Provision Of Direct Patient Care Research Articles

Clinical Pharmacy Faculty Provision of Direct Patient Care, Challenges, and Opportunities.

The quadripartite mission of clinical track faculty members involves research, teaching, services, and direct patient care. However, the extent of faculty involvement in direct patient care remains a challenge. Thus, the study's objective is to evaluate the effort spent on direct patient care by clinical faculty of pharmacy schools in Saudi Arabia (S.A.) and identify factors that hinder or facilitate providing direct patient care services. This multi-institutional, cross-sectional questionnaire study conducted between July 2021 and March 2022 involved several pharmacy schools' clinical pharmacy faculty members in S.A. The primary outcome was the percentage of time/effort spent on patient care services and other academic responsibilities. The secondary outcomes were the factors affecting the effort spent on direct patient care and the barriers preventing the provision of clinical services. A total of 44 faculty members took the survey. The percentage of effort spent on clinical education was highest at a median (IQR) of 37.5 (30, 50), followed by that spent on patient care [19 (10, 28.75)]. The percentages of effort spent on education and the length of academic experience were negatively associated with efforts spent on direct patient care. The most commonly reported barrier affecting fulfilling patient care duties was the lack of a clear practice policy (68%). Although most clinical pharmacy faculty members were involved in direct patient care, half of them devoted only 20% or less of their time to it. An effective effort allocation for clinical faculty duties will require the development of a clinical faculty workload model that sets realistic expectations about the time spent on clinical and non-clinical duties.

Raising Capacity to Address Mental Health Concerns in Costa Rica.

Background A family medicine team based out of Mayo Clinic, Rochester assembled in 2019 to provide home visits and direct care to underserved populations of patients in La Cruz, Costa Rica.In addition to the provision of direct patient care, our team was interested in conducting a community needs-based assessment to identify an area for provider education efforts and the local providers on a chronic health issue using local feedback and physician data. Suicide awareness and prevention were identified as a priority based on rising suicide rates as well as limited psychiatry services in the area, with some major providences having ~0.60 psychiatrists available per 100,000 people. Our group provided a half-day educational course on mental health topics related to suicide awareness for local health workers. The primary objective of this study was to evaluate any lasting changes in practice, confidence, and knowledge among local health workers attributable to our training and add to the limited research on this topic. Methods Two groups of participants (81) from local hospitals were recruited via local providers and divided into two morning and afternoon groups on a single day. Each group comprised primary care providers, nurses, social workers, and finance officers.Both were given the same educational presentation that could be broadly applied to each various role. Our team provided lectures on mental health, as well as how to improve personal resilience. Locally medically trained translators were used.Pre and post-lecture surveys gathered demographic data, experience with these mental health issues, and confidence in addressing mental health concerns. Pre and post-lecture surveys, including open-ended as well as Likert scale and multiple-choice questions, were handed out at the beginning and end of each lecture to all participants.A four to six months follow-up survey was delivered by email using SurveyMonkeyto evaluate retention and impact of educational materials. Results The initial two groups of participants (n = 81) were aged 23-60 years (mean: 43), and 67% (39) were female. Work experience ranged from 0 to 37 years (mean: 14) with 64% (37) doing direct patient care. Preliminary lecture content data from participants (n = 44) demonstrated an overall increase in correct responses by +15.4% from the pre-test (percent correct, 38.1%) to post-test (53.5%, p < 0.01). Individuals (n = 55) with past exposure to suicide were much more likely to report asking patients about suicide than those with no prior exposure (56.3% vs. 8.3%; p < 0.01). At the six-month follow-up with participants (n =11), when asked about their confidence in learning objectives from the lecture given prior, the rates of low confidence decreased as well as the level of high confidence improved but was not statistically significant. The rate of low confidence of respondents' confidence in asking about mental health concerns decreased from 35.2% to 0% (p < 0.01). Conclusions Our group was able to successfully deliver lectures to a mixed audience of health workers in a region self-identified as struggling with mental health issues in Costa Rica. The surveys suggested learning occurred. A trend suggestive that the educational content improved the participants' confidence and knowledge components over time was noted. Future service trips may be able to build on this initial experience to improve on ways to raise capacity whiledelivering direct care to regions in need.

