Hospital Pharmacy Services Research Articles

Enablers and challenges to pharmacy practice change in Kuwait hospitals: a qualitative exploration of pharmacists' perceptions.

The practice of hospital pharmacists in many developing countries has been changing to include the delivery of direct patient care services, but practice change can be a challenging process. This article explores the perceptions of hospital pharmacists in Kuwait about the enablers and challenges to expanding their scope of practice to include direct patient care. A phenomenological qualitative approach was employed to conduct focus group interviews to explore pharmacists' perceptions about their professional practice at different hospitals across Kuwait. Data were collected from 110 pharmacists using 11 focus group interviews. The interviews were audio-recorded, transcribed verbatim, and analysed using framework analysis. The practice of most hospital pharmacists includes limited direct patient care role. However, a growing number of pharmacists have been introducing clinical pharmacy services at hospitals. Three themes about enablers to practice change emerged from data: (a) increasing physicians' acceptance to pharmacists' role in patient care, (b) patients' trust in pharmacists' knowledge about medications, and (c) pharmacists' perceived benefits of providing direct patient care. These benefits includes enhancing patients' safety and adherence to therapy and improving the professional identity of pharmacists. Participants' perceived challenges to practice change include professional, individual, and organizational challenges. Most participants welcomed assuming direct patient care role. They agreed that pharmacists need to receive adequate education and training and to be equipped with a clinical degree to responsibly provide direct patient care services at hospitals. Pharmacists have been increasingly attempting to provide clinical pharmacy services in Kuwait hospitals. This qualitative data revealed breadth of challenges hindering pharmacists' attempts to expand their professional practice to include direct patient care role. It also outlines facets of improvement and enablers to practice change. The collaboration between different stakeholders in the profession is essential to support pharmacists' efforts in achieving the change in the scope of pharmacy practice to improve patient care services.

Utilizing Hospital Formulary System in Nepal.

Since the early 1950s, for medication management, the hospital formulary system subsisted as a list of drugs into the supply chain management process in hospitals. With the advent of pharmacy practice services, the system now is more oriented towards the rational use of drugs taking into account the safety of therapy, cost-effectiveness, and uninterrupted availability of drugs to improve and reflect upon the clinical judgment of healthcare professionals. Though very few hospitals in Nepal have adopted hospital formulary system, the perfect practice is still skimpy. The formation of drug and therapeutic committee along with the establishment of hospital pharmacy services is a growing trend with the arrival of hospital pharmacy guidelines 2072, thus, a positive spill-over of the hospital formulary system to each hospital in Nepal would be valuable in promoting rational drug therapy. Keywords: Cost-effectiveness; hospital formulary system, rational drug therapy.

Simulation-based learning and assessment for hospital pharmacy service experience among final year pharmacy students in Malaysia


 
 
 
 This case study reports on the simulation-based learning initiative to replace experiential learning in an actual hospital pharmacy setting, namely Outpatient and Inpatient Pharmacy Services. The report describes the teaching and learning as well as the assessment components given to the students in a Malaysian setting.
 
 
 

Psychotropic drug interactions among drug-dependent people

Abstract Background Using psychiatric drugs to treat drug dependence and its comorbidities is very common. The objective of this study was to analyze the interactions between prescribed drugs for patients treated at a specialized mental health care center for drug addicts, located in southern Brazil. Methods A cross-sectional study was conducted on secondary data collected from 2010 to 2018. We reviewed the medical records of patients aged 18 years or older who took psychotropic drugs and had any type of substance dependence. The analysis of psychotropic drug interactions was conducted in three databases: Medscape, Drug Interactions Checker, and Micromedex. Results We included 1,022 of the 2,322 patients attending the care center during the study period. Psychotropic drug interactions were found in 779 (76.4%) study participants, and they presented 2,292 (100%) interactions, out of which 136 (6.0%) had minor clinical risk, 537 (23.4%) had moderate risk, and 1,619 (70.6%) had major risk for the patient, totaling 172 incompatible combinations between two psychotropic drugs. Of the total number of interactions, 128 were pharmacokinetic and 44 were pharmacodynamic. Conclusions The high number of psychotropic drug interactions is a serious public health issue. Psychopharmacological treatment should be carefully addressed to be safe for the patient. Key messages The implementation of clinical pharmacy services in outpatient clinics, hospitals, and mental health care centers can be considered the most effective alternative to avoid adverse reactions. Pharmacists are ready to assist the entire multidisciplinary team involved in the treatment of patients with mental disorders or substance dependence, and provide pharmacological treatment.

