Abstract:Background
Pharmacist prescribing is now well established in several western countries. In New Zealand, an independent prescribing authority for suitably experienced clinical pharmacists has been approved, subject to successful delivery of a postgraduate educational program.
Aim
To describe the development of an educational program for pharmacist prescribers in New Zealand and to reflect on its suitability in producing safe and competent pharmacist prescribers.
Method
The educational program was based on simil… Show more
“…1). One of four pharmacists participated, each having a minimum of 6 years of clinical pharmacy experience, employed at a senior pharmacist level and had recently demonstrated a consistent level of competent ward-based performance measured using a clinical competency assessment tool [6]. The lead researcher briefed each of the pharmacists regarding their role and the expected level of interaction on the PTWR.Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Poor prescribing leads to patient harm through increased medication errors and adverse drug events (ADEs) [1]. Interventions by clinical pharmacists are known to improve the safety and quality of prescribing [2–5], with most interventions occurring independent of the ward round [6, 7]. In Australia, the duties of hospital based clinical pharmacists working on hospital wards includes medication reconciliation, clinical review and overall contribution to the medicines management pathway in order to minimise the risks associated with the use of medicines and to optimise the use of medicines [6].…”
Background
Medication communication and prescribing on the post-take ward round following patient admission to hospital can be suboptimal leading to worse patient outcomes.
Objective
To evaluate the impact of clinical pharmacist participation on the post-take ward round on the appropriateness of medication prescribing, medication communication, and overall patient health care outcomes.
Setting
Tertiary referral teaching hospital, Brisbane, Australia.
Method
A pre-post intervention study was undertaken that compared the addition of a senior clinical pharmacist attending the post-take ward was compared to usual wardbase pharmacist service, with no pharmacist present of the post-take ward round. We assessed the proportion of patients with an improvement in medication appropriateness from admission to discharge, using the START/STOPP checklists. Medication communication was assessed by the mean number of brief and in-depth discussions, with health care outcomes measured by comparing length of stay and 28-day readmission rates.
Main outcome measures:
Medication appropriateness according to the START/STOPP list, number and type of discussions with team members and length of stay and readmission rate.
Results
Two hundred and sixty patients were recruited (130 pre- and 130-post-intervention), across 23 and 20 post-take ward rounds, respectively. Post-intervention, there was increase in the proportion of patients who had an improvement medication appropriateness (pre-intervention 25.4%, post-intervention 36.9%;
p
= 0.004), the number of in-depth discussions about patients’ medication (1.9 ± 1.7 per patient pre-intervention, 2.7 ± 1.7 per patient post-,
p
< 0.001), and the number relating to high-risk medications (0.71 ± 1.1 per patient pre-intervention, to 1.2 ± 1.2 per patient post-,
p
< 0.05). Length of stay and 28-day mortality were unchanged.
Conclusion
Clinical pharmacist participation on the post-take ward round leads to improved medication-related communication and improved medication appropriateness but did not significantly improve health care outcomes.
“…1). One of four pharmacists participated, each having a minimum of 6 years of clinical pharmacy experience, employed at a senior pharmacist level and had recently demonstrated a consistent level of competent ward-based performance measured using a clinical competency assessment tool [6]. The lead researcher briefed each of the pharmacists regarding their role and the expected level of interaction on the PTWR.Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Poor prescribing leads to patient harm through increased medication errors and adverse drug events (ADEs) [1]. Interventions by clinical pharmacists are known to improve the safety and quality of prescribing [2–5], with most interventions occurring independent of the ward round [6, 7]. In Australia, the duties of hospital based clinical pharmacists working on hospital wards includes medication reconciliation, clinical review and overall contribution to the medicines management pathway in order to minimise the risks associated with the use of medicines and to optimise the use of medicines [6].…”
Background
Medication communication and prescribing on the post-take ward round following patient admission to hospital can be suboptimal leading to worse patient outcomes.
Objective
To evaluate the impact of clinical pharmacist participation on the post-take ward round on the appropriateness of medication prescribing, medication communication, and overall patient health care outcomes.
Setting
Tertiary referral teaching hospital, Brisbane, Australia.
Method
A pre-post intervention study was undertaken that compared the addition of a senior clinical pharmacist attending the post-take ward was compared to usual wardbase pharmacist service, with no pharmacist present of the post-take ward round. We assessed the proportion of patients with an improvement in medication appropriateness from admission to discharge, using the START/STOPP checklists. Medication communication was assessed by the mean number of brief and in-depth discussions, with health care outcomes measured by comparing length of stay and 28-day readmission rates.
