Hospital Pharmacy Department Research Articles

Response from Authors: a benchmarking scoping review of research output from hospital pharmacy departments in Australia

To the Editor, We thank Elliott et al.1 and Misko et al.2 for their feedback on our recent scoping review.3 They both provided valuable feedback for future benchmarking studies. We acknowledge that these limitations may impact state or territory-based benchmarking but reinforce that the national benchmarking offered by our paper appears useful for such sites to compare against. Amy Page is an Editorial Board member of the Journal of Pharmacy Practice and Research and a co-author of this article. To minimise bias, she was excluded from all editorial decision-making related to the acceptance of this article for publication. All listed authors comply with the Journal's authorship policy. No ethics approval was required for this letter to the editor. Data sharing is not applicable to this letter to the editor.

In response: A benchmarking scoping review of research output from hospital pharmacy departments in Australia

In response: A benchmarking scoping review of research output from hospital pharmacy departments in Australia

Scoping research output from tertiary hospital pharmacy departments: suggestions for improvement

Scoping research output from tertiary hospital pharmacy departments: suggestions for improvement

Views of Pharmacists and Government Representatives Toward the Pilot Chief Pharmacist System in Chinese Hospitals: A Multicenter Exploratory Qualitative Study

BackgroundIn China, the pharmacy departments of most hospitals have changed their main focus from drug procurement and distribution to providing pharmaceutical care services. Various regions of China have successively implemented the pilot Chief Pharmacist System (CPS) to help improve pharmaceutical care services and rational drug use in hospitals. This study was designed to explore the perspectives of pharmacists and government officials on CPS, including the advantages and barriers to the successful implementation of CPS.MethodsA qualitative study, based on semi-structured interviews, was conducted from October 1, 2018 to March 1, 2019. The interview data were gathered from 18 pharmacy staff and government representatives working in five distinct regions of China using purposive sampling. A thematic analysis approach and NVivo version 12 Plus was utilized to code and analysis of all interviews.ResultsFive broad themes were identified: the role of the chief pharmacist; their attitudes toward the CPS; the advantages and results of the CPS; the barriers toward CPS; and their suggestions toward CPS. Most of the participants believed that the chief pharmacist played a vital role in a hospital. Under CPS, the hospital pharmacy department pays more attention to prescription review, medication monitoring, and pharmaceutical consultation. However, an insufficient number of pharmacy personnel, unclear authority, and inadequate salaries were the main barriers to the implementation of the CPS.ConclusionThe attitudes of most of the participants were found to be positive toward CPS in China. The CPS can enhance the prestige of the hospital pharmacy department, improve the quality of hospital pharmaceutical care services, and promote rational drug use. Nevertheless, certain barriers highlighted in this study should be addressed promptly.

Drug Reconciliation Program as a Patient Safety Initiative in a Specialty Hospital in the Southeastern Region of Brazil: A Study Protocol

A common problem observed in patient safety is the lack of accurate and complete information about medications in regular use during transfers of care between different health facilities. In view of this, medication reconciliation is postulated as a barrier to reducing medication discrepancies and consequently medication errors. This project aims to evaluate the implementation of safe clinical practices conducted by clinical pharmacists. To this end, we will conduct a standardized process to obtain the best possible medication history (BPMH); assessment of the patient's level of understanding of pre-admission therapy; quantification, classification and analysis of discrepancies of unintentional drugs at hospital admission; effect of interventions conducted by clinical pharmacists and impact on patient safety. This prospective, pilot, descriptive, interventional and single-center study will be carried out in the Clinical Pharmacy Department of a large hospital in the state of São Paulo. In order to standardize the process of data collection and reconciliation of prescription drugs, the interview with the patient will be carried out using an adapted and modified form. After collecting information in the structured interview, clinical pharmacists will identify, analyze and classify possible discrepancies. All unintentional discrepancies found without any clinical justification will be considered medication errors. Finally, the degree of impact of each drug discrepancy will be defined as: clinically insignificant; clinically significant; serious and life-threatening.

