Hospital Pharmacy Staff Research Articles

Improving the impact of pharmacy interventions in hospitals

The clinical and pharmaceutical interventions of pharmacy professionals are considered impactful inputs towards optimised patient care and safety, by rationalising prescriptions, enhancing therapeutic choices and reducing and preventing medication errors...

Application of the COM-B model to explore barriers and facilitators to participation in research by hospital pharmacists and pharmacy technicians: A cross-sectional mixed-methods survey

BackgroundCombining research and clinical practice is crucial for advancing evidence-based healthcare and improving pharmacy service delivery. While hospital pharmacists report significant interest in research, this does not translate to high levels of research engagement. Furthermore, little is known regarding barriers and motivators for pharmacy technician involvement in research. ObjectiveTo characterise the barriers and enablers to engaging in practice-based research reported by hospital pharmacy staff using the Capability, Opportunity, Motivation - Behaviour (COM-B) framework. MethodsAn online cross-sectional survey, using the validated Research Capacity in Context tool, was sent to all employees of a statewide hospital pharmacy service. Respondent characteristics and quantitatively reported barriers and motivators were analysed using descriptive statistics. Qualitative data from open text responses were analysed through inductive thematic analysis. Results were mapped to the components of the COM-B framework at individual, team and organisation levels. Results278 responses were received (response rate 43.3%) from pharmacists (68.0%) and pharmacy assistants/technicians (28.4%) across 19 hospitals. Research behaviour was influenced by factors linked to five of six COM-B subdomains. Reflective motivation, linked to a desire to improve practice and patient care, self-development, and recognition, indicates pharmacy staff would like to engage in research. However, barriers related to physical opportunity (lack of time for research, other work roles that take priority) and psychological capability (lack of skills and mentorship) hindered involvement. Social opportunity and automatic motivation, tied to managerial support, role perceptions and departmental research culture were also reported facilitators. Subtle differences in the factors that motivate hospital pharmacists and pharmacy technicians were identified. ConclusionsMapping factors associated with research participation by hospital pharmacy staff to the COM-B model is an important step towards identifying evidence-based intervention types that could form the basis of strategies to optimise hospital pharmacy staff engagement with practice-based research, using the behaviour change wheel.

Medication supply at hospital discharge via community pharmacy: a quality improvement study.

Patient delays at the point of their discharge account for more than half a million additional bed days every year in Scotland, United Kingdom. Bottlenecks in discharge medication dispensing contribute to such delays. To test whether the discharge process could be made more time-efficient by utilising community pharmacy supply of medicines on the day of discharge, rather than hospital pharmacy supply. Glasgow Royal Infirmary, Scotland. Local community pharmacy staff received training and communication about each patient discharge. Pharmacies could access an immediate discharge letter (IDL) on a shared electronic record. The existing pandemic law allowed medication dispensing from this IDL, without a prescription. The programme was implemented from June to November 2020, across three Plan-Do-Study-Act (PDSA) cycles. Comparisons were made between the new community pharmacy model and standard hospital model. Across three PDSA cycles, in total 335 patients had community pharmacy supply compared to 376 patients eligible for hospital pharmacy supply. The median time taken from creation of the IDL to final completion was significantly lower in the new community pharmacy model compared to the hospital pharmacy model; 154min (interquartile range (IQR) 82-272min) vs 296min (IQR 197-1281min) p value < 0.000 CONCLUSION: A community pharmacy supply model compared to a standard hospital pharmacy model resulted in a median time saving of 142min per patient. Such a time saving has the potential to deliver a transformational change in patient flow and free up hospital pharmacy staff to deliver other clinical interventions.

