Development of an Emergency Department Pharmacist Practitioner service specification

Research output: Contribution to conferencePosterpeer-review

Abstract

Background
Emergency Department Pharmacist Practitioners (EDPPs) undertake both ‘traditional’ clinical pharmacy work e.g. checking prescriptions for their clinical appropriateness, and ‘practitioner’ work e.g. perform clinical examinations and diagnose. A recent study found large variation in the extent and type of care provided1. Whilst variation allows services to be tailored to local needs, it is important that care meets the minimum standards expected of a quality healthcare system. These are safe, effective, patient-centred, timely, efficient and equitable2.

Objectives
To develop an EDPP service specification, primarily to support providers with delivery of high quality services.

Method
Development involved patients, EDPPs and other ED healthcare professionals and was guided by the Institute of Medicine’s quality domains2. A convenience sample of 6 EDPPs, with varied roles, were recruited to an expert panel held in March 2017. Using an adapted Nominal Group Technique, participants suggested ideas as to what constitutes high quality EDPP care. These were grouped into themes and rated twice on a 9-point Likert scale (9=absolutely used). Themes with strong group support (median final rating of 7-9) and a high level of agreement achieved consensus. Semi-structured recorded telephone interviews were undertaken with 8 patients who had been cared for by EDPPs as to their expectations of the service. Template analysis of transcripts identified additional themes that were mapped to each domain. The specification was iteratively drafted by adding patient themes to those agreed by EDPPs. Finally, a multidisciplinary expert panel of healthcare professionals and researchers reviewed and refined the service specification. Health Research Authority ethics approval was obtained.

Results
EDPPs developed 36 themes with consensus achieved for 25. Additional themes from the patient interviews concerned the communication and behaviour of EDPPs rather than specific clinical activities undertaken. Whilst patients were happy to be cared for by an EDPP working within their competence, for certain conditions (e.g. major trauma) they wanted a doctor as their main care provider. An evidence-based EDPP service specification of 52 criteria grouped into 4 categories was produced: direct patient care (29); other activities (including indirect patient care) (10); general approach (10); and service structures (3). Some criteria, which require specific clinical training, are indicated as optional to accommodate some local variation of service.

Conclusions
As the product of both patient and expert input, EDs could align existing or newly developed services to the specification. The designation of some criteria as optional should support implementation. Whether or not the specification can support provision of high quality services is yet to be investigated. Future research should aim to evaluate the quality of EDPP services actually delivered compared with the specification. Further, patient outcomes should be measured to conclude the quality impact of EDPP services.

References
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.

2. Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press; 2001.
Original languageEnglish
Publication statusUnpublished - 2 Nov 2018
EventClinical Pharmacy Association Symposium - London
Duration: 2 Nov 20182 Nov 2018
http://hdl.handle.net/10454/16758

Conference

ConferenceClinical Pharmacy Association Symposium
CityLondon
Period2/11/182/11/18
Internet address

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