Perceptions of Healthcare Providers about Pharmacists' Clinical Roles in Patient Care in Ghana.

Background: Clinical pharmacy practice is distinguishable from the dispensing model by its focus on direct patient care. To function effectively in this role, pharmacists need to have clinical competencies, hence the establishment of the Doctor of Pharmacy (PharmD) program. In Ghana, the PharmD program is in its early stages; graduating its first set of pharmacists in 2018. There is therefore need to understand how these recent PharmD graduates are engaging in clinical roles and the perceptions of other health professionals they need to work collaboratively with. Methods: Four different focus group discussions (FGDs) were conducted with physicians, nurses and pharmacists in separate sessions. Questions explored perceptions of the clinical roles of pharmacists. The FGDs were audio-recorded and transcribed verbatim. A thematic analysis of the transcripts was conducted. Results: Perceptions around the roles of clinical pharmacists were in two categories - (1.) Roles associated with the provision of direct patient care [(i.) assurance of appropriateness, and (ii.) optimization of pharmacotherapy; and (2.) Roles involving participation in inter-professional collaborative care with other healthcare professionals through their (i.) contribution of pharmacotherapy expertise, and (ii.) input in interprofessional education and practice. Conclusion: Findings from the study highlight perceived contributions of pharmacists, and potential for more relevance to clinical care, while also drawing attention to the emergence of clinical roles of pharmacists in healthcare systems in a global context. There is continuing need for advocacy for the pharmacy profession and policy changes in healthcare delivery models to maximize potential benefits of clinical pharmacists to health outcomes.

Professional Quality of Life and Intention to Stay Among Perinatal Registered Nurses During the COVID-19 Pandemic

Professional Quality of Life and Intention to Stay Among Perinatal Registered Nurses During the COVID-19 Pandemic

Nurse-to-Patient Ratios in Tele-Critical Care.

Nurse-to-Patient Ratios in Tele-Critical Care.

Acceptance of COVID-19 vaccine in Pakistan among health care workers.

ObjectiveAcceptance of the COVID-19 vaccine will impart a pivotal role in eradicating the virus. In Pakistan, health care workers (HCWs) are the first group to receive vaccination. This survey aimed at the level of acceptance to the COVID-19 vaccine and predictors of non-acceptance in HCWs.MethodThis was a cross-sectional study design and data were collected through 3rd December 2020 and February 14th, 2021. An English questionnaire was distributed through social media platforms and administration of affiliate hospitals along with snowball sampling for private hospitals.ResultsOut of 5,237 responses, 3,679 (70.2%) accepted COVID-19 vaccination and 1,284 (24.5%) wanted to delay until more data was available. Only 5.2% of HCWs rejected being vaccinated. Vaccine acceptance was more in young (76%) and female gender (63.3%) who worked in a tertiary care hospital (51.2%) and were direct patient care providers (61.3%). The reason for rejection in females was doubtful vaccine effectiveness (31.48%) while males rejected due to prior COVID-19 exposure (42.19%) and side effect profile of the vaccine (33.17%). Logistic regression analysis demonstrated age between 51–60 years, female gender, Pashtuns, those working in the specialty of medicine and allied, taking direct care of COVID-19 patients, higher education, and prior COVID-19 infection as the predictors for acceptance or rejection of COVID-19 vaccine.ConclusionIn conclusion, this survey suggests that early on in a vaccination drive, majority of the HCWs in Pakistan are willing to be vaccinated and only a small number of participants would actually reject being vaccinated.

The Nurse Manager's Experience of Moral Distress.

The purpose of this study was to describe the moral distress experiences of nurse managers. Moral distress has been studied among direct patient care providers including nurses and physicians. The moral distress experience among nurse managers is less understood. We conducted a qualitative descriptive study with 19 nurse managers from 5 healthcare institutions in Virginia. Interview data were analyzed using a directed content analysis, as the structural components of the moral distress phenomenon are already known. Participants suffered moral distress when they were unable to achieve or maintain effective unit function and felt caught in the middle between their units' and employees' needs and organizational directives. System-level causes of moral distress are common among nurse managers. Future research should involve measurement of moral distress among nurse managers and exploration of effective interventions.

