The Canadian journal of hospital pharmacy最新文献

Background: Patient safety incidents are the third leading cause of death in Canada. These occurrences have negative effects on patients and on the well-being of health care professionals. They also lead to financial burdens on the health care system. Several organizations focus on minimizing patient safety incidents; however, an area requiring additional research is evaluating the emotional impact of medication-related patient safety incidents (MRPSIs) on Canadian hospital pharmacists. An MRPSI is a preventable, unintended outcome resulting from medication management rather than an underlying disease. The consequences may be no harm, temporary harm, prolonged hospital stay, disability, or death.

Objectives: To describe the psychological burden on pharmacists after occurrence of an MRPSI and to identify supportive strategies.

Methods: This mixed-methods study involved a voluntary survey of hospital pharmacists and structured individual interviews. Survey respondents scored their emotional distress on the Impact of Event Scale (IES), a validated self-reporting tool used to assess the impact of traumatic life events. Interviewees' responses were analyzed qualitatively.

Results: Of the 128 pharmacists who had experienced an MRPSI and submitted a complete survey response, 105 (82%) had a score above 8 on the IES, indicating that the MRPSI had an important impact. Commonly reported factors contributing to MRPSIs were heavy workload, interruptions, and inexperience. The most desired support strategies included talking to a colleague, compassionate notification of the event through management, and involvement in team debriefs.

Conclusions: The emotional impact of MRPSIs as reported by Canadian hospital pharmacists is significant. Most participants felt that increased support is needed to overcome emotional burdens related to MRPSIs.

Background: Many different teaching strategies are used to promote learning in an academic or professional environment. Among these can be noted the emergence of simulation, based on the concept of escape games.

Objective: To identify methodologies relating to the use, design, and implementation of escape games in health care.

Data sources: The Pubmed, Embase, and CINAHL databases were searched up to December 3, 2018.

Study selection: All studies focusing on the design or development of escape games in the health care field (published in English or French) were included.

Data extraction: For each study, the country, target population, design, development, method of evaluation, and results were extracted for analysis.

Data synthesis: Seven poster abstracts and 9 published articles were included. Twelve escape games were developed in the United States. They were used in medicine (n = 5), pharmacy (n = 4), nursing (n = 4) and other fields (n = 3), mainly within academic teaching contexts (n = 12) but also in professional settings (n = 4). Their goals were to improve knowledge (n = 8), to increase participants' interest and motivation regarding a specific topic (n = 2), and to improve cohesion and communication within a team (n = 2). Ten of the escape games described in the articles were based on a clinical scenario. Ten of the research teams held debriefings with participants, and one did not; 5 articles did not report information about debriefing.

Conclusions: Few data exist concerning the use of escape games in the health care setting, and it is too early to judge the efficiency of this approach to learning. However, growing interest justifies systematic monitoring of the literature to follow the evolution of such strategies and to better understand their place in health care education.

Background: The Ontario MedsCheck program was introduced in April 2007, with enhancements to strengthen the program made in October 2016. Previous literature has characterized patients who received the service before the enhancements and described the experiences of community pharmacists and physicians, but the experiences of participants in the enhanced MedsCheck program and those of hospital pharmacists and pharmacy technicians have not been explored.

Objectives: This study was designed to describe and compare the demographic and clinical characteristics of patients admitted to Sunnybrook Health Sciences Centre (SHSC) who had received a MedsCheck before and after the program enhancements of 2016. The study also aimed to describe the experiences of patients, hospital pharmacists, and pharmacy technicians with the MedsCheck program.

Methods: Chart reviews were completed to identify and characterize patients who had received a MedsCheck and were admitted to SHSC between March and May 2016 (retrospective cohort) and between March and May 2017 (prospective cohort). Patients were interviewed and focus groups were conducted with pharmacy staff to explore their experiences with the MedsCheck program.

Results: MedsChecks had been performed for 321 (14.5%) of 2216 patients in the retrospective cohort and 172 (6.8%) of 2547 patients in the prospective cohort, an absolute decline of 7.7% after the 2016 enhancements. Patient characteristics were similar between the 2 cohorts. Patients' experiences were varied, but because of low enrolment in the interview process (n = 3), it was difficult to identify and summarize common themes. The analysis of focus groups involving pharmacy staff (n = 27 participants) revealed that the benefits of MedsChecks depended on quality and access, and also identified common barriers and opportunities for future enhancements.

Conclusions: Patient interviews revealed the features of the program that patients valued. Pharmacy staff identified several benefits and barriers encountered when using MedsChecks. These findings can guide clinicians in optimal application of the current MedsCheck program and can inform subsequent program revisions.

Background: The rate of potential adverse drug events is reported to be 3 times higher among pediatric inpatients than among their adult counterparts. Various methods have been suggested to reduce medication errors in pediatric patients. One of the most influential of these strategies is inclusion of a clinical pharmacist on the multidisciplinary care team. However, there is currently no literature describing the inventory of pharmacy services provided to pediatric patients in Canadian adult hospitals.

Objectives: The primary objective of this study was to describe pediatric and neonatal pharmacy services provided in adult hospitals in Canada. The secondary objective was to determine whether the services provided correspond to services that pharmacists working in Canadian pediatric hospitals identified as important for adult hospitals that provide pediatric services.

Methods: Two web-based surveys were created, focusing on 35 pharmacy services. The first survey was intended for adult hospitals, and the second for pediatric hospitals. The surveys were distributed by e-mail and were completed in January and February 2018.

