Clinical Pharmacy Activities Research Articles

A multi-site evaluation of clinicalpharmacist time, motion, interventions and interruptions.

Patient centred clinical pharmacy activities have demonstrated improvements in patient outcomes. There are limited published data on workflow practices of pharmacists to assist with clinical pharmacy service delivery improvement. To determine the amount of time clinical pharmacists spend each day performing their work tasks, interventions and interruptions. To determine the proportion of time performing clinical tasks and tasks face-to-face with patients. Trained pharmacy students observed clinical pharmacists and recorded clinical activities using the timer app Clockify™ on a smart device (phone or tablet) at four hospitals over 9days between 29th July and 8th August 2024. Pharmacy students recorded the number and types of patients seen, interventions and interruption patterns. A total of 678.3h of pharmacist activity were recorded. The mean time spent per day per patient type was 25.9min (discharge patient), 23.5min (new patient) and 10.3min (review patient). Pharmacists spent the largest proportion of time (21.9%) on discharge patients followed by review patients (21.6%). Over 80% of pharmacist time was spent performing clinical activities, of which almost 12% was spent face-to-face with patients. Pharmacists were interrupted 34 times per day and performed 67 interventions per 100 patients. Pharmacists spend over 80% of their work time performing clinical activities for patients, of which almost 12% is spent face-to-face with patients. The largest proportion of time is spent with discharge patients followed by review patients.

Clinical pharmacy activities specific to patients treated with lithium.

Medication compliance in lithium-treated patients is poor (43-46%) and may be responsible for relapse or toxicity. Improving understanding of treatment principles leads to increased medication adherence. To do this, targeted and personalised pharmaceutical interviews on lithium were developed and implemented by a clinical pharmacy team in adult psychiatric departments of the Lille university hospital center. The primary aim of this work was to assess medication adherence with lithium, patients' understanding of the drug and of potential adverse effects. A secondary objective was to evaluate the feasibility of these pharmaceutical interviews in practice. Implementation of self-assessment questionnaires measuring medication adherence (Medication Adherence Rating Scale) as well as knowledge of lithium and risk of exposure to toxic effects (Lithium Knowledge Test) of patients. Conducting targeted pharmaceutical interviews about lithium, and recording of time spent, satisfaction of medical teams and difficulties encountered. Twenty patients were included in the 6-month study. Every patient benefited from a personalized pharmaceutical interview by a pharmacy intern focused on lithium during his hospitalization. Lithium adherence, patient knowledge and risk exposure to lithium toxicity was 5.5±0.9 (target ≥8), 8.9±0.9 (target >6) and 4.0±0.5 (target <4). The median time required for these new activities was 95minutes per patient. Medical satisfaction was observed in 70% to 100% of cases depending on the criterion assessed. The lack of pharmaceutical time and communication difficulties were the main obstacles encountered. Medication compliance in patients treated with lithium is poor as described in the literature. To improve this and to optimise drug management, patients have benefited from targeted and personalised pharmaceutical interviews. The satisfaction of patients and the medical team made it possible to sustain these new pharmaceutical activities.

Criteria for medication reconciliation in major orthopedic surgery in high-risk patients: A consensus based on the Delphi method.

Criteria for medication reconciliation in major orthopedic surgery in high-risk patients: A consensus based on the Delphi method.

Benchmarking hospital clinical pharmacy practice using standardised key performance indicators (KPIs).

