Development of a standard process to identify, implement, and validate pharmacist-impacted clinical outcome measures...

There is a need to develop a system-based approach to connect decentralized acute care pharmacy services to clinical outcomes. Given the gap in literature describing methods to identify service-specific outcomes impacted by acute care clinical pharmacists, the primary aim of this work was to develop a standard process to identify pharmacist contributions to clinical outcomes.

The Plan-Do-Study-Act (PDSA) quality improvement methodology was utilized with a mixed qualitative and quantitative assessment of potential clinical outcomes. The collection of qualitative data was used to refine the survey process. From August 2021 to March 2023, a 3-part framework was developed (environmental scan, subject matter expert consensus via Delphi surveys and final feedback) and then individually pilot tested across 3 acute care services at a large academic medical center to determine clinical outcomes a pharmacist may contribute to within their respective services. Improvements to the process were made in an iterative approach across the pilot tests.

The number and magnitude of process modifications diminished to zero from pilot 1 to pilot 3, reflecting success in incorporating rapid cycle improvement and validating achievement of the study aim. Consensus was achieved between subject matter experts utilizing the Delphi process and resulted in the following numbers of outcomes: 9 for the burn intensive care unit, 13 for the adult abdominal transplant service, and 16 for the adult emergency medicine service.

By employing the PDSA methodology, a standard and sustainable process was created to identify service-specific clinical outcomes for acute care services. The second phase of the research explored validation of identified outcomes and reporting methodologies within the electronic medical record.