Impacts from the Implementation of a Novel Clinical Pharmacist Training Program
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US C Fam Med Com Health: first published as 10.15212/FMCH.2017.0142 on 1 May 2018. Downloaded from Family Medicine and Community Health CHINA FO CHINA CHINA FOCUS Impacts from the implementation of a Novel Clinical Pharmacist Training Program in Changsha, Hunan Province, China Ping Xu1, Da Xiong Xiang1, Andrew J. Cave2, Hoan Linh Banh2 Abstract 1. Department of Pharmacy, The Ministry of Health and Family Planning of the People’s Republic of China issued a man- The Second Xiangya Hospital date to all hospitals to implement clinical pharmacy services by 2020. Implementation of clinical of Central South University, pharmacy services to provide pharmaceutical care is a priority. The Second Xiangya Hospital of No 139 Middle Renmin Road, Central South University in collaboration with the University of Alberta implemented a structured Changsha, Hunan, China 2. Department of Family train-the-trainer program to train pharmacists to provide direct patient care in collaboration with Medicine, Faculty of Medicine physicians, to teach/mentor other pharmacists and students from Hunan province, and to conduct and Dentistry, University of clinical pharmacy research. Following implementation of the program, the pharmacy department Alberta, Edmonton, Alberta, increased the number of clinical pharmacists, expanded the clinical pharmacy services, made Canada; and 6-10 University changes to hospital policies, and received a financial award of five million renminbi (one million Terrace, University of Alberta, Canadian dollars) to support the department. Edmonton, AB T6G 2T4, Canada Significant statement: This is the first clinical pharmacy train-the-trainer program in China CORRESPONDING AUTHORS: in collaboration with a university in Canada teaching clinical pharmacists how to provide direct Ping Xu patient care and to conduct clinical research. The program was well accepted by the hospital staff Department of Pharmacy, The http://fmch.bmj.com/ and administration. As a result of the changes implemented, the hospital was ranked as having the Second Xiangya Hospital of Central South University, No third best clinical pharmacy department in China. 139 Middle Renmin Road, Changsha 410011, Hunan, China Keywords: Clinical pharmacy; pharmaceutical care; pharmacy practice in China; hospital E-mail: [email protected] pharmacy; training program; pharmacy practice; China Hoan Linh Banh on September 26, 2021 by guest. Protected copyright. Department of Family Medicine, Faculty of Medicine and Dentistry, University of Background for pharmacists to receive clinical pharmacy Alberta, Edmonton, Alberta, The Ministry of Health and Family Planning of training overseas, most found it difficult to Canada; and 6-10 University the People’s Republic of China issued a mandate implement clinical pharmacy services back Terrace, University of Alberta, Edmonton, AB T6G 2T4, to all hospitals to implement clinical pharmacy in China because of the enormous differences Canada between the health care systems. services by 2020 [1]. The mandate requires all E-mail: [email protected] secondary hospitals to employ at least three The Second Xiangya Hospital of Central full-time clinical pharmacists and all tertiary South University (SXHCSU) is one of the Received 14 August 2017; hospital to employ at least five full-time clinical top tertiary hospitals located in Changsha, Accepted 28 September 2017 pharmacists. They are to provide clinical phar- Hunan, China. It has 5000 beds and serves macy services to all patients. While the gov- on average 100,000 inpatients and more than ernment of China has been providing support two million outpatients a year. One of the 89 Family Medicine and Community Health 2018;6(2):89–92 www.fmch-journal.org DOI 10.15212/FMCH.2017.0142 © 2018 Family Medicine and Community Health. Creative Commons Attribution-NonCommercial 4.0 International License CHINA FO CHINA Fam Med Com Health: first published as 10.15212/FMCH.2017.0142 on 1 May 2018. Downloaded from C Impacts from the implementation of a Novel Clinical Pharmacist Training Program US unique features of the teaching hospitals in China is the rela- problems, resolving drug-related problems, preventing poten- tionship with the universities. Among more than 3000 health tial drug-related problems, and monitoring drugs for efficacy care professionals, SXHCSU has more than 600 professors or and toxicity. They are able to assess and manage other medical associate professors with a joint appointment or with a teach- conditions above and beyond providing consultations for use ing commitment with Central South University. of antibiotics. In addition, the clinical pharmacists learned to Like all leading tertiary hospitals in China, SXHCSU