Evaluation of a facsimile (fax) transfer system for medication order delivery

Delivery of medication orders for initial processing is often slowed by distance between the nursing unit and the pharmacy. Messengers and pneumatic tubes are not always available or reliable. Facsimile (fax) machines are able to transmit photocopies of medication orders in seconds. An initial evaluation of available fax machines led to selection of three models for a trial installation. Criteria for fax evaluation included medication order turnaround time (TAT), percentage of orders requiring more than 2 hours to be received by the nursing unit, and number of orders recopied by nursing personnel for pharmacy use. An initial review identified the time required for order processing using a reliable pneumatic tube system to deliver orders to the central pharmacy. The number of orders recopied by nurses into the chart to provide working copies of misplaced or lost orders for pharmacy was also recorded. The fax system was installed and the initial data collection process was repeated. Statistics focused on the total time required to transmit an order to pharmacy and provide the initial dose to the nursing unit. Analysis of the mean (+/- SD) showed an initial TAT of 1.59 (+/- 1.30) hours (n = 92). TAT after initiation of fax transmission was 1.36 (+/- 1.15) hours, P = 0.20 (n = 104). This improvement is greater than it appears because 1.10 hours of both of these times are fixed times involving pharmacy order processing. The percentage of orders that required more than two hours to provide medication to the nursing unit was reduced from 29% (27/92) to 18% (19/104) P less than 0.05. The average number of nursing recopies into the chart was reduced.     

Understanding the factors influencing prescriber uptake of pharmacist recommendations in secondary care

BackgroundPharmacists are increasingly recognized as medication experts who can bring much to clinical teams and decision making. The inclusion of a pharmacist into a multidisciplinary team, including ward rounds, can be sporadic in some settings, meaning pharmacists are not always present at the point of decision making. In this way, subsequent recommendations may not always be adopted. Understanding the perceptions of prescribers to pharmacist input and preferences for receiving pharmacist input, may result in more effective and efficient patient care.ObjectiveThe purpose of this study is to understand how prescribers view pharmacist contributions and the factors that facilitate or hinder acceptance of pharmacist recommendations within a hospital setting.MethodThis mixed methods study consisted of two stages, initially focus groups and an online survey.Thematic analysis of the focus group discussions was conducted, and these formed the basis of the survey. A total of 17 prescribers participated in the focus groups and 99 of 335 prescribers participated in the survey. The questions centred on 4 key aspects, 1) the perceived role of a pharmacist, 2) communication strategies 3) the value added by pharmacists and 4) barriers and enablers to adopting pharmacist recommendations.ResultsPrescribers strongly valued dosing advice and information on medication interactions. Some prescribers did not believe that a pharmacist should attend ward rounds, with more senior clinicians seeing value of recommendations being given at the time of medication initiation. Within a busy clinical setting several barriers were identified, including communication method, differing priorities, presence of pharmacist at the time of decision making, and consultant led hierarchy.ConclusionSeveral factors influence acceptance of pharmacists’ recommendations. Working on communication methods may overcome some, but others such as pharmacist presence on rounds and consultant led decision-making hierarchy may be harder to change.     

Applying total quality management to a pharmacist intervention program

Intervention documentation continues to be a valuable tool for both documenting pharmacist impact on patient care and justifying new clinical pharmacy services. Utilizing TQM principles to improve documentation has yielded many long-term benefits. Not only has intervention documentation been streamlined, but pharmacists at the staff level were an integral part of the changes that were made and the improvements to come. Their familiarity with the pitfalls of the former system provided solutions to the problems that might have been overlooked without their input.     

Informing a collaborative-care model for delivering medication assisted treatment for opioid dependence (MATOD): An analysis of pharmacist,prescriber and patient perceptions

BackgroundDemand for medication assisted treatment for opioid dependence (MATOD) in Australia exceeds capacity, particularly in rural and regional areas. There is increasing recognition that community pharmacists are well-positioned to take on expanded roles in MATOD delivery, however there has been limited Australian research exploring attitudes of pharmacists, prescribers, and patients to collaborative models of care.Objective(s)This study aimed to better understand enablers and barriers to a collaborative model for MATOD, to inform implementation in regions where increases in treatment capacity are urgently needed.MethodsSemi-structured telephone interviews were conducted with pharmacists (n = 11), prescribers (n = 6), and patients (n = 8) recruited from the Frankston-Mornington Peninsula region in Victoria, Australia, where transport and access to services have impacts on health care utilisation. The COM-B model was used to explore perceptions of pharmacists’ capability, opportunity, and motivations for delivering collaborative care.ResultsThere was strong motivation among healthcare professionals to participate in a collaborative model of care, with the main perceived benefits including improvements in accessibility, convenience, and continuity of care, and leverage of pharmacists’ high level of patient engagement. Key barriers identified by both pharmacists and prescribers included a perceived lack of pharmacist skills in some areas (capability) and resources (opportunity) to deliver collaborative care in a community pharmacy setting. Established relationships between all stakeholders (social opportunity) and communication between pharmacists and prescribers were identified as facilitators. Barriers and facilitators aligned with seven key areas: skills, confidence, relationships, patient selection, protocols, communication and resources.ConclusionsFindings informed the development of a collaborative model that was individualised, protocol based, and supported by training and clear processes.Project impactThis study identifies specific barriers and facilitators to a pharmacist-prescriber collaborative model of care for MATOD. The resulting model will be tested in a hybrid implementation-effectiveness trial in the Frankston-Mornington Peninsula region.     

