How hospital pharmacists prioritise patients at high-risk for medication harm.
Adult
Aged
Australia
Cross-Sectional Studies
Drug Monitoring
/ methods
Drug-Related Side Effects and Adverse Reactions
/ prevention & control
Female
Focus Groups
Hospitalization
Humans
Male
Middle Aged
Pharmacists
/ organization & administration
Pharmacy Service, Hospital
/ organization & administration
Professional Role
Renal Insufficiency
/ complications
Surveys and Questionnaires
Young Adult
Hospital pharmacy
Medication harm
Patient prioritisation
Patient safety
Risk factors
Risk prediction
Journal
Research in social & administrative pharmacy : RSAP
ISSN: 1934-8150
Titre abrégé: Res Social Adm Pharm
Pays: United States
ID NLM: 101231974
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
02
11
2018
accepted:
03
11
2018
pubmed:
24
11
2018
medline:
6
6
2020
entrez:
24
11
2018
Statut:
ppublish
Résumé
Medication harm is experienced by up to 30% of hospitalised patients, of which 7% experience severe harm. Pharmacist review can mitigate this harm. However, in increasingly busy hospitals, with high patient throughput, and scarce resources, there is a need to prioritise patients. Current methods are cumbersome, include many risk factors and are not evaluated in the clinical setting. To determine key criteria used by hospital pharmacists and investigate perspectives related to patient prioritisation for potential medication harm in the hospital setting. This study used two methods; focus groups and a cross-sectional survey of Australian hospital pharmacists. Focus groups were used to identify criteria and perspectives related to prioritisation and were analysed thematically. Criteria from focus groups, and a systematic review, were used to design the survey. The survey was distributed via the Society of Hospital Pharmacists of Australia. The top 10 prioritisation criteria, and associated sub-criteria selected by over 50% of respondents were ranked. Combination of criteria used most frequently on a day-to-day basis were identified. Twenty clinical pharmacists participated in four, one-hour, audio recorded focus groups. Using inductive thematic analysis of transcripts three themes were identified; 1) prioritisation criteria, 2) barriers to, and 3) facilitators of patient prioritisation, with five sub-themes and 26 codes. Pharmacists identified a number of barriers such as a lack of relevant handover information. Organisational demands, such as patient discharge and medications supply also influenced priority and could act as barriers to a pharmacist enacting their prioritisation plan. A total of 231 pharmacists completed the survey. High priority criteria included, renal impairment, use of high-risk medications and therapeutic drug monitoring. Pharmacists described prioritisation as a multifactorial process with a focus on high-risk medications and renal impairment. These findings will inform the development of a predictive risk score for patient prioritisation.
Sections du résumé
BACKGROUND
Medication harm is experienced by up to 30% of hospitalised patients, of which 7% experience severe harm. Pharmacist review can mitigate this harm. However, in increasingly busy hospitals, with high patient throughput, and scarce resources, there is a need to prioritise patients. Current methods are cumbersome, include many risk factors and are not evaluated in the clinical setting.
OBJECTIVES
To determine key criteria used by hospital pharmacists and investigate perspectives related to patient prioritisation for potential medication harm in the hospital setting.
METHODS
This study used two methods; focus groups and a cross-sectional survey of Australian hospital pharmacists. Focus groups were used to identify criteria and perspectives related to prioritisation and were analysed thematically. Criteria from focus groups, and a systematic review, were used to design the survey. The survey was distributed via the Society of Hospital Pharmacists of Australia. The top 10 prioritisation criteria, and associated sub-criteria selected by over 50% of respondents were ranked. Combination of criteria used most frequently on a day-to-day basis were identified.
RESULTS
Twenty clinical pharmacists participated in four, one-hour, audio recorded focus groups. Using inductive thematic analysis of transcripts three themes were identified; 1) prioritisation criteria, 2) barriers to, and 3) facilitators of patient prioritisation, with five sub-themes and 26 codes. Pharmacists identified a number of barriers such as a lack of relevant handover information. Organisational demands, such as patient discharge and medications supply also influenced priority and could act as barriers to a pharmacist enacting their prioritisation plan. A total of 231 pharmacists completed the survey. High priority criteria included, renal impairment, use of high-risk medications and therapeutic drug monitoring.
CONCLUSION
Pharmacists described prioritisation as a multifactorial process with a focus on high-risk medications and renal impairment. These findings will inform the development of a predictive risk score for patient prioritisation.
Identifiants
pubmed: 30466812
pii: S1551-7411(18)30928-8
doi: 10.1016/j.sapharm.2018.11.003
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1266-1273Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.