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.

Refection on our leadership during COVID‐19: challenging our resilience

Refection on our leadership during COVID‐19: challenging our resilience

Oncology clinical pharmacy services in Chinese hospitals

AbstractIn recent years, with an increasing number of oncology patients and continuous introduction of new antitumor drugs in China, the demand for oncology clinical pharmacy services is growing rapidly, which is both an opportunity and a challenge for clinical pharmacists. However, there have not been many reports about different types of oncology clinical pharmacy services in China. In this report, we have summarized different oncology clinical pharmacy services commonly practiced in Chinese hospitals based on our review of the literature and current practice in our hospital. We are reporting the training programs and the certification process for oncology clinical pharmacists, basic and advanced patient services, pharmacist‐driven and pharmacist‐participated guidelines/expert consensuses/books on oncology pharmacotherapy, as well as professional and public health education performed by pharmacists. Based on what we have observed, oncology clinical pharmacy services in China are relatively comprehensive, however, there are needs for expanding certain advanced pharmacy services. Increasing the time spent on clinical services, improving pharmacists' competency, and optimizing clinical pharmacy workflow and evaluation mechanisms are important for enhancing the value of oncology clinical pharmacists in China.

Implementation of field hospital pharmacy services during the COVID-19 pandemic.

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

ESTRATÉGIAS DE GESTÃO DA QUALIDADE E GESTÃO DE MATERIAIS DE UMA FARMÁCIA HOSPITALAR: REVISÃO INTEGRATIVA DA LITERATURA

Objetivo: identificar as estratégias de gestão da qualidade e gestão de materiais utilizadas para a organização do processo de trabalho da farmácia hospitalar. Método: trata-se de uma Revisão Integrativa da Literatura realizada em quatro bases de dados. A coleta de dados ocorreu no mês de setembro de 2019. Os dados foram analisados por meio de estatística descritiva, de modo que foi possível fazer a contabilização e a descrição dos dados encontrados. Resultados: a amostra foi composta por 29 artigos, todos publicados no Brasil e a região que teve uma maior quantidade de artigos disponíveis foi a Sudeste. O instrumento de organização mais utilizado foi o questionário estruturado, citado em 17,24% (n=05) dos estudos, também foi identificado a utilização de ferramentas de gestão da qualidade. Dentre os benefícios, os mais citados foram a redução de custos para as instituições e a otimização do trabalho. Conclusão: a gestão do setor de farmácia hospitalar ainda é pouco discutida e a falta de trabalhos sobre o assunto se apresentou como uma dificuldade para o desenvolvimento da revisão de literatura.
 Palavras-chave: Gestão de materiais. Controle de qualidade. Serviço de farmácia hospitalar. Gestão em saúde.

Hospital pharmacy services supporting Aboriginal or Torres Strait Islander peoples in Australia: a systematic review

AbstractAimTo systematically review the literature to investigate the role of the hospital pharmacist and the services provided for Aboriginal and/or Torres Strait Islander people.MethodsA systematic literature review was performed following a search from inception to present of MEDLINE, International Pharmaceutical Abstracts (IPA), EMBASE, Scopus and Pubmed, in accordance with PRISMA guidelines. All forms of published literature were included. Aboriginal and/or Torres Strait Islander people and hospital pharmacists/pharmacy department services in Australia were the populations included.Results1592 studies were identified. After removal of duplicates and application of inclusion and exclusion criteria, 16 papers underwent full text review, with 7 papers included in the final review. No high‐level evidence articles were found. Joanna Briggs Institute Levels of Evidence for meaningfulness were low. Settings were varied and included rural, remote and urban sites. Five articles were allocated a Donabedian Model level where the structure was described. Two papers described structure and process. None described outcomes. Hospital pharmacy services included development of models for patient care, partnerships and resource sharing in rural and remote areas and ensuring continuity of care. ConclusionSystematic review of the literature to determine the role of hospital pharmacy services for Aboriginal and/or Torres Strait Islander people produced limited publications for review. From these, roles identified included: development of models for patient care, partnerships and resource sharing in rural and remote areas and ensuring continuity of care. Future research and publication of work by hospital pharmacists nurturing and developing relationships in partnership with Aboriginal and Torres Strait Islander communities is encouraged.