A benchmarking scoping review of research output from hospital pharmacy departments in Australia

AbstractAimTo benchmark annual research output from hospital pharmacy departments in Australian principal referral hospitals.Data sourcesEmbase, Medline, and Scopus.Study selectionAll 29 principal referral hospitals listed by the Australian Institute of Health and Welfare were searched using the institution field from 2018–2020. Articles were included if an author was affiliated with a hospital pharmacy department. Conference abstracts, letters, narrative reviews, opinions, commentaries, or editorials were excluded.ResultsA total of 261 research articles were identified from 27 principal referral hospital pharmacy departments from 2018–2020. Median research output over 3 years was five (interquartile range, 3–9) articles. In terms of annual research, hospital pharmacy departments in the 50th and 90th percentile for total publication output published two and ten original research articles every year, respectively. Overall, 56% (n = 145) of the published studies were observational, 35% (n = 90) had a first author with a pharmacy department affiliation, 97% (n = 252) had at least one author with a university affiliation, and in 5% (n = 12) of the articles there was more than one hospital pharmacy department affiliation.ConclusionOn average, hospital pharmacy departments in Australian principal referral hospitals publish two original research articles every year. Nearly all of these articles are published in collaborations with universities.

Reasons for Low Regulatory Body Discipline Rates for Canadian Hospital Pharmacists.

Past research on disciplinary action by pharmacist regulatory bodies has shown that most cases concern community pharmacists, with few occurring in a hospital setting. To investigate how discipline-related issues involving pharmacists are dealt with by hospital pharmacy departments in Canada. Hospital pharmacy directors and managers from small, medium, and large hospitals across Canada were invited to participate in semi-structured telephone interviews. The interview questions focused on the discipline process in participants' organizations, the situations when reporting to the regulatory body is deemed to be warranted, possible penalties, and recommendations for improving the regulatory body or organizational discipline process. Ten participants, from British Columbia, Saskatchewan, Ontario, New Brunswick, Prince Edward Island, and Newfoundland and Labrador, agreed to be interviewed. Five key themes emerged as contributing to lower rates of hospital pharmacist discipline cases being escalated to the regulatory college level: robust organizational discipline processes independent from the regulatory college, a practice environment promoting competence, union representation, preference for a remedial approach to discipline, and lack of clarity about when to report to the regulatory authority. This study identified a number of reasons why discipline of hospital pharmacists by a regulatory body may be less prevalent than discipline relating to community pharmacists. The main reasons may be lack of clarity about when to report a case to the regulator and a lack of transparency, given that many cases are handled internally within hospitals. Environmental supports for competence and employee protections (e.g., through a union) may also reduce discipline cases.

Impact of a pharmaceutical intervention on influenza vaccination in patients receiving treatment with biological medicines

ObjectiveThe aims of this study were twofold — to determine the impact of a health education intervention led by a hospital pharmacy department on influenza vaccination take-up in patients diagnosed...

Connecting the dots of care: survey of Australian hospital pharmacy departments regarding current initiatives in place to care for Aboriginal and/or Torres Strait Islander inpatients

AbstractIntroductionThere are limited data describing the role of hospital pharmacists caring for Aboriginal and/or Torres Strait Islander inpatients.ObjectivesTo determine roles of and specific services provided by Australian Hospital pharmacists/Pharmacy Departments in providing medicine management services to Aboriginal and/or Torres Strait Islander people admitted to Australian hospitals. The actual and perceived outcomes will be explored.MethodMixed method (online survey/ telephone semi‐structured interviews). The survey was emailed to all Directors of pharmacy departments listed in The Society of Hospital Pharmacists of Australia Directory (January 2019). Participants were invited for a digital, audio recorded follow‐up telephone interview. Recordings were transcribed verbatim and thematically analysed.ResultsSixty‐nine responses were received from 313 pharmacy departments (RR = 22%), of these, 20 (29%) pharmacists agreed to and underwent a semi‐structured interview. All hospital categories, states and territories were represented: Metropolitan (33, 48%); regional (22, 32%); rural (12, 17%) and remote (2, 3%).Over half (44, 64%) had specific processes for Aboriginal and/or Torres Strait Islander inpatients. Service outcome measurement was low (10, 14%). Survey results and qualitative interviews revealed work is being done under the broad themes: culturally safe care; provision of culturally appropriate medicines information; chronic disease management; continuum of care; managing funding models. Potential outcome measures and future plans were proposed.ConclusionSeveral sites have pharmacy services in place specifically for Aboriginal and/or Torres Strait Islander people admitted to hospital which are not included in the literature; however, outcomes of these services were not routinely assessed. The challenges faced are similar to those cited in international literature, including managing continuity of care issues and working in partnership on projects tailored to the needs of Indigenous peoples. Wider knowledge, evaluation and measurement of the impact of these services on health outcomes and equity is needed and would allow hospital pharmacy teams to better tailor initiatives to meet the needs of Aboriginal and/or Torres Strait Islander people.

