开展住院药师轮转以扩大分散式临床药学服务。

Hill John D, Williams Jonathan P, Barnes Julie F, Greenlee Katie M, Cardiology Bcps-Aq, Leonard Mandy C

Johns Hopkins Hospital, Baltimore, MD

Cleveland Clinic, Cleveland, OH.

Am J Health Syst Pharm. 2017 Jul 15;74(14):1085-1092. doi: 10.2146/ajhp160135.

PURPOSE

The development of a pharmacy resident rotation to expand decentralized clinical pharmacy services is described.

SUMMARY

In an effort to align with the initiatives proposed within the ASHP Practice Advancement Initiative, the department of pharmacy at Cleveland Clinic, a 1,400-bed academic, tertiary acute care medical center in Cleveland, Ohio, established a goal to provide decentralized clinical pharmacy services for 100% of patient care units within the hospital. Patient care units that previously had no decentralized pharmacy services were evaluated to identify opportunities for expansion. Metrics analyzed included number of medication orders verified per hour, number of pharmacy dosing consultations, and number of patient discharge counseling sessions. A pilot study was conducted to assess the feasibility of this service and potential resident learning opportunities. A learning experience description was drafted, and feedback was solicited regarding the development of educational components utilized throughout the rotation. Pharmacists who were providing services to similar patient populations were identified to serve as preceptors. Staff pharmacists were deployed to previously uncovered patient care units, with pharmacy residents providing decentralized services on previously covered areas. A rotating preceptor schedule was developed based on geographic proximity and clinical expertise. An initial postimplementation assessment of this resident-driven service revealed that pharmacy residents provided a comparable level of pharmacy services to that of staff pharmacists. Feedback collected from nurses, physicians, and pharmacy staff also supported residents' ability to operate sufficiently in this role to optimize patient care.

CONCLUSION

A learning experience developed for pharmacy residents in a large medical center enabled the expansion of decentralized clinical services without requiring additional pharmacist full-time equivalents.

目的

描述为扩大分散式临床药学服务而开展的药学住院医师轮转项目。

总结

为与美国卫生系统药师协会实践推进倡议中提出的举措保持一致，位于俄亥俄州克利夫兰市的拥有1400张床位的学术性三级急性护理医疗中心克利夫兰诊所的药学部设定了一个目标，即为医院内100%的患者护理单元提供分散式临床药学服务。对之前没有分散式药学服务的患者护理单元进行评估，以确定扩展机会。分析的指标包括每小时核实的用药医嘱数量、药学剂量咨询数量以及患者出院咨询会话数量。开展了一项试点研究，以评估这项服务的可行性和潜在的住院医师学习机会。起草了一份学习经历描述，并就轮转期间使用的教育内容的开发征求了反馈意见。确定为类似患者群体提供服务的药师担任带教老师。将药师部署到之前未覆盖的患者护理单元，药学住院医师则在之前已覆盖的区域提供分散式服务。根据地理位置和临床专业知识制定了一份带教老师轮流排班表。对这项由住院医师推动的服务进行的首次实施后评估显示，药学住院医师提供的药学服务水平与药师相当。从护士、医生和药学人员收集的反馈也支持住院医师在这一角色中充分发挥作用以优化患者护理的能力。