Pharmacy practice in a secondary care setting continues to evolve. A recent study of 20 Emergency Department Pharmacist Practitioners (EDPPs) found that care provided to 682 patients included traditional pharmaceutical care but also more novel activities such as clinical examination1. There is no consensus as to what is ‘novel’ within advanced roles such as the pharmacist practitioner. Role typologies have been used in nursing to compare novel roles and clarify role jurisdiction and title2. This research aimed to develop a typology that would define direct patient care activities as either ‘traditional’ or ‘practitioner’ (i.e., novel) and support the deductive description and comparison of EDPP roles.
A panel of hospital pharmacists and pharmacy researchers were recruited via e‐mail or Twitter™ to determine whether a junior pharmacist working in acute medicine would undertake each of 85 direct patient care activities: yes (regularly/rarely) or no (never). A junior pharmacist, who had completed a clinical diploma with no other clinical training, was chosen as a suitable differentiator between traditional and practitioner roles. The activities were taken from a clinical pharmacist work capture instrument used previously to study EDPPs1. Activities which received >50% ‘yes’ votes were defined ‘traditional’ and >50% ‘no’ votes defined ‘practitioner’ (novel). This was applied to an existing dataset of the care provided to 682 patients by 20 EDPPs1, and the ratio of traditional to practitioner activities calculated with an overall median ratio and range calculated for each EDPP. Analysis of individual and collective EDPP ratios enabled description and comparison of roles. As a study of expert opinion, ethical approval was not required.
There were 70 responses received with 40 activities defined ‘traditional’, e.g., review investigations (90% ‘yes’), and 45 activities ‘practitioner’, e.g., perform treatment procedures (100% ‘no’). Despite being asked to consider a junior pharmacist who was not a prescriber, respondents were divided 50:50 about whether ‘prescribing discharge medicines’ was a ‘traditional’ or ‘practitioner’ activity. Applied to the existing dataset, overall median ratios of traditional to practitioner work ranged from 1.11 to 5.50 for each EDPP. All 20 EDPPs carried out both traditional and practitioner work; all provided more traditional than practitioner care to more patients, but 9/20 EDPPs sometimes provided more practitioner than traditional care to individual patients. Those who provided a greater proportion of practitioner care did so more consistently and those who provided a greater proportion of traditional care did so less consistently.
A typology has been developed and validated through its use to describe and compare EDPPs. The activity ‘prescribing discharge medicines’ divided opinion and may suggest this is increasingly viewed as the norm for pharmacists working in hospital settings. Whilst activities questioned were limited to a traditional‐practitioner dichotomy, and external factors were not considered, the typology does address all areas of ED practice. Changes in practice should be measured through repeat survey of the typology at defined intervals to re‐evaluate what is ‘novel’ activity. Application of the typology to EDPPs enabled quantitative comparison of traditional and practitioner activities and will support future definition of the role.
Clinical pharmacy; Practitioner pharmacist; Emergency department; Activity; Typology.
1. Greenwood D, Tully MP, Martin S, Steinke D. Emergency Department Pharmacist Practitioners: A new role in the NHS, Res Social Adm Pharm, 2018; 14(8):e30.
2. Roberts‐Davis M, Nolan MR, Read S, Gilbert P. Realizing specialist and advanced nursing practice: a typology of innovative nursing roles, Accid Emerg Nurs, 1998; 6(1):36–40.