Adoption of Change in Hospital Pharmacy Practice 

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Adoption of Change in Hospital Pharmacy Practice. Jean-Franois Bussires B Pharm MSc MBA FCSHP Chef, dpartement de pharmacie et unit de recherche en pratique pharmaceutique, CHU Sainte-Justine Professeur titulaire de clinique, Facult de pharmacie, Universit de Montral Kevin Hall - PowerPoint PPT Presentation


  • Adoption of Change in Hospital Pharmacy PracticeJean-Franois BussiresB Pharm MSc MBA FCSHPChef, dpartement de pharmacie et unit de recherche en pratique pharmaceutique, CHU Sainte-JustineProfesseur titulaire de clinique, Facult de pharmacie, Universit de Montral

    Kevin HallB. Sc. Pharm., Pharm. D., FCSHPClinical Associate ProfessorFaculty of Pharmacy and Pharmaceutical SciencesUniversity of Alberta

  • Objectives

    To understand the typical trajectory associated with the adoption of change, following the initial availability of evidence supporting the change

    To discuss possible ways of accelerating the adoption of evidence-based improvements in the practice of pharmacy

    Hall, Kevin (revisions)

  • Adoption of change in healthcareFollowing the availability of evidence supporting the adoption of a new healthcare practice, how many years do you think will pass, on average, before the improved practice will be in widespread usage?

    2 years?5 years?9 years?17 years?25 years?

  • Balas et al.

  • Managing clinical knowledge for health care improvement1843Oliver Wendell Holmes Boston Society for Medical ImprovementContagiousness of puerperal feverAdvocated hand washing before examining a pregnant woman a revolutionary idea at the time

  • Managing clinical knowledge for health care improvementStudied nine clinical procedures

    Calculated the annual increase in use by dividing the current rate of use by the number of years between the publication of the landmark trial and the reported current use

    Average: 3.2% increase each year

    15.6 years required before an innovation is used by 50% of potential users

  • There was twice as much evidence available in 1995 than there was in 1966Imagine now

    2 x

  • The nine clinical interventions

  • Calculated that onaverage it takes17 yearsfor researchevidence toreach clinicalpractices

  • Does the figure of 17 years seem excessive for the adoption of change in hospital pharmacy practice?

  • Sources of information used to identify key issues in pharmacy practicePharmacy and other Scientific Literature

    Hospital Pharmacy in Canada Report

    CSHP 2015 Survey Results

  • What information can we glean from these sources concerning the adoption of change in pharmacy practice?

  • Trends from the HPC ReportSix examples .Unit-dose distribution serviceIV admixture service Use of barcodes in the drug-use processImplementation of computerized prescriber order entry (CPOE) systemsPharmacy technician scope of practicePharmacist scope of practice

    Hall, Kevin (revisions) - This is the type of material that I think should be emphasized in the presentation. In my opinion, many of the earlier slides could be deleted and the emphasis could be placed on 20 (or fewer) changes. I would focus on the changes, drawing upon the data from the HPC survey, including the CSHP 2015 data, to demonstrate how rapidly these changes were adopted (or not). Hall, Kevin (revisions) - A few other changes that I think we could examine include the following:

    Tech check techTechnician-managed drug distributionDecentralized pharmacist practice modelUse of automated decentralized cabinetsRemoval of concentrated KCL from patient unitsAdoption of TallMan letteringUse of pharmacists with advanced practice training

    I could come up with more by quickly skimming through the report

  • Adoption of change in Pharmacy Practice

    Approximately when was the innovation proven to be beneficial?

    What level of implementation had been achieved by 2012?

  • Source: Parker P. Unit-dose systems reduce error, increase efficiency. Hospitals JAHA 1968; 42: 65-72.

  • Unit-dose distribution systems65 %

    Hall, Kevin (revisions) - It's not clear if the 65% represents the combination of total and partial unit dose systems. Why isn't 2009/10 included? Is it correct to say "total" when the criteriawe use in the survey is coverage of "greater than 90% of beds?Hall, Kevin (revisions) - This isn't a big deal, but since the slides are otherwise in english, you might want to change the labels to "Total" and "Partial". Just for consistency

  • 2012 minus 1968=44 years and and the use of unit dose systems, full or partial, was reported by only 65% of respondents !

  • 1978

    Hall, Kevin (revisions) - I moved this slide ahead of the next slide, since I think the pattern you are pursuing is to show when the evidence for the initiative was first reported, then to show how the innovation has been adopted, or not, since then.

  • IV admixture to > 90% patients64 % in 2012

  • 2012 minus 1978=34 years !

  • 1974

  • Use of barcoding in hospital pharmacy Range of 2-22% in 2012

  • 2012 minus 1974=38 years !

  • Computerized prescriber order entry systems

  • Emergingevidencebut stilla lot ofunknownsabout theirimpact2008

  • Implementation of CPOEs5% in 2004 9% in 2012

  • Scope of Practice Changes for Pharmacists and Pharmacy Technicians

  • Pharmacy Technician Scope of Practice

  • The counting and pouring often alleged to be the pharmacists chief occupation will in time be done by technicians and eventually by automation. The pharmacist of tomorrow will function by reason of what he knows, increasing the efficiency and safety of drug therapy and working as a specialist in his own right., Dean Tice of the Philadelphia College of Pharmacy 1961

  • 2012

  • 2012 minus 1961=51 years !

  • Pharmacist Scope of PracticeI would establish as the principal qualifications of a clinical practitioner that he bear personal responsibility for the safe and effective use of drugs in a number of patients on a continuing basis.

    Don Francke 1976

  • Independent prescribing rights for pharmacistsAlberta allowed pharmacists to acquire independent prescribing rights beginning in 2006.

    Since then, what percentage of pharmacists have obtained independent prescribing rights?

    4% ?10% ?18% ?50% ?71% ?

  • 2012 minus 1976=36 years !

  • Pharmacy technicians as a supportrole for clinical services8to37%

    (excluding drug distribution liaison)

  • Is Pharmacy an evidence-based Profession?

  • No evidence for clinical activities=higher prioritySource:

  • So why do changes occurso slowly ?

  • Why do we have such significant gaps between objectives, priorities and implementation ?Limited resources ($, human)?Too many competing priorities?Lack of leadership?Staff attitudes?

    What contributes to the successes that are reported?Passion and motivation?Staff awareness?Incorportation of CSHP 2015 in strategic planning?Inspirational leadership?

  • Barriers to change Unsuccessful passive diffusion Results difficult to understand Too much information People feel they should not change what works !No expertise No incentive Fear

  • Hall, Kevin (revisions) - This slide is very busy and contains a lot of points that aren't related to the issue that I think you are trying to make. Couldn't you just put the title of the report on the slide and then speak to it?