Background
At a regional hospital, the surgical wards are managed via a ward based model with two pharmacists managing 72 inpatients, exceeding surgical standard of practice recommended ratios of 1:15-20. These patients can be admitted under 23 different treating teams, resulting in inefficient communication and discharge delays. The high variety and complexity of patients adds to the significant workload, and current limitations on pharmacy staffing means patient-pharmacist ratios are currently unable to be altered.
Objective
To conduct a pharmacy-led trial of team-based pharmacy service over two-weeks to compare with the current ward-based model for any changes to efficiency or workload.
Action
The surgical ward pharmacists were allocated to treating teams across the surgical wards with a mix of general and subspecialty surgery teams. Data was collected regarding discharge screening times as well as workload of discharge and non-imprest item requests. This was then compared to the same data collected over two weeks for the ward-based model.
Evaluation
The average and median discharge screening time reduced by 7 (14%) and 12 minutes (33%) respectively. The non-imprest order workload shifted distinctly to the acute and subspecialty team pharmacist from a 46%/54% split to an 65%/35% split. The study highlighted the major variation of patient numbers per team which required changes to the planned allocation of workload each day.
Discussion
Improvements to discharge screening time showed merit for adopting a team-based system, freeing time for pharmacists to focus on other clinical tasks and reducing patient wait times. However, non imprest orders were significantly imbalanced, shifting more work to one pharmacist over the other. Inconsistency in treating team patient load required inefficient daily reallocation of patients between pharmacists. A larger-scope trial over a longer time-period would be beneficial to potentially consider improvements to the distribution of workload for a team-based model.