Doctor - pharmacist collaborative prescribing in a multidisciplinary surgical preadmission clinic: Expanding the role of the preadmission clinic pharmacist

Abstract

Non-medical prescribing has been introduced in to several countries, with prescribing privileges being granted to health practitioners other than doctors, including pharmacists. The objectives behind the introduction of this new model of health care have been to create a more flexible system for the prescribing, dispensing and administration of medicines, increase access for the general public to safe and appropriate prescription medications, and to better utilise the skills of the current health workforce.Current research on non-medical prescribing is predominantly qualitative, with little evidence as to the safety, appropriateness, effectiveness or cost effectiveness of the prescribing. Pharmacist prescribing is yet to be introduced in Australia, and in light of some resistance it is important to ensure that this potential model of care meets expectation, prior to implementation.The overall aim of this thesis is to evaluate a model of pharmacist prescribing in an elective surgery pre admission clinic (PAC), using the validated National Health Performance Framework (NHPF), which was revised and approved by Australian Ministers in 2009. The framework uses six dimensions to assess how a health system performs; 'effectiveness', 'safety', 'responsiveness', 'continuity of care', 'accessibility' and 'efficiency and sustainability'.A randomised controlled trial was undertaken in PAC, with 400 patients randomised in to either the intervention or control arm. Patients in the intervention arm were seen by a nurse, Resident Medical Officer (RMO), anaesthetist and the pharmacist prescriber. The pharmacist was responsible for the taking of a medication history, and prescribing the national inpatient medication chart (NIMC) to reflect the patient's regular medications and the plan for medications peri operatively. Within the pharmacist's agreed scope of practice was also the initiation of venous thromboembolism (VTE) prophylaxis, following a risk and contraindication assessment. Patients randomised in to the control arm still saw the same four healthcare professionals, including a pharmacist for usual care duties.The prescribing of the medication chart, including VTE prophylaxis, was the responsibility of the Resident Medical Officer (RMO) from the treating surgical team. The primary end point of the study was the safety and accuracy of the NIMC. The secondary end point was the appropriateness of VTE prophylaxis prescribed in clinic.Medications charts were audited against the medication history and plan for medication peri operatively. Medication charts in the intervention arm contained significantly fewer omissions of regular medications, significantly less prescribing errors involving selection of drug, dose or frequency and significantly fewer orders with at least one component of the prescription missing, incorrect or unclear. VTE risk assessments were documented, and prophylaxis was prescribed, significantly more appropriately in clinic.iii The significant differences between arms in omissions of medication p...

Hospital Pharmacist‐Led Lipid Clinic for Surgical Patients with Peripheral Vascular Disease at a Regional Australian Hospital

“…28 Australian pilot studies of transcribing or prescribing activities within an extended scope have been restricted to discharge, peri-operative, emergency and HIV outpatient settings. 18,[29][30][31][32] The absence of a legal framework to prescribe and a credentialling process has limited progress. The study lipid clinic used collaborative prescribing with the pharmacist's clinical judgement supported by a cardiologist when needed.…”