Exploring the implementation of Discharge Medicines Review referrals by hospital pharmacy professionals: A qualitative study using the consolidated framework for implementation research

BackgroundThe Discharge Medicines Review (DMR) is a community pharmacy service in Wales that aims to reduce medicines-related harm after care transitions, including hospital discharge. To undertake a DMR, the Community Pharmacist must receive a patient's discharge medicines information, either electronically, by fax or presented by the patient. Although the DMR has evidenced benefits for improving patient safety, its evaluation showed inconsistent uptake, which Community Pharmacists partially attributed to hospitals not providing the necessary information. ObjectiveAiming to develop recommendations to improve hospital engagement to DMR referrals, this study explores hospital pharmacy professionals' views of the service. MethodsQualitative focus groups, using hermeneutic phenomenology, were conducted in 16 hospitals across Wales, using a quota sampling method to include 61 Pharmacists and 31 Pharmacy Technicians. To understand the suboptimal engagement to DMR referrals, framework analysis was undertaken using the Consolidated Framework for Implementation Research (CFIR). ResultsThe data were mapped onto all five CFIR domains, each containing barriers and facilitators to engagement with DMR referrals and suggestions for improvement. Only one hospital had successfully implemented DMR referrals, with many participants lacking any knowledge of the service or how to refer to it. Specific barriers included a clear absence of processes to implement referrals and engage hospital pharmacy professionals. A considerable barrier was many participants' perceptions that Community Pharmacist roles were less clinically orientated and patient-centred than their own, viewing them almost as a different profession.Participants believed that local champions for DMR referrals could promote engagement and integrate them into the workflow of hospital pharmacy professionals. Further recommendations to improve engagement was staff training for DMRs and regular feedback of its value. ConclusionPolicymakers may use the findings and recommendations from this study to promote hospital pharmacy staff engagement to similar community pharmacy services like the Discharge Medicines Service in England.

Qualitative investigation of barriers to providing an electronic hospital to community pharmacy referral service for discharged patients.

There has been a sustained interest in transfer of care (ToC) services, from hospital to home, in the past twenty years. In England, an electronic referral (e-referral) service from hospital to community pharmacy has been provided since 2014. However, to date, there has been little information about service implementation and delivery. This study investigates the barriers to this referral process in hospital and community pharmacy settings, and barriers to providing subsequent community pharmacy interventions from the perspectives of the service leaders (SLs), hospital pharmacy staff (HPS) and community pharmacists (CPs). Semi-structured face-to-face or telephone interviews were conducted with the key informants from two tertiary hospitals and nine pharmacies. The Consolidated Framework for Implementation Research (CFIR) tool informed the data collection tools and data analysis. A total of three SLs, ten HPS and nine CPs were interviewed. Data analysis identified various barriers to the provision of the e-referral service. Some were related to (1) patient engagement, e.g., patients' awareness/acceptance of the service, (2) the SLs and other National Health Service hospitals, e.g., lack of monitoring of the service progress, (3) the HPS, e.g., resource limitations, or (4) the CPs, e.g., lack of understanding/appreciation of the service. In-depth understanding of barriers related to the provision of e-referral service are essential to drive improvement and facilitate wider diffusion and adoption. The use of implementation science and behaviour change model as a lens to assess this service enables the identification of certain behaviours that can be modified to produce the required change to drive better implementation and delivery.

The effect of structured medication review followed by face-to-face feedback to prescribers on adverse drug events recognition and prevention in older inpatients – a multicenter interrupted time series study

