Understanding the implementation, impact and sustainable use of an electronic pharmacy referral service at hospital discharge: A qualitative evaluation from a sociotechnical perspective.

Introduction The transition of patients across care settings is associated with a high risk of errors and preventable medication-related harm. Ensuring effective communication of information between health professionals is considered important for improving patient safety. A National Health Service(NHS) organisation in the North West of England introduced an electronic transfer of care around medicines (TCAM) system which enabled hospital pharmacists to send information about patient’s medications to their nominated community pharmacy. We aimed to understand the adoption, and the implications for sustainable use in practice of the TCAM service Methods We evaluated the TCAM service in a Clinical Commissioning Group (CCG) and NHS Foundation Trust in Salford, United Kingdom (UK). Participants were opportunistically recruited to take part in qualitative interviews through stakeholder networks and during hospital admission, and included hospital pharmacists, hospital pharmacy technicians, community pharmacists, general practice-based pharmacists, patients and their carers. A thematic analysis, that was iterative and concurrent with data collection, was undertaken using a template approach. The interpretation of the data was informed by broad sociotechnical theory. Results Twenty-three interviews were conducted with health care professionals patients and carers. The ways in which the newly implemented TCAM intervention was adopted and used in practice and the perceptions of it from different stakeholders were conceptualised into four main thematic areas: The nature of the network and how it contributed to implementation, use and sustainability; The material properties of the system; How work practices for medicines safety were adapted and evolved; and The enhancement of medication safety activities. The TCAM intervention was perceived as effective in providing community pharmacists with timely, more accurate and enhanced information upon discharge. This allowed for pharmacists to enhance clinical services designed to ensure that accurate medication reconciliation was completed, and the correct medication was dispensed for the patient. Conclusions By providing pharmacy teams with accurate and enhanced information the TCAM intervention supported healthcare professionals to establish and/or strengthen interprofessional networks in order to provide clinical services designed to ensure that accurate medication reconciliation and dispensing activities were completed. However, the intervention was implemented into a complex and at times fragmented network, and we recommend opportunities be explored to fully integrate this network to involve patients/carers, general practice pharmacists and two-way communication between primary and secondary care to further enhance the reach and impact of the TCAM service.

Perceptions of pharmacists towards drug shortages in the healthcare system of Pakistan and its impact on patient care: findings from a cross-sectional survey

ObjectiveThis study aimed to explore pharmacists’ perceptions on drug shortages and its impingement on the Pakistani healthcare system, in particular on patient care.DesignOnline questionnaire survey.Setting and participantsHospital pharmacists from five out of seven regions of Pakistan were approached; including the federal territory (Islamabad) and four provinces (Khyber Pakhtunkhwa, Balochistan, Punjab and Sindh).Primary and secondary outcome measuresPrevalence and type of shortages were identified along with strategies to reduce its effect on patient care.MethodA validated questionnaire was distributed through various online platforms to 800 registered hospital pharmacists. A convenience sampling technique was used to obtain information on drug shortages, the reporting system for shortages, the impact on patients and policy solutions for managing drug shortages.ResultsOut of 800 hospital pharmacists, 708 completed the questionnaire (response rate: 88.5%). Of these hospital pharmacists, 47% came from hospitals of Punjab, 26% from Khyber Pakhtunkhwa, 13% from Sindh, 11% from Balochistan and 4% from Islamabad; 72% and 28% worked in tertiary and secondary hospitals, respectively. The majority (32%) interacted with shortages daily. The top three drug categories reported in shortage were oncology drugs (54%), cardiovascular drugs (53%) and antimicrobials (42%). 58% of the respondents have seen care delayed as a negative consequence of shortages. ‘Creating new communication system’ (65%) and ‘readjust budget plans’ (41%) were the two most frequently indicated recommendations for shortages management at hospital, while ‘circulars or alerts from the regulatory authority’ (60%) and ‘time to time directives from local health statuaries’ (48%) were two most widely suggested policy solutions.ConclusionDrug shortage is a serious concern in Pakistani hospitals, experienced on a daily basis endangering patients’ health. Enhanced communication is required, connecting the key stakeholders. Health policies should be reviewed; adequate funds should be allocated to the health sector preventing future shortages.

Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis

Antimicrobial stewardship programmes (ASPs) in hospitals are predominantly led by specific ASP physicians and pharmacists. Limited studies have been conducted to appreciate non-ASP-trained hospital pharmacists’ perspectives on their roles in antimicrobial stewardship. Focus group discussions (FGDs) were conducted with 74 pharmacists, purposively sampled from the 3 largest acute-care public hospitals in Singapore, to explore facilitators and barriers faced by them in antimicrobial stewardship. Applied thematic analysis was conducted and codes were categorised using the social–ecological model (SEM). At the intrapersonal level, pharmacists identified themselves as reviewers for drug safety before dispensing, confining to a restricted advisory role due to lack of clinical knowledge, experience, and empowerment to contribute actively to physicians’ prescribing decisions. At the interpersonal level, pharmacists expressed difficulties conveying their opinions and recommendations on antibiotic therapy to physicians despite frequent communications, but they assumed critical roles as educators for patients and their caregivers on proper antibiotic use. At the organisational level, in-house antibiotic guidelines supported pharmacists’ antibiotic interventions and recommendations. At the community level, pharmacists were motivated to improve low public awareness and knowledge on antibiotic use and antimicrobial resistance. These findings provide important insights into the gaps to be addressed in order to harness the untapped potential of hospital pharmacists and fully engage them in antimicrobial stewardship.

Development and use of an innovative Gap Finding Tool to create Pharmaceutical Care Model within a paediatric oncology setting

Introduction A paediatric cancer ward is a setting where pharmacists participate in direct patient care, acting as coordinators between the patient, caregivers and healthcare professionals. The aim of the study was to develop a Gap Finding Tool to support the setting up of a pharmaceutical care model at a Paediatric-Adolescent Cancer Ward. Methods The Standards of Practice for Clinical Pharmacy Services by the Society of Hospital Pharmacists of Australia Committee of Specialty Practice in Clinical Pharmacy (2013), the American College of Clinical Pharmacy (2014) and the European Association of Hospital Pharmacists (2014) were used to compile the Gap Finding Tool. The developed Tool was tested for content validity by a panel of experts and subsequently implemented over 2 months. Results The Gap Finding Tool comprised of nine sections with an average of eight statements each about pharmacy services that should be provided at ward level. For each statement, the rater indicates whether these contributions are provided. When the Tool was implemented at the Paediatric-Adolescent Cancer Ward, four major gaps were identified, namely, absence of a clinical pharmacist, lack of medicines information, vetting of chemotherapy prescriptions by pharmacist with limited access to patient data and lack of pharmacist-input on medicines availability. Processes requiring optimisation included discharge medication advice and documentation processes. Conclusion The developed Gap Finding Tool is an innovative tool which is versatile and can be used in ward or ambulatory clinical settings to identify gaps in pharmaceutical processes and services and compare national or regional practices to international standards.

Barriers and facilitators to patient-centred care in pharmacy consultations: A qualitative study with Malaysian hospital pharmacists and patients

Background Patient-centred care (PCC) has been suggested to provide benefits such as improved patient-healthcare provider communication and better disease self-management to patients. The practice of PCC should involve all healthcare professionals, including pharmacists who are well-positioned in providing pharmaceutical care to patients. However, a better understanding of the factors that can affect the practice of PCC in pharmacists’ consultations is needed. Objective To explore the perceptions of Malaysian hospital pharmacists and patients on the barriers and facilitators of a PCC approach in pharmacist consultations. Design This study employed a qualitative, explorative semi-structured interview design. Setting and participants Interviews were conducted with 17 patients and 18 pharmacists from three tertiary hospitals in Malaysia. The interviews were audiotaped and transcribed verbatim. Emerging themes were developed through a constant comparative approach and thematic analysis. Results Three themes were identified in this study: (i) patient-related factors (knowledge, role expectations, and sociocultural characteristics), (ii) pharmacist-related factors (personalities and communication), and (iii) healthcare institutional and system-related factors (resources, continuity of care, and interprofessional collaboration). Pharmacists and patients mentioned that factors such as patients’ knowledge and attitudes and pharmacists’ personality traits and communication styles can affect patients’ engagement in the consultation. Long waiting time and insufficient manpower were perceived as barriers to the practice of PCC. Continuity of care and interprofessional collaboration were viewed as crucial in providing supportive and tailored care to patients. Conclusion The study findings outlined the potential factors of PCC that may influence its implementation in pharmacist consultations. Strategic approaches can be undertaken by policymakers, healthcare institutions, and pharmacists themselves to address the identified barriers to more fully support the implementation of PCC in the pharmacy setting.

