Clinical pharmacist assessment of drug-related problems among intensive care unit patients in a Turkish university hospital

Background Critically ill patients treated in the intensive care units (ICUs) often suffer from side effects and drug-related problems (DRPs) that can be life-threatening. A way to prevent DRPs and improve drug safety and efficacy is to include clinical pharmacists in the clinical team. This study aims to evaluate the classification of drug-related problems and the implementation of clinical pharmacy services by a clinical pharmacist in the ICU of a university hospital in Turkey. Methods This study was carried out prospectively between December 2020 and July 2021 in Gazi University Medical Faculty Hospital Internal Diseases ICU. All patients hospitalized in the intensive care unit for more than 24 h were included in the study. During the study, the clinical pharmacist's interventions and other clinical services for patients were recorded. DRPs were classed according to the Pharmaceutical Care Network Europe V.8.02. Results A total of 151 patients were included during the study period corresponding to 2264 patient-days. Patients with DRPs had a longer hospital stay and a higher mortality rate (p < 0.05). 108 patients had at least one DRP and the total number of DRPs was 206. There was an average of 1.36 DRPs per patient, 71.5% of patients experienced DRP and 89.22 DRPs per 1000 patient-days. A total of 35 ADEs were observed in 32 patients. ADE incidence was per 1000 patient-days 15.45. ADEs were caused by nephrotoxicity (48.57%), electrolyte disorders (17.14%), drug-induced thrombocytopenia (17.14%), liver enzyme increase (8.57%) and other causes (8.57%). Drug selection (40.29%) and dose selection (54.36%) constituted most of the causes of DRPs. Dose change was the highest percentage of planned interventions with a rate of 56.79%. Intervention was accepted at a rate of 90.8% and it was fully implemented. Conclusion In this study, the importance of the clinical pharmacist in the determination and analysis of DRPs was emphasized. Clinical pharmacy services like the one described should be implemented widely to increase patient safety.

UPAYA PENERAPAN METODE LEAN THINKING PADA PROSES PELAYANAN FARMASI RAWAT JALAN

Pharmacy services in a hospital are an inaccessible part of the hospital services as a whole. The accumulation of prescriptions in the pharmacy will cause the prescription process to be long and long, which has an impact on customer waiting times, which of course will have a major impact on customer satisfaction. From the standard time set as Quality Indicators at Bali Jimbaran Hospital, namely: drug processing at the outpatient pharmacy of Bali Jimbaran Hospital is 60 minutes of concocted drugs, 30 minutes of non-concocted drugs. The purpose of this research is to identify activities starting from the input, process and results generated through the Lean approach. The method used is an observational action process research, using lean methods to photograph the outpatient pharmacy service process flow through document review, direct interviews, interviews. The result of the research is an improvement in waiting time, it can be seen that the NVA activities can be eliminated by 66% and VA activities show an increase of 44%. With the many activities that are VA and the elimination of NVA activities, it will accelerate the process of outpatient pharmacy services at the Bali Jimbaran Hospital and improve customer satisfaction, which can be seen from the decrease in customer complaints against outpatient pharmacy services by up to 50%, which was previously 80%. Keywords: Lean, Pharmacist, Waiting time, Value Added, Non-Value Added

Provision of community pharmacy services during the first wave of COVID-19 pandemic in Estonia – experiences and future implications

The spread of COVID-19 outbreak in 2020 had significant impact on the functioning of the existing healthcare system and required fast adaption to new circumstances for continuing with daily practices. Community pharmacists shared responsibility of ensuring supply of medicines and medical devices, educating people on health related issues, providing pharmaceutical care etc. The aim of this study was to understand how the provision of community pharmacy services changed during the first wave of COVID-19 pandemic in spring of 2020 in Estonia. Qualitative in-depth semi-structured interviews were conducted. Recorded interviews with community pharmacists (n = 21) and experts (n =10) were transcribed verbatim and a systematic text condensation method for textual content analysis was performed. The findings indicated that a number of changes took place in provision of community pharmacy services to assure continuity in providing high-quality pharmacy services in crisis, including addressing difficulties in the supply of medicines; at the same time, to acquire new knowledge for counselling health related topics and personal protective equipment, and to provide psychological support to people in stress. Pandemic had an impact on the content and structure of traditional community pharmacy services in Estonia. The need for expanded professional role of pharmacists was clearly expressed in an emergency situation.

