Obstetric Assistant Pharmacist: Innovative Workforce Solution During Surges in Workforce Shortage and Demand Open Access

COVID-19 has brought with it nursing and midwifery workforce shortages due to sickness, burnout, and recruitment challenges. A recent study reported that between 2018 and 2023, the number of registered midwives in Australia would decline from 28,087 to 26,642.^[1] The pandemic was reported to exacerbate the midwifery workforce shortage and significant skill mix issues in the workforce.^[2] In Western Australia, the significant workforce shortages have resulted in midwifery positions on postnatal wards being filled by nursing staff to cover midwives who are clinically trained or professionally registered to provide midwifery care.^[3] This unprecedented situation has created challenges, opportunities, and innovative workforce solutions working collaboratively with the pharmacy department in health organizations across Australia.^[4–6] These innovative pharmacist roles demonstrated during workforce shortages included completion of medication history,^[5] double-checking medications with the nurse,^[5] ordering medications,^[5] and assisting with bedside intravenous infusion in the intensive care unit.^[6] Previous literature also demonstrated that the pharmacist’s role was adapted to fit the needs of healthcare institutions with positive outcomes, such as pharmacist-led penicillin allergy assessment, pharmacist-led intervention strategies for managing type 2 diabetes mellitus, and opioid stewardship pharmacists.^[7–9]

The 300-bed study hospital (including 100 neonatal cots) is the only tertiary maternity and gynecological hospital in Western Australia. More than 6,000 births occur annually, and it is the only major referral center in the state for high-risk pregnancies. The significant shortages of midwives in Western Australia commanded attention to finding solutions to the workforce challenges.^[3] In the study hospital, a clinical support pharmacist role (obstetric assistant pharmacist) was approved to assist hospital midwives with medication-related tasks to direct more midwifery time to patient care. The position was supported and financially funded by the obstetrics and gynecology directorate in the hospital. The financial funding of the novel position was from the budgeted, allocated full-time equivalent (FTE) for nurses/midwives, hence, no additional budget was required to implement the strategic solution.

Before establishing the role, a document was developed to include the duties and responsibilities of the obstetric assistant pharmacist. As this role would coexist with the ward clinical pharmacist, the need to clearly delineate the two roles was deemed essential.^[5]

The obstetric assistant pharmacist’s duties included the following:

• Daily controlled medicines (Schedule 4 recordable and Schedule 8) checks, stock received or issue, second person check, as required by relevant legislation

• Independent second check of medication administration as required by the hospital guideline

• Non-imprest controlled medicine orders processed via REDCap database

• Central intravenous additive service (CIVAS) order for neonates

• Provision of discharge medications to patients

• Weekly controlled medicines imprest delivery

The duties, responsibilities, and workflow guide for the role were discussed and finalised over several weeks in the fortnightly departmental clinical meeting for the pharmacists. The meetings were useful in communicating the new role to the department and effective in the role discussion with useful input from the clinical pharmacists on the wards. The newly established role was implemented in January 2023.

This report aimed to was to describe the innovative leadership in the role establishment of obstetric assistant pharmacist and to evaluate the was to obtain an understanding of the value and impact of the role in the obstetric wards. Objectives were to: (1) to evaluate the time taken per activity performed by the pharmacist and how this would subsequently affect time saved per week, and (2) assess satisfaction and added value by the obstetric assistant pharmacist from the midwifery team’s perspectives with a survey completed by the staff.

The study was conducted across two obstetric wards. A self-activity report on activities performed and the time involved was documented by the obstetric assistant pharmacist over a 2-week period in March 2023. The time-in-motion study was evaluated the time taken per activity and how this would subsequently affect time saved per week based on average time and number of occurrences over a week. A feedback survey was collected to gauge the midwifery response regarding the role. The survey was disseminated as an online survey form via email and hardcopy on the obstetric wards.

Figure 1 identifies the time taken and saved for midwifery staff per week, which was calculated based on FTE requirements. A total of 2371.2 midwifery staffing minutes were saved over a period of 1 week, equating to 1.04 FTE.

An online feedback survey was conducted to understand ward feedback regarding the role. A total of 12 responses were received, with an approximate response rate of 25% based on the estimated number of midwives on the two obstetric wards to be minimum of 48. The timeframe for the responses was extended numerous times from first 2 weeks of March to the whole month; however, current work constraints may have contributed to a low response rate. Appendix 1, available online, outlines the responses from the survey.

Overall, the service received a 4.5 rating out of 5 for the role provided by the pharmacist. Of staff members who responded to the survey, 10 (83.3%) agreed that it is useful to have a pharmacist complete the daily controlled medicines checks, 11 (91.7%) believed they would have more time without having to check the daily balances, corresponding with 10 (83.3%) recognizing that checking controlled medicines was a time-consuming activity. A total of 11 (91.7%) respondents agreed that having a pharmacist on the wards is very useful to assist with medication management and queries.

Feedback from the midwives has been positive toward the pharmacists covering the role. Feedback responses included the following:

• “This has been so helpful having you around on the ward.”

• “It has freed up a lot of time for us.”

• “Scheduled delivery checks have been a lot less time-consuming.”

• “Great service, which has saved time on the ward.”

One respondent was unaware of the service provided, and this coincided with a feedback response noting that it was difficult to identify which ward pharmacist was available for medication checks.

Overall activity and feedback have shown the value of the obstetric assistant pharmacist in assisting midwifery staff with administration tasks regarding medication management. The presence of a pharmacist to assist with the handling, storage, reconciliation, and custody of scheduled medications on the wards has assisted with a time capacity of 1.0 FTE across two obstetric wards.

Controlled medicine daily checks freed up another midwife’s time to be available on the ward to attend to patients’ needs. On average, the counts took 50 minutes to complete on both obstetric wards. The obstetric assistant pharmacist assisted in ordering ad-hoc and non-imprest controlled medicines, requesting returns, and ordering CIVAS medications for neonates via the REDCap online portal. On average, these requests took approximately 8 minutes to complete.

The discharge process is often a very timely process for both midwives and clinical pharmacists. Depending on the complexity of the patient and the medications required on discharge, a discharge may take up to an hour to complete. Being present on the ward to provide discharge counseling and medications to the patients gave the midwives more time to finalize their patients’ discharge checklists. The obstetric assistant pharmacist’s assistance improved the discharge process’s timeliness, therefore fast-tracking discharges and freeing up beds for new admissions.

The limitation identified in the study was that the number of surveys received from midwives was relatively small and did not represent all midwives on obstetric wards. However, the responses received reflected the value of using this pharmacist to assist in medication management, which had been welcomed by midwifery staff with positive feedback received, which was valuable for staff morale during staff shortages.

The obstetric assistant pharmacist role was reviewed in December 2023, and the funding was extended for another 12 months based on the positive findings reported in this study and the availability of funding from midwife shortages. This is an innovative strategy to address the workforce shortages and increased demand for the nursing/midwifery workforce. The implementation of the obstetric-assistant pharmacist is patient-centered and consumer-focused. The role supports comprehensive patient counseling on discharge, improving patients’ understanding of medications. It also supports the midwives with medication-related tasks and redirects midwives to improve patient care and promote safe medication practice. The model could be adapted to suit the workflow and requirements of public and private hospitals with increased workforce demand and experienced workforce shortages.