Present Situation and Prospect of Clinical Pharmacy in Hospital Pharmacy Department

Present Situation and Prospect of Clinical Pharmacy in Hospital Pharmacy Department

Polypharmacy and the occurrence of potential drug\u2013drug interactions among geriatric patients at the outpatient pharmacy department of a regional hospital in Durban, South Africa

BackgroundPolypharmacy is the administration of an excessive number of medicines and a significant irrational medicine use practice. Little is known about this practice in South Africa. This study aimed to determine the level of polypharmacy and potential drug–drug interactions amongst the geriatric patient population in a facility in South Africa.MethodA cross-sectional retrospective prescription chart review for 250 geriatric patients was conducted at the outpatient pharmacy department of a regional hospital. Variables extracted included demographic information, diagnosis, type of prescriber contact, and polypharmacy. Potential drug–drug interactions were determined with web-based multi-drug interaction checkers.ResultsThe average (SD) number of diagnosed clinical problems was 3.54 ± 1.26, with hypertension, diabetes mellitus, and heart disease occurring most frequently. The level of polypharmacy was high with patients receiving an average (SD) of 12.13 ± 4.25 prescribed medicines from 3032 prescribed medicines. The level of polypharmacy was highest within the age categories, 60–64, and 70–74 years of age, respectively. The level of potential drug–drug interactions was also high with an average (SD) of 10.30 ± 7.48 from 2570 potential drug interactions. The majority of these interactions were moderate (72.5%) and pharmacodynamic (73.2%) by nature of the clinical severity of action and mechanism of action, respectively. Polypharmacy and type of prescriber contact were statistically significant contributors to the occurrence of potential drug–drug interactions, (F (2, 249) = 68.057, p < 0.05). However, in a multivariate analysis of variables to determine the strength of the association, polypharmacy was determined to be the strongest contributor to the occurrence of potential drug–drug interactions (p < 0.05) when compared with the type of prescriber contact (p value = 0.467). Therefore, irrespective of the type of prescriber contact, polypharmacy increases the potential for drug interactions among the sampled patient population.ConclusionA comprehensive consideration of disease management guidelines, patient factors, and rational medicine review could be measurable strategies towards improving medicine use. This would also limit the occurrence of significant drug interactions among the geriatric patient population. A national study is required to determine if differences occur across hospitals and regions.

Medication Wastage in a University Hospital in Japan.

Medication wastage is a global issue; however, there are few reports in Japanese hospitals. The purpose of this study was to clarify the situation of medication wastage at our university hospital. We investigated the numbers, costs, reasons, occurrence departments, and involvement of high-priced medications of medication wastage for two years. We analyzed 6730 cases and the total cost was 22782027 Japanese yen (JPY). The most common reasons for medication wastage were change or discontinuation of medication after preparation and breakage or contamination due to dropping. The highest cost was expired medications. The department with the highest number of cases was the hospital wards; however, the hospital pharmacy department accounted for the majority of the costs and most of the reasons were expired medications. Medication wastage of 50000 JPY or more per case was only 1.3% of the total but accounted for 70.7% of the cost and medication wastage of 100000 JPY or more per case was only 0.7% of the total but accounted for 58.6% of the cost. These findings indicate that expired medications in the hospital pharmacy department have the largest impact on medication wastage from the viewpoint of economic loss, and suggest the need for efforts on medication management focusing on high-priced medications. The challenge of minimizing medication wastage should be addressed from the perspectives of both hospital management and the effective use of resources.

The use of anti-hyperlipidemia in a private hospital in Yogyakarta during 2013-2019

Background: Lipid modifying agents have an important role in the primary and secondary prevention of cardiovascular diseases such as coronary heart disease and stroke. The use of lipid-modifying agents tends to increase along with the increasing prevalence of these diseases. Objectives: To determine the utilization of lipid modifying agents for hospitalized patients in a private hospital in Yogyakarta during the period of 2013 - 2019 in regard to the agents used and their quantity. Methods: The main data for this study were aggregate data on the use of lipid modifying agents for hospitalized patients during 2013-2019 obtained from the hospital pharmacy department. After identification of the names of lipid modifying agents, the quantities of these drugs were then calculated in units of defined daily dose (DDD) and the final quantity was expressed in DDD/100 bed days (BD). The R2 value from linear regression was used to determine the trend of use of individual agents over the period. Results: There were two pharmacological subgroups of lipid modifying agents used during the period of 2013 – 2019 with an average of total quantity of 14.81 DDD/100 BD. Utilization of statins was approximately 90% of the total use, and utilization of fibrates tended to decrease over the period. Individually, simvastatin use decreased significantly over the period (R2 = 0.885), but atorvastatin use continued to increase (R2 = 0.908) with 10-fold increase from 2013 to 2019. Conclusion: The lipid modifying agents used during the period 2013 - 2019 were predominantly statins, and the utilization of atorvastatin increased significantly during this period. Keywords: lipid modifying agents, ATC/DDD, fibrates, statins

Prevalence of and incentives for board certification among hospital pharmacy departments in California.

