Prioritizing patients for medication review by acute ward pharmacists – a mixed methods study in a Danish hospital.

doi:10.21203/rs.3.rs-1450848/v1

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Research Article

Prioritizing patients for medication review by acute ward pharmacists – a mixed methods study in a Danish hospital.

https://doi.org/10.21203/rs.3.rs-1450848/v1

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Background Little is known about how pharmacists think and act in the situation when they need to prioritize patients without prioritization tools.

Aim To understand the individual pharmacist professional’s analytic processes when prioritizing patients for medication review in an emergency department.

Method A mixed-methods study with pharmacists working in one emergency department in Denmark. Qualitative participant observations of all seven pharmacists who work at the emergency department were carried out. Semi-structured interviews with six of the pharmacists were held closely in time to the observations. Observations for each pharmacists’ patients were analysed inductively looking for patterns and themes. The interviews were audiotaped, transcribed verbatim and analysed inductively seeking to understand pharmacists’ analytic processes when prioritizing patients for medication review.

Results Observations showed that non-clinical prioritization rules had been implemented according to the wishes of the ward management, which affected how the pharmacists prioritized patients. The ways pharmacists prioritized was more targeted with more clinical experience. In the interviews, pharmacists told how they used the rules set out by ward management, how their collaboration with physicians was vital to prioritization, and how the pharmacy profession could better contribute to the ward team.

Conclusion Although the ward-established rules increased efficiency, it was not deemed the best way to detect the clinically meaningful patients for the pharmacists working at the Emergency Department. A prioritization tool and sitting closer to the physicians at the ward would help pharmacists be further integrated into patient care and improve prioritization of patients for medication reviews.

Clinical prioritization tool is needed to help the emergency ward select the most important patients for medication reviews
Situating pharmacists closer to the medical team would facilitate effective selection of patients for medication reviews
Clinical experience plays an important role when pharmacists prioritize patients without the help of tools, although it is unknown whether a clinical prioritization tool would eradicate differences in how pharmacists select according to clinical experience.

Medication reviews performed by clinical pharmacists’ help detect and prevent medication errors, and have been shown to increase patient safety and reduce the risk of medication errors by up to 50% [1, 2]. Clinical pharmacists have limited time to use their competencies within the field of patient safety and pharmaceuticals to optimize the patient's medication [3, 4]. Currently there is great interest in implementing clinical prioritisation tools so that patients in most need get a medication review by pharmacists [5–7]. Prioritization tools for medication review are prognostic models that target patients most in need of pharmacists’ input based on their risk of medication related problems [8]. Various such tools have been developed and already in use. For example, in the UK 70 out of 130 hospitals reported using such a tool [9]. The prioritisation tools often include indicators such as high-risk medicines, acute organ failure, age over 75, and polypharmacy. There are both paper-based, electronic and combined paper and electronic tools [10–12]. Most of the tools are designed for a specific setting and it is therefore uncertain whether they can be directly put to use in another setting. When prioritizing patients for medication review without using specific tools, factors such as patient’s age, polypharmacy, certain drugs classified as risky, and kidney function should be considered [8, 13–16]. Moreover, some professional and authority bodies provide official general guidance regarding certain medications. [17]

This qualitative mixed methods study was situated at the Emergency Department at Nordsjællands Hospital in Denmark. Pharmacist-led medication reviews are performed every day where one pharmacist is on duty 9 hours a day, all days of the year. The study was originally intended to understand how pharmacists prioritize patients without clinical algorithms, although, the ward management just before the initiation, implemented certain non-clinical ground rules to increase efficiency of the work. Therefore, the study was refocused on documenting how prioritization was carried out using these new ground rules. Although studies have asked pharmacists to name criteria they use to prioritize patients [18, 19] to the best of our knowledge this study is the first to look into the individual professional’s analytic processes when prioritizing patients for medication review in a setting where no clinical prioritization tools are in use.

To understand the individual pharmacist professional’s analytic processes when prioritizing patients for medication review in an emergency department.