Global Scope of Hospital Pharmacy Practice: A Scoping Review.

The pharmacy profession has undergone tremendous changes over the past few decades. Pharmacists’ roles have expanded their boundaries to encompass more patient-centered services. However, the degree to which these roles are practised may vary. This scoping review is aimed at describing the extent and range of the professional pharmacy services offered in hospital pharmacies across different countries and the barriers underlying inappropriate or incomplete implementation of these services. Studies published in the English language between 2015 and 2019 were retrieved from the following databases: PubMed, CINAHL, Scopus, EBSCO Discovery Service, and Web of Science. A thematic analysis across the included studies produced two main themes. “Scope of practice” comprised three subthemes: pharmaceutical care practice, clinical pharmacy practice, and public health services and “Multiple levels of influence” comprised five subthemes: individual, interpersonal, institutional, community, and public policy-related factors. The hospital pharmacy services across countries ranged from traditional drug-centered pharmacy practice to a more progressive, clinically oriented practice. In some countries, there is an apparent inadequacy in the clinical pharmacy services provided compared to other clinical settings. Understanding the current pharmacy practice culture across different health care systems is an essential step towards improving the profession.

Practice of prevention and control on COVID-19 through "internet plus" hospital pharmacy service

Internet plus pharmacy service center of Sir Run Run Shaw hospital is the 1st one in Zhejiang province to realize online health reexamination and medication dispensing, including prescriptions, prescription-checking, payment, delivery, consulting, continuing education, et al. The mode improves efficiency of whole hospital service which includes pharmacy service, avoids patients staying in the hospital and the cross infections. It is an innovative type of pharmacy service mode to treat COVID-19 epidemic. Key words: Internet plus; Pharmacy service; COVID-19

Perceptions and Attitudes Towards Clinical Pharmacy Services and Their Impact on The Management of Cancer in Taif, Saudi Arabia.

Aim:To assess the perception and attitude of HCPs and health-related science colleges’ students regarding the clinical pharmacists’ roles and responsibilities in providing better pharmaceutical care to patients in Taif, Saudi Arabia and to detect its impact on management of cancer. Methods:This study was conducted in four randomly selected hospitals in Taif and three health-related science colleges in Taif University. A questionnaire was distributed to HCPs and another questionnaire to students of health-related science colleges. Results:Three quarters of students perceived that the clinical pharmacist is an important part of the healthcare team. Two-thirds of HCPs expressed confidence in the ability of clinical pharmacists to minimize medication errors. Although two-thirds of HCPs reported that they did not have clinical pharmacists in their institutions, there was substantial willingness among HCPs to cooperate with the clinical pharmacists. Most HCPs expressed the view that the clinical pharmacist is an important integral part of the healthcare team and has a positive impact on cancer management. Conclusion:HCPs and students of health-related science colleges valued the role of clinical pharmacists in healthcare delivery and management of cancer. However, new developments in clinical pharmacy services in Taif hospitals are recommended to improve perception and attitudes towards the clinical pharmacy services. Also, well-organized programs should be conducted to students of health-related science colleges to improve their perceptions and attitudes towards the clinical pharmacy services which may have a positive impact on cancer management.

Challenges to the consolidation of pharmacovigilance practices in Brazil: limitations of the hospital pharmacist.

