Exploring current patient prioritisation approaches used by UK mental health inpatient pharmacy teams
Authors: Alshaikhmubarak F Q , Keers R N , Brown P , Lewis P J 
Published: November 2023

Abstract

Introduction
Clinical pharmacy services play a key role in reducing drug related problems and improving patient outcomes1. Prioritising patients for clinical pharmacy services is a relatively new approach that has been reported to have a positive impact on patients and pharmacy service delivery2. Although patient prioritisation for clinical pharmacy services have been studied in UK acute care settings, such approaches in UK mental health secondary care remain unexplored.

Aim
To explore current patient prioritisation systems used by UK mental health inpatient pharmacy teams.

Methods
This multi-method research comprised a survey, document analysis and semi-structured remote video interviews. A national survey was first distributed to all mental health UK organisations to understand the prevalence of patient prioritisation approaches. This was followed by pharmacy staff interviews and document analysis to learn more about existing patient prioritisation systems. Interviews and prioritisation documents were thematically analysed following Braun and Clark’s thematic analysis approach3. Ethical approval was obtained from the University of Manchester Ethics Committee (No. 13973).

Results
A total of 73 mental health trusts/boards were invited to take part in the survey between July 2022 and January 2023. Responses were received from 55 organisations achieving a 75.3% response rate, with 38.2% (n=21/55) of these reporting use of a patient prioritisation system for clinical pharmacy services. Survey respondents not using any patient prioritisation system reported in free text responses prioritising by reactive approaches, acuity, or prioritising new admissions or specific wards only. Additionally, over 70% of these organisations reported considering using a prioritisation system in the future with reported challenges to adoption being limited funding, staff shortage, lack of a standardised prioritisation system, and competing priorities. Organisations using patient prioritisation systems were then invited for follow up interviews and to share their patient prioritisation documents. Fifteen staff interviews were conducted between August and December 2022 and 11 prioritisation documents were analysed. Patient prioritisation approaches used in these organisations were either described as (a) guidance within their pharmacy standard operating procedures (n=3), (b) prioritisation criteria/space within handover tools between pharmacy staff (n=3), or (c) reports/tools designed specifically to guide patient prioritisation (n=9). Of the patient prioritisation report/tools (n=9), four were reports that guided pharmacy staff in prioritising through emailing a list of patients with a specific high-risk indicator whereas five were tools that categorised patients based on a pre-set criteria using a traffic light system (red, amber, and green) (n=3), numerical levels (1- 4) (n=1), or one high-risk category (n=1). All prioritisation tools depended on pharmacy staff categorising patients except one that was completely automatic. These approaches were perceived to be valuable in managing limited resources and optimising pharmacy services. Nevertheless, these benefits came with some reported challenges such us balancing between standardisation of services and use of clinical judgement.

Discussion/Conclusion
This research highlights the opportunities and limitations associated with highly variable patient prioritisation approaches used by UK mental health pharmacy teams. Future research could focus on developing a standardised evidence- and consensus- based patient prioritisation system for use by UK mental health inpatient pharmacy teams.

References
1. Viktil, K. Blix, H. Viktil KK, Blix HS. The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol. 2008;102(3):275-80.
2. Alshakrah MA, Steinke DT, Lewis PJ. Patient prioritization for pharmaceutical care in hospital: A systematic review of assessment tools. Res Social Adm Pharm. 2019 Jun;15(6):767-779.
3. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.