Background: Hospital pharmacy services support quality use of medicines and medication safety through clinical pharmacy activities such as medication reviews and patient education. These activities can be measured and monitored using evidence-based and standardised key performance indicators (KPIs), which highlight the value of pharmacy services. Standardisation of KPIs supports long-term benchmarking and inter- and intra-site comparisons to target key areas for improvement in clinical pharmacy services. Aim: To describe the type and frequency of clinical pharmacy activity across five hospitals within one metropolitan hospital district. Methods: Key Performance Indicator data were collected by pharmacists from five hospital sites at one metropolitan hospital district, in Queensland Australia. Data were collected over one week for the following clinical settings: inpatient, discharge, outpatient clinic, and the dispensary. Data were collected using a manual, paper-based data collection tool previously developed using a co-design process. Results: Across 11,215 inpatient encounters, hospital pharmacy services provided: best possible medication history (BPMH) within 24 h of admission: 69.5%; daily medication chart review: 57.2%; discharge education: 82.7%, discharge reconciliation: 88.2%; and provision of discharge medication record: 82.4%. Across 1,092 outpatient encounters, pharmacists documented BPMH for 33.3% of patients. Pharmacists identified a total of 5,009 drug-related problems (DRPs) across the data collection period, with the rate of identification highest in the outpatient clinic setting (64.8 per 100 patient reviews) followed by discharge (52.6 per 100 patient reviews) and then inpatient (48.1 per 100 patient reviews). Almost 20% of DRPs identified (n = 975) were high risk. Conclusion: Reporting and benchmarking clinical pharmacy activity through standardised KPIs supports opportunities to identify service improvements. Future research should focus on larger scale studies using routinely recorded data to monitor clinical pharmacy KPIs across all care settings.

Best Practices of Pharmaceutical Services at the Primary Health Center in Samarinda City-East Kalimantan Province

Primary health centers are government-owned first-level health care facilities that play a role in promotive and preventive through individual and public health efforts in their working areas. One type of service at a health center is pharmaceutical services. Pharmaceutical services at primary health centers have two functions, there are drug management and clinical pharmacy services. Pharmaceutical services at primary health centers are carried out in the Pharmacy Room led by a pharmacist. In carrying out both functions, pharmacists at primary health centers refer to the standards of pharmaceutical services at primary health centers as stated in the Regulation of the Minister of Health of the Republic of Indonesia Number 74 of 2016. This study aims to determine the implementation of pharmaceutical services at primary health centers in Samarinda City-East Kalimantan. The research method is descriptive method with quantitative approach. The population of this study were 26 pharmacists of primary health centers in Samarinda City. This study used saturated samples, meaning that all populations were sampled in this study. The data obtained were analyzed and presented descriptively. The results showed that the majority of primary health centers (92%) were non-inpatient health centers, had one pharmacist (85%) and two pharmacy vocational staff (46%). The average number of outpatients served was less than 50 per day (54%). All primary health centers pharmacists have conducted drug management except for the monitoring and evaluation stage of management. Meanwhile, clinical pharmacy activities have been carried out except for monitoring and reporting drug side effects.

Use of two general-purpose scales to assess clinical pharmacy activities in a cell transplantation unit.

The general-purpose rating scales used by clinical pharmacists to rate their activities have not been extensively studied in specialist care units. This study aims to describe drug-related problems (DRPs) and pharmacist interventions (PIs) in a French hematopoietic cell therapy (HCT) unit and to evaluate the PIs' likely clinical, economic, and organizational impacts. We retrospectively assessed all DRPs reported and all PIs issued between December 2018 and December 2021. The Act-IP scale was used to rate DRPs and PIs, and the ClEO scale was used to rate each PI's clinical, economic and organizational impacts. Fisher's exact test was used to assess the relationships between PIs and DRPs and between the three dimensions of the ClEO scale. The DRPs were most frequently related to drug-drug interactions (16.5%), physicochemical incompatibilities (15.5%), and drug monitoring problems (14.9%). 62.8% of the PIs had at least a moderate clinical impact. PIs that recommended drug monitoring were most frequent (26.8%), and most of these (75%) were likely to have prevented incidents that would have required patient monitoring or treatment. The results of this study showed that after a slight adaptation, the Act-IP scale can be used to map clinical pharmacy activity in an HCT unit. More than 60% of the DRPs/PIs were likely to have had a positive impact on the patient's clinical outcome. All the PIs were rated with a positive organizational impact and PIs likely to lead to cost savings were balanced by those likely to increase costs.

