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Hospital Pharmacy in Canada 2005-2006 Hey Kid

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Hospital Pharmacy in Canada 20052006 Hey Kid what do you do now – PowerPoint PPT presentation

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Title: Hospital Pharmacy in Canada 2005-2006 Hey Kid


1
Hospital Pharmacy in Canada 2005-2006 Hey Kid
what do you do now ?
  • Jean-François Bussières
  • B Pharm MSc MBA FCSHP
  • Chef, département de pharmacie et unité de
    recherche en pratique pharmaceutique
  • Professeur agrégé de clinique
  • Faculté de pharmacie, Université de Montréal
  • Membre du comité de rédaction
  • Rapport canadien sur la pharmacie hospitalière

2
Match plan
  • Objective provide participants with an overview
    of the alignment of hospital pharmacy practice
    (e.g. clinical pharmacy) with the evidence
  • What do we Know ?
  • What do we Ignore ?
  • What should we Do ?

KID
3
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4
Who are we ?
  • Response rate 74
  • Teaching institutions 26

Johnson N et al. Hospital Pharmacy in Canada
2005-6
5
Who are we ?
  • Please consider absolute numbers but prefer
    ratios when available
  • Always understand whats behind the numbers

Johnson N et al. Hospital Pharmacy in Canada
2005-6
6
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7
Clinical practice models
K
  • Clinical pharmacy has celebrated its 40th
    anniversary in 2006
  • There are many models and philosophy
  • Traditional clinical services
  • range of services based on a medication or a
    particular pharmaceutical function designed to
    optimize a given result for the patient for
    example pharmacokinetic services, total
    parenteral nutrition (TPN) monitoring services
    and so on.
  • Pharmaceutical care
  • organized delivery of pharmacotherapeutic
    services to achieve well-defined therapeutic
    results. In particular, it means designing,
    applying and managing a therapeutic care plan of
    monitoring, prevention and solution of
    pharmacotherapeutic problems, potential or real.
  • Interdisciplinary pharmacy practice
  • Total pharmacy practice

8
Clinical practice models
K
  • Traditional (89 ) and pharmaceutical care (82 )
    are largely implemented
  • Pharmacy departments use both models and an
    important or beds are still non covered

Johnson N et al. Hospital Pharmacy in Canada
2005-6
9
Clinical practice models
K
  • Pharmaceutical care AND absence of clinical
    services have progressed over the last 10
    year-period

10
Clinical practice models
K
  • The proportion of beds covered by PC has
    increased while the proportion of beds uncovered
    has decreased

11
Clinical practice models
i
  • But we ignore
  • If this distinction between models is still
    useful and reliable to report ?
  • If one model is superior to the other in all
    cases or some cases ?
  • What criteria should influence the implementation
    of one model or the other ? What is the best
    model mix ?
  • What will be the impact of the entry-level Pharm.
    D. on practice models

12
Clinical practice models
d
  • So we have to
  • Ensure that each pharmacy department has a
    reproductible framework for clinical pharmacy
    services
  • Ensure a better coherence between academia,
    hospital and community pharmacy practice
  • Document and publish successful practices from
    role model

13
A new entry-level Pharm. D.
d
  • Transversals
  • Professionnalism
  • Communication
  • Team work and interdisciplinarity
  • Scientifical reasoning and critical thinking
  • Autonomy in learning
  • Leadership
  • Specifics
  • Pharmaceutical care
  • Service to the community
  • Pharmacy management and operations

14
A new entry-level Pharm. D.
d
15
A new entry-level Pharm. D.
d
  • Module A Drugs and the human
  • Module B Drugs and society
  • Module C Labs
  • Module D Integration activities
  • Module E practical training/internship
  • Module F optional courses

16
d
17
Staffing
K
  • There are different ratios that can be used to
    compare pharmacy staffing to others e.g. doses
    dispensed/y, case-mix index-ajusted patient-days,
    admission, occupied beds etc.

