Redesign of the Pharmacy Practice Model at a Tertiary Care Teaching Hospital

Abstract

The past 3 decades have witnessed the evolution and refinement of clinical pharmacy. A growing body of evidence supports the proposition that ward-based clinical pharmacy practice improves patient care. The work of clinical pharmacists affects the health care system by significantly reducing mortality rates, medication errors, length of stay, and the cost of care. The Blueprint for Pharmacy, a Canada-wide collaborative initiative, has outlined the need for pharmacists to become more patient-centred and outcome-focused. This approach aligns with the Canadian Society of Hospital Pharmacy (CSHP) 2015 initiative, Targeting Excellence in Pharmacy Practice, which aims to “improve patients’ medicationrelated outcomes and safety by advancing pharmacy practice excellence”. Nationwide, the 2009/2010 Hospital Pharmacy in Canada survey demonstrated that the CSHP 2015 target of increasing the extent to which pharmacists help individual hospital inpatients achieve the best use of medications has not been attained. To achieve the aforementioned goal, hospitals and other health care institutions need to establish strong clinical pharmacy programs. Although clinical pharmacy has been in existence for the past 4 decades, there is still a struggle to define the role of the clinical pharmacist. The daily functions of clinical pharmacists vary greatly among institutions, and discussions continue as to the most effective use of this pharmacy resource. Despite this lack of consensus, it is clear that allowing pharmacists to practise to their full scope will necessitate a shift away from the dispensary-focused model of pharmacy service. More specifically, a patient-centred, integrated pharmacy practice model would allow nearly all pharmacists to have both distributive and clinical responsibilities. In addition, such a change would allow clinical pharmacists to seamlessly integrate into the interdisciplinary team and thereby improve patient care. Furthermore, it would offer pharmacists more opportunities for direct patient contact, a requirement for a fulfilling career. This article outlines changes made in a tertiary care teaching hospital to shift the pharmacy practice model from drug distribution with a clinical pharmacy specialist focus to an integrated, patient-centred model.