Collaborative prescribing to improve patient outcomes

The results of a study examining collaborative prescribing in Australian hospitals indicates that the practice, already successfully trialled in the US and the UK, effectively leverages the skills of pharmacists and could improve patient care outcomes in Australian hospitals.

The practice involves pharmacists taking admitted patients’ medication history and collating their recommendations for continuing, withholding or dose adjusting medicines during the hospital admission process. Pharmacists then discuss these recommendations and agree on a medication plan with the admitting medical officer.

The study, one of the first to test the efficacy of this model in Australia, was conducted by researchers from the Metro North Hospital and Health Service in Brisbane who reviewed 34 hospital medication charts for safety and accuracy. Seventeen were collaborative pharmacist-prescribed charts, the other half were medical officer-prescribed charts. This equated to 146 medical orders written by a pharmacist and 145 medication orders written by a medical officer.¹

When audited for safety, researchers found that 90% of the charts written by pharmacists prescribed medicine appropriately, compared with 26% of charts written by medical officers. They also found that charts written by pharmacists were more likely to be accurate against medication history than those written by medical officers, with a 2% chance of error per medication order compared to 16% from medical officers.¹

Lead researcher and Clinical Pharmacist at Brisbane’s Prince Charles Hospital, Sally Taylor, told Australian Pharmacist that the high accuracy of the charts written by pharmacists was indicative of the fast-paced hospital environment where, unlike other healthcare professionals, pharmacists are able to focus entirely on medicine management.

‘Pharmacists are medication experts, and we are able to focus all our attention on medication management. Medical officers, particularly at the time of admission, are focused on all aspects including diagnosis. This inevitably leaves less time to focus on a thorough medication history, medication plan, and prescribing that plan safely and accurately onto an inpatient medication chart,’ she said.

Researchers also noted that the model offered an effective solution to hospitals experiencing a ‘shortage of healthcare resources’, and suggested that pharmacists may be particularly well placed to act as non-medical prescribers, given their extensive training in pharmacology and experience in multidisciplinary teams.’¹

While Ms Taylor noted that the study is small in scale, she said that the results are consistent with international studies, and indicate that the collaborative model of prescribing has the potential to significantly increase health outcomes in Australian hospitals.

‘This is now one of a number of studies, both in Australia and internationally, that show the potential benefits of collaborative pharmacist prescribing,’ she said. ‘With appropriate governance, credentialing and the commitment of the multidisciplinary team, we will hopefully see more examples of collaborative prescribing in sustainable models of care that impact positively on patient care.’

Hear more about collaborative prescribing at PSA19 where Shane Jackson will discuss how the practice will improve patient care, access to medicine and medicine management. Register now to attend.

References

1. Taylor S, Hale A, Lewis R et al. Collaborative doctor–pharmacist prescribing in the emergency department and admissions unit: a study of accuracy and safety. Journal of Pharmacy Practice and Research 2019;49(2):176–178.At: https://onlinelibrary.wiley.com/doi/10.1002/jppr.1464