Analysis of activities undertaken by ward-based clinical pharmacy technicians during patient hospital journey

Optimisation of medication reconciliation using queueing theory: a computer experiment

BACKGROUND

Medication reconciliation (MedRec) in hospitals is an important tool to enhance the continuity of care, but completing MedRec is challenging.

AIM

The aim of this study was to investigate whether queueing theory could be used to compare various interventions to optimise the MedRec process to ultimately reduce the number of patients discharged prior to MedRec being completed. Queueing theory, the mathematical study of waiting lines or queues, has not been previously applied in hospital pharmacies but enables comparisons without interfering with the baseline workflow.

METHOD

Possible interventions to enhance the MedRec process (replacing in-person conversations with telephone conversations, reallocating pharmacy technicians (PTs) or adjusting their working schedule) were compared in a computer experiment. The primary outcome was the percentage of patients with an incomplete discharge MedRec. Due to the COVID-19 pandemic, it was possible to add a real-life post hoc intervention (PTs starting their shift later) to the theoretical interventions. Descriptive analysis was performed.

RESULTS

The queueing model showed that the number of patients with an incomplete discharge MedRec decreased from 37.2% in the original scenario to approximately 16% when the PTs started their shift 2 h earlier and 1 PT was reassigned to prepare the discharge MedRec. The number increased with the real-life post hoc intervention (PTs starting later), which matches a decrease in the computer experiment when started earlier.

CONCLUSION

Using queueing theory in a computer experiment could identify the most promising theoretical intervention to decrease the percentage of patients discharged prior to MedRec being completed.

Implementation of Pharmaceutical Technical Assistants on Hospital Wards and Their Impact on Patient Safety and Quality of Care: A Qualitative Study on Nurses' Experiences and Perceptions

Methods

In a qualitative descriptive study, between December 2022 and March 2023, 16 semistructured interviews were carried out with a stratified purposive sample of nurses across internal, surgical, and geriatric wards. The inclusion criteria required a minimum of six months of work experience and experience working both day and night shifts. Inductive thematic analysis was performed in NVivo 1.6.1.

Results

Semistructured interviews revealed three main themes: (1) patient safety and quality of care, (2) organization of care, and (3) role development and collaboration. The implementation of pharmaceutical technical assistants on nursing wards was perceived to reduce the risk of medication errors without compromising care quality, allowing nurses to spend more time on direct patient care. Clear communication procedures were vital for successful implementation, highlighting the need for collaboration and information exchange between pharmaceutical technical assistants and nurses. Continuity in assigning pharmaceutical technical assistants was highlighted as crucial to improve medication safety and quality of care. This is considered an important aspect to ensure a smooth and optimal cooperation between nurses and pharmaceutical technical assistants. Nurses expressed that working with pharmaceutical technical assistants challenged their supervisory role and teamwork dynamics.

Conclusions

Nurses confirmed the added value of pharmaceutical technical assistants in medication management. Critical factors included dedicated assignments to hospital wards, clear roles, and mutual expectations in collaboration with ward nurses.