AN ELECTRONIC PRESCRIPTION ALERTING SYSTEM-IMPROVING THE DISCHARGE MEDICINES PROCESS

2016 ◽  
Vol 101 (9) ◽  
pp. e2.55-e2 ◽  
Author(s):  
Amanda Bevan ◽  
Niesh Patel
Keyword(s):  
Clinical Pharmacist ◽  
Text Messaging ◽  
Database Query ◽  
Electronic Prescription ◽  
Clinical Pharmacists ◽  
Data Extract ◽  
Alerting System ◽  
Cost Implications ◽  
Electronic Messaging ◽  
Discharge Prescription

BackgroundWhilst the prescribing of both in-patient and discharge medicines is electronic, there was no automatic notification to clinical pharmacists when a discharge prescription was ready to be screened. The notification required a member of medical or nursing staff to bleep their pharmacist informing them of a prescription's availability. This manual process led to a delay in pharmacist screening which impacted on discharge. Prescriptions designated for pre-packed or patient's own medicine use were not seen at all by a clinical pharmacist. The initial intention was to develop a text messaging service; however this was not possible due to significant cost implications and its inflexibility.AimTo decrease the time to clinical pharmacist screening for children's discharge prescriptions.MethodA clinical pharmacist prescription alerting system was designed and implemented. The hospital's eDischarge Summaries are created and stored in the Trust's EPR database. A database query is executed that examines documents that have been signed by a prescriber which contain drug orders. The query runs every 15 minutes, Monday to Friday from 0800–2000. The database query exports a HTML data extract which is then packaged and sent using Exchange.Email was preferred as users access hospital WiFi, only receiving notifications on those laptops or smartphones connected to the Trust's email application. The HTML is embedded within the email body. The email is sent to named individuals within a given distribution list. The function is scalable to support all areas using Trust eDischarge Summaries.The system was introduced in April 2015. Data from before (June 2014–January 2015) and after (June 2015) implementation was compared.ResultsPrior to the introduction of an electronic alerting system the average time from a prescriber signing a prescription to clinical pharmacist screening was 93 minutes. Three months after starting the new system this time has reduced to 62 minutes, a reduction of 31 minutes or 33%. During the same time period, the number of discharge prescriptions screened by pharmacists rose from 172 to 218, an increase in workload of 26%.It has been possible to intervene on prescriptions containing errors which the clinical pharmacists would not previously have screened.ConclusionThe use of an electronic messaging system has met its primary aim to decrease the time delay from signing to pharmacist screening it has also increased pharmacist efficiency as evidenced by the increased workload.One limitation of this system is that it requires a regular e-mail check, for available prescriptions. The report runs every 15 minutes, an email is only sent if a prescription is found.The notification of all discharge prescriptions containing medicines has led to the identification of errors which have required intervention, in those prescriptions that a pharmacist would not have previously seen. These interventions have been for children who have received pre-packed antibiotics directly from the wards or for those where we have provided one-stop dispensing.It is hoped to role out this system across other areas of the organisation which should also enjoy this significant improvement in discharge prescription turnaround.

scholarly journals A study on Pharm D Students Present Views and Future Plans

2020 ◽  
pp. 232-236
Author(s):  
Badmanaban R ◽  
Janice Jacson Mandumpala ◽  
Krupamol Joy ◽  
Sulaikha Abdul Kareem ◽  
Bharat Mishra
Keyword(s):  
Clinical Pharmacist ◽  
Health Sciences ◽  
Career Plans ◽  
Clinical Pharmacists ◽  
Future Career ◽  
Online Portal ◽  
Work Abroad ◽  
Future Plans

