ABSTRACT
Background: During the first wave of the COVID-19 pandemic, an increased need for critical care pharmacist (CCP) coverage in the two medical/surgical intensive care units (ICUs) at the Queen Elizabeth II Health Sciences Centre (QEII HSC) in Halifax, Nova Scotia was identified. Description: CCP coverage was expanded in two medical/surgical ICUs from 8 hours per day, 5 days per week excluding holidays to 8 hours per day, 7 days per week including holidays. Action: Workflow within the pharmacy department was rearranged so that two CCPs, on a rotating schedule, provided dedicated clinical coverage to each ICU seven days a week. CCPs were not responsible for dispensary coverage during this time period. Evaluation: A 22 question survey was developed by the research team and distributed to all health care providers (HCP) who work in the medical/surgical ICUs. Survey questions solicited HCP perceptions and opinions on the impact of expanded CCP coverage;importance of 25 evidenceinformed CCP activities was assessed via 5-point Likert scale. Clinical pharmacist output, reported as the number of drug-therapy problems (DTPs) addressed over a 6-week period, was retrospectively evaluated. The majority of respondents agreed/strongly agreed with the following: CCP are integral members of the multidisciplinary healthcare team, CCP play an important role in improving patient outcomes, CCP presence in the unit and on patient care rounds allows HCP to concentrate on their own professional responsibilities, and that the expanded CCP coverage improved patient care. The majority of respondents categorized 23 of the 25 CCP activities as very important. During the 6-week time period, four CCPs addressed 798 DTPs for 140 discreet patients: an average of 5.7 DTPs per patient. Implications: HCPs felt that expanded CCP coverage improved patient care and that evidence-informed CCP activities were very important. Given the perceived impact of CCP in the ICU, novel staffing models are being explored to optimize CCP coverage.
ABSTRACT
Background: At the beginning of the COVID-19 pandemic, it was predicted that hospitals would accommodate both a high volume of COVID-19-related patient admissions as well as frequent patient transitions of care, including discharge. Effective communication between healthcare providers during transitions of care is crucial for promoting patient safety and continuity of care. Description: A mnemonic-based electronic handover tool was created to facilitate streamlined communication between clinical pharmacists caring for patients hospitalized with COVID-19. Action: The COVID Handover Tool was developed, refined, and implemented by clinical pharmacists working in COVID-19 care areas in early 2020. The tool provided a standardized template to communicate basic patient information and pharmaceutical care issues. The patient-specific handover tools were stored centrally using OneNote™, and shared for updating amongst pharmacists as patients transitioned between COVID-19 care areas (e.g., intensive to acute care). Evaluation: Pharmacists were surveyed to assess the tool's ease of use, perceived usefulness, and other subthemes. All eight clinical pharmacists working in COVID-19 care areas responded to the survey (100% response rate). The majority of respondents agreed or strongly agreed it was easy to learn to use the tool, and that the content was relevant and organized. Half agreed or strongly agreed that the tool made handover easier, quicker, and more effective. Responses trended towards neutrality regarding the tool being useful in respondents' jobs. Most pharmacists continued using previous handover methods in addition to or instead of the tool. Implications: Survey responses suggest the COVID Handover Tool is intuitive, and facilitated organized and efficient patient handover between clinical pharmacists. Pharmacist perceived usefulness during the study period was mixed, and the tool has been updated further based on feedback. The tool is adaptable to any patient care area or population, and may be useful to other institutions for patient handover between clinical pharmacists.