Keeping to the standard

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Evidence that hospital pharmacists can prescribe to the same standards as doctors: study

New Australia research provides low to moderate evidence that pharmacists can prescribe to the same standards as doctors in a hospital setting.

A review of 15 English language studies looking at the impacts of pharmacist prescribing on patient outcomes in the hospital revealed generally positive findings, said its authors, from SA Pharmacy and the University of South Australia.   

They found that pharmacists were better at “adhering to dosing guidelines when prescribing by protocol and make significantly less prescribing errors when charting patients’ usual medications on admission to hospital”.

The findings were positive for pharmacist prescribers clinical efficacy across a range of measures. 

Three studies found that pharmacist prescribers made from 20 to 25 less prescribing errors and from three to 116 times less omissions than doctors when prescribing patients’ usual medications on admission to hospital or in the preoperative setting.

In six studies, when pharmacists prescribed warfarin according to dosing nomograms, equivalent numbers or more patients were maintained in therapeutic range when compared to those prescribed by doctors, the review found.

In two studies, pharmacists were better at adhering to warfarin dosing nomograms than doctors, with an average of 100% compliance among patients prescribed to by pharmacists versus 62% compliance among those for whom a doctor prescribed.

In four studies that measured clinical outcomes, there was no difference in blood pressure management between pharmacists and doctors, while patients of pharmacist prescribers had better cholesterol levels (mean difference in low density lipoprotein of 0.4 mmol/L in one study and 1.1 mmol/L in another; mean difference in total cholesterol of 1.0 mmol/L) and blood sugar levels (mean difference of fasting blood sugar levels of 15 mg/dL, mean difference of glycosylated hemoglobin of 2.6%).

The findings were published online in the JBI Database of Systematic Reviews and Implementation Reports.


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