Chubaty Adriana J, Wills Carly, Yeung Kingston, Saran Harsheen K, Bordia Aagam S, Widjaja Gabrielle, Penm Jonathan
Department of Pharmacy, The Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
Medicines and Therapeutics Optimisation Program, Clinical Excellence Commission, NSW Health, St Leonards, NSW, 2065, Australia.
Int J Clin Pharm. 2025 Sep 5. doi: 10.1007/s11096-025-01967-3.
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.
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.
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.
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.
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.
药剂师是多学科团队不可或缺的一部分；然而，人员配备和资源挑战限制了药剂师的影响力。按收治专科团队安排药剂师，而非传统的基于病房的模式，可能解决这些挑战。
本研究旨在评估药房重新设计（包括将药剂师从基于病房的模式调整为基于专科的模式）是否会增加每名全职等效药剂师对住院患者进行干预的数量和质量。
在一家拥有550张床位的三级教学医院进行了前后对照观察队列研究。临床药学服务的重新设计采用重新设计方法构思并实施。实施的解决方案包括将药剂师调整为基于专科团队的模式、多学科团队合作、药剂师临床专业化、强调临床记录以及对需要药物审查的患者进行优先级排序。比较了临床重新设计前后记录的药剂师干预措施。两名独立评审员对干预类型进行分类，并确定其影响和重要性。
队列前共纳入226例患者，队列后纳入468例。两组患者的年龄（平均70岁对69岁，p值 = 0.404）和其他人口统计学特征相似。临床药房重新设计后，药剂师的干预措施有所增加（310次对1106次）。临床药房重新设计实施后，每名全职等效药剂师临床干预的中位数显著增加（13.5 [0 - 64]对81.5 [3 - 166]，p = 0.004）。重新设计对所有干预措施均显示出积极影响并有所增加。
药房服务的重新设计在不增加资源需求或使用筛查工具的情况下增加了药剂师的影响力，从而改善了患者的优先级排序，识别了药物相关问题并增加了干预措施。