Gupta SR et coll. AJHP 2007 64 937-44.
18
Staffing
K
  • 15 FTE pharmacists/ 100 occupied beds
  • 7 times more integrated pharmacists than clinical
    pharmacists/100 occupied beds

Pedersen CA et al. AJHP 2007 64 507-20.
19
Staffing
K
  • 19,1 FTE/100 occupied bed (estimated occ. Rate
    85 ) vs 14 up to 20 FTE/100 occupied bed in USA

Johnson N et al. Hospital Pharmacy in Canada
2005-6
20
Staffing
K
Johnson N et al. Hospital Pharmacy in Canada
2005-6
21
Staffing
i
  • But we ignore what
  • Is the optimal staffing in terms of FTE to
    fulfill adequately patient needs
  • Is the optimal ratio pharmacists / non
    pharmacists
  • Should be the future role of pharmacy technicians
    for non dispensing activities
  • Is the impact of having a non-pharmacist as a
    head of pharmacy department

22
Staffing
d
  • So we have to
  • Collect indicators to be able to calculate ratio
    ( dose dispensed, patient-days adjusted for
    case-mix )
  • Agree upon key ratio to be reported at least
    regionally for benchmarking
  • Develop indicators for ambulatory/outpatient care
    activities

23
Time devoted to clinical pharmacy
K
  • Only 24 of respondants devote gt 29 of their
    time to monitoring medication therapy in US

Pedersen CA et al. AJHP 2007 64 507-20.
24
Time devoted to clinical pharmacy
K
  • 41 of pharmacists time is devoted to clinical
    (patient care) activities in Canada

Johnson N et al. Hospital Pharmacy in Canada
2005-6
25
Time devoted to clinical pharmacy
i
  • But we ignore what
  • Is the optimal of time of clinical activities
    for a pharmacy department
  • Is the optimal of time for clinical activities
    of an individual on a daily, weekly, monthly or
    annual basis
  • Is the optimal number of clinical specialty per
    individual (1, 2, more ?)

26
Time devoted to clinical pharmacy
d
  • We have to
  • Agree upon a simple system to capture (bill) the
    nature of pharmacy services provided by
    individual on a regular basis
  • Evaluate the optimal mix (clinical/non clinical)
    for productivity, retenteion and impact of
    pharmacists

27
Specialization Outpatient and inpatient pharmacy
services
K
  • OUTPATIENT
  • Hematology-oncology 80
  • Renal/dialysis 63
  • Emergency 54
  • Anticoagulation 52
  • Infectious disease/AIDS 40
  • Diabetes 39
  • Transplantation 31
  • Mental health 27
  • Geriatrics/LTC 26
  • Pain/ palliative care 26
  • Asthma / allergy -16
  • General medicine 14
  • General surgery 14
  • Neurology 13
  • Gynecology obstetrics 8
  • Rehabilitation 7
  • INPATIENT
  • Geriatrics/LTD 83
  • Adult critical care 79
  • Hematology-oncology 78
  • General medicine 78
  • Pain / palliative care 70
  • Cardiovasculair /lipid 68
  • Mental health 63
  • General surgery 63
  • Pediatric /neonatal critical care 56
  • Renal / dialysis 51
  • Rehabiliation - 50
  • Hematology/anticoagulation 46
  • Infectious disease/AIDS 46
  • Transplantation 45
  • Gynecology obstetrics 43
  • Diabetes 41
  • Neurology 40
  • Asthma-allergy 37

Johnson N et al. Hospital Pharmacy in Canada
2005-6
28
Specialization Outpatient pharmacy services
K
Johnson N et al. Hospital Pharmacy in Canada
2005-6
29
Specialization Inpatient pharmacy services
K
Johnson N et al. Hospital Pharmacy in Canada
2005-6
30

K
31
K
32
K
33
Effectiveness of hospital pharmacy
K
  • Litterature search and review
  • Different domains
  • General medication review and clinical
    intervention monitoring
  • Multidisciplinary teamwork
  • Patients own drugs and self-administration
    schemes
  • Pre-admission clinics
  • Patient discharge services
  • Shared care, primary/secondary care interface and
    outreach services
  • Outpatient service
  • Mental Health
  • Intensive care units and theatres
  • Patient counselling and education
  • Aseptic services
  • Non-sterile manufacturing
  • Pain control
  • Medicines information
  • Anticoagulant services
  • Pharmacokinetic and therapeutic drug monitoring
    services
  • Extended hours, residency and on-call services