Ethics Approval

Written informed consent was given by all pharmacists for participant observations and interviews. No ethics approval was required according to Danish law [20], however, ethical considerations were met. All interviewees are anonymous and all materials are stored confidentially. All data collection and processing were carried out in compliance with European General Data Protection regulation (GDPR).

Design

A case study was conducted using mixed methods. One of the authors (RH) a pharmacy student in her last semester prior to graduating as a pharmacist (a five-year programme), observed the pharmacists while working at the Emergency Department for one day each. RH then followed up the observation with a semi-structured interview with each pharmacist who was being observed.

Setting

The Emergency Department at Nordsjællands Hospital in Denmark covers a triage, an acute medical department, an emergency room, and the medical specialities cardiology, lung and infectious disease medicine, nephrology, endocrinology, neurology and surgery. All days of the year, a pharmacist is present in the hours 8am-5pm, aiding with obtaining a medication history, performing medication reviews and making sure the patient’s medication list is up to date in the hospital electronic health record (EHR) system EPIC. At the time of this study, seven pharmacists were employed by the hospital pharmacy to consult the Emergency Department on a regular rotation, in addition to other wards at the hospital.

In Denmark, authorities have defined seven high-risk situation medication categories that require extra attention by all healthcare workers [17]. These include warfarin, digoxin, insulin, potassium, gentamicin, methotrexate, and opioids. While there also are other tools to aid in medication reviews, such as a national interaction database, national deprescribing guidelines and overviews, no algorithm or guideline for prioritizing patients for medication review exists. However, there are ward-specific guidelines in place, which include criteria such as age and number of medications. In early February 2021, a set of non-clinical rules were implemented at the Emergency Department, which are further described in the Results section.

Data collection

The observations were qualitative and quantitative participant observations and followed a pre-constructed observation guide. The observation guide focused on each patient that could potentially be chosen by the pharmacist to receive a medication review and included clinical data on the patient; observations on which approaches and which parameters the pharmacist used in prioritizing the patients for medication review; and which activities or steps the pharmacist took in the process. In addition, the observer recorded data on how and why the pharmacist prioritized or did not prioritize each patient admitted to the ward. The interview followed an interview guide constructed to collect the pharmacists’ views on the current and past work process at the ward, how the pharmacist thinks when prioritizing patients for medication review and suggestions for improvement of workflow.

Data analysis

The observations were noted in writing on the observation guide. Quantitative variables in the observation guide were entered into an excel file (results not reported here) and written open-ended observations were collected for each pharmacists’ patients and analysed inductively looking for patterns and themes. The interviews were audiotaped, transcribed verbatim and analysed inductively. The interviews were read repeatedly looking for themes, marking representative quotes and condensing the meaning of each theme and its relevance for the study objective. The analysis was conducted by one of the authors (RH) and validated on three interviews by another author (ABA). Any discrepancies or uncertainties were resolved among all authors.

Seven pharmacists (all female, mean age 35.4 years (range 29–42)) were observed and six were interviewed (F1-6). Three of the pharmacists had less than two years’ experience working in the hospital (F1, F5 and F7). Six of them worked one day per week at the Emergency Department and every eighth weekend, whereas one worked there on a less regular basis.

The interviews and observations were carried out on nine separate whole days from March 29 to May 5, 2021. The observations lasted at least one whole workday for each of the seven pharmacists.

Observations

The observations showed firstly, that changes implemented, according to the wishes of the ward management, affected the study. Secondly, there were some notable differences between pharmacists that could be linked to their clinical experience.

Changes in procedures

A few days prior to the initiation of the study, a change in workflow was instated at the Emergency Department. The ward leadership wished to put a higher focus on medication histories rather than thorough medication reviews, and that medication lists were prepared for doctors’ approval in the EHR. The management from the Capital Region of Denmark's Pharmacy at Nordsjællands Hospital therefore set up a group to investigate how this could be implemented. This resulted in a Plan-Do-Study-Act process (PDSA) which was initiated in early February 2021. Patients were to be selected according to three prioritization criteria. The pharmacists should 1) ensure that all patients had their medication entered in the EHR; 2) then prioritize patients according to length of stay. When all patients had their medication entered, the pharmacist could turn their attention to other patients where it was believed a medication review would be beneficial. 3) Regardless of these two criteria, referrals from a physician for a medication review were to be prioritized first.