The Sri Lankan Perspective of Implementing Clinical Pharmacy Services

Clinical Pharmacists provide pharmaceutical care to patients to ensure quality use of medicines and to improve patients’ quality of life. Although clinical pharmacy services have shown medication related benefits to patients, this service has still not been formerly established in Sri Lanka. This report is on the status of developing clinical pharmacy services in Sri Lanka as perceived by an academic who has been involved in teaching, research, and in the development of clinical pharmacy services in Sri Lanka. Keywords: Clinical pharmacy, Pharmacy education, Pharmaceutical care, Sri Lanka

The Manchester Framework For The Evaluation of Emergency Department Pharmacy Services

Background: Many countries, including the United Kingdom, have established Emergency Department (ED) pharmacy services where some ED pharmacists now work as practitioners. They provide both traditional pharmaceutical care and novel practitioner care i.e. clinical examination, yet their impact on quality of care is unknown.Aim: To develop a framework of structures, processes and potential outcome indicators to support evaluation of the quality of ED pharmacy services in future studies.Method: Framework components (structures, processes and potential outcome indicators) were identified in three ways, from a narrative review of relevant international literature identified through systematic searches; a panel meeting with ED pharmacists; and a panel meeting with other ED healthcare professionals. Structures and processes were collated into categories developed iteratively throughout data collection, with outcome indicators collated into six domains of quality as proposed by the Institute of Medicine. These raw data were then processed e.g. outcome indicators screened for clarity i.e. those which explicitly stated what would be measured were included in the framework.Results: A total of 190 structures, 533 processes, and 503 outcome indicators were identified. Through data processing a total of 153 outcome indicators were included in the final framework divided into the domains safe (32 outcome indicators), effective (50), patient centred (18), timely (24), efficient (20) and equitable (9). Fewer potential outcome indicators were identified for the patient centred, efficient and equitable domains than others. Conclusion: Whilst frameworks to support evaluation of general ED care exist, this is the first framework specific to ED pharmacy services. Although included in the framework, potential outcome indicators require further development prior to their use in evaluation studies. To that end, evaluation teams should be multidisciplinary and ideally involve researchers with expertise in outcome measurement. Finally, evaluation should not neglect some domains of quality at the expense of others, as previously found by the Institute of Medicine. High quality health services are not only safe, effective and timely, but also patient centred, efficient and equitable.

Association of pharmacy services with patient satisfaction in public and private tertiary care hospitals of Rawalpindi and Islamabad

Background The healthcare system in Pakistan is facing a shortage of human resources and appropriate and sustainable financial measures and therefore fails to provide optimum services to the population of Pakistan. Furthermore, research is limited in the healthcare institutes; therefore, there is a scarcity of information about patient satisfaction with pharmacists and pharmacy services in Pakistan. As evident from the inadequate information in the literature, patients’ opinions about the pharmacy services in Pakistan are important [1]. Therefore, the current study was designed to assess patient satisfaction with the pharmacy performance of the outpatient pharmacy and its variation with socio-demographic characteristics in twin cities of Pakistan (Rawalpindi and Islamabad). Method A cross-sectional study design was used to assess the patient satisfaction through convenience sampling technique. Minimum sample size of 250 respondents who visit pharmacy department of public and private hospital for pharmaceutical care were included in this study. A pre validated tool was used to assess the patient satisfaction. Data was clean coded and import into spss for analysis. Descriptive and inferential statistic was applied to calculate frequency, standard deviation, mean deviation and p value to find the association among different domain of patient satisfaction with different demographic characteristics of respondents. Result Current study shows overall patients were satisfied from pharmacy services provided by government and private hospitals. Furthermore patient satisfaction towards pharmacist medication advice was very good however patient satisfaction towards pharmacist approach was good while patient perception with pharmacy setting, drug availability and cost were underrated. Significance difference (p ≤ 0.05) was observed in pharmacist’s approach with different gender, age groups and qualification. No significant difference (p ≥ 0.05) was observed in pharmacy setting drug availability and cost with different gender, age groups and marital status of respondents. However Significance difference (p ≤ 0.05) was observed in pharmacy setting drug availability and cost with different level of education patients with less education had better satisfaction as compared to highly educated respondents. Furthermore Significance difference (p ≤ 0.05) was observed in pharmacy setting drug availability and cost with occupation. Self-employee and government employee had low satisfaction score while other had better satisfactory score. Significance difference (p ≤ 0.05) was observed in pharmacist’s approach with different gender, age groups and qualification. Females had better satisfactory score as compared to female. Younger age group had better satisfaction as compared to elderly. Patients belong to higher educational groups had better satisfaction toward pharmacist approach as compared to low qualification groups respondents. Furthermore No significant difference (p ≥ 0.05) was observed in pharmacist’s approach with marital status and number of visits Conclusion Current study concluded that overall patient had average satisfaction score. Patients shows a better satisfaction towards pharmacist behavior/ way of handling the patients, information provided by pharmacist regarding medicine. Patient had less satisfaction towards the location of pharmacy, Availability and affordability of medicine. Patient shows negative satisfaction regarding waiting area and counselling area at in door patient pharmacy. It has been observed that educated respondents shows high level of satisfaction towards pharmacist availability and information provided by the pharmacist.

