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Hareem A, Stupans I, Park JS, Stevens JE, Wang K. Electronic health records and e-prescribing in Australia: An exploration of technological utilisation in Australian community pharmacies. Int J Med Inform 2024; 187:105472. [PMID: 38718670 DOI: 10.1016/j.ijmedinf.2024.105472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE This study aimed to assess the utilisation, benefits, and challenges associated with Electronic Health Records (EHR) and e-prescribing systems in Australian Community Pharmacies, focusing on their integration into daily practice and the impacts on operational efficiency, while also gathering qualitative insights from community pharmacists. METHODS A mixed-methods online survey was carried out among community pharmacists throughout Australia to assess the utilisation of EHR and e-prescribing systems, including the benefits and challenges associated with their use. Data was analysed based on pharmacists' age, gender, and practice location (metropolitan vs. regional). The chi-square test was applied to examine the relationship between these demographic factors and the utilisation and operational challenges of EHR and e-prescribing systems. RESULTS The survey engaged 120 Australian community pharmacists. Of the participants, 67 % reported usability and efficiency issues with EHR systems. Regarding e-prescribing, 58 % of pharmacists faced delays due to slow software performance, while 42 % encountered errors in data transmission. Despite these challenges, the benefits of e-prescribing were evident, with 79 % of respondents noting the elimination of illegible prescriptions and 40 % observing a reduction in their workload. Issues with prescription quantity discrepancies and the reprinting process were highlighted, indicating areas for improvement in workflow and system usability. The analysis revealed no significant statistical relationship between the utilisation and challenges of EHR and e-prescribing systems with the demographic variables of age, gender and location (p > 0.05), emphasising the necessity for healthcare solutions that address the needs of all pharmacists regardless of specific demographic segments. CONCLUSION In Australian community pharmacies, EHR and e-prescribing may enhance patient care but come with challenges such as data completeness, technical issues, and usability concerns. Implementing successful integration relies on user-centric design, standardised practices, and robust infrastructure. While demanding for pharmacists, the digital transition improves efficiency and quality of care. Ensuring user-friendly tools is crucial for the smooth utilisation of digital health.
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Affiliation(s)
- Amina Hareem
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
| | - Ieva Stupans
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Joon Soo Park
- School of Engineering, Information Technology and Physical Sciences, Federation University Australia, Ballarat, Victoria, Australia; Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Julie E Stevens
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia; Adelaide Medical School, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Kate Wang
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia; School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
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Claeys KC, Morgan DJ, Johnson MD. The importance of pharmacist engagement in diagnostic stewardship. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e43. [PMID: 38628377 PMCID: PMC11019581 DOI: 10.1017/ash.2024.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 04/19/2024]
Abstract
Diagnostic stewardship is increasingly recognized as a powerful tool to improve patient safety. Given the close relationship between diagnostic testing and antimicrobial misuse, antimicrobial stewardship (AMS) pharmacists should be key members of the diagnostic team. Pharmacists practicing in AMS already frequently engage with clinicians to improve the diagnostic process and have many skills needed for the implementation of diagnostic stewardship initiatives. As diagnostic stewardship becomes more broadly used, all infectious disease clinicians, including pharmacists, must collaborate to optimize patient care.
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Affiliation(s)
- Kimberly C. Claeys
- Associate Professor Infectious Diseases, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Daniel J. Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Veterans’ Affairs Maryland Healthcare System, Baltimore, MD, USA
| | - Melissa D. Johnson
- Professor in Medicine, Division of Infectious Diseases & International Health, Duke University School of Medicine, Durham, NC, USA
- Liaison Clinical Pharmacist, Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University Medical Center, Durham, NC, USA
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Pereira N, Duff JP, Hayward T, Kherani T, Moniz N, Champigny C, Carson-Stevens A, Bowie P, Egan R. Methods for studying medication safety following electronic health record implementation in acute care: a scoping review. J Am Med Inform Assoc 2024; 31:499-508. [PMID: 38037171 PMCID: PMC10797275 DOI: 10.1093/jamia/ocad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES The objective of this scoping review is to map methods used to study medication safety following electronic health record (EHR) implementation. Patterns and methodological gaps can provide insight for future research design. MATERIALS AND METHODS We used the Joanna Briggs Institute scoping review methodology and a custom data extraction table to summarize the following data: (1) study demographics (year, country, setting); (2) study design, study period, data sources, and measures; (3) analysis strategy; (4) identified limitations or recommendations; (5) quality appraisal; and (6) if a Safety-I or Safety-II perspective was employed. RESULTS We screened 5879 articles. One hundred and fifteen articles met our inclusion criteria and were assessed for eligibility by full-text review. Twenty-seven articles were eligible for extraction. DISCUSSION AND CONCLUSION We found little consistency in how medication safety following EHR implementation was studied. Three study designs, 7 study settings, and 10 data sources were used across 27 articles. None of the articles shared the same combination of design, data sources, study periods, and research settings. Outcome measures were neither defined nor measured consistently. It may be difficult for researchers to aggregate and synthesize medication safety findings following EHR implementation research. All studies but one used a Safety-I perspective to study medication safety. We offer a conceptual model to support a more consistent approach to studying medication safety following EHR implementation.
