English Sarah, Hort Adam, Sullivan Nicholas, Shoaib Muhammad, Chalmers Leanne
Curtin University, School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Kent Street, BENTLEY Western Australia, 6102, Australia; Fiona Stanley Hospital, Department of Pharmacy, Robin Warren Drive, MURDOCH Western Australia, 6150, Australia.
Fiona Stanley Hospital, Department of Pharmacy, Robin Warren Drive, MURDOCH Western Australia, 6150, Australia.
Res Social Adm Pharm. 2020 Aug;16(8):1026-1032. doi: 10.1016/j.sapharm.2019.10.014. Epub 2019 Oct 24.
While the benefits of multidisciplinary ward round (WR) participation by clinical pharmacists have been demonstrated, it can be time-consuming. No previous studies have compared the specific benefits of WR participation and other clinical activities.
To assess the clinical impact of different clinical pharmacist activities and analyse patterns of practice based on WR involvement and timing and significance of clinical interventions.
In a prospective, observational time and motion study, clinical pharmacists servicing 6 unmatched specialty areas in a major quaternary public hospital were observed and their activities documented. Pharmacists' self-recorded interventions underwent expert panel assessment for significance and potential cost savings. Workflows and interventions were analysed for the 4 pharmacists involved in WRs ('WR pharmacists') during their time 'on' and 'off' rounds and for 2 pharmacists not involved in WRs ('non-WR pharmacists') using chi-square analyses.
During 170 h of observation, 267 clinical interventions (53.9% minor, 40.1% moderate, 6.0% major) were recorded. WR pharmacists spent 24.3% of their time on rounds, and 64.8% of interventions were made during this time (intervention rates: 4.5/hour on WR vs. 0.8/hour off WR vs. 1.3/hour for non-WR pharmacists). Differences in WR and non-WR pharmacists' workflows were observed, although there was no difference in time spent on clinical/patient-centred activities (p = 0.70). WR involvement was associated with significantly quicker interventions (p < 0.001). All major interventions were made by WR pharmacists; 80% were made on rounds. Major interventions were estimated to have decreased lengths of stay, intensive care requirements and procedure costs.
Clinical pharmacists focussed on patient-centred activities, regardless of WR involvement. Notwithstanding differences in the WR and non-WR specialty areas, WR participation was associated with more significant and timely interventions and potential cost savings. Coupled with the subjective benefits of WR participation observed, these findings support the potential value of clinical pharmacist WR participation.
虽然临床药师参与多学科查房（WR）的益处已得到证实，但这可能很耗时。以前没有研究比较过参与查房和其他临床活动的具体益处。
评估不同临床药师活动的临床影响，并根据参与查房情况、临床干预的时间和意义分析实践模式。
在一项前瞻性观察性时间和动作研究中，观察了在一家大型四级公立医院服务于6个不匹配专科领域的临床药师，并记录了他们的活动。药师自行记录的干预措施经过专家小组评估其意义和潜在成本节约情况。使用卡方分析对参与查房的4名药师（“查房药师”）在查房期间和非查房期间以及2名不参与查房的药师（“非查房药师”）的工作流程和干预措施进行了分析。
在170小时的观察期间，记录了267项临床干预措施（53.9%为轻微，40.1%为中度，6.0%为重大）。查房药师将24.3%的时间用于查房，在此期间进行了64.8%的干预措施（干预率：查房时为4.5次/小时，非查房时为0.8次/小时，非查房药师为1.3次/小时）。观察到查房药师和非查房药师工作流程存在差异，尽管在以临床/患者为中心的活动上花费的时间没有差异（p = 0.70）。参与查房与显著更快的干预措施相关（p < 0.001）。所有重大干预措施均由查房药师进行；80%是在查房时进行的。据估计，重大干预措施减少了住院时间、重症监护需求和手术成本。
临床药师专注于以患者为中心的活动，无论是否参与查房。尽管查房和非查房专科领域存在差异，但参与查房与更显著、及时的干预措施以及潜在成本节约相关。再加上观察到的参与查房的主观益处，这些发现支持了临床药师参与查房的潜在价值。
