Hospital Pharmacy Practice Research Articles

Barcode technology and emergency medicine pharmacy

AbstractBackgroundThe emergency medicine pharmacist (EMP) represents a new field of pharmacy practice in many hospitals and at St Vincent's Hospital Sydney the EMP visits the emergency department (ED) daily Monday to Wednesday (MW), with other pharmacists providing services on Thursday and Friday. Because newer practice areas need to justify services, barcode technology offers an efficient means to collect service provision data.AimThe aim of this study was to determine whether barcode scanning could be used to efficiently describe and quantify EMP services, including the time involved in undertaking activities.MethodThe Activity BarCoding (ABC®) system is a commercially available software package that involves using a portable barcode scanner to collect and present data as an activity profile. The ABC® data generated for the EMP were reviewed for September 2012–March 2013.ResultsThe MW EMP spent 124.5 h undertaking ED clinical care activities (1.48 h/day). In all, 634 patients were seen and, on average, the MW EMP spent 8.94 min with each patient (range: 6.97–9.93 min). Both clinical and non‐clinical activities could be described, with time allocation and interventions easily quantifiable.DiscussionBarcode technology accurately recorded the variety of and time required for activities performed by the EMP and demonstrated EMP involvement in ED patient care. It provides information that describes and quantifies EMP services that can be used for business case development and service improvements. Further standardisation of activity and intervention categories will enhance data collection, benchmarking possibilities and multicentre research.

Physician Acceptance of Pharmacist Recommendations about Medication Prescribing Errors in Iraqi Hospitals

The objectives of this study were to measure the incidence and types of medication prescribing errors (MPEs) in Iraqi hospitals, to calculate for the first time the percentage of physician agreement with pharmacist medication regimen review (MRR) recommendations regarding MPEs, and to identify the factors influencing the physician agreement rate with these recommendations. Methods: Fourteen pharmacists (10 females and 4 males) reviewed each hand-written physician order for 1506 patients who were admitted to two public hospitals in Al-Najaf, Iraq during August 2015. The pharmacists identified medication prescribing errors using the Medscape WebMD, LCC phone application as a reference. The pharmacists contacted the physicians (2 females and 34 males) in-person to address MPEs that were identified. Results: The pharmacists identified 78 physician orders containing 99 MPEs with an incidence of 6.57 percent of all the physician orders reviewed. The patients with MPEs were taking 4.8 medications on average. The MPEs included drug-drug interactions (65.7%), incorrect doses (16.2%), unnecessary medications (8.1%), contra-indications (7.1%), incorrect drug duration (2%), and untreated conditions (1%). The physicians implemented 37 (37.4%) pharmacist recommendations. Three factors were significantly related to physician acceptance of pharmacist recommendations. These were physician specialty, pharmacist gender, and patient gender. Pediatricians were less likely (OR= 0.1) to accept pharmacist recommendations compared to internal medicine physicians. Male pharmacists received more positive responses from physicians (OR=7.11) than female pharmacists. Lastly, the recommendations were significantly more likely to be accepted (OR= 3.72) when the patients were females. Conclusions: The incidence of MPEs is higher in Iraqi hospitalized patients than in the U.S. and U.K, but lower than in Brazil, Ethiopia, India, and Croatia. Drug-drug interactions were the most common type of MPEs in hospitals. Physician specialty and pharmacist gender and patient gender significantly influenced physician agreement with the pharmacist comments. Only one-third of the pharmacist recommendations were implemented. Phone drug applications would be helpful for daily hospital pharmacy practice. More pharmacist-physician collaboration is needed to address MPEs. Pharmacist-led MRR can identify and address MPEs to improve patient safety.
 
 Type: Original Research

Improved Organizational Outcomes Associated With Incorporation of Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center

Purpose: To assess the feasibility of engaging second professional year student pharmacists in the medication reconciliation process on hospital and health system pharmacy practice outcomes. Methods: Student pharmacists in their second professional year in the Doctor of Pharmacy degree program at our institution were randomly selected from volunteers to participate. Each participant completed training prior to completing three 5-hour evening shifts. Organizational metrics, student pharmacist perception regarding quality of interactions with health care professionals, and pharmacist perceptions were collected. Results: A total of 83 medication histories were performed on complex medical patients (57.0 ± 19.2 years, 51% female, 65% Caucasian, 12 ± 6 medications); of those, 93% were completed within 24 hours of hospital admission. Second professional student pharmacists completed on average 1.9 ± 0.6 medication histories per shift (range 1-3). Student pharmacists identified 0.9 medication-related problems per patient in collaboration with a pharmacist preceptor. Student pharmacists believed the quality of their interactions with health care professionals in the Student Medication and Reconciliation Team (SMART) program was good or excellent. The program has been well received by clinical pharmacists involved in its design and implementation. Conclusion: This study provides evidence that second professional year student pharmacists can assist pharmacy departments in the care of medically complex patients upon hospital admission.