药物治疗管理(MTM)门诊服务模式探索与实践

目的介绍本院药物治疗管理(MTM)门诊服务模式与流程,总结分析MTM门诊开诊以来的实践效果,剖析存在的问题,进一步优化服务,为将来准备开展MTM门诊的医疗机构提供经验参考。方法收集2018年10月12日至2019年3月12日本院MTM门诊患者信息,从就诊来源、就诊人数、慢病种类、药物治疗相关问题、行动计划的制订、患者满意度、服务时长等几个方面进行分析总结。结果开诊5个月来共服务患者98例,平均患慢病种类4.5种,平均服药品种9.5种,共发现药物相关问题529个。患者主动回访比例31.6%,平均服务时长50 min,患者满意度100%。结论本院MTM门诊已经初步建立了标准化的服务模式,药师能够帮助慢病患者解决多重用药相关问题,获得了患者的一致认可,能够体现药师的价值。但是目前患者知晓率低、信息获取不完整、服务时间长、失访率高是主要问题,仍需进一步扩大宣传和优化服务流程。     

Evaluation of pharmacists' barriers to the implementation of medication therapy management services

ObjectivesTo assess pharmacists' actual and perceived barriers to implementing medication therapy management (MTM) services in the outpatient setting and to assess demographic and other factors associated with identified barriers.DesignCross-sectional study.SettingUnited States in 2007.Participants970 pharmacists practicing in an outpatient setting.InterventionE-mail invitation to participate in an Internet-based survey.Main outcome measuresBarriers to implementing MTM, practice characteristic influences on barriers, and personal characteristic influences on barriers.Results776 of the 970 respondents (80.0%) were providing MTM or direct patient care services. Of respondents, 35% were compensated and 45% were not compensated for providing MTM services they provided to patients. The most common barriers identified for pharmacists providing MTM services with or without compensation were related to compensation. The most common barriers identified for those interested in providing MTM services were lack of additional staffing (89.6%) and poor access to medical information (84.0%). Pharmacists providing MTM with compensation were significantly less likely to agree with barriers relating to management, documentation, and compensation compared with those providing MTM without compensation. Those providing MTM with compensation were less likely to agree with most barriers compared with pharmacists who were interested in providing MTM services. Pharmacists practicing in a noncommunity setting were less likely to agree with barriers related to interprofessional relationships and documentation.ConclusionThese results show that the most important barriers to implementing MTM services in the outpatient setting identified by pharmacist survey respondents were related to interprofessional relationships, documentation, and compensation. Despite the resources available to pharmacists, barriers continue to hinder the expansion of MTM and direct patient care services.     

Clinical medication review by a pharmacist of elderly people living in care homes: pharmacist interventions

Objectives To describe the rate and nature of pharmacist interventions following clinical medication review of elderly people living in care homes. Setting Care home residents aged 65+ years, prescribed at least one repeat medication, living in nursing, residential and mixed care homes for older people in Leeds, UK. Method Analysis of data from care home residents receiving clinical medication review in the intervention arm of a randomised controlled trial. Intervention outcomes for each medicine were evaluated for each resident. Key findings Three‐hundred and thirty‐one residents were randomised to receive a clinical medication review and 315 (95%) were reviewed by the study pharmacist; 256 (77%) residents had at least one recommendation made to the general practitioner. For the 2280 medicines prescribed, there were 672 medicine‐related interventions: medicines for cardiovascular system (167 (25%)), nutrition and blood (121 (18%)), central nervous system (113 (17%)) and gastrointestinal conditions (86 (13%)) accounted for 487 (73%) of medicine‐related interventions. There were 75 non‐medicine‐related interventions. The most common interventions were ‘technical’ (225 (30%)), ‘test to monitor medicine’ (161 (22%)), ‘stop drug’ (100 (13%)), ‘test to monitor conditions' (75 (10%)), ‘start drug’ (76 (10%)), ‘alter dose’ (40 (5%)) and ‘switch drug’ (37 (5%)). Recommendations to stop a medicine were most common for CNS drugs (32 (32%)). The most common medicine to be recommended to be started was calcium and vitamin D (45 (59%)). Following a recommendation to test to monitor a medicine, 23 (14%) medicines required a change. Conclusions This study has demonstrated that clinical medication review by a pharmacist can identify medicine problems in approximately 80% of care home residents, requiring intervention in 1 in 4 of their prescribed medications.