APPLIED RESEARCH
Initial observations on the implementation of a clinical pharmacy service in a rural hospital in Austria
Clinical pharmacy services ( CPS ) are rare in Austria , with only 15.8 % of all hospitals having a dedicated pharmacy department , and even fewer offering CPS . Many countries have demonstrated that CPS in hospitals enhance patient safety and provide cost efficiencies .
Sonja Guntschnig MSc Tauernklinikum , Zell am See , Austria
Kathryn Burnett School of Pharmacy and Pharmaceutical Sciences , Ulster University , Northern Ireland , UK
Aaron Courtenay School of Pharmacy and Pharmaceutical Sciences , Ulster University , Northern Ireland , UK
Michael Scott Medicines Optimisation and Innovation Centre , Antrim , UK
ABSTRACT
AIM To determine which types of clinical pharmacy interventions are needed at a small rural 360-bed hospital in Austria , and to assess the physicians ’ acceptance rate of the pharmacists ’ suggestions .
METHODS Data on interventions made by one clinical pharmacist were collected over a six-month period and rated on a six-point clinical significance scale . A subset of 30 interventions was rated for clinical significance by four independent consultants to determine inter-rater reliability .
RESULTS During the six-month period , 255 clinical pharmacy interventions were made . In a subset of 159 patients , 95 met the criteria for medication review which resulted in 140 interventions being made . Clinical pharmacy input was needed by 59.8 % ( 98 / 159 ) of patients , requiring on average 1.5 interventions per patient . Acceptance rate was 59.6 % ( 152 / 255 ), a change was considered by the physician involved , but not immediately followed through with in 40.0 % ( 102 / 255 ). Average score for clinical significance intervention rating was 2.18 . Inter-rater reliability ( IRR ) agreement was ‘ good ’ between the four consultants , and the four consultants with the pharmacist , respectively .
CONCLUSION Clinical pharmacy services ( CPS ) are needed and well accepted in Austrian hospitals . The clinical pharmacist is a missing member of the multidisciplinary ward team , a key player in reducing adverse drug reactions and improving patient safety , enabling treatment to become more holistic and patient-centred .
Clinical pharmacy services ( CPS ) have evolved greatly in recent years . In some countries they are normal practice , whereas in many , they do not exist . In Austria , only 15.8 % 1 of all hospitals have a pharmacy department , with only a few regularly providing CPS . In terms of numbers there is one hospital pharmacist per 300 patients . 2 Stereotypical and traditional role models for both medical and pharmacy staff make it difficult to widen the scope of CPS . Medical staff are beginning to recognise the worth of clinical pharmacists and although it is well recognised that clinical pharmacists have a positive impact on patient care and are positively received by both medical and nursing staff , 3 – 9 more needs to be done in Austria in order to change stakeholders ’ perspectives and to inform policy to deliver necessary legislative changes . Compared with the UK , pharmacists in Austria have not been deployed to a level commensurate with their education and training ; for example , they cannot run clinics , or work in general practice surgeries to perform medication use reviews 10 and further training to become an independent non-medical prescriber is still not available . This is in an environment in which both hospital doctors and GPs frequently complain about their immense workload , 11 a situation that could be alleviated by maximising the use of clinical pharmacists .
This study aims to demonstrate the need for CPS in hospitals across Austria , the acceptance rate of clinical pharmacy interventions by physicians and the impact on inpatient safety by having a clinical pharmacist supporting the ward team .
Methods Study site This clinical service evaluation pilot study was undertaken at Tauernklinikum in Zell am See , Austria – a rural 360-bed clinic in the federal state of Salzburg . The clinical pharmacy interventions took place on the medical ward ( 72 beds ), involving polypharmacy patients ( with five or more prescribed medical preparations ) who were chosen randomly by the clinical pharmacist . Randomisation on ward rounds took place , choosing the patient rooms first according to ward round groups and then performing medication reviews . The pharmacist requested a call as to when the ward round would start and would then come and join – so not all patients in the chosen rooms would be seen , depending on time available . Randomisation for remote ( not attending the ward round physically ) medical review was undertaken in a similar fashion . This would facilitate reaching the patients ’ physicians . Instead of joining the ward round , the
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