Impact of pharmacist interventions on drug-related problems in general surgery patients: a randomised controlled trial

Cost-effectiveness of preoperative pharmaceutical care consultations: a 5-year analysis

OBJECTIVES

Preoperative medication errors can be prevented by screening patients through a preoperative pharmaceutical care consultation. The aim of this study was to analyse the cost-effectiveness of implementing such a consultation and to determine which patients would benefit most.

METHODS

A retrospective study was conducted that included all patients who underwent a preoperative pharmacy consultation between 2016 and 2020. During this consultation, two part-time pharmacists reviewed patients' appropriate preoperative chronic medication management. All prevented errors were collected and classified by therapeutic group and type of error. A team of pharmacists and anaesthetists assigned to each prevented medication error a probability of causing an adverse event 'p', following the methodology of Nesbit et al by establishing five different 'p' values: 0, 0.01, 0.1, 0.4, and 0.6. 'p' = 1 was not considered. The cost of an adverse event was determined to be between €4124 and €6946 according to current literature, and a sensitivity analysis was performed by increasing the interval by 20% above and below. The cost of employing two part-time specialist pharmacists was estimated to be €59 142. Savings per medication error prevented were calculated as (€4124 OR €6946) × 'p'. Total savings were the sum of all costs associated with prevented medication errors. Patients on chronic medications who were in therapeutic groups with a 0.6 probability of an adverse event or who were in therapeutic groups responsible for 50% of the prevented adverse events were considered prioritisable.

RESULTS

3105 patients attended the consultation and 1179 medication errors were prevented, corresponding to 300 adverse events. 42.2% of the errors had a 'p' of 0.4. The costs avoided by this consultation ranged from €1 237 200 to €2 083 800, while the cost of its implementation was €295 710. The cost-effectiveness ratio was between €4.2 and €7.0 saved per euro invested. In the sensitivity analysis, the ratios ranged from €3.3 to €8.5 per euro invested. Fifteen different therapeutic groups accounted for 90% of the medication errors prevented. The therapeutic groups 'Agents acting on the renin-angiotensin system', 'Antidiabetics, non-insulin (excluding SGLT2)' and 'Antithrombotics: low molecular weight heparins' were responsible for 56% of the prevented adverse events. The therapeutic groups 'Antidiabetics: rapid-acting insulin' and 'Antithrombotic agents: vitamin K antagonists, low-molecular-weight heparins, or direct oral anticoagulants' had a 'p' of 0.6. Therefore, patients in six therapeutic groups should be prioritised for preoperative pharmacy counselling.

CONCLUSIONS

The implementation of preoperative pharmaceutical care consultations in Spain has proven to be cost-effective. Incorporating the probability of a medication error causing an adverse event allowed the prioritisation of patients for these consultations. Patients taking anticoagulants, oral antidiabetics, rapid-acting insulins, and agents acting on the renin-angiotensin system benefited the most. This study could serve as a basis for implementing such consultations in other hospitals, as they are effective in reducing the cost of medication errors in surgical patients.

Established and emerging roles for pharmacy in operating theatres: a scoping review

BACKGROUND

Pharmacy services at surgical pre-assessment clinics and on inpatient wards are well-documented, but services to theatre appear comparatively under-developed. High-risk and high-cost medicines are used routinely in theatre; pharmacists are well-qualified to optimise their use and improve patient care.

AIM

To determine the range, extent and nature of pharmacy services to theatre internationally, and to describe any reported outcomes of these services.

METHOD

This scoping review was conducted and reported as per PRISMA-ScR and Joanna Briggs Institute methodology. A search was conducted across MEDLINE, Embase, CINAHL, PsycInfo, Bielefeld Academic Search Engine, Canada's Drug and Health Technology Agency, Google and Google Scholar in April 2023. One reviewer screened titles and abstracts. Two reviewers screened full texts. Data extraction was completed by one reviewer. Two reviewers used the Mixed Methods Appraisal Tool (MMAT) to perform quality appraisal. For work completed by one reviewer, a 10% sample was randomly selected for screening by a second reviewer.

