The Role of the Clinical Pharmacist in an Irish University Teaching Hospital: A Mixed-Methods Study.

Sarah Ronan,Nicola Shannon,Katie Cooke,Elaine K Walsh,Alan Kearney,Laura J Sahm,Trish Mckeon

doi:10.3390/pharmacy8010014

Abstract

Medication review (MR) is a vital part of the pharmacist’s role in hospital. However, in the South Infirmary Victoria University Hospital (SIVUH), Cork, Ireland, this has not been fully implemented due to resource issues. In addition, the cost of providing this service has not been evaluated. Moreover, it is not clear how other members of the multidisciplinary team e.g., Nurses, value any interventions made as a result of the MR. This mixed methods study assessed the impact of MR in terms of (i) potential clinical harm, (ii) cost avoidance and (iii) the views of nursing staff on the role of the pharmacist. The setting is a 192-bed, voluntary, acute hospital, in the Munster region of Ireland. Study I: The pharmacist provided MR to patients conventionally once a week. Any interventions were then assessed for potential clinical harm and to calculate cost avoidance. Study II: Semi-structured interviews, guided by a topic guide were completed with 12 nurses (11 female). Thematic analysis was used to code the main themes. Main outcome measure: To estimate the cost, cost avoidance, and the net cost benefit ratio of MR provided by pharmacists. Study I: Of 128 patients who received the MR, 113 interventions were made. The estimated cost of providing the MR was €2559 (senior pharmacist). Using €1084 as the cost of an adverse drug event (ADE), the cost avoidance was calculated at €42,330. This led to a net cost benefit of €39,771 (senior pharmacist) which equated to a net cost benefit ratio of 16.5:1. Study II: The main themes were (i) perceptions of pharmacy services, (ii) the role of the pharmacist—past, present and future, and (iii) teamwork and communication. Nurses expressed a desire to have more pharmacists present on the wards.

Highlights

The traditional role of a pharmacist predominantly involved the dispensing of medications in both hospital and community settings
113 pharmacist intervention (PI) were identified in 59 patients
This study found a prevalence of 0.88 PIs per patient who received a Medication review (MR) by a pharmacist, in a hospital setting in Ireland

Summary

Introduction

The traditional role of a pharmacist predominantly involved the dispensing of medications in both hospital and community settings. Pharmacists are increasingly being viewed as key members of multidisciplinary teams in both primary and secondary care settings. A study by Makowsky et al described how the integration of pharmacists into healthcare teams assists in improving team decision-making on drug therapy, positive patient outcomes, increasing patient safety, Pharmacy 2020, 8, 14; doi:10.3390/pharmacy8010014 www.mdpi.com/journal/pharmacy. A Cochrane report stated that the concept of collaboration, which is the process in which different professional groups work together, if successfully implemented, will have a positive impact on healthcare [3]. Other studies have shown that multi-professional collaboration including pharmacists, results in beneficial effects [4,5,6,7]

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Discussion

Conclusion