Abstract
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.
Pharmacy services in the emergency department: not a butterfly effect
