Activities of the Clinical Pharmacist Practicing in the Office of a Family Practitioner

1975 ◽  
Vol 9 (3) ◽  
pp. 129-133 ◽  
Author(s):  
Paul J. Perry ◽  
Stephen C. Hurley
Keyword(s):  
Patient Care ◽  
Community Pharmacist ◽  
Clinical Pharmacist ◽  
Care Facility ◽  
Improve Patient Care ◽  
Family Practitioner ◽  
Care Services ◽  
Time Motion ◽  
Motion Study ◽  
Significant Difference

The activities of a clinical pharmacist within a primary care facility are measured in a time-motion study. This type of practice allows the pharmacist an opportunity to provide many patient-care services normally unavailable at community pharmacies. The innovative services are described in detail to establish how they produce savings of physician time and to imply how they improve patient care. The activities of the clinical pharmacist are compared to those of the community pharmacist. The indications are that a significant difference exists between the activities of the community pharmacist and a clinical pharmacist working within the office of a physician.

Comparison of Time spent between an electronic and a paper-based laboratory information system by laboratorians at a polyclinic in Greater Accra, Ghana: A time-motion study

2020 ◽  
Author(s):  
Philip Boakye
Keyword(s):  
Information System ◽  
Negative Impact ◽  
Laboratory Information System ◽  
Time Motion ◽  
Accessible Information ◽  
Motion Study ◽  
Significant Difference ◽  
Significant Negative Impact ◽  
Key Issues ◽  
Motion Studies

The acceptance of electronic laboratory information system (LIS) is gradually increasing in developing countries. However, the issue of time effectiveness due to computerization is less clear as there is fewer accessible information. One of the key issues for laboratorians is their indecision with LISs’ would-be effect of time on their work. A polyclinic in Ghana was in the process of implementing electronic LIS. Several of the laboratorians did not have knowledge and skill in computing and there were disagreeing views on the time effectiveness of the LIS after implementation. The management of the polyclinic laboratory was concerned to assess time advantageousness of recording data when using the electronic LIS compared with paper-based LIS. <div><br></div><div>Five randomly selected laboratorians were provided two sheets of paper with tables to document the time they spent for both paper-based and electronic LIS. Data were collected for a total of 230 records,115 electronic LIS and 115 paper-based LIS. The t-test (mean-comparison test) was computed to compare the means of both electronic and paperbased LIS times. </div><div><br></div><div>There was a statistical significant difference in the time spent between electronic and paper-based LIS. The time spent between paper-based and electronic LIS was 0.41 minutes (95% CI 0.15 to 0.66) longer than in electronic LIS. </div><div><br></div><div>LIS can be adopted in polyclinics without having significant negative impact on time spent between electronic and paper-based LIS. More time–motion studies that include laboratorians are however necessary in order to get a more complete picture of time spent between electronic and paper-based LIS. </div>

Abstract 11119: Real-Time Nanopore Sequencing for Bacterial Pneumonia After Out-of-Hospital Cardiac Arrest, a Pilot Proof-of-Concept Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Alexandra Weissman ◽  
Mariam Bramah Lawani ◽  
Thomas Rohan ◽  
Clifton W CALLAWAY
Keyword(s):  
Patient Care ◽  
Pathogen Detection ◽  
Bacterial Pathogen ◽  
Improve Patient Care ◽  
Antibiotic Administration ◽  
Nanopore Sequencing ◽  
Proof Of Concept ◽  
Chi Square ◽  
Significant Difference ◽  
Improve Patient

