Yung Jason, Nguyen Tiffany, MacLean Robert, Wentzell Jason
, BMSc, PharmD, ACPR, was at the time of this study, with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, and the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario. He is now with Toronto Western Hospital, University Health Network, Toronto, Ontario.
, BScPhm, ACPR, BCOP, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario.
Can J Hosp Pharm. 2019 May-Jun;72(3):202-210. Epub 2018 Jun 30.
The layered learning practice model (LLPM), within which a pharmacist supervises both a pharmacy resident and a student, mitigates the growing demand for clinical rotations that has accompanied national expansion of Doctor of Pharmacy programs. A Canadian collaborative of hospital pharmacists established consensus on 8 clinical pharmacy key performance indicators (cpKPIs), activities associated with improved patient outcomes. Increased implementation of the LLPM alongside cpKPI measurement offers opportunities to compare the LLPM with standard practice in terms of pharmaceutical care delivery.
To quantify clinical productivity, as measured by proportions of eligible patients receiving cpKPIs and absolute numbers of completed cpKPIs, across scenarios involving pharmacists working with and without pharmacy learners.
In this retrospective observational study, pharmacy students, pharmacy residents, and pharmacists recorded completion of 7 cpKPIs for oncology inpatients over a total of 6 months in 2017 and 2018. Clinical productivity was described across the following 3 scenarios: presence of one or more pharmacists with one resident and one or more students (P-R-S); presence of one or more pharmacists with one or more students (P-S); and presence of one or more pharmacists only (P; standard practice).
During the study, there were 685 recorded admissions to the inpatient oncology service. Generally, the proportions of patients who received cpKPIs were similar for scenarios with and without pharmacy learners present. Standardized to 20 pharmacist workdays, the total number of cpKPIs 1, 2, 3, 5, 6, and 7 (255 with P-R-S scenario, 281 with P-S scenario, and 258 with P scenario) and the total number of drug therapy problems resolved (i.e., cpKPI 3; 153 with P-R-S scenario, 180 with P-S scenario, and 149 with P scenario) were similar across the scenarios. Scenario P had fewer admitted patients per pharmacist workday (3.2) than scenarios P-S and P-R-S (3.4 and 3.7, respectively), which may have contributed to a trend toward greater proportions of patients receiving cpKPIs under scenario P.
Compared with standard practice, integration of pharmacy learners within an oncology unit did not appear to impair clinical productivity, as demonstrated by the comparable proportions of patients receiving cpKPIs and the total number of completed cpKPIs.
分层学习实践模式（LLPM）中，药剂师同时指导住院药师和学生，缓解了随着药学博士项目在全国范围内扩张而不断增长的临床轮转需求。一个加拿大医院药剂师协作组织就8项临床药学关键绩效指标（cpKPI）达成了共识，这些指标与改善患者预后相关。LLPM的更多实施以及cpKPI测量提供了在药学服务提供方面将LLPM与标准实践进行比较的机会。
通过接受cpKPI的合格患者比例和完成的cpKPI绝对数量来量化临床生产力，涵盖有和没有药学学习者参与工作的药剂师的不同情况。
在这项回顾性观察研究中，药学专业学生、住院药师和药剂师记录了2017年和2018年共6个月期间肿瘤内科住院患者7项cpKPI的完成情况。临床生产力在以下3种情况下进行描述：一名或多名药剂师与一名住院药师和一名或多名学生一起工作（P-R-S）；一名或多名药剂师与一名或多名学生一起工作（P-S）；仅一名或多名药剂师工作（P；标准实践）。
在研究期间，肿瘤内科住院服务共记录了685例入院病例。总体而言，有和没有药学学习者参与工作的情况下，接受cpKPI的患者比例相似。以20个药剂师工作日为标准，cpKPI 1、2、3、5、6和7的总数（P-R-S情况下为255个，P-S情况下为281个，P情况下为258个）以及解决的药物治疗问题总数（即cpKPI 3；P-R-S情况下为153个，P-S情况下为180个，P情况下为149个）在不同情况下相似。P情况下每个药剂师工作日的入院患者（3.2例）少于P-S和P-R-S情况（分别为3.4例和3.7例），这可能导致了P情况下接受cpKPI的患者比例有增加的趋势。
与标准实践相比，肿瘤科室纳入药学学习者似乎并未损害临床生产力，接受cpKPI的患者比例和完成的cpKPI总数相当即可证明。
