No abstract

Introduction The increasing incidence of cancer and the finite capacity of hospital aseptic compounding units pose a serious challenge to the provision of cancer care. Chemotherapy dose-banding is a method of rationalising parenteral chemotherapy dosing and supply, whereby patient-individualised doses are rounded to predetermined banded doses. The banded doses may be outsourced as stock items which increases the supply capacity of the aseptic compounding unit. Methods Kotter's 8-step change management model was used to structure the implementation of dose-banding of 5-fluorouracil 46-h infusers on the haematology-oncology day ward in St. James's Hospital, Dublin. The impact of dose-banding on local practice was assessed through pre- and post-implementation surveys of stakeholders. Results In-house surveys of pharmacy, medical and nursing staff identified a generally favourable attitude towards implementing changes in the parenteral chemotherapy supply system, with some resistance to change evident. Dose-banding of 5-fluorouracil 46-h infusers was implemented successfully on the haematology-oncology day ward. Dose rationalisation and flexibility of re-allocation of standard banded doses between patients were the primary benefits of dose-banding found. Post-implementation surveys showed that clinical staff were in favour of adopting dose-banding into standard practice; however, they were cautious about the degree to which the results of this limited study would be translated into substantive benefits if dose-banding was adopted for all suitable preparations. Conclusion The success of the implementation process and the favourable opinions of stakeholders shown in the post-implementation survey enabled the dose-banding service to be extended to a further nine drugs. Kotter's 8-step change management model was a useful tool for structuring this process change in St. James's Hospital.

Background Advances in medicines reconciliation, drug monitoring and patient counselling requirements as well as added non-clinical responsibilities at ward level have led to an increased workload on a ward-based pharmacist. There is a need to optimise the service to meet these demands. The aim of this study was to audit the current clinical pharmacy services and to implement a New Model of Clinical Pharmacy on four wards to aid in the optimisation and prioritisation of patients during the clinical ward service. Methods The study was undertaken in Dublin based, University Teaching Hospital between March and June 2018. The study included the following: (1) a comprehensive literature review, (2) focus groups with key decision makers, (3) the collection and analysis of quantitative data on patients screening and interventions performed pre- and post- model implementation, (4) the final stage involved a satisfaction surveys from pharmacists involved in the study. Local ethical approval was obtained for this study. Results The new clinical pharmacy model increased the amount of medicines reconciliation completed (pre-model implementation 77.7% (n=192) versus post-model implementation 81.6% (n=236)), decreased time to medication reconciliation completion on Mondays and Fridays, increased discharge information cards completed and did not show statistical inferiority in the amount of interventions picked up by pharmacists (p value= 0.86; two tailed t-test). Pharmacists in the study felt the model impacted their clinical ward visit positively and aided prioritisation but did not improve on their overall job satisfaction level. Conclusion The study shows that a new model of clinical pharmacy can impact positively on a pharmacist’s working day by formalising the prioritisation of high-risk patients, setting clear expectations and structure without impacting negatively on other clinical duties. It is believed that the model developed will continue to support the pharmacists’ decision making and workload prioritisation post implementation of electronic prescribing.