Background In the UK, pharmacist independent prescribers can prescribe for any condition within their clinical competence including systemic anti-cancer therapy. Competency frameworks have been developed but contain little detail on the patient assessment skills pharmacist independent prescribers require to prescribe systemic anti-cancer therapy with concern in the literature over current training on these skills. Aim To gain consensus on the patient assessment skills required by pharmacist independent prescribers prescribing systemic anti-cancer therapy for genitourinary cancer (prostate and renal) and lung cancer across National Health Service Scotland. Method Two phases were performed to generate patient assessment skill consensus. Initially, the Nominal Group Technique was performed within a local cancer network by discussion and participant ranking within genitourinary and lung cancer multi-disciplinary teams. Where consensus was achieved, patient assessment skills were carried forward to try to achieve national (National Health Service Scotland) consensus using a two-round Delphi questionnaire. Results Of the 27 patient assessment skills, consensus was gained for 21 and 23 patient assessment skills in the genitourinary and lung Nominal Group Technique groups, respectively. Within the genitourinary and lung national groups, 13/21 and 18/23 patient assessment skills were agreed as required for a pharmacist independent prescriber to prescribe systemic anti-cancer therapy in genitourinary and lung cancer, respectively. Eight common patient assessment skills were identified as core skills. Reasons for not reaching consensus included pharmacist independent prescriber competence, knowledge, skills and the roles and responsibilities of pharmacist independent prescribers within the multi-disciplinary team. Conclusion We identified the core and specific patient assessment skills required to prescribe systemic anti-cancer therapy within two tumour groups. Further work is necessary to develop patient assessment skill competency frameworks, training and assessment methods and to redefine the roles of pharmacist independent prescribers within the multi-disciplinary team.
Survey and analysis of pharmaceutical care issues (PCIs) occurring during the course of chemotherapy. Feedback from future users to design and test a documentation system to facilitate information transfer between hospital and community pharmacists. Setting Day-case chemotherapy clinics at the Edinburgh Cancer Centre, community pharmacies providing palliative care services and community pharmacies used by patients recruited to the survey. Prospective cross-sectional cohort survey of PCIs in 90 day-case patients receiving chemotherapy. The identified PCIs and the interview transcripts from one-to-one interviews with six local specialist community pharmacists informed the design of the patient medication profile (PMP), the use of which was tested in 20 patients. Two postal questionnaires were used: one to 153 pharmacists in other UK cancer centres/units, one to 20 community pharmacists involved in the testing of the PMP. Of the 271 recorded PCIs in 90 patients, 41% (112/271) PCIs were identified for the transfer of care and were mostly associated with supportive medication prescribed to manage chemotherapy toxicities. In the testing of the PMP, 88 PCIs were identified in 20 patients and 59% (52/88) of PCIs judged relevant to continuity of care were documented on the PMP and transferred via the patient to community pharmacists together with an information sheet and questionnaire. Seventy-five percent (15/20) of pharmacists replied to the questionnaire, indicating they had followed up 52% (27/52) of all transferred PCIs. ‘Lack of time’ was the only reason given by community pharmacists for not following up PCIs. The majority of community pharmacists thought the information received was useful and increased their contribution to patient care. Although oncology patients receive treatment in secondary care, almost half of the associated PCIs require follow-up in primary care between cycles of chemotherapy. The PMP was considered supportive to community pharmacists in the continuity of pharmaceutical care of these patients. The study helped to define the next stage of the development work which requires to define patients' needs and to test a system in practice. Community pharmacists' expectations and requirements must be part of the continuing development of the seamless provision of pharmaceutical care to this patient group
Articles were rated by strength of evidence.4 Level 1 evidence, that established by meta-analysis or systemic review (and also the highest level of evidence) was not found. No Cochrane reviews or national practice guidelines that were related to the subject had been published between 2007 and 2012. Since that time, a clinical practice guideline 2 related to pain, agitation, and delirium in the critically ill has A new bundle of interventions to improve the care of critically ill patients receiving mechanical ventilation has been identified. 1,2This bundle incorporates performance and coordination of spontaneous awakening trials and spontaneous breathing trials; careful selection of sedatives; assessment, prevention, and management of delirium; and early exercise with progressive mobility.1,2 In collaboration with the Institute for Healthcare Improvement, and as a part of a critical care collaborative, our hospital had implemented many parts of the bundle, but early exercise and progressive mobility had not yet been incorporated into care. In this article, we share our process for literature review, appraisal, and synthesis along with protocol development. An evidencebased performance improvement (EBPI) model was used to plan, implement, and disseminate the change.3 High-fidelity human simulation boosted confidence and teamwork and also underscored important safety aspects before implementation. Unit champions and daily multidisciplinary rounding assisted with culture change.
Background and Issues: Stroke is the leading cause of dysphagia with 42% to 67% of patients presenting with dysphagia within 3 days. Patients admitted to Fisher-Titus Medical Center with stroke-like symptoms were often missed for dysphagia screening or given oral medication prior to a screening. After investigation, it was discovered that the screening process and the electronic medical record (EMR) were too lengthy, hard to remember to complete, and not mandatory fields. The purpose of this initiative was to leverage the EMR to improve staff compliance rates to Healthcare Facilities Accreditation Program (HFAP) stroke accreditation standards of dysphagia screening for TIA and ischemic stroke patients. Methods: A multidisciplinary team was formed to analyze factors contributing to missed dysphagia screenings. The team then modified the EMR to make it more lean and effective. Changes to the EMR included: addition of a mandatory “Risk Factors for Stroke” check box targeting vague stroke symptoms; auto-population of the dysphagia screen form when a “risk factor” was selected; and implementation of a rapid screen format. Dysphagia screening rates were monitored over 16 quarters. Results: The purpose of the initiative to improve the EMR, streamline the screening process, and increase staff compliance rates of dysphagia screening to HFAP standard of >85%. This goal was met. Prior to the changes in the EMR, compliance rates in 2011 were inconsistent and significantly below threshold. The multidisciplinary team was formed in Q1 2012, began changes in the EMR Q3 2012, and concluded changes in Q1 2014. Since conclusion of EMR revisions the threshold has been consistently exceeded. Conclusions: Our data suggests that optimizing the use and functionality of EMR formats improve compliance rates of dysphagia screenings. In our sample, after completion of EMR changes compliance rate averaged 96%. Other institutions who wish to improve compliance rates of dysphagia screenings (and potentially other clinical standards) should consider evaluating their current EMR format, delineating its strengths/weaknesses by interviewing team members, and revising to optimize compliance.
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