RESULTS

Ninety-two publications were included from 3924. Fifty-seven were primary research articles. Other publication types included conference abstracts, journal columns, letters to the editor, practice standards/guidelines, opinion papers, narrative reviews and newsletter articles. Medication management and clinical services across five continents were described. Most reported outcomes related to cost savings. Nine of the 57 articles met the criteria for MMAT appraisal: of these, adherence to quality criteria ranged from 40 to 100%.

CONCLUSION

Evidence for theatre pharmacy services is extensive and varied. Empirical research of high methodological quality is required to assess the outcomes of these services.

Effectiveness of Quality Use of Medicines (QUM) Programs and Strategies in Saudi Arabia: A Narrative Review

Background

The high prevalence of chronic diseases, workforce challenges, and growing polypharmacy adversely impact the quality use of medicines (QUM) and health outcomes in Saudi Arabia (SA). The SA Ministry of Health (MOH) has initiated several programs and policies to enhance QUM including a National Medication Safety Program, national clinical guidelines, and technology-based strategies.

Objective

To assess the published literature on the range, quality, and effectiveness of QUM methods in the SA health system.

Methods

Comprehensive search of electronic databases Scopus, Medline, and PubMed for papers reporting evaluation of QUM interventions or programs in SA.

Results

QUM programs involving medication reconciliation, interventions by hospital pharmacists, antibiotics stewardship, technology and staff training are the most commonly used programs reported in SA. Evaluations of several QUM interventions found a significant positive impact on health outcomes, prescribing patterns, chronic disease management, medication safety, and healthcare costs. Medication reconciliation programs reduced discrepancies by up to 20% in some studies. Hospital pharmacist interventions showed high acceptance rates (up to 92%) and improved medication safety. Antibiotic stewardship programs effectively reduced antimicrobial use and costs. Health information technology implementations like electronic health records (EHR), and computerized physician order entry (CPOE) showed mixed results but generally improved medication safety and efficiency. Staff training initiatives enhanced healthcare professionals' knowledge and skills in medication management.

Conclusion

While SA has national QUM policies and programs, and evidence that individual QUM interventions have significant positive local impact, more large-scale, multi-center studies are needed to provide a comprehensive view of QUM practices. More rigorous evaluations of existing programs and expansion of the range of QUM programs to align with international ones could further improve medication safety and patient outcomes in Saudi Arabia.

Medication use and potential drug-drug interactions in a general surgery clinic: A descriptive study

Aim

Perioperative pharmacies optimize medication safety and patient-centered care during surgery. This research aims to assess medication usage and potential drug-drug interactions (pDDIs) in a general surgery clinic.

Methods

This prospective and descriptive research was carried out in a general surgery clinic at a hospital in Turkey. The patients who were admitted for any surgical procedure and stayed for a minimum of 24 h were included in the study. Information on prior medication use as well as pre- and post-operative medications was documented. pDDIs were assessed using the Lexicomp database.

Results

The study involved 95 patients, with a median age of 54 (ranging from 19 to 86). It was found that 66.3 % of the patients had at least one comorbidities. The average number of medications administered during the post-operative period was greater than during the preoperative period (5.7 vs 4.5, p < 0.0001). Furthermore, the incidence of pDDIs identified in doctors' orders after surgery was higher compared to before surgery (p < 0.05).

Conclusion

In this study, the majority of patients scheduled for surgery had at least one comorbidity. We suspect that the elevated number of medications administered postoperatively could have led to pDDIs Consequently, we expect that clinical pharmacy services will help ensure the safe and rational use of medications in surgical clinics.

Evaluation and redesign of an internal medicine pharmacy practice model at a tertiary care hospital

PURPOSE

Clinical pharmacists are embedded into the care for patients admitted to internal medicine floors at Cleveland Clinic. The existing practice model utilized by the internal medicine pharmacy team had an uneven distribution of clinical activities among the various pharmacist roles. A study was completed to evaluate a potential adjustment to the pharmacy practice model. The objective of this study was to assess the type and quantity of clinical activities performed by each pharmacist role. These data were then utilized to evaluate the need for redistribution of care activities among the pharmacist roles and to determine the need for additional pharmacist full-time equivalents.

