Greenwood Daniel, Steinke Douglas, Martin Sandra, Tully Mary P
Division of Pharmacy and Optometry, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
Division of Pharmacy and Optometry, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
Res Social Adm Pharm. 2020 Aug 28. doi: 10.1016/j.sapharm.2020.08.016.
Emergency Department Pharmacist Practitioners (EDPPs) undertake both 'traditional' clinical pharmacy work, e.g. check prescriptions, and 'practitioner' work, e.g. perform clinical examinations. A recent study found a large variation in the extent and type of care provided. Whilst variation allows services to be tailored to local needs, it is important that care meets the minimum standards that are safe, effective, patient-centred, timely, efficient, and equitable.
OBJECTIVE(S): To develop an EDPP service specification based on views of professional and patient stakeholders, primarily to support providers with delivery of high quality services.
Patients, ED pharmacists and other ED healthcare professionals developed standards guided by the Institute of Medicine's quality domains. A panel of six ED pharmacists suggested and agreed on themes that should be included in the service specification. Additional themes were identified through interviews with eight patients who had been cared for by EDPPs as to their expectations of the service. Finally, a multidisciplinary expert panel of healthcare professionals and researchers reviewed and refined the service specification.
ED pharmacists developed 36 themes with consensus achieved for 25. Additional themes from the patient interviews concerned the communication and behaviour of EDPPs rather than specific clinical activities undertaken. Whilst patients were happy to be cared for by an EDPP working within their competence, for certain conditions (e.g. major trauma) they wanted a doctor as their main care provider. An evidence-based EDPP service specification of 52 criteria grouped into 4 categories was produced: direct patient care (29); other activities (10); general approach (10); and service structures (3).
As the product of both patient and expert input, EDs could align existing or newly developed services to the specification. Whether or not the specification actually improves the quality of EDPP services requires investigation, as does the absolute quality impact of services.
急诊科药剂师从业者（EDPPs）既要承担“传统”的临床药学工作，如检查处方，也要承担“从业者”工作，如进行临床检查。最近一项研究发现，所提供护理的范围和类型存在很大差异。虽然差异使服务能够根据当地需求进行调整，但护理符合安全、有效、以患者为中心、及时、高效和公平的最低标准非常重要。
根据专业和患者利益相关者的意见制定一份EDPP服务规范，主要是为服务提供者提供高质量服务提供支持。
患者、急诊科药剂师和其他急诊科医疗保健专业人员在医学研究所的质量领域指导下制定标准。一个由六名急诊科药剂师组成的小组提出并商定了应纳入服务规范的主题。通过对八名曾接受过EDPPs护理的患者进行访谈，了解他们对服务的期望，从而确定了其他主题。最后，一个由医疗保健专业人员和研究人员组成的多学科专家小组对服务规范进行了审查和完善。
急诊科药剂师提出了36个主题，其中25个达成了共识。患者访谈中的其他主题涉及EDPPs的沟通和行为，而非具体的临床活动。虽然患者乐于接受在其能力范围内工作的EDPPs的护理，但对于某些病症（如重大创伤），他们希望由医生作为主要护理提供者。制定了一份基于证据的EDPP服务规范，包括52条标准，分为4类：直接患者护理（29条）；其他活动（10条）；一般方法（10条）；服务结构（3条）。
作为患者和专家意见的产物，急诊科可以使现有或新开发的服务符合该规范。该规范是否真的能提高EDPP服务质量需要进行调查，服务的绝对质量影响也需要调查。