EAHP European Statements survey 2015

ObjectivesThe 2015 EAHP European Statements survey was related to sections 2, 5 and 6 of the European Statements of Hospital Pharmacy (Statements). In addition to collection of statistical data about...

Revision of the International Pharmaceutical Federation's Basel Statements on the future of hospital pharmacy: From Basel to Bangkok.

The processes used to revise the 2008 Basel Statements on the future of hospital pharmacy are summarized, and the revised statements are presented. The process for revising the Basel Statements followed an approach similar to that used during their initial development. The Hospital Pharmacy Section (HPS) of the International Pharmaceutical Federation (FIP) revised the 2008 FIP Basel Statements in four phases, including a survey of hospital pharmacists worldwide, an internal review, online forums, and a face-to-face "World Café" workshop in Bangkok, Thailand. The global survey on the initial Basel Statements included input from 334 respondents from 62 countries. The majority of respondents agreed that most of the initial Basel Statements were acceptable as written and did not require revision. In total, 11 statements were judged by more than 10% of respondents as needing revision or deletion. The FIP HPS executive committee used the survey results to develop 69 initial revised draft statements. After an online discussion with the international hospital pharmacy community, including individuals from 28 countries representing all six World Health Organization regions, a final set of draft statements was prepared for the live discussion involving participants from 20 countries. The final 65 revised Basel Statements were voted on and accepted. Systematic revision of the FIP Basel Statements resulted in an updated reflection of aspirational goals for the future of hospital pharmacy practice. While this revision reflects the development of new goals for hospital pharmacy practice, the core principles of the Basel Statements remain an essential foundation for the discipline.

Use of the International Pharmaceutical Federation's Basel Statements to Assess and Advance Hospital Pharmacy Practice: A Scoping Review.

The Basel statements of the International Pharmaceutical Federation, which provide the first global, unified vision for the hospital pharmacy profession, have recently been revised. Originally released in 2008, the Basel statements have since been made available in 21 languages, and thus have the potential for great impact around the world. To conduct a scoping review to examine the extent and nature of research activity related to the Basel statements. Google Scholar, PubMed, and International Pharmaceutical Abstracts were searched using the key term "Basel statements" for relevant research articles. From each included study, data were extracted on geographic location, study design, study outcomes, and use of the Basel statements. The search strategy generated 113 results. Further refinement resulted in 14 English-language articles that met the inclusion criteria. Four of these articles focused on adapting the Basel statements to European practice, an initiative of the European Association of Hospital Pharmacists that led to development of the European statements of Hospital Pharmacy. Six studies focused on monitoring hospital pharmacy practice in Uganda, the Pacific island countries, and the Western Pacific Region. These studies provide valuable baseline data to measure and track the development of hospital pharmacy practices in their respective countries and regions. The remaining 4 studies used qualitative methods to explore the barriers to and facilitators of implementation of the Basel statements in South Africa, China, and Australia. The Basel statements have led to multiple initiatives around the world, involving more than 70 countries. The European and Western Pacific regions have been the most active. Current initiatives should be continued to ensure identification and resolution of issues related to sustaining their use over time.

Measurement of Clinical Pharmacy Key Performance Indicators to Focus and Improve Your Hospital Pharmacy Practice.

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Hospital Pharmacy in Belgium: From Moving Boxes to Providing Optimal Therapy.

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Challenges to clinical pharmacy practice in Nigerian hospitals: a qualitative exploration of stakeholders' views.

In Nigeria, a shift from the traditional pharmacists' role of dispensing and compounding of medications began in the 1980s with the introduction of drug information services and unit dose-dispensing systems in some hospitals. More than three decades after this, clinical pharmacy practice is still underdeveloped. This study was conducted to explore stakeholders' views on the barriers to the development of clinical pharmacy practice in Nigerian hospitals. Qualitative, semi-structured interviews were conducted with 44 purposefully sampled Nigerian stakeholders including pharmacists, pharmacy technicians, doctors, policymakers and patient group representatives. Transcribed interviews were entered into the QSR (Burlington, MA, USA) NVivo 10 software and analysed thematically. Three major themes emerged from the study: pharmacists' professional identity, the structure of pharmacy practice and external barriers. The results revealed an ongoing struggle by Nigerian hospital pharmacists to establish their clinical identities as many non-pharmacy stakeholders viewed pharmacists' roles to be mainly supply based. Barriers to the development of clinical pharmacy practice identified included pharmacists' lack of confidence, shortage of pharmacy staff, underutilisation of pharmacy technicians, lack of specialisation and clinical career structure, medical dominance and opposition and lack of policies that support clinical pharmacy practice. Several years after its introduction, clinical pharmacy practice is yet to be fully developed in Nigerian hospitals. The barriers identified in this study need to be addressed in order for clinical pharmacy practice to flourish.