Measuring the productivity growth and quality changes of teaching and non-teaching hospitals in Taiwan

The objective of this study was to compare productivity growth and quality changes in teaching and non-teaching hospitals in Taiwan using a quality-based Malmquist productivity index under a metafrontier framework. Researchers have argued that teaching hospitals are more costly than non-teaching hospitals. Whether Taiwanese teaching hospitals operate with higher productivity than non-teaching hospitals is important to determine given increasing financial pressure on hospitals. The results of this study show that, among the Taiwanese teaching and non-teaching hospitals in the study sample, both types of institutions increased in productivity and improved in quality from 2008 to 2014. However, non-teaching hospitals saw much greater positive developments in productivity and quality than teaching hospitals. Therefore, additional teaching and research duties may influence the performance of teaching hospitals in provision of direct patient care.

Shared Decision-Making Competency: Provider-Specific Factors in Hematology-Oncology Clinical Practice.

A computerized database search was performed using PubMed®, CINAHL®, and EBSCOhost to identify provider-specific factors associated with shared decision-making (SDM) competency among direct patient care providers in hematology-oncology practice. Personal factors included being female or older in age and having higher education. Years of clinical experience, nonclinical experiences, institutional support for SDM, administrative support for SDM training and education, and cultural competence were also reported as having a positive correlation with SDM competence among care providers. Future research is needed to identify core SDM competencies in the interprofessional hematology-oncology care setting.

Increasing access to care using clinical pharmacy specialist providers in outpatient mental health: Successful practice integration within the Department of Veterans Affairs

BackgroundTo highlight the role and impact of the mental health (MH) clinical pharmacist provider in outpatient MH through successful practice integration into team-based care. ObjectiveThe MH clinical pharmacy specialist (CPS) provider serves in many key roles to improve patient-centered care and medication outcomes by supporting the needs of the MH team, patients, and caregivers in areas of comprehensive medication management. MH CPS providers are integrated as MH providers in general and specialty MH clinics, behavioral health clinics embedded in primary care, residential rehabilitation facilities, specialty MH programs, and in inpatient MH units to improve access, quality, and safety. Practice descriptionThere is a shortage of psychiatrists across the United States, which affects the ability to provide MH care to patients. Practice innovationThere is a need to transform the MH team to include clinicians focused on providing services to the growing population with MH conditions; hence, the expertise of the MH CPS is an asset to increase access to comprehensive medication management services. EvaluationThe MH CPS provider serves patients with a variety of MH conditions, managing medication-related adverse events, performing ongoing and acute medication monitoring, and collaborating with other health care providers for management of new diagnoses. ResultsThe MH CPS provider improves access to care, clinical outcomes, and safety when deployed as direct patient care providers on Veterans Affairs (VA) interprofessional care teams. VA MH clinical pharmacy practice continues to demonstrate what the MH CPS provider, practicing at the top of their license, can achieve as a core member in MH team-based care. ConclusionThese foundational concepts can be applied to further expand MH clinical pharmacy practice into non-VA settings through the use collaborative practice agreements and integration into interprofessional care teams, providing access to patients in need of MH care.

Sliding Sheet Use in Nursing Practice: An Intervention Study.

Background: Previous studies have discovered that the utilization of sliding sheets in patient care is a valuable technique for repositioning bedridden patients compared with traditional cotton sheets or carriers. Our aim was to examine the effects of sliding sheet usage on work-related musculoskeletal disorders and disability, perceived workload, burnout, and job satisfaction, among nurses and nursing assistants. Method: This repeated measurement study included 41 female nurses and nursing assistants from three internal medicine departments who provided direct patient care. Participants completed an eight-part questionnaire (demographics, Neck Disability Index, Quick Disability of the Arms, Shoulder and Hand Questionnaire, Modified Oswestry Low Back Pain Disability Questionnaire, BackAche Disability Index workload, burnout, and job satisfaction) 4 times during the study period: 3 months prior to the intervention, on the first day of the intervention, and 3 and 6 months after commencement of the intervention. Findings: After 3 and 6 months of sliding sheet usage, pain and disability decreased in the neck (p < .001); arms, shoulders, hands (p = .041); and lower back (p < .001), with an increase in job satisfaction (p < .001). Discussion/Application to Practice: The findings of our study indicate a clear influence of reducing work-related musculoskeletal pain and disability while increasing job satisfaction when sliding sheets are introduced into nursing practice. Occupational health nurses in health care should consider this type of low-cost intervention as a method for reducing musculoskeletal injury among direct patient care providers.

