Patient outcomes improve when pharmacists chart medications

When medication charting involves a pharmacist as well as a doctor, medication error rates in hospital admissions are significantly reduced, according to a new study.¹

Researchers from Monash University’s Centre for Medicine Use and Safety (CMUS) at the Monash Institute of Pharmaceutical Sciences and Alfred Health evaluated the model of collaborative medication-charting in public hospitals in Victoria. Over 8,500 patients in general medical wards were included in the study, making it the largest of its kind.¹

Generally, a doctor charts a patient’s medications on admission, after which a pharmacist reviews and reconciles the medication list. However, delays and review omissions can occur. This increases the risk of medication errors, potentially leading to patient harm and increased duration of hospitalisation.

The 2016 study aimed to see whether timely, collaborative care as soon as possible after admission would reduce medication errors.

Patients who had partnered pharmacist medication charting (known as PPMC) were found to have a reduced hospital stay from 4.7 (IQR* 2.8-8.2) days to 4.2 (IQR 2.3-7.5) days (p<0.001); a reduction of half a day on average.¹

Also, the number of medication errors detected within 24 hours of admission was significantly reduced. Medications charts that had at least one error was reduced from 66% to 3.6%.The number-needed-to-treat to prevent one error was 1.6 (95% Cl:1.57-1.64).¹

The PPMC model involved a pharmacist taking a medication history, reconciling medications, assessing risk of venous thromboembolism (VTE), collaboratively making decisions with the admitting medical officer and charting the medication.

A second pharmacist took the role of independent assessor, reviewing all medications charted by a pharmacist within 24 hours, to provide a second check and identify any medication errors. 

A limitation of the study was that pharmacists were only available during normal working hours during the intervention phase, whereas in the pre–intervention phase all admitted patients were included in the study, no matter what time of day or night.

The Deputy Director of Pharmacy at Alfred Health, Erica Tong, praised the collaborative work with the medical team at the point of admission, and believes the partnered pharmacist model around the clock should be evaluated. 

‘Implementation of this model to other clinical areas such as surgical and oncology services should be considered, and evaluation of the impact on electronic prescribing systems on this model should also be investigated,’ Ms Tong said.¹

The Acting Director of Pharmacy Services at Brisbane’s Princess Alexandra Hospital (PAH) and Associate Professor at the University of Queensland’s School of Pharmacy, Michael Barras, welcomed the study findings and fully supports this model of care. 

‘Prescribing is not currently in a pharmacist’s scope of practice, unless under a research framework, so that task remains with the medical officer,’ he added. Although not providing 24-hour care, Emergency Department pharmacists are available until 8.00 pm daily.

‘Models of care like this pharmacist-led medicines charting initiative need to become normal care for all patients in all hospitals if we are serious about medicine safety. Whatever Australian hospital a patient is in, they deserve to receive access to high quality pharmacist care like this,’ according to PSA National President Associate Professor Chris Freeman.

‘We welcome this research as it adds further weight to PSA’s call in Pharmacists in 2023 for hospital pharmacists to be available at comparable levels regardless of location, timing or nature of stay to make patients in Australian hospitals safer.’

The Monash study on minimising medication errors on admission builds on a previous study conducted by Erica Tong and colleagues – Reducing medication errors in hospital discharge summaries: a randomised controlled trial. The study involved pharmacists completing the medical discharge summary, resulting in a reduction of medication errors from 60% to 15%. This study was published in the Medical Journal of Australia (MJA) and was independently judged to be the best paper published by the MJA in 2017.²

*IQR = interquartile range, or middle 50% – used as a measure of statistical spread of results

References

1. Tong EY, Mitra, B, Yip, G, et al. Multi‐site evaluation of partnered pharmacist medication charting and in‐hospital length of stay. Br J Clinl Pharmacol 2019. Epub 2019 Oct 21.
2. Tong EY, Roman C, Mitra B, et al. Reducing medication errors in hospital discharge summaries: a randomised controlled trial. Med J Aust 2017;206:36–39.