School-wide Clinical Intervention System to Document Pharmacy Students' Impact on Patient Care

Objectives

To implement and evaluate a school wide, Web-based clinical intervention system to document types and impact of pharmacy students'' clinical activities during advanced pharmacy practice experiences (APPEs).

Methods

A clinical intervention form was developed by pharmacy practice faculty consensus and uploaded to a secure Web site. Prior to APPEs, all pharmacy students were trained on the purpose and use of the system as well as strategies to document interventions appropriately.

Results

Over the 3-year period of data collection, 15,393 interventions were documented. Most common intervention types included dosage adjustments, education of patients and providers, and optimization of therapeutic regimens. The majority of the interventions were accepted by the medical team and resulted in positive clinical and economic outcomes.

Conclusions

Our school-wide system allowed students and faculty members to document clinical activities. Reporting can serve a number of purposes, including incorporation into student portfolios and faculty merit and promotion dossiers, and demonstration of the positive impact on patient care.     

Impact of a Clinical Decision Support System on Pharmacy Clinical Interventions,Documentation Efforts,and Costs

Health care organizations are turning to electronic clinical decision support systems (CDSSs) to increase quality of patient care and promote a safer environment. A CDSS is a promising approach to the aggregation and use of patient data to identify patients who would most benefit from interventions by pharmacy clinicians. However, there are limited published reports describing the impact of CDSS on clinical pharmacy measures. In February 2011, Good Shepherd Medical Center, a 425-bed acute care community hospital in East Texas, implemented a CDSS (TheraDoc clinical surveillance system). Prior to CDSS implementation, clinicians struggled with obtaining and documenting the data needed to support clinical initiatives. The value of having both clinical and staff pharmacists utilizing the CDSS has improved communication and knowledge among staff and improved relationships with medical staff, nursing, and case management. The department of pharmacy increased its clinical interventions from an average of 1,986 per month to 4,065 per month; this represents a 105% increase in the number of interventions. The annual estimated cost savings after CDSS implementation is $2,999,508, representing a 96% increase per year and translating into a $1,469,907 annual return on investment.     

Impact of Pharmacy Student Interventions in an Urban Family Medicine Clinic

Objectives. To determine the number of interventions made by pharmacy students at an urban family medicine clinic and the acceptance rate of these recommendations by the healthcare providers. The secondary objective was to investigate the cost avoidance value of the interventions.Methods. A prospective, unblinded study was conducted to determine the number and cost avoidance value of clinical interventions made by pharmacy students completing advanced pharmacy practice experiences (APPEs) in an urban family medicine clinic.Results. Eighteen students completed this experience in the 8 months studied. Of the 718 interventions performed, 77% were accepted by physicians, including 58% of the 200 interventions that required immediate action. Projected avoidance was estimated at $61,855.Conclusion. The clinical interventions by pharmacy students were generally well received by healthcare providers and resulted in significant cost savings. Pharmacy students can play an important role in a family medicine clinic.     

Cost Savings Associated With Pharmacy Student Interventions During APPEs

Objective. To quantify the impact of pharmacy students’ clinical interventions in terms of number and cost savings throughout advanced pharmacy practice experiences (APPEs) using a Web-based documentation program.Methods. Five hundred eighty doctor of pharmacy (PharmD) students completing ten 4-week APPEs during the final year of the curriculum were asked to document all clinical interventions they made using a Web-based documentation tool. Data were collected over 4 academic years.Results. The total number of interventions made was 59,613, the total dollars saved was $8,583,681, and the average savings per intervention was $148. The top 3 categories of interventions made by students were identifying dosing issues, conducting chart reviews, and recommending appropriate therapy. The top 3 intervention types made by students that resulted in the most dollars saved per intervention were identifying potential allergic reactions, identifying drug interactions, and resolving contraindications.Conclusions. Pharmacy students made important and cost-effective clinical interventions during their APPEs that resulted in significant savings. Documentation programs can track the number, type, and value of the interventions that pharmacy students are making.     

适应医院药学模式的转变,努力开展临床药学工作

本文总结了为适应医院药学模式的转变,努力开展临床药学工作的经验和体会。     

Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice

This paper describes the goals of the American Society of Health‐System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health‐system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication‐related outcomes and technicians assume greater responsibility for product‐related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed.     

