Pharmacists better at prescribing: study


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Collaborative prescribing sees hospital pharmacists achieve a 90% error-free rate on medication orders compared with 26% for medical officers

Pharmacists in the emergency department and admissions unit setting have been found to be more accurate at making medication orders than their medical officer counterparts – under specific conditions.

The Australian study, conducted by researchers from the Metro North Hospital and Health Service in Brisbane, reviewed collaborative pharmacist-prescribed charts for 17 patients and medical officer-prescribed charts for another 17 patients.

This equated to 146 medication orders written by a pharmacist and 145 written by a medical officer.

Where the pharmacist acted as prescriber, a pharmacist completed the medication history as is usual practice, documented on a medication action plan.

The prescribing pharmacist then collated recommendations on continuation, withholding or ceasing usual medicines.

Medication history and recommendations were discussed with the admitting medical officer to agree on a medication plan.

Medication charts were reviewed by the usual ward pharmacist, as is usual practice, to perform medication reconciliation.

Meanwhile when the medical officer acted as prescriber, the medication history was taken by a pharmacist either before or after the medication chart of ongoing medicines had been completed.

The admitting medical officer was in charge of prescribing the medication chart.

There were three errors identified in the pharmacist prescriber group (2% chance of error per medication order) and 23 errors identified in the medical officer prescriber group (16% chance of error per medication order).

In the pharmacist-prescribed charts, one error was considered to have high potential for patient harm (<1% chance of medium-very high risk error per medication order), whereas the other two issues were considered low risk.

In the medical officer-prescribed charts, 15 of 23 orders (65%) were considered to have a medium, high or very high risk of patient harm (10% chance of medium-very high risk error per medication order).

When assessed using the national inpatient medication chart (NIMC) audit tool, 90% of medication orders written by the pharmacist were considered error free.

The error-free rate for medical officers was 26%.

“Pharmacist prescribing is in the early stages of practice in the Australian setting,” said the researchers.

“The present small study demonstrates that pharmacist prescribing of regular medicines for general medical patients is safer and more accurate than medical officer prescribing.”

The study was published in the Journal of Pharmacy Practice and Research.

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6 Comments

  1. Philip Smith
    27/04/2019

    While good to see, how many years experience did each have in their current position?

  2. pagophilus
    27/04/2019

    Was the pharmacist position funded or subsidised? When there’s a small number of pharmacists involved in a study, the accuracy goes up. But if pharmacist prescribing would be scaled up and rolled out and would be subject to the usual time and workload pressures, how high would the accuracy be then? I believe still higher than doctors, but how much higher?

    If you gave doctors a proper education on prescribing requirements (including PBS peculiarities) and employed more of them to ease time pressures, how high would their accuracy rate be? With their workload, medical prescribing is often little more than an afterthought, especially on weekends.

    • Michael Ortiz
      27/04/2019

      Interesting pilot study of collaborative prescribing.
      I suggests that there needs to be a larger study to confirm these results.
      The low level of error free medical officer prescribing should of concern.
      This study provides evidence that pharmacists could make a positive contribution in the ED given the opportunity and allow medical officers to focus on treating seriously ill patients. Pharmacy services would need to provide 24 hour coverage.
      Consideration should be given to examining prescribing error rates in medical and surgical wards and conducting similar pilot studies of collaborative prescribing.
      Scale up of collaborating prescribing may result in increased error rates by pharmacists, but of more concern is the level of serious errors made by medical officers in the ED. What can be done to reduce the risk of harm from prescribing errors to already sick patients attending the ED? Educating medical officers about the PBS peculiarities is unlikely to achieve this, where collaborative prescribing may?

      • pagophilus
        27/04/2019

        We found getting doctors to do a few med recs helps them to understand the process and its necessity, but ultimately they don’t have the time to do it properly. Which is also why I feel that in the real world outside of a study, pharmacists may not do such a good job either due to our own time pressures. (Modern management’s modus operandi is push your employees until they start dropping like flies, then turn it down a wee bit. You’re always operating at that level where you can’t just devote yourself completely to the task at hand because there’s always something else pressing to be done.)

        • Michael Ortiz
          27/04/2019

          I understand your concerns but we need to look at the whole picture. Collaborative prescribing is about fixing a problem in the ED. There are also problems with the Medication distribution systems in most hospitals with unacceptably high error rates. Pharmacists need to stop hiding in the basement and become more proactive in ensuring that right patient gets the right drug at the right dose at the right time. Pharmacists have a responsibility to stand up and draw attention to these problems. It may even surprise management if someone were to conduct a cost benefit analysis of collaborative prescribing. A 9% absolute reduction in serious prescribing errors will have a financial saving. At around $1000 a day per admitted patient, then it doesn’t take too many prescribing errors to make this service value for money from a hospital management perspective. Pharmacists need to stop making excuses and become more evidence based about expanding professional services in areas of unmet clinical need. You should be congratulating the researchers for their vision and in conducting this innovative research. I hope we see more studies looking at how pharmacist can meet unmet clinical needs associated with medications. How hospitals are able to avoid 24 hour pharmacy services should no longer be allowed to continue based on this study alone. Patients don’t take medicines between the hours of 8am and 5 pm Monday to Friday. Pharmacist services should be available whenever patients are admitted to hospitals

          • 27/04/2019

            Guys this is old news. There are many hospitals already adopting this collaborative prescribing model in in one form or another. Cost benefit has been proven time and time again, from memory it’s about $1.47 saved for every $1 spent.

            In terms of hospital pharmacy, major tertiary hospitals have departments of 120 EFT+, there are specialist clinical pharmacists, junior pharmacists and pharmacy has active executive roles with anything related to medication safety. The medical interns and HMO’s absolutely rely on their ward pharmacist.

            Hospital pharmacy is thriving. Professor Dooley ex SHPA president did wonders for hospital pharmacy.

            One key ingredient is that pharmacy worked collaboratively with all health professionals including and especially doctors. Our skills are acknowledged and we are welcomed in our entirety to fit the healthcare system of the hospital. In hospital pharmacy you can proudly call yourself a clinician. Surgeons absolutely cherish you as they know comparatively little about medications.

            I have now left the comfortable confines of the hospital and found the opposite to be true in community.

            Our profession is at war with our medical colleagues. Although I thoroughly understand the complexities of catering for pharmacy owners and their investments, I do not believe it needs to be in conflict with our medical peers.

            Pharmacy and Medicine should be working together. The GP+Pharmacist relationship can and should be an ASSET of our healthcare system.

            It works all so well in acute care. We need to learn. #StrongerTogether

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