Clinical Pharmacy Services In Hospitals Research Articles

Development of hospital clinical pharmacy services in Denmark from 2008 to 2023

ObjectivesThe role of the hospital pharmacist is evolving, and in many countries pharmacists play an increasingly patient-centred role in healthcare. This study aimed to investigate the development of Danish hospital...

Development, content validation and standardization of an adult patient prioritization tool for hospital clinical pharmacy services

BackgroundPatient prioritization is a effective strategy to identify high risk patients for targeted Clinical Pharmacy Service (CPS) in hospital pharmacy. However, there is a paucity of patient prioritization tool to use in clinical practice. ObjectivesDescribe the development, content validation and standardization of an adult patient prioritization tool for hospital CPS named, PrioFarClinH. MethodsThe tool was developed using a stepwise design multi: Scoping Review to identify prioritization criteria/sub-criteria; Delphi technique to obtain consensus under the identified criteria/sub-criteria; Survey with pharmacists evaluating applicability of the criteria/sub-criteria obtained from Delphi; Definition of criteria/sub-criteria to be included in PrioFarClinH attribution of scores. Content validation was performed by a panel of experts evaluating relevance, feasibility, clarity and adequacy of the score. Content Validity Index (CVI) was calculated. Standardization occurred through a retrospective observational study carried out at 24 and 72 h and median of the patient's hospital stay. An intragroup norm was performed, determining percentile ranks of the instrument's total scores. Patients with a P90 score were classified with a high level of prioritization for CPS. ResultsPrioFarClinH is divided into three sections, with prioritization criteria for health issues; therapeutic classes; laboratory parameters. It comprises 51 criteria with specific scores with simple total calculation. None of the criteria presented CVI <0.78, maintaining the items from the initial version of PrioFarClinH. The scores were adjusted per suggestions from the panel of judges. Data were collected from 393 patients. The P90 percentile in the three hospitalization stages (24 h, 72 h, and median) was found, respectively, in the following scores: 18.0, 20.0, and 22.6. ConclusionsPrioFarClinH is a comprehensive tool to target and to prioritize adults patients most likely to benefit from CPS. Evidence for adequate content validity was provided. However, further validation of this tool is necessary to establish tool performance.

Uptake of pharmacist recommendations by patients after discharge: Implementation study of a patient-centered medicines review service

BackgroundPolypharmacy and potentially inappropriate medicine use is common in older people, resulting in harm increased by lack of patient-centred care. Hospital clinical pharmacy services may reduce such harm, particularly prevalent at transitions of care. An implementation program to achieve such services can be a complex long-term process.ObjectivesTo describe an implementation program and discuss its application in the development of a patient-centred discharge medicine review service; to assess service impact on older patients and their caregivers.MethodAn implementation program was begun in 2006. To assess program effectiveness, 100 patients were recruited for follow-up after discharge from a private hospital between July 2019 and March 2020. There were no exclusion criteria other than age less than 65 years. Medicine review and education were provided for each patient/caregiver by a clinical pharmacist, including recommendations for future management, written in lay language. Patients were asked to consult their general practitioner to discuss those recommendations important to them. Patients were followed-up after discharge.ResultsOf 368 recommendations made, 351 (95%) were actioned by patients, resulting in 284 (77% of those actioned) being implemented, and 206 regularly taken medicines (19.7 % of all regular medicines) deprescribed. ConclusionImplementation of a patient-centred medicine review discharge service resulted in patient-reported reduction in potentially inappropriate medicine use and hospital funding of this service. This study was registered retrospectively on 12th July 2022 with the ISRCTN registry, ISRCTN21156862, https://www.isrctn.com/ISRCTN21156862.

Consensus on the criteria for patient prioritization in hospital clinical pharmacy services: a Delphi study.