Results: A total of 55 and 43 valid responses were received from respondents in adult hospitals and pediatric hospitals, respectively. An inventory of pharmacy services provided by adult hospitals to their pediatric and neonatal patients was obtained. Of the adult hospitals that responded, 61% (33/54) had pharmacists assigned to pediatric or neonatal units. The frequency with which most pharmacy services were provided was comparable to the importance identified by pharmacists working in pediatric hospitals. However, for the provision of education during admission and at discharge and for the provision of medication reconciliation at discharge, frequency and importance were not comparable.

Conclusions: Adult hospitals with a pharmacist assigned to an inpatient pediatric or neonatal clinical area met most expectations of pharmacists working in pediatric hospitals in terms of pharmacy services provided. However, some services require optimization for this patient population.

Background: Pharmacists often overlook drug interaction alerts because of limitations in clinical decision support (CDS) software systems intended to detect evidence-based, clinically significant drug-drug interactions (DDIs). Alert fatigue, which occurs when pharmacists become desensitized to an overload of DDIs, may also contribute.

Objectives: To gain a better understanding of how pharmacists assess common DDIs and the extent to which computerized drug alerts affect their decision-making, as background for initiatives to overcome alert fatigue and improve detection of DDIs.

Methods: This qualitative study used focus group methodology. A structured focus group was planned at each of 3 large tertiary hospitals. Pharmacists were invited to participate if their jobs included patient care and/or dispensary responsibilities. The focus group discussions were audio-recorded and subsequently transcribed, analyzed, and coded into themes using NVivo software. Four main categories of themes were identified: perceived challenges, pharmacists' assessment of DDIs, barriers to responding to alerts, and proposed solutions.

Results: The participants (n = 24) described a large discrepancy among CDS software systems in terms of the severity of specific DDIs, which made it difficult to view these systems as reliable sources. The participants agreed that alert fatigue is present and contributes to DDIs being overlooked. However, lack of patient information to make an initial assessment, as well as the constant need for multitasking, prevents pharmacists from focusing on the evaluation of DDIs.

Conclusions: Although alert fatigue was reported to be a common factor responsible for pharmacists missing DDIs, other barriers also exist. Participants suggested ways to limit DDI alerts to those that are clinically relevant. Having a collaborative team of pharmacists periodically review the DDIs embedded in the CDS system, incorporating a colour-code system, and removing duplicate entries were discussed as ways to improve system efficiency.

Background: Antimicrobial use is the major factor in the development of antimicrobial resistance. Antimicrobial stewardship has been recommended as a strategy to improve antimicrobial use.

Objective: To learn about health care providers' perceptions of current antimicrobial use and stewardship, including barriers and facilitators to improving antimicrobial use at acute care hospitals in Nova Scotia.

Methods: This qualitative research study was conducted at acute care hospitals in Nova Scotia using focus groups and semistructured interviews. Health care providers (nurses, nurse practitioners, pharmacists, pharmacy students, and physicians) were invited to participate. Focus groups and interviews were conducted at each participant's place of employment. Interviews and focus groups were facilitated with an interview guide, audio-recorded, and transcribed verbatim. Transcripts were independently coded by 2 investigators and analyzed using thematic analysis.

Results: A total of 9 focus groups and 3 individual interviews were conducted between June and August 2017. Fifty-four health care professionals and trainees (24 pharmacists and pharmacy students, 14 physicians, and 16 nurses and nurse practitioners) from 5 hospitals participated. The following themes were identified: current practices, prescribing influences, access to information, collaboration and communication, resources, and antimicrobial stewardship. Within each theme, barriers and facilitators to improving antimicrobial use were identified as subthemes.

Conclusion: Participants identified current barriers to appropriate use of antimicrobials and suggested facilitators that might improve the use of these drugs. The results of this study could be used by antimicrobial stewardship teams and decision-makers to improve antimicrobial use and stewardship initiatives throughout Nova Scotia, and may be applicable to hospitals outside the province.

Background: Leadership turnover is unavoidable in all organizations, including hospital pharmacy departments. Succession planning can promote organizational stability, among other benefits.

Objectives: To gather a contemporary, nationwide measure of the level of preparedness for department leadership succession and to gain related insight from a variety of pharmacy leaders.

Methods: This study was an environmental scan of Canadian hospital pharmacy leaders. An online survey was conducted to identify the current rate of succession planning; to describe existing succession plans; to determine the perceived need for succession planning; and to describe strategies for, barriers to, and facilitators of succession planning.

Results: Eighty-three responses were received. Thirteen respondents (16%) reported that their hospital pharmacy departments had a succession plan, and 13 (16%) of individuals had known successors. Most respondents (64/75 [85%]) perceived succession plans to be rare or nonexistent across Canada. However, 72% (54/75) felt that succession planning was needed for their own leadership position. The most common barriers to succession planning were a lack of formal structure or tools, lack of plan implementation, unionization, and lack of career ladder positions. Select facilitators to succession planning identified by respondents were having a strong existing leadership and having an abundant pool of capable successors.

Conclusions: Most Canadian hospital pharmacy departments and individual leaders represented in this survey were not prepared with succession plans. A collective effort to proactively enact succession planning in Canadian hospital pharmacy departments would have multiple benefits for existing and aspiring leaders and, ultimately, the profession as a whole.