BackgroundThe effectiveness of interventions to improve medication safety in older inpatients is unclear, given a paucity of properly designed intervention studies applying clinically relevant endpoints such as hospital-acquired preventable Adverse Drug Events (pADEs) and unrecognized Adverse Drug Events (uADEs). Therefore, we conducted a quality improvement study and used hospital-acquired pADEs and uADEs as main outcomes to assess the effect of an intervention aimed to improve medication safety in older inpatients.MethodThe study followed an interrupted time series design and consisted of three equally spaced sampling points during baseline and during intervention measurements. Each sampling point included between 80 to 90 patients. A total of 500 inpatients ≥65 years and admitted to internal medicine wards of three Dutch hospitals were included. An expert team retrospectively identified and assessed ADEs via a structured patient chart review. The findings from baseline measurement and meetings with the internal medicine and hospital pharmacy staff were used to design the intervention. The intervention consisted of a structured medication review by hospital pharmacists, followed by face-to-face feedback to prescribers, on average 3 days per week.ResultsThe rate of hospital-acquired pADEs per 100 hospitalizations was reduced by 50.6% (difference 16.8, 95% confidence interval (CI): 9.0 to 24.6, P < 0.001), serious hospital-acquired pADEs by 62.7% (difference 12.8, 95% CI: 6.4 to 19.2, P < 0.001), and uADEs by 51.8% (difference 11.2, 95% CI: 4.4 to 18.0, P < 0.001). Additional analyses confirmed the robustness of the intervention effect, but residual bias cannot be excluded.ConclusionsThe intervention significantly decreased the overall and serious hospital-acquired pADE occurrence in older inpatients, and significantly improved overall ADE recognition by prescribers.Trial registrationInternational Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN64974377, registration date (date assigned): 07/02/2011.

Investigational medicinal products, related costs and hospital pharmacy services for investigator-initiated trials: A mixed-methods study.

Conducting high quality investigator-initiated trials (IITs) is challenging and costly. The costs of investigational medicinal products (IMPs) in IITs and the role of hospital pharmacies in the planning of IITs are unclear. We conducted a mixed-methods study to compare planned and actual costs of IMPs in Swiss IITs, to examine potential reasons for differences, and to gather stakeholder views about hospital services for IITs. We included all IITs with IMP services from the Basel hospital pharmacy invoiced between January 2014 and June 2020 (n = 24). We documented trial and IMP characteristics including planned and actual IMP costs. Our working definition for a substantial cost difference was that the actual IMP costs were more than 10% higher than the planned IMP costs in a trial. We conducted semi-structured interviews with investigators, clinical trials unit and hospital pharmacy staff, and qualitatively analyzed transcribed interviews. For 13 IITs we observed no differences between planned and actual costs of IMPs (median, 11'000 US$; interquartile range [IQR], 8'882-16'302 US$), but for 11 IITs we found cost increases from a median of 11'000 US$ (IQR, 8'922-36'166 US$) to a median over 28'000 US$ (IQR, 13'004-49'777 US$). All multicenter trials and 10 of 11 IITs with patients experienced substantial cost differences. From the interviews we identified four main themes: 1) Patient recruitment and organizational problems were identified as main reasons for cost differences, 2) higher actual IMP costs were bearable for most investigators, 3) IMP services for IITs were not a priority for the hospital pharmacy, and 4) closer collaboration between clinical trial unit and hospital pharmacy staff, and sufficient staff for IITs at the hospital pharmacy could improve IMP services. Multicenter IITs enrolling patients are particularly at risk for higher IMP costs than planned. These trials are more difficult to plan and logistically challenging, which leads to delays and expiring IMP shelf-lives. IMP services of hospital pharmacies are important for IITs in Switzerland, but need to be further developed.

Bespoke rulers invented by hospital pharmacy staff led to 35% reduction in loss of controlled liquid drugs

A ruler-type device for measuring the volume of controlled drug liquids, invented by two hospital pharmacy staff, reduced the loss of drug volume by 35% during a one-year pilot at Northampton General Hospital NHS Trust. The ruler was developed by Rosemary Griffiths, a registered pharmacy technician and former dispensary manager at the trust, and Siobhan […]

Hospital pharmacy staff absences soar as COVID-19 cases rise

Some hospital pharmacy teams in England are facing absence rates of up to 30% and there is a danger that some services may have to be withdrawn if absence rates go any higher, chief pharmacists have told The Pharmaceutical Journal. The warning comes after the UK reported a record number of 218,724 COVID-19 cases on […]

