Implementation of a renal pharmacist consultant service — Information sharing in paper versus digital form

Seiberth, Sarah; Bauer, Dominik; Schönermarck, Ulf; Mannell, Hanna; Stief, Christian G.; Hasford, Joerg; Strobach, Dorothea

doi:10.1111/jcpt.13371

Cited by 3 publications

(15 citation statements)

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“…19 Several studies show that a renal pharmacist can successfully support physicians with manual interventions in the complexity of drug therapy in patients with RI. 10,12,15 Generally, clinical pharmacist services take a key role in ensuring the safety of the prescription practice. 13,14 However, the use of CPOE-CDS-systems has been reported to reduce the amount of ADE in patients with RI.…”

Section: Discussionmentioning

confidence: 99%

“…10,12,15 In this case, information sharing with the physician as paper chart inlays was the most effective way to inform about and solve DRP. 15 In the recent decade, traditional paper charts have increasingly been substituted by an electronic medical record (EMR) which represents the digital version of the paper chart. 16,17 These systems include a computerized physician order entry (CPOE)-system with a clinical decision support (CDS).…”

Section: What Is Known and Objectivementioning

confidence: 94%

“…13,14 The implementation of a ‚renal pharmacist consulting service' (RPCS) at urological wards of an university hospital, screening patients with RI for DRP significantly increased appropriate prescribing by physicians and, thus, patient safety. 15 In this study as well as in many others evaluating a renal pharmacists' activities, paper charts were used in daily hospital routine. 10,12,15 In this case, information sharing with the physician as paper chart inlays was the most effective way to inform about and solve DRP.…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…15 In this study as well as in many others evaluating a renal pharmacists' activities, paper charts were used in daily hospital routine. 10,12,15 In this case, information sharing with the physician as paper chart inlays was the most effective way to inform about and solve DRP. 15 In the recent decade, traditional paper charts have increasingly been substituted by an electronic medical record (EMR) which represents the digital version of the paper chart.…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…For analysis, the identified DRP were categorized as described in previous studies with regard to the 'PCNE classification'. 4,11,15 The RPCS only forwarded manifest DRP to the physicians, which were presently of concern regarding the current renal function of the patient. Potential DRP, that could arise if renal function would decrease further, were not forwarded to avoid over alerting.…”

Section: Data Collection and Assessmentmentioning

confidence: 99%

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Benefit of medication reviews by renal pharmacists in the setting of a computerized physician order entry system with clinical decision support

Seiberth

Mannell

Birkenmaier³

et al. 2022

Clinical Pharmacy Therapeu

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What Is Known and Objective A ‘renal pharmacist consultant service’ (RPCS) reviewing patients' charts with renal impairment (RI) for drug‐related problems (DRP) can foster patient safety. However, the benefit of this service in the new setting of a computerized physician order entry (CPOE)‐system with a clinical decision support (CDS)‐system is unknown. The aim of our study was to evaluate the general need for an RPCS on wards with a CPOE‐CDS‐system already in use and its effectiveness on prescription changes to ensure in‐hospital patient safety. Methods Over a period of 3 months (02‐04/2021), elective orthopaedic and trauma patients with eGFRabsolute/CrCl <60 ml/min at a German University Hospital received a medication review by a renal pharmacist for all medication entered into the CPOE‐system (Meona®) by the treating physicians. Written consultations explaining identified DRP and recommending interventions to solve them, for example, dose or drug adaptation, were shared with the physicians directly in the drug chart tab of Meona®. In complex cases, DRP were additionally discussed via phone. The prescription changes were evaluated retrospectively. Results and Discussion During 53 working days, 712 (30.5%) of 2331 screened patients were included with an eGFRnon‐indexed/CrCl <60 ml/min and a pharmacist‐led medication review was performed for all medication presented in the CPOE‐system (Meona®). In 79 of 712 (11.1%) patients, one or more DRP were detected (median 1 DRP (1–3) per patient) and written recommendations concerning 106 of 1090 (9.7%) drugs were shared via Meona®. In total, 104 DRP were identified, mostly caused by ‘dosage too high’ (n = 55, 52.9%), ‘dosage regime wrong’ (n = 13, 12.5%), and ‘contraindication’ (n = 9, 8.7%). Acceptance rate of recommendations was 74.0% (n = 77/104). In nine cases (8.7%), despite of specific recommendations, no adjustment of drugs was made because of lack of alternatives. In 11 (10.6%) cases, prescription remained unchanged for unknown reasons and in seven (6.7%) cases, the result was unknown due to discharge. What Is New and Conclusion In the setting of prescribing in a CPOE‐CDS‐system, that provides physicians with advice for drug or dose adaption, the pharmacist‐led medication reviews still identified DRP in orthopaedic and trauma patients with RI. A RPCS forwarding recommendations to solve DRP via the electronic medical record increased appropriate prescribing by physicians and, thus, may further improve patient safety.

