Assessing the Impact of an Expanded Scope of Practice for Pharmacists at a Community Hospital (oral presentation): Management and Leadership Best Practice Award, sponsored by Apotex Inc.

摘要

Introduction: Clinical pharmacists at Burnaby Hospital began including expanded scope of practice (ESP) activities in their practice on April 1, 2012. ESP activities that a pharmacist may perform without prior authorization from a prescriber include re-ordering chronic medications, initiating OTC medications, changing drug formulations, changing drugs within same therapeutic classes, and titrating medication doses. The objective of this study was to describe and assess the impact of ESP at Burnaby Hospital, in terms of ESP activities performed and their associated outcomes, and the experience of pharmacists and the impact of ESP on physicians after its implementation. Methods: All ESP activities by pharmacists required documentation in the patient health care record via a Clinical Pharmacy Note (CPN). CPNs were collected from April 1st to September 30th, 2012 and were reviewed. Physicians and participating pharmacists were surveyed to gather feedback on their experiences. Results: A total of 227 CPNs produced by 11 clinical pharmacists were reviewed. These CPNs documented 194 activities that met the inclusion criteria. Of 194 activities, 135 (69.6%) were titrating medication doses. The majority of the outcomes were deemed to enhance clinical outcomes of the patient (81.5%). All of eight pharmacists and fourteen physicians surveyed either agreed or strongly agreed that the implementation of ESP improved overall quality of comprehensive patient care. Discussion: There was a high percentage of ESPs that pharmacists have traditionally performed, such as vancomycin and phenytoin pharmacokinetic dosing, and renal dosing services as expected. Since ESP implementation, pharmacists also provided new services, such as re-ordering chronic medications, initiating OTC medications, changing medications within therapeutic class, and titrating various other medications. Conclusion: Hospital pharmacists integrated ESP activities into their clinical practice with relative ease. These activities resulted in improved patient-related clinical and humanistic outcomes, as well as decreased health-care costs.