(insert Fig. 1)

The PDSA went through two rounds during the observation period (Fig. 1). During the first round, all patients were to undergo a medication history assessment and medication review. However, due to the fact that there was only one pharmacist on call, it was not always possible to assess medicines of all admitted patients. During the second round, several exclusion criteria were added such as: patients with deep venous thrombosis (DVT) or anaemia, since these patients would likely be discharged quickly, and patients who only used 1–2 medications. After completion of the study, the PDSA went through further rounds in order to optimize workflow.

Pharmacists’ work experience in relation to prioritization decisions and workflow

One key observation during this study was the difference in workflow and prioritization of patients according to the pharmacists’ clinical experience.

Pharmacists with less experience (less than two years of clinical hospital experience) worked in the following way: Sorting patients by length of stay, and selecting those where medications had not been entered into the EHR. In contrast, experienced pharmacists (two or more years of clinical hospital experience) worked in the following way: The patients' length of stay was noted and used to prioritize the patients. The reason for admission was noted for each patient and whether the medications had been added to the EHR or not. If medications had been added to the EHR, the pharmacist would then critically evaluate if a medication review should be carried out based on the medication list in the EHR and the shared medication record (a prescription records system covering all of Denmark). With the notes from the morning conference in mind, they decided which patients to prioritize.

In addition, most pharmacists with less clinical experience used the medication list in the EHR and not in the shared medication record to check whether the usual medication had been added or not. This could potentially be misleading as some patients upon admission were prescribed medication for their acute condition without transferring the usual medication list (as apparent in the shared medication record) to the EHR. The observations generally showed that the prioritization guidelines were only used as a rough guidance, although less experienced pharmacists followed them more closely than their more experienced colleagues.

Interviews

The interviews were held for the most part on the same day as each pharmacist was observed. One pharmacist was interviewed the following day. The interviews shed light on what kinds of considerations pharmacists went through when prioritizing patients, how they used the ground rules (as set out in the PDSA process), their collaboration with physicians, and how pharmacists could better contribute to the ward team.

Factors to focus on when prioritizing patients

Pharmacists have complex considerations when prioritizing patients during their workday at the Emergency Department. They all agreed that not all medications are important when scanning a patient’s medication list. Missing a few regular doses of preventive medications for patients during their stay at the ward could for instance, be viewed lightly as the patients would soon be discharged from the ward.

Whether it is a simvastatin or losartan or something like that, I am a bit more, like oh well (…) I am a bit more laid back about that. But of course, they need their medication, however [for these drugs], they won’t die from missing a single dose. (F2)

The seven risk-situation medications were mentioned, but not found to be enough help. Conversely, the whole medication list, looking for interactions, and evaluating the appropriateness of dosages were more important to consider. Age of the patient was not always relevant, but the number of medications and the reason for admittance could be important factors.

They [elderly patients] use more medications than the younger patients. But sometimes the younger patients are also important since a few [in this patient group] might also be using a lot of medications, even though they are young. (F3)

So I think it is important [to do a medication review] where there is a fair number of medications – and it doesn’t have to be a lot [of medicines], because there could be an interaction that we need to address. It could also be a decreased kidney function where we need to look at the dosages. Or that there is some medication that actually caused the admission or the general diagnosis. Is there some sort of a [prescribing] cascade? (F5)

Views on the implemented guidelines (PDSA)

The interviews also shed light on how the pharmacists viewed the guidelines implemented during the observation period and how they chose to work with these or around them. They saw both positive and negative aspects. On the positive side, they felt that they became more efficient due to the PDSA process; that they reviewed a higher number of patient charts per shift and identified a higher number of appropriate patients.

