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      The pharmacist and the EHR

      Author(s): , , , ,
      Publication date Created:
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      Journal: Journal of the American Medical Informatics Association
      Publisher: Oxford University Press (OUP)

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          Abstract

          The adoption of electronic health records (EHRs) across the United States has impacted the methods by which health care professionals care for their patients. It is not always recognized, however, that pharmacists also actively use advanced functionality within the EHR. As critical members of the health care team, pharmacists utilize many different features of the EHR. The literature focuses on 3 main roles: documentation, medication reconciliation, and patient evaluation and monitoring. As health information technology proliferates, it is imperative that pharmacists’ workflow and information needs are met within the EHR to optimize medication therapy quality, team communication, and patient outcomes.

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          Clinical pharmacists and inpatient medical care: a systematic review.

          Peter J Kaboli, Angela B Hoth, Brad J McClimon … (2006)
          The role of clinical pharmacists in the care of hospitalized patients has evolved over time, with increased emphasis on collaborative care and patient interaction. The purpose of this review was to evaluate the published literature on the effects of interventions by clinical pharmacists on processes and outcomes of care in hospitalized adults. Peer-reviewed, English-language articles were identified from January 1, 1985, through April 30, 2005. Three independent assessors evaluated 343 citations. Inpatient pharmacist interventions were selected if they included a control group and objective patient-specific health outcomes; type of intervention, study design, and outcomes such as adverse drug events, medication appropriateness, and resource use were abstracted. Thirty-six studies met inclusion criteria, including 10 evaluating pharmacists' participation on rounds, 11 medication reconciliation studies, and 15 on drug-specific pharmacist services. Adverse drug events, adverse drug reactions, or medication errors were reduced in 7 of 12 trials that included these outcomes. Medication adherence, knowledge, and appropriateness improved in 7 of 11 studies, while there was shortened hospital length of stay in 9 of 17 trials. No intervention led to worse clinical outcomes and only 1 reported higher health care use. Improvements in both inpatient and outpatient outcome measurements were observed. The addition of clinical pharmacist services in the care of inpatients generally resulted in improved care, with no evidence of harm. Interacting with the health care team on patient rounds, interviewing patients, reconciling medications, and providing patient discharge counseling and follow-up all resulted in improved outcomes. Future studies should include multiple sites, larger sample sizes, reproducible interventions, and identification of patient-specific factors that lead to improved outcomes.
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            The definition of clinical pharmacy.

            (2008)
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              The impact of clinical pharmacists on drug-related problems and clinical outcomes.

              Hege Salvesen Blix, Kirsten Viktil (2008)
              Drug-related problems are frequent and may result in reduced quality of life, and even morbidity and mortality. Many studies have shown that clinical pharmacists can effectively identify and prevent clinically significant drug-related problems and that physicians acknowledge and act on the clinical pharmacist's suggestions for interventions to the drug-related problems. A pro-active rather than a reactive approach on the part of the pharmacists seems prudent for obtaining most benefit. This includes participation of pharmacists in the multidisciplinary team discussions - at the stage of ordering and prescribing - where all types of drug-related problems, including also potential problems, should be discussed. In addition, counselling by pharmacists about medication on discharge and follow-up after discharge resulted in better outcomes. Furthermore, clinical pharmacists can positively influence other outcomes, such as improvement of levels of markers for drug use (e.g. optimization of lipid levels, anticoagulation levels and blood pressure). Some studies have reported positive effects on hard clinical outcomes, such as reduced length of stay, fewer re-admissions and fewer disease events (e.g. heart failure events and thromboembolism). However, more studies should be undertaken with larger patient populations, including patients from multiple sites. More knowledge about patient-specific factors that predict improved care is also needed. In conclusion, there is increasing evidence that participation and interventions of clinical pharmacists in health care positively influence clinical practice.
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                Author and article information

                Journal
                Title: Journal of the American Medical Informatics Association
                Abbreviated Title: J Am Med Inform Assoc
                Publisher: Oxford University Press (OUP)
                ISSN (Print): 1067-5027
                ISSN (Electronic): 1527-974X
                Publication date Created: December 30 2016
                Publication date Created: January 2017
                Publication date (Print): January 2017
                Publication date (Electronic): April 23 2016
                Volume: 24
                Issue: 1
                Pages: 193-197
                Article
                DOI: 10.1093/jamia/ocw044
                PMC ID: 7654075
                PubMed ID: 27107439
                SO-VID: b7f45639-5f37-4de3-bdc6-4a2c11888895
                Copyright © © 2016
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