Timely Discharge Prescription Review by Clinical Pharmacists at a COVID-19 Facility

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.

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Side Effects of Chemotherapy and Cancer Treatment in Tertiary Care Teaching Hospital

Research in Pharmacy and Health Sciences ◽

10.32463/rphs.2016.v02i01.13 ◽

2016 ◽

Vol 2 (1) ◽

pp. 62-78

Author(s):

. Hemraj ◽

Raj Kumar ◽

Sourabh Kosey ◽

Amit Sharma ◽

Nalini Negi

Keyword(s):

Side Effects ◽

Tertiary Care ◽

Cross Sectional Study ◽

Informational Needs ◽

Cross Sectional ◽

Clinical Pharmacists ◽

Medical College ◽

Related Information ◽

The Common ◽

Chemotherapy Patients

To determine the most common physical side effects experienced by local chemotherapy patients. Their perceptions of these side effects and informational needs from clinical pharmacists were also evaluated. This was a single center, observational cross-sectional study conducted at department of General Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab. A face to face interview was conducted. Information collected included chemotherapy related side effects after last chemotherapy experience, the most worrisome side effects, overlooked by healthcare professionals and the preferred method, amount and source of receiving related information. In this study, hundred patients were enrolled out of them 48 were male and 52 were female. When differential calculations was done, common side effects or adverse effects of chemotherapy in the patients of breast, lung cancer, Ovarian Cancer, Colon cancer, Prostate cancer, Lymphoma Cancer, Cervix cancer where there is much irregular medicine intake 57.4% may be due to common problem of joint pain reported by all the patients under study, with the consecutive problem of nausea and vomiting. The high prevalence of chemotherapy related side effects among local patients is a major concern and findings of their perceptions and informational needs may serve as a valuable guide for clinical pharmacists and physicians to help in side effect management. This study shows the common problems reported by the patients when they are suffering from cancer condition, according to their incidence perceptions as experienced by the patient, this will allow the physician and clinical pharmacist to effectively counsel and manage the common symptoms as reported prior to its occurrence in the patient, so that withdrawal can be checked.

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Electronic medication systems simplify antimicrobial prescription review by clinical pharmacists and facilitate complex antimicrobial stewardship interventions

10.26226/morressier.5991c409d462b80292388c18 ◽

2017 ◽

Author(s):

Flaminia Olearo

Keyword(s):

Antimicrobial Stewardship ◽

Clinical Pharmacists ◽

Medication Systems ◽

Antimicrobial Prescription

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Evaluation of the Effectiveness of Clinical Pharmacists’ Consultation in the Treatment of Infectious Diseases: A Single-Arm, Prospective Cohort Study

Frontiers in Pharmacology ◽

10.3389/fphar.2019.00187 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 3

Author(s):

Jiaxing Zhang ◽

Xin Qian ◽

Lingmin Zhang ◽

Linfang Hu ◽

Lingyan Fan ◽

...

Keyword(s):

Cohort Study ◽

Infectious Diseases ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Clinical Pharmacists

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Immunosuppression medication adherence after allogeneic hematopoietic stem cell transplant: Impact of a specialized clinical pharmacy program

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211000115 ◽

2021 ◽

pp. 107815522110001

Author(s):

Florent Charra ◽

Michael Philippe ◽

Chloé Herledan ◽

Anne-Gaëlle Caffin ◽

Virginie Larbre ◽

...

Keyword(s):

Clinical Pharmacy ◽

Hematopoietic Stem Cell Transplant ◽

Acute Gvhd ◽

Intervention Group ◽

Serum Levels ◽

Control Group ◽

Cell Transplant ◽

Drug Adherence ◽

Hematopoietic Stem ◽

Discharge Prescription

This study aims to evaluate the impact of implementing a specialized clinical pharmacy program in patients with allogeneic hematopoietic stem cell transplant (HSCT) on their adherence to the immunosuppression treatment after discharge. A prospective open interventional design using a retrospective control group was used. The intervention was based on pharmaceutical consultations: the first was performed the day before discharge of HSCT unit and the next consultations during day-care follow-up (weeks 2 and 4 after discharge). Proactive medication reconciliation was implemented with a complete list of medications before the discharge prescription. The discharge prescription summarized on a personalized drug schedule was explained to the patient. The importance of optimal adherence and the potential problems related to self-medication were explained to the patient. Immunosuppression drug adherence was assessed by a direct method using serum levels of calcineurin inhibitors. The potential impact on acute GvHD, and infection was investigated. Twenty-six patients were included in the specialized clinical pharmacy program and 35 patients were in the control group. Seventy-nine pharmaceutical consultations were conducted in the intervention group, lasting a mean 25 min and 16 min for the first and following consultations, respectively. Serum levels in the therapeutic target range were higher in the intervention group (61.5% versus 53.0%, p = 0.07), with greater intra-individual variation (p = 0.005). There was no significant intergroup difference in acute GvHD (53.8% versus 50.3%, p = 0.85) or infection (26.9 versus 22.8%, p = 0.72). The implementation of a specialized clinical pharmacy program for patients who have received allogeneic HSCT seems to be beneficial for immunosuppression drug adherence; this now needs to be confirmed in a multicenter study involving a larger number of patients.

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Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before–after study

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab011 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Joao Gabriel Rosa Ramos ◽

Sandra Cristina Hernandes ◽

Talita Teles Teixeira Pereira ◽

Shana Oliveira ◽

Denis de Melo Soares ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Phase 1 ◽

Phase 2 ◽

Differential Impact ◽

Scarce Resources ◽

Clinical Pharmacists ◽

Versus Phase ◽

Quasi Experimental ◽

The Impact

Abstract Background Clinical pharmacists have an important role in the intensive care unit (ICU) team but are scarce resources. Our aim was to evaluate the impact of on-site pharmacists on medical prescriptions in the ICU. Methods This is a retrospective, quasi-experimental, controlled before-after study in two ICUs. Interventions by pharmacists were evaluated in phase 1 (February to November 2016) and phase 2 (February to May 2017) in ICU A (intervention) and ICU B (control). In phase 1, both ICUs had a telepharmacy service in which medical prescriptions were evaluated and interventions were made remotely. In phase 2, an on-site pharmacist was implemented in ICU A, but not in ICU B. We compared the number of interventions that were accepted in phase 1 versus phase 2. Results During the study period, 8797/9603 (91.6%) prescriptions were evaluated, and 935 (10.6%) needed intervention. In phase 2, there was an increase in the proportion of interventions that were accepted by the physician in comparison to phase 1 (93.9% versus 76.8%, P < 0.001) in ICU A, but there was no change in ICU B (75.2% versus 73.9%, P = 0.845). Conclusion An on-site pharmacist in the ICU was associated with an increase in the proportion of interventions that were accepted by physicians.

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A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists

Applied Clinical Informatics ◽

10.1055/s-0041-1722916 ◽

2021 ◽

Vol 12 (02) ◽

pp. 199-207

Author(s):

Liang Yan ◽

Thomas Reese ◽

Scott D. Nelson

Keyword(s):

Patient Safety ◽

Quality Of Care ◽

Decision Support ◽

Clinical Decision Support ◽

Clinical Decision ◽

Controlled Trials ◽

Clinical Pharmacists ◽

Randomized Controlled ◽

The Impact

Abstract Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.

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