Year: 2015
Type: article
Study design: Observational Study
Abstract: Nearly two decades ago, it was recognised that in complex clinical cases, and in complex health organisations, no one person has the capability to deliver high-quality care by acting alone.1 The paradigm of an ‘inter-professional approach’ in patient-centred care has thus emerged in recognition of the synergistic roles that discipline specialists bring to decision-making and care provision.2 Exploration of collaboration in pharmacist–physician pairs in primary care has demonstrated that in successful collaborative work relationships, there was mutual recognition and acknowledgement of pharmacists as the collaborative relationship initiators, making high-quality contributions, and physicians as the decision makers.3 In our multi-specialty wards of acute care hospital setting, introducing the model of pharmacist-initiated information provision linked to doctor's decision making has its unique challenges. The inter-professional communication involved in patient-centred care is complex, owing to the diversity of patient populations and healthcare providers working on any given ward. Synchronous inter-professional communication, i.e. multi-professional team members engaging in discussion of individual patient's clinical issues within the same tight time frame of medical ward rounds, typically through oral communications, is particularly problematic. This difficulty arises from the time overlap of ward rounds of the multiple medical specialties as well as the profession-specific priority in patient-focused tasks. However, effective inter-professional communication in such an information-intensive environment is critical to achieving optimal patient care. Hence, an electronic medical record (eMR) infrastructure was introduced in our local practice setting in order to provide a platform for asynchronous, time-efficient and timely written inter-professional communication that was previously unachievable, logistically, in the practice of paper-based clinical progress notes writing. With the Institutional Medical Administration's approval, we evaluated the perceptions of and receptiveness to this approach of inter-professional collaborative endeavour by conducting surveys of medical interns, who are the primary audience for eMR Pharmacy Reviews. Surveys were conducted in June and August 2011, January 2012 and March 2013. The specific questions and the rating of eMR Pharmacy Reviews are detailed in Table 1. The survey results revealed that after 7 months of their internship in the local environment where eMR Pharmacy Review had been embedded in routine practice, 67% (8 out of 12) of the medical interns who provided feedback considered pharmacists’ eMR reviews interpretative, contextualised and clinically relevant, and the same proportion of them regarded pharmacists’ eMR reviews as collaborative, succinct and impartial professional discourse. From the survey conducted at the end of their 12-month internship, the proportion of responding medical interns who held this view rose to 91% (10 out of 11). This increase is interpreted as a reflection of their capability of appreciating pharmacists’ input expanding with their own practice experience. In contrast, survey results from earlier times were less encouraging, suggesting that the interns were at that time still developing capacity for inter-professional collaboration during the first half of their internship. The results of surveys conducted in the later months of internship, when the medical interns have gained more inter-professional practice experience, are consistent with the notion that asynchronous, written eMR Pharmacy Reviews enhance and promote inter-profession collaboration. Melinda Y. Yeung, BPharm, CGP, BCPS (Pharmacotherapy), Grad Dip Health Sciences (Edu) Grad Cert Applied Epidemiology, Grad Dip Food & Drug Analysis Clinical Pharmacy Educator, Department of Pharmacy, Blacktown Hospital, Sydney, Australia E-mail: [email protected] Helen Wong, BPharm, Clinical Pharmacist, Department of Pharmacy, Blacktown Hospital, Sydney, Australia Margaret J. Macarthur, BPharm, BA, MA, PhD (Media Communication), Director of Pharmacy, Blacktown and Mount Druitt Hospitals and WSLHD Pharmacy Directorate, Western Sydney Local Health District, Department of Pharmacy, Blacktown Hospital, Sydney, Australia
DOI: 10.1002/jppr.1131
Authors: Melinda Y. Yeung, Helen Wong, Margaret J. Macarthur
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W1843669361