Collaborative doctor–pharmacist prescribing in the emergency department and admissions unit: a study of accuracy and safety

Abstract

Prescribing by pharmacists in a collaborative manner has been occurring in the UK for several years. There are minimal studies involving pharmacist prescribing in Australia. In the present audit, 34 medication charts (17 each from the pharmacist prescriber and medical officer) were reviewed for safety and accuracy. Medication charts written by a pharmacist were more accurate than those written by a medical officer when compared to the medication history. Discrepancies and omissions had more potential for patient harm in the charts written by the medical officer. In all, 146 orders prescribed by pharmacists and 145 orders prescribed by medical officers were reviewed for safety. Of these, 90% of orders written by the pharmacist were error free, compared with 26% written by medical officers. The incorporation of pharmacist prescribers into the admissions process has the potential to improve patient safety and decrease medication errors.

Impact of pharmacist interventions provided in the emergency department on quality use of medicines: a systematic review and meta-analysis

“…These studies included 13 242 participants in total, with sample sizes varying considerably between 34 and 3594 participants 17 18. Ten studies were controlled pre–post interventional studies,19–28 nine were cohort studies,29–37 three were RCTs,38–40 three were controlled concurrent studies,18 41 42 three were pre–post interventional studies without controls,17 43 44 two were controlled sequential studies45 46 and one was a multicentre cross-sectional study 47. Seven of the studies exclusively limited the participants to older adults, aged 65 years and above 18 23 28 40 41 45 46…”

“…Ten studies were controlled pre–post interventional studies,19–28 nine were cohort studies,29–37 three were RCTs,38–40 three were controlled concurrent studies,18 41 42 three were pre–post interventional studies without controls,17 43 44 two were controlled sequential studies45 46 and one was a multicentre cross-sectional study 47. Seven of the studies exclusively limited the participants to older adults, aged 65 years and above 18 23 28 40 41 45 46…”

“…Types of interventions were clustered around eight activities (table 2 and online supplemental table 4). Pharmacists were predominantly involved in comprehensive medication reviews and order verification,19 20 22 23 28–33 37–42 44 45 identification of drug-related problems,19 32 40 41 43 46 47 structured patient and/or caregiver interviews,19 20 28 33 37–41 43–47 or medication prescribing/co-prescribing 18 20 21 23 29 35 36 46…”

Impact of proactive pharmacist‐assisted warfarin management using an electronic medication management system in Australian hospitalised patients

“…Several recent Australian studies have demonstrated partnered pharmacist charting of medicines to be safe and effective in reducing medication‐related errors in areas such as orthopaedics, the emergency department and general medicine . Partnered pharmacist anticoagulant prescribing in an Australian ambulatory care Hospital In The Home (HITH) program, reduced time to reach therapeutic INR and facilitated earlier discharge back to community care …”

A study to investigate the impact of a clinical pharmacist on post take ward round medication communication, prescribing and appropriateness

“…This extends the scope by offering additional flexibility to pharmacists prescribing beyond "Supplementary prescribing" which is limited to working in partnership with an independent prescriber within an individualised clinical management plan (206). Pharmacist-Physician Collaborative Ordering of Medications on admission and discharge is a model of care with proven benefits in medication safety and appropriateness, continuity of care, reduced length LOS and has been demonstrated to be sustainable (76,196,201,(207)(208)(209). As presented and discussed in Chapter four, 8.3% of in-depth discussions were not actioned in the comparator group and 7.1% in the intervention group: these offer an opportunity for improved prescribing.…”