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Affiliation(s)
- Nichole Pereira
- Faculty of Health Sciences, Health Quality Program, Queen’s University, Kingston, ON K7L 3N6, Canada
- Pediatric Intensive Care Unit, Alberta Health Services, Edmonton, AB T6G 2B7, Canada
| | - Jonathan P Duff
- Pediatric Intensive Care Unit, Alberta Health Services, Edmonton, AB T6G 2B7, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Tracy Hayward
- Department of Patient Safety, Covenant Health, Edmonton, AB T5R 4H5, Canada
| | - Tamizan Kherani
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Nadine Moniz
- Stroke Program, Alberta Health Services, Edmonton, AB T6G 2J3, Canada
| | | | - Andrew Carson-Stevens
- Faculty of Health Sciences, Health Quality Program, Queen’s University, Kingston, ON K7L 3N6, Canada
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Paul Bowie
- Faculty of Health Sciences, Health Quality Program, Queen’s University, Kingston, ON K7L 3N6, Canada
- Medical Directorate, NHS Education for Scotland, Glasgow EH4 2XU, United Kingdom
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8TB, United Kingdom
| | - Rylan Egan
- Faculty of Health Sciences, Health Quality Program, Queen’s University, Kingston, ON K7L 3N6, Canada
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Ranusch A, Lin YJ, Dorsch MP, Allen AL, Spoutz P, Seagull FJ, Sussman JB, Barnes GD. Role of Individual Clinician Authority in the Implementation of Informatics Tools for Population-Based Medication Management: Qualitative Semistructured Interview Study. JMIR Hum Factors 2023; 10:e49025. [PMID: 37874636 PMCID: PMC10630856 DOI: 10.2196/49025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/16/2023] [Accepted: 09/02/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Direct oral anticoagulant (DOAC) medications are frequently associated with inappropriate prescribing and adverse events. To improve the safe use of DOACs, health systems are implementing population health tools within their electronic health record (EHR). While EHR informatics tools can help increase awareness of inappropriate prescribing of medications, a lack of empowerment (or insufficient empowerment) of nonphysicians to implement change is a key barrier. OBJECTIVE This study examined how the individual authority of clinical pharmacists and anticoagulation nurses is impacted by and changes the implementation success of an EHR DOAC Dashboard for safe DOAC medication prescribing. METHODS We conducted semistructured interviews with pharmacists and nurses following the implementation of the EHR DOAC Dashboard at 3 clinical sites. Interview transcripts were coded according to the key determinants of implementation success. The intersections between individual clinician authority and other determinants were examined to identify themes. RESULTS A high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard (communication, staffing and work schedule, job satisfaction, and EHR integration). Conversely, a lack of individual authority was often associated with key barriers to effective DOAC Dashboard use. Positive individual authority was sometimes present with a negative example of another determinant, but no evidence was found of individual authority co-occurring with a positive instance of another determinant. CONCLUSIONS Increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard and positively affects other aspects of implementation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13012-020-01044-5.
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Affiliation(s)
- Allison Ranusch
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Ying-Jen Lin
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Arthur L Allen
- Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Patrick Spoutz
- Veterans Integrated Service Network 20 Northwest Network, Vancouver, WA, United States
| | - F Jacob Seagull
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jeremy B Sussman
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Geoffrey D Barnes
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
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Al-Kubaisi KA, Elnour AA, Sadeq A. Factors influencing pharmacists' participation in continuing education activities in the United Arab Emirates: insights and implications from a cross-sectional study. J Pharm Policy Pract 2023; 16:112. [PMID: 37784207 PMCID: PMC10546650 DOI: 10.1186/s40545-023-00623-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Continuing professional development (CPD) is essential for pharmacists to maintain and enhance their knowledge and skills. The purpose of this research was to collect data about the perception of pharmacists in the United Arab Emirates (UAE) towards CPD and identify factors that motivate or hinder their participation in different types of CPD activities. METHODS A cross-sectional survey was conducted among 322 pharmacists who completed a self-administered questionnaire that assessed their demographic characteristics, CPD preferences, motivators and obstacles to attending CPD programs, and perceived learning outcomes. RESULTS Participants' average age was 33 years (mean = 30.6, SD = 5.97), and the range of years, since they graduated from a pharmacy degree program was 18 years (mean = 10.9, SD = 4.8). More than half of the participants were female; 198 (61.5%) and 193 (59.9%) of them were married. The study found that married pharmacists (AOR = 0.5, 95% CI 0.266-0.939, P value = 0.031), older participants (AOR = 0.232, 95% CI 0.266-0.939, P value = 0.04), and those who graduated longer than 16 years ago were less likely to attend live CPD events (AOR = 0.454, 95% CI 0.22-0.924). However, participants who worked up to 15 h had higher odds of attending live CPD events (AOR = 3.511, 95% CI 1.117-11.039, P value: 0.026). In addition, female pharmacists were less likely to participate in computer/internet-based continuing education than male pharmacists (AOR = 0.038, 95% CI 0.293-0.965, P value = 0.038). It also revealed that pharmacists who were not motivated by the topic of the CPD activity had a higher chance of attending computer/internet-based format (AOR = 2.289, 95% CI 1.198-4.371, P value = 0.012). In contrast, those who did not report the long distance to the CPD site as a hindrance had a lower likelihood of attending online internet-based CPD (AOR = 0.548, 95% CI 0.319-0.941, P value = 0.029). CONCLUSIONS This study is the first to explore pharmacists' predictors of attending different CPD activities. These predictors are gender, age, marital status, experience since graduation, working hours, family barriers, work responsibilities, interest in the presentation topic, and the long travel distance to the site. These findings suggest that pharmacists have unique challenges and motivations regarding continuing education and that tailored approaches may be necessary to encourage participation.
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Affiliation(s)
- Khalid Awad Al-Kubaisi
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, P. O. Box 27272, Sharjah, United Arab Emirates
| | - Asim Ahmed Elnour
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University (AAU), Abu Dhabi Campus, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research Centre, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Adel Sadeq
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
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Sanders KA, Wolverton D, Stamopoulos M, Zunich R, Niznik J, Ferreri SP. An EHR-based method to structure, standardize, and automate clinical documentation tasks for pharmacists to generate extractable outcomes. JAMIA Open 2023; 6:ooad034. [PMID: 37181730 PMCID: PMC10174697 DOI: 10.1093/jamiaopen/ooad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023] Open
Abstract
As the recognition of team-based care grows and pharmacists increase in patient care interventions, it is important that tools to track clinical services are easily accessible and well-integrated into workflow for all providers. We describe and discuss feasibility and implementation of data tools in an electronic health record to evaluate a pragmatic clinical pharmacy intervention focused on deprescribing in aged adults delivered at multiple clinical sites in a large academic health system. Of the data tools utilized, we were able to demonstrate clear documentation frequency of certain phrases during the intervention period for 574 patients receiving opioids and 537 patients receiving benzodiazepines. Although clinical decision support and documentation tools exist, they are underutilized or cumbersome to integrate into primary health care and strategies, such as employed, are a solution. This communication incorporates the importance of clinical pharmacy information systems in research design.
