Evaluation of the impact of the addition of a heart failure prescribing pharmacist to consultant-led heart failure ward round at a tertiary hospital

Abstract

Objective Pharmacists attending general medical post-admission ward rounds is established good practice. However, there is a lack of evidence on the impact of specialist heart failure (HF) prescribing pharmacists on consultant HF ward rounds. The aim of this study was to evaluate the impact on prescribing when a specialist HF prescribing pharmacist attended inpatient HF ward rounds. Methods A prospective service evaluation completed at a tertiary hospital between September and December 2020. The same HF prescribing pharmacist attended the HF consultant-led ward round once a week on 15 occasions. For each medicine change, the pharmacist documented: who suggested the intervention, the medicine, prescribing action, reason for review and the primary reason for change. Medicines were categorised into four groups (heart failure, cardiovascular, anticoagulation and other) for analysis. Results A total of 158 patients were reviewed and 226 individual changes suggested; 48% of these were consultant led (n=108) and 52% (n=118) due to pharmacist recommendations. All medicines interventions were prescribed on the round by the pharmacist. For consultants, the primary reason for medicine change was to ensure efficacy of HF medicines, 80% (n=73), followed by safety (HF medicines), 20% (n=18). For the pharmacist, the primary reason was safety across all the medicine groups, 36% (n=42), followed by efficacy relating to missing drug history items, 24% (n=28). Conclusions HF consultants focused on ensuring patients have the most effective combination of HF medications. The addition of a specialist HF prescribing pharmacist ensured a wider range of medicines were reviewed for safety and optimisation, helping to deliver a holistic review of all medications. http://ejhp.bmj.com/

Identification of Barriers for Active Disease Management and of Medication-Related Problems through Therapeutic Patient Education in Older Home-Care Patients

“…These results are consistent with other studies that included an evaluation of the prescriptive appropriateness of chronic pharmacological therapies [36,37]. This underlines the importance of involving a drug expert, such as a pharmacist or a researcher on drug utilization, in the patient care pathway: although some of the evidence [40][41][42][43][44] associated the presence of a drug expert with positive health outcomes, this figure is still not systematically involved in clinical practice at a national level.…”

Insights into participation in ward rounds in hospitals: A survey of clinical pharmacists' perceptions

“…The present study shows that well-recognised Goals of participation in WRs, with a median and IQR of 15 (13–15), and ‘clinical pharmacists in the multidisciplinary team help improve overall patient outcome and quality of care during a WR,' were identified more positively among clinical pharmacists who participated in 12 months of internship. Clinical pharmacists’ participation in hospital wards has led to improved clinical outcomes for patients with various diseases, including chronic non-communicable and infectious diseases ( Campbell et al, 2023 ; Thomas et al, 2014; Bullock et al, 2020 ; Kubas et al, 2020 ). Recently, this was clearly supported by their participation during the COVID-19 pandemic and the critical role they played ( Baudouin et al, 2023 ; Alshakka et al, 2022 ).…”

“…Our current survey expands on the understanding that clinical pharmacists’ involvement in WR also requires special Skills and Capabilities in the form of professional confidence, and clinical pharmacists involved in 12-month internships reported having more professional confidence to contribute effectively to WR. A cornerstone of clinical pharmacists’ participation in WRs is the identification, solving, and prevention of drug-related problems ( Campbell et al, 2023; Thomas et al, 2014; Bullock et al, 2019; Bullock et al, 2020; Kubas et al, 2020 ). In the present survey, almost all Yemeni clinical pharmacists showed they could solve medication-related problems and perform this critical clinical task in WR.…”

“…During a ward round, each patient's current condition is determined, and the next steps in their treatment are planned ( Cohn, 2014 ). Clinical pharmacists’ contributions have been shown to significantly improve patient medication management, lower morbidity and mortality, decrease the frequency of adverse drug reactions, and reduce the cost of care ( Campbell et al, 2023 ; Thomas et al, 2014; Bullock et al, 2019 ). Additionally, it has been shown that clinical pharmacist participation in the ward round WR increases the number of medication-related conversations and results in the prescription of more rational drugs upon discharge ( Thomas et al, 2014 ).…”