The COVID-19 pandemic caused by SARS-CoV-2 spread rapidly throughout the world, with more than 33 million reported cases leading to over 2.2 million hospital admissions. Similar to many countries around the world, the health care system in the United States was stretched to its limit.1
Like many health care providers, pharmacists have been on the frontlines throughout the pandemic providing much needed support to a strained health care system.2
The COVID-19 pandemic has led to significant health care innovation, ranging from the use of investigational therapies—such as the antiviral remdesivir3 and the interleukin-6 inhibitor tocilizumab—4 to the development of new antibody cocktails. Many of these novel therapies required robust monitoring to ensure safety and efficacy.
This presented a unique opportunity for pharmacists to advance pharmacy practice by serving as the integral drug monitoring experts of the health care team. Pharmacists have long been seen as the most accessible health care professional; however, the work of what we do in the inpatient setting is not always visible.
Documentation is a great way for pharmacists to demonstrate their impact in optimization of patient care.
As part of advancing patient-centered care, the American Society of Health-System Pharmacists (ASHP) Practice Advancement Initiative 2030 recommends pharmacist documentation to be available to all members of the health care team.6 Via documentation, pharmacists can demonstrate their decision-making in a way that is visible to the entire care team, assume accountability for drug therapy, and illustrate the value of having a drug expert actively involved in patient care.
To maximize the benefits of the pharmacist’s expertise, a robust training program needs to be established. The ASHP states that pharmacist documentation is a skill that requires ongoing training and evaluation.7
ASHP guidelines recommend developing a formal facility policy and offering appropriate training that includes training pharmacists on what and when to document. A study in the Canadian Journal of Hospital Pharmacy concluded that pharmacists were competent in documenting in a clear, concise, and understandable way, but may require additional training in the specific elements of the note, such as documenting drug related problems, pharmacokinetics, and patient education.8
Although pharmacists recognize the importance and benefits of documentation, there are also barriers. Pullinger, et al conducted a survey of pharmacists on their view of documentation in the medical record and concluded that common themes and fears were barriers to a successful program. These included fears of acceptance by other providers, criticism, and making the wrong recommendation in documentation leading to litigation.
The study investigators concluded that fears may be mitigated by additional training of pharmacy staff.9 To continue advancing practice, it is imperative for pharmacy leaders to develop best practices to help pharmacists overcome these challenges.
First, pharmacy leaders could leverage clinical pharmacy specialists to develop an education program aimed to increase knowledge and comfort level in communicating via the electronic health record. Interdisciplinary practitioners who are experienced in documentation could be leveraged in the development of documentation templates.
Second, a standardized, objective, and quantifiable competency assessment could be developed to assess the knowledge and skills that are taught. The assessment may also be used as a powerful tool to identify further opportunities for improvement.
Finally, it is equally imperative to develop a methodology to systematically quantify documentation as clinical interventions. This is crucial in demonstrating the clinical and financial impacts pharmacists have for the institution.
