was developed based on existing literature and qualitative interviews with 20 experts. The scale was included in a small-range pilot survey and then administered to a validation survey in 31 provinces in China. Exploratory factor analysis was used to identify the structure of the scale. Confirmatory factor analysis was applied to verify the structure of the scale and to validate the scale's convergent and discriminative validity. Known-group validity was also examined. Cronbach's alpha examined the internal consistency reliability of the scale. Results: 292 scales were completed and returned for a response rate of 85.6% in the pilot study. Exploratory factor analysis of the scale suggested a five-factor solution (Cognition and attitude, Knowledge and skills, Objective conditions, External cooperation, and Support from managers) accounting for 66.03% of the total variance. 443 scales were sent out in the validation study, with a response rate of 81.0%. Confirmatory factor analysis demonstrated a good fit of the structural model for pharmaceutical care barriers. It showed the scale's good convergent and discriminative validity (The average variance extracted >0.5 and composite reliability >0.7). The scale could also identify the differences in total score among the clinical pharmacists from different hospital grades (p < 0.05). Cronbach's alpha is between 0.658 and 0.896, indicating good internal consistency. Conclusion: From the perspective of clinical pharmacists, this study has developed a scale to assess obstacles to pharmaceutical care. The scale comprehensively encompasses barriers to clinical pharmacists' cognitive and ability-related aspects, hindrances encountered in collaborating with other health professionals and patients, and barriers to the working environment. The reliability and validity have been established through verification.

Background: Key performance indicators (KPIs) are a set of measures used to help an organization in assessing and achieving goals critical to success. The aim of this study was to quantify the clinical pharmacists' contribution to patient care in a tertiary care hospital using predefined clinical pharmacy KPIs. Method: This study was a prospective, observational study conducted by the Pharmaceutical Care Division of a tertiary care hospital. Clinical pharmacy KPIs were submitted by each clinical pharmacist on a monthly basis for 12 months during 2017. All clinical pharmacists up to the managerial level were included in the study. Data were analyzed, stratified, and correlated using Microsoft Excel, JMP statistical software, and Spearman correlation. The study was approved by the hospital's Office of Research Affairs, RAC number 2171-080. Results: A total of 42 clinical pharmacists reviewed 104 728 patient encounters. They performed an adjusted average of 1221 interventions with an acceptance rate of 91.5%, 273 medication reconciliations, 325 discharge consultations, 332 pharmacokinetic consultations, 700 total parenteral nutrition consultations and follow-ups, and 12 688 electronic order verifications per clinical pharmacist per year. These interventions collectively resulted in a cost saving of $316 087.65 per clinical pharmacist per year. Statistical significance with positive correlation was noted for a number of precepted residents/students and clinical pharmacists' experience (R = 0.382, P = .013) and board certification (R = 0.428, P = .0047). Conclusion: Clinical pharmacy KPIs were able to quantify the clinical pharmacists' contributions to patient care and cost savings, which may lead to improve, standardize, and benchmark clinical pharmacy activities in the region.

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Objectives: To describe a model for the development of a competency‐based clinical pharmacy training program using educational principles and practice change strategies.Method: The program development was guided by educational literature and advice from an educationalist and a staff development consultant. Clinical pharmacy competencies were identified in a series of consultant‐led staff forums. Performance indicators and evidence guides were established to measure attainment of each competency. Staff values were also identified and a practice change strategy devised. Instructional methods were devised which optimised progression to competent practice: reading, lectures, interactive tutorials, guided discussion, case presentations, case‐based training, simulation/role play and practice‐based learning. These were supported by interactive training through mentoring, individualised practice‐based learning using direct instruction, modelling (problem clarification), coaching (practice in problem solving), and facilitating (self evaluation).Conclusion: This model provides a sound approach to clinical pharmacy education as it is based on an accepted definition of competency and uses values established by staff combined with recognised educational principles and practice change strategies.

