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

A method for rating the value of pharmacists' clinical services was studied . An instrument was developed to measure the severity of medication errors an d the value of pharmacists' clinical interventions. Pharmacists at a hospit al pharmacy department used the instrument at the time they made an interve ntion. A single pharmacist reviewed and adjusted the scores assigned by the pharmacist who made the intervention. An expert panel consisting of two cl inical pharmacists and two physicians also scored all the interventions usi ng the same instrument. All rankings were compared using kappa (kappa) and weighted kappa statistics, and symmetry tests were applied to examine wheth er specific raters consistently rated higher or lower than other raters. Da ta were extracted from the pharmacy departments intervention database to ra te 300 interventions. Agreement between the raters was substantial, both overall and for each dim ension individually. However, the physicians rated severity of error and va lue of service lower than their pharmacist counterparts. The study indicate d 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 p rescribing 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.