I feel like I am covering more, which means that I am getting more done. Which also means that there might be a higher percentage [of patients reviewed] who aren’t important, but I also think that I am catching more relevant [cases], where I might [before] have said “Well, we’ll wait and see [before performing a review]. (F2)

The negative aspects were that pharmacists feared that the focus on the longest stays and entering medicines into the EHR made for a more haphazard selection of patients. This could make them miss patients in great need of pharmaceutical care.

But I think it’s a bit due to chance that I catch them [patients in need of a medication review]. So it all comes down to when you [the patient] enter [the Emergency Department]. It is left up to the time factor [to prioritize]. (F5)

In principle we just have to note if they [the patients] have had their medication entered [into the EHR] and [if they have] you aren’t supposed to look any more at the patient. (…) I can’t help it, because sometimes I think there is something problematic, that I spot right away [and need to act upon]. (F6)

When the pharmacists talked about the PDSA and guidelines, it was clear that they felt that their clinical experience and use of pharmaceutical competencies were undervalued. Most of the pharmacists uttered that this process did not utilize the competencies of the pharmacists optimally and that they as professionals would be more valuable in direct patient care.

I just don’t think that our focus with the doctors should be that we can enter the medication [into the EHR]. I think we need to show that “We are pharmacists. We are specialists within the pharmaceutical treatment”. So we are able to do something else than this. (F6)

This indicated that the pharmacists felt that they were viewed more as technical staff than professionals who have clinical skills.

Collaboration with physicians

All respondents talked about how they see their collaboration with physicians at the Emergency Department. Firstly, how being situated close to physicians facilitates the collaboration and how they wish to have more referrals from physicians. They related to how the Covid-19 pandemic had removed morning briefings and the location of the pharmacists within the department was changed so they did not sit with the physicians anymore.

I was used to have a lot more [contact with the physicians] when I was sitting next to them compared to now (…). And I felt more like a part of the team [then] than now (…) Also, during Covid-19 this [contact with the physicians] has been lost, the morning briefing, and then you are a bit lost [in regards to prioritizing patients]. And now I still think we [pharmacists] are lost [when not sitting in close proximity to physicians], because you don’t know if the patients are about to be discharged. (F6)

Secondly, many pharmacists mentioned how a better collaboration between physicians and pharmacists on prioritization of patients could improve both the workflow and the impact of medication reviews. Getting referrals from physicians about patients to review had the benefits of providing the pharmacists with more clinically relevant cases and led to a higher rate of acceptance of recommended changes to the patient’s medications.

I wish that we [physicians and pharmacists in collaboration] were a bit better at prioritizing patients together – what is it we want to look at? So, in the ideal world, the referrals would always be prioritized first [because they always are important for medication review]. (F5)

Ideas for improvements – using and developing clinical competencies

The pharmacists had ideas for improving their prioritization and work with patients needing a medication review. The ideas reflected that, although they had a quantitative sense that they were more efficient, they were still not satisfied with the PDSA criteria set out for their work at the Emergency Department. Especially the longest stay criterion was criticized for not being useful.

I don’t think we should prioritize based on the length of stay. I think you need to assess which [individual] patients are important. Thereby obtaining tools to help defining “this is an important patient; this isn’t an important patient. (F6)

Another dissatisfaction among pharmacists was that they felt they were not allocated to the most appropriate patient groups within the Emergency Department. Being a department with several specialties, the pharmacists primarily worked with the acute medicine specialty. This specialty has a high turnover rate and patients are often discharged after a short stay. Therefore, the pharmacists’ medication review would not always be ready before the patient was discharged.

Another important improvement they note is that each pharmacist should work more frequently at the Emergency Department. Being there only once per week hampers them in getting a routine and competencies in working with acutely admitted patients and belonging to the ward team. They stated that it takes some time to become professionally strong and experienced in this type of setting. In relation to this improvement idea, they talked about how much they could benefit from being more than one pharmacist at the time on the ward in order to get the professional sparring in their medication reviews. Some also suggested that pharmacists at the hospital or across the region should exchange experience and knowledge better than what was currently the case.