Board of Pharmacy Specialties (BPS) certification is endorsed to distinguish pharmacists for advanced practice areas, yet perceived value to stakeholders remains poorly described. This study characterized how board certification is integrated in hospital pharmacy departments across California. A prospective, cross-sectional study was conducted in which a survey was administered to all hospital pharmacy directors in California between November 2019 and March 2020. Licensed institutions and corresponding pharmacy directors were identified from the California State Board of Pharmacy. The survey queried for institution and pharmacy director characteristics and if/how board certification was integrated. Multivariable logistic models identified predictors of institutions with at least 25% full-time board certified pharmacists and those that reward board certification. Surveys were completed by 29% of institutions. Most of these institutions were urban (81%) and nonteaching (57%), with fewer than 325 hospital beds (71%), and with fewer than 50 full-time pharmacist positions (86%). The majority reported that less than 25% of their pharmacists were board certified. Currently, 47% consider board certification during hiring and 38% reward board certified employees. Predictors of institutions with 25% or more board certified pharmacists included being a teaching institution (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.24-7.06), having 325 or more beds (OR, 7.17; 95% CI, 2.86-17.97), and having a pharmacy director who was previously or currently board certified (OR, 3.69; 95% CI, 1.46-9.35). Hospitals with 100 or more pharmacist positions predicted institutions that reward board certification (OR, 16.69; 95% CI, 1.78-156.86). Board certification was an employment preference for almost half of the hospital survey respondents in California. Institutions more likely to reward board certified pharmacists are larger, urban, and teaching hospitals and have pharmacy directors who have been board certified.

ASHP Foundation Pharmacy Forecast 2022: Strategic Planning Guidance for Pharmacy Departments in Hospitals and Health Systems.

ASHP Foundation Pharmacy Forecast 2022: Strategic Planning Guidance for Pharmacy Departments in Hospitals and Health Systems.

Optimization of the medication-use process for fentanyl patches at a small community hospital.

To describe a community hospital pharmacy department's novel approach to addressing safe use of fentanyl patches in acute and subacute care patients. Beginning in 2017, improvement opportunities were identified within the medication-use process for fentanyl patches at Cleveland Clinic Euclid Hospital. Prescribing was addressed through development of a procedure requiring an opioid status verification by a pharmacist for all fentanyl patch orders. This procedure includes determination of indication, review of prior opioid use, and documentation within the medical record. At baseline in 2017, 11 of 45 fentanyl patches were initiated for acute pain. In the first year of the procedure, 1 of 13 orders was initiated for acute pain, and in the second year 2 of 24 orders for fentanyl patches were initiated for acute pain. With each review, the pharmacy department identified additional safety and clinical education opportunities. Subsequently, inventory and dispensing practices for patches were assessed. The hospital's inventory was decreased and dispensing practices were altered to mitigate accessibility of the patches. This resulted in a decrease of 73.65% in the on-hand quantity from 2018 to 2020. The overall morphine milligram equivalents (MME) per 24 hours of this dosage form available in the hospital were reduced from 56,073.6 MME in 2018 to 13,557.6 MME in 2020 (75.82% decrease). Evaluation of the fentanyl patch medication-use process and pharmacy-driven interventions resulted in an increase in appropriate utilization of fentanyl patches and a decrease in accessible MME of this potent dosage form.

Characteristics Contributing to a Pharmacy Services Excellence Model in a Large Health System.

