On occasion, only one clinical pharmacy specialist is available to cover both of the ICU care teams. Reasons for this situation include illness, attendance at meetings, teaching sessions at the Faculty of Pharmaceutical Sciences, or other situations when back-filling cannot be provided. The CPST can minimize the impact of reduced pharmacist coverage in the ICU by helping the remaining pharmacist to triage and deal with issues for the other ICU team. The CPST liaises with the covering clinical pharmacy specialist and discusses issues that might be expected to arise during the day, including pending results for serum drug concentrations, critical laboratory values, pharmacy consults, new admissions, transfers, and any clinical issues brought up by the pharmacy dispensary staff. The CPST updates the patient monitoring and therapeutic drug monitoring forms for all patients as usual, thus ensuring that the covering pharmacist has all the information needed for effective troubleshooting. All of these activities are performed in collaboration with the covering clinical pharmacy specialist.
Several large projects undertaken recently at the Royal Columbian Hospital have involved the CPST. The ICU recently moved to a new location, and the CPSTs were in charge of organizing the drug-distribution system in the new unit and transferring ward stock, narcotics, and patient-specific drugs during the move. Having the CPSTs take charge of the move allowed the clinical pharmacy specialists to continue focusing on their patient care duties.
Another project with which the CPSTs were involved at the time of writing was the roll-out of the computer-generated medication administration record (MAR) in the ICU. Various meetings were held to plan the logistics of this initiative and to discuss potential issues with the nursing staff, and in this regard the CPSTs have been the main liaison between the nursing staff and pharmacy department. In addition, the CPSTs have been responsible for many of the prerequisite background tasks related to the information system, such as entering preprogrammed order sets and evaluating the format of the MAR. Any issues related to generation and formatting of the MAR that have arisen because of the change in process are now reviewed and solved by the CPST liaison.
BENEFITS OF THE CPST PROGRAM
The primary benefit anticipated from any CPST program is an increase in the ability to provide comprehensive pharmaceutical care. A multifacility health care system in Pittsburgh evaluated its clinical technician program in terms of the number of patients assessed in a day and the number of interventions performed by a pharmacist toward targeted initiatives. After 2 years, the investigators observed a 3-fold increase in the number of patients seen in a day (from 23 to more than 90 patients). In addition, the satisfaction of both pharmacists and pharmacy technicians increased, which was attributed to improvements in efficiency and expanded scope of clinical services. Viagra Professional
Incorporating a CPST program in the delivery of direct patient care in an adult tertiary-level ICU can improve pharmacists’ work efficiency in a number of ways, as exemplified by the program described here. First, the clinical pharmacy specialists were able to increase the number of comprehensive patient assessments per day. Initially, each pharmacist had to assess 13 patients within the 2-h period before patient care rounds. This was challenging, because an experienced pharmacist needs about 15 min to perform a standard comprehensive assessment for each patient. As such, each clinical pharmacy specialist typically completed a full assessment for only 8 patients before patient care rounds. After initiation of the CPST program, the time spent for data collection by the pharmacist was reduced by about 5 min per patient, and the clinical pharmacy specialists increased to 12 the number of comprehensive assessments they could perform in the time available.
Second, the clinical pharmacy specialist could spend more time performing cognitive-based activities throughout the day, with minimal time used for data collection. The CPST assisted the pharmacists in technical functions such as data collection, patient triage, ward-based troubleshooting, student orientation, and various projects. The main impact has been evident in the morning, when there is typically limited time to assess patients before multidisciplinary patient care rounds. There have also been fewer interruptions during patient care rounds, since the CPST can solve drug-related issues that do not require input from a pharmacist.
Third, assistance from the CPST for data collection in the morning allows the clinical pharmacy specialists to start their shifts later. Before initiation of the CPST program, the clinical pharmacy specialists arrived at 0700 in the morning to perform detailed patient assessments, including collection of data. If patient care rounds extended late into the afternoon, the pharmacists would have to stay later. It is valuable to have the clinical pharmacy specialist stay for all patient care rounds, to allow them to provide prospective input into decisions about patient care and to ensure that appropriate decisions are made about drug therapy, but this meant extended work hours for the pharmacists. Once the CPST took over data collection activities in the morning, the pharmacists were able to start later, and their work hours became more compatible with situations in which rounds extend late into the afternoon. Furthermore, the CPST can free up time for the clinical pharmacy specialist in the afternoon to perform other patient care-related activities. Overall, this leads to a reduction in overtime worked by the clinical pharmacy specialist. canadian antibiotics
Finally, when clinical pharmacy coverage in the ICU is reduced, the CPST helps the remaining pharmacist to manage the workload. Information for all ICU patients is up to date, and less time is required to collect data for patients under the care of the other multidisciplinary team.
All of these benefits became apparent through a comparison of the periods before and after initiation of the CPST program. We continue to monitor the impact of the program as it evolves.