Hospital pharmacists cannot provide extensive clinical pharmacy service to every inpatient because the demand for these services can exceed pharmacists' available work time. A way to solve this issue is hospital pharmacists to prioritize their clinical tasks. Tool prioritization could determine which patients would benefit from clinical pharmacists' input. Establishing consensus on which criteria are relevant for prioritizing patients for clinical pharmacy services. The Delphi method was performed with criteria identified from a previously published Scoping Review. The panel of experts included hospital pharmacists, who evaluated the clinical significance of criteria in a three-round Delphi panel from July to December 2020. They determined the need for sub-criteria and evaluated their clinical significance. The experts also analyzed the criteria/sub-criteria as to their applicability in clinical practice. Consensus criteria were defined as 70% or more participants scoring the criteria as critical and 15% or fewer scoring the criteria as unimportant. A total of 19 criteria and 230 sub-criteria were included for evaluation by panel experts based on scoping review. Twenty-nine, 22, and 17 experts participated per round, respectively. After completing the three rounds, experts suggested the inclusion of one criterion, the exclusion of one criterion, and the inclusion of 29 sub-criteria. The final list consisted of 18 criteria and 177 sub-criteria, divided into 28 groups. The result was comprehensive and coherent, potentially contributing to developing an instrument for prioritizing hospitalized patients for clinical pharmacy services.

Improving rural hospital clinical pharmacy services through workforce innovation with ward‐based pharmacy technicians

AbstractAustralian regional hospitals regularly face significant challenges in the recruitment and retainment of clinical pharmacists. An audit conducted at a regional hospital in Southern New South Wales (NSW) demonstrated that 79% of patients did not receive clinical pharmacy services during their admission. It was recognised that there was an urgent need for innovation within the current workforce. The ward‐based pharmacy technician (WBPT) model was implemented by establishing a 14‐day training program with subsequent assessment by clinical pharmacists. WBPTs undertook activities including assisting clinical pharmacists in compiling medication histories and participating in ward‐specific medication safety audits. An audit of comparison indicators before and after implementation demonstrated significant improvements in all comparative measures. Implementation of WBPTs in this regional hospital has demonstrated improved workflow for the clinical pharmacist, and contributed to patient and medication safety via increased completion rates of medication reconciliation.

The Juridical Analysis of Setting of Clinical Pharmacy Services in Hospitals

This research is based on statutory regulation relating to clinical pharmacy services in hospitals afterthe issuance of Minister of Health Regulation Number 3 of 2020 concerning Hospital Classification andLicensing (PMK 3 of 2020) which reaps various interpretations, especially clinical pharmacy services inhospitals. The methodology in this study used a normative juridical type and used four approaches, namelythe statute approach, historical approach, comparative approach, and conceptual approach. Then a documentstudy was carried out through tracing the sources of legal materials such as the Constitution, the Health Law,the Hospital Law, the Health Manpower Law and the statutory regulations relating to the rules for classifyingpharmaceutical services in hospitals as well as studying reading sources related to the object of research.This research showed that there is actually a contradiction in norms between the Hospital Law, the HealthLaw, the Health Manpower Law and the Minister of Health Regulation Number 72 of 2016 concerning theStandard of Pharmaceutical Services in Hospitals which is the implementer of the Hospital Law and PMK3 of 2020 concerning Hospital Classification and Licensing, where the lower statutory regulations may notconflict with the statutory regulations under it or known as the lex superior derogate legi inferiori principle.

Prognostic prediction models and clinical tools based on consensus to support patient prioritization for clinical pharmacy services in hospitals: A scoping review.

Identifying patients at high risk of adverse medication-related outcomes for targeted clinical pharmacy services is essential in hospital pharmacy. Models and predictive tools to prioritize patients are available to the clinical pharmacy services for hospital use. To describe and assess prognostic models and predictive tools used to identify inpatients at risk of adverse medication-related outcomes. We searched in Medline, Lilacs, Cochrane, CINAHL, Embase, Scopus and Web of Science, databases of theses and dissertations, and the references of the selected studies. The screening was carried out by two independent researchers. Cross-sectional studies, prospective or retrospective cohort studies, and case-control studies were eligible for inclusion. The studies addressed the development or validation of predictive models and clinical prioritization tools based on expert opinion to identify inpatients at risk of adverse medication-related outcomes. 25 studies were included, 13 of which were prognostic prediction models, seven were instrument development using the consensus method, and five were validation. The outcome events were drug-related problems (9), adverse drug reactions (8), adverse drug events (6), and medication errors (2). Most studies targeted adult patients (14), eight had older adult patients, one had obstetric patients, and others had pediatric patients. External validation was performed after the development study in three studies. The predictive model with a low risk of bias was the Medicines Optimisation Assessment Tool. Limited details on the method of expert involvement and the number of experts were identified in four studies. The development of patient prioritization tools to optimize pharmacotherapy by clinical pharmacy services is a complex process. The predictive models and tools analyzed are limited in their development and validation process, hindering their effective use in prioritizing patients by the clinical pharmacy services. The development of additional prognostic prediction models for drug-related problems is a priority.