To identify characteristics that contribute to and promote a pharmacy services center of excellence model in a large health system. In 2019, a survey was conducted of 161 acute care pharmacy departments of health system-affiliated hospitals. Information captured included pharmacy practice models, pharmacist resource allocation, training of pharmacy residents, postgraduate training and pharmacist certifications. Results were combined with clinical pharmacy metric performance and centralized electronic data to identify features of top performing pharmacy departments. Survey results were received from 141 of 161 affiliated hospitals (88%). Hospitals with 100 to 299 beds comprised 54% (n = 16 of 30) of the hospitals "at goal" and 66% (n = 26 of 40) of hospitals with "opportunity". Hospitals with top performing pharmacy services had greater participation in interdisciplinary rounds, reporting "always" participating in Adult Critical Care (67% versus 43%) and Medical/Surgical (30% vs. 8%) rounds. Hospitals that trained pharmacy residents had a greater number of clinical pharmacy metrics at goal (5.89 ± 1.59 versus 4.16 ± 1.86, p < 0.001), employed more board-certified pharmacists (2.32 ± 1.49 versus 1.57 ± 1.62, p = 0.019), more postgraduate year 1 (PGY1) trained pharmacists (2.06 ± 1.33 versus 1.19 ± 1.19, p < 0.001) and more PGY2 trained pharmacists (0.58 ± 0.64 versus 0.19 ± 0.44, p = 0.002). When including several key hospital characteristics into a single model, hospitals that trained pharmacy residents were significantly associated with achieving "at goal" status (p = 0.011). Defining characteristics of a pharmacy services center of excellence model included "at goal" clinical pharmacy metrics performance, clinical pharmacist time dedicated to patient care activities, accredited pharmacy residency training programs, presence of pharmacists with advanced training or board certification and optimal operations and scheduling.

Anti-Inflammatory Effect of Tacrolimus/Hydroxypropyl-β-Cyclodextrin Eye Drops in an Endotoxin-Induced Uveitis Model.

Background: Uveitis is an infrequent disease which constitutes a major cause of ocular morbidity. Correct management is essential, being corticosteroids its cornerstone. In case of contraindication to corticosteroids or treatment failure, the use of topical tacrolimus (TAC) could be an alternative which has already demonstrated safety and effectiveness in other ocular pathologies. However, TAC eye drops are not marketed, thus their elaboration must be carried out in Hospital Pharmacy Departments (HPDs). Methods: 32 Sprague-Dawley rats were divided into 4 groups of 8 rats each: (a) untreated healthy rats (Healthy); (b) untreated Endotoxin-Induced Uveitis model-rats (EIU); (c) EIU-rats treated with standard treatment of dexamethasone ophthalmic drops (DXM) and (d) EIU-rats treated with TAC-hydroxypropyl-β-cyclodextrin eye drops previously developed by our group (TAC-HPβCD). The mRNA expression levels of IL-6, IL-8, MIP-1α and TNF-α, quantitative analysis of leucocytes in aqueous humor and histological evaluation were performed. Results: TAC-HPβCD eye drops demonstrated to reduce ocular inflammation, expression of IL-6, TNF-α, MIP-1α and leukocyte infiltration in aqueous humor. Conclusions: TAC-HPβCD eye drops showed beneficial effect in EIU model in rats, positioning as an alternative for uveitis treatment in case of corticosteroids resistance or intolerance.

An Australian hospital pharmacy department’s pandemic response plan to coronavirus disease of 2019

AbstractAimThis paper provides the main accomplishments of the Royal North Shore Hospital (RNSH) Pharmacy Department’s COVID‐19 Pandemic Response Plan and key recommendations for other departments developing a remote model of care.MethodsThe overall objective was to preserve the active workforce by minimising staff‐to‐staff and staff‐to‐patient contact. The response plan involved splitting the department into teams, implementing a remote ward‐based clinical pharmacy service, staff upskilling and optimising the physical environment.ResultsIn April 2020, 1240 clinical tasks were completed remotely compared with 1254 tasks completed on site. In May 2020, 1700 tasks were completed offsite, compared with 1544 tasks onsite. The percentage of pharmacists rating themselves 5 out of 5 (very confident) in communicating over the phone increased from 34.8% prior to remote service delivery, to 60% after completion of the service. Counselling patients over the phone increased from 17.4% to 40% while providing remote clinical service increased from 26.1% to 80%.DiscussionThe paper provides key recommendations for other sites wanting to implement a remote model of care. There are details of recommendations for communication, adequate skill mix, upskilling, education, training, staff resilience, role expansion and administration.ConclusionThe formation of a team hospital pharmacy department COVID‐19 Pandemic Response Plan has provided assurance that a complete pharmacy service could continue in the event of reduced staffing. Intense, thoughtful, collaborative work was required in a short period of time to design an appropriate physical environment, create a remote working model of care, and to train and educate members of staff.

Assessment of drug use pattern using WHO core drug use indicators in selected general hospitals: a cross-sectional study in Tigray region, Ethiopia

ObjectiveInappropriate use of medicine is a global challenge with greater impact on developing countries. Assessment of drug use pattern is used to identify gaps in medicine utilisation to implement strategies...