Impact of pharmacy clinical service redesign on quantity and quality of pharmacy interventions in a tertiary teaching hospital: a pre-post cohort study.

BACKGROUND

Pharmacists are integral to the multidisciplinary team; however, staffing and resource challenges limit pharmacists' impact. Aligning pharmacists by admission specialty teams, rather than traditional ward-based models, may address these challenges.

AIM

This study aimed to evaluate whether a pharmacy redesign, which included aligning pharmacists to a specialty-based model from a ward-based model, increased the number and quality of interventions made per full-time equivalent pharmacist in hospitalised patients.

METHOD

The pre-post observational cohort study was conducted at a 550-bed tertiary teaching hospital. The redesign of the clinical pharmacy service was conceived and implemented using redesign methodology. Implemented solutions involved alignment of pharmacists to a specialty team-based model, multidisciplinary teamwork, pharmacist clinical specialisation, an emphasis on clinical documentation, and prioritisation of patients requiring medication review. Pharmacist interventions documented pre- and post-clinical redesign were compared. Two independent reviewers classified the intervention type and determined the impact and significance.

RESULTS

In total, 226 patients were included in the pre-cohort and 468 post. Age (mean 70 vs 69, p-value = 0.404) and other demographics were similar between the cohorts. Pharmacist interventions increased after the clinical pharmacy redesign (n = 310 vs n = 1,106). After the implementation of the clinical pharmacy redesign, there was a significant increase in the median number of clinical interventions per Full-time Equivalent pharmacist (13.5 [0-64] vs 81.5 [3-166], p = 0.004). The redesign showed a positive impact and increase in all interventions.

CONCLUSION

The redesign of pharmacy services increased pharmacist impact without increasing resource requirements or using screening tools, resulting in improved prioritisation of patients, identifying drug-related problems and increased interventions.