Clinical Pharmacist Activities Research Articles

The participation of clinical pharmacists in the treatment of patients with central nervous system infection can improve the effectiveness and appropriateness of anti-infective treatments: a retrospective cohort study.

Background: Central nervous system infection (CNSI) treatment in hospital neurosurgery emphasizes the importance of optimizing antimicrobial therapy. Timely and appropriate empiric antibiotic treatment is critical for managing patients with bacterial meningitis. Objectives: To evaluate the activities of clinical pharmacists in the anti-infective treatment of patients with CNSI in neurosurgery. Method: A single-center retrospective cohort study was carried out from January 2021 to March 2023 at a tertiary teaching hospital in China. The study sample included a group that received pharmacy services and a group that did not. In the pharmacy services group, the anti-infective treatment plan was led and developed by pharmacists. Pharmaceutical care, including medication therapy and all CNSI treatment regimens, was administered in daily unit rounds by pharmacists. Baseline demographics, treatment outcomes, and rational use of antibiotics were compared between the two groups, and the impact of a antimicrobial stewardship (AMS) program was evaluated. Results: Of the 306 patients assessed according to the inclusion and exclusion criteria, 151 patients were included, and 155 patients were excluded due to abnormal data and missing information on antibiotic costs or antimicrobial use. Eventually, 73 were included in the pharmacy services group and 78 in the group without pharmacist participation. The antibiotic use density (AUD) of the pharmacy services group decreased from 167.68 to 127.63 compared to the group without pharmacist participation. After the pharmacist services, the AUD for linezolid decreased from 9.15% to 5.23% and that for miscellaneous agents decreased from 17.91% to 6.72%. The pharmacy services group had better improvement (p < 0.05) and a significantly higher score for the rational use of antibiotics (p < 0.05) than the group without pharmacist participation. Conclusion: The clinical pharmacist services evaluation results demonstrated an essential role of clinical pharmacist-led AMS programs in the effective and appropriate use of anti-infective treatments in neurosurgery with patients with CNSI.

The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review

BackgroundClinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear. AimsTo undertake a systematic review to identify, critically appraise and present the evidence on post-discharge hospital clinics that provide clinical pharmacist medication review; report the patient clinical outcomes measured; and describe the activities of the clinical pharmacist. MethodsPublished studies evaluating a patient clinical outcome following a post-discharge hospital clinic pharmacy service were included. All studies needed a comparative design (intervention vs control or comparator). Pubmed, Embase, CINAHL, PsycnINFO, Web of Science, IPA and APAIS-Health databases were searched to identify studies. The type of clinic and the clinical pharmacist activities were linked to patient clinical outcomes. ResultsFifty-seven studies were included in the final analysis, 14 randomised controlled trials and 43 non-randomised studies. Three key clinic types were identified: post-discharge pharmacist review alone, inpatient care plus post-discharge review and post-discharge collaborative clinics. The three main outcome metrics identified were hospital readmission and/or representation, adverse events and improved disease state metrics. There was often a mix of these outcomes reported as primary and secondary outcomes. High heterogeneity of interventions and clinical pharmacist activities reported meant it was difficult to link clinical pharmacist activities with the outcomes reported. ConclusionsA post-discharge clinic pharmacist may improve patient clinical outcomes such as hospital readmission and representation rates. Future research needs to provide a clearer description of the clinical pharmacist activities provided in both arms of comparative studies.

A Study on the Impact of Pharmaceutical Care on the Management of Diabetes Mellitus During Pregnancy

ABSTRACT: The aim of the study was to assess the impact of pharmaceutical care on the management of diabetes mellitus during pregnancy.A prospective observational study was carried out for six months at a hospital in Palakkad. The study assesses pregnant women's medication adherence and health-related quality of life. Patients were randomly allocated to the study population, and data were entered in a self-design data collection form. The collected cases were entered in MS Excel 2019 and calculated percentage of various parameters by descriptive statistics.The study included a total of 60 participants, with an age range ranging from 18 to 45. GDM is more prevalent between the age group of 25-31 years. Among 60 subjects an increase in medication adherence observed with their value from5.72±1.03 to 6.40±0.89 during their initial and follow up visits (p&lt;0.0001) respectively. The EQ-5D-5L mean (SD) index showed significantly lower quality of life during the baseline visit (0.529 ± 0.03) and higher quality of life during the follow-up visits (0.826 ± 0.297) with (p&lt;0.0001), suggesting the importance of clinical pharmacist activities making positive impact on medication adherence and quality life of pregnant women with diabetes.

Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa

BackgroundIncorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs’ understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors.MethodsAn exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs’ understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital.ResultsThe factor analysis yielded two separate subscales, measuring HCPs’ (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5–16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist’s role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist’s activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities.ConclusionThe findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists’ understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession.

Assessing the impact of an electronic therapeutic drug monitoring record in the management of vancomycin through pharmacist intervention: a single‐centre study

AbstractBackgroundA gap in vancomycin therapeutic drug monitoring (TDM) electronic documentation, management, and related clinical pharmacist activities was identified by our clinical pharmacy team. In response, an electronic TDM (eTDM) template was planned, designed, and implemented by the pharmacy department team in collaboration with the electronic medical records team (EMR) and documentation committee.AimTo assess the impact of an electronic therapeutic drug monitoring (eTDM) template to measure the impact of adherence to vancomycin guidelines. Guideline adherence indicators include the number of vancomycin levels within the therapeutic range and the number of appropriate concentrations taken.MethodAn interventional, single‐centre study of vancomycin therapy in adult patients was performed from 2019–2021. Data were extracted from the electronic medical records and TDM paper‐based forms completed by clinical pharmacists. The number of concentrations within the therapeutic range and the number of appropriately taken levels were analysed by the chi‐square test. This study received an exemption from the Peninsula Health Human Research Ethics Commitee (QA/60523/PH‐2019/197291).ResultsThere was a total of 198 concentrations collected in the ‘before’ period and 125 concentrations collected in the ‘after’ period. The number of concentrations in therapeutic range increased from 34.8% to 43.2% (p = 0.132), not statistically significant. The number of concentrations taken appropriately increased from 33.8% to 55.2% (p &lt; 0.001). The proportion of patients with pharmacist involvement increased from 43.0% to 57.0% (p = 0.868).ConclusionThe study shows that implementation of an electronic vancomycin monitoring template improved the proportion of appropriate levels taken and is the preferred method of documentation by clinical pharmacists. Future projects may benefit from analysing the cost associated with unnecessary vancomycin serum levels ordered or inclusion of pharmacists in the TDM of other narrow therapeutic medications.

Validation of an assessment, medical problem-oriented plan, and care plan tools for demonstrating the clinical pharmacist's activities

BackgroundIdentifying, preventing, and resolving medical problems are some of the most central functions of clinical pharmacy (CP) and pharmaceutical care (PC) practitioners. Usually, the practitioners and researchers find a challenging to link the problem and the appropriate intervention to be included in the care plan. A comprehensive, well-structured, validated, simple use and standardized tool, which fulfill these requirements in daily clinical practice, are currently rare. PurposeTo design and validate a comprehensive medical problem-oriented plan (MPOP) classification system in addition to assessment and care plan tools for use in practicing, researching, and teaching CP and PC. Materials and methodsThe methodology was composed of five steps: literature searching and classification of the problems; developing the assessment of treatments and care plan templates; implementing the tutorial; validation; completion and evaluation of the final version. ResultsThe classification system (MPOP tool) is an open hierarchical structure, where higher levels are broadly defined, consisting of 5 main categories, and lower levels become more specific. In the MPOP tool's final version, a total of 24 major subcategories were distributed to the major five categories as 4 (Indication), 5 (Effectiveness), 7 (Safety), 3 (Patient), and 5 (Miscellaneous). Different minor subcategories (subcategory 2, n = 62) and 95 plans (interventions) were determined. Each of the subcategories and plans includes a notes section that represents a specific detail. There was strong agreement on using the MPOP tool between the two authors (κ = 1.000, p < 0.0005) and between three random clinical pharmacists out of 17 (κ = 0.947, 95% CI, 0.840 to 1.055, p < 0.0005). The validity and reliability statistics demonstrate that the Alsayed_v1 tools are extremely appropriate. The majority of users expressed high satisfaction with all the assessment, MPOP, and care plan tools. ConclusionThe Alsayed_v1 tools introduced in this paper were applied to actual patient cases and were validated. These tools include: assessment of treatments, MPOP, and care plan. Including the interventions in the classification system is important especially in PC research where the type of recommendations should be documented to assess the value and impact of the service and saves the time of practitioners in typing the appropriate interventions. By applying the steps within these Alsayed tools, the clinical pharmacists can actively provide the best practice to achieve the optimal patient outcome.

