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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