International Journal of Pharmaceutical Sciences and Clinical Pharmacy Volume 2 | Issue 1
Opinion Article Open Access Clinical Pharmacist Intervention in Improving Health Outcomes by Reducing Physician’s Burden and Medication Errors: A Proposed Model 1,3 2,5 3 3,4,5* Muhammad Ahmer Raza , Shireen Aziz , Sana Shahzad , Shahid Masood Raza 1Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, Shandong, Jinan 250012, China 2School of Pharmacy, Zhengzhou University, Zhengzhou 450001, Henan, China 3Faculty of Pharmacy, The University of Faisalabad, Faisalabad, 38000, Punjab, Pakistan 4School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China 5Faculty of Pharmacy, Sargodha University, Sargodha 40100, Punjab, Pakistan
*Corresponding author: Shahid Masood Raza,School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China. Email: [email protected]
Citation: Raza MA, Aziz S, Shahzad S, Raza SM. Clinical Pharmacist Intervention in Improving Health Outcomes by Reducing Physician’s Burden and Medication Errors: A Proposed Model. Int J Pharm Sci Clin Pharm. 2021;2(1):1-5. http://dx.doi.org/10.47890/IJPSCP/ShahidMasoodRaza/2020/24148306
Received Date: November 19, 2020 Accepted Date: December 03, 2020 Published Date: December 11, 2020
Abstract Healthcare is a team effort. Each healthcare provider is like a member of the team with a special role. Some team members are doctors or technicians who help in diagnosing disease. Others are experts who help in treating disease or care for patients’ physical and emotional needs. Understanding the role of each member in healthcare settings can reduce the burden of duties. According to World Health Organization (WHO) reports, burden of workload on physicians is the main cause of medical errors each day practice and thousands of people die as a result each year. Such errors can be minimized by reducing the workload on physicians and strengthening the role of clinical pharmacists in healthcare settings.
Keywords: Health care; Team Members; Physicians; Clinical Pharmacist
Introduction Healthcare team consists of a group of people who coordinate their Among other jobs, clinical pharmacists are responsible for selecting particular skills for the wellbeing of patients. A physician or medical appropriate drugs, monitoring patients’ progress, diagnosing potentially practitioner is a member of a healthcare team who practices medicine, untreated diseases, consulting with the patient on the effects of the which is concerned with promoting, maintaining, restoring health through drugs, and ensuring that patients following prescribed drug regimens [2]. study, diagnosis, prognosis, and treatment of disease, injury and other physical or mental impairments. Several nursing staff may involve in health WHO has set a global standard of one pharmacist per 50 beds. For the team and have their own nursing team. A nursing team is comprised of implement of this rule, National Drug Policy (NDP) of Pakistan stipulates personnel who provide nursing services to patients. Other healthcare team that one hospital pharmacist should be appointed for every 50 beds in members include dietitians, physiotherapists, pharmacists, pathologists, hospital facilities [3, 4]. It is about a decade still there is no improvement social healthcare workers, and technicians [1]. in clinical pharmacy profession and shortage of clinical pharmacists has been observed. Despite the shortage, clinical pharmacists in hospitals are Clinical pharmacists work as part of the general practice team to not properly engaged in providing clinical services and pharmaceutical improve value and outcomes from medicines and consult with and treat care to patients. Majority of pharmacists in hospitals are performing only patients directly. Clinical pharmacists are mainly trained to work directly conventional duties and responsibilities of recordkeeping, maintaining with patients in health care system, such as in hospitals or clinics. A hospital formulary, and drug purchasing. Due to these conventional clinical pharmacist has detailed knowledge and deep understanding of practices, doctors are overburdened and medical errors are part of each drugs and their effects, and doctors often give clinical pharmacists a great day practice ultimatly results in high morbidity and mortality rates. Thus, deal of controlling overprescribing medications and monitoring patients. the purpose of this article is to give a model in which clinical pharmacist
https://journalofpharma.com 1 Helics Group International Journal of Pharmaceutical Sciences and Clinical Pharmacy intervention can reduce the burden on physician’s, thereby improving their work quality, reducing medical errors and improving patient health outcomes.
