Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic

Abstract

Background Seven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls. Aim To optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability. Setting A tertiary-referral teaching hospital, London, United Kingdom. Development The seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed. Implementation The service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these. Evaluation A prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical. The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34–1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome. Conclusion Seven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.

Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey

“…The PROTECTED-UK study reported a higher clinical intervention rate (to correct medication errors) by pharmacists on weekends compared to weekdays (33.6% vs 16.1%; p < 0.0001), with clinical interventions rated as moderate to high clinical impact in the majority of scenarios [5]. The utilisation of critical care pharmacists has repeatedly shown to lower ICU mortality, lower ICU length of stay, lower healthcare costs, and detect adverse drug events [3,5,20,29]. Extending the clinical pharmacy at the weekend provides an opportunity to extend these patient bene ts across a seven-day service.…”

“…Furthermore, the NHS England critical care service speci cation states that commissioned CCUs must align to GPICS guidelines [17]. In the UK, there is a good evidence base describing the CC pharmacy workforce and activities, especially clinical pharmacists, although there remains great variation in the delivery of the clinical pharmacy service, MDT ward round participation and 7-day clinical pharmacy services, despite evidence of bene t [18][19][20]. This is not the case for commissioned ECMO services, where no data exists for the clinical pharmacy workforce.…”

Improving the pragmatic usefulness of the scoring matrix for the Consolidated Framework for Implementation Research (CFIR). A proposal for a more frequency-based approach: The CFIR-f

“…The CFIR is a conceptual, systematic and meta-theoretical approach that is used to assess the uptake of a program against key factors that have been shown to influence the implementation of complex programs [8][9][10]. The CFIR has been used to assess the implementation of health-related services, such as weight management [7], hospital care [11], chronic disease [12] and pharmacy services [13], and the implementation of social services, such as the introduction of intensive family-based therapy programs in the Australian state of Victoria [4].…”