Pharmaceutical Review: Resource Implications for the Pharmacy Component in Australian Public Hospitals

Abstract

Background Pharmaceutical review requires a facility‐wide approach and multidisciplinary collaboration between all involved in the use of medicines. Standards of practice for clinical pharmacy services and distribution of medicines, provide a blueprint for two activity groups provided by pharmacy services that contribute to pharmaceutical review. Aim To explore the pharmacy components required to deliver pharmaceutical review in Australian public hospitals and examine the resource implications to meet these objectives. Method Workforce data were collected from a questionnaire sent to hospital pharmacy managers in 2005. Respondents were asked to detail the pharmacist full‐time equivalents (FTEs) devoted to clinical, distribution and management activities. They were also asked to detail clinical service delivery models and the number of beds at their facility according to clinical pharmacy categories. Ratios of the number of pharmacists to clinical pharmacy bed type were used to calculate the national workforce requirements estimated after extrapolation. Results Approximately 768 pharmacist FTEs would be required to provide a basic clinical pharmacy service (3 clinical pharmacy activities: accurate medication history, assessment of current medication management, provision of medicines information to patients) for all patients in Australian public hospitals; approximately 1300 pharmacist FTEs would be required for a comprehensive clinical pharmacy service. This equates to 58 minutes of pharmacist time during an inpatient stay, for each overnight admission. At least 40% of clinical pharmacy services are required for general medical type beds and this should be considered when identifying the skills base required in the hospital pharmacy workforce. Conclusion Retaining the current highly skilled pharmacist workforce and attracting pharmacists into the hospital sector to fill vacant establishment positions is the first step. The number of establishment positions will then need to be increased nationally to fully deliver pharmaceutical review in Australia's public hospitals.

Determining Clinical Pharmacy Workload by Patient Disease Classification in Medical and Surgical Patients

“…A 2006 analysis of the Australian pharmacy workforce, attempted to forecast the clinical pharmacist workforce needed to meet the requirements of the Australian Health Ministers' recommendation for the provision of pharmaceutical review for inpatients. 15 This included estimates of the beds to pharmacist ratios for the provision of 'comprehensive' clinical pharmacy services and 'basic' clinical pharmacy services.…”

“…These findings can be applied to the recently proposed beds to pharmacist ratios for the provision of 'basic' clinical pharmacy services. 15 A pharmacist with a daily case load of 55 medical beds to which they are providing a 'basic' clinical pharmacy service, could expect ten new patients requiring admission interviews as well as interventions to correct medication admission errors and for other therapeutic recommendations. Approximately ten patients would need provision of medicines information on discharge and the remaining 45 patients would require ongoing medication management assessment.…”

Clinical Pharmacist Staffing Levels Needed to Deliver Clinical Services in Australian Hospitals

“…15 A 2005 Australian workforce study reported that across the 88 hospitals surveyed, one full-time pharmacist covered 69 beds. 13 Only 16 of the 88 respondent hospitals offered a comprehensive clinical pharmacy service to all patients and nine offered no clinical pharmacy services. It was not surprising that the authors found that many more pharmacists were required to provide a comprehensive clinical service for the 22 824 beds at these hospitals (one clinical pharmacist to 34 beds).…”

Link Between Clinical Pharmacy Services, Pharmacy Staffing and Hospital Mortality Rates

“…5 The data also showed that no clinical pharmacy service was available for at least 22% of overnight inpatients and that an additional 150 clinical pharmacists were needed across Australia's public hospitals for all overnight inpatients to have access to a basic clinical pharmacy service. 5 The link between the number of pharmacy administrators and reduced mortality rates may surprise some.…”

“…5 The data also showed that no clinical pharmacy service was available for at least 22% of overnight inpatients and that an additional 150 clinical pharmacists were needed across Australia's public hospitals for all overnight inpatients to have access to a basic clinical pharmacy service. 5 The link between the number of pharmacy administrators and reduced mortality rates may surprise some. However, as noted in the Australian paper on pharmaceutical review, nonpatient-specific, or hospital-wide pharmacy activities, aimed at improving patient safety (institutional medicine policy management, adverse drug event alert systems, standardisation of protocols for high-risk medicines, reviewing systems to minimise incidents, staff education on procedures and policies) are needed for optimum patient care.…”