1. Clinical Pharmacist Service
Evaluation of the Pharmacy Service provided to a Hospice
C. McGann, C. Hayden, E. O’Dwyer, S. Tobin
Pharmacy Department, Our Lady's Hospice & Care Services, Harold’s Cross, Dublin 6W
Introduction
International evidence and recommendations have been shown to favour the involvement of a pharmacist in palliative care. In view of this, the palliative care service in this study developed its pharmacy service to include a senior pharmacist as a member of the inpatient multidisciplinary team and an in-house pharmacy dispensing service. Previously, the inpatient unit received its medicine supply from a retail community pharmacy and did not have a pharmacist on its multidisciplinary team. In the first year of service provision, the pharmacist conducted 939 reviews of patients and their prescriptions and attended 90 MDT meetings. Drug costs were reduced by 44%.1
Aims
To provide qualitative evaluation of the pharmacy service in a hospice through measurement of pharmacist interventions in patient care and assessment of staff satisfaction with both the clinical and dispensing services provided.
Design & Methods
A literature review was carried out to inform the design of the intervention audit and the staff survey. 2,3,4
An intervention audit was completed over a two week period. An excel audit tool to capture and categorise pharmaceutical interventions was adapted for use in Blackrock Hospice from a tool developed in acute hospitals. The pharmacist prospectively recorded her interventions while providing pharmaceutical care to the inpatients of the hospice. Over a two week period, the pharmacist attended four multidisciplinary (MDT) ward rounds and conducted 34 prescription chart reviews. These pertained to a total of 12 patients. Five patients were newly admitted to the ward within the research time frame and for each patient, medicines reconciliation was carried out by the pharmacist.
A staff survey was designed based on adaptations from Norrstrom et al.2 who completed similar research in 2010 when introducing pharmaceutical expertise to a palliative care team in Sweden. On the 21st of June, the survey was circulated to all members of hospice staff who were in post prior to the implementation of the pharmacy service. The surveys were completed anonymously with a designated place appointed for return of completed surveys.
Results
Interventions: Over the 2 week period, a total of 45 pharmacist interventions were recorded.
38% (17/45) interventions related to drug therapy review, 31% (14/45) related to technical written prescriptions. Medicines reconciliation interventions accounted for 16% (7/45) of interventions. Medicines information requests 8% (4/45) and follow up on administration issues 6% (3/45) accounted for the remainder of interventions. Follow up was complete in all 45 instances. The majority of interventions (80%) were followed up with medical staff, whilst follow up with nursing staff accounted for five instances (11%).
Figure 1. Bar charts representing pharmacist intervention types
Staff Survey: Of ten surveys, eight (medical staff = 2, nursing staff = 6) were completed and analysed, with a response rate of 80%. The questionnaire used rating scales allowing participants to rate the questions/statements. The results of the survey were compared with Norrstrom et al.2 as seen in table 1 (extract only).
Table 1. Staff responses (%) to questions/statements in the survey evaluating the provision of a pharmacy service to the inpatient unit in Blackrock Hospice (BRH) [Black type: BRH results; Blue type: results reported by Norrstrom et al]
Not at all
Somewhat
To a great extent
To a very great extent
Do you have contact with pharmacy staff?
(14%)
25% (57%)
50% (17%)
25% (11%)
Strongly disagree
Disagree
Neither agree not disagree
Agree
Strongly agree
Not Applicable
Prior to the introduction of a pharmacy service, my opinion was that a pharmacist would be of benefit to BRH
(3%)
(11%)
25% (20%)
75% (57%)
(9%)
My opinion today is that the pharmacy service is of benefit to BRH
12.5% (14%)
87.5% (83%)
Clinical Pharmacist Service
The pharmacist is an asset to the team regarding questions about medicines
(6%)
12.5% (11%)
87.5% (77%)
In my opinion patient safety in the drug handling process has improved with the presence of a pharmacist on the team
37.5% (43%)
62.5% (35%)
(17%)
The presence of pharmacist on the ward has enhanced the quality of pharmaceutical care provided to patients
12.5%
87.5%
Pharmacist participation in multi-disciplinary team meetings is beneficial to the pharmaceutical care provided to patients
My experience of the pharmacist is in general positive
12.5% (9%)
87.5% (80%)
Conclusion
The results from the two week intervention audit show the wide variety of medication management issues in which the pharmacist had involvement. Although patient outcome was not directly evaluated in this study, the majority of the pharmacist’s interventions were accepted by the team which concurs with other research, highlighting that pharmacy input enhances the quality of care provided to patients. It is likely that the high level of acceptance is as a result of close collaboration with MDT. The staff satisfaction survey indicates that the provision of a pharmacy service is highly valued, and seen as an asset to the hospice. All staff agreed that the pharmacist enhanced the quality of care provided to the patient. There was overall agreement that the pharmacy supply service has had a positive impact with enhanced governance and supervision of medicines in Blackrock Hospice. Limitations of the study include the relatively short study period and the single study site. Future multicentre, direct or indirect studies on patient outcomes of a pharmacist service in palliative care would contribute to the limited evidence in published research.
References:
McGann, C., O'Dwyer, E., Hayden, C., Gregan, P., Cunningham, J., Linnane, T. Development of a Palliative Care Clinical Pharmacist Service. Abstract 9th World Research Congress of the EAPC, Dublin, Ireland. June 2016.
Norrstrom B, Cannerfelt I, Frid H, Roos K and Ramstrom H. (2010) Introduction of pharmaceutical expertise in a palliative care team in Sweden. Pharmacy World & Science 32:829-83
Knez, L., Laaksonen, R., Duggan, C. and Nijjar, R. (2008) Evaluation of Clinical Interventions made by Pharmacists in Cancer Services. The Pharmacy Journal 208;
Alldred, D., Xermansky, A., Petty, D., Raynor, D., Freemantle, N., Eastaugh, J., and Bowie P. (2007) Clinical medication review by a pharmacist of elderly people living in care homes: pharmacist interventions International Journal of Pharmacy Practice 13:93-99