Proposed Model
When patients (adults, children, and geriatrics) visit hospital for treatment, the visit involves many more people than just the doctor. Here is a brief outline of the new proposed model in replacing conventional practices in Pakistan. Figure 1 shows the clinical pharmacist intervention and details of each step in the model. Table 1 summarizes the outcomes of clinical pharmacist intervention in healthcare settings. The important points concerning innovation in this topic are as follows:
Greet patient
Check medical record
Schedule appointment Administrative staff Make reminder call
Verify insurance
Patient admission refer case
Record vital signs Nursing station Record patient’s weight and temperature
Record the reason for visit
Patient medication
major ailment send prescription
minor ailments refer case pharmacist guide nurses about the therapy and management
discuss Nurses encourage patients to take care of Doctor check up ADRs in therapy own health
physical weakness recover
Discharge contact pharmacist stress, depression
write up test discuss results motor abnormalities
Pathologist Pharmacist Psychologist Physiotherapist Nutritionist
Ship out sample Review lab test Patient Exercise, Develop a diet (blood, saliva, results counseling urine, feces) manual therapy plan/chart Fill out Perform test, & prescription Maintain mental Education and Producing analysis dose health advice power and management energy
follow up care
Discharge Medical billing
Figure 1:Proposed model showing clinical pharmacist intervention
https://journalofpharma.com 2 Helics Group International Journal of Pharmaceutical Sciences and Clinical Pharmacy Table-1: Outcomes of clinical pharmacist intervention in healthcare setting
Clinical pharmacist intervention Examples Outcomes Reduce physician’s burden by sharing Review lab test, fill out prescription Improve physicians’ work quality workload Reduce medical errors Reduce mortality and morbidity
Guide nurses about preparation and Ceftriaxone And Calcium Gluconate Cannot Reduce adverse drug reactions (adrs) administration Be Administered Together
Replace safer and effective drugs Replace omeprazole with ranitidine Cost-effective
Educate and provide information to Complete antibiotics course Reduce antibiotic resistance patients and healthcare professionals
Follow-up care Phone call, message, email Reduce hospital re-admission
• A member of the administrative staff schedule the appointment finds • In the end, medical billing experts then bill the patient’s insurance for the medical record, make a reminder call, greet the patient, and verify the office visit and either the test or the medication. insurance information and refer the case to the nursing station. • The pharmacist records the phone number and email for follow-up • A nurse in the nursing station record the patient’s weight and vital care to reduce hospital re-admission. signs, escort the patient to an exam room, and record the reason for the visit. If there is a minor ailment, encourage patients to take care Discussion of their health and be discharged. If there is a major ailment refering Clinical pharmacist is an integral part of the healthcare team aiming the case to the doctor. to improve value and outcomes from medicines and consult with and treat patients directly. We intended to give a model in which clinical • The doctor and general practitioner (GP) examines and talks with pharmacist intervention can reduce the workload on physicians; thereby the patient to develop a diagnosis and plan of care. improving their work quality, reducing medical errors, and improving patient health outcomes • If laboratory tests are required before starting medication, refer the . case to the pathologist. A technician may help to ship out the sample Advantages of clinical pharmacist intervention (blood, skin, saliva, urine, feces) and administrative staff performs analysis, write-up the results, and discuss with the doctor and GP. Multidisciplinary teamwork is the best way to ensure patient safety. For many years, pharmacists in the United States (U.S) and United Kingdom • If treatment, such as medication is prescribed, the doctor contacts (UK) were restricted to the management of hospital pharmacies. However, the clinical pharmacist and fills the prescription. every day, the demand for this profession in clinical units is becoming clearer and clearer. Our proposed model will bring the following outcomes: • The doctor sends a prescription filled out by the pharmacist to the nursing station. Pharmacist instructs nurses about medication therapy Reduce workload on physician and GPs and management. Clinical pharmacists are experts in the therapeutic use of • If any ADR reported, the pharmacist will discuss possible changes medications. They regularly provide medication therapy evaluations and in therapy to the doctor and GP. recommendations to patients and other healthcare professionals. Clinical pharmacists are the main source of scientifically valid information and • If there are mental health problems such as anxiety and depression, advice on the safe, appropriate, and cost-effective use. Having clinical refer the case to a psychologist for patient counseling, and support pharmacist in healthcare settings means that physicians and GPs can mental health. focus their skills where they are most needed, such as diagnosing and • If there are motor abnormalities, refer the case to a physiotherapist treating patients with more complex conditions of medications. This helps for exercise, manual therapy, education, and advice. doctors and GPs to manage the demands on their time [2].