Evaluating hematology/oncology clinical pharmacist activities via self-reported work sampling.

Hematology/oncology clinical pharmacists' work activities have been described in previous literature, but time spent on pharmacist tasks has not been well characterized. Random work sampling (WS) is a form of activity assessment to determine the proportion of time spent in various types of work. Based on results from previous WS evaluations at University of Utah and its Huntsman Cancer Hospital, activities were changed to maximize time dedicated to clinical activities and pharmacists' benefit to providers and patients in both inpatient and ambulatory care settings. Therefore, updated random WS evaluations were completed during spring 2019 and fall 2020. Personal digital assistant (PDA) devices were used to record hematology/oncology clinical pharmacists' onsite or remote location and work activity data. Data were collected 8 times per hour on weekdays, with a goal of 275 observations per pharmacist. Results were then classified as clinical, professional, or technical activities. In 2019, 9,079 observations were recorded by 31 onsite pharmacists. In 2020, 28 pharmacists recorded 8,803 observations (5,524 during onsite work and 3,279 during remote work). The overall distribution of pharmacists' work activities remained stable between 2019 and 2020, with 89% of activities classified as clinical or professional. Pharmacists spent a smaller proportion of time on in-person communication in 2020, balanced by increases in chart review and text-based communication. Onsite pharmacists reported a larger proportion of clinical activities, while remote pharmacists reported a larger proportion of professional activities. Continued WS assessment of work activity patterns will allow identification of opportunities to streamline workflows, maximize pharmacist engagement in clinical activities, and development of remote work policy.

Challenges for expansion of thoracic transplant clinical pharmacy in a developing country: comparison with U.S. accredited centres and call for action.

Clinical pharmacists' involvement in the care of solid organ transplant recipients has been discussed worldwide given its potential to improve clinical outcomes. As thoracic transplant activity grows in Brazil, it is important to understand how pharmacists are inserted in transplant programmes nationwide. We conducted a survey to explore clinical pharmacy activities in thoracic transplant centres in Brazil and compared them with accredited programmes in the United States. An electronic questionnaire was distributed to all 40heart and lung transplant centres registered in the Brazilian Organ Transplantation Agency (ABTO) in May 2019. Survey findings were compared to previously published data from accredited U.S. centres. From 22 centre respondents, ten (45.5%) declared not to have a pharmacist at any part of the transplantation process, which translated into 158 (37.6%) transplant recipients without any direct pharmaceutical care. In centres with pharmacists (n=12), none had a full-time professional dedicated to their heart and/or lung programmes. When compared to U.S. centres, there was a significantly lower insertion of clinical pharmacist activities among Brazilian centres. Our findings point to an unmet need related to clinical pharmacy activity within thoracic transplant programmes, especially in a developing country, and highlight a call for action in order to reach higher accredited regulatory standards regarding pharmacist-driven workforce in transplant care worldwide.

Electronic monitoring of potential adverse drug events related to lopinavir/ritonavir and hydroxychloroquine during the first wave of COVID-19

During Switzerland’s first wave of COVID-19, clinical pharmacy activities during medical rounds in Geneva University Hospitals were replaced by targeted remote interventions. We describe using the electronic PharmaCheck system to...

