The Role of the Clinical Pharmacist in an Irish University Teaching Hospital: A Mixed-Methods Study

Abstract

Medication review (MR) is a vital part of the pharmacist’s role in hospital. However, in the South Infirmary Victoria University Hospital (SIVUH), Cork, Ireland, this has not been fully implemented due to resource issues. In addition, the cost of providing this service has not been evaluated. Moreover, it is not clear how other members of the multidisciplinary team e.g., Nurses, value any interventions made as a result of the MR. This mixed methods study assessed the impact of MR in terms of (i) potential clinical harm, (ii) cost avoidance and (iii) the views of nursing staff on the role of the pharmacist. The setting is a 192-bed, voluntary, acute hospital, in the Munster region of Ireland. Study I: The pharmacist provided MR to patients conventionally once a week. Any interventions were then assessed for potential clinical harm and to calculate cost avoidance. Study II: Semi-structured interviews, guided by a topic guide were completed with 12 nurses (11 female). Thematic analysis was used to code the main themes. Main outcome measure: To estimate the cost, cost avoidance, and the net cost benefit ratio of MR provided by pharmacists. Study I: Of 128 patients who received the MR, 113 interventions were made. The estimated cost of providing the MR was €2559 (senior pharmacist). Using €1084 as the cost of an adverse drug event (ADE), the cost avoidance was calculated at €42,330. This led to a net cost benefit of €39,771 (senior pharmacist) which equated to a net cost benefit ratio of 16.5:1. Study II: The main themes were (i) perceptions of pharmacy services, (ii) the role of the pharmacist—past, present and future, and (iii) teamwork and communication. Nurses expressed a desire to have more pharmacists present on the wards.

A cost–benefit analysis of hospital-wide medication reviews: a period prevalence study

“…In contrast to our design, these studies focused on specific wards. Our detection rate of pDRPs and the most frequently given recommendations are also in line with previous studies on hospital-wide integration of clinical pharmacists in other hospitals worldwide [ 11 , 12 , 25 – 27 ].…”

“…The high amount of administrative prescribing errors in our study might indicate that physicians need more training for adequate prescribing skills, or that the prescribing system might not work intuitively to prevent this type of error. Poor prescribing practice was also found by Ronan et al [11], where administrative prescribing errors accounted for 15% of the DRPs.…”

“…Although CDSSs are getting more advanced, they are still not able to detect all DRPs. Several studies show that the involvement of a clinical pharmacist conducting medication reviews, besides using CDSS, has beneficial effects on medication safety [5][6][7][8][9][10][11][12].…”

Reductions in Medication Wastage and Costs in a Pediatric Intensive Care Unit by Changing the Order Entry System

“…Many studies have shown the effectiveness of the presence of a pharmacist or a clinical pharmacist in hospitals using a computer system to request medication for reducing medication errors and hospital costs [20][21][22][23][24][25]. The findings of one study demonstrated the effectiveness of the presence of a clinical pharmacist in reducing medication errors when using a computer system [26].…”

Perceptions, Experiences, and Expectations of Hospital Physicians Regarding Pharmacists’ Professional Duties in Yemen

“…Physicians and pharmacists are being progressively encouraged to implement a collaborative method to delivery of health services and the patient care. Strong collaboration between pharmacists and physicians optimizes patient outcomes [13][14][15][16][17].…”