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Affiliation(s)
- Kimberly A Sanders
- Corresponding Author: Kimberly A. Sanders, PharmD, Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, 301 Pharmacy Lane, Campus Box 7574, Chapel Hill, NC 27599-7574, USA;
| | - Daniel Wolverton
- Department of Pharmacy, UNC Health, Chapel Hill, North Carolina, USA
| | | | - Rada Zunich
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Joshua Niznik
- Division of Geriatrics and Center for Aging and Health, Division of Pharmaceutical Outcomes and Policy, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
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Raat W, Truyts P, Gaillaert J, Van de Putte M, Van der Linden L, Janssens S, Vaes B, Smeets M. Community pharmacists' perceptions on multidisciplinary heart failure care: an exploratory qualitative study. BMC Health Serv Res 2023; 23:638. [PMID: 37316813 PMCID: PMC10266313 DOI: 10.1186/s12913-023-09661-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Heart failure (HF) is an important health problem and guidelines recommend multidisciplinary management. The pharmacist is an important member of the multidisciplinary heart failure team, both in the hospital and community setting. This study aims to explore the perceptions of community pharmacists on their role in HF care. METHODS We conducted a qualitative study based on face-to-face semi-structured interviews with 13 Belgian community pharmacists between September 2020 and December 2020. We used the Qualitative Analysis Guide of Leuven (QUAGOL) method as guidance for data analysis until data saturation was reached. We structured interview content into a thematic matrix. RESULTS We identified two major themes: heart failure management and multidisciplinary management. Pharmacists feel responsible for the pharmacological and non-pharmacological management of heart failure, citing easy access and pharmacological expertise as important assets. Diagnostic uncertainty, lack of knowledge and time, disease complexity and difficulties in communication with patients and informal care providers are barriers to optimal management. General practitioners are the most important partners in multidisciplinary community heart failure management, although pharmacists perceive a lack of appreciation and cooperation and deplore communication difficulties. They feel intrinsically motivated to provide extended pharmaceutical care in HF but cite the lack of financial viability and information sharing structures as important barriers. CONCLUSION The importance of pharmacist involvement in multidisciplinary heart failure teams is undisputed by Belgian pharmacists, who cite easy access and pharmacological expertise as important assets. They point out several barriers impeding evidence-based pharmacist care for outpatients with heart failure: diagnostic uncertainty and disease complexity, lack of multidisciplinary information technology and insufficient resources. We recommend that future policy should focus on improved medical data exchanges between primary and secondary care electronic health records as well as the reinforcement of interprofessional relationships between locally affiliated pharmacists and general practitioners.
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Affiliation(s)
- Willem Raat
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, blok D bus 7001 3000, Leuven, Belgium.
| | - Pauline Truyts
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Justine Gaillaert
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Lorenz Van der Linden
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Pharmacy Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, blok D bus 7001 3000, Leuven, Belgium
| | - Miek Smeets
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, blok D bus 7001 3000, Leuven, Belgium
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Dupree LH, Schmittgen J, Taylor TH. Teaching pharmacy students a systematic approach to medication order verification. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1015-1020. [PMID: 36055691 DOI: 10.1016/j.cptl.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 05/28/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE Inpatient medication order verification is an important skill for pharmacy students to learn for patient safety. This article describes a systematic approach to order verification that enables students to apply didactic knowledge and determine the presence of drug therapy problems during verification decisions. EDUCATIONAL ACTIVITY AND SETTING At two different colleges of pharmacy, an order verification module for second-year pharmacy students introduced a checklist for reviewing medication orders in a patient chart and identifying the presence of drug therapy problems. Students had to make a "verify or not" decision for each non-verified order and document their decision in both the chart and on a game-based learning platform. FINDINGS Over four academic years, 756 students participated in the module. With the checklist approach to order verification, students were able to identify the drug therapy problems of "dose too high" and "no drug therapy problem present" but were challenged by "wrong drug," "dose too low/renal dosing," and "duplication of therapy." SUMMARY The order verification checklist was a beneficial tool for teaching a systematic approach to inpatient medication order verification.
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Affiliation(s)
- Lori H Dupree
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
| | - Janet Schmittgen
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, 1225 Center Drive, Gainesville, FL 32611, United States.
| | - Thomas H Taylor
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
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Kang D, Charlton P, Applebury DE, Robinson EJ, Merkel MJ, Rowe S, Mohan V, Gold JA. Utilizing eye tracking to assess electronic health record use by pharmacists in the intensive care unit. Am J Health Syst Pharm 2022; 79:2018-2025. [PMID: 35671342 DOI: 10.1093/ajhp/zxac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE A study was conducted using high-fidelity electronic health record (EHR)-based simulations with incorporated eye tracking to understand the workflow of critical care pharmacists within the EHR, with specific attention to the data elements most frequently viewed. METHODS Eight critical care pharmacists were given 25 minutes to review 3 simulated intensive care unit (ICU) charts deployed in the simulation instance of the EHR. Using monitor-based eye trackers, time spent reviewing screens, clinical information accessed, and screens used to access specific information were reviewed and quantified to look for trends. RESULTS Overall, pharmacists viewed 25.5 total and 15.1 unique EHR screens per case. The majority of time was spent looking at screens focused on medications, followed by screens displaying notes, laboratory values, and vital signs. With regard to medication data, the vast majority of screen visitations were to view information on opioids/sedatives and antibiotics. With regard to laboratory values, the majority of views were focused on basic chemistry and hematology data. While there was significant variance between pharmacists, individual navigation patterns remained constant across cases. CONCLUSION The study results suggest that in addition to medication information, laboratory data and clinical notes are key focuses of ICU pharmacist review of patient records and that navigation to multiple screens is required in order to view these data with the EHR. New pharmacy-specific EHR interfaces should consolidate these elements within a primary interface.