• If there is physical weakness, refer the case to a nutritionist for Reduce medical errors and ADRs developing a diet plan and producing power and energy. Prescription errors are the main cause of ADRs. Studies have shown that majority of medication errors occur during medication
https://journalofpharma.com 3 Helics Group International Journal of Pharmaceutical Sciences and Clinical Pharmacy prescription and administration processes [5-8]. Therefore, intervention decreasing hospital visits and readmission rates, minimizing ADRs, and of clinical pharmacist may have a greater impact on the use of proper improving patients’ compliance with medication. Our proposed model prescription towards quality in medication use. In Europe, the clinical demonstrates that follow-up care by the clinical pharmacist is an integral pharmacist intervention in the monitoring of therapeutic plans and part of successful therapy. The competent authorities should dictate preventing medication errors was investigated. The study showed that, about the importance and ensuring that patients have proper follow-up the clinical pharmacist intervention might prevent 58% of all and 72% of care by the clinical pharmacist after being discharged from the hospital. potentially harmful medical errors and that improved physician-pharmacist communication might prevent 47.4% of errors [9]. A study conducted by The model we presented has limitation worth mentioning. The Kimet al., in USA, showed that 76% of prescriptions did not reach patient proposed model has not explained the fact that clinical pharmacist demands but had the significant potential to cause morbidity or mortality. participation in clinical rounds with physicians and GPs. Further studies The study showed that 22% of medical orders were duplicate, 19% of should be conducted in exploring the importance and outcomes of clinical prescriptions had wrong doses, 16% were with wrong frequencies [10]. pharmacist participation in clinical rounds. The study concluded that clinical pharmacists intervene in reviewing Conclusion medical orders and prescription by physicians to make sure the rational use of medication in right dose, duration, and time, and if any modification A collaborative, inter-professional teamwork supports high quality and is needed they inform the prescriber and make appropriate changes might safe care, patient satisfaction, and engagement. The proposed model reduce morbidity and mortality rates. Contrary to this, in Pakistan, the and literature suggest that having clinical pharmacists in healthcare role of clinical pharmacists in helping physicians while making decision settings can reduce the workload on physicians and GPs and they can on drug therapy, monitoring prescribed drug therapy, and solving drug- focus on their skills where they most needed. Besides, clinical pharmacist related problems and thereby; providing pharmaceutical care is neglected intervention reduces the rate of drug-related problems when patients or underestimated. In absence of these guidelines, the patients are admitted to the hospital through medication reconciliation and patient not getting the benefit of clinical pharmacy services, and drug-related readmission by education and proper follow-up care. problems are at an alarming stage. Acknowledgment: Reporting and monitoring ADRs are an essential part of activities We are thankful to our colleagues to address the attention to this issue. performing in healthcare settings. ADRs are unpleasant and harmful effects occur due to mediation errors. Several studies have found that majority of Author contributions the ADRs could be detected and prevented [11, 12]. Clinical pharmacists MAR and SA were engaged in reviewing the literature, writing, in hospitals play a vital role in the detection, identification, prevention, designing the model, and drafting the manuscript. SS and SMR were and proper management of ADRs [13]. Khalili H et al. addressed in their responsible for the conception and critical revision of the manuscript. study that clinical pharmacists’ intervention has resulted in increasing the number of reported ADRs [14]. A study from Iran conducted on clinical Funding pharmacy residents revealed that involving clinical pharmacy residents in None ADR reporting program could improve the ADR reporting system [15]. In another study from Iran reported that intervention of clinical pharmacists Conflict of interest regarding ADR committees’ establishment in hospitals resulted in an improved output of the Pharmacovigilance system [16]. None
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