Table 3

Pharmaceutical assessment screening tool (PAST) factors for all sampled patients stratified by agreement of pharmacist-documented and expected PALs

Pharmaceutical assessment screening factors	Stratified levels of agreement (number (%))*
Pharmaceutical assessment screening factors	−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.