Introduction: Pneumonia is common after OHCA but is difficult to diagnose in the first 72 hours following ROSC, this results in early untargeted antibiotic administration based on non-specific imaging and laboratory findings. Antibiotic resistance is rising, is influenced by untargeted antibiotic administration, and can increase patient morbidity and mortality as well as healthcare costs. Precision methods of bacterial pathogen detection in OHCA patients are needed to improve patient care. This proof-of-concept pilot study aimed to assess feasibility of bacterial pathogen sequencing and comparability of sequencing results to clinical culture after OHCA. Methods: Blood and bronchoalveolar lavage (BAL) were obtained from residual clinical specimens collected within 12 hours of ROSC. Bacterial DNA was extracted using the Qiagen PowerLyzer PowerSoil DNA kit, sequenced using the MinION nanopore sequencer, and analyzed with Oxford Nanopore Technologies’ EPI2ME bioinformatics software. Sequencing results were compared to culture results using McNemar’s chi-square statistic. Study-defined pneumonia was based on presence of at least two characteristics within 72 hours of ROSC: fever (temperature ≥38°C); persistent leukocytosis >15,000 or leukopenia <3,500 for 48 hours; persistent chest radiography infiltrates for 48 hours per clinical radiology read; bacterial pathogen cultured. Results: We enrolled 38 consecutive OHCA subjects: mean age 61.8 years (18.0); 16 (42%) female; 25 (66%) White, 7 (18%) Black, 6 (16%) “Other” race; 7 subjects (18%) survived and 31 (82%) died; 16 (42%) subjects had pneumonia. Sequencing results were available in 12 hours while culture results were available in 48-72 hours after collection. There was a non-significant difference in the proportion of the same pathogens identified for each method per McNemar’s chi-square: p = 0.38, difference of 0.095 (-0.095, 0.286). Conclusions: Nanopore sequencing detects pathogenic bacteria comparable to clinical microbiologic culture and in less time. This technology can produce a paradigm shift in early bacterial pathogen detection in OHCA survivors, which can improve patient care. The technology is applicable to other patient populations and for viral and fungal pathogens.

scholarly journals High-Resolution Esophageal Manometry: A Time Motion Study

2008 ◽  
Vol 22 (4) ◽  
pp. 365-368 ◽  
Author(s):  
Daniel C Sadowski ◽  
Linda Broenink
Keyword(s):  
High Resolution ◽  
Esophageal Manometry ◽  
Clinical Investigation ◽  
Study Quality ◽  
Procedure Time ◽  
High Resolution Manometry ◽  
Time Motion ◽  
Motion Study ◽  
Significant Difference ◽  
End Times

INTRODUCTION: High-resolution manometry (HRM) of the esophagus is a new technique that provides a more precise assessment of esophageal motility than conventional techniques. Because HRM measures pressure events along the entire length of the esophagus simultaneously, clinical procedure time should be shorter because less catheter manipulation is required. According to manufacturer advertising, the new HRM system is more accurate and up to 50% faster than conventional methods.OBJECTIVE: To test the hypothesis that clinical testing with HRM requires less procedural time than a standard water perfusion (WP) method.METHODS: Forty-one consecutive patients were studied (20 underwent WP and 21 underwent HRM). Using time-motion analysis, the start and end times for each task associated with performing the study were recorded. Patient discomfort and study quality were also assessed by using five- and four-point qualitative scales, respectively.RESULTS: Total procedure time was reduced on average by 25.6% in the HRM group (from 41.8 minutes with WP to 30.7 minutes with HRM, P<0.05). There was no significant difference in the discomfort scores reported by the study subjects and no difference in study quality.CONCLUSIONS: HRM requires less time to complete than conventional manometry and should therefore shorten the wait-times of patients scheduled for esophageal manometry and have a significant impact on the cost of performing this commonly used clinical investigation.

A Time-Motion Study of Patient Care Activities of a Geriatric Home Care Team

1983 ◽  
Vol 4 (1) ◽  
pp. 67-78 ◽  
Author(s):  
James G. Zimmer ◽  
Annemarie Groth-Juncker
Keyword(s):  
Home Care ◽  
Patient Care ◽  
Care Team ◽  
Time Motion ◽  
Motion Study

scholarly journals MP02: The impact of adoption of an electronic health record on emergency physician work: a time motion study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S42-S43
Author(s):  
S. Calder-Sprackman ◽  
G. Clapham ◽  
T. Kandiah ◽  
J. Choo-Foo ◽  
S. Aggarwal ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Emergency Physician ◽  
Chart Review ◽  
Direct Patient Care ◽  
Health Record ◽  
Physical Movement ◽  
Time Motion ◽  
Motion Study ◽  
The Impact

