Pharmaceutical assessment screening tool (PAST) factors for all sampled patients
| Pharmaceutical assessment screening factors | Number (%) |
|---|---|
| N | 35 |
| Organ dysfunction | |
| Kidney | 8 (23) |
| Liver | 1 (3) |
| Heart | 0 (0) |
| Lung | 0 (0) |
| Bone marrow | 0 (0) |
| Brain | 0 (0) |
| Dysfunction of more than one organ | 0 (0) |
| Drugs requiring therapeutic monitoring | |
| Glycopeptide antibiotic | 1 (3) |
| Aminoglycosides | 4 (11) |
| Theophylline/aminophylline | 3 (9) |
| Digoxin | 1 (3) |
| Carbamazepine | 0 (0) |
| Lithium | 0 (0) |
| Ciclosporin | 0 (0) |
| Amphotericin B | 0 (0) |
| Triazole antifungals | 0 (0) |
| Number of drugs requiring therapeutic monitoring | |
| 0 | 28 (80) |
| 1 | 5 (14) |
| 2 | 2 (6) |
| Other high-risk medications | |
| Anticoagulation | 5 (14) |
| Insulin | 8 (23) |
| Opiates | 6 (17) |
| Chemotherapy | 0 (0) |
| Antiretrovirals | 0 (0) |
| Clozapine | 0 (0) |
| Number of high-risk medications* | |
| 0 | 18 (51) |
| 1 | 8 (23) |
| 2 | 7 (20) |
| 3 | 2 (6) |
| ICU step-down patient | 1 (3) |
| Patient with an infectious disease consult | 0 (0) |
| Patient with cystic fibrosis | 5 (14) |
| Organ transplant patient | 0 (0) |
| Home intravenous therapy | 0 (0) |
| Out-of-hospital respiratory service | 0 (0) |
| Patient with HIV | 0 (0) |
| Patient with Parkinson's disease on apomorphine | 0 (0) |
| High-cost medication (not within NHS tariff) | 0 (0) |
| Outside competency of attending pharmacist† | 0 (0) |
| Pharmacist-documented PAL | |
| 1 | 4 (11) |
| 2 | 25 (71) |
| 3 | 6 (17) |
| Expected PAL | |
| 1 | 11 (31) |
| 2 | 15 (43) |
| 3 | 9 (26) |
| Measured agreement of PAL‡ | |
| −2 | 0 (0) |
| −1 | 6 (17) |
| 0 | 20 (57) |
| +1 | 8 (23) |
| +2 | 1 (3) |
*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.
‡Measured agreement of PALs is the difference of pharmacist-documented PAL minus the expected PAL with a range of values from −2 to +2.
ICU, intensive care unit; NHS, National Health Service; PAL, patient acuity level.