Role Of Clinical Pharmacy Research Articles

Project advances health system’s clinical pharmacy services

The Sisters of Mercy Health System’s recent initiative to transform its medication-use process was “not all about the technology,” said Kelly L. Turner, pharmacy services manager for the health system, which has hospitals in Arkansas, Kansas, Missouri, and Oklahoma. In addition to procuring and implementing new technology, she said, a major focus of the initiative, dubbed Mercy Meds, was getting pharmacists “out of the basement” and engaged as part of the care team on patient units. Turner said that while it took some initial effort to educate and sell Mercy’s leadership on the value that clinical pharmacy services add to medication-use safety, administrators and other leaders quickly came on board to support having more pharmacists involved directly in patient care. Before Mercy Meds, she said, few of the health system’s hospitals had pharmacists serving in clinical pharmacy roles. “We had about 0.5 [full-time-equivalent] clinical pharmacist activity per 100 beds,” Turner said. “So that was pretty small. We spent 80% of our time historically on distributive work.”

Models of hospital drug policy in the UK.

Pharmacists in UK National Health Service (NHS) hospitals have a long tradition of involvement in the development of drug policy. This paper describes various approaches that have been employed in the development and implementation of drug policy in hospitals and examines the evidence for their effectiveness and acceptability in the context of a changing health service. A series of focused interviews was conducted with a range of staff, including doctors, nurses, pharmacists and managers at eight hospitals. Interview sites were selected on the basis of a national survey of clinical pharmacy roles and were broadly representative of UK NHS hospitals. Interview data were analysed using constant comparison and analytic induction. Three models used in the development of drug policy were identified: a 'traditional' model, in which a drug and therapeutics committee establishes a hospital-wide formulary which is implemented by pharmacists; a 'combined' model, in which there is much more emphasis on tailoring policies and feedback to specialties or clinical directorates; and a 'medical control' model, in which prescribing decisions are made by individual doctors without reference to explicit policies and with little active pharmacy involvement. Pharmacy involvement was seen as vital to the development of effective policies but hospital-specific factors influenced the choice of model at particular sites. Hospitals may be moving towards the 'combined' model which could have advantages in the current internal market within the NHS. However, evaluations of the various approaches to drug policy should help inform this decision.

Scenario analysis of the future of clinical pharmacy.

The role of clinical pharmacy in the health care system is changing rapidly. This change is almost universal among different countries and is related to developments in medical technology, health economics, informatics, socio-economic status, and professional relations. Transitions to new systems of clinical pharmacy are difficult to anticipate. Even with well defined targets, it remains uncertain what the future of clinical pharmacy will bring us. The construction of plausible scenarios may help us better in preparing for the 'new world' ahead. At the annual congresses of ESCP in Prague 1995 (24th) and Lisbon 1996 (25th), a number of scenario analysis workshops with respect to the future of clinical pharmacy were organized. This paper gives a report of the results of these scenario sessions and reflects on the implications for future policy making. After we identified the driving forces behind the future of clinical pharmacy, various sets of assumptions were made and from them scenarios were constructed which are plausible: they 'could' happen. This analysis provided a logical framework in which we ultimately depicted three alternating stories of the future of clinical pharmacy, named 'CLERK', 'CONTROLLER' and 'CARE MANAGER'. These scenarios are intended to help clinical pharmacists to break free of familiar mental maps and to stimulate creative thinking on the future.