Aims:The aim of this study was to present the needs of hospital pharmacists in pharmacovigilance practices.Methods:This study has a cross-sectional design and was carried out with hospital pharmacists in Brazil. The sample was obtained by voluntary recruitment. Pharmacists who worked at Brazilian hospitals and were registered in their respective regulatory councils were invited to participate in the present study. A personalized questionnaire was developed by the authors and was electronically filled out by the respondents on the platform ‘Google forms’. The questionnaire was nationally available on the digital platform of the Pharmacy Federal Council, the Brazilian Society of Hospital Pharmacy and Health Services, four Pharmacy regional councils and the social network farmacêuticoclínico®. Quantitative variables were analyzed by mean and standard deviation. The qualitative variables were analyzed by means of absolute and relative frequency. Difficulties related to pharmacovigilance activities are presented in an Ishikawa diagram in the Supplemental Material online.Results:Of the 27 federative units of Brazil, we obtained answers from pharmacists located in 85.2% (n = 23) of them. Among the pharmacovigilance practices developed by Brazilian pharmacists, the adverse drug reaction investigation (55.4%) and notification activities (47.0%) were worthy of note. Numerous difficulties were reported by the pharmacists, highlighting the difficulty in monitoring the medication and imputation of causality (27.7%). After categorizing the difficulties reported, it was observed that the category ‘people involved’ (45.1%) stood out from the others.Conclusion:This study pointed out numerous challenges to pharmacovigilance practices involving pharmacists in Brazil. It is believed that the correction of certain difficulties may impact on the better consolidation of pharmacovigilance activities in the country. However, regulatory agencies at all hierarchical levels of pharmacovigilance must work together to make it possible.Plain language Summary Challenges to the consolidation of pharmacovigilance This is a study that seeks to present the needs of Brazilian hospital pharmacists in relation to pharmacovigilance activities. Through online interviews, pharmacists answered a questionnaire, presented the pharmacovigilance activities they develop and expressed their anxieties and difficulties for the development of these activities. With this study, it was concluded that numerous activities of active search, investigation and notification of adverse drug reaction are developed by Brazilian pharmacists. However, each pharmacist performs a different method of pharmacovigilance. In addition, it was observed that among the interviewees there was a perception of insufficient professional training and a shortage of professionals to assist in pharmacovigilance activities. These were the main difficulties reported. Therefore, the search for models or agile solutions to solve problems involving adverse drug reactions seems necessary for a better consolidation of pharmacovigilance services in Brazil.

Standardization Consensus of a Hospital Drug Database: An Efficient Tool.

Although the electronic prescribing software is the same for all hospitals of a regional health service, each has its own drug database, which it is responsible for maintaining. The aim of this study was to develop a consensus to standardize the hospital drug database of the electronic prescribing software, and to apply this tool to the electronic prescribing system of an oncology outpatient clinic of a Spanish tertiary-level hospital. Additionally, we sought to analyze the impact of the implemented actions on the health care services provided. This was a prospective study carried out over a period of 15 months by a group of pharmacists representing all Organizational Integrated Management Systems of a regional health service, and coordinated by the General Subdirectorate of Pharmaceuticals. A total of 500 drugs and 500 active pharmaceutical ingredients included in the hospital drug database were standardized to implement the electronic prescribing system in the oncology outpatient clinic. The implementation of such standardization process yielded a 70% decrease in medication errors. In the satisfaction survey concerning the usefulness of the tall-man letters implemented in the electronic prescribing system, the interviewed doctors reported the highest levels of satisfaction. The creation of consensus documents to standardize the hospital drug database served to unify the information available in the regional hospital pharmacy services of an autonomous community. In addition, the implementation of the electronic prescribing system in the oncology outpatient clinic of a tertiary-level hospital resulted in a decrease in the number of medication errors.

The Pharmaceutical Journal report on outsourcing of hospital pharmacy services cited in parliamentary debate

The Pharmaceutical Journal report on outsourcing of hospital pharmacy services cited in parliamentary debate

Evaluation of hospital pharmacy services: an integrative review

Background: Pharmaceutical services performed in the hospital context have specific structure and processes, which should be continuously evaluated because they influence the results obtained.
 Objective: To identify, describe and compare studies of evaluation of pharmaceutical services performed in the hospital context.
 Methods: Integrative review of articles found in databases SciELO, LILACS, MEDLINE and IBECS, indexed in the period from 2000 to 2016, using the following descriptors: “Hospital Pharmacy Service” and “Evaluation“. The references were analyzed according to year, language, country of publication and type of study and classified according to their focus on the components of the hospital pharmacy service logic model that dealt with the management, selection, programming, acquisition, storage and distribution of medicines, information, pharmacotherapeutic, pharmacotechnical and teaching and research follow-up.
 Results: Of the 25 publications, 16 (64%) were in the English language, of which 10 (40%) were in the United States; 17 (70%) studies were published from 2010 to 2016 and 13 (52%) were observational descriptive type. The most discussed component of pharmaceutical services was distribution logistics addressed in 15 publications (60%), followed by the management component addressed by 14 (56%) studies.
 Conclusions: The publications emphasized the discussion on drug logistics. Only a few presented discussions on the impact of these services on health care, such as patient safety. Such studies can support the decision-making process and the formulation of strategies aimed at increasing the management capacity and the quality of the service provided.