Quantitative evaluation of clinical pharmacy activities following implementation of an enhanced weekend service at a teaching hospital

Abstract Introduction Improving equity of staffing across seven-days is a strategic priority for the National Health Service (NHS).1 Development of enhanced weekend clinical pharmacy services presents opportunity to improve admission and discharge medicines reconciliation (MR), reduce medication error and increase patient counselling.2 At the study site, an enhanced weekend clinical pharmacy service was implemented in October 2021. The service was delivered 9am-5pm to all clinical specialities across 54 wards. Defined minimum staffing was 13 pharmacists and 2 medicines management pharmacy technicians (MMPT). Service specification included: clinical screen and order of medications; admission MR, review of high-risk patients (critical care patients and those prioritised by the weekday team); and discharge activities including patient counselling. Aim To evaluate provision of the enhanced weekend clinical pharmacy service post-implementation by quantification of shift fill and clinical pharmacy professional activities. Methods A quantitative study was conducted over two separate weekends one month and six months post-implementation (13th-14th November 2021 and 9-10th April 2022). Pharmacy professionals collected data using a paper activity tool validated for use at the study site. Interventions included rectification of medication error, medicines optimisation or consult. Data were collated in Microsoft Excel immediately after each study weekend. Simple descriptive statistics were performed in Microsoft Excel. The study was registered with KCH Pharmacy Research and Audit Group (07/2021), deemed service evaluation and ethics approval waived. Results Pharmacy professionals reviewed 1,056 patients over 3,645 occupied bed-days. Services were delivered by 13 pharmacists and 1 MMPT on weekend 1, 12 pharmacists and 1 MMPT on weekend 2. Data were collected for all wards on weekend 1; on weekend 2 activity data was not collected for five surgical wards (Saturday and Sunday), four post-acute medical wards (Saturday) and the acute medical unit (Sunday). Admission MR was conducted for 77% (317/412) of newly-admitted patients. Pharmacists recommended prescription amendment for 68% (217/317) of patients receiving admissions MR; affecting 517 medicines. The recorded intervention rate per patient reviewed was 0.64 (680/1056). Pharmacy professionals responded to 211 queries from healthcare professionals (HCPs), undertook 90 incidences of pro-active HCP education and counselled 92 patients/carers. Pharmacists prepared discharge medication lists or clinically screened discharge prescriptions for 205 patients. A total of 952 non-stock medicines were ordered and 313 patients own medicines checked for suitability for reuse. Discussion / Conclusion These findings add to existing evidence for seven-day clinical pharmacy services. Defined minimum staffing was not fulfilled with 90% shift fill rate. Clear benefit was demonstrated in terms of admission MR and resultant intervention, HCP education, discharge and counselling activities. The percentage of patients with a recommended prescription amendment following admission MR matched findings from a separate service evaluation during February 2021 of an enhanced weekend service introduced at our study site during the COVID-19 pandemic (68%).3 The intervention rate for reviewed patients was also comparable (0.64 compared with 0.57 during COVID-19).3 Limitations include the relatively short period of data collection at a single-site which limits generalisability of findings. There were some gaps in data collection and acceptance rate of interventions was not collected.

Exploring the suitability of a ward-based clinical pharmacy activity collection tool for ambulatory care practice: a mixed-methods study.

At a London-based hospital, a validated ward-based clinical pharmacy activity collection tool has been used to monitor activities of clinical pharmacy teams across all settings, including ambulatory care services. No data confirm its representativeness for the full range of ambulatory clinical pharmacy services, and pharmacists share this concern. This study aimed to identify the range of clinical pharmacy activities in ambulatory care, assess the suitability of the existing ward-based tool for capturing these activities, and recommend modifications. Non-participant direct observations were conducted to record pharmacists' clinical activities in ambulatory clinics and multidisciplinary meetings. These observations were compared to the existing ward-based tool to identify discrepancies. Semi-structured interviews with eight ambulatory pharmacists were transcribed verbatim and thematically analysed inductively to explore the tool's representativeness of their routine clinical activities. Twenty-nine clinical pharmacy activities were observed in ambulatory services. Only fifteen were captured by the existing tool, with therapy monitoring and recommending therapeutic changes not accurately captured. Pharmacists agreed that the tool was not fully representative and included irrelevant activities. Four common uncaptured activities were multidisciplinary meeting-specific activities, arranging laboratory tests, monitoring patient outcomes, and liaising with community healthcare professionals. This study identified 33 candidate ambulatory clinical pharmacy activities. The existing ward-based tool does not fully capture the full range of ambulatory care clinical pharmacy activities, highlighting the need for an improved tool. Pharmacists recommended including the uncaptured activities. The candidate activities provide a foundation for standardised measurement of relevant ambulatory care activities to enable effective workforce deployment and improve patient outcomes.

