Background and importance The medication process in hospitals that comprises prescribing, dispensing, administration and monitoring is an interprofessional collaboration. This includes hospital pharmacists (HPs) in one or more stages, which improves patient safety and reduces costs. However, the use of HPs varies greatly between countries and so do the results of studies evaluating the benefit of HPs. The differences between the HP’s role across countries has not yet been described on a tangible level.
Aim and objectives The aim of this study was to use the functional resonance analysis method (FRAM) to compare the HP’s role in the medication process in three countries using the same electronic health record (EHR) software.
Material and methods To compare the medication process across countries, field study observations were carried out by the same observer in the USA, the Netherlands and Denmark in hospitals using the EPIC Systems for the EHRs. FRAM, a way to describe outcomes using the idea of resonance arising from the variability of everyday performance, was used to illustrate and analyse the medication process. The FRAM model highlights the connection between the workflows involved in the medication process, and maps out functions, represented by hexagons and the associated aspects of each function, as well as interconnections between them. The aspects used are input (I), output (O), precondition (P), resource (R), control (C) and time (T).
Results When studying the FRAM model describing the medication process, differences between countries became apparent. HPs in Denmark take part in monitoring, such as medication reconciliation and medication review, whereas HPs in the USA and the Netherlands take part in medication verification, review of medication orders made in the hospital setting by physicians as well as monitoring. In the USA and the Netherlands, monitoring includes antibiotic stewardship, therapeutic drug monitoring as well as pharmacogenomics. In Denmark, HPs act as a resource for the physician in the monitoring process, whereas for both the USA and the Netherlands, the HP is in charge of both medication verification and monitoring.
Conclusion and relevance By comparing the hospital pharmacist’s role across countries, the potential for extended use of hospital pharmacists emerged.
Conflict of interest No conflict of interest
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