Measuring the proportion of time spent on work activities of clinical pharmacists using work sampling technique at a public hospital in Malaysia

Main Article Content

Keywords

Pharmacists, Professional Practice, Workload, Clinical Competence, Pharmacy Service, Hospital, Quality of Health Care, Observation, Management Audit, Behavior Observation Techniques, Malaysia

Abstract

Background: The clinical pharmacy service to the ward was established in 2005 in Malaysia, as the number of pharmacists working in the public service sector began to grow. Yet, there has been little local research done on reporting the range of work activities of clinical pharmacists and the amount of time that they spent on their work activities.


Objective: This study aimed to identify the range of work activities of clinical pharmacists by observation and to estimate the proportion of time spent on different work activities by using the work sampling technique.


Methods: The time spent by clinical pharmacists on various activities was measured using the work sampling technique over 30 working days. The work activities of clinical pharmacists were pre-identified and customized into an activity checklist. Two observers were placed at the study site and took turns recording the activities performed by the clinical pharmacists by following a randomly generated observation schedule.


Results: 1,455 observations were made on five clinical pharmacists with a total of 3493 events recorded. Overall, clinical pharmacists spent 78.8% (n=2751) of their time providing clinical services whereas 12.3% (n=433) of their time was spent on non-clinical activities. They were found to be idle from work for 8.9% of the time. There was no difference in bed occupancy rate in the study site regardless of the presence of the observer (p=0.384). Clinical pharmacists were found to report a higher average daily cumulative work unit of 9.8 (SD=4.3) when under observation compared to an average daily cumulative work unit of 6.5 (SD=4.6) when no observer was present (p=0.005).


Conclusions: The results revealed that clinical pharmacists spent a significant amount of time on non-clinical work. Their responsibilities with non-clinical work should be properly taken care of so they can allocate more time to providing patient care.