Impact of Pharmacy Services on Time to Elexacaftor-Tezacaftor-Ivacaftor Initiation

The approval of elexacaftor-tezacaftor-ivacaftor (ELX/TEZ/IVA) expanded highly effective cystic fibrosis transmembrane receptor modulator therapy to approximately 90% of persons age 12 and older with cystic fibrosis. Clinical pharmacists and pharmacy technicians played a key role in planning for ELX/TEZ/IVA initiation prior to FDA approval as well as initiating therapy after approval. This study evaluates the impact of pharmacy services on time to ELX/TEZ/IVA initiation. A retrospective chart review evaluated patients qualifying for ELX/TEZ/IVA at a single health system between October 21, 2019 and April 1, 2020. Patients filling ELX/TEZ/IVA at an integrated health system specialty pharmacy (HSSP) versus an outside specialty pharmacy (SP) started on therapy an average of 10.8 days faster (10.8 days ± 14.0 vs 21.6 days ± 18.8 respectively; p=0.006). More patients filling at a HSSP received ELX/TEZ/IVA within 14 days of the prescription being written compared to outside SPs (82.0% vs 41.4% respectively; p=0.001). Pre-ELX/TEZ/IVA initiation, patients were hospitalized for a CF related complication for an average of 6.26 days (range 0-183) compared to 1.16 days (range 0-91) post-ELX/TEZ/IVA initiation. Lastly, an estimated $134,810 was saved in the 105 patients that were able to fill ELX/TEZ/IVA at a HSSP by initiating drug an average of 10.8 days quicker than outside SPs. The results of this study demonstrate the value of an integrated HSSP model. Further advocacy for inclusion of integrated HSSPs by pharmacy benefit managers is needed to optimize medication access, control costs, and improve patient outcomes for patients receiving care within a health system.

The Importance of the Pharmacist’s Role and the Quality of Pharmacy Services in Nursing Home Care

The Centers for Medicare & Medicaid Services requires nursing homes (NHs) to provide pharmacy services to ensure the safety of medication use, such as minimizing off-label medication use for residents with dementia. This study examined NH’s response to this requirement and its relationship to medication-related outcomes. The contemporaneous relationship between the quality of pharmacy services and outcome measures were modeled using facility-level longitudinal data from 2011-2017 and facility fixed-effects. The results revealed that deficiency in pharmacy services increased medication-related issues by: 11% in inappropriate medication regimen, 5% in medication error rate &gt;5%, and 3% in any serious medication errors. Additionally, deficiency in pharmacy services was associated with small but statistically significant increases in antipsychotic use, residents with daily pain, number of hospitalizations and rehospitalization rate. The results suggest that pharmacy services have a direct and immediate impact on medication outcomes. The results underscore the importance of pharmacy services in NHs.