Redesigning the clinical pharmacy practice model at a psychiatric hospital

Abstract

Introduction: Integrated, patient-centered clinical pharmacy services have been shown to improve patient outcomes in a variety of settings, including mental health. In this article, we describe and report the impact of a restructured clinical practice model that incorporated direct patient care by pharmacists implemented at a psychiatric facility in Edmonton, Canada. The purpose of redesigning the clinical pharmacy program was to deliver proactive pharmacist care through integrated clinical pharmacy services and to better align pharmacists' activities with those that have been reported to have a positive impact on patient outcomes. Methods: Pharmacists' documentation notes in medical records for patients admitted and discharged from the hospital at four different time periods were reviewed. For each time period, the number, type, and documentation rate were measured and compared using a Student t test with correction for unequal variances. Significant change was defined as P,.05. Documentation rates were also compared for short-stay versus long-stay patients. Results: A consistent and statistically significant increase was found in pharmacists' clinical notes per chart from 0.15 to 1.5 (P,.001) after implementation of the redesigned clinical practice model. The proportion of clinical notes also increased from 22% in the preimplementation period to up to 68% in the current period. This indicates that pharmacists were spending proportionally more time on proactive versus reactive care. Documentation rates also increased regardless of the patients' length of stay. Discussion: The redesigned clinical practice model enabled a successful transition of the pharmacists' role, from being predominantly reactive to becoming more proactive and integrated.