METHODS

From January to February 2023, data pertaining to the amount and type of clinical activities completed by the 9 internal medicine pharmacist roles was either manually collected or extracted from the electronic medical record. The data were then utilized to calculate a responsibility score for each role. Descriptive statistics were also calculated to assess the results.

RESULTS

Each pharmacist role cared for an average of 34.4 patients (minimum, 24.4; maximum, 57.7) during the study period. The average responsibility score for each pharmacist role was 309.8 (minimum, 237.5; maximum, 447.8).

CONCLUSION

On the basis of the data collected during the 4-week study period, a new pharmacy practice model was developed that incorporated 2 additional full-time equivalents. This model balanced patient care responsibilities among the pharmacist roles and moved the practice model from a location-based to a team-based coverage model.

The role of pharmacists in mitigating medication errors in the perioperative setting: a systematic review

INTRODUCTION

Medication errors occur at any point of the medication management process and are a major cause of death and harm globally. The perioperative environment introduces challenges in identifying medication errors due to the frequent use of time-sensitive, high-alert medications in a dynamic and intricate setting. Pharmacists could potentially reduce the occurrence of these errors because of their training and expertise.

AIM

To provide the most up-to-date evidence on the roles and effects of pharmacist interventions on medication errors in perioperative settings.

METHODS

PubMed, CINAHL, and Embase were searched from inception to September 2023. Studies were included if they tested a pharmacist-led intervention aimed at reducing medication errors in adult perioperative settings. The included studies were assessed for quality using the Crowe Critical Appraisal Tool. Data were extracted and synthesized using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool). Screening, quality assessment, and data extraction were performed by two independent researchers.

RESULTS

Sixteen studies were eligible. All included studies incorporated multicomponent interventions, primarily medication reconciliation (n = 13), medicine-related recommendations (n = 12), staff education (n = 6), and patient counselling (n = 4). The development of implemented interventions was poorly reported across all papers. A diverse range of error reporting was observed, and none of the included studies provided definitions or basis for the categorization of errors. Although the studies showed that pharmacist interventions were associated with a reduction in overall medication errors rates, some studies showed inconsistent findings regarding error subtypes. The most common pharmacist intervention was medication optimization via holding or switching between agents.

CONCLUSION

While there is some evidence of positive impact of the pharmacist-led interventions on medication errors in perioperative setting, this evidence is generally of low quality and insufficient volume. Heterogeneity in study design, definitions, and case detection is common; hence, high-quality research that applies more stringent controls and uses clearer definitions is warranted.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023460812.

Pharmacist-led interventions for vascular surgery patients: a prospective study on reducing drug-related problems

BACKGROUND

Vascular surgery patients are at a high risk of polypharmacy and drug-related problems. Only a limited number of studies have explored the impact of hospital pharmacists being members of a multidisciplinary team in the care of vascular surgery patients. The clinical study (Trial Registration Number NCT04930302, 16th June 2021) aimed to assess the impact of pharmacist-led interventions on the prevalence of drug-related problems among patients hospitalised at the vascular surgery department.

METHODS

The study, conducted at a specialised hospital in Slovakia during a 1-year period, included adult patients with carotid artery disease or lower extremity artery disease, taking ≥3 medications. Medication reconciliation and medication reviews were performed by hospital pharmacists at both admission and discharge. Pharmacist-proposed interventions were documented and communicated to the physician, patients were educated about their medications upon discharge.