Main outcome measures:
Medication appropriateness according to the START/STOPP list, number and type of discussions with team members and length of stay and readmission rate.
Results
Two hundred and sixty patients were recruited (130 pre- and 130-post-intervention), across 23 and 20 post-take ward rounds, respectively. Post-intervention, there was increase in the proportion of patients who had an improvement medication appropriateness (pre-intervention 25.4%, post-intervention 36.9%;
p
= 0.004), the number of in-depth discussions about patients’ medication (1.9 ± 1.7 per patient pre-intervention, 2.7 ± 1.7 per patient post-,
p
< 0.001), and the number relating to high-risk medications (0.71 ± 1.1 per patient pre-intervention, to 1.2 ± 1.2 per patient post-,
p
< 0.05). Length of stay and 28-day mortality were unchanged.
Conclusion
Clinical pharmacist participation on the post-take ward round leads to improved medication-related communication and improved medication appropriateness but did not significantly improve health care outcomes.
“…The role of pharmacists as collaborative, supplementary prescribers is well established in the United Kingdom (UK). These pharmacists who have appropriate registration and experience have been authorized to register as supplementary prescribers since 2004 and as independent prescribers since 2007 . Independent prescribing rights were granted to credentialed New Zealand pharmacists in 2013 .…”
Section: What Is Known and Objectivementioning
confidence: 99%
“…These pharmacists who have appropriate registration and experience have been authorized to register as supplementary prescribers since 2004 and as independent prescribers since 2007. 6 Independent prescribing rights were granted to credentialed New Zealand pharmacists in 2013. 7 Two Australian studies involving pharmacist prescribing as an intervention in the perioperative setting, which used medication charting and communication errors as endpoints, have shown statistically significant improvements in prescribing.…”
A model of a collaborative clinical pharmacist reconciliation and charting service for admitted medical patients in an Australian hospital was successfully implemented. The service was well received and has shown to save medical staff time allowing them to attend to other duties. Moreover, the pharmacist charting and reconciliation service has resulted in a statistically significant reduction in medication errors.
“…Program information in published literature 17 or available on public websites from the following universities was included in the mapping exercise: University of Auckland and University of Otago, New Zealand: Postgraduate Certificate in Clinical Pharmacy in Prescribing (University of Auck-land) and Postgraduate Certificate in Pharmacist Prescribing (University of Otago); 18 , 19 Robert Gordon University, UK: Pharmacist Independent Prescribing program; 20 and Keele University, UK: Certificate in Independent Prescribing. 21 These programs were selected as they appeared to be designed to upskill pharmacists, which comprised approximately half of the cohort when the program was developed.…”
BackgroundPrescribing medicines is a complex task. A robust prerequisite curriculum that enables the efficient and consistent training of safe and effective prescribers is important. Despite differing prescribing contexts and professional attributes, the core elements of safe and effective prescribing relevant to all prescribers can be identified. This article describes the development process and content of a training program for safe prescribing, which was designed for a mixed cohort of allied health professionals in Queensland, Australia.MethodsThe allied health prescribing training program was designed to align with national standards for prescribing and competencies for safe prescribing. International training programs, for nonmedical prescribing, were examined to inform the program development. Content was delivered by experienced prescribers from a range of professions. The inaugural cohort was surveyed before and after training to ascertain their confidence to prescribe.ResultsA training program for allied health prescribers was developed and delivered to enable the implementation of a state-sponsored research trial in Queensland public facilities. The program consisted of two modules (the second of which is described in this article) complemented by a mandatory period of supervised workplace learning. Remote blended learning, comprising online prerecorded lectures, self-directed learning, teleconference seminars, and a 2-day on-campus intensive residential, was used to deliver content. A total of 19 allied health professionals (12 physiotherapists and 7 pharmacists) completed the program that equipped them to begin a prescribing trial within their specific practice settings. Post module completion, 90% of the cohort felt confident to prescribe for patients in their practice area.ConclusionProgram development and delivery were challenging, requiring attention to both the needs of each profession and those of the individual practitioner who was required to apply generic prescribing principles to their specific practice setting. Further refinement of content, delivery, assessment, and resource allocation is required for future cohorts.
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