Mapping the implementation of a hospital-based pharmacist-led post-discharge medication review clinic using the KTA...

The implementation of new services in healthcare is complex, and an effective strategy is required to produce the desired patient outcomes. This paper aims to describe the implementation of a pharmacist-led post-discharge medication review clinic and outline the clinical pharmacist activities provided during the clinic review.

The Knowledge to Action (KTA) framework was used to map the actions involved for the planning, implementation and review of outcomes of the clinic. The Consolidated Framework for Implementation Research (CFIR) was used to describe dependent and independent barriers and facilitators encountered throughout the implementation process. The clinical pharmacist activities provided during the clinic review were defined according to local guidelines.

The KTA framework provided the key steps to implement the clinic service, monitor patient outcomes, that included 30-day hospital readmissions, and review clinic processes. Follow-up and troubleshooting of patient non-attendance and referral pathways were a key component of utilising the circular nature of the KTA framework. Facilitators included hospital funding models, growing evidence for pharmacist-led medication review and support from key stakeholders. Barriers included running costs, patient understanding of the service, attendance, and technology constraints. The clinic review included five key clinical pharmacist activities: confirmation of a best possible medication history, medication reconciliation, medication review, patient education, and communication of medication related problems identified with the patient's healthcare team.

The KTA framework was a useful tool for implementing the pharmacist-led post-discharge medication review clinic, adapting and monitoring processes and improving knowledge of key stakeholders. Identified barriers and facilitators are relevant to implementing future clinic models.