RESULTS

Among our study participants (n = 105), the average number of drug-related problems at admission was 2.3 ± 2.1, significantly decreasing to 1.6 ± 1.8 at discharge (p < 0.001). The predominant drug classes associated with drug-related problems were those related to the cardiovascular system (41.9%). At admission, the most frequent drug-related problem was untreated indication (40.3%), mostly caused by the failure to prescribe statin in patients with lower extremity artery disease. The highest acceptance rate of pharmacist-led interventions was at hospital admission (66.1%). More than 50% of patients were classified as those with good understanding of their pharmacotherapy.

CONCLUSIONS

This study demonstrates that pharmacist-led interventions significantly reduce drug-related problems in vascular surgery patients during hospitalisation, contributing to patient safety and clinical outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov Trial Registration Number: NCT04930302, 16th June 2021.

Components of pharmacist-led medication reviews and their relationship to outcomes: a systematic review and narrative synthesis

INTRODUCTION

Pharmacist-led medication reviews are an established intervention to support patients prescribed multiple medicines or with complex medication regimes. For this systematic review, a medication review was defined as 'a consultation between a pharmacist and a patient to review the patient's total medicines use with a view to improve patient health outcomes and minimise medicines-related problems'. It is not known how varying approaches to medication reviews lead to different outcomes.

AIM

To explore the common themes associated with positive outcomes from pharmacist-led medication reviews.

METHOD

Randomised controlled trials of pharmacist-led medication reviews in adults aged 18 years and over were included. The search terms used in MEDLINE, EMBASE and Web of Science databases were "medication review", "pharmacist", "randomised controlled trial" and their synonyms, time filter 2015 to September 2023. Studies published before 2015 were identified from a previous systematic review. Risk of bias was assessed using the Cochrane risk of bias 2 tool. Descriptions of medication reviews' components, implementation and outcomes were narratively synthesised to draw out common themes. Results are presented in tables.

RESULTS

Sixty-eight papers describing 50 studies met the inclusion criteria. Common themes that emerged from synthesis include collaborative working which may help reduce medicines-related problems and the number of medicines prescribed; patient involvement in goal setting and action planning which may improve patients' ability to take medicines as prescribed and help them achieve their treatment goals; additional support and follow-up, which may lead to improved blood pressure, diabetes control, quality of life and a reduction of medicines-related problems.

CONCLUSION

This systematic review identified common themes and components, for example, goal setting, action planning, additional support and follow-up, that may influence outcomes of pharmacist-led medication reviews. Researchers, health professionals and commissioners could use these for a comprehensive evaluation of medication review implementation.

PROSPERO REGISTRATION NUMBER

CRD42020173907.

Development of an innovative clinical pharmacy service in a urology surgical unit: a new initiative from Qatar

Purpose

To provide an insight into the role of a clinical pharmacy initiative in a surgical urology unit through evaluating the nature, significance, associated medications, and acceptance rate of pharmacist interventions.

Methods

A cross-sectional study was carried out at the Ambulatory Care Center (ACC), Doha, Qatar. Data related to clinical pharmacist interventions and associated rationale were classified according to the nature of the intervention using an adapted classification system. The assessment of the severity followed the National Patient Safety Agency (NPSA) Risk Matrix. Linear regression, Kruskal-Wallis, and post-hoc analyses were performed to determine the association between patient-related and medication-related characteristics on pharmacist interventions.

Results

A total of 3284 interventions (on 1486 patients) were analysed. Most patients (n = 1105; 74.4%) had 1-2 interventions. Age and gender showed a positive linear correlation with the number of interventions per patient (p < 0.01). Majority of interventions were related to pharmacological strategy (n = 1858; 56.6%) and quantity of drug (n = 821; 25%). Additional drug therapy (n = 748; 22.78%) was the most common subcategory followed by optimum dose/frequency (n = 691; 21.04%) and discontinuation of medications (n = 352, 10.72%). Anti-infectives were the most identified drug category (n = 798, 55.1%). Most interventions (59.4%) were of moderate significance; patients with moderate interventions were found to be older compared to patients with minor interventions (p = 0.032). Prescribers' acceptance rate was high (>90%), with a notable increase of 6.6% from 2021 to 2023.