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Affiliation(s)
- Dean Kang
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, Portland, OR, and United States Department of the Navy, USA
| | - Patrick Charlton
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - David E Applebury
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - Eric J Robinson
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - Matthias J Merkel
- OHSU Health, Portland, OR, and Department of Anesthesiology & Perioperative Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - Sandra Rowe
- OHSU Health, Portland, OR, and Department of Anesthesiology & Perioperative Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - Vishnu Mohan
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, Portland, OR, USA
| | - Jeffrey A Gold
- Department of Medical Informatics and Clinical Epidemiology and Division of Pulmonary and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA
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Predictors of clinician use of Australia’s national health information exchange in the emergency Department: An analysis of log data. Int J Med Inform 2022; 161:104725. [DOI: 10.1016/j.ijmedinf.2022.104725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/10/2022] [Accepted: 02/20/2022] [Indexed: 11/19/2022]
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Lee KC, Silvia RJ, Payne GH, Moore TD, Ansara ED, Ross CA. Best practice model for outpatient psychiatric pharmacy practice, part 2: Confirmation of the attribute statements. Ment Health Clin 2022; 12:65-76. [PMID: 35582319 PMCID: PMC9009822 DOI: 10.9740/mhc.2022.04.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The American Association of Psychiatric Pharmacists (AAPP) used multiple modalities to develop and refine 28 attribute statements to describe a best practice model for outpatient psychiatric pharmacists. Before addressing implementation, assessment, and field testing, it was necessary to finalize and confirm the statements and their supporting narratives among stakeholders. The objective of this project was to confirm the attribute statements and supporting justifications for a best practice model for outpatient psychiatric pharmacists providing direct patient care. Methods The 4 phases that resulted in the 28 attribute statements and supporting narratives have been described and published elsewhere. As part of phase 5, the confirmation survey was distributed to pharmacists and resident members of AAPP in November 2021 for 3 weeks. Results The survey respondents (n = 74; 6.1%) were licensed pharmacists for an average of 15.6 years (SD = 12.0) and had been practicing as psychiatric pharmacists for an average of 11.3 years (SD = 10.4). Slightly more than half (54.2%) of the respondents reported practicing in the outpatient setting and three-fourths (74.3%) were Board Certified Psychiatric Pharmacists. For each of the 28 statements, more than 90% of respondents either agreed or agreed with minimal reservations. Discussion Given the high degree of agreement on the proposed practice model statements, they will be used as the basis for the outpatient psychiatric pharmacist best practice model. Next steps in developing this model include establishing implementation guidance, determining appropriate metrics for evaluation of these statements in practice, and establishing appropriate field-testing methods.
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Affiliation(s)
| | - Richard J. Silvia
- Professor of Pharmacy Practice, School of Pharmacy-Boston, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts
| | - Gregory H. Payne
- Director of Strategic Initiatives, American Association of Psychiatric Pharmacists, Lincoln, Nebraska
| | - Tera D. Moore
- Pharmacy Benefits Management Services, Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC
| | - Elayne D. Ansara
- Clinical Pharmacy Practitioner–Mental Health, Veteran Health Indiana, Indianapolis, Indiana
| | - Clint A. Ross
- Pharmacy Coordinator, Institute of Psychiatry, MUSC Health, Charleston, South Carolina
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Serhal S, Armour C, Billot L, Krass I, Emmerton L, Saini B, Bosnic-Anticevich S, Bereznicki B, Bereznicki L, Shan S, Campain A. Integrating Pharmacy and Registry Data Strengthens Clinical Assessments of Patient Adherence. Front Pharmacol 2022; 13:869162. [PMID: 35401235 PMCID: PMC8990834 DOI: 10.3389/fphar.2022.869162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Accurate clinical assessment of patient adherence using reliable and valid measures is essential in establishing the presence of adherence issues and support practices for pharmacists.Objective: This investigation aims to conduct a novel assessment of patient adherence to asthma controller therapy by combining 1) patient-specific dosage data found in pharmacy dispensing data with 2) centrally collected administrative claims records, to determine the added value of using both sources of data.Methods: A total of 381 clinically uncontrolled asthma patients, from 95 community pharmacies across three Australian States were recruited and provided consent for the retrieval of their claims records and pharmacy dispensing data. Patients were stratified as multiple or single pharmacy users and adherence scores were calculated via the proportion of days covered (PDC) method using 1) patient claims records, 2) patient pharmacy dispensing data, and 3) combined claims records and pharmacy dispensing data. Cohort and subgroup adherence estimates were then compared.Results: Low levels of adherence were evident amongst the cohort irrespective of the data source used. PDC estimates based on claims records alone or combined claims records and pharmacy dispensing data were significantly higher than estimates based on pharmacy dispensing data for the total cohort (56%, 52%, 42% respectively, p < 0.001) and more noticeably for multiple pharmacy users (67%, 64%, 35% respectively, p < 0.001). PDC estimates based on combined claims records and pharmacy dispensing data were significantly lower than estimates based on claims records alone, indicating that perhaps standard daily dose is not a robust proxy for prescribed dosage to inhaled respiratory devices in adherence approximations. Poorer adherence was found amongst single pharmacy users than multiple pharmacy users when combined claims records and pharmacy dispensing data (46% compared to 64% respectively, p < 0.001) or claims records alone (51% compared to 67% respectively, p < 0.001) were compared.Conclusion: Access to routine collected data increases clinical acuity over patient adherence to asthma controller medications and is a valuable resource for health care professionals. A policy of secure accessibility of such data at the patient-pharmacist or patient-GP interface may allow real-time intervention and assist in decision making across numerous therapeutic areas.