Implementation of defined criteria for clinical pharmacists in a pediatric cardiac transplant ambulatory clinic

AbstractIntroductionThe United Network of Organ Sharing (UNOS) bylaws and Centers for Medicare and Medicaid Services (CMS) accreditation standards require that transplant centers have a pharmacist. However, there are no established guidelines and there is a paucity of literature describing pharmacists in the pediatric ambulatory setting.ObjectiveThis project aims to describe the activities of pediatric clinical pharmacists in an ambulatory pediatric cardiac transplant clinic.MethodsThis is a single‐center pilot project describing pediatric clinical pharmacist interventions before (phase I) and after (phase II) implementation of comprehensive and standardized clinical activities. The list of defined key clinical activities was developed using UNOS and CMS accreditation standards, an evaluation of the literature, and cardiac transplant team feedback.ResultsPrior to a defined list of clinical activities, pediatric clinical pharmacists saw 74 unique patients during 174 patient encounters and recorded 240 interventions (phase I). Following implementation of standard activities, pediatric clinical pharmacists saw 81 unique patients during 225 patient encounters and recorded 510 interventions (phase II). The development of defined key activities led to a 129.4% increase in documented interventions per patient encounter. Interventions with the greatest increase included: medication schedule (phase I, 13.2%; phase II, 37.3%; P &lt; .001), medication dose adjustment (phase I, 5.7%; phase II, 22.2%; P &lt; .001), outpatient pharmacy coordination (phase I, 1.1%; phase II, 15.6%; P &lt; .001), medication discontinuation (phase I, 0.6%; phase II, 9.3%; P &lt; .001), and medication adherence education (phase I, 0%; phase II, 6.2%; P &lt; .001).ConclusionThere was a significant increase in the number and variety of medication‐related interventions after the development and implementation of defined key clinical activities for pediatric clinical pharmacists in a pediatric cardiac transplant ambulatory care clinic.

Measuring the proportion of time spent on work activities of clinical pharmacists using work sampling technique at a public hospital in Malaysia

Background:The clinical pharmacy service to the ward was established in 2005 in Malaysia, as the number of pharmacists working in the public service sector began to grow. Yet, there has been little local research done on reporting the range of work activities of clinical pharmacists and the amount of time that they spent on their work activities.Objective:This study aimed to identify the range of work activities of clinical pharmacists by observation and to estimate the proportion of time spent on different work activities by using the work sampling technique.Methods:The time spent by clinical pharmacists on various activities was measured using the work sampling technique over 30 working days. The work activities of clinical pharmacists were pre-identified and customized into an activity checklist. Two observers were placed at the study site and took turns recording the activities performed by the clinical pharmacists by following a randomly generated observation schedule.Results:1,455 observations were made on five clinical pharmacists with a total of 3493 events recorded. Overall, clinical pharmacists spent 78.8% (n=2751) of their time providing clinical services whereas 12.3% (n=433) of their time was spent on non-clinical activities. They were found to be idle from work for 8.9% of the time. There was no difference in bed occupancy rate in the study site regardless of the presence of the observer (p=0.384). Clinical pharmacists were found to report a higher average daily cumulative work unit of 9.8 (SD=4.3) when under observation compared to an average daily cumulative work unit of 6.5 (SD=4.6) when no observer was present (p=0.005).Conclusions:The results revealed that clinical pharmacists spent a significant amount of time on non-clinical work. Their responsibilities with non-clinical work should be properly taken care of so they can allocate more time to providing patient care.

41: Relationship Between Critical Care Clinical Pharmacist Activities and Burnout Syndrome

41: Relationship Between Critical Care Clinical Pharmacist Activities and Burnout Syndrome

Evaluation of the Role and Impact of Ambulatory Clinical Pharmacists in an Academic Comprehensive Cancer Center.

IntroductionIn recent years, there has been significant growth of ambulatory oncology pharmacy, yet there is a paucity of published studies on the clinical activities and impact of ambulatory oncology clinical pharmacists. At Duke Cancer Center, dedicated pharmacist services are embedded in specialized outpatient oncology areas. Pharmacists document their clinical and administrative activities in the electronic health record. The primary objective of this study is to quantify and assess ambulatory oncology pharmacist interventions in clinics in a large academic comprehensive cancer center.MethodsFor the purposes of this single-center, retrospective, descriptive study, pharmacist interventions were collected, quantified, and described over a 6-month period from July 1 to December 31, 2015. The study evaluated the perceived contribution and impact of a pharmacist on patient care in ambulatory oncology clinics via a survey that was distributed to providers and nurses.ResultsIn the 6-month time period, there were 5,091 interventions spanning 3,967 patient encounters between nine ambulatory oncology clinic pharmacists. The average time per encounter in the 6-month time frame was 22.4 minutes. There were 92 respondents to the survey (61.7% response rate). Overall, responses showed that the clinical pharmacists add value to patient care and are integral members of the team.ConclusionsAlthough previous studies have described pharmacist activities in outpatient oncology clinics, this study showed a larger number and variety of clinical pharmacist activities in outpatient cancer clinics to improve patient care. Future directions include conducting prospective, controlled studies to link pharmacist activities to tangible outcomes.