… There is so much knowledge and learning potential in each other’s way of working which we don’t really obtain (F5)

Lastly, the pharmacists talked about how the “clinical insight” of the pharmacist needed to come more into play. This would aid them in identifying patients more effectively using the medication lists and the EHR information.

So eventually, it’s just experience, it’s just something you know instinctively. “IS there something here [in the medication list]? There is just something strange here [in the medication list]”. Or… not that I can remember exactly what it is, but there is just something that tells me that I need to look into this patient. (F3)

Statement of key findings and interpretation

Currently, there is no national or international consensus on prioritizing patients for medication reviews, but screening tools have been developed to guide clinical pharmacists [10–12]. In Denmark there are seven so-called risk situation medications [17], but this list is far from being sufficient for the pharmacists in our study. Research has shown that there is disagreement about what constitutes high-risk medications [16]. This lack of consensus is reflected in the variability in the existing screening tools [10]. The non-clinical rules set at the beginning of the study (through a PDSA process) did make for more efficiency, the number of patients seen by the pharmacists was boosted (results not shown), although the quality of the medication reviews per se was not measured. Efficiency increases have also been observed when using clinical prioritization tools [21].

Studies have shown that pharmacists with longer experience and more training are more skilled in detecting drug related problems and medication errors [9, 18, 22, 23]. This was evident in this study’s observations, as more experienced pharmacists did not solely go by the dictated criteria to select patients based on whether their medicines had been entered into the EHR and longest stay. They instead went by more a clinical insight that is gained from experience in the clinic. Personality types could be an alternate explanation, but profiles using the types defined by Carl Jung were not found to explain the difference in workflow between participants (data not shown).

The pharmacists in this study found the physician referrals gave more cases for relevant medication reviews. They also stressed the importance of physical proximity to the physicians’ working stations at the ward. Studies from primary care have shown that pharmacists’ personal contact with physicians enables trust and furthers collaboration [24, 25]. However, another mixed methods study in the hospital setting has shown that even with physical proximity, it is also important that pharmacists engage in proactive communication with physicians [26].

The interviews emphasized that pharmacists felt their clinical knowledge was underutilized which was not surprising and a well-known fact in professional pharmacy circles [27]. One such technical task is entering medications into the EHR. The other profession who does this is at the ward are medical doctors, which is no less of a waste of resources. In other hospitals in Denmark, pharmaconomists (highly trained pharmacy technicians) are in some cases responsible for this task and the competencies of the pharmacist used only on medication reviews and consulting about complex pharmaceutical matters.

Strengths and weaknesses

This study’s strengths stem from the mixed methods design of observing with a structured and semi-structured guide, followed by qualitative interviews by the researcher who observed. The interviews provided the observer the opportunity to ask questions close in time about what had been observed. That is, the situations were fresh in the interviewee´s mind and she could reflect on what she was thinking during her work. The observer/interviewer was an outsider to the setting, but still a pharmacy student within the clinical track and insights into medication reviews. Being an outsider made her more able to observe the setting and the pharmacists’ actions with fresh eyes and that she could later inquire about in her interviews. This was also a weakness as the observer/interviewer was not yet a pharmacist and a novice to the research methods. She may therefore have been unable to catch some nuances of the professional work and the organization around the work. Another limitation is that the study was only carried out in one hospital, which lowers transferability, although it was possible to observe all pharmacists and interview most to cover the work and views of the whole population in the studied case.

Further research

The clinical pharmacy training that pharmacists receive while in their 5-year pharmacy program in Denmark constitutes a minor part of the program. Due to a high proportion of pharmacy graduates entering the pharmaceutical industry in Denmark, there is less emphasis on clinical pharmacy subjects than in programs in other countries such as the UK or USA. No literature is available describing the on the job training of clinical pharmacists in hospitals in Denmark and there are no national requirements that pharmacists need to meet in order to practice patient care. The results of this study indicate that on the job training could be optimised for new pharmacists prior to working individually at the Emergency Department. This makes for future research into the optimisation of clinical skills and knowledge of pharmacists in a Danish hospital setting.

