Sowell Amanda J, Pherson Emily C, Almuete Virna I, Gillespie Jennifer V, Gilmore Vi, Jensen Megan, Nehra Ravi, Durand Kimberly M, Nesbit Todd W, Swarthout Meghan D, Efird Leigh E
Department of Pharmacy, Palmetto Health Richland, Columbia, SC.
Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD.
Am J Health Syst Pharm. 2017 Nov 1;74(21):1806-1813. doi: 10.2146/ajhp160231. Epub 2017 Sep 11.
The redesign of an inpatient pharmacy practice model through reallocation of pharmacy resources in order to expand clinical services is described.
A pharmacy practice model change was implemented at a nonprofit academic medical center to meet the increasing demand for direct patient care services. In order to accomplish this change, the following steps were completed: reevaluation of daily tasks and responsibilities, reallocation of remaining tasks to the most appropriate pharmacy staff member, determination of the ideal number of positions needed to complete each task, and reorganization of the model into a collection of teams. Data were collected in both the preimplementation and postimplementation periods to assess the impact of the model change on operational workflow and clinical service expansion.
The mean ± S.D. times to order verification were 17 ± 52 minutes during the preimplementation period and 21 ± 70 minutes in the postimplementation period ( < 0.001). During the 3 months before and after implementation of the model change, the mean number of medication reconciliations performed increased from 114 to 144. After implementation of the model change, total interventions increased 194%. Notably, there was a 736% increase in the number of interventions focused on facilitating safe discharge.
A pharmacy practice model change was successfully implemented by reallocating existing pharmacist and technician roles and increasing incorporation of pharmacy residents and students. This change led to an expansion of direct patient care coordination services without negatively affecting the operational responsibilities of the pharmacy or the need to hire additional staff.
描述通过重新分配药房资源对住院药房实践模式进行重新设计，以扩大临床服务。
在一家非营利性学术医疗中心实施了药房实践模式变革，以满足对直接患者护理服务日益增长的需求。为实现这一变革，完成了以下步骤：重新评估日常任务和职责，将剩余任务重新分配给最合适的药房工作人员，确定完成每项任务所需的理想岗位数量，并将模式重组为团队集合。在实施前和实施后阶段收集数据，以评估模式变革对运营工作流程和临床服务扩展的影响。
实施前阶段订单核实的平均±标准差时间为17±52分钟，实施后阶段为21±70分钟（<0.001）。在模式变革实施前后的3个月期间，进行的用药核对平均数量从114次增加到144次。模式变革实施后，总干预措施增加了194%。值得注意的是，侧重于促进安全出院的干预措施数量增加了736%。
通过重新分配现有药剂师和技术员的角色，并增加药房住院医师和学生的参与，成功实施了药房实践模式变革。这一变革导致直接患者护理协调服务的扩展，而不会对药房的运营职责产生负面影响，也无需额外招聘员工。