Conclusion

This study showed that the clinical pharmacy service in the urology surgical field was a fruitful initiative. The clinical pharmacist's role has expanded to include not only therapeutic optimisation while ensuring medication safety across the continuum of perioperative care but also the identification and management of untreated health problems. The dynamic and complexity of the urology patient population challenge clinical pharmacists; however, the practice concepts remain the same as in any other clinical setting.

Drug Therapy Problems Identified by Clinical Pharmacists at a General Surgery Ward of an Academic Referral Hospital in Jordan

Introduction

Drug therapy problems (DTPs) continuously occur in hospitalized patients. This study aims to emphasize the role of clinical pharmacists in evaluating the DTP's frequencies, causes, severity ratings, and contributing factors at a general surgery ward in Jordan.

Methods

This prospective observational study was conducted at one of the major teaching and referral hospitals in Jordan. Data were collected through clinical pharmacist reviews of paper and electronic medical records as well as patient interviews. DTPs were identified using Cipolle's classification system and rated for severity on a scale of 10. Multiple linear regression was performed to identify factors contributing to DTPs. Drug classes primarily associated with DTPs were specified.

Results

During enrollment, a total of 80 patients were recruited in this study. The mean age of the enrolled patients was 52.35 ± 14.82 years, and 49 (61.25%) of them were males. Within the study period, 192 DTPs were identified by clinical pharmacists in 87.5%of the total recruited patients. The mean number of DTPs per patient was 2.40 ± 1.83. The most common categories of DTPs were "needs additional therapy" 46 (23.96%), "unnecessary drug therapy" 45 (23.44%), and "dosage too low" 39 (20.31%). Of the total DTPs, 127 (66.15%) were rated as severe. Multiple linear regression revealed that patients' length of hospital stay and the number of current medications had a statistically significant effect on the number of DTPs identified during hospitalization. Endocrine and metabolic drugs 51 (26.56%) and cardiovascular drugs 36 (18.75%) were the most frequent classes of drugs contributing to DTPs.

Conclusion

DTPs are common in the general surgery ward. Clinical pharmacists can provide medication reviews for surgical patients to identify DTPs and rate their severities. Detecting risk factors for DTPs and the most common drug classes associated with them can assist in decision-making relevant to reducing DTPs in the surgical ward.

Impact of preoperative pharmaceutical care consultation on medication errors in surgical patients: a comprehensive analysis

OBJECTIVE

Assessing the impact of introducing preoperative pharmaceutical care consultations by analyzing the severity of prevented medication errors (MEs) and their potential effects on the surgical process.

METHODS

Preoperative pharmaceutical care consultation was implemented in our hospital to assess the preoperative medication management of surgical patients between the pre-anesthesia consultation and the day of surgery. Pharmacists evaluated the appropriateness of medication management based on a consensus multidisciplinary institutional protocol. All errors identified between 2016 and 2020 were analyzed, and their severity and potential impact on surgery were standardized. A list of therapeutic groups was created to prioritize patients for consultations.

RESULTS

During the study period, 3,105 patients attended the consultations and 1,179 MEs were prevented. According to severity, 30.6% of MEs were classified as category E and 26.2% as D. The Number Needed to Treat to prevent a category E or higher ME (indicating potential harm to patients) was 5 patients. About 14.84% of MEs belonged to the prioritized drug groups. One hundred and thirteen errors would have resulted in a surgery delay of more than 24 h, and 175 errors were classified as G-H (irreversible damage).

CONCLUSIONS

This study highlights the effectiveness of pharmaceutical care consultations in preventing MEs and improving surgical outcomes.

Medication review in hospitalised patients to reduce morbidity and mortality

BACKGROUND

A medication review can be defined as a structured evaluation of a patient's medication conducted by healthcare professionals with the aim of optimising medication use and improving health outcomes. Optimising medication therapy though medication reviews may benefit hospitalised patients.

OBJECTIVES

We examined the effects of medication review interventions in hospitalised adult patients compared to standard care or to other types of medication reviews on all-cause mortality, hospital readmissions, emergency department contacts and health-related quality of life.

