Clinical pharmacy services in an Iranian teaching hospital: a descriptive study

Objective To understand the types of services provided by Iranian clinical pharmacists in nephrology and infectious disease wards, the acceptance rate of clinical pharmacy services in these wards by physicians and the clinical significance of these services in the main teaching hospital in Iran. Setting: Nephrology and infectious disease departments of a university hospital in Iran. Methods During a 12-month prospective data gathering phase, details of all clinical pharmacy services in the nephrology and infectious disease wards of a large university hospital were recorded in the pharmacotherapy monitoring forms. Significance impact of clinical pharmacists’ services was assessed according to the guidelines of The Society of Hospital Pharmacists of Australia. Main outcome measure: Number and type of services provided. Results During 1 year, clinical pharmacists contributed to 1,386 services for 1,105 patients who were admitted in these two wards; of these services, about 95% were accepted by the physicians and about half of them were of moderate-to-life saving clinical significance. Also at least 32% of services were considered to reduce the cost of drug therapy. Conclusions These results support the importance of clinical pharmacists’ participation in health care team rounds to improve the overall quality of medication therapy, enhance patient care and outcome and reduce drug costs to patients and society.     

Research skills training for the Doctor of Pharmacy in US Schools of Pharmacy: A descriptive study

Objectives As the practice of pharmacy grows increasingly complex, graduates are expected to possess a comprehensive set of skills enabling them to provide optimal patient care. Thus, research skills are becoming increasingly valuable and a necessary part of pharmacist training globally. However, training opportunities for improving research skills have not been well explored in the literature. This study examines how research skills are currently being offered in various Doctor of Pharmacy curricula in US Schools of Pharmacy. Methods A five‐question survey was e‐mailed to key individuals at 95 Colleges of Pharmacy in the USA and Puerto Rico. Responses were aggregated and then stratified by research project requirements, as well as by school type (public or private; Carnegie Foundation classification). Key findings Seventy‐nine respondents provided usable surveys for an 83% response rate. Respondents encompassed a representative population of school types. Although most schools do not require completion of a research project (75%), the majority of research skills listed were taught in various forms in over half of the responding institutions. There did not appear to be a significant distinction in research skills training provided based upon school type. However, schools requiring students to complete a research project in order to graduate provided the most comprehensive research skills training. Conclusions Research skills training has greatly increased over the past 10 years. However, more study needs to be done in a number of areas, including determining the most effective way to offer research skills training, determining its post‐graduate impact and determining its overall effect on the profession of pharmacy.     

Pharmacy services in a 240-bed Gordon Friesen-design hospital

This article describes a typical Gordon Friesen-design institution in which the facility design and systems design complement one another to make an efficiently run hospital. The basic concepts of the hospital are to keep the nurse with the patient and to maintain a steady supply flow by centralizing responsibility for materials. Problems that occur in pharmacies of facilities designed by Friesen usually are related to logistics. The design of the institution make delivery of medication and communication with staff nurses more difficult. Pharmacy programs such as unit dose and intravenous admixtures, excellent examples of products in "patient-ready units," complement the other supply delivery systems that are typical of a Friesen-design institution. Good written and verbal communications between nursing staff and pharmacy can bring about a smoothly flowing pharmacy service that blends with the overall concept.     

某儿童专科医院急诊药房存在的问题与对策

目的：探讨如何加强儿童专科医院急诊药房管理,为患儿提供更加安全、高效的药学服务。方法：针对儿童专科医院急诊药房的问题现状,分析原因,提出对策和改进措施。结果：通过优化急诊药房的管理,急诊药房药学服务能力增强,医师处方更合理,患儿家属满意度提高。结论：在儿童专科医院急诊药房的工作中,要注意硬件设施、人力资源配备、医师、药师、药品、收费、家属等多方面的问题,主动参与到治疗过程中,更好的为患者服务。     