Hypertension management in Federally Qualified Health Centers (FQHCs) requires innovative and comprehensive strategies beyond traditional methods. This study explores a collaborative approach by integrating clinical pharmacists into the healthcare team and utilizing the EPIC Electronic Medical Record (EMR) system. The model addresses medical and non-medical health determinants, offering comprehensive treatment for underserved communities regardless of their ability to pay. We hypothesized that integrating clinical pharmacists would improve and sustain blood pressure control, resulting in more patients achieving their target health outcomes. As part of multidisciplinary teams, clinical pharmacists identify, track, and analyze patient data, manage medication therapies under collaborative practice agreements, and coordinate with other healthcare providers to ensure continuous care. By leveraging EPIC EMR’s data management and patient monitoring capabilities, clinical pharmacists use real-time data to tailor medication regimens, ensure timely interventions, and conduct follow-ups every 2 to 4 weeks via telemedicine or in-clinic visits until patients reach their goals. This approach enhances patient engagement and medication adherence, which is crucial for adequate blood pressure control and cost management. It also supports personalized care addressing medical needs, lifestyle, and socioeconomic factors affecting patient health. The study, initiated in January 2024, involves adult patients with hypertension at one of the largest FQHC in Houston, TX. Key performance indicators include the percentage of patients achieving target blood pressure levels, medication adherence rates, and the frequency of follow-up visits. Preliminary data from quarter 1, 2024, shows that out of 327 patients, 58% have had at least 2 consultations with a clinical pharmacist. Out of those patients, 46% reached blood pressure control below 140/90 mmHg, while 27% showed improvement toward their goal. This quality and result-driven approach elevates hypertension management standards, reduces health disparities, and enhances healthcare delivery within FQHCs. Clinical pharmacists have proven to be indispensable members of the healthcare team. This session aims to provide practical insights and strategies for healthcare professionals to implement similar models, paving the way for the future of hypertension care.

description on a competency-based approach Aim. To study the attitude of experts to various aspects of the professional activity of a clinical pharmacist (CP) and determine the current requirements for professional competencies necessary for the effective performance of duties in modern conditions, with further consideration of the results when developing a job description on a competence-based approach. Materials and methods. The survey methods, analysis and synthesis, as well as formal-logical, semantic, comparative, and systematic methods were used in the study. The data was analyzed using Microsoft Office Excel, Epitools (Ausvet Ltd., Australia), and STATISTICA 13 (TIBCO Software Inc., USA). Results. The significance of CP job functions, workplace requirements, documentation and reporting has been assessed. The study has confirmed the need to update professional competencies in accordance with changes in legislation and current challenges, especially under martial law conditions. Regulatory documents governing CP activities have been identified, and attention has been focused on professional development, rights, duties, and responsibilities. The key documents for the Infection Control Department (ICD) have been highlighted, and the importance of standard operating procedures (SOP) has been evaluated. The issues related to the medical staff consulting, performing duties outside the hospital, communication barriers with the healthcare personnel, and the assessment of key performance indicators (KPI) have been studied. Conclusions. The study has confirmed the expansion of CP’s professional responsibilities, in particular in the field of the rational use of antimicrobial agents (AMA), drug monitoring, and the medical staff consulting. The key professional competencies have been defined, including AMA therapy management, compliance with SOP, and maintenance of relevant documentation. The main professional development activities identified are continuous professional development (CPD) initiatives, such as simulation training and practical skills training, as well as advanced training courses in thematic improvement and specialization. Based on the study, a job description for CP has been developed, and it meets modern standards and contributes to improving the CP efficiency in healthcare institutions.

Key performance indicators are a way to improve performance, including in the hospital sector. In this study,the hospital used was private hospital, Central Java, especially in the field of Clinical Pharmacy services. Thisresearch is motivated by the low achievement of clinical pharmacy services. The purpose of this researchis to measure the performance of the clinical pharmacy service before and after the intervention with theapplication of clinical pharmacy Key Performance Indicators (cpKPI). This study is an observational studyby observing differences in the achievement of clinical pharmacist performance indicators before and afterthe implementation of cpKPIs. This studywas conducted using clinical pharmacist visit data for all inpatientsat the hospital in September 2019-February 2020. Data analysis used a paired t-test.The use of cpKPI wasable to significantly improve the performance of clinical pharmacists (p&lt;0.05) related to drug reconciliationindicators, drug therapy services, pharmacist participation in patient management, patient education duringhospitalization, and comprehensive direct pharmacists’ care. The result proves that cpKPI can improve theperformance of clinical pharmacists at Private hospital so that this method can be used by other hospitals toimprove the performance of clinical pharmacy services.

