Care providers' satisfaction with restructured clinical pharmacy services in a tertiary care teaching hospital.

BACKGROUND At the time this study was undertaken, clinical pharmacy services at the authors' institution, a tertiary care teaching hospital, were largely reactive in nature, with patients and units receiving inconsistent coverage. OBJECTIVE To develop an evidence-based model of proactive practice and to evaluate the satisfaction of pharmacists and other stakeholders after restructuring of clinical pharmacy services. METHODS The literature was reviewed to determine a core set of pharmacist services associated with the greatest beneficial impact on patients' health. On the basis of established staffing levels, the work schedule was modified, and pharmacists were assigned to a limited number of patient care teams to proactively and consistently provide these core services. Other patient care teams continued to receive reactive troubleshooting-based services, as directed by staff in the pharmacy dispensary. A satisfaction survey was distributed to all pharmacists, nurses, and physicians 18 months after the restructuring. RESULTS Of the 26 pharmacists who responded to the survey, all agreed or strongly agreed that the restructuring of services had improved job satisfaction and patient safety and that other health care professionals valued their contribution to patient care. Nurses and physicians from units where pharmacists had been assigned to provide proactive services perceived pharmacist services more favourably than those from units where pharmacist services were reactive. Pharmacists, nurses, and physicians all felt that proactive pharmacist services should be more widely available. Challenges reported by pharmacists included increased expectations for documentation and guilt about "cutting back" services where they had previously been provided. CONCLUSIONS Restructuring clinical pharmacy services in an evidence-based manner improved pharmacists' satisfaction and created demand from other stakeholders to provide this level of service for all patients.