Objective- This study aims to evaluate reasons for joining the Pharm D program among the graduates and students, their levels of satisfaction regarding choice, their perception towards the program and future career plans. Methods- All students and graduates under the Kerala University of Health Sciences, KUHS were invited to participate in the study conducted using the online portal- Google forms. Results- A total of 199 participants responded to the questionnaire, where the main reasons for choosing the program were to serve the society (88.4%), he/she is good at science (81.4%) and to settle and work abroad (70.9%). Working as hospital Clinical Pharmacist (87.9%) and Pharmacovigilance(80.4%) were the most preferred future career plans. About 59.8% respondents were ambitious towards pharmacy field. Conclusion- More than half of the respondents were satisfied to choose pharmacy and their reason for choice was to serve the society which outstood other factors and were more inclined to depict their skills in the field of pharmacovigilance and as clinical pharmacists.

Description of Pharmacist Recommendations in the Caring for Older Adults and Caregivers at Home (COACH) Program

2020 ◽  
Vol 35 (1) ◽  
pp. 38-46 ◽  
Author(s):  
Brittany Loy Melville ◽  
Janine Bailey ◽  
Jason Moss ◽  
William Bryan ◽  
Judith Davagnino ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Pharmacist ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Program Assessment ◽  
Potentially Inappropriate Medications ◽  
Care Model ◽  
Clinical Pharmacists ◽  
Coach Program ◽  
At Home

OBJECTIVE: To describe recommendations made by geriatric clinical pharmacists within an innovative care model focusing on patients with dementia living at home. DESIGN: Retrospective chart review. SETTING: Outpatients in a tertiary care Veterans Affairs health care system. PARTICIPANTS: Veterans who underwent a Caring for Older Adults and Caregivers at Home (COACH) Program assessment and had at least one medicationrelated recommendation made by a geriatric clinical pharmacist. MAIN OUTCOME MEASURES: The primary endpoint was the number and category of medication-related recommendations made by a geriatric clinical pharmacist at the initial COACH program assessment. Secondary endpoints were recommendation acceptance rates and change in potentially inappropriate medications (PIMs) at six months. RESULTS: There were 104 patients included. The mean age was 81 years and the majority of patients were male and Caucasian. At baseline, patients were receiving a mean of 12 medications/person, and 59% of patients were receiving at least one PIM. There were 248 total medication recommendations made, with a mean of 2.4 recommendations/person (range 1-5). The three most common recommendation categories were to discontinue a drug, decrease the dose, and switch to a potentially safer alternative. Providers accepted 110 (44%) recommendations within six months. Patients were receiving a mean of one PIM/person at baseline, and no change was observed at six months.CONCLUSION: This study describes recommendations made through medication reviews by geriatric clinical pharmacists within an innovative care model for patients with dementia living at home. These data may provide information to other clinical pharmacists implementing consult services in similar settings.

P6145Atrial fibrillation screening in care homes by clinical pharmacists using pulse palpation and single-lead ECG: a feasibility study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Savickas ◽  
A J Stewart ◽  
V J Short ◽  
A Mathie ◽  
S K Bhamra ◽  
...  
Keyword(s):  
General Population ◽  
Feasibility Study ◽  
Anticoagulant Therapy ◽  
Clinical Pharmacist ◽  
Community Education ◽  
Mental Capacity ◽  
Care Homes ◽  
Hand Tremor ◽  
Clinical Pharmacists ◽  
Pulse Palpation