To develop viable clinical indicators of preventable drug-related morbidity (PDRM) in older adults. A survey was constructed, listing the clinical outcome and pattern of care related to a number of possible PDRMs in older adults. Using the Delphi technique, a geriatric medicine expert panel of 6 physicians and one clinical pharmacist from a hospital-based health care system was asked to judge whether the outcome in each situation was foreseeable and recognizable, and whether causality was identifiable and controllable. The panel could also suggest additional PDRMs. Fifty-two consensus-approved clinical indicators of PDRM in older adults were developed after 2 rounds of the Delphi technique. There was a high degree of consensus among the expert panel: all 7 members agreed on 35 indicators; 6 of 7 members agreed on 15 indicators; and 5 members agreed on 2 indicators. Only 6 outcomes and patterns of care were rejected as indicators. This phase of the study showed that consensus on clinical indicators of PDRM can be reached among experts. These indicators could be used by a managed care organization to proactively identify patients at risk for a PDRM and to improve the quality, safety, and appropriateness of medication use. Additionally, the indicators form an important bridge between processes and outcomes of care and could be used in conjunction with HEDIS and other performance indicators.

BackgroundKey performance indicators (KPIs) are quantifiable measures used to monitor the quality of health services. Implementation guidelines for clinical pharmacy services (CPS) do not specify KPIs.AimTo assess the quality of the studies that have developed KPIs for CPS in inpatient hospital settings.MethodA systematic review was conducted by searching in Web of Science, Scopus, and PubMed, supplemented with citation analyses and grey literature searches, to retrieve studies addressing the development of KPIs in CPS for hospital inpatients. Exclusions comprised drug- or disease-specific studies and those not written in English, French, Portuguese, or Spanish. The Appraisal of Indicators through Research and Evaluation (AIRE) instrument assessed methodological quality. Domain scores and an overall score were calculated using an equal-weight principle. KPIs were classified into structure, process, and outcome categories. The protocol is available at https://doi.org/10.17605/OSF.IO/KS2G3.ResultsWe included thirteen studies that collectively developed 225 KPIs. Merely five studies scored over 50% on the AIRE instrument, with domains #3 (scientific evidence) and #4 (formulation and usage) displaying low scores. Among the KPIs, 8.4% were classified as structure, 85.8% as process, and 5.8% as outcome indicators. The overall methodological quality did not exhibit a clear association with a major focus on outcomes. None of the studies provided benchmarking reference values.ConclusionThe KPIs formulated for evaluating CPS in hospital settings primarily comprised process measures, predominantly suggested by pharmacists, with inadequate evidence support, lacked piloting or validation, and consequently, were devoid of benchmarking reference values.

The American College of Clinical Pharmacy (ACCP) 2011 publication “Tenets for Developing Quality Measures for Ambulatory Clinical Pharmacy Services” describes comprehensive, accountable, feasible, scientifically sound, and usable quality metrics for ambulatory care (AC) practice. ACCP endorsed the definition of comprehensive medication management (CMM) in 2014 and has since advocated consistent implementation of CMM in patient‐centered, team‐based care. Given the decade of changes and advances in AC practice since the 2011 publication, the 2020 ACCP Publications Committee has developed the present white paper to update quality metrics and provide performance indicators with proposed guidance for CMM in AC practice.

BackgroundThe clinical pharmacist is an essential member of the healthcare team and plays an important role in health care in the primary care and the hospital setting. Knowledge regarding the instruments that evaluate the different activities of the clinical pharmacist, as well as the evaluation of the psychometric properties of these instruments, is necessary.MethodsA literature search was performed in the PubMed and Scopus electronic databases without time and language restrictions. For the search strategy, the “pharmaceutical services,” “validity studies,” and “professional performance” domains were used. To assess the quality of the instruments, the five sources of validity evidence of contemporary psychometry were used, and the Joanna Briggs Institute’s standardized instrument was used to assess the methodological quality of the studies. After screening 4096 articles, 32 studies were selected.ResultsA total of 32 studies were included, and 32 instruments were identified to be used by pharmacists acting in various pharmaceutical practice scenarios. It was found that the available instruments were developed or adapted from others, with variation in the methods, constructs, dimensions, and domains, as well as the psychometric properties. Most of the instruments addressed community pharmacies, and evidence of content validity and internal structure was found most frequently. A standardized and validated instrument that comprehensively assessed the performance of the clinical pharmacist, addressing clinical activities, was not identified for all practice environments.ConclusionsWithout standardized and validated instruments specifics to assess the performance of the clinical pharmacist, it is hard to establish the main clinical activities performed by pharmacists in their pharmaceutical practice environments and to propose training actions to improve professional practice. Despite the large number of instruments available and considered validated by the authors, it is questioned to what extent the validity indicators presented in the different studies really show the validation status.Systematic review registrationPROSPERO CRD 42018099912.