Identification of knowledge deficits of pharmacy students at the beginning of the fifth year of pharmacy practice experience: Proposals to change the content of academic programs

In France, community pharmacy students performed a hospital pharmacy practice experience during the 5th year of the university curriculum. The purpose of a part of the content of the academic teaching program delivered before this practice experience is to prepare the students for their future hospital activities. It should enable them for the practical use of knowledge in order to improve pharmacotherapy, laboratory diagnosis and monitoring of patients' care. The aim of this study was to show if there are gaps in this program. Fourteen students performing their clerkship in a teaching hospital were invited to highlight these gaps when they were gradually immersed in the pharmaceutical care. They did so under the careful observation of hospital pharmacist preceptors. These practitioners referred to professional guidelines, documentary tools used in daily clinical practice and publications supporting their pharmaceutical care practices. Shortcomings and gaps identified were: how to communicate with other healthcare professionals and the content of verbal exchanges, how to conduct a patient-centered consultation, documentation tools required for relevant pharmacist' interventions, codification of pharmacist's interventions, risks related to drug packaging and benefit risk assessment of health information technologies. These gaps represent a handicap by delaying the process that led to move from student to healthcare professional. Hospital pharmacist preceptors have to fill in these gaps before engaging students in pharmaceutical care. These results invite to revise partly the content of the academic teaching program delivered before the 5th year hospital pharmacy practice experience.

EAHP European Statements baseline survey 2015: results

ObjectivesThe European Statements baseline survey was designed to give an insight to how well the European Statements of Hospital Pharmacy (the Statements) are being implemented and to help inform the...

EAHP European Statements baseline survey 2015: methodology

The European Statements of Hospital Pharmacy are a set of hospital pharmacy practice standards published by the European Association of Hospital Pharmacists (EAHP) for European health systems to ensure safe,...

Construction and practice on rational medication model of Chinese patent medicine for orthopedics based on ″symdrome-dosage-toxicity differentiation″ theory

Chinese patent medicines for orthopedics are among the hotspot and difficulty in the rational medication of traditional Chinese medicine (TCM), because they mostly contain toxic medicinal herbs and oriented to special patients. According to the hospital pharmacy practices and the therapeutic theories of TCM, this paper focused on a novel model of rational drug use of Chinese patent medicine for orthopedics based on the principles of ″syndrome-dosage-toxicity differentiation″. We also proposed relevant specifications for guiding their clinical use. Firstly, we proposed a list of the primary clinical application characteristics for rational drug use of orthopedic TCMs, including the syndromes of patient, the dosage of medicine and the toxic ingredients in medicine. Secondly, a database was established for recording the package inserts of all of the 81 orthopedic patent medicines in our hospital, and 2 000 retrospective recipes were analyzed for looking for the high-frequency medicines and common irrational factors. Then clinical case reports involving the adverse reactions and side effects of related drugs were searched from CNKI, VIP and WanFang databases. Then the key information for rational application of each medicine was extracted from these resources and some survey questionnaires. Finally, we established a guide named instructions for clinical use of orthopedic Chinese patient medicines (ICUOCPM) after the discusstion with experts. According to the effect after the practice in hospital for 2 months, the proposed principles of ″syndrome-dosage-toxicity differentiation″ in this paper were believed to be the core elements and the most important clinical monitoring points in TCM for orthopedic patents. It would provide innovative ideas, theoretical guarantee and data support for the development of TCM clinical pharmacy.

Clinical and conventional pharmacy services in Polish hospitals: a national survey.

Background Pharmacist-led care services within the hospital pharmacy setting have a significant impact on efficient drug management processes. The work of pharmacists is directly associated with the provision of drugs and medical supplies along with additional clinical, administrative, organizational and educational duties. Depending on the country, these practice roles may differ to a significant extent. Objective The aim of this research was to explore the role of the hospital pharmacist and the provision of both clinical and traditional pharmaceutical services for patients and medical staff in Polish general hospitals. Setting Hospital pharmacies from all general hospitals in Poland. Method A cross-sectional study was conducted, utilizing an anonymous questionnaire as the research instrument. Heads of hospital pharmacies were requested to participate in this study and complete the questionnaire. The survey was initially piloted to improve the research method. Main outcome measure The types of pharmaceutical services performed in Polish general hospitals. Results 166 hospital pharmacies took part in this survey. The overall response rate was 60.8 %. The total number of full-time equivalent (FTE) professionals employed within the surveyed hospital pharmacies was approximately 833. The procurement and distribution of drugs were identified as pharmaceutical services performed by most of the participants. The significant majority of pharmacists were also involved in compounding, adverse drug reaction monitoring and rational drug management services. Eleven (7 %) of the responding pharmacists had direct contact with patients and 7 (4 %) pharmacists took part in ward rounds. More precise legal regulations regarding hospital pharmacy practice were measures indicated by most pharmacists as necessary changes required in the hospital pharmacy system. Conclusion Polish hospital pharmacists provide various pharmaceutical services. Their work is closely related with direct provision of drugs. There is an observed inadequate level of clinical services provided in comparison to clinical settings in other countries.Electronic supplementary materialThe online version of this article (doi:10.1007/s11096-015-0234-9) contains supplementary material, which is available to authorized users.