Abstract Background The prevalence of atrial fibrillation (AF) amongst care home residents ranges from 7–19% with the number of undiagnosed cases five-fold above that of the general population. Clinical pharmacists providing services to care homes may offer opportunistic AF screening, improving residents' access to timely diagnosis and treatment. Purpose The aim of this feasibility study was to determine the prevalence of AF in UK care homes and to evaluate the feasibility of clinical pharmacist-led AF screening in this setting. It also aimed to ascertain the proportion of residents who could be screened using pulse palpation and single-lead electrocardiogram (ECG) and those with new AF who qualified for anticoagulant therapy. Methods This screening initiative was delivered in 4 care homes linked to 2 general practices in Kent (UK). The clinical pharmacist providing AF screening was trained by a cardiologist to pulse palpate and record a mobile ECG. A designated general practitioner (GP) assessed each resident's mental capacity to consent. Any residents with mental capacity and no pacemaker were offered a free heart rhythm check with the pharmacist. After written consent, each participant underwent a pulse palpation (1 min), followed by ECG (30 sec) and a provisional diagnosis. All ECGs were overread by a cardiologist within 72 hrs, and any residents requiring further investigation were referred to their GP. Results Fifty-three eligible individuals (mean age 90 years, 76% female) were screened between October 2018 and January 2019. Fifty-eight residents (52%) could not be screened due to lack of mental capacity. One participant with a regular pulse could not be tested with the ECG device due to severe hand tremor. The quality of 14 ECGs (27%) was determined as poor. Following the cardiologist's interpretation, 17 residents (33%) required a 12-lead ECG: 7 (14%) with possible AF and 10 (19%) with an inconclusive result. Amongst those with suspected AF, 5 had hypertension, 3 - chronic kidney disease and 2 - diabetes mellitus or peripheral vascular disease. Five had not been previously diagnosed with AF and all qualified for anticoagulant therapy (CHA2DS2-VASc ≥2). The device's algorithm displayed low sensitivity for AF (57%) despite greater agreement with the cardiologist's interpretation (Cohen's κ 0.70) than either the pharmacist's interpretation (0.56) or pulse palpation (0.44). Conclusion(s) This research was the first of its kind in UK care homes and identified a suspected AF prevalence >5 times higher than in the general population. Several barriers to AF screening in this setting, including mental incapacity and physical comorbidities, led to poor ECG quality, low diagnostic accuracy and 1 in 5 inconclusive diagnoses potentially limiting the economic viability of the intervention proposed. Future studies will explore the feasibility of using alternative strategies which may circumvent these barriers to AF screening in care homes. Acknowledgement/Funding This work was supported by Kent Surrey and Sussex Community Education Providers Network and Faculty of Science Research Funding, University of Kent.

scholarly journals Assessment of Clinical Pharmacists' Assistance for Patients With Established Cardiovascular Diseases During the COVID-19 Pandemic: Insights From Southern India

2020 ◽  
Vol 7 ◽  
Author(s):  
Oliver Joel Gona ◽  
Ramesh Madhan ◽  
Sunil Kumar Shambu
Keyword(s):  
Cardiovascular Diseases ◽  
Clinical Pharmacist ◽  
Southern India ◽  
World Health ◽  
Self Management ◽  
Sign Test ◽  
Care Hospital ◽  
Post Intervention ◽  
Clinical Pharmacists ◽  
Coronary Syndrome

Objectives: We aimed to assess the clinical pharmacist-initiated telephone-based patient education and self-management support for patients with cardiovascular disease during the nationwide lockdown during COVID-19 pandemic.Methods: A prospective single-center telephone-based cross-sectional study was conducted among patients at the Cardiology Department and its speciality clinic at a 1,800-bed tertiary care hospital in Southern India. A validated 8-item clinical pharmacist aided on-call questionnaire with two Domains was administered during and after lockdown (15 March and 8 June 2020). Clinical pharmacist-provided educational assistance on self-management practices were in accordance with the guidelines of Indian Council of Medical Research (ICMR) and World Health Organization. Comparisons was performed using sign test and association of responses were analyzed using the Goodman and Kruskal's gamma test. All the tests were two-tailed, p < 0.05 was considered to be statistically significant.Results: Of the 1,080 patients, 907 consented with a response rate of (83.9%) and 574 (96.36%) patients were analyzed post-intervention. Majority of the patients were male (54.7%) and had Acute Coronary Syndrome [NSTEMI (42.10%), STEMI (33.92%) and Unstable Angina (9.86)]. The majority of subjects had at least two co-morbid conditions [(Type II Diabetes (48.33%), Hypertension (50.11%)] and were rural population (82.5%) as self-employed (43.1%) with a middle-class economy (31.6%). In the Domain-1 of checklist the awareness toward complications caused by COVID-19 in cardiovascular diseases (Z = −19.698, p = 0.000) and the importance of universal safety precautions enhanced after clinical pharmacist assistance [(Z = −8.603, p = 0.000) and (Z = −21.795, p = 0.000)]. In Domain-II of checklist there was a significant improvement in patients awareness toward fatal complications caused by COVID-19 (Z = −20.543, p = 0.000), maintenance of self-hygiene (Z = −19.287, p = 0.000), practice of universal safety precautions (Z = −16.912, p = 0.000) and self-isolation (Z = −19.545, p = 0.000). The results of our study population varied from baseline evaluation (41.7%, n = 907) to post-intervention (95%, n = 574) based on Literacy, employment status and economic status.Conclusions: The proactive role of clinical pharmacists in providing instructional services in collaboration with cardiologist during the pandemic circumstances increased patients understanding and mitigated infection exposure among patients, health care professionals and also assuring the continuity of care in patients with established cardiovascular diseases.

