Clarke Rebecca, Colleran Maeve, Melanophy Gail, Bermingham Margaret
Pharmacy Department, St James's Hospital, Dublin 8, Ireland.
Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
Explor Res Clin Soc Pharm. 2023 Sep 21;12:100335. doi: 10.1016/j.rcsop.2023.100335. eCollection 2023 Dec.
The number and complexity of patients being admitted to hospitals is rising and some patients may not receive a full clinical pharmacy review or be reviewed as regularly as needed during their inpatient stay. This is a risk factor for medication errors. Clinical prioritisation identifies patients who are high-risk and most in need of a pharmacist review, targeting finite pharmacy resources to patients who will benefit the most.
Assess and enhance clinical prioritisation within a hospital pharmacy department.
The study was conducted in a large urban academic teaching hospital. A cross-sectional survey of clinical pharmacists in the hospital was conducted to establish the patient clinical criteria they prioritise in their work. A clinical prioritisation tool was developed based on survey findings and was integrated into an existing electronic pharmacy care interface. A pre- and post-intervention study was conducted, consisting of data collection for five days pre- and five days post-implementation of the tool. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were analysed by thematic analysis.
Of 39 eligible pharmacists, 37 (95%) responded to the survey. The top-rated prioritisation criteria, including medicines reconciliation tasks and high-risk medicines, helped to inform the content of the clinical prioritisation tool. Post-intervention, there were more Level 1 complex patients reviewed by pharmacists and fewer Level 3 stable patients compared to pre-intervention. Tool sensitivity ranged from 51 to 88%, depending on the experience of the pharmacist using the tool. High levels of satisfaction with clinical prioritisation were reported by those using the tool.
This newly developed clinical prioritisation tool has the potential to support pharmacists in identifying and reviewing patients in a more targeted manner than practice prior to tool development. Continued development and validation of the tool is essential, with a focus on developing a fully automated tool.
入院患者的数量和复杂性不断增加，一些患者可能无法接受全面的临床药学评估，或者在住院期间未按需要定期接受评估。这是用药错误的一个风险因素。临床优先级确定高危且最需要药剂师评估的患者，将有限的药学资源用于受益最大的患者。
评估并加强医院药房部门的临床优先级。
该研究在一家大型城市学术教学医院进行。对医院临床药师进行横断面调查，以确定他们在工作中优先考虑的患者临床标准。根据调查结果开发了一种临床优先级工具，并将其集成到现有的电子药学护理界面中。进行了一项干预前后研究，包括在工具实施前五天和实施后五天收集数据。定量数据采用描述性和推断性统计进行分析。定性数据通过主题分析进行分析。
在39名符合条件的药剂师中，37名（95%）回复了调查。排名靠前的优先级标准，包括用药核对任务和高风险药物，为临床优先级工具的内容提供了参考。与干预前相比，干预后药剂师评估的1级复杂患者更多，3级稳定患者更少。工具敏感性在51%至88%之间，具体取决于使用该工具的药剂师的经验。使用该工具的人对临床优先级的满意度较高。
与工具开发前的实践相比，这种新开发的临床优先级工具有可能支持药剂师以更有针对性的方式识别和评估患者。该工具的持续开发和验证至关重要，重点是开发一个全自动工具。