Criteria for medication reconciliation in major orthopedic surgery in high-risk patients: A consensus based on the Delphi method

Criteria for medication reconciliation in major orthopedic surgery in high-risk patients: A consensus based on the Delphi method

The Pharma work unit facing the challenges of inter-establishment pharmaceutical cooperation and the deployment of clinical pharmacy activities in psychiatry

The Pharma work unit facing the challenges of inter-establishment pharmaceutical cooperation and the deployment of clinical pharmacy activities in psychiatry

A systematic review of the impact of simulation on students' confidence in performing clinical pharmacy activities.

Although confidence does not automatically imply competence, it does provide pharmacy students with a sense of empowerment to manage a pharmacotherapeutic problem independently. Among the methods used in higher education, there is growing interest in simulation. To evaluate the impact of simulation on pharmacy students' confidence in performing clinical pharmacy activities. Articles that reported the use of simulation among pharmacy students with fully described outcomes about confidence were included. Studies for which it was impossible to extract data specific to pharmacy students or simulation were excluded. The search was carried out in Medline, Embase, Lissa and PsycInfo from inception to August the 31th, 2022. The results were synthesized into 4 parts: confidence in collecting information, being an expert in a procedure/pathology, counselling and communicating, and other results. The quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool "MMAT" tool. Among the 39 included articles, the majority were published in the last 5years and conducted in the United States. The majority included pharmacy students in years 1 through 3 (69.2%). The most common study design was the pre-post uncontrolled design (66.7%). Studies measuring the effects of human and/or virtual simulation were mainly focused on confidence to counsel and/or communicate with patients and colleagues (n = 20). Evaluations of the effects of these types of simulation on confidence in information gathering by health professionals were also well represented (n = 16). Simulation-based training generally yielded positive impact on improving pharmacy students' confidence in performing clinical pharmacy activities. Rigorous assessment methods and validated confidence questionnaires should be developed for future studies.

Impact of the Clinical Pharmacist in Rheumatology Practice: A Systematic Review.

This is a systematic literature review on the impact of pharmacists in rheumatology, conducted using the PubMed®, CINAHL®, Cochrane Library®, and Web of science® databases and using the PRISMA 2020 checklist. This review was conducted from 2000 to June 2024. A quality analysis was performed. The selection of articles, as well as all analyses, including quality analyses, were conducted by a pair of pharmacists with experience in rheumatology, and included 24 articles. This study highlights the growth of clinical pharmacy activities in rheumatology and the positive influence of clinical pharmacists on patient care. The implementation of such initiatives has the potential to improve medication adherence, reduce medication-related risks, and optimize associated healthcare costs. All these pharmaceutical interventions aim to make the patient care journey smoother and safer. Additionally, the diversity of available pharmaceutical services caters to the varied needs of rheumatology. Furthermore, outpatient clinical pharmacy is also explored in this field and garners interest from patients. The vast majority of studies demonstrate significant improvement in patient care with promising performance outcomes when pharmacists are involved. This review highlights the diverse range of interventions by clinical pharmacists in rheumatology, which is very promising. However, to better assess the benefits of clinical pharmacists, this activity needs further development and evaluation through controlled and randomized clinical research programs.

Measuring pharmacy clinical workload in the emergency department: Current status and a plan for action

Measuring pharmacy clinical workload in the emergency department: Current status and a plan for action

Economic impact of a clinical pharmacist in the orthopaedic sector: a review of the literature

ObjectivesThis review of the literature aimed to evaluate the economic impact of a clinical pharmacist in the orthopaedic sector.MethodsThe review followed the PRISMA recommendations. A bibliographic search was conducted on...