scholarly journals Evaluation of a clinical pharmacist team-based telehealth intervention in a rural clinic setting: a pilot study of feasibility, organizational perceptions, and return on investment

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Logan T. Murry ◽  
Christopher P. Parker ◽  
Rachel J. Finkelstein ◽  
Matthew Arnold ◽  
Korey Kennelty
Keyword(s):  
Clinical Pharmacy ◽  
Clinical Pharmacist ◽  
Return On Investment ◽  
Assistance Program ◽  
Medication Discrepancies ◽  
Clinical Pharmacists ◽  
Clinic Setting ◽  
Rural Clinic ◽  
Uncontrolled Diabetes ◽  
Telehealth Intervention

Abstract Background Remote, centralized clinical pharmacist services provided by board-certified clinical pharmacists have been shown to effectively assist in chronic disease management. We assess the feasibility of implementing a pharmacist-led, remote, centralized pharmacy service to improve A1c levels in patient with diabetes in a rural clinic setting. Methods This was a non-randomized pilot and feasibility study. Participants were enrolled in a pharmacist-led telehealth intervention service, with data prior to enrollment used as baseline data for control. To be included, patients needed to have A1c readings of greater than 7% to be considered uncontrolled. A1c changes were reported for two groups based on A1c ranges: between 7 and 10% and ≥ 10%. Clinical pharmacists and clinical pharmacy interns initiated contact with patients via telephone communication and managed the patients remotely. The following outcomes were evaluated: organization perceptions (patients, providers, and clinic staff), changes in A1c, medication discrepancies, impact of an internally operated Patient Assistance Program, and potential return on investment (ROI). Results Fifty-two patients were initially identified and referred to the service with 43 patients consenting to participate in the intervention. Patient and provider survey responses were recorded. In the initial analysis occurring during the first 3 to 5 months of the program, there was considerable improvement in diabetes control as measured by A1c. For patients with uncontrolled diabetes with a baseline A1c > 7% but less than < 10% and ≥ 10%, the intervention resulted in an A1c decrease of 0.57% and 2.55%, respectively. Clinical pharmacists and clinical pharmacy interns identified at least one medication discrepancy in 44% of patients, with number of discrepancies ranging from 1 to 5 per patient. At the conclusion of the study window, 42 potentially billable encounters were documented, which would have generated a net profit of $1140 USD, had they been submitted for reimbursement. Given the potential revenue generation, the service theoretically yields a ROI of 1.4 to 1. Conclusions Initial results suggest that a pharmacist-led telehealth intervention has potential to decrease A1c levels in patients with diabetes, assist in identification of medication discrepancies, provide a positive return on investment for rural clinics, and potentially increase reimbursement for providers and clinics tasked with managing patients with uncontrolled diabetes.