Quantitative analysis of nonvisit care activities performed by ambulatory care pharmacists in the outpatient primary care clinic setting

IntroductionThe value of pharmacists as direct patient care providers in integrated ambulatory care teams has been demonstrated. As the reimbursement landscape changes, patient care outside of office visits is increasing through nonvisit care.ObjectiveWe aimed to quantify the time spent by ambulatory care pharmacists on nonvisit care activities in the outpatient primary care clinic setting.MethodsData were collected from four outpatient ambulatory care practices in our institution over 12 weeks. The primary objective was to quantify the time spent performing nonvisit care activities. Secondary objectives were to quantify the number of patients affected, the number of nonvisit care activities, the types of medication therapy problems (MTPs) encountered during nonvisit care activities, and the resulting medication therapy interventions.ResultsA total of 1311 patients were affected during the study, and pharmacists spent a daily average of 1.6 hours performing nonvisit patient care. Among 1548 nonvisit care activities, staff face‐to‐face curbside consult was the most frequent (41%). Among 1866 MTPs identified (1.4 MTP per patient), the most common problems identified were need for education (31%), adverse medication events (21%), need for an additional medication (20%), and nonadherence (12%). The most common interventions were health care team education (28%), recommendation to switch medication (18%), patient education (17%), and start a new medication (14%).ConclusionAmbulatory care pharmacists spent considerable time performing nonvisit care, with multiple MTPs identified during these encounters. Health care teams frequently used pharmacists for nonvisit patient care. Further research is needed to determine the best utilization of pharmacist resources allocated to nonvisit care in an integrated ambulatory care practice.

Urban Hospitals as Anchor Institutions: Frameworks for Medical Sociology

Recent policy developments are forcing many hospitals to supplement their traditional focus on the provision of direct patient care by using mechanisms to address the social determinants of health in local communities. Sociologists have studied hospital organizations for decades, to great effect, highlighting key processes of professional socialization and external influences that shape hospital-based care. New methods are needed, however, to capture more recent changes in hospital population health initiatives in their surrounding neighborhoods. The authors describe three promising sociological frameworks for studying the changing hospital: (1) the study of professions, (2) social network analysis, and (3) community-based participatory research. The authors argue that future analyses of hospitals and health outcomes must move beyond the internal-external dichotomy to see hospitals as complex institutions that are increasingly entwined with communities and subject to changes in state regulation.

Telepharmacy for remote hospital inpatients in north-west Queensland.

Clinical pharmacy service delivery is currently a significant challenge in remote areas. Mount Isa Base Hospital provides clinical pharmacy support to ten remote sites across an area of over 300,000 square kilometres. These sites do not have on-site pharmacists available and, due to the vast distances and unpredictable travel conditions, the outreach pharmacist from Mount Isa Base Hospital only visits sporadically. Provision of direct patient care and advice on medication safety with this model was restricted and insufficient. Telepharmacy provides an opportunity for these services to be vastly expanded. In an attempt to increase pharmacist accessibility for remote hospital sites, the Mount Isa Base Hospital pharmacy department developed an inpatient telepharmacy service. Telehealth equipment is being used to communicate directly with patients and hospital staff, review inpatient medication charts, generate patient medication lists, identify and resolve clinical interventions and provide medication-related advice and counselling. As a result of this implementation, all patients and health professionals in remote north-west Queensland hospitals now have access to a pharmacist. The number of inpatient medication reviews, clinical interventions and patient-pharmacist/clinician-pharmacist interactions occurring at each remote hospital site has increased. Since service initiation, 106 medication-related reviews have been completed via telepharmacy, including 48 patient interactions, and 111 medication-related interventions have been made. This paper outlines the process for the development of an inpatient telepharmacy service for remote hospitals and discusses the benefits and limitations associated with implementation.