临床药学实践中的循证药学

目的 :提出循证药学的定义、内容以及在临床药物治疗决策中的应用原则。方法 :阐述不同研究方法的证据效力及其影响因素 ,讨论如何对文献资料进行解释。结果 :循证药学的原则有助于临床药师解决临床药物治疗中遇到的问题。结论 :临床药师在选择、评价药物治疗方案和开展用药咨询的临床药学实践中 ,应用循证药学的原则与方法 ,正确地搜集、评价和应用相关文献 ,做出合理的决策     

中医院开展临床药学的实践与设想

本文从情报资料、科学的中药质量管理系统、治疗药物监测、发展方向与设想等五个方面,探讨了中医院的临床药学工作。拟在继承祖国医学的基础上,借鉴现代医学理论及实验方法,逐渐形成自己的体系,使之适应现代医学发展的需要。     

我院开展临床药学工作的体会

目的介绍我院临床药学工作的开展情况。方法从临床药师参与临床查房,开展处方点评,ADR监测和报告,用药咨询,学术活动,专业培训等方面阐述我院临床药学工作的内容。结果与结论我院临床药学工作目标明确,对临床合理用药起到了一定的促进作用。     

Bullying in the Clinical Training of Pharmacy Students

Objective. To determine whether bullying is a significant factor in the clinical training of pharmacy students.Methods. The literature as well as the Accreditation Council for Pharmacy Education (ACPE) Standards and American Association of Colleges of Pharmacy (AACP) surveys were reviewed for mention and/or measurement of bullying behaviors in the clinical training of pharmacy students. The authors used a Delphi process to define bullying behavior. The consensus definition was used to analyze 2,087 in-house student evaluations of preceptors for evidence of bullying behaviors. The authors mapped strings of text from in-house student comments to different, established categories of bullying behaviors.Results. The ACPE Standards and AACP surveys contained no mention or measures of bullying. The 2013 AACP survey data reported overwhelmingly positive preceptor ratings. Of the 2,087 student evaluations of preceptors, 119 (5.7%) had at least 1 low rating. Within those 119 survey instruments, 34 comments were found describing bullying behaviors. Students’ responses to the AACP survey were similar to data from the national cohort.Conclusions. Given the evidence that bullying behaviors occur in pharmacy education and that bullying has long-term and short-term damaging effects, more attention should be focused on this problem. Efforts should include addressing bullying in ACPE Standards and AACP survey tools developing a consensus definition for bullying and conducting more research into bullying in the clinical training of pharmacy students.     

四川省临床药学培养模式及认知现状调研

目的：为改进临床药学人才培养模式提出建议。方法：采用调查研究法,对四川省部分医院的临床药学利益相关方和四川省开设了临床药学专业（或方向）的高校进行问卷调查。结果：共发出问卷511份,收回有效问卷495份,有效回收率为96.87%。调查显示,临床药师的工作得到了医疗团队成员的肯定。大部分临床药师或在读的临床药学专业学生对目前的知识结构和培养方案表示认可,但仍认为应加强临床药学实践以及相关交叉学科知识的学习;现行的学科体系基本可以满足需求,只是在实践与理论教学比重、学科交叉、部分课程设置、教师资源整合上有待完善。结论：①应制定准则,促进临床药学工作的规范化发展;②合理调整专业课程内容,有效进行学科交叉;③设置统一的课程标准,进行专业认证标准分层;④设置长学制临床药学本硕连读专业,增加实践课程比例;⑤整合师资力量,充分发挥医院临床药师的潜能。     

基层医院临床药学实践体会

目的 交流基层医院临床药学工作体会.方法 介绍基层医院临床药学实践经验.结果与结论 基层医院临床药师应正确认识各项临床药学工作,坚持临床查房基础不动摇,保证医院《药讯》和宣教授课的质量,寻找适合自己医院的临床药学工作亮点.     

我国高等临床药学专业设置硕士学位的探讨

目的:为高等临床药学教育改革提供参考。方法:分析设置临床药学硕士专业学位的背景和可行性,并提出临床药学硕士专业学位的设置方案。结果与结论:设置临床药学硕士专业学位,符合我国药学研究生教育发展方向,可满足学生就业的市场需求,有利于促进我国高等临床药学教育的发展,提高临床药学人才培养质量。     

某医院护士对临床药学认知及药学服务需求内容的调查分析

目的为了解某医院护士对临床药学认知及药学服务内容的需求,为临床药师开展药学服务工作提供参考。方法采用问卷调查法,对驻天津6家部队医院的护士采用非概率随机抽样的方法进行调查。结果共发放问卷270份,回收有效问卷223份,有效回收率为82．59％。结论天津部队医院护士对药学服务有着较大需求。三级医院开展临床药学以及护士对临床药师进入临床一线的需求优于二级医院。中高级职称护士对临床药师作用的了解程度明显高于初级护士。护士对临床药学的需求多在于药品的具体使用细节上,临床药师要根据护士对药学服务的需求开展工作。     