576 Audit of Instillation of Intravesical Mitomycin-C Following Transurethral Resection for Bladder Tumour

Abstract Aim The administration of intravesical chemotherapy (IVCT) following transurethral resection of bladder tumour (TURBT) has been shown to decrease the risk of recurrence and is recommended as standard practice following TURBT for new &amp; recurrent tumours. Our aim was to evaluate the adherence to this guideline in our trust and if needed, to implement changes in order to improve the patient care. Method A retrospective analysis of 25 patients was done and details regarding the time interval between administration, demographic details and disease staging was collected. NICE guidelines were later implemented, and the data was recollected for 24 patients who underwent TURBT Results The analysis showed that the mean time between the end point of TURBT and instillation of Intravesicular Mitomycin-C was 7.66 hours. Thereafter, we tried to implement the guidelines by improving communication between the Theatre staff, Nursing staff and the pharmacy. The data was collected for re-audit for 24 patients and it was observed that the interval between surgery and Mitomycin administration had dropped down to 4.67 hours. The 3rd cycle of the audit revealed the interval dropping down further to 4.24hours.The 24hr administration rate was &amp;gt;90%, which was much higher than previous year audits Conclusions Engagement with theatre team and pharmacy is required, in order to coordinate the delivery of the IVCT to theatre for administration at the time of surgery. If everyone (hospital pharmacy and theatre staff) is supportive, patients’ quality of care can be improved by following the standardised protocol.

Reducing medication‐related harm through the adoption of technology

Reducing medication‐related harm through the adoption of technology

A mixed-method study of community pharmacy staff's use, perceptions and acceptance of barcode scanning technology: Pharmacy's experience of scanning technology

IntroductionIncreasing technology is a strategic goal within pharmacy to facilitate medicines’ dispensing. Barcode scanning technology (BST) is considered low cost and reliable with potential safety benefits. A barrier to BST implementation within hospital pharmacy includes staff resistance; however, few studies explore BST within community pharmacy. To address this, pharmacy staff's use, perceptions and acceptance of BST within Scottish community pharmacies were examined. MethodsCommunity pharmacies within Scotland using BST to scan medicines were identified using Twitter, eNewsletters and snowball sampling; 57 pharmacies were identified. Between May-Aug 2019, managers/owners participated in semi-structured interviews to explore BST use, and staff operating BST completed an online questionnaire to examine perceptions and acceptance. Interview data underwent content analysis and questionnaire data presented as medians (IQR). ResultsBST was used for various purposes, most commonly for dispensed item verification (n = 43 pharmacies) and to identify falsified medicines (n = 10 pharmacies). Twenty pharmacy managers/owners were interviewed which revealed multiple scanners and BST functionalities. Thirty-five participants from 16 pharmacies participated in the questionnaire. Staff considered BST as easy to use. There were positive perceptions and acceptance of BST for dispensed item verification, and negative perceptions and less acceptance of BST for identifying falsified medicines. DiscussionBST implementation was identified in a minority of Scotland's 1,254 community pharmacies, and greater effort may be needed to increase technology utilisation. The variation of BST use may affect safety due to increased complexity. BST's purpose may underpin staff perceptions and acceptance. Future studies should explore barriers and observe BST use in practice. Public interest summaryBarcode scanning technology (BST) may help pharmacy staff to dispense medicines safely. Hospital pharmacy staff have reported disliking using BST to scan medicines; however, no similar research has been carried out within community pharmacy. This study examined Scottish community pharmacies’ use of BST to scan medicines, and the pharmacy staff's views. Fifty-seven pharmacies were identified. BST was most commonly used to verify that the correct medicine was selected during dispensing (n = 43 pharmacies) and to identify ‘falsified medicines’ which were not safe to dispense (n = 10 pharmacies). Staff considered BST as easy to use, but were more positive and accepting of BST for verifying the correct medicine than for identifying falsified medicines. This suggests BST's purpose may underpin pharmacy staff perceptions and acceptance. A small number of pharmacies in Scotland used BST for this purpose, therefore more efforts may be needed to promote technology use.

Adopting a systems thinking approach to investigate the implementation and provision of a pharmacist-led post-discharge domiciliary medicines review service.