Assessment of Canadian Hospital Pharmacists’ Job Satisfaction and Impact of Clinical Pharmacy Key Performance Indicators

Background: The clinical pharmacy key performance indicators (cpKPIs) are quantifiable measures of quality to advance clinical pharmacy practice and improve patient care. Although when delivered in combination they have been linked to important patient outcomes, no data are available relating to their impact on hospital pharmacists’ job satisfaction. Objectives: To determine the level of job satisfaction among Canadian hospital pharmacists and whether participation in cpKPI activities contributes to hospital pharmacists’ job satisfaction. Methods: A mixed-methods study was conducted. An electronic survey, consisting of 36 questions, was developed using a validated pharmacist job satisfaction tool and was then distributed nationally to hospital pharmacists between January 30 and March 14, 2019. Focus groups were conducted with pharmacists at Horizon Health Network in New Brunswick to further explore activities that contribute to their job satisfaction. Results: Overall, 284 pharmacists from 9 provinces completed the electronic survey. The mean job satisfaction score among hospital pharmacists was 3.93 (standard deviation 0.85) out of 5. Job satisfaction scores increased with increases in self-identified time spent performing cpKPI activities (r = 0.148, p = 0.014). Pharmacist satisfaction increased with time spent performing medication reconciliation on admission (β = 0.140, p = 0.032) and decreased with time spent identifying and resolving drug therapy problems (β = –0.153, p = 0.030). Three focus groups, comprising a total of 13 pharmacists, were conducted; during these sessions, some cpKPIs were highlighted favourably, although pharmacists described some ambivalence toward patient education. The importance of having an impact and receiving appreciation was highlighted. Conclusions: Canadian hospital pharmacists are generally satisfied with their jobs, and participation in cpKPI activities was found to be positively associated with hospital pharmacists’ job satisfaction. RÉSUMÉ Contexte : Les indicateurs clés de performance de la pharmacie clinique (ICPpc) sont des mesures quantifiables de la qualité qui permettent de faire avancer la pratique en pharmacie et d’améliorer les soins du patient. Bien qu’ils aient été associés à des résultats importants pour les patients lorsqu’ils sont utilisés conjointement, aucune donnée concernant leur impact sur la satisfaction professionnelle des pharmaciens d’hôpitaux n’est disponible. Objectifs : Déterminer le degré de satisfaction professionnelle des pharmaciens d’hôpitaux canadiens et noter si la participation aux activités liées aux ICPpc y contribue. Méthodes : Une étude à méthodologie mixte a été menée. À l’aide d’un outil validé mesurant la satisfaction professionnelle du pharmacien, les investigateurs ont préparé une enquête électronique comprenant 36 questions, qui a été distribuée à l’échelle nationale aux pharmaciens d’hôpitaux entre le 30 janvier et le 14 mars 2019. Des groupes de travail comprenant des pharmaciens au Réseau de santé Horizon au Nouveau-Brunswick ont exploré plus en profondeur les activités qui contribuaient à leur satisfaction professionnelle. Résultats : Globalement, 284 pharmaciens de neuf provinces ont répondu à l’enquête électronique. Le score moyen de satisfaction des pharmaciens d’hôpitaux était de 3,93 (écart type 0,85) sur 5. Les scores relatifs à la satisfaction professionnelle augmentaient lorsque le temps passé à faire des activités liées aux ICPpc augmentait (r = 0,148, p = 0,014). La satisfaction du pharmacien augmentait quand il passait du temps à faire le bilan comparatif des médicaments au moment de l’admission (β = 0,140, p = 0,032) et diminuait quand il devait déterminer et résoudre des problèmes de pharmacothérapie (β = –0,153, p = 0,030). Trois groupes de discussion comprenant 13 pharmaciens au total se sont penchés sur la question. Pendant leurs séances, ils ont mis en valeur certains ICPpc, bien que les pharmaciens aient décrit des ambivalences concernant les instructions données au patient. Ils ont aussi souligné l’importance d’avoir un effet positif et d’être apprécié. Conclusions : Les pharmaciens d’hôpitaux canadiens sont généralement satisfaits de leur travail et la participation à des activités liées aux ICPpc est associée à leur satisfaction professionnelle.