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