SEARCH METHODS

In this Cochrane Review update, we searched for new published and unpublished trials using the following electronic databases from 1 January 2014 to 17 January 2022 without language restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). To identify additional trials, we searched the reference lists of included trials and other publications by lead trial authors, and contacted experts.

SELECTION CRITERIA

We included randomised trials of medication reviews delivered by healthcare professionals for hospitalised adult patients. We excluded trials including outpatients and paediatric patients.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials, extracted data and assessed risk of bias. We contacted trial authors for data clarification and relevant unpublished data. We calculated risk ratios (RRs) for dichotomous data and mean differences (MDs) or standardised mean differences (SMDs) for continuous data (with 95% confidence intervals (CIs)). We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess the overall certainty of the evidence.

MAIN RESULTS

In this updated review, we included a total of 25 trials (15,076 participants), of which 15 were new trials (11,501 participants). Follow-up ranged from 1 to 20 months. We found that medication reviews in hospitalised adults may have little to no effect on mortality (RR 0.96, 95% CI 0.87 to 1.05; 18 trials, 10,108 participants; low-certainty evidence); likely reduce hospital readmissions (RR 0.93, 95% CI 0.89 to 0.98; 17 trials, 9561 participants; moderate-certainty evidence); may reduce emergency department contacts (RR 0.84, 95% CI 0.68 to 1.03; 8 trials, 3527 participants; low-certainty evidence) and have very uncertain effects on health-related quality of life (SMD 0.10, 95% CI -0.10 to 0.30; 4 trials, 392 participants; very low-certainty evidence).

AUTHORS' CONCLUSIONS

Medication reviews in hospitalised adult patients likely reduce hospital readmissions and may reduce emergency department contacts. The evidence suggests that mediation reviews may have little to no effect on mortality, while the effect on health-related quality of life is very uncertain. Almost all trials included elderly polypharmacy patients, which limits the generalisability of the results beyond this population.

The impact of telepharmacy on hypertension management in the United Arab Emirates

Objectives

To assess the effectiveness of telepharmacy services delivered by community pharmacies in hypertension management and examine its influence on pharmacists' ability to identify drug-related problems (DRPs).

Methods

This was a 2-arm, randomised, clinical trial conducted among 16 community pharmacies and 239 patients with uncontrolled HTN in the U.A.E over a period of 12 months. The first arm (n=119) received telepharmacy services and the second arm (n=120) received traditional pharmaceutical services. Both arms were followed up to 12 months. Pharmacists self-reported the study outcomes, which primarily were the changes in SBP and DBP from baseline to 12-month meeting. Blood pressure readings were taken at baseline, 3, 6, 9, and 12 months. Other outcomes were the mean knowledge, medication adherence and DRP incidence and types. The frequency and nature of pharmacist interventions in both groups were also reported.

Results

The mean SBP and DBP differences were statistically significant across the study groups at 3-, 6-, and 9-month follow-up and 3-, 6-, 9-, 12- month follow-up, respectively. In detail, the mean SBP was reduced from 145.9 mm Hg in the intervention group (IG) and 146.7 mm Hg in the control group (CG) to 124.5, 123.2, 123.5, and 124.9 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the IG and 135.9, 133.8, 133.7, and 132.4 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the CG. The mean DBP was reduced from 84.3 mm Hg in IG and 85.1 mm Hg in CG to 77.6, 76.2, 76.1, and 77.8 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the IG and 82.3, 81.5, 81.5, and 81.9 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the CG. Medication adherence and knowledge of participants in the IG towards hypertension were significantly improved. The DRP incidence and DRPs per patient identified by pharmacists in the intervention and control groups were 2.1% versus 1.0% (p=0.002) and 0.6 versus 0.3 (p=0.001), respectively. The total numbers of pharmacist interventions in the IG and CG were 331 and 196, respectively. The proportions of pharmacist interventions related to patient education, cessation of drug therapy, adjustment of drug dose, and addition of drug therapy across the IG and CG were 27.5% versus 20.9%, 15.4% versus 18.9%, 14.5% versus 14.8%, and 13.9% versus 9.7%, respectively (all with p<0.05).