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Affiliation(s)
- Sarah Serhal
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Sarah Serhal,
| | - Carol Armour
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute, Newtown, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Lynne Emmerton
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | | | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Sana Shan
- The George Institute, Newtown, NSW, Australia
| | - Anna Campain
- The George Institute, Newtown, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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13
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Hamad MME, Bah S. Impact of Implementing Electronic Health Records on Medication Safety at an HIMSS Stage 6 Hospital: The Pharmacist's Perspective. Can J Hosp Pharm 2022; 75:267-275. [PMID: 36246440 PMCID: PMC9524548 DOI: 10.4212/cjhp.3223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Background Medication errors can cause severe injuries and may lead to death. Electronic health records (EHRs) that are well designed and implemented could help to reduce medication errors. The medication management process needs close study to understand how medication safety metrics evolve as hospitals mature in terms of their EHR implementation. Objective To examine the effect of adopting EHRs on medication errors at the Royal Commission Hospital in Jubail, Saudi Arabia, a Health Information Management System Society (HIMSS) stage 6 hospital. Methods This study had a quasi-experimental time-series design. Retrospective data were collected for 1.5-year periods before and after implementation of EHRs. The variables analyzed were obtained from various units in the study setting. Data on medication errors were collected from the risk management section of the quality department. The medication management process was studied qualitatively. The quantitative data were analyzed using descriptive and inferential statistics. Results The median number of medication orders per patient showed a significant decrease, from 22.76 before EHR implementation to 18.76 after implementation (p < 0.001). The median number of incidents per patient showed a significant increase, from 0.029 before to 0.040 after implementation (p = 0.004). The qualitative analysis of processes involved in the medication management process helped to explain these changes. Conclusion Contrary to expectations, this study showed that an HIMSS stage 6 hospital could experience an increase in medication errors following implementation of EHRs. Qualitative analysis showed that the increase in medication error reporting rate could be attributed to an increase in detection following improvement in the medication management process. This has implications for interpreting quality metrics as hospitals mature in terms of their EHR implementation.
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Affiliation(s)
| | - Sulaiman Bah
- , PhD, is with the Department of Public Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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14
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Almansour HA, Aloudah NM, Alhawassi TM, Chaar B, Krass I, Saini B. Physicians' views on cardiovascular disease risk prevention services by pharmacists and potential for collaboration. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:100077. [PMID: 35479842 PMCID: PMC9029915 DOI: 10.1016/j.rcsop.2021.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/10/2021] [Accepted: 09/26/2021] [Indexed: 10/26/2022] Open
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Mullins AK, Morris H, Enticott J, Ben-Meir M, Rankin D, Mantripragada K, Skouteris H. Use of My Health Record by Clinicians in the Emergency Department: An Analysis of Log Data. Front Digit Health 2021; 3:725300. [PMID: 34713198 PMCID: PMC8521888 DOI: 10.3389/fdgth.2021.725300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Leverage log data to explore access to My Health Record (MHR), the national electronic health record of Australia, by clinicians in the emergency department. Materials and Methods: A retrospective analysis was conducted using secondary routinely-collected data. Log data pertaining to all patients who presented to the emergency department between 2019 and 2021 of a not-for-profit hospital (that annually observes 23,000 emergency department presentations) were included in this research. Attendance data and human resources data were linked with MHR log data. The primary outcome was a dichotomous variable that indicated whether the MHR of a patient was accessed. Logistic regression facilitated the exploration of factors (user role, day of the week, and month) associated with access. Results: My Health Record was accessed by a pharmacist, doctor, or nurse in 19.60% (n = 9,262) of all emergency department presentations. Access was dominated by pharmacists (18.31%, n = 8,656). All users demonstrated a small, yet significant, increase in access every month (odds ratio = 1.07, 95% Confidence interval: 1.06-1.07, p ≤ 0.001). Discussion: Doctors, pharmacists, and nurses are increasingly accessing MHR. Based on this research, substantially more pharmacists appear to be accessing MHR, compared to other user groups. However, only one in every five patients who present to the emergency department have their MHR accessed, thereby indicating a need to accelerate and encourage the adoption and access of MHR by clinicians.
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Affiliation(s)
- Alexandra K Mullins
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Heather Morris
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Enticott
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | | | | | | | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.,Warwick Business School, University of Warwick, Coventry, United Kingdom
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16
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Al Anazi A. Medication reconciliation process: Assessing value, adoption, and the potential of information technology from pharmacists' perspective. Health Informatics J 2021; 27:1460458220987276. [PMID: 33467954 DOI: 10.1177/1460458220987276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Medication Reconciliation (MedRec) process aims to improve patient safety through safe prescription and medication administration. A validated survey was carried out to address aspects related to MedRec process, its obstacles, the role of information technology, and the required functionalities for optimizing the MedRec process. A total of 81% of the survey's respondents acknowledged the roles of EHR (62% of respondents), PHR (41%), and electronic medication registration list (33%) as necessary technology tools for MedRec. Most respondents emphasized the need to compile multiple medications' entries of information technology systems into one application (96.4%), allowing the entries from community pharmacies (90.6%). Further, incorporating information technology into the MedRec process presents a challenge in terms of legal responsibility (92 %) and the ability to integrate medications with other hospitals and community medications (78.6%). Findings affirm the need for a well-designed MedRec process aided with information technology solutions. The external data and user preferences should be considered when redesigning the MedRec process. The study also suggests initiating a policy that mandates sharing data necessary for creating a compiled medication list for each patient. MedRec is an indispensable tool for building a fruitful medication management system in a healthcare organization.
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Affiliation(s)
- Abdullah Al Anazi
- King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.,King Abdullah International Medical Research Center, Saudi Arabia.,Ministry of National Guard-Health Affairs, Saudi Arabia
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17
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Yan L, Reese T, Nelson SD. A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists. Appl Clin Inform 2021; 12:199-207. [PMID: 33730757 DOI: 10.1055/s-0041-1722916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. METHODS We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. CONCLUSION These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.
