Aim: To evaluate whether pharmacist-assisted electronic warfarin charting and monitoring reduces warfarin-related errors and improves post-discharge continuum of care. Method: Cardiology and medical patients admitted for at least 24 h and prescribed at least one warfarin dose were included in a pre/post-intervention study. The intervention involved pharmacists proactively charting warfarin and ordering international normalised ratios (INRs) using electronic prescribing software, following discussion with medical doctors. Endpoints included: percentage of patients with one or more warfarin errors, INR > 5.0 during admission, readmission within 30 days for anticoagulant-related issues and warfarin discharge plan (WDP) completeness (including documentation of next dose/s, and when and where the next INR was to be checked). Results: Pre-and post-intervention groups comprised 130 and 108 patients, respectively. Post-intervention, more patients received warfarin following heart valve replacement and fewer for venous thromboembolism. Post-intervention, pharmacists ordered 130 doses (72 patients) and 98 INRs (59 patients). Percentage of patients with one or more warfarin errors declined from 27.7 to 7.4% (p < 0.01), with INR> 5.0 decreased from 7.7 to 2.8% (p = 0.17) and readmission within 30 days for anticoagulation problems occurred in 4 and 0 cases pre-and post-intervention, respectively. While there was a non-significant decline in the proportion of patients with a WDP post-intervention, when patients had a WDP it was more comprehensively completed (p < 0.01). Conclusion: Pharmacists proactively charting and monitoring warfarin reduced warfarin-related errors during hospitalisation and improved elements of post-discharge communication. Closer multi-disciplinary communication and 7-day pharmacy services may result in further continuum of care improvements.

Background Despite evidence to support pharmacists practicing in advanced scope roles, embedding such roles into practice is challenging. Upskilling hospital pharmacy technicians (HPTs) to undertake selected clinical support roles under indirect supervision could relieve pharmacists from non‐complex tasks. Aim To compare patient satisfaction with routine postoperative discharge medication education provided by a HPT or pharmacists in a short‐stay surgery setting. Method An HPT completed a comprehensive training program to become a credentialed medication education technician (MEdTech). Consecutive overnight‐staying patients were assigned to receive education by the MEdTech or pharmacists according to staff availability. Patient satisfaction with their education experience was measured via telephone calls the day following discharge. The hospital’s Research Office approved this study as quality improvement. Results Overall, 341 patients were screened and 217 met all inclusion criteria. Two hundred patients provided feedback (100 educated by the MEdTech and 100 by pharmacists). All patients reported high levels of overall satisfaction with their education experience, irrespective of which pharmacy staff member provided the education; a finding supported by the qualitative feedback. Significantly more MEdTech‐educated patients were very satisfied with the amount of information provided (92% vs 79%) and ease of following the education (97% vs 86%) than pharmacist‐educated patients, respectively. Conclusion This study supports advanced practice HPTs assisting with the provision of medication information to patients. This novel workforce model could facilitate pharmacists working in advanced‐scope roles by having advanced HPTs undertake uncomplicated aspects of clinical pharmacy within a defined scope of practice and with specific pharmacist referral criteria.