Development of a framework to support the evaluation of Emergency Department Pharmacist Practitioners’ impact on quality of care

Introduction: Emergency department pharmacist practitioners (EDPPs) provide both traditional pharmaceutical care and novel practitioner care, that is clinical examination,[1] yet their impact on quality of care is unknown.

Aim: This study aimed to develop an EDPP quality evaluation framework and identify a priority outcome for evaluation.

Methods: First, five databases were searched (no date limits) using three search terms limited to title/topic/abstract: ‘emergency department’ AND ‘structure, process and outcome’ AND ‘pharmacist’, with 52 synonyms. Extracted from relevant papers, outcomes and outcome indicators were categorised into 6 Institute of Medicine quality domains, and their related structures and processes grouped by similarity. Then, framework components from current practice were obtained through 2 expert panels. The first was with 6 EDPPs, for outcomes (with 5 to be prioritised for future evaluation), outcome indicators and related processes. The second was with 5 healthcare professionals from 4 professions (only outcome indicators sought). Data sources that could support indicator measurement were also collected in both meetings. Data from the review and panel meetings were collated and processed, for example language modified to ensure relevance to a UK setting.

Results: From 33/432 relevant papers and expert input respectively, the framework has 72 outcomes (literature = 27, EDPP panel = 45); 399 outcome indicators (literature = 54, EDPP panel = 181, multidisciplinary panel = 164); 424 related processes; and 178 structures. Outcomes and outcome indicators related to all 6 quality domains: safe (13 outcomes, 44 outcome indicators); effective (26, 93); patient centred (7, 24); timely (15, 38); efficient (8, 25); and equitable (6, 20). Only 3/6 EDPPs prioritised outcomes with ‘prescribing errors’ in first place, and possible indicators being ‘number of interventions made for pharmacist prescriptions’ (quantitative) and ‘how prescribing errors were resolved’ (qualitative). Generally, across all outcomes, indicators suggested by experts were vague and more closely resembled themes rather than indicators that could be measured. Data sources proposed were from the hospital, for example incident reports, but also from primary care, for example general practitioner appointment records, to evaluate events after discharge. Few outcomes were identified for ‘patient‐centred’ and ‘equitable’ domains, which could be increased with patient input. Few outcomes were also related to ‘efficient’ care, possibly due to this study's focus on the NHS where costs are rarely imposed on individual patients.

Conclusion: A framework that can support the structured and comprehensive evaluation of the quality of care provided by EDPPs has been developed. Organised into quality domains with indicators categorised, and with related structures and processes included, the framework also supports more focused evaluation. It is also independent of any study design and therefore can be used to evaluate the impact of any ED pharmacist using any method. Prior to their use in a specific setting, outcome indicators should be clearly defined, and some suggested by experts require further development. As EDPP services vary,[1] outcomes could be prioritised locally with broad stakeholder input to ensure the results of any evaluation are relevant and therefore useful.

Reference

1. Greenwood D, Tully M, Martin S, Steinke D. Emergency Department Pharmacist Practitioners: A new role in the NHS. Research in Social and Administrative Pharmacy. 2018;14(8):e30.