The study has pointed out that processes and practices can be improved to better use the skills and competencies of the pharmacists studied. The most important practice improvement is to implement valid and feasible prioritization tools in the clinical pharmacy services. This will firstly, enable pharmacists to focus on which patients need medication reviews from a clinical perspective, instead of a mostly technical procedure. Secondly, it will assist pharmacists with less experience to focus on the patients in most need. Thirdly, having a more clinical way of prioritizing will give the profession of pharmacy a stronger standing with the physicians with whom they need to collaborate regarding patients.

This study has highlighted that pharmacists according to clinical experience handled the current non-clinical prioritization process differently. Although the process increased efficiency, it was not deemed helpful for detecting the clinically meaningful patients for the pharmacists working at the Emergency Department. The study showed that a prioritization tool and being situated more closely to the physicians at the ward would help pharmacists be further integrated into patient care. Future research should focus on documenting how pre- and post-graduate training of pharmacists in Denmark can strengthen the role of clinical pharmacists in the hospital setting.

Acknowledgements

We would like to thank all the pharmacists who made this study possible.

Funding

No funding was obtained for this study.

Conflicts of interest

One of the authors (JN) was employed as clinical pharmacist at Nordsjællands Hospital at the time of the study and practiced at the Emergency Department. The other authors declare that they have no conflict of interest.

