Background

Hospital pharmacists play an essential role in patient care; however, a lack of resources means pharmacists are unable to review all patients daily. Consequently, there is a demand for reliable screening tools to allocate care to patients with urgent and/or complex pharmaceutical needs. Several tools have been developed, but no broad consensus exists on the design of a screening tool to be used in the adult hospital setting.

Objective

To obtain expert consensus on the design of a pharmaceutical care complexity screening tool for use on admission to hospital.

Methods

Two Delphi studies were conducted: the first sought to gain consensus from experts including pharmacists, academics and physicians on the components of a pharmaceutical complexity tool, the second to achieve consensus from UK chief pharmacists and clinical service pharmacy managers on the clinical appropriateness and practicality of the tool. Tool components and Delphi statements were identified and refined from our previous systematic review, UK survey and interview study of prioritisation tools. A valid definition for consensus was used.

Results

Over 300 components were extracted from the interview data and systematic review and then refined for inclusion in the first Delphi study. Thirty-three experts completed Delphi One and consensus was reached on 92 components. Components were grouped into demographic, clinical and medication components and condensed to 33 items, which were included in the first draft of the Adult Complexity Tool for Pharmaceutical Care (ACTPC). The tool stratified patients into highly, moderately or least complex. Forty expert panellists completed Delphi Two and consensus was reached on review frequency and experience of pharmacy practitioner at each level. These decisions were incorporated into the final version of the ACTPC.

Conclusions

The ACTPC is the first systematically designed and internationally agreed tool for use on medical admission to hospital. It has potential to enable the delivery of targeted patient-centred pharmaceutical care.

中文翻译：

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医院药学护理成人复杂性工具 (ACTPC) 的开发：改进的德尔福研究

背景

医院药剂师在患者护理中发挥着重要作用；然而，缺乏资源意味着药剂师无法每天检查所有患者。因此，需要可靠的筛选工具来为有紧急和/或复杂药物需求的患者分配护理。已经开发了几种工具，但在成人医院环境中使用的筛查工具的设计上还没有广泛的共识。

客观的

就入院时使用的药学护理复杂性筛查工具的设计获得专家共识。

方法

进行了两项 Delphi 研究：第一项旨在就药物复杂性工具的组成部分获得包括药剂师、学者和医生在内的专家的共识，第二项旨在就药物复杂性工具的临床适用性和实用性获得英国首席药剂师和临床服务药房经理的共识。工具。工具组件和 Delphi 语句是从我们之前的系统审查、英国调查和优先级工具的访谈研究中确定和改进的。使用了一个有效的共识定义。

结果

从访谈数据和系统评价中提取了 300 多个组成部分，然后进行了改进以纳入第一个德尔福研究。33 位专家完成了 Delphi One，并就 92 个组件达成了共识。组成部分被分为人口统计学、临床和药物组成部分，并浓缩为 33 个项目，包括在成人药物护理复杂性工具 (ACTPC) 的初稿中。该工具将患者分为高度、中等或最不复杂。四十名专家小组成员完成了德尔福二期，并就各级药学从业者的审查频率和经验达成了共识。这些决定被纳入 ACTPC 的最终版本。

结论

ACTPC 是第一个系统设计且国际认可的用于入院医疗的工具。它有可能实现以患者为中心的有针对性的药学护理。