药物经济学评价方法在临床药学中的应用

概述了药物经济学常用的 4种评价方法并且进行了对比 ,通过引用实例阐述了药物经济学在临床药学中的应用     

试论开展中药临床药学的必要性

本文对中药调剂工作中存在的问题、注意事项、剂型改革的意义、必要性和可能性作了阐述。结合中药临床研究现状,提出了中药临床研究中亟待加强和深化研究的问题。针对中药质量低的问题,提出重视中药质控和质控研究的意见。为保持和发扬中医药特色,提高临床用药水平,中药师走向临床与中医师携手合作。籍此阐明,为了进一步提高中药质量和药疗水平,开展中药临床药学工作是非常必要的。     

信息化服务在临床药学工作中的重要性

目的从药品不良反应、药物咨询服务、药学教育3个侧面反映信息服务在现代临床药学工作实践中的重要性,揭示信息系统与医院药学、临床药学密不可分的关系。方法分析了信息服务对药品不良反应监测、药学教育以及药物咨询等药学服务工作的推动、促进作用。结果信息化系统的持续改进是全面提升临床药学和药学服务质量的保证。结论信息服务是药学服务的精髓,只有进一步完善信息化服务系统,才能为广大患者和医务工作者提供更加完善的药学服务。     

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

A framework for evaluating pharmacists’ impact on cost avoidance in the intensive care unit (ICU) and emergency department (ED) has not been established. This scoping review was registered (CRD42018091217) and conducted to identify, aggregate, and qualitatively describe the highest quality evidence for cost avoidance generated by clinical pharmacists on interventions performed in an ICU or ED. Searches were conducted in PubMed, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception until April 2018. The level of evidence (LOE) for each specific category of intervention was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation evidence-to-decision framework. The risks of bias for articles were evaluated using Newcastle Ottawa and Cochrane Collaboration tools. The values from all interventions were inflated to 2018 U.S. dollars using the consumer price index for medical care. Of the 464 articles initially identified, 371 were excluded and 93 were included. After reviewing references from the articles included, an additional 71 articles were also reviewed. The 38 cost intervention categories were supported by varying LOEs: IA (0 categories), IB (1 category), IIA (4 categories), IIB (0 categories), III (27 categories), and IV (6 categories), and articles mostly displayed low to moderate risks of bias. Pharmacists generate cost avoidance through a variety of interventions in critically and emergently ill patients. The quality of evidence supporting specific cost avoidance values is generally low. Quantification of and factors associated with the cost avoidance generated from pharmacists caring for these patients are of paramount importance.     

Validity Evidence for FASTHUG-MAIDENS,a Mnemonic for Identifying Drug-Related Problems in the Intensive Care Unit

BackgroundThe mnemonic FASTHUG (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head of bed elevation, stress Ulcer prophylaxis, Glucose control) was developed by intensive care unit (ICU) physicians to ensure that key aspects of care are addressed during each patient encounter. Because this tool does not specifically target pharmacotherapy assessments, a modified version, FASTHUG-MAIDENS, was created, by changing the H to mean Hypoactive or Hyperactive delirium and adding M for Medication reconciliation; A for Antibiotics or Anti-infectives; I for Indications for medications; D for drug Dosing; E for Electrolytes, hematology, and other laboratory tests; N for No drug interactions, allergies, duplication, or side effects; and S for Stop dates.Objective:To validate the use of FASTHUG-MAIDENS as a tool for identifying drug-related problems (DRPs) in the ICU.Methods:This randomized, prospective validation study took place between January and May 2011 in the ICUs of 4 hospitals: 2 community-level ICUs and 2 tertiary referral ICUs. Each ICU had a dedicated ICU pharmacist and one or more pharmacy residents completing an ICU rotation as part of their pharmacy practice residency (total of 6 residents). The 6 pharmacy residents were randomly assigned to assess patients admitted to the ICU using FASTHUG-MAIDENS or standard monitoring practice. The mean proportion of DRPs per patient encounter identified by the residents (relative to DRPs identified by the ICU pharmacists) was the primary outcome, and the proportion of total DRPs identified in each group was assessed as a secondary end point.Results:Pharmacy residents using the FASTHUG-MAIDENS mnemonic identified a significantly greater mean proportion of DRPs per patient encounter (73.2% versus 52.4%, p = 0.008) and a greater proportion of total DRPs (77.1% versus 52.5%, p < 0.001) than those assessing patients according to standard monitoring practice.Conclusion:In this sample, the mnemonic FASTHUG-MAIDENS was a useful tool to facilitate the capture of DRPs by pharmacy residents working in the ICU.     

浅谈医院药师参与临床实践的必要性

本文针对目前医院临床药学工作的现状,分析和探讨了医,药两者之间相互作用,相互依存的紧密关系,阐述了医院药师参与临床实践的必要性。