Saxby Katherine J E, Murdoch Ruth, McGuinness John, Steinke Douglas T, Williams Steven D
University Hospital of South Manchester, Manchester, UK.
Manchester Pharmacy School, University of Manchester, Manchester, UK.
Eur J Hosp Pharm. 2017 Nov;24(6):315-319. doi: 10.1136/ejhpharm-2016-001074. Epub 2016 Dec 20.
To establish the thoughts of pharmacists using the pharmaceutical assessment screening tool (PAST) when assigning a patient acuity level (PAL) and establish other decision factors. A PAL is a pharmaceutical assessment of a patient (lowest=1 to highest=3), higher PALs highlight the requirement for a more intensive pharmaceutical input to reduce potential harm.
A questionnaire designed to elicit attitudes about the PAST was circulated to 32 pharmacists working in a 900 bed UK university teaching hospital. Respondents were asked to document what PAL they would assign for six theoretical patient cases with an explanation. The data collected was analysed using Microsoft Excel and further analysis was undertaken about the strength of agreement to PAST using the κ statistic using Stata V.12 (StataCorp, Texas, USA).
The questionnaire was completed by 28/32 pharmacists (87.5% response rate). The mean confidence (SD) for assigning a PAL was 81% (±20%). 26/28 pharmacists (93%) agreed or strongly agreed that professional judgement guided them most when allocating a PAL. The PAL assigned to the case studies presented both overestimations and underestimations compared with the guidance but overall the strength of agreement was considered to be 'fair' (κ=0.202).
Pharmacists feel confident about using PAST to help them assign a PAL. However, the use of professional judgement to assign an acuity level overrides any predicted level from PAST.
确立药剂师在确定患者 acuity level（PAL）时使用药物评估筛查工具（PAST）的思路，并确定其他决策因素。PAL 是对患者的药物评估（最低 = 1 至最高 = 3），较高的 PAL 突出显示需要更密集的药物投入以减少潜在危害。
向在一家拥有 900 张床位的英国大学教学医院工作的 32 名药剂师发放了一份旨在引出对 PAST 态度的问卷。要求受访者记录他们会为六个理论患者病例确定的 PAL 并给出解释。使用 Microsoft Excel 对收集到的数据进行分析，并使用 Stata V.12（美国德克萨斯州的 StataCorp）的 κ 统计量对与 PAST 的一致强度进行进一步分析。
28/32 名药剂师（87.5% 的回复率）完成了问卷。确定 PAL 的平均置信度（标准差）为 81%（±20%）。26/28 名药剂师（93%）同意或强烈同意在分配 PAL 时专业判断对他们的指导作用最大。与指导意见相比，分配给案例研究的 PAL 既有高估也有低估，但总体而言一致强度被认为是“中等”（κ = 0.202）。
药剂师对使用 PAST 来帮助他们确定 PAL 感到有信心。然而，在确定 acuity level 时使用专业判断优先于 PAST 预测的任何水平。