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Section: Discussionmentioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 94%

Section: What Is Known and Objectivementioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

Section: Data Collection and Assessmentmentioning

confidence: 99%

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Benefit of medication reviews by renal pharmacists in the setting of a computerized physician order entry system with clinical decision support

Seiberth

Mannell

Birkenmaier³

et al. 2022

Clinical Pharmacy Therapeu

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Evaluation of pharmacist’s practices regarding the antimicrobials dispensing: a simulated patient study

Souza

Vieira

Santos

et al. 2022

BMC Health Serv Res

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Background The indiscriminate use of antimicrobials is considered a major contributing factor to the increase in antimicrobial resistance. Community pharmacies are the main source of access to antimicrobials, and pharmacists are in a strategic position to promote rational use of these medicines. Therefore, it is important to know dispensing service quality. Objective To evaluate the behavior of pharmacists in dispensing antimicrobials in community pharmacies in northeast Brazil. Methods This cross-sectional pilot study was conducted from August to October 2021 in a private community pharmacy chain in Sergipe. Dispensing was evaluated using the simulated patient (SP) technique. Two SP asked the pharmacists for the antimicrobials (case clinic 1: upper respiratory infection; case clinic 2: urinary tract infection) and recorded the service through audio. Dispensing practices were independently analyzed by two researchers based on the tools available in the literature. Data were presented using descriptive statistics. Results A total of 54 simulated patient visits were conducted. Based on the 12 steps recommended by the research team for good dispensing, pharmacists asked an average of 1 (±1.17) question for upper respiratory infections and 0.3 (±0.54) for urinary tract infections, as well as provided counseling (mean number of recommendations, 2.6 (±1.44) and 4.5 (±2.35), respectively). As for communication skills, pharmacists had a regular score (3.07 ± 0.34). Furthermore, there was no significant difference in the number of steps and counseling recommendations by pharmacists in dispensing clinical cases 1 and 2 (p = 0.0674). Conclusion The quality of antimicrobial dispensing was evaluated as suboptimal, requiring improvements in practice and multifaceted strategies to promote continuing education of these professionals. In addition, awareness actions for the population must be implemented to promote the rational use of antimicrobials and reduce microbial resistance.

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Acceptance rate of clinical pharmacists’ recommendations—an ongoing journey for integration

Peled,

Vitzrabin,

Beit Ner

et al. 2023

Front. Pharmacol.

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Introduction: Multidisciplinary expert team collaboration in the clinical setting, which includes clinical pharmacist involvement can facilitate significant improvements in outcomes and optimize patient management by preventing drug-related problems (DRP). This type of collaboration is particularly valuable in patients with multi-morbidity and polypharmacy such as diabetic foot patients. Evidence regarding the successful integration of a new clinical pharmacist, without previous experience into a unit is still scarce. Therefore, this study aimed to describe and evaluate the actual successful integration process of the clinical pharmacist into a diabetic foot unit by measuring the change in recommendation acceptance rate over time.Methods: A prospective, exploratory treatment effectiveness study based on the recommendation acceptance rate of a new clinical pharmacist introduced into the diabetic foot unit was conducted over a 9- month period. The clinical pharmacist identified medical and drug-related problems (DRP) or any discrepancies in the prescribing and administration of medications. Each identified DRP was documented and formulated as a recommendation by the clinical pharmacist. The main outcome measure was the acceptance rate of recommendations over time.Results: A total of 86 patients, of which 67% were men, averagely aged 66.5 (SD 11.8) years were evaluated. Calculated BMI was 30.2 (SD 6.2). The average number of medical diagnoses was 8.9 (SD3.2), and 11.1 (SD 3.7) prescribed drugs for each patient. Cardiovascular disease was presented by 95% (n = 82) of the patients and 33% of them (n = 28) had uncontrolled hyperglycemia. Averagely, 3.3 (SD 1.9) DRPs were identified pre patient. The efficacy-related DRP recommendation acceptance rate increased over the study period from 37.8% in the first 4 months to 79.4% after a period of 4.75 months. Safety-related DRP recommendation acceptance rate increased from 56% to 67.6%.Conclusion: Improved clinical outcomes and optimized pharmacologic patient management may be achieved by the successful integration of a clinical pharmacist into the team. This study provides evidence of the increasing recommendation acceptance rate of integrated, pharmacist-driven comprehensive medication management in an unexperienced unit. To overcome challenges, team members should collaborate to fully integrate the clinical pharmacist into the team-based structure and utilize proper strategies to minimize and transcend barriers.

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Implementation of a renal pharmacist consultant service — Information sharing in paper versus digital form

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 3 publications

References 14 publications

Benefit of medication reviews by renal pharmacists in the setting of a computerized physician order entry system with clinical decision support

Benefit of medication reviews by renal pharmacists in the setting of a computerized physician order entry system with clinical decision support

Evaluation of pharmacist’s practices regarding the antimicrobials dispensing: a simulated patient study

Acceptance rate of clinical pharmacists’ recommendations—an ongoing journey for integration

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