Pharmacist-assisted electronic prescribing at the time of admission to an inpatient orthopaedic unit and its impact on medication errors: a pre- and postintervention study

Abstract

Background: Prescribing and administration errors related to pre-admission medications are common amongst orthopaedic inpatients. Postprescribing medication reconciliation by clinical pharmacists after hospital admission prevents some but not all errors from reaching the patient. Involving pharmacists at the prescribing stage may more effectively prevent errors. The aim of the study was to evaluate the effect of pharmacist-assisted electronic prescribing at the time of hospital admission on medication errors in orthopaedic inpatients. Methods: A pre- and postintervention study was conducted in the orthopaedic unit of a major metropolitan Australian hospital. During the 10-week intervention phase, a project pharmacist used electronic prescribing to assist with prescribing admission medications and postoperative venous thromboembolism (VTE) prophylaxis, in consultation with orthopaedic medical officers. The primary endpoint was the number of medication errors per patient within 72 h of admission. Secondary endpoints included the number and consequence of adverse events (AEs) associated with admission medication errors and the time delay in administering VTE prophylaxis after elective surgery (number of hours after recommended postoperative dose-time). Results: A total of 198 and 210 patients, pre- and postintervention, were evaluated, respectively. The median number of admission medication errors per patient declined from six pre-intervention to one postintervention ( p < 0.01). A total of 17 AEs were related to admission medication errors during the pre-intervention period compared with 1 postintervention. There were 54 and 63 elective surgery patients pre- and postintervention, respectively. The median delay in administering VTE prophylaxis for these patients declined from 9 h pre-intervention to 2 h postintervention ( p < 0.01). Conclusions: Pharmacist-assisted electronic prescribing reduced the number of admission medication errors and associated AEs.

Standard of practice in geriatric medicine for pharmacy services

“…Emerging clinical pharmacist services for older people include charting medicines on admission to hospital (evidence of reduced medicine omissions and adverse events), and charting and administering influenza vaccines in hospital and RACF settings (evidence of increased vaccination rates) …”

Impact of pharmaceutical care in the orthopaedic department

“…With intensified interventions required to achieve the full benefit for all patients, it is essential that pharmacists adopt a much more proactive approach to prescribing to ensure medications are correct on admission, rather than reviewing and correcting prescriptions hour or days later . Furthermore, with the rapid growth of electronic health information and technologies, the rational use of medications can more efficiently be improved and information more readily provided for patients . Orthopaedists and pharmacists are clearly experts in their respective fields, each with a unique and important role in the medical optimization of patients, but as more in‐depth research is conducted and experiences accumulated, the further development of clinical pharmaceutical services should bring considerable benefit to both orthopaedics and the whole medical system.…”

Impact of clinical pharmacist services on anticoagulation management of total joint arthroplasty: A retrospective observational study

“…Although several studies have explored pharmacist-led anticoagulation service, to our knowledge, limited evidence had comprehensively evaluated its impact on the relevant indicators of anticoagulation management in patients with TJA. 7,11,12 The aim of this study was to evaluate the impact of clinical pharmacist intervention on the administration of anticoagulant drugs, the rationality of the medication and the incidence of thromboembolic events.…”

“…The main responsibility was to provide optimized medication therapy options for all TJA patients in the orthopaedic department. Specifically, these measures were as follows: (1) conducting thrombosis and bleeding risk assessment for patients; (2) consulting with physicians to formulate antithrombotic treatment protocols; (3) optimizing perioperative medication regimens for special populations; (4) evaluating and optimizing the feasibility of discharge prescriptions; (5) providing consultation for medical staff and patients throughout the hospital stay; (6) providing anticoagulant-related training for medical staff every quarter; and (7) following up the thrombosis of TJA patients in the first and third month after surgery. During the study period, all physicians and care providers benefited from a full-time pharmaceutical presence.…”

“…Optimizing perioperative drug therapy such as anticoagulation management, anti‐infective treatment and postoperative pain control can directly improve the patient's postoperative situation like postoperative venous thromboembolism (VTE), postoperative infection, hospital stay and readmission rate. Published studies on the role of clinical pharmacists in multidisciplinary teams have shown that clinical pharmacists have a positive influence on orthopaedic surgery care, including optimization of VTE prophylaxis administration, related quality indicators, 6,7 surgical site infection prevention, 8 pain management and opioid use 9,10 . The implementation of a comprehensive clinical pharmacy service, from an institution providing TJA procedures in the United States, was associated with improved institutional rates of postoperative readmissions and complications, patient understanding and satisfaction 11 …”