TABLE 3
Factors that influence pharmacy staff in prioritising patients for MR, clinical review
and discharge
Factors that influence priority of patients MR Clinical review Discharge
Responses % Responses % Responses %
Medical notes 88 42.51208 76 36.71498 41 19.80676
Summary care record 69 33.33333 25 12.07729 5 2.415459
Electronic Prescribing and Medicines Admin systems 22 10.62802 19 9.178744 9 4.347826
Clinical judgement 118 57.00483 143 69.08213 74 35.74879
Patient on a high risk medicine 175 84.54106 147 71.01449 73 35.2657
Clinical factors relating to patient (eg AKI, pregnancy) 124 59.90338 150 72.46377 42 20.28986
Referral from other healthcare professionals 132 63.76812 134 64.7343 99 47.82609
Pressure from non-pharmacy staff 30 14.49275 35 16.90821 92 44.44444
Patient has complex pharmaceutical needs 137 66.18357 133 64.25121 81 39.13043
(eg compliance or polypharmacy)
Target (eg MR or discharge) 82 39.61353 19 9.178744 81 39.13043
Electronic displays 38 18.35749 18 8.695652 56 27.05314
(eg ward whiteboards or dashboards)
Pressure from non-clinical duties 25 12.07729 26 12.56039 29 14.00966
Patient available to speak to 85 41.0628 29 14.00966 41 19.80676
Total 1125 954 723
in the North East of England and North Cumbria.
The questionnaire was emailed to all pharmacists
and technicians working in clinical, patient-facing
and clinical leadership roles within the surveyed
organisations. The questionnaire explored how
pharmacy teams were prioritising in their practice,
what methods for prioritisation were in use, their
view on both the benefits and challenges associated
with prioritisation (see appendix for copy of the
questionnaire).
Data analysis
The study commenced in November 2016 and
concluded once 200 responses had been received.
Quantitative data were transferred into an Excel
document for analysis. Data were analysed by
simple statistical methods and qualitative data were
analysed using a thematic approach. Information
was coded and analysed for themes using inductive
methodology.
Results
A total of 207 responses were received (39
technicians and 162 pharmacists) working in 11
different acute physical and mental health Trusts
based across the study region. This is a response
rate of 58%. Respondents ranged across a broad
spectrum of pay grade suggesting a diverse level
of experience and seniority. The respondents were
senior technicians (n=39), junior pharmacists (n=79)
and specialist pharmacist (n=89) who are those
most often working in ward based or direct patient
care roles. Responses were received from a wide
range of specialties including acute admissions,
Pharmacy staff
need to use their
experience and
knowledge to
interpret the risk
and complexity of
the individual and
consider this
within the wider
context of the
current clinical
picture
general surgery, specialist surgery, general medicine,
medical specialities, mental health, orthopaedics,
critical care, and paediatrics. Respondents’ workload
varied between 5 to over 50 patients on an average
day. This variation was explained by non-clinical
workload demands and patient or ward complexity.
Views on the importance of prioritising for
various different ward-based clinical activities are
shown in Table 1. The majority of respondents
(62%, n=207) felt that prioritising was essential
for medicines reconciliation but fewer rated it as
essential for clinical review and discharge activity
(37% and 44%, respectively).
Methods of prioritisation varied dependent upon
the pharmacy activity undertaken. Methods used
to prioritise patients for medicines reconciliation
differed from those used to prioritise clinical review.
Discharge was also prioritised by differing methods.
Date and time of admission was the most important
factor that drove prioritisation for medicines
reconciliation (Table 2). Communication with the
multidisciplinary team and referrals from nursing
and medical staff were also important mechanisms
to aid prioritisation in all clinical activities. Another
important factor that determined the priority of the
pharmacy clinical workload was the complexity of
a patient’s drug regimen reflected by polypharmacy
and long hospital stay. Prioritisation tools were
widely available across the study hospitals but
pharmacy staff did not rate them highly as a method
used for prioritising clinical workload (See Table 2
for responses on methods pharmacy staff used for
prioritisation their clinical workload).
Influences on pharmacy staff prioritisation
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