Characterization of clinical pharmacist and hospitalist collaborative relationships

AbstractIntroductionHospitalists provide inpatient care including coordinating with other providers and transitioning care to the community. Clinical pharmacists interact with hospitalists, usually on multidisciplinary teams. A statement by the American Society of Health‐System Pharmacists and the Society of Hospital Medicine promotes collaboration and encourages interdisciplinary optimization of patient care. However, literature detailing this collaboration is sparse. It is unclear how to utilize these joint working relationships most effectively.ObjectivesThe purpose of this study was to describe the environment of pharmacist and hospitalist collaborative relationships and activities of pharmacists practicing with hospitalists for foundational information.MethodsThis was a cross‐sectional study. An Institutional Review Board‐approved survey was distributed to pharmacists and hospitalists via email. Questions considered the team and the environment, clinical pharmacist activities related to the pharmacists' patient care process, and perceived barriers to effective teamwork. Results were analyzed with descriptive statistics.ResultsSeventy pharmacists and 25 hospitalists participated in the survey. Most were from the Midwest or Southeast United States and practicing up to 10 years in a large health care system. Pharmacists spent the most time on development of a therapeutic plan (1‐5 ranking scale [1 = most, 5 = least time spent]; median 2; range 1‐5.) There were variations in responses related to the institutional staffing model allowing for collaboration with hospitalists, whether technology enhanced collaboration and additional job responsibilities hindered collaboration, and whether absence of pharmacy participation on rounds was noticed. Most hospitalists (68%) initiated frequent communication with a pharmacist. Hospitalists (32%) would collaborate with a pharmacist more frequently if a specific individual was designated for the position.ConclusionsClinical pharmacists and hospitalists collaborate in team‐based care environments within larger health care systems. This hypothesis‐generating survey attempts to assess the current environment. Further research can work toward establishing practice standards and improving collaborations.

Leveraging telecommuting pharmacists in the post–COVID-19 world

In response to the coronavirus disease 2019 (COVID-19) pandemic, many industries, including pharmacy, rapidly expanded the use of telecommuting workers to assure business continuity and address social distancing needs. Advances in electronic health records and telepharmacy over the past 2 decades enabled pharmacy leaders to easily adapt their practice models to allow for telecommuting alternatives during the pandemic. While these changes were generally intended to be part of the short-term response, the sustained expansion of telecommuting within the pharmacy profession merits further exploration. Documented experience with telepharmacy and telehealth indicate a wide array of clinical and operational pharmacist activities that could be conducted by telecommuters. In addition, experience with telecommuters in other industries suggests potential benefits ranging from improving pharmacists' work-life balance to mitigating postpandemic financial burden. Health care organizations should consider integrating part-time telecommuter pharmacists into contemporary practice models to address other frontline issues and facilitate ongoing expansion of clinical pharmacy services to meet emerging patient needs.

Challenges for Expansion of Thoracic Transplant Clinical Pharmacy in Brazil: Comparison with U.S. Accredited Centers and Call for Action