OPINIONS OF USERS OF PHARMACY SERVICE PROVIDED TO PICU

2016 ◽  
Vol 101 (9) ◽  
pp. e2.59-e2
Author(s):  
Rhian Isaac ◽  
Astrid Gerrard ◽  
Kevin Bazaz
Keyword(s):  
Nurse Practitioners ◽  
Clinical Pharmacist ◽  
Time Allocation ◽  
Pharmacy Service ◽  
Clinical Pharmacy Service ◽  
Therapeutic Drug ◽  
Free Text ◽  
Pharmacy Services ◽  
Clinical Pharmacists ◽  
Ward Rounds

BackgroundPressures to open pharmacy services 7 days a week, with no financial input for these extra resources, has knock on effects that may dilute accessibility to clinical pharmacists in specialist areas.AimsThe aim of this survey was to assess opinions of the users of the current pharmacy services to PICU and the planned extended hours provision.MethodAn e-survey was sent to PIC Consultants, Advanced Nurse Practitioners, and Senior Nursing Staff following a six month period of increased clinical pharmacists time allocation to PIC. Free-text area was added to each multiple choice question.ResultsTwenty-four staff responded, 14 prescribers and 10 senior nursesPresence of PICU trained clinical pharmacist on morning ward rounds was considered essential by 19 (79%) respondents and desirable by 4 (17%). Attendance on the afternoon round was deemed essential by 14 (59%) and desirable by 8 (33%) of respondents.Comments on the benefits of pharmacists on ward rounds included:“Enabling a second professional review of the patient overall—it prevents forced direction from the consultant and the pharmacists are empowered to ask us to reconsider. Very useful to have this safety and reality check.”“Essential for the guidance of drug usage and drug chart review which improves safety, benefit of advice for use with specialist patients, best cost approach, multiple benefits.”Roles expected as routine from the clinical pharmacist included patient safety (100%), managing parenteral nutrition (80%), advice on intravenous therapy e.g. compatibility (100%), education of the multidisciplinary team (96%), management of long term medicines e.g. sedation withdrawal (83%), and therapeutic drug monitoring control (83%).Only 6 respondents felt the PICU patient would benefit from extending access to dispensary only over weekends, 11 felt that there was no benefit, and 6 respondent unsure.Provision of the pharmacy on call service which involves both supply and clinical advice, was felt sufficient to the requirements of the PICU patient by less than a third of repondents,56% feeling the current service insufficient. Comments on the on call service included.“difficult to get experienced advice on weekends”“need access to pic pharmacists officially.”“we may direct queries to the on call pharmacy staff but 9 times out of 10 theses queries are redirected to our PICU pharmacists. Our questions are answered at any time of the weekend”Ninety one percent answered positively to the final question asked about extending the current clinical pharmacy service from 5 to 7 days per week. Comments included.“PICU is a 24 hr, 7 day a week service…how we can provide adequate care to children if this valuable service is only provided 5 days a week.”ConclusionPharmacy is a valued service on PICU, where the service users support increased access and attendance on certain ward rounds by specifically PICU trained pharmacist.

scholarly journals Integrating a Clinical Pharmacist into a Multidisciplinary Pain Center: Feedback and Perspectives

2021 ◽  
Author(s):  
Amélie BOURSIER ◽  
Laurie Ferret ◽  
Julie Fulcrand ◽  
Julie Delvoye - Heiremans ◽  
Pascal Charpentier ◽  
...  
Keyword(s):  
Clinical Pharmacy ◽  
Clinical Pharmacist ◽  
Care Team ◽  
Clinical Pharmacy Service ◽  
Healthcare Team ◽  
Clinical Pharmacists ◽  
Team Satisfaction ◽  
Pain Center ◽  
Multidisciplinary Pain Center

