Pharmacists critical to prescribing process


prescription

A recent Australian trial found pharmacist involvement in medication charting lowered inaccuracies from 41.1% to just 1.4%. AJP spoke with the lead researcher to find out more…

During the one-month trial held in a Sydney teaching hospital, preadmission clinic pharmacists completed 72 medication charts as part of an intervention to find out the impact they would have on chart accuracy and completeness.

The study results, published in the October issue of the Journal of Pharmacy Practice and Research, found pharmacist involvement led to the proportion of charts with inaccuracies lowering from 41.1% to 1.4% (p < 0.001).

Only one (1.4%) pharmacist-prescribed medication chart was identified as having an inaccuracy, which was an error citing the generic name of a branded product.

The study also found that pharmacist involvement led to completeness of charts significantly improving, from 5.4% to 80.6% (p < 0.001).

A/Prof Beata Bajorek
A/Prof Beata Bajorek

AJP interviewed lead author Associate Professor Beata Bajorek, from the University of Technology Sydney, about what the results mean for hospital pharmacists.

1. Why are the findings of this research important?

The findings are important for several reasons. First, this study addresses one of the most important steps in a patient’s treatment – the prescribing of medicines, which is a core part of a patient’s clinical management.

It’s the process where the details of the therapeutic intervention are recorded and communicated to all members of the team; in a hospital setting, this treatment plan is ‘operationalised’ via the medication chart (and referred to as ‘charting’).

It is therefore critically important that the medication chart is both complete (that is, it contains all the specific information required about the treatment) and accurate (or more to the point, error-free), and prepared in a timely fashion. So, we’ve focused on a really important step in patient care.

Second, the study shows how we can better utilise our hospital pharmacists’ skills and expertise in pharmacotherapeutics, and their ‘eye for detail’, to ensure that we have the best medication chart possible for each patient to serve as the foundation of the patient’s treatment plan.

In this study, medication charts prepared by our hospital pharmacists for patients presenting to a pre-admission clinic were significantly more complete and accurate than those that were prepared by hospital doctors.

In fact, the pharmacist-prepared charts were near to 100% accurate – that is exactly what we want in the hospital setting, where we are providing complex care to at-risk and highly vulnerable patients.

We’ve shown that by tapping into the pharmacists’ unique skills and expertise, we can in fact achieve the medication safety and quality use of medicines that we’re striving for.

Additionally, we’ve shown that these significant outcomes can be achieved with relatively simple adjustments to the workflow, using existing pharmacists who are integral to the pre-admission clinic review process – they are the health professionals who are already responsible for eliciting a comprehensive medication history as well as for identifying therapeutic interventions and generating treatment recommendations that are important to the pre- and post-operative management of a patient.

In this study, we’ve simply extended the pharmacists’ existing role by enabling them to document their therapeutic recommendations and interventions on the medication chart as part of their scheduled patient consultation.

2. Do you think it’s possible in the near future for pharmacist charting to be implemented across Australian hospitals?

Certainly, pharmacist charting could be implemented across Australian hospitals. Many hospitals already have a range of dedicated clinics and units where pharmacists are already core members of the teams and are integral to these steps in the medicines management pathway – in these settings, medication charting is a logical application and extension of the pharmacists’ service.

3. How does pharmacist prescribing play into the pharmacist charting role?

Medication charting is a form of prescribing, similar to the protocol or supplementary models of pharmacist prescribing that have been implemented overseas.

Such models work particularly well in hospital settings where the diagnostic steps in the prescribing process are very comprehensive, well documented, and accessible to all health professionals – this provides the pharmacist the necessary foundation for generating therapeutic recommendations, in complement with their own comprehensive assessment of the patient’s medication history and their expert knowledge of therapeutics.

In this study we’ve shown the benefits of such a model, where there is extensive multidisciplinary collaboration between the pharmacist, nurse and doctor, and where each health professionals skills are maximised – it’s a perfect example of how pharmacist prescribing can support the patient care process to ensure both safe and effective treatment.

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3 Comments

  1. John Wilks
    30/10/2017

    This report builds on similar strong results when pharmacists construct med charts. I have been involved bmat the admission point and now do med chart reviews when the patient hits the ward. The errors on charts dine by drs validates these findings. My worst case was 11 ommissions and two charted errors. It is past the time when pharmacists construct admission charts.

  2. Raymond Li
    31/10/2017

    I think everyone needs to be very careful with how these results are being represented in this story. While the key results presented in this article are very encouraging for pharmacists, after reading the full paper, I want to highlight several limitations listed below:

    1. As the authors have acknowledged in the limitations section, it is important to note that this is just a pilot study involving 1 hospital and 2 PAC pharmacists. A larger study is definitely required to confirm these results.
    2. The pre-intervention baseline results were published in 2011, and the post intervention results were published now in 2017. The 6 year difference is significant and a lot of other factors can influence why there was such a drastic improvement in the reduction of errors in medication charts. Perhaps better education and training for hospital staff? or improvements in the working procedures? We need to take these into consideration before arriving at the conclusion that it is the pharmacists who are responsible for this improvement
    3. There was also a significant difference in the mean number of medications listed on the charts at pre-intervention vs post-intervention. The charts used in the baseline pre-intervention study had a mean of 5.3 medications compared to only 3.6 in this post intervention phase (P<0.01). Obviously more errors are likely when there are more medications listed on charts.
    4. In stage 4 of this study (feedback survey), the results actually showed that there was a decrease in the opinion scores for the following items: (1-10 Likert scale from strongly disagree to strongly agree)

    a) Drug omission on medication charts will or has decreased as a result of pharmacist charting in PAC
    (9 down to 7.6)
    b) Charting and prescribing errors will have been decreased as a result of pharmacist charting in PAC
    (8.5 down to 7.6)
    c) The pharmacist charting service will or has increased the efficiency and overall workflow in PAC
    (8 down to 6.6)

    And most significantly:

    d) Pharmacist charting in PAC may or has helped improve clinical outcomes for patients
    (7.5 down to 5.5)

    Therefore, these results have to be interpreted with caution before we as pharmacists get too excited.

    Raymond

    • Amber Cameron
      07/11/2017

      I understand you feeling cautious about the results but the UK pharmacists have been involved in medical admissions and checking charts since I left in 2008. They have pharmacist prescribers who are working alongside doctors and independently quite successfully. I’m sure pharmacists in Australia can achieve the same results as our counterparts in the UK.

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