Practical, reliable, comprehensive method for characterizing pharmacists' clinical activities

Abstract

A method for rating the value of pharmacists' clinical services was studied. An instrument was developed to measure the severity of medication errors and the value of pharmacists' clinical interventions. Pharmacists at a hospital pharmacy department used the instrument at the time they made an intervention. A single pharmacist reviewed and adjusted the scores assigned by the pharmacist who made the intervention. An expert panel consisting of two clinical pharmacists and two physicians also scored all the interventions using the same instrument. All rankings were compared using κ (kappa) and weighted κ statistics, and symmetry tests were applied to examine whether specific raters consistently rated higher or lower than other raters. Data were extracted from the pharmacy department's intervention database to rate 300 interventions. Agreement between the raters was substantial, both overall and for each dimension individually. However, the physicians rated severity of error and value of service lower than their pharmacist counterparts. The study indicated that severity of error and value of service are clearly related, but not linearly. Services can be identified as high value even when there are no prescribing errors. Pharmacists found the instrument usable and practical. A literature-based instrument for simultaneously assessing the severity of errors in medication orders and the value of pharmacists' interventions was constructed, tested in a hospital, and determined to be reliable.