Impact of Introducing Clinical Pharmacy Services in A Respiratory Diseases Clinic: A Report from North Cyprus

Aims: The Implementation of Clinical Pharmacy Services (CPS) in hospitals is currently gaining attention in an effort to rationalize drug use in many developing countries. This study aims to introduce and evaluate ward-based CPS in a Respiratory Diseases clinic in North Cyprus and assess its efficacy and physician's perceptions toward the services.
 Study Design: A prospective interventional study.
 Place and Duration of Study: The study was carried out in the respiratory clinic from 01 December 2013, to 30 January 2014 at Near East University Hospital, in Nicosia, North Cyprus.
 Methodology: Clinical Pharmacy Services (CPS) were introduced and documented over the study period of 60 days in a tertiary university hospital. DTPs and Interventions were documented and classified using DTP classification tool obtained from previous studies, and later evaluated by an independent clinical committee for their feasibility. Physician’s attitudes and perceptions were evaluated before for and after introducing CPS's using a questionnaire tool.
 Results: 82.35% of the targeted physician's sample have responded to baseline survey, (n=17) majority (92%) did not have any previous interaction with clinical pharmacists, they generally well perceived and had high expectations to pharmaceutical care services in general. This further enhanced the post-implementation of CPS. 118 interventions were carried during the program, 86.6% accepted and regarded as clinically relevant. Interventions mostly related to cardiovascular agents. Add/ change/stop medications were the most common type of interventions (21%). Most common resultant outcome was to avoid adverse effects or toxicities. The intervention was significantly related to the number of drugs used (r=0,487; p=0,006), the rate of acceptance significantly was higher to services compared to DRP interventions (p<0.005).
 Conclusion: The introduction of CPS's lead to clinically relevant and highly accepted optimization of medicine use in different wards and clinics including respiratory diseases clinic in the case of this study, it was relatively well perceived by physicians, but also could be more valued if more optimized and practiced by talented proactive clinical pharmacists within a multidisciplinary team.

Phantom pharmacists and mysterious medications: educating graduate nurses on the role of a hospital pharmacist, pharmacy services and medication resources

Phantom pharmacists and mysterious medications: educating graduate nurses on the role of a hospital pharmacist, pharmacy services and medication resources

Strategies for improving medication safety in hospitals: Evolution of clinical pharmacy services.

Medication safety risks are the most important preventable factors jeopardizing patient safety. To manage these risks, extending pharmacists' involvement in patient care and patient safety work has been systematically addressed in patient safety initiatives since the early 2000s. To explore the extent and range of clinical pharmacy services in Finnish hospitals to promote medication safety: 1) in 2011, when the first National Patient Safety Strategy, the new Health Care Act and the Medicines Policy 2020 had been recently enacted; and 2) five years later in 2016. The study was conducted in 2011 and 2016 as a national online survey targeted to hospital pharmacies (n = 24) and medical dispensaries (n = 131 in 2011; n = 28 in 2016). The questions were analyzed using descriptive statistics and qualitative content analysis. Overall response rate was 60% in 2011 and 52% in 2016. Clinical pharmacy services were provided by 51% of the responding units in 2011, whereas by 85% in 2016. The reported number of clinical pharmacists had increased during the five years. The most notable increase in reported tasks occurred in conducting medication reconciliations (+63% increase in the number of providing units). By 2016 pharmacists had extended their tasks particularly towards system-based medication safety work: e.g. developing instructions for medication-use (91% of the responding units), creating and updating medication safety plans (87%) and using medication error reports in developing the process of medication use safer (78%). Pharmacists' participation in long-term continuing education became more common in 2016, which was perceived as helpful in extending their responsibilities to improve medication safety. Pharmacists' involvement in patient care and system-based medication safety work was reported to become more common in Finnish hospitals during 2011-2016. This development is in line with patient safety policy initiatives and its impact on patient care outcomes should be followed up.