Richard A. Hutchinson

An Eleven-Year Review of the Pharmacy Literature: Documentation of the Value and Acceptance of Clinical Pharmacy

The primary objectives of the article were accomplished by providing both a bibliography of articles dealing with clinical pharmacy services in acute-care facilities and summaries of those constituting original research reports on clinical pharmacy services. However, in the process, we made the following interesting observations. We found that articles reporting impacts on cost, quality, and attitude numbered 48, 58, and 24, respectively. Most articles relating to drug therapy monitoring, with minor exceptions, dealt with either the quality or cost-savings impact or a combination of both. Also, articles concerning drug therapy monitoring comprised almost half of all those summarized (40 articles). Articles detailing drug information and education (category 2) numbered 28 and dealt mainly with attitudes or quality impacts with minor reference to cost-savings. It was also interesting, albeit expected, to observe that the bulk of attitudinal studies fell in category 2. We found category 5, controlling medication administration, had 13 articles, primarily concerned with cost and or quality. Category 4, reporting and detection of adverse drug reactions, contained a total of eight articles mainly studying the impact on quality. The other categories contained very few, if any, articles. From these results, it is evident that the profession has made significant strides in building a strong scientific data base to support the value of its clinical services. However, there is ample room for additional original research reports. Although it can be argued that alone many of the studies could not justify clinical pharmacy as cost-effective, organized as one reference they provide an invaluable resource. Although it might be unreasonable to expect each pharmacy department to be able to cost-justify its existence, this work presents the background data needed to begin or develop such efforts.

Clinical pharmacy on-call program in the emergency department

This is a descriptive and evaluative report regarding a clinical pharmacy residency in-house on-call program that facilitates the provision of 24-hour clinical pharmacy consultative services within the emergency department. During the two-year evaluation period, clinical pharmacy residents completed 3.1 consultations per 14-hour call period. Additionally, greater than 90% of the clinical pharmacy recommendations were accepted and completely followed by physician cohorts. These consultations were usually solicited by internal medicine physicians within the emergency department, involved patient-specific drug therapy recommendations, and required about 100 minutes (mean per consultation) of the clinical pharmacists time. Thus, clinical pharmacy consultative services can be a useful addition to health care within the emergency department in teaching hospitals.

Evaluating the Performance of Clinical Pharmacy Faculty: Putting the ACCP Template to Use

The responsibilities of clinical faculty members are often multifaceted and may include direct patient care, didactic and experiential teaching, research, and administrative duties. Specialization, poorly defined standards of care, and lack of direct supervision have traditionally made performance evaluation difficult. We implemented a method to evaluate clinical faculty as they carried out patient care activities using a revised template for the evaluation of a clinical pharmacist developed by the American College of Clinical Pharmacy Clinical Practice Affairs Committee. In addition, it allows individuals to report and evaluate their own performance in the areas of patient care, instructional activity, university and public service, research and scholarly activities, and administrative duties. Teaching evaluations from clerkship students and residents are also submitted and assessed during the annual interview. To determine the usefulness of the evaluation, including the template, we surveyed the opinions of clinical faculty (nontenured) at four primary practice sites (response rate 92%). Mean scores for responses suggested agreement with statements as to the merits of the evaluation system; however, there was some variation among practice sites. Incorporating the template into a broad evaluation system was effective in facilitating improved job performance and career development. Adaptation of the template may be practice site dependent and should be coordinated by a participative approach. Additional assessment may be facilitated by physician, nurse, or peer evaluation.

A Model for Inpatient Clinical Pharmacy Practice and Reimbursement

The development and expansion of clinical pharmacy over the past 15 years have resulted in several debates. One debate that was very lively in the late 1970s concerned proper reimbursement for clinical pharmacy services. Although this debate is less heated now, its importance is even more significant with todays major changes in health care reimbursement. This article reviews the key reasons for the original debate and discusses how recent changes have increased and added direction to the debate. A model is presented that the authors believe represents the key to the increasing acceptance of the pharmacists clinical role.

Journal Club—A Method of Inservice Clinical Education for Pharmacists

the group should discuss the original article and decide whether the conclusion and study were valid. This type of journal club is probably the most uninteresting to pharmacists because it is a presentation of isolated facts that are difficult to relate to actual practice. However, it does allow the pharmacists to become familiar with the vast number of journals available and the type of articles appearing in each journal. If the main concern of the journal club is to organize material for a pharmacy newsletter, it is best to cover one drug or class of drugs at a time. Responsibility should be divided by assigning areas such as (1) clinical uses, (2) adverse effects and (3) clinical investigation of new drugs and dosage forms. If the information is to be used for compiling a newsletter, decide if it is to be a physicians newsletter or a nurses newsletter. The information should be geared to stress different points. The nurse is more interested in information that will improve her abilities to handle and administer drugs safely, while the physician is primarily interested in new clinical uses for drugs and information that will lead to safer utilization of the drug in relation to the disease. If, on the other hand, the main purpose is to educate your staff, it is usually best to base the journal club