Practice activities of privately-practicing nurse practitioners: Results from an Australian survey.

To facilitate expansion of privately-practicing nurse practitioners in community and primary care settings, a legislative amendment in 2010 made privately-practicing nurse practitioners eligible to provide services subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. To evaluate their practice activities, a national survey of privately-practicing nurse practitioners in Australia was conducted, and data analysed using descriptive statistics and thematic analysis (n=73). As part of their role, 96% (n=70) participants reported undertaking direct patient care, 95% (n=69) patient education and health promotion, 95% (n=69) prescribed medications, 92% (n=67) referred patients for diagnostic investigations, and 88% (n=64) reported making a diagnosis. Over 50% of participants saw up to 15 patients daily, and 80% (n=58) treated the same patients on a regular basis. Of the participants, 59% (n=43) perceived that they worked to their full scope of practice. The mainstay of privately-practicing nurse practitioner services is provision of direct patient care in community and primary healthcare settings, suggesting they have emerging potential in addressing the ever-increasing demand for healthcare in Australia.

ACCP Clinical Pharmacist Competencies.

The purpose of the American College of Clinical Pharmacy (ACCP) is to advance human health by extending the frontiers of clinical pharmacy. Consistent with this mission and its core values, ACCP is committed to ensuring that clinical pharmacists possess the knowledge, skills, attitudes, and behaviors necessary to deliver comprehensive medication management (CMM) in team-based, direct patient care environments. These components form the basis for the core competencies of a clinical pharmacist and reflect the competencies of other direct patient care providers. This paper is an update to a previous ACCP document and includes the expectation that clinical pharmacists be competent in six essential domains: direct patient care, pharmacotherapy knowledge, systems-based care and population health, communication, professionalism, and continuing professional development. Although these domains align with the competencies of physician providers, they are specifically designed to better reflect the clinical pharmacy expertise required to provide CMM in patient-centered, team-based settings. Clinical pharmacists must be prepared to complete the education and training needed to achieve these competencies and must commit to ongoing efforts to maintain competence through ongoing professional development. Collaboration among stakeholders will be needed to ensure that these competencies guide clinical pharmacists' professional development and evaluation by educational institutions, postgraduate training programs, professional societies, and employers.

Adding an advanced practice provider to a neurology practice: Introduction to outpatient and inpatient models.

Advanced practice providers (APPs) are qualified medically licensed health care providers, including nurse practitioners (NPs), physician assistants (PAs), nurse anesthetists, certified nurse-midwives, and clinical nurse specialists, who can function either independently or alongside a physician in population-centered care models, disease management integration, care coordination, or in the provision of direct patient care. They also can improve revenue and reduce physician burnout. The use of APPs in the practice of neurology is still in its infancy, and many neurologists are not sure how to integrate an APP in their practice. This article addresses some concerns related to integrating an APP in the inpatient and outpatient settings.

House Staff Participation in Patient Safety Reporting: Identification of Predominant Barriers and Implementation of a Pilot Program.

Patient safety event (PSE) reporting is a critical element for healthcare organizations that are striving for continuous quality improvement. Although resident physicians routinely provide the majority of direct patient care, the level of their participation in PSE reporting historically has been low. In addition, as part of the Accreditation Council for Graduate Medical Education's Next Accreditation System, the Clinical Learning Environment Review site visit assesses residents' engagement in PSE reporting at each accredited academic institution. The objective of this study was to understand the common barriers to PSE reporting and design an intervention to increase the number of PSE reports by resident physicians. We surveyed 304 residents and fellows to assess attitudes toward the PSE reporting system and identify barriers to submitting online PSE reports. Based on this analysis of barriers, we piloted interventions with the internal medicine residency program and measured their effect on resident PSE reporting. Of the survey respondents, 58% had never submitted a PSE report. The most commonly identified barriers were too much time required to submit a report (38% of all respondents), lack of education on how or what to report (37%), lack of feedback or change after reporting (19%), and concern for repercussions or lack of anonymity (13%). Based on this analysis of barriers, we piloted interventions with the internal medicine residency program to educate residents about PSE reporting through a reminder message in their orientation e-mail, informational slides at the end of conferences that described what and how to report, a pocket card with reporting instructions, and leadership encouragement during walk rounds by chief medical residents and the program director. Compared with the 10 weeks before the start of the intervention, the number of PSE reports submitted by internal medicine residents more than doubled, from 16 to 37 reports (P < 0.01). This increase in resident PSE reporting was sustained for 20 weeks despite the interventions lasting only 8 weeks. A resident-driven intervention that fostered a culture of encouragement for PSE reporting through leadership support and targeted education increased the number of PSE reports submitted by internal medicine residents at our health system. Hospitals and health systems should seek to understand the common barriers to PSE reporting from this important group of direct patient care providers and administer structured educational programs to encourage their participation.

