Suzuki S*, Yoshino N, Koike T, Mochizuki N, Ohta T, Hisamatsui D, Takeno M, Shinohara A, Ouchi H, Ikegawa K, Saito S and Yamaguchi M
Department of Pharmacy, National Cancer Center Hospital East, National Research and Development Agency, Japan
Received date: July 25, 2016; Accepted date: August 10, 2016; Published date: August 15, 2016
Citation: Suzuki S, Yoshino N, Koike T, Mochizuki N, Ohta T, et al. (2016) Places to Managing Medicines Patients Brought in Hospital: Which is Better Central Pharmacy or Hospital Wards? J Community Med Health Educ 6:460. doi:10.4172/2161-0711.1000460
Copyright: © 2016 Suzuki S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Background: Checking patients brought in medicine (CPBM) service in a hospital is one of the core service in the pharmacy division. At the National Cancer Center Hospital East, pharmacists performed the service in a central pharmacy, however, it has changed the working place, from the central pharmacy to hospital wards, since it was criticized that patients had long waiting time for CPBM. According to the change of working place, ward pharmacists check the medicines in a ward from February 5th 2015, compared that pharmacists checked the medicine in the central pharmacy in the past.
Objective: We evaluated benefits of change locations from the central pharmacy to hospital wards to check medicines brought to hospital by inpatients.
Methods: We conducted retrospective analysis of pharmacists' records of medicines brought to a hospital. We made two groups, central pharmacy group (CG) which pharmacists who worked in a dispensing room worked for the service in the central pharmacy from January 7th 2015 to February 4th 2015 and ward pharmacy group (WG) which ward pharmacists worked for the service in the ward from February 5th 2015 to March 5th 2015.
Results: There were 836 cases in WG and 836 cases in CG, respectively. There is no difference in patient demographics between WG and CG. The rate of CPBM was higher in WG [87% (724/836)] than in CG [72% (606/836)] (p<0.001). Average (± SD) time of the service, from start to double check, was shorter in WG [53 minutes (± 38)] than in CG [126 minutes (± 60)] (p<0.001). Pharmacists' interventions according to the check was higher in WG [32% (264/836)] than in CG [14% (121/836)] (p<0.001). Check for narcotic medicines was 15% (127/836) in WG and 0% in CG.
Conclusion: The change of service location does not only reduce patients' waiting time but also enhance clinical pharmacy service in inpatient.
Ward pharmacist; Clinical pharmacy; Pharmacy service; Patients' brought in medicines; Multidisciplinary medicine
In a hospital, pharmacy services have a range of responsibilities for patients’ treatment in various fields and those pharmacy services related to patients’ outcome [1,2]. Since 2012, allocation of pharmacists in every hospital ward on medical safety managing medicines achieve health reimbursement fee in Japan, role of pharmacists in a hospital ward has been developed dramatically . Checking and managing patients brought in medicine (CPBM) is one of the core service in pharmacy division [3,4]. At the National Cancer Center Hospital East (NCCHE), pharmacists performed the service in a central pharmacy, however, it has changed the working place, from central pharmacy to hospital wards, since it was criticized that patients had long waiting time for the CPBM service. The central pharmacy was in the first floor and its counter did not have enough space to perform the CPBM service and it caused long line of inpatients, moreover, there was no seats for patients and therefore patients have to stand during the CPBM service. To solve the problem, we decided to change the location of the CPBM service from the pharmacy counter to a ward due to limited place of the pharmacy counter. According to the change of working place, ward pharmacists see patients in a patient room and check the medicines in a ward from February 5th 2015, compared that pharmacists see patients on a pharmacy counter and check the medicine in a dispensing room in the past. Even though there were reports that oncology pharmacists contributed for cancer treatment [5-7] and CPBM [3,4,8,9] was beneficial for hospitalized patients, no data has been reported on the effects of the workplace of the service.
We evaluated benefits of change locations from central pharmacy to hospital wards to check medicines brought to hospital by inpatients.
Study design and data sources
We conducted retrospective analysis of pharmacists’ records of medicines brought to hospital January 7th to March 5th 2015. Subjects were identified from a computer-generated list from the electric patients’ record database system. We made two groups, central pharmacy group (CG) which pharmacists who worked in dispensing room worked for the service in the central pharmacy from January 7th 2015 to February 4th 2015 and ward pharmacy group (WG) which ward pharmacists worked for the service in a ward from February 5th 2015 to March 5th 2015. We compared the two groups for 20 business days in each group (Figure 1).
The NCCHE is the national research center hospital and one of the largest cancer treatment hospitals in Japan, which has 425 beds, total ten hospital wards, number of inpatients was from 800 to 900 per month, number of pharmacists was about 50 and number of ward pharmacists was nine.
Bivariate analyses were employed to examine differences in the background characteristics of the hospitals, using t-tests for continuous variables and chi-square tests for categorical variables. All data were analyzed using SPSS version 22.0 (SPSS Inc., Chicago, IL). A p-value of <0.05 was considered statistically significant.