A cohort study comparing pharmacist activities during participation in general medical ward rounds: telehealth versus in-person during the COVID-19 pandemic.

The COVID-19 pandemic created systemic challenges in patient care delivery. To evaluate the impact on pharmacist activities during pharmacist participation in ward rounds via telehealth, compared to physical attendance. A single-centre, retrospective cohort study conducted from 18th Aug through 26th Oct 2020. Patients admitted to COVID and non-COVID general medical teams were included. Pharmacists attended ward rounds via telehealth for COVID teams; physical attendance continued for non-COVID teams. Telehealth involved pharmacists interacting with clinicians and patients virtually via videoconferencing whilst stationed remotely on the ward. Routine clinical pharmacy activities during telehealth ward rounds were compared to those during face-to-face ward rounds using comparative statistics. Among the 1230 patients included (762 COVID, 468 non-COVID), pharmacist participation in telehealth ward rounds demonstrated significantly more documented activities compared with face-to-face rounds (mean 6.7 vs 4.9 per patient per day, p < 0.001). The telehealth cohort exhibited a higher number of orders placed via pharmacy-partnered medication charting (3.0 vs 2.4 per patient per day, p < 0.001), medication orders verified (2.3 vs 1.1, p < 0.001), and documented pharmacy notes (0.6 vs 0.2, p < 0.001). No significant difference was observed in medication requests processed (0.4 vs 0.4, p = 738), whilst non-COVID patients had more discharge prescription items generated (0.3 vs 0.7, p < 0.001). Pharmacist involvement in medical ward rounds via telehealth enabled the ongoing provision of advanced clinical pharmacy services to inpatients in isolation rooms during the COVID-19 pandemic. This approach resulted in a greater number of pharmacy activities during telehealth ward rounds compared to standard in-person attendance.

Defining quality indicators, pharmaceutical care bundles and outcomes of clinical pharmacy service delivery using a Delphi consensus approach.

Clinical pharmacy quality indicators are often non-uniform and measure individual activities not linked to outcomes. To define a consensus agreed pharmaceutical care bundle and patient outcome measures across an entire state health service. A four-round modified-Delphi approach with state Directors of Pharmacy was performed (n = 25). They were asked to rate on a 5-point Likert scale the relevance and measurability of 32 inpatient clinical pharmacy quality indicators and outcome measures. They also ranked clinical pharmacy activities in order from perceived most to least beneficial. Based upon these results, pharmaceutical care bundles consisting of multiple clinical pharmacy activities were formed, and relevance and measurability assessed. Response rate ranged from 40 to 60%. Twenty-six individual clinical pharmacy quality indicators reached consensus. The top ranked clinical pharmacy quality indicator was 'proportion of patients where a pharmacist documents an accurate list of medicines during admission'. There were nine pharmaceutical care bundles formed consisting between 3 and 7 activities. Only one pharmaceutical care bundle reached consensus: medication history, adverse drug reaction/allergy documentation, admission and discharge medication reconciliation, medication review, provision of medicines education and provision of a medication list on discharge. Sixteen outcome measures reached consensus. The top ranked were hospital acquired complications, readmission due to medication misadventure and unplanned readmission within 10 days. Consensus has been reached on one pharmaceutical care bundle and sixteen outcomes to monitor clinical pharmacy service delivery. The next step is to measure the extent of pharmaceutical care bundle delivery and the link to patient outcomes.

Anti-Cancer: Principles of use and Management of Side Effects

Today, with the rapid progress we are seeing in the development of new cancer drugs, the importance of pharmacist in the interprofessional oncology team and in the pathway therapy for people with cancer. therefore, the control of principles of use and management of side effects turns out to be crucial. This short communication aims to present the essential points helping the pharmacist in his oncological clinical pharmacy activity.

