HPE 91 – March 2019 | Page 19

TABLE 2 Methods used by clinical pharmacy staff to prioritise their workload for medicines reconciliation, clinical review and discharge activities Methods for prioritisation Medicines reconciliation Clinical review Discharge Responses % Responses % Responses % I don’t prioritise 7 3.381643 16 7.729469 26 12.56039 Using a prioritisation tool to determine 43 20.77295 43 20.77295 10 4.830918 patients clinical need Aim to see every patient daily 74 35.74879 58 28.01932 39 18.84058 Use referrals from nursing and medical staff 99 47.82609 119 57.48792 118 57.00483 Use ward rounds and MDT meetings 86 41.54589 112 54.10628 99 47.82609 to highlight patients Use medicines reconciliation to prioritise patients 56 27.05314 106 51.20773 26 12.56039 Patients who are going to have a longer length of stay 47 22.70531 63 30.43478 13 6.280193 Polypharmacy (ie patient on more than 98 47.343 87 42.02899 35 16.90821 a specific number of medicines) Time/date of admission (ie 24hr MR target or similar) 121 58.45411 28 13.52657 6 2.898551 Start at Bay 1 Bed 1 and move round chronologically 19 9.178744 26 12.56039 4 1.932367 Use Summary Care Record as a prioritisation tool 39 18.84058 12 5.797101 3 1.449275 Total 689 670 379 did not match the expected level as per the guidelines. The author concluded that the tool was not validated in consistently assessing a patient acuity level. This is thought to be because individual pharmacists assigned an acuity level based on their own interpretation of complexity, that the risk score was not updated as a patient’s condition changed through the hospital stay, and that the tool was used to remind pharmacists of tasks to perform out width the scope of PAST. The author concluded that pharmacists’ clinical experience and judgement might be as important when assessing patient clinical acuity. Additionally, it was noted that pharmacists on wards with less-complex patients tended to assign patients a higher acuity level; conversely wards with a higher average patient complexity tended to undervalue patients’ acuity level. The author explained this discrepancy because the tool was not sensitive enough to separate large numbers of patients who were assessed as being in the highest risk category. 12 Further work on the PAST tool concentrated on pharmacists’ attitudes towards its use in prioritisation. 13 All 32 pharmacists working at the study hospital were questioned about their attitudes towards the use of PAST, with a response rate of 87.5% (28/32). The study found that pharmacists felt confident about using PAST but that clinical experience and judgement over-rode any score generated by the tool. Pharmacists were using the tool as a guide to prioritise their own work but were not using it to prioritise the wider pharmacy team’s work schedule. 13 To effectively implement clinical pharmacy prioritisation into practice, a validated tool is needed with enough precision to accurately predict a patient’s acuity level, while also being easy to use, and preferably automated. Common themes identified through thematic analysis were that prioritisation was an essential skill that all pharmacy professionals required. It is described as a ‘skill that needs to be learnt’ and that ‘professional judgement needs to be applied’ Prognostic factors Work has been undertaken to understand what prognostic factors make patients a priority for pharmaceutical care. Using a review of published literature and an internet survey of 247 pharmacists, 23 important or very important prognostic factors were identified. These included renal function, patient age, number of medications prescribed and comorbidities. The author states that identification of these prognostic factors will allow the development of tools to enable prioritisation based on clinical credible prognostic factors for risk. 14 Despite the drive to introduce prioritisation and triage tools, to facilitate efficient and targeted clinical pharmacy services, there has been no research into how clinical pharmacists currently view prioritisation in their day to day practice. This research aims to understand how pharmacists are using prioritisation, how they view the impact of prioritisation on the patient care they deliver and what are the challenges associated with implementing prioritisation into day-to-day pharmacy practice. Methods Setting Participants in the study were pharmacists and technicians working in clinical roles in NHS secondary care acute and mental hospital organisations in the North East of England and North Cumbria. This covers nine acute Trusts and two mental health Trusts. Data collection An electronic questionnaire was developed by a panel of nine clinical pharmacy leaders representing all acute and mental health hospital organisations hospitalpharmacyeurope.com | 2019 | Issue 91 | 19