Hints for success in ASHP's Clinical Skills Competition.

ASHP’s Clinical Skills Competition (CSC) is a team-based analysis of a patient case for pharmacy students. It provides students the opportunity to enhance their skills in collaborative practice with physicians in the provision of direct patient care.1 The national CSC is held during the annual ASHP Midyear Clinical Meeting. It involves teams from schools of pharmacy accredited by the Accreditation Council for Pharmacy Education (ACPE). Students compete in pairs on a timed case study, demonstrating their skills in assessing and presenting patient information and current therapy. They work to prioritize treatment goals, identify problems with existing drug therapies, and formulate a comprehensive patient care plan. Participants first compete at a school-level CSC that consists of a written evaluation and assessment of a patient case. Teams then present their recommendations to a panel of faculty judges. The participants are evaluated based on standardized evaluation criteria. The winning team subsequently represents the school at the national CSC, where the top 10 finalists are given the opportunity to present their plan to a panel of judges.

Communication and Collaboration: Creating a Culture of Teamwork Through the Use of TeamSTEPPS Strategies

Professional Issues Poster Presentation Purpose for the Program To improve patient safety and satisfaction by implementing an evidence‐based system to enhance communication and teamwork skills among healthcare professionals. Proposed Change TeamSTEPPS is an innovative program that works to solidify collaboration among the healthcare team to achieve the best outcomes for patients. A multidisciplinary group committed to changing the culture of the department attended the TeamSTEPPS master training course. The team identified communication as a recurring problem that threatened patient safety and satisfaction. The team then developed the department‐wide as an intervention to improve communication. Implementation, Outcomes, and Evaluation The women's services department consists of high‐risk labor and delivery (L&D), well‐baby nursery, level II and level III neonatology units, mother–baby couplet unit, and perinatal special care unit. Direct patient care providers from the departmental units attended the TeamSTEPPS fundamentals 4‐hour interactive workshop. This workshop provided hands‐on learning experience of the TeamSTEPPS philosophy as well as an opportunity to practice the TeamSTEPPS behaviors. At 8 a.m. and 8 p.m. daily, the obstetric (OB) faculty member on duty conducts the interdisciplinary department‐wide snapshot. The snapshot is a scripted report that begins with the OB faculty giving L&D staff the big picture report. Next, the L&D team lead nurse reports on inductions, surgeries, expected patients, antepartum unit census and concerns, OB triage status, and patients waiting for beds and staffing. The OR nurse discusses concerns about scheduled cases and the mother–baby team lead nurse reports census, discharges, and concerns. The nurse–midwife and family medicine resident report on admitted patients and bring to light any concerns they may have. Next, staff from the anesthesia department discuss the OR cases, epidurals infusing, problem epidurals, and anticipated high‐risk cases. The staff from the neonatology department then has an opportunity to discuss any concerns. To close the snapshot, the OB faculty clearly states, any team member sees anything unsafe or not in the best interests of our patients, we expect you to speak up. If you are unable to get a timely or effective response, call me, OB faculty, Dr. _______. Improved communication has been evidenced by expediting safe mother–baby discharges during periods of increased census, improved operating room productivity, timely and effective neonatology consultations, and accessibility and accountability of the OB faculty member on duty. Implications for Nursing Practice Effective collaboration and communication are essential elements of professional nursing. The department‐wide snapshot encourages nurses to be actively involved in the multidisciplinary healthcare team and make valuable, evidence‐based contributions to patient safety and satisfaction.