Intervention planners need to be sufficiently cognisant of the health system landscape to facilitate embedding, adoption and diffusion of new services. Pharmacist-led transfer of care initiatives from hospital to community have been developed to address a health system flaw: patient hospital readmissions. A hospital in England partnered with a chain of community pharmacies establishing a domiciliary pharmacist medicines use review service (DMRS) for discharged patients to reduce hospital readmissions. We adopt a systems thinking approach to understand the adoption and diffusion of the service by investigating the perceptions of hospital and community pharmacy staff. The experience of a role swap between these settings is investigated to probe further system factors influencing service provision. Semi-structured interviews informed by a conceptual model for the diffusion, dissemination and implementation of innovations, were conducted with hospital and community pharmacy staff between Oct-Dec 2016. Interviews were audio-recorded with consent, transcribed verbatim and a combination of inductive and deductive thematic analysis was used. Four each of hospital and community pharmacy staff were interviewed and four hospital staff were interviewed after the role swap. Staff indicated barriers and facilitators thematically related to organisational and individual-level components of a conceptual model about service diffusion and implementation. The role swap appeared to address the lack of a feedback loop, which was limiting engagement of hospital staff. The role swap led to improved trust and shared goals between the healthcare sectors and increased appreciation and self-efficacy of the hospital staff role. A systems thinking lens offered the opportunity to investigate the wider healthcare system within which the DMRS was being provided. The role swap aligned to the principles of participatory design of an intervention to facilitate successful adoption and diffusion and contribute to more insightful evaluation about the process and context of service implementation.

Healthcare workers’ perspectives on participatory system dynamics modelling and simulation: designing safe and efficient hospital pharmacy dispensing systems together

With increasingly complex safety-critical systems like healthcare being developed and managed, there is a need for a tool that permits decision-makers to better understand the complexity, test various strategies and guide effective changes. System Dynamics (SD) modelling is an effective approach that can aid strategic decision-making in healthcare systems but has been underutilised partly due to the challenge of engaging healthcare stakeholders in the modelling process. This paper, therefore, investigates the applicability of a participatory SD approach based on healthcare workers’ perspectives on ease of use (usability) and usefulness (utility). The study developed an interactive simulation dashboard platform which facilitated participatory simulation for exploring various hospital pharmacy staffing level arrangements and their impacts on interruptions, fatigue, workload, rework, productivity and safety. The findings reveal that participatory SD approach can enhance team learning by converging on a shared mental model, aid decision-making and identifying trade-offs. The implications of these findings are discussed as well as experience and lessons learned on modelling facilitation. Practitioner Summary: This paper reports the perspectives of healthcare workers, who were engaged with a participatory system dynamics modelling and simulation process for hospital pharmacy staffing level management. Evaluative feedback revealed that the participatory SD approach can be a valuable tool for participatory ergonomics by helping the participants gain a deeper understanding of the complex dynamic interactions between workload, rework, safety and efficiency. Abbreviations: SD: system dynamics; ETTO: efficiency-thoroughness trade-off

Using the Systems Engineering Initiative for Patient Safety (SEIPS) model to describe critical care nursing during the SARS-CoV-2 pandemic (2020).

Using the Systems Engineering Initiative for Patient Safety (SEIPS) model to describe critical care nursing during the SARS-CoV-2 pandemic (2020).

Factors influencing acceptance of robotics in hospital pharmacy: a longitudinal study using the Extended Technology Acceptance Model.

To explore factors influencing hospital pharmacy staff acceptance of a pharmacy robotic dispensing system during implementation and over time. A single centred, prospective, longitudinal cohort quantitative study was conducted in an Australian tertiary public hospital using the Extended Technology Acceptance Model (ETAM). Staff were surveyed during the implementation of a pharmacy dispensing robot (May 2016) and again after working with the system for fifteen months (August 2017). Fishers exact test and correlation analysis of paired responses were used to identify significant factors influencing use of the system between the two time points. Sixty four respondents completed surveys during implementation (n=64) and 34-paired surveys were collected fifteen months later. Respondents were predominantly young, female with a tertiary qualification. Initial perceptions did not change over time, with the exception of reliability. Departmental leaders had greatest influence on technology acceptance during implementation and over time. Other key factors correlating with acceptance included: how useful the robot was perceived to be; ease of use and how relevant the robot was for an individual role. Higher levels of education had a negative association with usage during implementation and age was not a factor. This study identified critical insights influencing staff acceptance of pharmacy robots that will help inform future implementation. The influence of pharmacy leaders emerged as key influence on technology acceptance. Leveraging on this influence a communication strategy prior to implementation should include information on useful functions and known benefits of the system customised for individual roles.

