Pharmacist-Managed Toxicology Consult Service at the Ottawa Hospital: DISCUSSION part 2
Studies based on reviews of medical records have limitations. The accuracy of the data depends on the adequacy of documentation and the ability to identify all eligible patients who meet the inclusion and exclusion criteria. To minimize the potential impact of these methodologic limitations in this study, patients with toxic exposure referred to the TCS were identified prospectively, and data were extracted from multiple sources, including written consultation notes, medical records, and electronic databases. As a result, less than 1% of the data collected were missing from our database.We used a survey to gather information about residents’ perceptions of the value of the TCS. The validity of survey data depends on the adequacy of sampling within the target population and the response rate within the sampling frame. Despite the lack of a participation incentive, the survey response rate was 90%, which meant that the risk of responder bias was low. The risk of coercion was minimized by ensuring that the survey was anonymous and that potentially identifying variables (e.g., year of residency completion) were changed to categorical variables. The sensitivity analysis showed no evidence of recall bias between the 2 groups of former pharmacy residents with respect to the skills and values gained by participating in the TCS. The only significant difference between groups was the level of stress encountered. Contributors to the level of stress may have been differing workload, requests for consultations at different times of the day, and different levels of training. Overall, the residents agreed that the TCS had been a valuable learning experience that had allowed the development of useful skills and values for those starting careers, regardless of profession. These results reinforce the importance of this component of the residency training program at the Ottawa Hospital. Given the nature of the survey, which focused on the impact of the TCS for residents, it was impossible to determine whether the residents would have developed these attributes without participation in the TCS; however, this limitation is inherent to all surveys of this type.
CONCLUSIONS
The Ottawa Hospital’s TCS is a unique service available to medical staff and their patients and represents an important component of the educational and experiential training of pharmacy residents. The components of a written toxicology consultation note that physicians perceive as essential were identified, and this information was used to evaluate the completeness of consultation notes prepared during the 1-year study period. The variety of overdoses observed during the study period illustrated the complexity of cases for which consults are requested and provided guidance for further training initiatives. Most former pharmacy residents felt that participation in the program had been an important part of their residency, and the skills and values that they developed were useful in their subsequent careers. This study provides a benchmark for the residency program at the Ottawa Hospital and perhaps a model for other pharmacy residency programs.
