Clinical pharmacist service in the acute ward

Nielsen, Trine Rune Høgh; Andersen, Stig Ejdrup; Rasmussen, Mette; Honoré, Per Hartvig

doi:10.1007/s11096-013-9837-1

Cited by 48 publications

(54 citation statements)

References 50 publications

(65 reference statements)

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“…This is less than the 44 min found in a comparable Danish study12 and longer than the 21.2 min found by Gleason et al 20. In general, it is difficult to compare results of time expenditures, since most studies do not state exactly what components were actually covered.…”

Section: Discussionmentioning

confidence: 69%

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Impact of clinical pharmacist intervention on length of stay in an acute admission unit: a cluster randomised study

et al. 2015

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Objectives Physicians in acute admission units (AAUs) are obliged to obtain medication history and perform medication reconciliation, which is time consuming and often incomplete. Studies show that clinical pharmacists (CPs) can obtain accurate medication histories, but so far no studies have investigated the effect of this on time measures. Therefore, the objective of the present study was to investigate the effect of a CP intervention on length of stay (LOS) in an AAU. Methods The study was designed as a prospective, cluster randomised study. Weekdays were randomised to control or intervention. CP intervention consisted of obtaining medication history and performing medication reconciliation and review. The primary outcome was LOS in the AAU. Secondary outcomes were other timerelated measures-for example, physicians' self-reported time spent on medication topics. Finally, the number of documented medications per patient was established. Results 232 and 216 patients, respectively, were included on control (n=63) and intervention (n=63) days. The mean LOS was 342 (95% CI 323 to 362) min in the intervention group and 339 (95% CI 322 to 357) min in the control group, which was not statistically significantly different. Physicians spent on average 4.3 (95% CI 3.7 to 5.0) min in the intervention group and 7.5 (95% CI 6.6 to 8.5) min in the control group, corresponding to an overall reduction of 43.0% (95% CI 30.9% to 53.

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Section: Discussionmentioning

confidence: 69%

“…An average reduction of 30 min between study groups was considered a clinically relevant difference in LOS. This was based on data from a study with a similar CP intervention taking 44 min 12. To take clustering into account, we used an intracluster correlation coefficient (ICC) of 0.05.…”

Section: Methodsmentioning

confidence: 99%

Impact of clinical pharmacist intervention on length of stay in an acute admission unit: a cluster randomised study

et al. 2015

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“…This enables the pharmacist to perform a more comprehensive medication review, as the pharmacist has more information available. In other models proposed for medication review in the acute hospital setting, the pharmacist meets the patient before the physician,12 which adds the element of obtaining the medication history and to conduct medication reconciliation before the actual review can be performed. A recent Danish study has shown that more medication-related problems are found, when medication reconciliation is also performed, but that the clinical importance is largest for problems found during medication review 24.…”

Section: Discussionmentioning

confidence: 99%

“…As an example, a recent systematic review could in 18 out of 31 studies not even determine if the pharmacists’ recommendations were passed on to the physician orally or in writing 2. A few, more recent, studies have published their methodologies in detail, one specific to the hospital setting,12 one specific to a primary care setting13 and one which can be used in both settings 14. The setting will likely influence the procedure for medication review, due to variations in access to the full medical record, laboratory results and contact with the physician and patient.…”

Section: Introductionmentioning

confidence: 99%

Pharmacist-led medication review in an acute admissions unit: a systematic procedure description

Graabæk

Bonnerup

Kjeldsen³

et al. 2015

Eur J Hosp Pharm

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ObjectivesOver the last decades, several papers have evaluated clinical pharmacy interventions in hospital settings with conflicting findings as results. Medication reviews are frequently a central component of these interventions. However, the term ‘medication review’ covers a plethora of principles and methodologies, and the practical procedure is seldom described in detail, which makes reproducing study findings difficult. The objective of this paper is to provide a detailed description of a procedure developed and used for pharmacist-led medication review in acute admissions units.MethodsA procedure was developed based on clinical experience and inspiration from previous studies and literature on medication review models. The procedure was developed to fit the busy workflow in acute admissions units.ResultsThe procedure consists of five steps: (1) collection of clinical patient data, (2) collection of information about the patient's medical treatment, (3) patient interview, (4) critical examination of the patient's medications and (5) recommendations for the hospital physician.ConclusionsWe have provided a detailed description of a procedure for pharmacist-led medication review. We do so, not to provide or advocate a single one-size-fits-all solution, but in an attempt to inspire a debate of the practical approach on how to execute a systematic medication review in order to develop and expand clinical pharmacy and achieve better patient outcomes.

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“…The acceptance rate of CP interventions varies considerably, ranging from 18% to 80% 11 13 17 18. One reason for this could be how interventions are communicated, which has been shown to influence the acceptance rate 11 13 19…”

Section: Introductionmentioning

confidence: 99%

Consequence of delegating medication-related tasks from physician to clinical pharmacist in an acute admission unit: an analytical study

et al. 2016

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ObjectivesStudies have shown that medication histories obtained by clinical pharmacists (CPs) are more complete, and that medication reviews by CPs reduce healthcare costs, drug-related readmissions and emergency readmissions. The aim of this study was to identify the consequences of delegating medication-related tasks from physicians to CPs.MethodsAn analytical study based on data from a prospective cluster randomised trial was performed. The intervention consisted of CPs obtaining medication history, performing medication reconciliation and medication review. The physician had to approve the prescriptions and assess changes proposed by the CP. The primary outcome measure was a comparison of changes in the Electronic Medication Module (EMM) and changes proposed by CPs.Results232 and 216 patients were included on control days (n=63) and intervention days (n=63). In total, 1018 changes were made in the control group (by physicians). In the intervention group 2123 changes were made, 1808 by CPs and 315 by physicians. In particular, the number of substitutions, registration of drugs and change of instructions for use (eg, administration times) differed between physicians and pharmacists. CPs made 341 written proposals in the intervention group and, of these, 22.9% (95% CI 18.7% to 27.8%) and 50.9% (95% CI 45.5% to 56.2%) were accepted by a physician at discharge from the acute admission unit (AAU) and hospital, respectively.ConclusionsCPs updated the EMM more thoroughly than physicians, especially entering new prescriptions, substitutions and changing instructions for use. Half of the written proposals were accepted. The extent to which patients benefit from a CP intervention is unknown.

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Clinical pharmacist service in the acute ward

Cited by 48 publications

References 50 publications

Impact of clinical pharmacist intervention on length of stay in an acute admission unit: a cluster randomised study

Impact of clinical pharmacist intervention on length of stay in an acute admission unit: a cluster randomised study

Pharmacist-led medication review in an acute admissions unit: a systematic procedure description

Consequence of delegating medication-related tasks from physician to clinical pharmacist in an acute admission unit: an analytical study

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