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.