Hickson Ryan P, Steinke Douglas T, Skitterall Charlotte, Williams Steven D
Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Manchester Pharmacy School, University of Manchester, Manchester, UK.
Eur J Hosp Pharm. 2017 Mar;24(2):74-79. doi: 10.1136/ejhpharm-2015-000829. Epub 2016 May 31.
A service evaluation project was conducted to design a pharmaceutical assessment screening tool (PAST) to assign all inpatients a patient acuity level (PAL) to then help teams of clinical pharmacists prioritise the frequency of, and the seniority of, pharmacists performing patient reviews; assess clinical pharmacists' adherence to the tool; and identify when pharmacists do not adhere to the tool.
The PAST was developed by consensus methodology to prioritise departmental workflow for clinical pharmacists. The most pharmaceutically complex patients at the greatest risk of adverse drug events were expected to receive a PAL score of 3, while the least complex receive a PAL of 1. A quasi-experimental service evaluation study was conducted 6 months after implementation of the tool to quantify agreement between pharmacist-documented and expected per-guidance PALs. Patients were selected via random clusters from wards. For each patient, a PAL was calculated by the researcher and compared with the pharmacist-documented PAL.
20 patients (57%) had documented PALs that matched the expected PAL based on pharmacy departmental guidance. Seven of nine patients with overvalued pharmacist-documented PALs had no high-risk medications and no organ dysfunction. Four of six patients with undervalued pharmacist-documented PALs had cystic fibrosis, who should all automatically score the maximum level.
Until electronic health records allow the calculation of PALs automatically, the utilisation of the current tool may be improved by eliminating unclear and unused portions of the tool and reiterating the true purpose of the tool to all pharmacists.
开展一项服务评估项目，以设计一种药学评估筛查工具（PAST），为所有住院患者确定患者 acuity 水平（PAL），从而帮助临床药师团队确定药师进行患者评估的频率和资历优先级；评估临床药师对该工具的依从性；并确定药师何时未遵守该工具。
PAST 通过共识方法开发，以确定临床药师的部门工作流程优先级。预计药物不良事件风险最高且药学情况最复杂的患者 PAL 评分为 3，而最不复杂的患者 PAL 为 1。在该工具实施 6 个月后进行了一项准实验性服务评估研究，以量化药师记录的 PAL 与根据指南预期的 PAL 之间的一致性。通过病房随机整群抽样选择患者。对于每位患者，研究人员计算 PAL，并与药师记录的 PAL 进行比较。
20 名患者（57%）记录的 PAL 与基于药房部门指南预期的 PAL 相符。药师记录的 PAL 高估的 9 名患者中有 7 名没有高风险药物且没有器官功能障碍。药师记录的 PAL 低估的 6 名患者中有 4 名患有囊性纤维化，他们都应自动获得最高级别评分。
在电子健康记录能够自动计算 PALs之前，可以通过消除该工具中不明确和未使用的部分，并向所有药师重申该工具的真正用途，来提高当前工具的利用率。