Introduction: Adoption of a new Electronic Health Record (EHR) can introduce radical changes in task allocation, work processes, and efficiency for providers. In June 2019, The Ottawa Hospital transitioned from a primarily paper based EHR to a comprehensive EHR (Epic) using a “big bang” approach. The objective of this study was to assess the impact of the transition to Epic on Emergency Physician (EP) work activities in a tertiary care academic Emergency Department (ED). Methods: We conducted a time motion study of EPs on shift in low acuity areas of our ED (CTAS 3-5). Fifteen EPs representing a spectrum of pre-Epic baseline workflow efficiencies were directly observed in real-time during two 4-hour sessions prior to EHR implementation (May 2019) and again in go live (August 2019). Trained observers performed continuous observation and measured times for the following EP tasks: chart review, direct patient care, documentation, physical movement, communication, teaching, handover, and other (including breaks). We compared time spent on tasks pre Epic and during go live and report mean times for the EP tasks per patient and per shift using two tailed t-test for comparison. Results: All physicians had a 17% decrease in patients seen after Epic implementation (2.72/hr vs 2.24/hr, p < 0.01). EPs spent the same amount of time per patient on direct patient care and chart review (direct patient care: 9min06sec/pt pre vs 8min56sec/pt go live, p = 0.77; chart review: 2min47sec/pt pre vs 2min50sec/pt go live, p = 0.88), however, documentation time increased (5min28sec/pt pre vs 7min12sec/pt go live, p < 0.01). Time spent on shift teaching learners increased but did not reach statistical significance (31min26sec/shift pre vs 36min21sec/shift go live, p = 0.39), and time spent on non-patient-specific activities – physical movement, handover, team communication, and other – did not change (50min49sec/shift pre vs 50min53sec/shift go live, p = 0.99). Conclusion: Implementation of Epic did not affect EP time with individual patients - there was no change in direct patient care or chart review. Documentation time increased and EP efficiency (patients seen per hr on shift) decreased after go live. Patient volumes cannot be adjusted in the ED therefore anticipating the EHR impact on EP workflow is critical for successful implementation. EDs may consider up staffing 20% during go live. Findings from this study can inform how to best support EDs nationally through transition to EHR.

Pharmacist-Initiated Prior Authorization Process to Improve Patient Care in a Psychiatric Acute Care Hospital

2014 ◽  
Vol 28 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Shari N. Allen ◽  
Mebanga Ojong-Salako
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Acute Care ◽  
Health Care Professionals ◽  
Care Facility ◽  
Improve Patient Care ◽  
Care Hospital ◽  
Prior Authorization ◽  
Care Plans ◽  
Effective Manner

A prior authorization (PA) is a requirement implemented by managed care organizations to help provide medications to consumers in a cost-effective manner. The PA process may be seen as a barrier by prescribers, pharmacists, pharmaceutical companies, and consumers. The lack of a standardized PA process, implemented prior to a patient’s discharge from a health care facility, may increase nonadherence to inpatient prescribed medications. Pharmacists and other health care professionals can implement a PA process specific to their institution. This article describes a pharmacist-initiated PA process implemented at an acute care psychiatric hospital. This process was initiated secondary to a need for a standardized process at the facility. To date, the process has been seen as a valuable aspect to patient care. Plans to expand this process include collecting data with regards to adherence and readmissions as well as applying for a grant to help develop a program to automate the PA program at this facility.

Building the Case: Changing Consumer Perceptions of the Value of Expanded Community Pharmacist Services

2018 ◽  
Vol 32 (6) ◽  
pp. 637-647 ◽  
Author(s):  
Kathryn Steckowych ◽  
Marie Smith ◽  
Susan Spiggle ◽  
Andrew Stevens ◽  
Hao Li
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Community Pharmacist ◽  
Community Pharmacists ◽  
Primary Care Providers ◽  
Consumer Perceptions ◽  
Care Practice ◽  
Care Services ◽  
Facilitators And Barriers ◽  
Pharmacist Services