Arabic Version of Learning Organization Survey Short-Form: Hospital Pharmacy Settings.

Objective: The objective of this study was to assess the psychometric properties of a translated Arabic version of the Learning Organization Survey (LOS-27) and to use this to evaluate staff perceptions about the organizational learning process in Kuwaiti hospital pharmacies. Setting: This study adopted a cross-sectional survey of the pharmacy employees in 6 hospital pharmacies in Kuwait. Results: The results indicated that the internal consistency of all composites was more than 0.7, except for one. All item loadings for the construct measurements were above 0.7. The standardized root mean square residual (SRMR) score showed a good fit with a value of 0.08. The intercorrelation among composites ranged from 0.34 to 0.68. Conclusions: The results indicate that the Arabic translation of the LOS-27 questionnaire has adequate levels of reliability and validity in comparison with the original US survey results. The overall average positive rate of composites was 64%. Therefore, the findings suggest that the hospital pharmacy staff surveyed in Kuwait were moderately positive in their perceptions about organizational learning in their organizations.

Pharmacy Interweaving Safety Within Hospital Health Information Technology.

Research on the impact of hospital technology on medication safety usually focuses on prescribing and administration. Less is known about the pharmacy-related processes of reviewing, ordering and dispensing medications and how technology supports this work. We carried out a qualitative exploratory study of a hospital in England (UK) with the aim of gaining insight into processes of digitalisation. We found that hospital pharmacy staff perform safety work with technology aiming to prevent harm, such as 'scaffolding' people's thinking processes, or linking-up unintegrated systems. Their work seems to 'interweave' safety in between others' medication activities, but they do so sometimes struggling with technological deficiencies.

Annals for Educators - 5 March 2019.

Annals for Educators - 5 March 2019.

Knowledge and Attitudes of Hospital Pharmacy Staff in Canada Regarding Medical Assistance in Dying (MAiD)

In February 2015, the Supreme Court of Canada ruled that it was unconstitutional to prohibit physicians from assisting in a patient's consensual death, thereby setting the groundwork for the legalization of medical assistance in dying (MAiD). Much of the research on this topic has focused on physicians, although other health care professionals will be involved in the process, including pharmacists, pharmacy technicians, and pharmacy assistants. In many provinces, the medications required for MAiD will be dispensed from hospital pharmacies, which will result in direct involvement of hospital pharmacy staff. The primary objective was to investigate the knowledge and attitudes of hospital pharmacy staff in Canada regarding MAiD. The secondary objective was to determine the factors that might influence those opinions. A 34-question web-based survey was available for 6 weeks during early 2017 to hospital pharmacy staff throughout Canada. For most questions, responses were based on a 5-point Likert scale, ranging from "strongly agree" to "strongly disagree". Descriptive and inferential statistics were used to analyze the data. A total of 1040 valid survey responses were received: 607 from pharmacists, 273 from pharmacy technicians, and 160 from pharmacy assistants. Most respondents were supportive of MAiD; however, nearly all respondents (99% [601/607] of pharmacists, 73% [315/431] of technicians and assistants]) reported lacking comprehensive education on the topic. Despite high levels of overall support, pharmacists tended to be less supportive of MAiD than pharmacy technicians or assistants. Factors that influenced opinions included strong religious beliefs, region, and knowledge of provincial and federal legislation. The majority of respondents, particularly technicians and assistants, were supportive of MAiD, but most respondents lacked education about the topic.