Conclusion

Telepharmacy may have a sustained effect for up to 12 months on blood pressure of patients with hypertension. This intervention also improves pharmacists' ability to identify and prevent drug-related problems in community setting.

The impact of clinical pharmacist-physician communication on reducing drug-related problems: a mixed study design in a tertiary teaching Hospital in Xinjiang, China

BACKGROUND

The incidence of drug-related problems (DRPs) has caused serious health hazards and economic burdens among polymedicine patients. Effective communication between clinical pharmacists and physicians has a significant impact on reducing DRPs, but the evidence is poor. This study aimed to explore the impact of communication between clinical pharmacists and physicians on reducing DRPs.

METHODS

A semistructured interview was conducted to explore the communication mode between clinical pharmacists and physicians based on the interprofessional approach of the shared decision-making model and relational coordination theory. A randomized controlled trial (RCT) was used to explore the effects of communication intervention on reducing DRPs. Logistic regression analysis was used to identify the influencing factors of communication.

RESULTS

The mode of communication is driven by clinical pharmacists between clinical pharmacists and physicians and selectively based on different DRP types. Normally, the communication contents only cover two (33.8%) types of DRP contents or fewer (35.1%). The communication time averaged 5.8 minutes. The communication way is predominantly face-to-face (91.3%), but telephone or other online means (such as WeChat) may be preferred for urgent tasks or long physical distances. Among the 367 participants, 44 patients had DRPs. The RCT results indicated a significant difference in DRP incidence between the control group and the intervention group after the communication intervention (p = 0.02), and the incidence of DRPs in the intervention group was significantly reduced (15.6% vs. 0.07%). Regression analysis showed that communication time had a negative impact on DRP incidence (OR = 13.22, p < 0.001).

CONCLUSION

The communication mode based on the interprofessional approach of the shared decision-making between clinical pharmacists and physicians in medication decision-making could significantly reduce the incidence of DRPs, and the length of communication time is a significant factor. The longer the communication time is, the fewer DRPs that occur.

TRIAL REGISTRATION

This trial was approved by the ethics committee of The First Affiliated Hospital of Medical College of Xinjiang Shihezi University Hospital (kj2020-087-03) and registered in the China clinical trial registry (https://www.chictr.org.cn , number ChiCTR2000035321 date: 08/08/2020).

The COVID-19 Pandemic and Patient Safety Culture: A Cross-Sectional Study among Community Pharmacies in Jordan

The COVID-19 pandemic has dramatically imposed stressful conditions that may impact the ability of healthcare staff to provide safe and effective care. Research on patient safety culture among community pharmacies during the pandemic is limited. This study aimed to assess the patient safety culture among community pharmacies in Jordan during the COVID-19 pandemic. Pharmacists and pharmacy assistants from 450 community pharmacies were approached through online means, with 378 answering the questionnaire written in Arabic that had been adapted from the Community Pharmacy Survey on Patient Safety Culture (PSOPSC). This study showed that various patient safety standards were addressed to a high degree during the COVID-19 pandemic, as represented by the high positive response rate (PRR) measures that were mainly observed in the dimensions "Teamwork" (90.1%), "Patient Counseling" (85.2%), and "Staff Training and Skills" (82.7%). Furthermore, significantly higher PRR scores for the "Teamwork", "Staffing, Work Pressure, and Pace", "Response to Mistakes", "Organizational Learning-Continuous Improvement", and "Overall Perceptions of Patient Safety" dimensions were observed among participants who worked in independent pharmacies than those who worked in chain pharmacies. Despite an overall positive patient safety culture in the current context of community pharmacies in Jordan during the COVID-19 pandemic, pitfalls were observed in the "Staffing, Work Pressure, and Pace" dimension.