Pharmacist intervention tops the charts

hospital pharmacist medication chart

Medication errors are among the most common incidents reported in hospitals, new research has shown

The study, led by Monash University and Alfred Health researchers evaluating a collaborative model to reduce medication errors and length of hospital stay, has been published in the British Journal of Clinical Pharmacology and is the largest study of its kind conducted across multiple hospitals in Victoria.

Medication errors often occur at hospital admission, the study of 8,648 patients across seven hospitals found.

It examined the outcomes of an intervention involving medication charting by pharmacists using a partnered pharmacist model compared to traditional medication charting.

“The primary outcome variable was the length of inpatient hospital stay,” the authors wrote.

“Secondary outcome measures were medication errors detected within 24 hours of the patients’ admission, identified by an independent pharmacist assessor.

“A total of 8,648 patients were included in the study. Patients who had partnered pharmacist medication charting (PPMC) had reduced median length of inpatient hospital stay from 4.7 (IQR 2.8‐8.2) days to 4.2 (IQR 2.3‐7.5) days (p<0.001).

“PPMC was associated with a reduction in the proportion of patients with at least one medication error from 66% to 3.6% with a NNT to prevent one error of 1.6 (95% CI: 1.57‐1.64).”

Principal investigator Professor of Clinical Pharmacy at Monash University’s Centre for Medicine Use and Safety and Director of Pharmacy at Alfred Health, Michael Dooley, said timely medication reconciliation and review of patients’ medications by pharmacists is not routine in many settings, and if it occurs, it’s often sometime after admission.

“Errors relating to medications are often not identified or rectified in a timely manner, resulting in patient harm and increased duration of hospitalisation; however, early interventions such as the PPMC model have shown to be effective in significantly reducing medication errors and subsequent patient harm,” he said.

“It’s conceivable that the partnered pharmacist charting model contributes to a reduction in inpatient length of hospital stay by improving the timely delivery of appropriate therapy immediately upon the patient’s admission.”

Medication error rates in the setting of standard medical charting observed in the pre-intervention phase of the study were consistent with previous studies. 

PhD candidate at Monash University’s CMUS, Chief Pharmacy Information Officer and Deputy Director of Pharmacy at Alfred Health, Erica Tong, said potential factors associated with such errors may be the multiple tasks provided by junior medical officers in the setting of an acute admission, and the often-limited history available from patients who are acutely unwell. 

“Pharmacists are well-placed to work collaboratively with the medical team to optimise medication therapy at the time of admission,” she said.

“Consideration should be given to implementation and evaluation of the partnered pharmacist charting model that operates around the clock.

“Implementation of this model to other clinical areas such as surgical and oncology services should be considered, and evaluation of the impact on electronic prescribing systems on this model should also be investigated.”

A national credentialing program for partnered pharmacist charting is being implemented, and further expansion of this model across Victorian rural and regional areas, oncology services and private hospitals is underway. 

“Expansion of a collaborative medication-charting model to reduce length of hospital stay and medication errors can have a large impact in an era where physician burnout is a major concern, balanced against reducing clinical risk for patients and maximising the use of resources available,” said Professor Dooley.

The authors concluded that, “Expansion of the partnered pharmacist charting model across multiple organisations was effective and feasible and is recommended for adoption by health services”.

A spokesperson for the Society of Hospital Pharmacists of Australia told the AJP that the results had been foreshadowed by the recent Pharmacy Board announcement of its position on pharmacist prescribing.

At the time, SHPA Chief Executive Kristin Michaels welcomed the Board’s acknowledgment there are no regulatory barriers in place for pharmacists to prescribe “via a structured prescribing arrangement or under supervision within a collaborative healthcare environment”.

Ms Michaels said that the Board’s statement was “strong endorsement for the continuation of clinical pharmacy practices in Australian hospitals that already involve medication chart review and endorsement, and which are proven to improve patient care by optimising the efficacy of multidisciplinary teams”.

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1 Comment

  1. (Mary) Kay Dunkley

    In 1983 as a trainee pharmacists I undertook a survey on the incidence and type of errors and omissions on prescriptions and drug charts in a major teaching hospital (The Alfred Hospital in Victoria) and considered their contribution to the pharmacist’s workload. This was only a small project in comparison to the one described above. However it is of concern that 36 years later we are still looking at similar issues albeit in a much more sophisticated way on a much larger scale and with proposals to address it with pharmacist charting of medications. It is essential to ensure that there are adequate pharmacists in all hospital pharmacies around Australia in order to ensure that we can be effective in addressing this issue which continues to put patients in our hospitals at risk.

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