Pharmaceutical assessment screening factors | Stratified levels of agreement (number (%))* | |||
---|---|---|---|---|
−1 | 0 | +1 | +2 | |
N | 6 (100) | 20 (100) | 8 (100) | 1 (100) |
Organ dysfunction | ||||
Kidney | 2 (33) | 5 (25) | 1 (13) | 0 (0) |
Liver | 0 (0) | 1 (5) | 0 (0) | 0 (0) |
Heart | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Lung | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Bone marrow | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Brain | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Drugs requiring therapeutic monitoring | ||||
Glycopeptide antibiotic | 0 (0) | 1 (5) | 0 (0) | 0 (0) |
Aminoglycosides | 2 (33) | 1 (5) | 1 (13) | 0 (0) |
Theophylline/aminophylline | 3 (50) | 0 (0) | 0 (0) | 0 (0) |
Digoxin | 1 (17) | 0 (0) | 0 (0) | 0 (0) |
Carbamazepine | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Lithium | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Ciclosporin | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Amphotericin B | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Triazole antifungals | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Number of drugs requiring therapeutic monitoring | ||||
0 | 2 (33) | 18 (90) | 7 (88) | 1 (100) |
1 | 2 (33) | 2 (10) | 1 (13) | 0 (0) |
2 | 2 (33) | 0 (0) | 0 (0) | 0 (0) |
Other high-risk medications | ||||
Anticoagulation | 1 (17) | 4 (20) | 0 (0) | 0 (0) |
Insulin | 4 (67) | 4 (20) | 0 (0) | 0 (0) |
Opiates | 1 (17) | 5 (25) | 0 (0) | 0 (0) |
Chemotherapy | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Antiretrovirals | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Clozapine | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Number of high-risk medications† | ||||
0 | 0 (0) | 10 (50) | 7 (88) | 1 (100) |
1 | 2 (33) | 5 (25) | 1 (13) | 0 (0) |
2 | 2 (33) | 5 (25) | 0 (0) | 0 (0) |
3 | 2 (33) | 0 (0) | 0 (0) | 0 (0) |
ICU step-down patient | 0 (0) | 1 (5) | 0 (0) | 0 (0) |
Patient with an infectious disease consult | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Patient with cystic fibrosis | 4 (67) | 1 (5) | 0 (0) | 0 (0) |
Organ transplant patient | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Home intravenous therapy | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Out-of-hospital respiratory service | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Patient with HIV | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Patient with Parkinson's disease on apomorphine | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
High-cost medication (not within NHS tariff) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Outside competency of attending pharmacist‡ | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Pharmacist-documented PAL | ||||
1 | 0 (0) | 4 (20) | 0 (0) | 0 (0) |
2 | 6 (100) | 13 (65) | 6 (75) | 0 (0) |
3 | 0 (0) | 3 (15) | 2 (25) | 1 (100) |
*Measured agreement of PALs is the difference of pharmacist-documented PAL minus the expected PAL with a range of values from −2 to +2.
†Number of high-risk medications includes drugs requiring therapeutic monitoring plus other high-risk medications.
‡Outside competency refers to documentation by a junior pharmacist that the patient’s complexity is outside the scope of their competency.
ICU, intensive care unit; NHS, National Health Service; PAL, patient acuity level.