Diabetes care in Norwegian pharmacies: a descriptive study

OBJECTIVE: To describe Norwegian pharmacies' involvement in diabetes care, to investigate pharmacists' views on future services and to investigate whether the recommendations in the Norwegian diabetes declaration for pharmacies have been implemented. Setting Hospital and community pharmacies in Norway. METHOD: All 543 pharmacies in Norway, of which 511 were community pharmacies and 32 were hospital pharmacies, received a link to a web-based questionnaire. One pharmacist from each pharmacy was asked to complete the questionnaire. The questionnaire covered subjects ranging from the diabetes declaration and the pharmacists' views on which services the pharmacy should offer in the future, to demographic characteristics. RESULTS: In total 358 (66%) questionnaires were completed. The diabetes declaration was read by 37% of the pharmacists. Almost all pharmacies complied with the declarations' recommendations regarding glucose monitoring services. Twenty four percent of the pharmacies could offer medication reviews, and roughly 10% could offer screening for undiagnosed diabetes. Counseling on lifestyle issues was the least implemented recommendation. Eighty one percent of the pharmacists reported a wish to expand their services towards diabetes patients. Services in regard to glucose monitoring had the highest score, however the views on which services should be offered varied a great deal. Already performing a service increased the chance of the pharmacist being positive towards offering it. CONCLUSION: Norwegian pharmacists report that they are involved in a wide range of diabetes related services, although only 37% report to have read the diabetes declaration. The pharmacists generally wish to actively support patients with diabetes, and further research should concentrate on identifying the areas where their involvement is most productive.     

Medication Reconciliation Practices in Canadian Emergency Departments: A National Survey

Background:

As of 2015, Accreditation Canada’s Qmentum program expects emergency departments (EDs) to initiate medication reconciliation for 2 groups of patients: (1) those with a decision to admit and (2) those without a decision to admit who meet the criteria of a risk-based, health care organization–defined selection process. Pharmacist-led best possible medication histories (BPMHs) obtained in the ED are considered more complete and accurate than BPMHs obtained by other ED providers, with pharmacy technicians obtaining BPMHs as effectively as do pharmacists. A current assessment of the role of pharmacy in BPMH processes in Canadian EDs is lacking.

Objectives:

To identify and describe BPMH and medication reconciliation practices in Canadian EDs, including those performed by members of the ED pharmacy team.

Methods:

All Canadian hospitals with an ED and at least 50 acute care beds were contacted to identify the presence of dedicated ED pharmacy services (defined as at least a 0.5 full-time equivalent position). Different electronic surveys were then distributed to ED pharmacy team members (where available) and ED managers (all hospitals).

Results:

Survey responses were obtained from 60 (63%) of 95 ED pharmacy teams and 128 (53%) of 243 ED managers. Only 38 (30%) of the 128 ED managers believed that their current BPMH processes were adequate to obtain a BPMH for all admissions. Fifty-nine (98%) of the ED pharmacy personnel reported obtaining BPMHs (most commonly 6–10 per day), with priority given to admitted patients. Only 14 (23%) of the 60 ED pharmacy teams reported that their EDs had adequate staffing to comply with Accreditation Canada’s requirements for obtaining BPMHs. This result is supported by the 104 (81%) out of 128 ED managers who reported that additional ED staffing would be needed to comply with the requirements. Numerous ED managers identified the need to expand ED pharmacy services and improve information technology support.

Conclusions:

BPMH processes in Canadian EDs were variable and inadequately supported. Survey responses suggested that additional staff and significant improvements in structured processes would be required to meet Accreditation Canada standards.     

