Harmonisation of a 24-hour drug information service

Abstract

The Pharmacy Department at Mater Dei Hospital (MDH) operates a drug information service (DIS) during normal working hours through its Medicines Information Department (MID). The after-hours DIS is provided by shift pharmacists and follows a different model to that made available by the MID. The aim of this research was to achieve harmonisation between the DIS provided by the MID and shift pharmacists by addressing the needs of, and identifying improvements required by, the after-hours DIS. A three-week research observation placement was attended at the drug information centre at the University of Illinois in Chicago (UIC), USA, to detect the framework used. A gap-analysis comparing the DIS at MDH to that of UIC was performed. A nine member focus group was set up to discuss improvements required in the after-hours DIS at MDH, based on the observational placement. An improvement framework with a timeline over four months for implementation was drafted and validated. Five categories of needs were identified from the improvement framework: communication, quality assurance, documentation, standardisation of workforce number and organisation of resources. A liaison pharmacist,introduced to enhance communication between the MID and after-hours, performed eighteen interventions. Eleven training sessions were held by the MID for the two pharmacists forming part of one shift complement. Seven and seventeen pharmacists attended the journal club and clinical based discussion, respectively. An electronic documentation form was developed, validated and used to document seventy-one DI requests, nine of which were audited by three pharmacists. An on-call system to keep staff levels constant was implemented in thirteen and nine cases of vacation and sickness leave, respectively, for one shift complement. Twelve out of twenty-four printed after-hours reference resources were outdated and were removed from circulation. Access information for four electronic subscription-based reference resources was assembled. The improvements identified from the gap analysis and the focus group led to the development and implementation of the improvement framework. The outcomes of the framework laid down a harmonised system leading to the supply of high quality DI at all hours. Features of the improvement framework were incorporated into standard work practice at MDH.