Background: The role of the community pharmacist has traditionally been a medication dispenser; however, community pharmacists’ responsibilities must expand to include more direct patient care services in order to transform primary care practice. Objectives: Use case-based scenarios to (1) determine factors that contribute to positive and negative consumer perceptions of expanded community pharmacist patient care roles, (2) identify facilitators and barriers that contribute to consumer perceptions of the value of expanded community pharmacist patient care services, and (3) develop a successful approach and strategies for increasing consumer advocacy for the value of expanded community pharmacist patient care services. Methods: Two consumer focus groups used scenario-based guided discussions and Likert scale questionnaires to elicit consumer reactions, facilitators, and barriers to expanded community pharmacist services. Results: Convenience, timeliness, and accessibility were common positive reactions across all 3 scenarios. Team approach to care and trust were viewed as major facilitators. Participant concerns included uncertainty about pharmacist training and qualifications, privacy, pharmacists’ limited bandwidth to accept new tasks, and potential increased patient costs. Common barriers to service uptake included a lack of insurance payment and physician preference to provide the services. Conclusion: Consumer unfamiliarity with non-traditional community pharmacist services is likely an influencer of consumers’ hesitancy to utilize such services; therefore, an opportunity exists to engage consumers and advocacy organizations in supporting expanded community pharmacist roles. This study can inform consumers, advocates, community pharmacists, primary care providers, and community-based organizations on methods to shape consumer perceptions on the value of community pharmacist expanded services.

Reporting Sysmex XN Absolute Neutrophil Count in Samples with Leukocyte Analyzer Flagging

2020 ◽  
Author(s):  
Anna-Maria Linko-Parvinen ◽  
Heidi Turkia
Keyword(s):  
Confidence Interval ◽  
Patient Care ◽  
Absolute Neutrophil Count ◽  
Neutrophil Count ◽  
Laboratory Data ◽  
Improve Patient Care ◽  
Significant Difference ◽  
Clinically Significant ◽  
Method Bias ◽  
Improve Patient

Abstract Objective To provide faster laboratory data reporting, we evaluated the accuracy of Sysmex XN (Sysmex Inc, Kobe, Japan) absolute neutrophil count (ANC) in the presence of analyzer flagging. Methods Sysmex XN and manual microscopy ANC were compared with 80 autovalidated control specimens and with 280 study specimens with analyzer flagging regarding immature granulocytes (IG) &gt;3% or other leukocyte abnormalities. Specimens with ambiguous neutrophil clusters were excluded. Results A slight positive overall method bias was seen for Sysmex XN compared to manual microscopy (n = 280), 0.025 (95% confidence interval [CI], –0.023 to 0.069) × 109/L. With IG &gt; 10% (n = 123) the bias was larger, but not clinically significant, 0.17 (95% CI, 0.060–0.25) × 109/L. No clinically significant difference was seen in neutropenic (ANC &lt; 1.5 × 109/L) specimens (n = 91), 0.070 (95% CI, –0.013 to 0.14) × 109/L. Conclusion These data indicate that Sysmex XN ANC can be reported in the presence of certain analyzer flagging to improve patient care.

Pathophysiology of Volume Administration in Septic Shock and the Role of the Clinical Pharmacist

2019 ◽  
Vol 54 (4) ◽  
pp. 388-396
Author(s):  
Brittany D. Bissell ◽  
Breanne Mefford
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Patient Care ◽  
Fluid Balance ◽  
Clinical Pharmacist ◽  
Improve Patient Care ◽  
Positive Fluid Balance ◽  
Medline Search ◽  
Icu Stay ◽  
Organ Systems

Objective: To review physiological rationale and evidence base surrounding fluid harm to prepare the clinical pharmacist for accountability regarding volume-related outcomes. Data Sources: A PubMed/MEDLINE search was conducted using the following terms: (fluid therapy) AND [(critical care) OR (sepsis)] from 1966 to August 2019 published in English. Study Selection and Data Extraction: A total of 3364 citations were reviewed with only relevant clinical data extracted. Data Synthesis: Although early fluid resuscitation may be a necessary component to decrease mortality in the majority of patients with septic shock admitted to the intensive care unit (ICU), the benefit of continued administration after the first 24 hours is uncertain. Paradoxically, a positive fluid balance secondary to intravenous fluid receipt has been associated with diverse and perpetuating detriment on a multitude of organ systems after the first 24 hours of ICU stay. Continued clinical harm has been demonstrated on patient outcomes such as rates of mortality and length of stay. Despite the growing body of evidence supporting the potential adverse aspects of positive fluid balance, fluid overload remains common during critical care admission. Conclusion: Physiological concerns to overly zealous fluid administration and subsequent volume overload are vast. Relevance to Patient Care and Clinical Practice: Optimization of fluid balance in critically ill patients with sepsis is primed for clinical pharmacy intervention. Critical care pharmacists have the potential to improve patient care by optimizing fluid pharmacotherapy while potentially reducing adverse events, days on mechanical ventilation, and length of ICU stay.

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