Le pharmacien clinicien, un maillon indispensable dans la nouvelle gradation de prise en charge des patients ambulatoires

Le pharmacien clinicien, un maillon indispensable dans la nouvelle gradation de prise en charge des patients ambulatoires

Integrated clinical pharmacy activities into the pediatric kidney graft pathway

The pediatric renal graft pathway is at risk of care discontinuation, even though therapeutic adherence is essential. The objective is to evaluate the integration of clinical pharmacy activities into this care pathway. This feasibility study is divided into three stages: structuring, implementing and evaluation. In pre-transplant, immediate and remote post-transplant, interviews were proposed as well as the pharmaceutical analysis of medication prescriptions. In 8 months duration, 32 patients were included. All patients included in pre-transplant and immediate post-transplant benefited from the activities. At M0, all the prescriptions analyzed resulted in at least one problem detected. Half of the transplanted patients benefited from M1 maintenance, one patient from M3 maintenance and no M6 follow-up could be carried out. This work concludes with the good feasibility and integration of clinical pharmacy activities within the care pathway.

Beyond the boundaries of ward-based services – exploring the scope of “non-traditional” clinical pharmacy practice in a tertiary referral teaching hospital

Abstract Introduction Hospital clinical pharmacy practice in the UK has developed beyond traditional boundaries of ward-based inpatient services. Royal Pharmaceutical Society Hospital Pharmacy Standards recommend pharmacy team members are integrated into multidisciplinary teams across the organisation to ensure safe and appropriate medicines use whatever the setting1. Pharmacy professionals provide pharmaceutical care and specialist services in outpatient and ambulatory settings and through participation in multidisciplinary team (MDT) meetings. Within the outpatient setting, research typically focusses on single outpatient clinics within specific disciplines, little evidence describes the overall contribution to patient care across whole pharmacy services2. Aim To describe the scope of clinical pharmacy services occurring beyond traditional ward-based services in a tertiary hospital; including quantification of outpatient clinics and MDT meetings provided by pharmacy professionals. Methods The Deputy Chief Pharmacist invited clinical Principal Pharmacists to participate in semi-structured interviews exploring the scope of “non-traditional” services across the Trust during March 2023. Non-traditional services were defined as direct clinical care outside of ward-based inpatient clinical pharmacy services. Indirect clinical care activities such as guideline writing, drug expenditure and governance activities were excluded. Inpatient board rounds/ward rounds and any service not currently provided due to vacancy were excluded. Participants were asked to quantify services provided, advise who provided the services and to describe contributions provided by the pharmacy team. The study was deemed service evaluation and ethical approval waived. Results 100% invited pharmacists participated. Pharmacists attended and contributed to over 150 MDT meetings monthly across 24 sub-specialities; 80% were for outpatients. In tertiary/quaternary services, these frequently covered patients beyond local geography. MDT meetings were typically attended by specialist, principal or consultant pharmacists. Common contributions included: provision of pro-active advice/responding to queries; medicines optimisation; monitoring; income or compliance assurance; prescribing/deprescribing. Specialist pharmacists provided 80-100 outpatient clinic sessions across 17 sub-specialities through a mix of face-to-face and virtual appointments, advanced pharmacy technicians provided on-treatment and counselling clinics. Activities included: initiation, monitoring, adjustment and cessation of medicines; patient counselling and MDT referral. Medicines prescribed were typically high cost, complex and higher risk. Pharmacists prescribed and clinically verified homecare medicines and provided ongoing annual review of outpatient medicines, including prescribing/deprescribing. Teams described medicines reconciliation and counselling in ambulatory haematology settings, off-site units and infusion suites. The team organised, optimised and provided advice and counselling for patients requiring antimicrobial therapies at home. Clinical pharmacists and pharmacy technicians provided medicines information to patients, internal and external healthcare professionals. Discussion/Conclusion This study provides evidence of the broad scope of clinical pharmacy practice beyond the boundaries of traditional ward-based services in a tertiary teaching hospital. This study was limited to a single organisation, specific clinical pharmacy activities and outcomes of these services were not fully quantified. Formal collation of clinical pharmacy activities within “non-traditional” outpatient and ambulatory settings is limited because activity data collection forms in hospital pharmacy are typically validated in traditional ward-based pharmacy services. We recommend further studies to validate activity collection tools to benchmark the activities of clinical pharmacy professionals providing services in outpatient and ambulatory settings both within and between hospital Trusts.