Buckley MS, Harinstein LM, Clark KB, et al. Impact of a clinical pharmacy admission medication reconciliation program on medication errors in “high-risk” patients. Ann Pharmacother. 2013;47(12):1599–610.
Lewis P. Right patient, right time, right pharmacist: the time for clinical prioritisation tools? EJHP 2017;24:314. http://dx.doi.org/10.1136/ejhpharm-2017-001395.
Isetts BJ, Schondelmeyer SW, Artz MB, et al. Clinical and economic outcomes of medication therapy management services: the Minnesota experience. JAPhA. 2008;48(2):203–14.
Fernandes O, Shojania KG. Medication reconciliation in the hospital: what, why, where, when, who and how. Healthc Q. 2012;15(special):42–9. doi:10.12927/hcq.2012.22842.
Corny J, Rajkumar A, Martin O, et al. A machine learning–based clinical decision support system to identify prescriptions with a high risk of medication error. JAMIA. 2020;27(11):1688–94.
Nguyen T-L, Leguelinel-Blache G, Kinowski J-M, et al. Improving medication safety: Development and impact of a multivariate model-based strategy to target high-risk patients. PLoS ONE. 2017;12(2):e0171995.
Martinbiancho JK, Zuckermann J, Mahmud SD, et al. Development of risk score to hospitalized patients for clinical pharmacy rationalization in a high complexity hospital. Lat Am J Pharm. 2011;30(7):1342–7.
Geeson C, Wei L, Franklin BD. High-risk medicines associated with clinically relevant medication‐related problems in UK hospitals: A prospective observational study. Br J Clin Pharmacol. 2020;86(1):165–9.
Abuzour AS, Hoad-Reddick G, Shahid M, et al. Patient prioritisation for hospital pharmacy services: current approaches in the UK. EJHP. 2021;28<bvertical-align:super;>:</bvertical-align:super;>:e102–8.
Alshakrah MA, Steinke DT, Tully MP, et al. Development of the adult complexity tool for pharmaceutical care (ACTPC) in hospital: A modified Delphi study. Res Social Adm Pharm. 2021;17(11):1907–22. https://doi.org/10.1016/j.sapharm.2021.02.009.
Falconer N, Nand S, Liow D, et al. Development of an electronic patient prioritization tool for clinical pharmacist interventions. Am J Health Syst Pharm. 2014;71(4):311–20.
Geeson C, Wei L, Franklin BD. Development and performance evaluation of the Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists’ input to prevent medication-related problems. BMJ Qual Saf. 2019;28(8):645–56.
Boeker EB, Ram K, Klopotowska JE, de Boer M, Creus MT, de Andrés AL, et al. An individual patient data meta-analysis on factors associated with adverse drug events in surgical and non‐surgical inpatients. Br J Clin Pharmacol. 2015;79(4):548–57.
Cornuault L, Mouchel V, Thi T-TP, Beaussier H, Bézie Y, Corny J. Identification of variables influencing pharmaceutical interventions to improve medication review efficiency. Int J Clin Pharm. 2018;40(5):1175–9.
Saedder EA, Brock B, Nielsen LP, Bonnerup DK, Lisby M. Identifying high-risk medication: a systematic literature review. Eur J Clin Pharmacol. 2014;70(6):637–45.
Suggett E, Marriott J. Risk factors associated with the requirement for pharmaceutical intervention in the hospital setting: a systematic review of the literature. DOAJ. 2016;3(3):241–63.
Risikosituationslægemidler. Styrelsen for Patientsikkerhed; [cited 2021 28.05]. Available from: https://stps.dk/da/laering/risikoomraader/risikosituationslaegemidler/.
Falconer N, Barras M, Cottrell N. How hospital pharmacists prioritise patients at high-risk for medication harm. Res Soc Adm Pharm. 2019;15(10):1266–73.
Gibson D, Forlow J, Davison J. Staff perceptions and opinions on workload prioritisation practices in hospital pharmacy. Hospital Pharmacy Europe 9. January 2020.
Danish National Committee on Health Research Ethics. Act on Reseach Ethics Review of Health Research Projects Published 2018. Accessed July 11 2021.
Robertshawe BJ, McDermott LM, Harden B. Introduction of An Electronic Prioritisation Tool for Medicines Reconciliation for Maternity Patients at Christchurch Women’s Hospital. J Paediatr Child Health 54:107–107. https://doi.org/10.1111/jpc.13882_291.
Dodds L. Prioritising pharmaceutical care delivery at ward level: a resource for pharmacy managers working in inpatient settings. East South East England Spec Pharm Serv 2011:1–23.
Shane R, Gouveia W. The dilemma of establishing effective pharmacy staffing levels. Am J Health Syst Pharm 2009 Dec 1;66(23):2103. doi: 10.2146/ajhp090490.
Duncan P, Ridd MJ, McCahon D, Guthrie B, Cabral C. Barriers and enablers to collaborative working between GPs and pharmacists: a qualitative interview study. Br J Gen Pract. 2020;70(692):e155-e63.
Blondal AB, Sporrong SK, Almarsdottir AB. Introducing pharmaceutical care to primary care in Iceland—an action research study. Pharmacy. 2017;5(2):23. https://doi.org/10.3390/pharmacy5020023.
Rixon S, Braaf S, Williams A, Liew D, Manias E. Pharmacists’ interprofessional communication about medications in specialty hospital settings. Health Commun. 2015;30(11):1065–75.
Wertheimer AI. The underutilised pharmacist. J Pharm Health Serv Res. 2018;9:77. https://doi.org/10.1111/jphs.12234.

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You are reading this latest preprint version

Prioritizing patients for medication review by acute ward pharmacists – a mixed methods study in a Danish hospital.

Status:

Version 1

Abstract

Figures

Impact Of Findings On Practice

Introduction

Aim

Ethics Approval

Method

Design

Setting

Data collection

Data analysis

Results

Observations

Changes in procedures

Pharmacists’ work experience in relation to prioritization decisions and workflow

Interviews

Factors to focus on when prioritizing patients

Views on the implemented guidelines (PDSA)

Collaboration with physicians

Ideas for improvements – using and developing clinical competencies

Discussion

Statement of key findings and interpretation

Strengths and weaknesses

Further research

Conclusion

Declarations

References

Status:

Version 1