Downloads

Download data is not yet available.
Abstract 346 | pdf Downloads 129

References

1. Hassali MAA, Shafie AA, See OG, Wong ZY. Chapter 2 - Pharmacy Practice in Malaysia. In: Fathelrahman AI, Ibrahim MIM, Wertheimer AI, editors. Pharmacy Practice in Developing Countries. Boston: Academic Press; 2016.
2. Pharmaceutical Service Programme MoHM. Our history 2013. https://www.pharmacy.gov.my/v2/en/content/our-history.html (accessed Feb 1, 2021).
3. Liew SJX. Malaysia’s MOH Contract Pharmacists: Stuck in Limbo? https://mpsypc.com.my/publications/malaysias-moh-contract-pharmacists-stuck-in-limbo/ (accessed Apr 19, 2021).
4. Atun R, Berman P, Hsiao W, Myers E, Yap WA. Malaysia Health System Research (MHSR) Volume 1, contextual analysis of the Malaysian health system March 2016. Malaysia: MHSR; 2016.
5. Fathelrahman A, Ibrahim M, Wertheimer A. Pharmacy practice in developing countries: achievements and challenges. Boston: Academic Press; 2016.
6. Abida Haq SMH, Ainul Salhani AR, Rabi'ah M, Phuah HL. Guidelines for Inpatient Pharmacy Practice. 1st ed. Ministry of Health Malaysia; 2010.
7. Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacotherapy. 2007;27(4):481-493. https://doi.org/10.1592/phco.27.4.481
8. Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists' effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48(10):923-933. https://doi.org/10.1097/mlr.0b013e3181e57962
9. Gillespie U, Alassaad A, Henrohn D, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169(9):894-900. https://doi.org/10.1001/archinternmed.2009.71
10. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166(9):955-964. https://doi.org/10.1001/archinte.166.9.955
11. Boardman H, Fitzpatrick R. Self reported clinical pharmacist interventions under-estimate their input to patient care. Pharm World Sci. 2001;23(2):55-59. https://doi.org/10.1023/a:1011270507539
12. Parrish RH 2nd. Lecture 3-Measuring Pharmacy's Work in the 21st Century. Pharmacy (Basel). 2018;6(3):63. https://doi.org/10.3390/pharmacy6030063
13. Millar T, Sandilya R, Tordoff J, Ferguson R. Documenting pharmacist's clinical interventions in New Zealand hospitals. Pharm World Sci. 2008;30(1):99-106. https://doi.org/10.1007/s11096-007-9150-y
14. Rutter PM, Brown D, Jones IF. Pharmacy research: the place of work measurement. Int J Pharm Pract. 1998;6:46-58. https://doi.org/10.1111/j.2042-7174.1998.tb00915.x
15. Guarisco S, Oddone E, Simel D. Time analysis of a general medicine service: results from a random work sampling study. J Gen Intern Med. 1994;9(5):272-277. https://doi.org/10.1007/bf02599655
16. Rascati KL, Kimberlin CL, McCormick WC. Work measurement in pharmacy research. Am J Hosp Pharm. 1986;43(10):2445-2452.
17. Sittig DF. Work-sampling: a statistical approach to evaluation of the effect of computers on work patterns in the healthcare industry. Proc Annu Symp Comput Appl Med Care. 1992;537-541.
18. Stuchbery P, Kong DC, Desantis GN, Lo SK. Identification by observation of clinical pharmacists' activities in a hospital inpatient setting. Pharm Pract (Granada). 2007;5(1):10-16. https://doi.org/10.4321/s1886-36552007000100002
19. Jenkins D, Cairns C, Barber N. How do ward pharmacists spend their time?: an activity sampling study. Int J Pharm Pract. 1992;1(3):148-151. https://doi.org/10.1111/j.2042-7174.1992.tb00557.x
20. Barsness FR, Trinca CE. Activity analysis and cost study of clinical pharmacists practicing in a university medical center: comparison with previously established criteria. Drug Intell Clin Pharm. 1978;12(5):284-294. https://doi.org/10.1177/106002807801200504
21. Guerrero RM, Nickman NA, Bair JN. Work activities of pharmacy teams with drug distribution and clinical responsibilities. Am J Health Syst Pharm. 1995;52(6):614-620. https://doi.org/10.1093/ajhp/52.6.614
22. Hamai T, Kimura M, Suzuki T, Misaki Y, Shiga Y, Nishigaki M. Work Measurement in Clinical Pharmacist's Activities. Iryo Yakugaku. 2001;27(3):193-204. https://doi.org/10.5649/jjphcs.27.193
23. Panthong S, Daosodsai P. Work Analysis Model Of Hospital Pharmacy Services: Case Study In Outpatient Dispensing Services At Banphai Hospital, Thailand. Malaysian J Pharm Sci. 2005;3(2):66.
24. de Clifford JM, Blewitt P, Lam SS, Leung BK. How do clinical pharmacists spend their working day? A time and motion study. J Pharm Pract Res. 2012;42(2):134-139. https://doi.org/10.1002/j.2055-2335.2012.tb00151.x
25. Naing L, Winn T, Rusli BN. Practical Issues in Calculating the Sample Size for Prevalence Studies. Archives of Orofacial Sciences. 2006;1:9-14.
26. Pharmaceutical Services Division and Information Management Division MoHM. Overview and Background Project PhIS & CPS. https://phisportal.moh.gov.my/project-profile/pharmacy-information-system-phis-dan-clinic-pharmacy-system-cps (accessed Jun 11, 2021).
27. Holden JD. Hawthorne effects and research into professional practice. J Eval Clin Pract. 2001;7(1):65-70. https://doi.org/10.1046/j.1365-2753.2001.00280.x
28. Oswald D, Sherratt F, Smith S. Handling the Hawthorne effect: The challenges surrounding a participant observer. Review of Social Studies. 2014;1(1):53-73.
29. McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67(3):267-277. https://doi.org/10.1016/j.jclinepi.2013.08.015
30. Lopetegui M, Yen PY, Lai A, Jeffries J, Embi P, Payne P. Time motion studies in healthcare: what are we talking about?. J Biomed Inform. 2014;49:292-299. https://doi.org/10.1016/j.jbi.2014.02.017
31. Lehmann C, Nowak A. The Hawthorne effect: can it be measured and utilized?. Br J Anaesth. 2013;110(4):658-659. https://doi.org/10.1093/bja/aet035
32. Friebel R, Fisher R, Deeny SR, Gardner T, Molloy A, Steventon A. The implications of high bed occupancy rates on readmission rates in England: A longitudinal study. Health Policy. 2019;123(8):765-772. https://doi.org/10.1016/j.healthpol.2019.06.006
33. Cucolo DF, Perroca MG. The qualitative dimension of Nursing workload: a measurement proposal. Rev Lat Am Enfermagem. 2019;27:e3238. https://doi.org/10.1590/1518-8345.3274.3238
34. Briatte I, Allix-Béguec C, Garnier G, Michel M. Revision of hospital work organization using nurse and healthcare assistant workload indicators as decision aid tools. BMC Health Serv Res. 2019;19(1):554. https://doi.org/10.1186/s12913-019-4376-7
35. Fisher AM, Ding MQ, Hochheiser H, Douglas GP. Measuring time utilization of pharmacists in the Birmingham Free Clinic dispensary. BMC Health Serv Res. 2016;16(1):529. https://doi.org/10.1186/s12913-016-1787-6
36. Negaard BJ, Lyons KP, Nichol CL, Polgreen LA. What does a pharmacist do? A time and motion study. Res Social Adm Pharm. 2020;16(9):1314-1317. https://doi.org/10.1016/j.sapharm.2019.03.007
37. English S, Hort A, Sullivan N, Shoaib M, Chalmers L. Is ward round participation by clinical pharmacists a valuable use of time and money? A time and motion study. Res Social Adm Pharm. 2020;16(8):1026-1032. https://doi.org/10.1016/j.sapharm.2019.10.014
38. Wirth F, Azzopardi LM, Gauci M, Adami MZ, Serracino‐Inglott A. Time and motion study for pharmacists' activities in a geriatric hospital. INt J Pharm Pract. 2009;17(6):373-376. https://doi.org/10.1211/ijpp.17.06.0010
39. ASHP. Workload Monitoring and Reporting. Pharmacy Management. Bethesda: American Society of Health-System Pharmacists; 2013.
40. Olthof M, Stevens M, Dijkstra B, Bulstra SK, Van Den Akker-Scheek I. Actual and perceived nursing workload and the complexity of patients with total hip arthroplasty. Appl Nurs Res. 2018;39:195-199. https://doi.org/10.1016/j.apnr.2017.11.023
41. Tommasi V, Campolongo A, Caridi I, et al. Variables determining clinical complexity in hospitalized Internal Medicine patients: A workload analysis. Italian J Med. 2017;11:202. https://doi.org/10.4081/itjm.2017.725
42. Unruh LY, Fottler MD. Patient turnover and nursing staff adequacy. Health Serv Res. 2006;41(2):599-612. https://doi.org/10.1111/j.1475-6773.2005.00496.x

Most read articles by the same author(s)

1 2 > >>