A major trial has reinforced pharmacists’ role in hospital discharges, although some say it is impractical to involve pharmacists 24/7
Published this week in the Medical Journal of Australia, the trial evaluated patient discharge summaries from Melbourne’s Alfred Hospital between March and July in 2015.
General medical patients were randomised to either receive medication management plans completed by a pharmacist (intervention), or standard medical discharge summaries (control).
Led by SHPA’s Young Pharmacist of the Year Erica Tong, the trial found at least one medication error for 61.5% of patients in the control arm, compared with 15% in the intervention arm.
The absolute risk reduction for at least one medication error was 46.5%, while the absolute risk reduction for a high or extreme risk error was 9.6%.
SHPA CEO Kristin Michaels says the study reveals pharmacists completing medication management plans, for patients being discharged, significantly reduces the rate of medication errors.
“This is important because transitions of care, such as discharge from hospital, have been identified as times of risk for medication errors which contribute to adverse events,” Ms Michaels says.
“As members of multidisciplinary teams, pharmacists can advise and support patients to understand changes to medications while in hospital. They are the key professional group to manage medicines advice.”
Medicines mismanagement is a significant problem in Australia, she points out, with about 230,000 hospital admissions being medicines-related and the annual cost of medications-related admissions being $1.2 billion.
“Unless a digital health record becomes a reality, greater recognition for the important clinical role of pharmacists in hospitals will facilitate the collaboration necessary to provide improved medication reconciliation and documentation,” adds Ms Michaels.
In an accompanying editorial in the MJA, professors Jennifer Martin and Jennifer May say the trial results highlight a possible weakness in the current model, in which medication reconciliation is delegated to a junior member of the team.
However, they add that “for most hospitals, providing a 24-hour/seven-day pharmacist service as described in this study (necessitated by the fact that not all patients are discharged during business hours) is unlikely to be feasible”.
“In smaller hospitals and locations in rural and remote Australia, its practicality is even more problematic because of small patient numbers and limited hospital staff numbers,” they add.
Dr Martin and Dr May suggest doctors working together with pharmacists in drug and pharmaceutical matters, as well as a push for doctors to improve their pharmacology knowledge.
“Discussing changed medications with the pharmacist at discharge would also be useful,” they say.
See the full research here.
See the editorial here.