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Published on 1 July 2006

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Database for pharmacist clinical interventions

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JF Rangel Mayoral*
PharmD

J Luis Fernández**

FJ Liso Rubio*
PharmD
*Pharmacy Department
Hospital Infanta Cristina
Badajoz
**Pharmacy Department
Hospital de Mérida
Mérida
Spain
E:juanfrancisco.rangel@hifc.ses.juntaex.es

When hospital pharmacists interact with patients, they perform a clinical function. Registering pharmacists’ activities, both quantitatively and qualitatively, would allow an analysis of these interventions, emphasising critical points and taking corrective measures if necessary, in order to help improve the quality of patient care.(1,2)

Hospital pharmacists work in two different areas: central pharmacy and wards. It is important to minimise the differences between these two groups so that both are able to develop a clinical function directed at the patient. In order to achieve this, it is necessary to provide pharmacists with the tools to register their activities, regardless of the place where they develop them. Personal digital assistants (PDAs) are the perfect tool for data register on wards. They also have a consultative value,(3,4) with software being available to check for adverse drug reactions, drug interactions,(5) drug use review (DUR) and antibiotic management programmes,(6) as well as for registering and justifying clinical activity.(7–14)

Furthermore, it is also possible to work with intervention databases in the central pharmacy.(15) Thus, it is necessary to create a connection between both tools, so that they can be synchronised to integrate information. This would allow a combined analysis of the data. The objective is to design a computer program for registering and analysing clinical interventions.

Discussion
A computer program was designed (see Figure 1) with the Microsoft Access(™) Database Manager. The demographic, clinical and pharmacological variables are displayed in Figure 1. We developed a pharmaceutical intervention ranking (see Table 1) based mainly on the intervention types of the pharmacy department of Massachusetts Memorial Medical Center of Worcester (MA, USA). This program was inserted in a Central Server Unix open to all pharmacy services computers through the intranet. The program contains a general form that gives access to data, queries and reports, with a possibility to send this information to the wards.

[[HPE27_fig1_24]]

[[HPE27_table1_25]]

Furthermore, a computer program was designed with the HandBase Desktop Professional v3.0 for Pocket PC database, although there is also a version for Palm OS. This program exports the data to applications such as Microsoft Excel(™), Access(™) and Word(™), through files with extensions .csv, .xml and .html. Synchronisation of the PDA with the computer generates an automatic update of the data in the personal computer (PC). The information coming from the PDA is integrated into the intervention program through an added data query. Several types of computer programs were incorporated into the PDA (Vademecum [Epocrates] Hospital Formulary [available online in intranet], medical calculators [Archimedes PPC; Softonic], diagnostic programs [STAT Hypertension; STATcoder/miniMSE; Tucows], clinical guidelines [see Resources] and other utilities [from CalorieKing, GlucoControl, etc]).

Activities were registered by two pharmacy practice residents in the Internal Medicine Department for 15 months, with 169 patients included in the study. Main reasons for admission were: respiratory infection, chronic obstructive pulmonary disease (COPD), respiratory failure, chronic heart failure, stroke and community-acquired pneumonia. Total number of clinical interventions by pharmacists was 431. Intervention distribution is showed in Table 1. The physician’s satisfaction level was 93.97%.

The use of computer programs for data register allows measurement of the economic efficiency of pharmaceutical interventions.(12,16) It is necessary to use standardised intervention types to compare the different activities.(15)

Conclusion
We used a decentralised computer program to measure pharmacist activity inside (at the central pharmacy) and outside (on the wards) the pharmacy department. Intermediate analysis was possible using the program, allowing us to make corrections. Pharmacists should develop their clinical skills to improve the quality of patient care, regardless of the place where they develop their activity (ie, central pharmacy or wards). It would now be useful to establish standardised intervention types in order to facilitate activity comparisons between different pharmacy services.

Acknowledgement
We would like to thank warmly the Pharmacy Department of University Massachusetts Memorial Medical Center of Worcester (MA, USA)

References

  1. Farré R, Clopes A, Sala ML, et al. Intervenciones farmacéuticas (parte I): metodología y evaluación. Farm Hosp 2000;24:136-44.
  2. Clopes A, Castro I, Sala ML, et al. Intervenciones farmacéuticas (parte II): validación de la metodología utilizada para medir el impacto. Farm Hosp 2000;24:215-20.
  3. McCreadie SR, Stevenson JG, Sweet BV, Kramer M. Using personal digital assistants to access drug information. Am J Health-Syst Pharm 2002;59:1340-3.
  4. Cimino JJ, Bakken S. Personal digital educators. N Engl J Med 2005;352:860-2.
  5. Barrons R. Evaluation of personal digital assistant software for drug interactions. Am J Health-Syst Pharm 2004;61:380-5.
  6. Evans RS, Pestotnik SL, Classen DC, et al. A computer-assisted ­management program for antibiotics and other antiinfective agents. N Engl J Med 1998;338:232-8.
  7. Brody JA, Camamo JM, Maloney ME. Implementing a personal digital assistant to document clinical ­interventions by pharmacy residents. Am J Health-Syst Pharm 2001;58:1520-2.
  8. Raybardhan S, Balen RM, Partovi N, Loewen P, Liu G, Jewesson PJ. Documentation drug-related problems with personal digital assistants in a multisite health system. Am J Health-Syst Pharm 2005;62(17):1782-7.
  9. Carroll AE, Tarczy-Hornoch P, O’Reilly E, Christakis DA. The effect of point-of-care personal ­digital ­assistant use on resident ­documentation ­discrepancies. Pediatrics 2004;113(3):450-4.
  10. Chan SSM, Chu CPW, Cheng BCP, Chen PP. Data management using the personal digital assistant in an acute pain service. Anaesth Intensive Care 2004;32(1):81-6.
  11. Ling JM, Mike LA, Rubin J, et al. Documentation of pharmacist interventions in the emergency department. Am J Health-Syst Pharm 2005;62:1793-7.
  12. Silva MA, Tataronis GR, Maas B. Using personal digital assistants to document pharmacist cognitive services and estimate potential reimbursement. Am J Health-Syst Pharm 2003;60:911-5.
  13. Clark JS, Klauck JA. Recording pharmacists’ interventions with a personal digital assistant. Am J Health-Syst Pharm 2003;60:1772-4.
  14. Lynx DH, Brockmiller HR, Connelly RT, Crawford SY. Use of a PDA-based pharmacist ­intervention system. Am J Health-Syst Pharm 2003;60:2341-4.
  15. Simonian AI. Documenting pharmacist interventions on an intranet. Am J Health-Syst Pharm 2003;60(2):151-5.
  16. Sayles TJ. Documentation of pharmacists’ interventions and associated cost savings. Am J Health- Syst Pharm 2004;61(8):838, 840.

Resources
Clinical Practice Guidelines and Protocols in British Columbia
W:www.healthservices.gov.bc.ca/msp/protoguides/
ABX Guide (Johns Hopkins)
W:hopkins-abxguide.org/
Bayer Critical Care Guide
W:www.pdacortex.com/Bayer_Critical_Care_Guide_Download.htm



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