is address clinical policies that may not offer benefits to patients exploring opportunities to implement a clinical pharmacy or may impede the clinical outcomes of patients. For instance, service to provide pharmaceutical care. Currently the phar- the hospital has a very high rate of false negative culture macy dispenses about 10,000 prescriptions for outpatients results. This made appropriate antibiotic selections very dif- and more than 5000 prescriptions for inpatients in the hos- ficult. One of the clinical pharmacists investigated the cause pital each day. There are more than 100 staff pharmacists, for the high rate of false negative culture results. The reason 15 clinical pharmacists, and more than 30 pharmacy techni- is that the specimens do not reach the laboratory in the time cians in the pharmacy department. Most of the clinical phar- recommended by the Center for Disease Control. On average, macists have a doctor of philosophy degree in pharmacology it took the specimens two to three times longer than recom- or pharmaceutical sciences. Hence these pharmacists con- mended to be delivered to the laboratory. The department will tinue to conduct research in the laboratory. However, some present the findings to the leaders of the hospital in the hope of of these pharmacists have spent 6–12 months in hospitals changing the policy on specimen delivery methods. in North America to gain some understanding of clinical Currently, the department is attempting to minimize non- pharmacy services. In 2013 the Director of Pharmacy of steroidal anti-inflammatory drug (NSAID)-induced renal SXHCSU was invited to the University of Alberta as a visit- insufficiency in perioperative patients. Because of the stigma ing professor. During his visit to Edmonton, he and a fac- and fear of opium and narcotic addiction, there is a reluc- ulty member from the University of Alberta initiated a col- tance to use opioids for pain control in perioperative patients. laboration to assist SXHCSU in implementing a structured The clinical pharmacy leader identified and completed a http://fmch.bmj.com/ train-the-trainer program between April 2015 and May 2017 patient record review. The results will be presented to the [2]. The goals of the program were to train pharmacists to leaders of the hospital and eventually published. The goal provide direct patient care in collaboration with physicians, is to encourage the hospital leaders to change the policy for to teach/mentor other pharmacists and students from Hunan opioid use in perioperative pain control and thus reduce the province about clinical pharmacy, and to conduct clinical use of NSAIDs. pharmacy research. Beginning in January 2016 the department began to docu- on September 26, 2021 by guest. Protected copyright. ment clinical pharmacists’ workload on a daily basis. Each Impacts from the train-the-trainer program clinical pharmacist documents his or her daily clinical inter- Practice of patient care ventions and the time spent on each intervention. The depart- Since 2015 the clinical pharmacy department at SXHCSU ment will use the data from the workload documentation for has gained four additional clinical pharmacists in geriatrics, quality assurance and will also present them to the leaders oncology, intensive care, and neurology. of the h ospital. Moreover, the department will use the docu- Before 2015 the clinical pharmacists were focused on the mentation data to support the addition of clinical pharmacists antibiotics consultation service, with only eight clinical phar- where needed. macists in the pharmacy department. Now the pharmacists are To foster continuous learning for the clinical pharmacists, able to care for patients in a holistic way. They are currently the department adopted “lunch and learn” sessions. Each providing comprehensive pharmaceutical care to the patients month, a clinical pharmacist presents a clinical topic to all in the h ospital. This includes taking patient history and medi- pharmacists and students during the lunch break. To date, the cation history, identifying actual and potential drug-related learning sessions have been well received. Family Medicine and Community Health 2018;6(2):89–92 90 US C Fam Med Com Health: first published as 10.15212/FMCH.2017.0142 on 1 May 2018. Downloaded from Xu et al. CHINA FO CHINA Education of other pharmacists projects have been completed, and two articles were published SXHSCU is one of the tertiary hospitals approved by the in 2017 [3, 4]. Through these research projects, the pharma- Ministry of Health and Family Planning to provide training cists learned to design and develop clinical studies. Also, the for clinical pharmacists throughout China. Each year, other results from the studies show that clinical pharmacists could secondary and tertiary hospitals assign pharmacists