Clinical pharmacists' involvement in the care of transplant recipients has become a requirement in the accreditation process of transplant centers. As thoracic transplant activity grows in Brazil, it is important to understand how pharmacists are inserted in transplant programs nationwide. We conducted a survey to explore clinical pharmacy activities in thoracic transplant centers in Brazil and compared them with accredited U. S. programs. An electronic questionnaire was distributed to all heart and lung transplant centers registered in the Brazilian Organ Transplantation Agency (ABTO) in May 2019. The survey consisted of 16 questions on presence, full-time equivalents (FTEs), practice-setting and training of clinical pharmacists at each center. Survey findings were compared to available published data from accredited U.S. centers. From 39 centers invited, 22 (16 heart and 6 lung) responded, representing 88.6% (n=420) of thoracic transplants performed nationally in 2018. Ten centers (45.5%) declared not to have a pharmacist at any part of the transplantation process, which translates into 144 (35.2%) transplant recipients without any direct pharmaceutical care. In centers with pharmacists (n=12), none had a full-time professional dedicated to their programs. When compared to U.S. centers, there was a significantly lower expression of several aspects of transplant clinical pharmacist activities among Brazilian centers (Figure 1). Importantly, pharmacist FTE in Brazil was less than half of that observed in the U.S. Marked differences exist in Brazilian centers in comparison to the U.S. Our findings point to an unmet need related to clinical pharmacist activity within thoracic transplant programs, especially in developing countries, and highlight a call for action in order to reach higher accredited regulatory standards regarding pharmacist-driven workforce in transplant care worldwide.

Role of clinical pharmacists and pharmacy support personnel in transitions of care

AbstractPatients moving between health care settings or providers are at increased risk of complications, including unplanned hospital readmissions and medication errors. Several actions must occur in concert with members of the health care team and across settings to ensure coordinated and continuous care for patients undergoing these transitions of care (TOC). Clinical pharmacists support patients during care transitions by providing interventions and services designed to improve medication outcomes. Clinical pharmacists and team members who support clinical pharmacist activities (eg, pharmacy students, technicians, and residents) are located throughout the care continuum, from acute care to care in the community, with each contributing to improved TOC outcomes. This article provides information on evidence of high‐impact clinical pharmacist TOC practices to serve as a practical guide for practitioners interested in starting or improving TOC activities. This article also addresses current and emerging best practices and offers suggestions for improving clinical pharmacist involvement in care transition activities.

Quantifying Clinical Pharmacist Activities in a Tertiary Care Hospital Using Key Performance Indicators.

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.

Arcabouço legal para implantação e execução dos serviços farmacêuticos relacionados à farmácia clínica

The clinical pharmacist's activities are crucial to the process of patient care. The implementation and execution of these activities must be guided by technical criteria and legal regulations. Therefore, this study aims to identify and compile legal norms which supports the implementation of pharmaceutical care services. National legal norms were addressed to the following topics: sanitary control of medicines and pharmaceutical supplies; patient safety; rational drug use; quality of health services; pharmaceutical care; health information technology; users rights, duties and access to pharmaceutical care and inspection practice of pharmaceutical activities. Then, legal regulations with relevant information for the pharmacist's clinical performance were selected and a list of legal references was created. Eleven federal laws were found, ten ordinances from the Ministry of Health, ten resolutions from the Federal Pharmacy Council (CFF), seven resolutions from the National Health Surveillance Agency (ANVISA) and one from the World Health Organization (WHO). Finally, from this study it was possible to elaborate a compilation of regulations that subsidize pharmaceutical care performance.

Perception of benefits and risks by clinical pharmacists regarding utilization of drugs during pregnancy: A narrative review

Pregnancy is a happy and positive experience for women because pregnancy in addition, having a baby is a life-changing event: the body undergoes major changes. There may be considerable discomfort or ill health takes place during pregnancy. Therefore, they face problems about taking medicines. All the illicit drugs are associated with medical complications, but some may lead to severe damage and increases the risk of serious harm to both fetus and for the mother. Drugs have shown to pass into breast milk, so advice the mothers to avoid breastfeeding when using it. There is a need to be cautious in using medication during pregnancy. However, women with lower levels of education tend to use more prescription or illicit drugs, as they do not understand the proper use of medications, which were associated with several adverse teratogenic outcomes. According to World Health Organization, therapeutic use of medication does not cause developmental abnormalities in the fetus or newborns, but abuse does pose risks to the fetus. The provision of health education during pregnancy to be an important aspect of prenatal care. Indulging effective knowledge and counseling impact of clinical pharmacist activities tends to be promoting awareness to all patients receiving drugs during pregnancy as well as providing information on the consequences and potential harm or effects for mothers and for foetuses based on their need. Communicate with the nearby pharmacists, while using medications to avoid accidental damage during pregnancy.