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Affiliation(s)
- Liang Yan
- University of Utah College of Pharmacy, University of Utah Health, Salt Lake City, Utah, United States
| | - Thomas Reese
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Scott D Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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18
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Turton H, Jones C, Levy R, Patanwala AE. Comparison of intermittent audit vs daily documentation of pharmacist interventions. Am J Health Syst Pharm 2021; 78:222-228. [PMID: 33274361 DOI: 10.1093/ajhp/zxaa382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare an intermittent audit method vs a daily documentation method with regard to the number of interventions documented by clinical pharmacists in the hospital setting. METHODS A 2-phase pre-post cohort study was conducted at an academic hospital to compare numbers and types of pharmacist interventions documented over an 18-month period before implementation of a daily documentation method (the "pre-phase" period) and during the 6 months after implementation (the "post-phase" period). During the pre-phase period (January 2018 to July 2019), pharmacists prospectively documented interventions on specific audit days. The audit days occurred at approximately monthly intervals. During the post-phase period (July 2019 to March 2020) pharmacists used electronic medical record tools to document interventions daily. The primary outcome was the total number of interventions per day. Values for the pre- and post-phase periods were compared using an unpaired Student t test and through interrupted time series analysis. RESULTS There were a total of 3,628 interventions (on 14 intermittent audit days) during the pre-phase period and 9,300 interventions (on 163 continuous days) in the post-phase period. The mean (SD) number of reported interventions per day decreased from 259 (82) in the pre-phase period to 57 (33) in the post-phase period (P < 0.001). The mean (SD) number of daily reported interventions per pharmacist decreased from 24 (5) in the pre-phase period to 6 (2) in the post-phase period (P < 0.001). This decrease was consistent with results of the interrupted time series analysis. There was a decrease in reported interventions at the time of implementation (change from most recent audit day, -125 interventions; 95% confidence interval [CI], -187 to -62 interventions; P < 0.001). Similarly, there was a decrease in reported interventions per pharmacist at the time of implementation (change from most recent audit day, -22 [95% CI, -26 to -18] interventions; P < 0.001). CONCLUSION A change from intermittent audits to daily documentation of interventions resulted in an approximately 5-fold decrease in the number of interventions recorded by pharmacists.
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Affiliation(s)
- Hannah Turton
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Ceridwen Jones
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Russell Levy
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Asad E Patanwala
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, Australia.,School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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19
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Pharmacists' Perspectives on the Use of My Health Record. PHARMACY 2020; 8:pharmacy8040190. [PMID: 33066569 PMCID: PMC7712990 DOI: 10.3390/pharmacy8040190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 11/17/2022] Open
Abstract
(1) Background: My Health Record (MHR) is a relatively new nationwide Australian digital health record system accessible by patients and a range of healthcare professionals. Pharmacists will be key contributors and users of the MHR system, yet little is known about the perceived barriers and benefits of use. (2) Objective: To explore pharmacists' perspectives related to potential benefits and barriers associated with use of MHR. (3) Methods: An online survey was developed and face-validated. The survey was advertised to Australian pharmacists on pharmacy professional bodies' websites. This was a cross-sectional study using an anonymous questionnaire. Descriptive statistics were used to describe the distribution of the data. Chi-square, Kendall's tau coefficient (tau-c) and Kruskal-Wallis tests were used to examine the relationships where appropriate. (4) Results: A total of 63 pharmacists completed the survey. The majority of respondents worked in a metropolitan area (74%), and the most common workplace setting was community pharmacy (65%). Perceived benefits identified by responders include that the use of MHR would help with continuity of care (90%), and that it would improve the safety (71%) and quality (75%) of care they provided. Importantly, more than half of pharmacists surveyed agreed that MHR could reduce medication errors during dispensing (57%) and could improve professional relationships with patients (57%) and general practitioners (59%). Potential barriers identified by pharmacists included patients' concerns about privacy (81%), pharmacists' own concern about privacy (46%), lack of training, access to and confidence in using the system. Sixty six percent of respondents had concerns about the accuracy of information contained within MHR, particularly among hospital and general practice pharmacists (p = 0.016) and almost half (44%) had concerns about the security of information in the system, mainly pharmacists working at general practice and providing medication review services (p = 0.007). Overall satisfaction with MHR varied, with 48% satisfied, 33% neither satisfied nor dissatisfied, and 19% dissatisfied, with a higher satisfaction rate among younger pharmacists (p = 0.032). (5) Conclusions: Pharmacists considered that the MHR offered key potential benefits, notably improving the safety and quality of care provided. To optimize the use of MHR, there is a need to improve privacy and data security measures, and to ensure adequate provision of user support and education surrounding the ability to integrate use of MHR with existing workflows and software.
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20
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Vlashyn OO, Adeoye-Olatunde OA, Illingworth Plake KS, Woodyard JL, Weber ZA, Russ-Jara AL. Pharmacy students' perspectives on the initial implementation of a teaching electronic medical record: results from a mixed-methods assessment. BMC MEDICAL EDUCATION 2020; 20:187. [PMID: 32517745 PMCID: PMC7285515 DOI: 10.1186/s12909-020-02091-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Electronic medical records (EMRs) have been used for nearly three decades. Pharmacists use EMRs on a daily basis, but EMRs have only recently been incorporated into pharmacy education. Some pharmacy programs have implemented teaching electronic medical records (tEMRs), but best practices for incorporating tEMRs into pharmacy education remain unknown. The objectives of this study were to 1) assess pharmacy students' views and experiences with a tEMR; and 2) identify current learning activities and future priorities for tEMR use in pharmacy education. METHODS We used a mixed-methods approach, including three, two-hour student focus groups and a 42-item web-based survey to examine student perspectives of the tEMR. All first, second, and third year professional pharmacy students were eligible to participate in the survey and a focus group. Web-based survey items were measured on a 7-point Likert scale, and quantitative analyses included descriptive statistics. Two researchers independently coded transcripts using both deductive and inductive approaches to identify emergent themes. These analysts met and resolved any coding discrepancies via consensus. RESULTS Focus groups were conducted with 22 total students, with 6-8 students represented from each year of pharmacy training. The survey was completed by 156 students: 47 first year, 55 second year, and 54 third year. Overall, 48.7% of survey respondents altogether agreed or strongly agreed that using the tEMR enhanced their learning in pharmacy classes and laboratories. Qualitative data were organized into four major themes regarding tEMR adoption: current priorities for use within the pharmacy curriculum; tEMR benefits; tEMR barriers; and future priorities for tEMR use to prepare students for pharmacy practice. CONCLUSIONS This study reveals pharmacy students' perspectives and attitudes towards using a tEMR, the types of classroom activities that incorporate the tEMR, and students' future suggestions to enhance the design or application of the tEMR for their learning. Our research findings may aid other pharmacy programs and promote more effective use of tEMRs in pharmacy education. In the long-term, this study may strengthen pharmacy education on EMRs and thus increase the efficacy and safety of pharmacists' EMR use for patients' medication management.
