A realist review of pharmacists' integration and participation in interprofessional ward rounds: what works, for whom, why and in what circumstances

Abstract

Introduction: Pharmacists' participation in interprofessional ward rounds has been shown to reduce adverse drug events, improve medication appropriateness and communication about medicines. However, pharmacists do not routinely participate in interprofessional ward rounds with reports of participation varying from 10 % to 39 %. Knowledge about how, under what circumstances and why integration of pharmacists into interprofessional ward round teams can be successfully achieved remains limited.

Objective: A realist review was conducted to explore the underlying causal mechanisms and the contexts that influence the success or failure of pharmacists' integration into interprofessional ward rounds.

Method: Evidence from a literature review focusing on pharmacists and interprofessional ward rounds was synthesised using realist logic. Demi-regularities of contexts, mechanisms, and outcomes relating to pharmacists' participation in interprofessional ward rounds were identified and configured into context-mechanism-outcome configurations to establish causation.

Results: Thirty-six documents were synthesised into twelve context-mechanism-outcome configurations which supported the development of a program theory of how and why pharmacists integrate successfully into interprofessional ward round teams. Introduction of the pharmacist to team members by the consultant can initiate building trust amongst all members of the interprofessional ward round team. Consultants creating shared values and inviting contributions from the pharmacists can create a respectful atmosphere and enable pharmacists to contribute to patient care. The early engagement of multiple internal stakeholders prior to integration of pharmacists in interprofessional ward rounds results in shared solutions which can include discussions of concerns regarding the integration of non-medical practitioners in ward rounds and choosing an appropriate ward or unit for integration.

Conclusion: The causal relationships established between the contexts and mechanisms favouring positive outcomes provides guidance to successful integration of pharmacists in interprofessional ward rounds.

Keywords: Interprofessional practice; Pharmacy; Realist review; Ward round.