Factors influencing the implementation of clinical pharmacy services for hospitalized patients: A mixed-methods systematic review.

Despite the evidence of benefits, clinical pharmacy services (CPS) are not uniformly implemented across healthcare institutions. Understanding the influencing factors and identifying the domains in which they act is the first step to a successful implementation. To identify the factors that affect the implementation of CPS for inpatients and to categorize them. Cochrane Library, Embase, CINAHL, IPA, Medline/PubMed, and Lilacs databases were researched up until January 2018. The search strategy was developed using text words or MESH terms related to the following four domains: "clinical pharmacy," "influencing factors," "implementation," and "hospital." Two reviewers selected original research articles that reported the factors influencing the implementation of CPS in hospitals, extracted data, and assessed the quality of the studies. After framework synthesis and categorization of the factors, a diagrammatic approach was used to present the results. Fifty-three factors were identified in the 21 studies that were included in this review. The most cited influencing factors were uniformly distributed across the following four domains: Attitudinal, POlitical, TEChnical and Administrative (APOTECA domains). However, in terms of level (pharmacist, healthcare team, patient, institution, and national organization), the "pharmacist" group had the highest concentration of factors. "Clinical skills and knowledge" was the most frequently cited implementation factor, followed by "time to implement CPS." Our findings showed the multifactorial nature of CPS implementation process. We suggest that factors from all four APOTECA domains need to be fully considered and strategies need to be addressed for all five groups of interest to successfully implement CPS in hospitals. Future studies on the influence of implementation stages, interrelationships of implementing factors, and strategies to overcome barriers could accelerate the successful adoption of these services. PROSPERO register CRD42016050140.

Impact of a pharmacy technician on clinical pharmacy services in an Australian hospital.

Background There is increasing recognition for the role of pharmacy technicians in obtaining medication histories and performing administrative tasks which may represent an opportunity cost when completed by pharmacists. Technician-enhanced teams can therefore improve hospital clinical pharmacy services. In Australian hospitals, medication reconciliation and reviews can be documented in Medication Management Plans (MMPs) upon admission. Thus, MMPs can be used as feasible measures of the efficiency of pharmacy teams. Objective To quantify the impact of a technician-enhanced clinical pharmacy model on medication reconciliation and timeliness of pharmacist tasks. Setting 480-bed tertiary teaching hospital in New South Wales. Method The effect of a technician working alongside the geriatric pharmacist in a single hospital was evaluated. Outcomes were measured throughout two 4-week periods pre- and post-implementation for patients under the supervision of a geriatrician who were discharged during usual business hours. Data were collected by the supervising pharmacist. Main outcome measure Primary outcomes were the number of MMPs completed daily on average and during admission, as well as the timeliness of updating discharge summaries, medication histories and MMPs. Results The mean number of daily MMPs significantly increased from 2.25 to 4.90 with the technician (p < 0.001, 95% CI 1.66 to 3.64). The median time to update discharge summary significantly decreased from 6:48 to 2:33h (p = 0.01). Conclusion This study suggested that technician-enhanced teams could improve the efficiency of clinical pharmacy services in an Australian hospital.

Hospital clinical pharmacy services in Vietnam.