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Affiliation(s)
- Olga O. Vlashyn
- Purdue University College of Pharmacy, 575 W. Stadium Ave, West Lafayette, IN 47907 USA
- The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210 USA
| | | | | | - Jamie L. Woodyard
- Purdue University College of Pharmacy, 575 W. Stadium Ave, West Lafayette, IN 47907 USA
| | - Zachary A. Weber
- Purdue University College of Pharmacy, 575 W. Stadium Ave, West Lafayette, IN 47907 USA
| | - Alissa L. Russ-Jara
- Purdue University College of Pharmacy, 575 W. Stadium Ave, West Lafayette, IN 47907 USA
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21
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Philippon JS, Kusoski CL, Kennerly-Shah JM, Barreto JS. Describing the role of the hematology/oncology clinical pharmacist in health information technology. J Oncol Pharm Pract 2020; 27:14-19. [PMID: 32306889 DOI: 10.1177/1078155220908924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the role of hematology/oncology clinical pharmacists in health information technology as well as their perceptions of the impact of technology expansion on patient care. METHODS A single-center, web-based survey was distributed to 30 hematology/oncology clinical pharmacists by email over the two-week-period of 24 September 2018 to 8 October 2018. The anonymous survey was composed of 19 questions, with varying formats including multiple choice, fill-in-the-blank, and rank order. Primary endpoints were quantification of time spent in the electronic health record and perceptions on how technology expansion has impacted the safety, quality, and efficiency of patient care. RESULTS Twenty-seven hematology/oncology clinical pharmacists (90% response rate) completed the survey in its entirety. Respondents reported that they spend an average of 84.1% of their work day in the electronic health record. Based on a 40-h work week, clinical pharmacists indicated that they spend approximately 32.2 h each week performing direct patient care tasks in the electronic health record compared to 3.7 h on indirect patient care tasks. All respondents reported a greater utilization of technology over the last five years, and most respondents felt that patient care is safer, of better quality, and more efficient with technology expansion. The majority of respondents (81.5%) indicated that clinical pharmacists have the best understanding of the health information technology system, followed by generalist pharmacists and informatics pharmacists. CONCLUSION The hematology/oncology clinical pharmacist is well positioned to serve as a health information technology leader on the interdisciplinary healthcare team.
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Affiliation(s)
- Jennifer S Philippon
- The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The 12306Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carolyn L Kusoski
- The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The 12306Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie M Kennerly-Shah
- The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The 12306Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Janinah S Barreto
- The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The 12306Ohio State University Wexner Medical Center, Columbus, OH, USA
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22
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Vordenberg SE, Lindell V, Sheerer K, Settles A, Fan AL, Serlin DC, Parker-Featherstone E, Bernstein SJ, Choe HM. Improving hypertension control through a collaboration between an academic medical center and a chain community pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Valerie Lindell
- Pharmacy Innovations and Partnerships; Michigan Medicine; Ann Arbor Michigan
| | | | - Amy Settles
- Pharmacy Innovations and Partnerships; Michigan Medicine; Ann Arbor Michigan
| | - Audrey L. Fan
- Internal Medicine; Michigan Medicine; Northville Michigan
| | | | | | - Steven J. Bernstein
- Internal Medicine and Center for Clinical Management Research; Michigan Medicine; Ann Arbor Michigan
- VA Ann Arbor Healthcare System; Ann Arbor Michigan
| | - Hae M. Choe
- College of Pharmacy; University of Michigan; Ann Arbor Michigan
- Pharmacy Innovations and Partnerships; Michigan Medicine; Ann Arbor Michigan
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23
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Affiliation(s)
- Shane Jackson
- Pharmaceutical Society of Australia, Canberra.,Division of Pharmacy, School of Medicine, University of Tasmania, Hobart.,School of Medicine, University of Tasmania, Hobart.,University of Canberra
| | - Gregory Peterson
- Pharmaceutical Society of Australia, Canberra.,Division of Pharmacy, School of Medicine, University of Tasmania, Hobart.,School of Medicine, University of Tasmania, Hobart.,University of Canberra
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24
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Improving care transitions through medication therapy management: A community partnership to reduce readmissions in multiple health-systems. J Am Pharm Assoc (2003) 2019; 59:319-328. [DOI: 10.1016/j.japh.2019.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/30/2018] [Accepted: 01/07/2019] [Indexed: 11/18/2022]
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25
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Carroll N, Richardson I. Enablers and barriers for hospital pharmacy information systems. Health Informatics J 2019; 26:406-419. [PMID: 30841781 DOI: 10.1177/1460458219832056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pharmacy plays a pivotal role in supporting acute clinical care pathways. However, across hospital environments, pharmacies are often stretched by growing service demands and conflicted by increased medication and service costs. Ultimately, such factors contribute towards process inefficiencies that impact on the provision of healthcare services. Following a literature review, we examined clinical pharmacy services by undertaking three acute hospital pharmacy case studies. We adopted an ethnographic approach, observing and interviewing pharmacists, pharmacy staff and nurses. With a view to improving healthcare information systems (ISs), we identified the enablers and barriers in service efficiency, thus identifying opportunities for pharmacy IS implementation across acute hospital environments. The findings also reveal some of the key enablers and barriers towards the introduction of hospital IS innovation. We present recommendations to overcome such barriers.
