individual patient factors above targets and system
pressures as the most important factors when
prioritising workload.
For pharmacy to make the most of its workforce,
it should aim to move from a basic prioritisation
process that solely highlights patients with defined
high-risk characteristics to a more nuanced
approach. Pharmacy staff have described the
need for a flexible approach to prioritisation
that enables them to identify patients with
greatest risk or pharmaceutical need. Pharmacy
services can then focus the appropriate level
of pharmaceutical care to address the patient’s
individual requirements. The process needs to
go beyond simple prioritisation to a system-wide
approach that would be better described as triaging
patients for pharmaceutical clinical intervention.
A triaging process would empower pharmacy
staff to use different prioritisation methods. This
process would include collection of all the relevant
information about patients, analysis of the data,
identifying the activities where pharmacy could
have the greatest impact and then act to implement
the plan. The challenge is for pharmacy to perform
‘pharmaceutical triaging’ rapidly and accurately to
enable appropriate deployment of the pharmacy
workforce. A pictorial representation of the ideas
developed (Figure 1) describes how pharmacy staff
should work flexibly and be influenced by different
factors when prioritising patients for different
clinical activities.
The model of prioritisation of clinical pharmacy
services described by this study can best be
explained by situational awareness. Situational
awareness is our mental picture of what is
happening around us and of what is about to
happen. 15 This can be broken down into three steps
This research
describes that
pharmacy staff
perceive
pharmacy clinical
prioritisation in
hospital as a
complex process
that involves risk
assessment and
also situational
awareness
that involve the perception of the current situation,
comprehension of the situation and anticipation of
future changes. 16 The key element that differentiates
this from a simple clinical prioritisation method
is that it involves the pharmacy professional
interpreting the information using their experience
and knowledge to assign value to relevant risk
factors. The advantage of this approach is that
it will allow the pharmacy staff to interpret the
complexity of situations, decide upon relevancy of
different variables and then allow focussed action
to resolve the problems which pharmacy are best
suited to deal with. Systems need to be set up
so that pharmacy teams can rapidly review the
patients they are caring for and identify those with
greatest risk. They need to be able to consider the
complexity of individual patients, understand the
context of the current pharmacy service provision
and communicate effectively with other healthcare
professionals. The pharmacy team then needs
to be empowered to make decisions and have
the appropriate level of skills and knowledge to
anticipate what might happen in the future. The key
to pharmacy teams being able to prioritise workload
is to use these prioritise tools, apply their judgement
to the information and respond flexibly dependent
upon the specific circumstances.
This research describes that pharmacy staff
perceive pharmacy clinical prioritisation in hospital
as a complex process that involves risk assessment
and also situational awareness. This is a process
that requires the clinical knowledge and experience
of trained pharmacy staff interpreting risk in
the context of the pharmacy service they deliver.
Further work needs to be done to understand the
development needs of pharmacy staff to enable
implementation of situational awareness and
judgement into their practice to aid prioritisation.
Links between clinical pharmacy prioritisation
and efficiency could also be explored in further
studies. To enable the efficiency goals that modern
healthcare demands whilst ensuring that pharmacy
provides optimal care for those with greatest
pharmaceutical need an increased understand of
how best to focus pharmaceutical resources are
needed. This research highlights that situational
awareness and risk management are tools that
may aid in balancing the conflict demands made of
clinical pharmacy teams to ensure they provide the
best care for the patients with the greatest need.
It is worth noting this study focused on the views
of pharmacy staff in the North East of England.
It would be beneficial to understand the views of
pharmacy staff working in other areas and countries
to explore how prioritisation is viewed elsewhere.
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22 | Issue 91 | 2019 | hospitalpharmacyeurope.com