There were 836 cases in WG and 836 cases in CG, respectively. There were no statistical differences in number of patients in each hospital ward and diagnosis and treatment department between two groups (Table 1).
|Palliative care unit||22||3%||30||4%||n.s.|
|Diagnosis and treatment department|
|Hepatobiliary and Pancreatic Surgery||24||3%||29||3%||n.s.|
|Hepatobiliary and Pancreatic Oncology||112||13%||114||14%||n.s.|
|Plastic and Reconstructive Surgery||1||0.1%||1||0.1%||n.s.|
|Head and Neck Surgery||44||5%||49||6%||n.s.|
|Head and Neck Medical Oncology||30||4%||44||5%||n.s.|
|Breast and Medical Oncology||38||5%||34||4%||n.s.|
|n.s: no signisicant by Chi-squared test and Fisher’s exact probability test|
Table 1: Patients’ characteristics.
Rates of CPBM service
The rate of CPBM service was higher in WG [87% (724/836)] than in CG [72% (606/836)] (p<0.001). Of 836 inpatients in WG, 112 patients (13%) did not have brought in medicine and 110 patients (13%) were emergency hospital admission patients, however, we did not find the reasons of missing 230 patients in CG.
Time required for CPBM service
Average (± SD) time of the service, from start to double check, was shorter in WG [53 minutes (± 38)] than in CG [126 minutes (± 60)] (p<0.001). Median [range] time of the service, from start to double check, was 46 minutes [2-300] in WG and 121 minutes [6-305] in CG.
Pharmacy intervention through CPBM service
Pharmacists’ interventions according to the check was higher in WG [32% (264/836)] than in CG [14% (121/836)] (p<0.001). Fifteen percent of inpatient of WG (127/836) had narcotic medicines and ward pharmacists timely controlled and registered of the narcotic medicines in a ward compare that CG had no timely management for the medicine in a ward and nurses had to bring the narcotic medicine to pharmacy dispensing room to ask double check and register the medicine. Of the 15% patients, average and median number of narcotic drugs was 1.8 and 2.0, respectively (Table 2).
|Rate of CPBM||723||86%||606||72%||p<0.001*|
|Did not do CPBM||0||0%||230||28%||ã|
|Patients who did not have medicine||113||14%||n.a.||ã||ã|
|Admissions after office hours||110||13%||n.a.||ã||ã|
|Time required CPBM service [minutes]||ã||ã||ã|
|Pharmacy intervention through CPBM service||264||37%||121||20%||p<0.001**|
|n.a.: no available; *Chi-squared test; **Student t-test|
Table 2: Comparison between CG and WG.
This study clarified the change location for CPBM service from central pharmacy dispensing room to a hospital ward enhanced the service and ward pharmacy interventions. It is obvious that patients waiting time was zero in WG because pharmacists went to patients’ room to receive their brought in medicines. In addition, time required for CPBM was decreased by half and the rate of the services was increased after the improvement of business operations. It was surprised that 200 cases in the CG was not performed CPBM service. From the WG data, about 100 cases might not have their medicine to a hospital, however, the CG would not check emergency hospital admission cases or patients who did not want to visit pharmacy counter. Compared to the CG, the WG checked all cases because a ward pharmacists work in a ward with nurses and doctors. Without pharmacists’ CPBM, nurses have to check the medicine, however, there was a report that pharmacists’ CPBM was superior to nurses . The benefit of ward pharmacy services have been reported [3,11,12] and the CPBM is beneficial for patients’ care in a hospital [3,4,8]. The CPBM service is basic evaluation of inpatients and the information relates to following patients’ treatment. For example, Imai et al., reported that the service prevents potential adverse drug reactions  and Horiuchi et al., reported that screening of cancellation medicine before operation at medicine support center . The CPBM is necessary to evaluate patients’ pharmacotherapy and pharmacists could work for the risk management using STOPP criteria [14-16]. In the NCCHE, pharmacists do not use STOPP criteria  for inpatient intervention, however, the change of work setting was associated with a twofold increase in pharmacy interventions for patients’ treatment. The incidence that patients had narcotic medicines was 15%. Apparently, these controlled medicines should be checked and registered by pharmacists, and the improvement of service enabled pharmacists that they promptly manage for patients’ brought in narcotic medicines in a ward. There were study limitations that we did not measure number of pharmacists who worked for CPBM service in the CG. In the CG, four or three pharmacists and two ward pharmacists supported the service. In the WG, nine pharmacists worked at least four hours in a ward. So, there might be more manpower in WG, compared to CG. Number of pharmacists who involved for the CBPM is not possible to compare between WG and CG due to complicated work shift. Pharmacists in CG work for dispensing service in central pharmacy and ward pharmacists in WG work for clinical role, such as medication counseling and review of treatment and doctors’ prescriptions. Working style and efficiency for clinical interventions, including CBPM, is different between WG and CG. It could be major reason causing the observed differences. Even though we randomly chose subjects who admitted to a hospital January 7th to March 5th 2015, there were no significant difference in patients’ characteristics, such as the diagnosis and treatment, between WG and CG. Our results showed benefits of CBPM by ward pharmacists in a ward from relatively reliable and adequate populations.
The survey clarified that the change of service location does not only reduce patients’ waiting time but also enhance the CPBM and following clinical pharmacy services in inpatient.
The study was approved by the Institutional Review Board of the National Cancer Center (Approval# 2015-228) and was conducted in accordance with all applicable ethical standards.
The authors wish to thank the National Cancer Center Hospital East and members of its staff and family members for supporting the study.