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26
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Gupta V, Williams E. Establishing a New Ambulatory Care Practice Site as a Pharmacy Practice Faculty. PHARMACY 2018; 6:pharmacy6040111. [PMID: 30314305 PMCID: PMC6306766 DOI: 10.3390/pharmacy6040111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 11/16/2022] Open
Abstract
There is an imminent need to identify and develop new ambulatory care practice sites with the increase in the number of colleges of pharmacy across the nation. This manuscript provides recommendations to help clinical faculty determine whether a potential pharmacy practice site will be able to provide adequate resources and support to establish a successful practice. This may be challenging to pharmacy practice faculty in settings where clinical pharmacy services have never been utilized. Topics include the pre-work needed prior to approaching a new practice site, assessing the need for physical requirements, meeting key personnel, marketing clinical skills and services, implementing, and evaluating practice site. Preparation includes having a clear vision of the pharmacist services, ensuring that stakeholders have an understanding of the pharmacy services inquiring the site support and resources for the pharmacist, and regularly communicating.
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Affiliation(s)
- Vasudha Gupta
- College of Pharmacy, Roseman University of Health Sciences, 11 Sunset Way, Henderson, NV 89014, USA.
| | - Evan Williams
- College of Pharmacy, Roseman University of Health Sciences, 11 Sunset Way, Henderson, NV 89014, USA.
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27
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MacKeigan LD, Dolovich L, Petrovic B, MacCallum L, Bojarski EA, Pojskic N. Audit of community pharmacists' prescribing interventions: Quality assessment of a newly reimbursed service. J Am Pharm Assoc (2003) 2018; 58:622-629. [PMID: 30190200 DOI: 10.1016/j.japh.2018.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/07/2018] [Accepted: 07/17/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate community pharmacists' reimbursed prescribing interventions (called pharmaceutical opinions/POs in Canada) by determining the types of drug-related problems (DRPs) identified; the type, quality, and clinical impact of recommendations made; and variation in recommendation quality across regions, pharmacy ownership type, and pharmacy size. DESIGN Retrospective audit of randomly sampled service documentation records. SETTING Community pharmacies in Ontario, Canada, 3 years after implementation of a government program that reimburses pharmacies for providing DRP-based POs to physicians. PARTICIPANTS Thirty-six community pharmacies in 4 regions of Ontario. MAIN OUTCOME MEASURES For each PO, 2 experienced clinical pharmacists independently, and then by consensus, determined the primary drug implicated and its therapeutic category, the type of DRP, and the type of prescriber recommendation. Each PO recommendation was assessed for clinical impact, evidence base, and overall quality. Chi-square analyses assessed the relationship between PO quality and pharmacy characteristics. RESULTS Of 563 POs, 261 (46%) met reimbursement criteria for stating a DRP and prescriber recommendation. Among these eligible POs, systemic antiinfective (22%), alimentary tract and metabolism (19%), nervous system (15%), and cardiovascular (15%) drugs were most commonly identified in the DRP. Adverse drug reactions (which included drug interactions) were the most common type of DRP (42.5%), followed by "dose too high" (16%) and "needs additional therapy" (14%). Top recommendations were to change the drug (41%) and to decrease the dose (20%). The quality of the pharmacist's recommendation was judged to be good to excellent in 70% of the 261 eligible POs; quality was associated with region and ownership type. CONCLUSION PO quality was suboptimal: the primary issue was failure to state a prescriber recommendation. Collaborative efforts are needed from community pharmacy stakeholders (schools of pharmacy, regulatory colleges, and continuing education providers) to help pharmacists enhance the quality of their POs, beginning with their clinical documentation skills.
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Pellegrin K, Chan F, Pagoria N, Jolson-Oakes S, Uyeno R, Levin A. A Statewide Medication Management System: Health Information Exchange to Support Drug Therapy Optimization by Pharmacists across the Continuum of Care. Appl Clin Inform 2018; 9:1-10. [PMID: 29298450 PMCID: PMC5801897 DOI: 10.1055/s-0037-1620262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background
While evidence generally supports the use of medication management technology, systems are typically implemented and evaluated piecemeal rather than as part of a comprehensive model for medication management. Systems to support drug therapy optimization, increasingly a key role of pharmacists in our healthcare system, have not yet been reported.
Objective
Our objective is to describe the design, implementation, and use of health information technology to support the hospital and community pharmacists' management of medications for high-risk patients statewide in the “Pharm2Pharm” model of care. Our aims were to make it easier for the pharmacists to access information needed to identify and resolve drug therapy problems using best practices for medication management and communicate with other members of the care team.
Methods
The pharmacist's roles and the medication management processes guided the design of the supporting technology, which was implemented after the Pharm2Pharm model was launched and the pharmacists' technology needs were assessed. Priorities for technology included sending care transition documents from hospital to community pharmacist securely and efficiently, access to medical records, including medications and laboratory results, documentation, and patient tracking. Implementation and use of the technology were documented.
Results
Communications, medication management, and population management solutions were implemented to support the Pharm2Pharm model. The pharmacists delivering services through this model adopted and meaningfully used this technology to support their work.
Conclusion
Implementing technology with value outside of the Pharm2Pharm model was a strategic approach to investment. This work emphasizes the importance of shifting the focus of technology from supporting a specific piece of the medication management process to supporting the goal of optimizing medication regimens. Health information exchange systems can provide important technology needed to integrate pharmacists into care teams as they are deployed to improve patient outcomes.
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Moczygemba LR, Pierce AL, Dang A, Emberley P, Czar MJ, Matzke GR. The ADAPT online education program: A tool for practicing pharmacists delivering patient-centered care. J Am Pharm Assoc (2003) 2017; 57:601-607. [DOI: 10.1016/j.japh.2017.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/08/2017] [Accepted: 05/14/2017] [Indexed: 11/25/2022]
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