Background Clinical pharmacy is key to the quality use of medicines. While there are different approaches in different countries, international perspectives may inform health service development. The Vietnamese Ministry of Health introduced a legal regulation of clinical pharmacy services in December 2012. Objective To describe the services, and to explore reported barriers and facilitators in implementing clinical pharmacy activities in Vietnamese hospitals after the introduction of Vietnamese Ministry of Health legal regulation. Setting Thirty-nine hospitals in Hanoi, Vietnam, including 22 provincial and 17 district hospitals. Method A mixed methods study was utilized. An online questionnaire was sent to the hospitals. In-depth interviews were conducted with pairs of nominated pharmacists at ten of these hospitals. The questionnaire focused on four areas: facilities, workforce, policies and clinical pharmacy activities. Main outcome measure Proportion of clinical pharmacy activities in hospitals. Themes in clinical pharmacy practice. Results 34/39 (87%) hospitals had established clinical pharmacy teams. Most activities were non-patient-specific (87%) while the preliminary patient-specific clinical pharmacy services were available in only 8/39 hospitals (21%). The most common non-patient-specific activities were providing medicines information (97%), reporting adverse drug reactions (97%), monitoring medication usage (97%). The patient specific activities varied widely between hospitals and were ad hoc. The main challenges reported were: lack of workforce and qualified clinical pharmacists. Conclusion While most hospitals had hospital-based pharmacy activities, the direct patient care was limited. Training, education and an expanded work forces are needed to improve clinical pharmacy services.

National Survey on Clinical Pharmacy Services of Tertiary Hospitals in China: Part 1. Introduction of Survey and Basic Conditions of Clinical Pharmacy Service Provision

OBJECTIVE: To obtain data related to clinical pharmacy services of Tertiary hospitals, find problems in the service system, based on which provide advice on policy formulation. METHODS: A face-to-face interview survey was conducted to collect data on management system construction, hardware & facility equipment and professional staffing, et al which was analyzed with descriptive statistics tools. RESULTS: Only 59.7% of the hospital within the sample established clinical pharmacist performance appraisal systems; 18.4% of the hospital's clinical pharmacy services were charged; 30.0% of the hospitals provided offices for clinical pharmacists; each 100 beds were equipped with an average of 5.6 technical professionals and an average 0.43 clinical pharmacists; most of the professionals' educational background were undergraduate (51.5%) and below undergraduate (28.7%), and most of the professionals' professional titles were primary (53.1%) and intermediate (33.4%); dispensing remained main duty of pharmaceutical professionals(67.4%).CONCLUSION: Management system construction, hardware & facility equipment and professional staffing of tertiary hospitals in China require further improvement.

Hospital clinical pharmacy services in Vietnam

Hospital clinical pharmacy services in Vietnam

Assessment of surveys for the management of hospital clinical pharmacy services.

Survey data sets are important sources of data, and their successful exploitation is of key importance for informed policy decision-making. We present how a survey analysis approach initially developed for customer satisfaction research in marketing can be adapted for an introduction of clinical pharmacy services into a hospital. We use a data mining analytical approach to extract relevant managerial consequences. We evaluate the importance of competences for users of a clinical pharmacy with the OrdEval algorithm and determine their nature according to the users' expectations. For this, we need substantially fewer questions than are required by the Kano approach. From 52 clinical pharmacy activities we were able to identify seven activities with a substantial negative impact (i.e., negative reinforcement) on the overall satisfaction of clinical pharmacy services, and two activities with a strong positive impact (upward reinforcement). Using analysis of individual feature values, we identified six performance, 10 excitement, and one basic clinical pharmacists' activity. We show how the OrdEval algorithm can exploit the information hidden in the ordering of class and attribute values, and their inherent correlation using a small sample of highly relevant respondents. The visualization of the outputs turns out highly useful in our clinical pharmacy research case study.

Factors Affecting the Implementation of Clinical Pharmacy Services in China

New policies in China have recently led to the implementation of clinical pharmacy services in hospitals. We explored the views of hospital administrators, pharmacy directors, clinical pharmacists, and dispensing pharmacists about the factors affecting clinical pharmacy services in China, using the framework approach and organizational theory. We conducted 30 interviews with 130 participants at 29 hospitals (both secondary and tertiary) in Beijing, Zhengzhou, Luoyang, and Shanghai. We found that the barriers to and facilitators of implementation of clinical pharmacy services slotted into the environment and participant dimensions of Scott's adapted version of Leavitt's organizational model. External support from government was perceived as crucial to promoting pharmacy services. It is proposed that the internationally recognized Basel Statements of the International Pharmaceutical Federation also provide a strong foundation for guiding China in implementing clinical pharmacy services.