Clinical pharmacy practice in Egyptian hospitals.

The profession of pharmacy has undergone many changes in recent years, and clinical practice has emerged as an important area for pharmacists in healthcare settings.[1][1]–[3][2] Clinical pharmacy practice emerged in the United States in the 1960s.[4][3] In the United Kingdom, clinical pharmacy

Pharmacy Practices and Technologies: Evidence for Effectiveness and Adoption into Canadian Hospital Pharmacy Practice

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Narrative review: status of key performance indicators in contemporary hospital pharmacy practice

AbstractAimThe aim of this review was to explore the status of key performance indicators (KPIs) in Australian hospital pharmacy practice.Data sourcesFor this narrative review, databases (MEDLINE, PubMed and EBSCO) were searched for relevant publications within the period from April 1980 to April 2014 using the following search terms: hospital pharmacy, key performance indicators, performance measures, clinical indicators and benchmarking. The inclusion criteria were as follows: full text papers (papers only available as abstracts were discarded) and English language. Reference lists of selected papers were also searched to identify additional literature.ResultsWhile there are established competencies, standards and quality use of medicines (QUM) indicators for hospital pharmacy in Australia, there are no standardised KPIs relating to the performance and practice of hospital pharmacy. International research has demonstrated that KPIs are valuable tools for measuring pharmacy performance; the need for KPIs is highlighted in research from the UK, USA, Canada, New Zealand and Australia. Particular challenges associated with KPI implementation include: the need for relevance to all stakeholders; difficulties in measuring pharmacists’ activities due to the inherent nature of their work; lack of resources for data collection; limited understanding of KPIs; and negative attitudes toward KPIs by some pharmacists.ConclusionBefore nationally standardised KPIs are introduced into Australian hospital pharmacy practice, attention must be paid to developing relevant measures through careful consultation with all relevant stakeholders, including pharmacists themselves. KPIs should provide relevant results, be easy to measure and highlight the value of hospital pharmacy services in a resource‐friendly manner.

FIP Hospital Pharmacy Section releases new version of Basel Statements

The Hospital Pharmacy Section of the International Pharmaceutical Federation (FIP) on September 10 released the newest version of statements describing the future of hospital pharmacy practice. In revising the Basel Statements on the future of hospital pharmacy, said Section President Marianne F.

Pharmacy students’ knowledge and perceptions of adverse drug reactions and reporting

Adverse Drug Reactions (ADRs) have medical as well as economic consequences, leading to increased patient morbidity and mortality. Under reporting of ADRs is a huge health problem globally. Malaysia like many other countries worldwide uses spontaneous reporting systems as a means of collecting data on suspected adverse drug reactions. However, compared to other countries, which use the system, the reporting rate in Malaysia is very low. The aim of this study is to evaluate the knowledge and perception of pharmacy students at Management and Science University, Selangor, Malaysia in pharmacovigilance system and ADR reporting. This was a descriptive cross-sectional study. Pharmacy students have high understanding and are knowledgeable about the ADR reporting process and the current pharmacovigilance system. However, skill on reporting ADR is poor among pharmacy students and promoting on ADR reporting is also poor in Malaysia. Pharmacy curriculum should include skill related topics related to the methods of detecting, preventing, and reporting ADRs. Competency in the skill of ADRs reporting may be assessed by using of an Objective Structured Clinical Examination (OSCE). Policy makers and responsible government bodies should take initiatives to promote ADR reporting among health professionals, including pharmacists, in order to improve the reporting system. Interactive interventional programs could be conducted among pharmacists to improve and promote spontaneous reporting of ADRs both in the hospital and community pharmacy practice settings.

A clinical audit of sterile medical devices: a French experience of quality and safety improvement in hospital services

ObjectivesTo audit the quality and safe management of sterile medical devices (SMDs), to examine the pharmacist's role in a multidisciplinary team, and to provide an example of hospital staff assessment...