Guild of healthcare pharmacists. 2001
34
Effectiveness of hospital pharmacy
K
  • 10 099 articles
  • 13 reference database (Medline, Pharmline, EPIC,
    etc.)
  • Mainly UK publications
  • No statistical analysis
  • Most studies have positive results (publication
    biais ?)
  • Authors have identified 7 key concerns

Guild of healthcare pharmacists. 2001
35
Specialization
i
  • But we ignore
  • How to better prioritize a clinical specialty vs
    another
  • The evidences about the impact of pharmacist per
    specialty
  • What level of resources should be devoted to a
    specific specialty
  • How to recognize specialist vs generalist

36
Specialization
d
  • But we have to
  • Monitor published evidences for pharmacy practice
    as for drug therapy
  • Build business cases for clinical pharmacy with
    evidences, patients and professionals needs
  • Recognize specialist in pharmacy

37
Impact of clinical pharmacy
K
  • Clinical pharmacy can have
  • A positive impact on costs
  • A positive impact on adverse drug event, reaction
    and medication error
  • A positive impact on lenght of stay
  • A positive impact on

38
Economic benefits
K
39
Economic benefits
K
40
K
41
Effect of pharmacists interventions on patient
and process outcomes
K

42
Effect of pharmacists interventions on patient
and process outcomes
K
  • 343 articles retrieved from 1985-2003 but only 36
    included
  • Controlled studies, inpatient, patient outcomes
  • Pharmacists participation on medical rounds (n
    10)
  • Medication reconciliation studies (n11)
  • Drug specific services (n15)
  • Global impact
  • ADE, ADR or ME were reduced in 7/12
  • Medication adherence, knowledge and
    appropriateness were improved in 7/11
  • Shorten lenght of stay in 9/17
  • Higher use of healthcare in one study
  • No studies reported worse clinical outcome

43
K
44
K
45
K
46
(No Transcript)
47
Association between pharmacists, clinical
pharmacy and health care outcomes
K
  • Increasing pharmacists/100 occupied beds is
    associated with a reduction in
    deaths/hospital/year
  • Increasing clinical pharmacists/100 occupied
    beds is associated deaths/1000 admissions

Bond CA et al. Pharmacotherapy 2001 21 (2)
129-41.
48
Association between pharmacists, clinical
pharmacy and health care outcomes
K
  • Increasing clinical pharmacists is associated
    with a reduction in LOS

Bond CA et al. Pharmacotherapy 2001 21 (2)
129-41.
49
Association between pharmacists, clinical
pharmacy and health care outcomes
K
? 50 des ADR/year by increasing the clinical
pharmacists/100 occupied beds from 0,9 à 5,7
Bond CA et al. Pharmacotherapy 2006 26 (6)
735-47
50
K
Association between pharmacists, clinical
pharmacy and health care outcomes
  • Medication errors/occupied bed/year rate is lower
  • when pharmacists are decentralised (1,74)
  • or centralized with ward visits (1,93)
  • Vs centralized (3,15)

51
BEFORE
52
Prioritization Admission and discharge interviews
K
53
Prioritization - Rounds and consultation with
physicians and kardex rounds with nurses
K
54
Prioritization Pharmacokinetic dosings
K
55
AFTER
56
Average level of service and ranking priority
K
Johnson N et al. Hospital Pharmacy in Canada
2005-6
57
Average level of service and ranking priority
K
Johnson N et al. Hospital Pharmacy in Canada
2005-6
58
K
59
Prescribing
60
Evaluation
Johnson N et al. Hospital Pharmacy in Canada
2005-6
61
Prioritization
i
  • But we ignore
  • How to prioritize amongst all clinical pharmacy
    activities
  • How to better delegate or collaborate with other
    professionals without losing the essence of
    pharmacy practice
  • How to document and evaluate theses activites

62
2015 Vision
d
63
So whats next ?
d
  • Find, read, understand and use evidences
  • Document, benchmark, evaluate and update models,
    specialty areas, hierarchy of activities
  • Meet, discuss, move towards consensus about
    pharmacist role to develop an evidence based
    practice model
  • Question, research, answer, publish and transfer
    the knowledge within and outside the profession
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