Efficacy of naltrexone treatment with combined crack and opiate users: A descriptive study of a new treatment service in Bristol, UK

Naltrexone has been shown to be clinically effective in treating opioid dependence, although there are reports that it may be unsafe in treatment of unselected cases. Although there are no generally accepted pharmacological treatments for crack cocaine addiction alone, there is evidence that naltrexone can be useful in cases of concurrent cocaine and heroin use. In 2005 Bristol Specialist Drug Service initiated a naltrexone treatment programme targeted at pre-release offenders using both crack cocaine and heroin. Of 172 referrals, only 51 (30%) were inducted into treatment, and only 16% of these were retained at 3 months, and 4% at 9 months. There was evidence to support induction in prison, as 90% of those who were inducted there continued treatment on release. An integrated approach between criminal justice and community services is of primary importance in getting users into treatment. Interviews highlighted that the environment outside of prison can trigger relapse, and that community clinics need to separate clients on an abstinence programme from those who continue to use. Of clients interviewed, 52% reported that they use heroin to mitigate severe come down from crack, and it is suggested that naltrexone may be of use for these specialized combined users.     

Efficacy of naltrexone treatment with combined crack and opiate users: A descriptive study of a new treatment service in Bristol,UK

Naltrexone has been shown to be clinically effective in treating opioid dependence, although there are reports that it may be unsafe in treatment of unselected cases. Although there are no generally accepted pharmacological treatments for crack cocaine addiction alone, there is evidence that naltrexone can be useful in cases of concurrent cocaine and heroin use. In 2005 Bristol Specialist Drug Service initiated a naltrexone treatment programme targeted at pre-release offenders using both crack cocaine and heroin. Of 172 referrals, only 51 (30%) were inducted into treatment, and only 16% of these were retained at 3 months, and 4% at 9 months. There was evidence to support induction in prison, as 90% of those who were inducted there continued treatment on release. An integrated approach between criminal justice and community services is of primary importance in getting users into treatment. Interviews highlighted that the environment outside of prison can trigger relapse, and that community clinics need to separate clients on an abstinence programme from those who continue to use. Of clients interviewed, 52% reported that they use heroin to mitigate severe come down from crack, and it is suggested that naltrexone may be of use for these specialized combined users.     

Pharmacy services for diabetic patients in South Carolina: a survey of physician and patient attitudes

Diabetic patients and physicians in South Carolina were surveyed to gauge their attitudes to 13 potential pharmacy services. Approximately 33% of the physician sample and 42% of the patient sample responded to a self-administered, mailed questionnaire. The results indicated that both groups held favorable attitudes toward services aimed at improving the patient's knowledge of diabetes but reacted negatively to services in which the pharmacist would be involved in the collection of information relating to diabetic control. Although the attitudes of patients and physicians were highly congruent, patients typically held more favorable attitudes than physicians when significant differences were found. It also was found that patient and physician characteristics were incapable of segregating respondents into groups with varying attitudes.     

Prescribing omissions in elderly patients admitted to a stroke unit: descriptive study using START criteria

Background Underuse of medication considered beneficial is particularly common in elderly patients. A new Screening Tool to Alert Doctors to the Right Treatment (START) has been published to identify potential prescribing omissions. Objective To quantify and characterize potential prescribing omissions of cardiovascular risk management therapy using START criteria. Setting This study was conducted in the Stroke Unit of the university teaching hospital of Cova da Beira Hospital Centre, Covilh?, located in the Eastern Central Region of Portugal. Method During 6?months, the medical files of all elderly patients (age????65?years) admitted with acute cardiovascular disease were reviewed and the START criteria applied to the information of medication, at admission and at the time of discharge from the hospital Stroke Unit. Main outcome measure Potential prescribing omissions of cardiovascular and endocrine pharmacological therapy were identified and the difference in the potential prescribing omissions between admission and discharge from hospital Stroke Unit was also evaluated. Results At the time of admission to the Stroke Unit, 101 potential prescribing omissions were found in 68.1?% (n?=?91) of elderly (average 1.11 omissions per patient), of which 84.2?% (n?=?85) were corrected at the time of discharge. In 14 patients, 16 omissions found at admission were not corrected during hospitalization, and in 5 patients 5 new omissions were detected. Conclusion Prescribing omissions of beneficial drugs are highly prevalent in acutely ill admitted to a Stroke Unit. START criteria represent a simple, evidence-based and easy-to-use tool to screen underuse of cardiovascular risk management therapy in elderly patients.