Abstract Background:In January 2017, two clinical pharmacists joined our institution’s multidisciplinary pain center care team. They help optimize management of chronic pain patients. The purpose of this study is to present and discuss an innovative model of clinical pharmacy development in France.Method:A retrospective study for the period January 1, 2017 to June 30, 2019 was conducted.The care team evaluated the clinical pharmacy service using a satisfaction questionnaire.The outcome measures were the type of activities, number of interventions and healthcare team satisfaction.Results:During this period, the clinical pharmacists intervened 1839 times. Conventional clinical pharmacy activities do not represent the majority of solicitations, which shows the advantage of both adapting the activities deployed to the expectations of care teams and expanding care packages to those needs.Pharmaceutical advice was the main activity, mostly given to physicians (55%) and patients (35%).They consisted in contributing to the choice of drug strategy, explaining the treatment, adjusting a dosage, and improving relations between hospital and community caregivers.The feedback forms showed that caregivers believe that clinical pharmacy has positive impacts on patient care and healthcare team quality of life. Conclusion:The numerous requests for clinical pharmacist interventions show the care team’s significant interest in this new activity. Clinical pharmacy has shown its added value in patient quality of care and helps optimize the patient's care pathway by decompartmentalizing hospital and community medicine.This clinical pharmacy development model is innovative in France, as pharmacists are full members of the care team. Specific activities were set up progressively according to the care team’s needs. Caregivers’ expectations and requests made in clinical pharmacy progressed over time to more specialized activities. Assessment of team satisfaction showed that this model was very well accepted by caregivers and highlights the relevance of adapting and specializing clinical pharmacy development to the care team’s needs.

scholarly journals Utilizing Consumer Health Informatics to Support Management of Hypertension by Clinical Pharmacists in Primary Care: Study Protocol (Preprint)

2017 ◽  
Author(s):  
Lorraine R Buis ◽  
Dana N Roberson ◽  
Reema Kadri ◽  
Nicole G Rockey ◽  
Melissa A Plegue ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Clinical Pharmacist ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Home Blood Pressure ◽  
Health Concern ◽  
Clinical Pharmacists ◽  
Mhealth Intervention

BACKGROUND Hypertension (HTN) is a major public health concern in the United States given its wide prevalence, high cost, and poor rates of control. Multiple strategies to counter this growing epidemic have been studied, and home blood pressure (BP) monitoring, mobile health (mHealth) interventions, and referrals to clinical pharmacists for BP management have all shown potential to be effective intervention strategies. OBJECTIVE The purpose of this study is to establish feasibility and acceptability of BPTrack, a clinical pharmacist-led mHealth intervention that aims to improve BP control by supporting home BP monitoring and medication adherence among patients with uncontrolled HTN. BPTrack is an intervention that makes home-monitored BP data available to clinical pharmacists for use in HTN management. Secondarily, this study seeks to understand barriers to adoption of this intervention, as well as points of improvement among key stakeholders, so that larger scale dissemination of the intervention may be achieved and more rigorous research can be conducted. METHODS This study is recruiting up to 25 individuals who have poorly controlled HTN from a Family Medicine clinic affiliated with a large Midwestern academic medical center. Patient participants complete a baseline visit, including installation and instructions on how to use BPTrack. Patient participants are then asked to follow the BP monitoring protocol for a period of 12 weeks, and subsequently complete a follow-up visit at the conclusion of the study period. RESULTS The recruitment period for the pilot study began in November 2016, and data collection is expected to conclude in late-2017. CONCLUSIONS This pilot study seeks to document the feasibility and acceptability of a clinical pharmacist-led mHealth approach to managing HTN within a primary care setting. Through our 12-week pilot study, we expect to lend support for this approach, and lay the foundation for translating this approach into wider-scale implementation. This mHealth intervention seeks to leverage the multidisciplinary care team already in place within primary care, and to improve health outcomes for patients with uncontrolled HTN. CLINICALTRIAL Clinicaltrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 (Archived by WebCite® at http://www.webcitation.org/6u3wTGbe6)

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