Evaluation of implementation of clinical pharmacy services in Central Norway

This paper describes the implementation of a clinical pharmacy services in hospitals in Central Norway. Our model for clinical pharmacy services is based on the Integrated Medicines Management (IMM) model...

Hospital clinical pharmacy services provided to primary care

Abstract Recent changes in the United Kingdom national health service (NHS) have increased the need for pharmacy services in primary care. Government documents have advocated a role for hospital pharmacists in the provision of clinical pharmacy services to primary care. A census survey was carried out to establish the extent to which hospital pharmacists have become involved in the provision of clinical pharmacy services to primary care patients and health professionals. Questionnaires were sent to district pharmaceutical officers in England (and their equivalents in the rest of the UK). One hundred and ninety-three questionnaires were returned (92 per cent). Hospital pharmacists provided few advisory, educational or information services to patients and primary care health professionals, with the exception of primary care nurses. Pronounced variations in service provision were observed in different parts of the UK. Respondents gave reasons for their limited involvement and indicated that the provision of services is increasing. The survey shows that government policy on the provision of hospital clinical pharmacy services to patients and health professionals in primary care has not been implemented. The provision of such service is, however, increasing, mainly as a consequence of the NHS reforms and the movement of resources to primary care.

A Survey of the Provision of Clinical Pharmacy Services in Relation to Existing Published Standards

To investigate the provision of clinical pharmacy services in hospitals in one NHS region in UK, and to measure the delivery of these services against published standards. The study comprised two phases. Phase 1 was a postal questionnaire to hospital chief pharmacists seeking information on the provision of clinical pharmacy in their hospital. Phase 2 involved a semi-structured interview with hospital chief pharmacists to obtain a detailed understanding of clinical pharmacy services in their hospital and factors influencing the provision of these services. Ninety-four percent of all hospitals surveyed were providing a clinical pharmacy service. However, only two thirds provided a service to all wards, and the main reason given for not doing so, was lack of resources. There was a divergence of opinion amongst chief pharmacists whether it was better to provide a limited service to all wards or a good service to some wards. Thirty-seven percent of hospitals did not meet the minimum standard of frequency for visiting acute wards, whereas, 58 were meeting the optimal standard of frequency of visits for non-acute short stay wards and 67 for long stay wards, primarily because the latter required less frequent visiting. The study showed that hospital pharmacies were influencing prescribing decisions in a variety of ways other than ward visiting. Although hospital chief pharmacists see clinical pharmacy as a core service, published standards for these services are not being met. As a result of staff shortages, managers are using a variety of approaches to maintain clinical pharmacy services. There is scope for further devolvement of duties to pharmacy technicians in order to release valuable pharmacist time.

Challenge to clinical pharmacy practice in Malaysia.

To report on the current status and future trends of clinical pharmacy practice in Malaysia. Published conference reports and journal articles. Data on areas related to clinical pharmacy practice in Malaysian hospitals were gleaned from various publications. Malaysia is capable of implementing clinical pharmacy services in hospitals and perhaps also in the community setting. The important factors in clinically oriented pharmacy practice include improvement of the drug-control process, development of physical and human resources, clinical pharmacy skills, and the training of practicing pharmacists. A number of Malaysian pharmacists have already developed a unit-dose drug distribution system, patient counseling, therapeutic drug monitoring, drug information, and total parenteral nutrition services. The pharmacy profession in Malaysia has many challenges ahead and it is hoped that every practicing pharmacist will be highly committed to future professional needs so that clinical pharmacy practice in Malaysia becomes a reality.

Administrative directives for clinical practice

Factors that will influence the future of comprehensive pharmaceutical services are discussed, and administrative strategies for developing clinical pharmacy services in hospitals are presented. The future of clinical pharmacy practice will be affected by: (1) health-manpower levels; (2) the trend toward centralized, prospective payment for health services; (3) emphasis on cost containment; and (4) the quality of existing pharmaceutical services. Of primary importance to the development of clinical services is to have in place a centralized, unified pharmaceutical service. A staff of qualified practitioners, as well as executive direction to determine goals and priorities, is needed. Valid clinical roles should be identified that meet health-care needs, meet legal and accreditation standards, avoid conflict with physician-roles help deal with the nursing shortage, and contain health-care costs. Cost of the clinical service must be determined so that financial support can be arranged.