Study design
The World Health Organisation’s (WHO) accepted methodology for
determining healthcare staffing, the Workload Indicators of Staffing
Need (WISN), was used as a theoretical framework for this study[14].
This has been applied in many healthcare settings
internationally[15-17], but there are no published reports of its
application to pharmacy services. Using the WISN approach required
defining the ‘Activity Standard’ (i.e. the tasks and their times and
frequencies) for clinical pharmacy service delivery (Figure 1).
WISN suggests that this should be a consensus of ‘experts in the field’
and so developing this consensus on the ‘Activity Standard’ for
pharmaceutical care formed the primary aim of the study this paper
reports on. This also involved establishing the amount of time when
pharmacy staff do not undertake clinical activities, which is termed
here as ‘unavailable’ time. A two-round Delphi study (a well-established
method of developing consensus)[18-21] was undertaken to confirm the
‘Activity Standard’ for in-patient clinical pharmacy services and the
‘unavailable’ time for pharmacy staff. This was distributed and returned
by email which facilitated a wide geographical response.
The second aim of the study was to establish the reliability of the tool
through a subsequent ‘operator evaluation’. This was completed by
respondents from the Delphi study, again distributed and returned by
email. Participants were provided with a copy of the CPWC, including
instructions for use, and asked to use it to answer three hospital
pharmacy staffing scenarios (shown in Table 1). Answers generated by
participants were compared to identify whether a consistent response was
achieved.