Aiya Almogaber, PharmD
Pharmacists play a critical role within the broad spectrum of multidisciplinary teams in inpatient care environments. According to research findings published January 14, 2024, in the Journal of the American College of Clinical Pharmacy, pharmacists are applying their versatile skill sets to improve patient care within the complex landscape of adult medicine.
Inpatient health care in the United States is defined by comprehensive medical services delivered within a hospital or health care institution. These services can range from diagnostic tests, surgical procedures, and nursing care to therapeutic interventions and more.
“I wasn’t surprised by how much the pharmacists can do,” said lead author Jennifer Szwak, PharmD, who has practiced in adult medicine for over 10 years. “It was exciting to see how many different disease states adult medicine pharmacists impact. I think this speaks to the adaptability of adult medicine pharmacists and the variety of patients for whom we care.”
In just a 1-week timeframe, 33 pharmacists provided 988.5 hours of direct patient care, according to the study findings. A total of 4,488 interventions that spanned a wide variety of activities were documented, with the optimization and initiation of therapy emerging as predominant themes. Other activities included interpretation of diagnostic data or lab values, responding to drug information inquiries, and recognizing inappropriate therapy. The therapeutic categories most affected included antimicrobials, cardiovascular medications, and antithrombotics.
Foundational research
Szwak said the aim of their research was to convey a clear picture to pharmacy and hospital administrators about what adult medicine pharmacists can add to patient care.
“We wanted to provide an idea of the clinical activities an adult medicine pharmacist can provide, which may help expand current practice, establish pharmacist-to-patient ratios, or justify new pharmacist positions,” said Szwak.
According to Heather Wilson, PharmD, a critical care clinical pharmacist at Moses Cone Hospital in Greensboro, NC, the study findings could allow for foundational development for clinical positions.
“As a current practitioner, I feel that the current pharmacy gap of care is in adult medicine units,” said Wilson. She said that up until now, there hasn’t been much research to demonstrate the typical workflow for clinical pharmacists and their interventions in this area of practice.
Proactive role, proactive findings
The study was a prospective, multicenter endeavor that used a 65-item survey to explore the clinical activities of inpatient adult medicine pharmacists. The survey was designed to collect information related to practice site types, geographic regions, daily duties, therapeutic interventions, and evaluation of those interventions.
Nearly 90% of the documented interventions were accepted, with 82% initiated directly by pharmacists. Notably, 277 potential outcomes were classified as “serious” or “potentially lethal” without intervention, underscoring pharmacists’ proactive role and impact on patient care.
“Pharmacists have expertise in all organ systems and pharmaceutical classes. The quantification of time per activity gives other health care professionals a glimpse into the typical day of a clinical pharmacist, beyond operational responsibilities,” said Wilson.
Laying the groundwork
This study’s analysis can serve as a benchmark and also lays the groundwork for future research efforts.
“The key takeaway is the need for pharmacists to continue to advocate for bedside clinical positions,” said Wilson.
As health care continues to evolve, this call for advocacy becomes a cornerstone for advancing the role of pharmacists in optimizing patient outcomes.
“I hope clinical managers and [clinical] pharmacists are able to use [this] information to expand the services and activities provided by the adult medicine pharmacy team,” Szwak said.
Overall, this study is a launching pad for a broader exploration of the multifaceted contributions of inpatient adult medicine pharmacists, including their varying levels of experience, specialty, and involvement in therapeutic areas.
“This study provides a starting point for future studies exploring more details about the interventions being made, their impact on readmissions or lengths of stay, patient safety, or clinical outcomes. I see this study as the forward that is followed by many stories of adult medicine pharmacists improving clinical care for patients across the country,” Szwak said. ■