Collaborative Pharmacist Medication Prescribing Enhancing Flow

Aim

Two acute care hospitals (one digital, one paper-based) implemented and evaluated Collaborative  Pharmacist Medication Prescribing (CPMP) throughout the 2025/6 financial year, to reduce medication misadventure for general medical patients admitted via the Emergency Department (ED).

Outcomes

• Both sites demonstrated reductions in length of stay (LOS). The digital site reported  a median LOS reduction of 0.3 days, whilst the paper-based site demonstrated a median LOS reduction of 0.4 days.
• The paper-based site reported improvements in the quality of prescribing for patients who received CPMP (n=116). In comparison with historical data obtained in 2024 (n=79), patient identification on medication charts improved from 35% to 91%. “As required” medicines contained an hourly frequency and an indication for 82% and 83% of orders respectively, compared with 26% and 60% in 2024.

Background

Medication safety is a critical element of the patient journey through acute care. Prescribing errors increase morbidity and mortality, with subsequent negative impacts on length of stay and access (1). The role of the pharmacist prescriber in acute care is well documented in Australian and international literature, as a strategy to mitigate prescribing  errors (2), enhance adverse drug reaction (ADR) documentation (3), improve antimicrobial prescribing (4), reduce length of stay (5), and improve venous thromboembolism (VTE) preventative care (6). Further, pharmacist involvement in prescribing has demonstrated cost savings, time savings for clinicians, improved timeliness of medicine administration and improved quality use of medicines (7).

In April 2025, the Medicines and Poisons (Medicines) Regulation 2021 (MPMR) was amended to enable Collaborative Pharmacist Medication Prescribing (CPMP) in Queensland hospitals (8). Following this amendment, two acute care hospitals within the same health service developed local protocols to facilitate CPMP. The CPMP model was developed in alignment with interstate evidence which demonstrated a significant reduction in prescribing errors (5) and LOS (9). Local partnered prescribing models tailored to patients transitioning from the intensive care unit to general wards also demonstrated reductions in prescribing errors and patient flow improvements (10). The health service invested in additional pharmacist and clinical assistant workforce to implement an extended hour, seven-day model. One hospital was digitally enabled, and one hospital was paper based. Evaluation was performed between August 2025 and February 2026, to assess impact of CPMP on prescribing quality, consumer and staff satisfaction, and patient flow.

Discussion

251 episodes of CPMP were audited at the digital facility between 01/10/25 and 31/11/25. A total of 337 episodes of CPMP were audited at the paper-based facility between 10/12/25 and 26/2/26. The median LOS for CPMP patients at the digital site was lower (4.22 (n=197) V 4.51 (n=219) days). A similar effect was observed at the paper-based facility, with a CPMP LOS of 3.00 (n=100) compared with a non-CPMP LOS of 3.4 (n=311). 78% of CPMP episodes (n=90) performed at the paper-based site complied with the prescribing protocol. 9% (n=10) of CPMP episodes did not have a CPMP sticker attached to all medication charts.  Similarly, 14% of CPMP episodes included non-scheduled medicines (such as vitamins or lubricating eyedrops) that were not documented in the management plan. These protocol deviations were not considered clinically significant however feedback was provided  to the CPMP pharmacists to enhance the quality of documentation.

There were no examples of prescribing-related clinical incidents arising from CPMP during the study period however there were 26 prescribing incidents reported amongst the non-CPMP cohort across the two facilities, including incorrect insulin doses, duplicate prescriptions, wrong patient, medication omissions, opioid toxicity, ADR re-exposure and delays in prescribing discharge medications.

The following safe prescribing metrics were improved in the CPMP cohort at the paper-based site (n=116), compared with historical results gathered in 2024 (n=79):

• Confirmation of patient identification results improved from 35% to 91%
• ADR documentation improved from 70% to 92%
• VTE risk assessment documentation improved from 28% to 98%
• Indication documentation for “as required” medicines improved from 60% to 83%
• Hourly frequency of “as required” medicines improved from 26% to 82%
• Slow-release formulation documentation improved from 51% to 96% CPMP was well-received by prescribers across both facilities (n=23).

All prescribers agreed that CPMP had improved medication safety for patients. All respondents would recommend extending the model to other units or specialties, and they could all foresee CPMP becoming a permanent component of their service. The key enablers to the success of this project were comprehensive stakeholder consultation, robust clinical governance and ongoing feedback and education for pharmacists and co-prescribers. Implementation and evaluation of partnered prescribing models at each facility in the years leading up to legislative change enhanced socialisation of pharmacist prescribing and the transition to CPMP was well-accepted by stakeholders. Constructive feedback was received from two co-prescribers advocating for a more flexible approach to discussing the medication management plan.

Prescribing pharmacists are encouraged to confirm an appropriate time to discuss plans with their co-prescriber, as these discussions required dedicated time free of distractions. Co-prescribers and prescribing pharmacists both recognised the need for clear communication to prevent duplicitous prescribing and robust referral mechanisms to enhance efficiency. CPMP is a scalable model that can enhance medication safety and access to acute care. There are high quality resources available to assist with service implementation and staff credentialing. Robust evidence exists to demonstrate benefit for medical patients admitted via the ED, however the impact of CPMP on clinical outcomes should also be explored in other patient cohorts, such as mental health, and medical subspecialties. CPMP has the potential to positively impact patient outcomes at all transitions of care.

References

1. Australian Commission on Safety and Quality in Health Care. Medication Safety Standard.  Available at: https://www.safetyandquality.gov.au/standards/nsqhs-standards/medication-safety-standard (Accessed: 9/2/2026)

2. Atey TM, Peterson GM, Salahudeen MS, Bereznicki LR, Simpson T, Boland CM, et al. Impact of Partnered Pharmacist Medication Charting
(PPMC) on Medication Discrepancies and Errors: A Pragmatic Evaluation of an Emergency Department-Based Process Redesign. Int J Environ Res Public Health. 2023;20(2).

(3) Khalil V, deClifford JM, Lam S, Subramaniam A. Implementation and evaluation of a collaborative  clinical pharmacist’s medications reconciliation and charting service for admitted medical inpatients in a metropolitan hospital. J Clin Pharm Ther. 2016;41(6):662-6.

(4) Garwood-Gowers P. A comparison between a doctor-pharmacist collaborative model and the  usual medical model for perioperative prescribing of medications in an anesthetic-led preadmission clinic [Masters by Research] 2020.

(5) Tong EY, Mitra B, Yip G, Galbraith K, Dooley MJ, Group PR. Multi-site evaluation of partnered pharmacist medication charting
and in-hospital length of stay. British Journal of Clinical Pharmacology. 2020;86(2):285-90.

(6) Atey TM, Peterson GM, Salahudeen MS, Simpson T, Boland CM, Anderson E, et al. Redesigning Medication Management in the Emergency Department: The Impact of Partnered  Pharmacist Medication Charting on the Time to Administer Pre-Admission Time-Critical Medicines, Medication Order Completeness, and Venous Thromboembolism Risk Assessment. Pharmacy (Basel). 2024;12(2).

(7) Dalton A, Beks H, McNamara K, Manias E, Mohebbi M.  Health Economic Evaluation of the Partnered Pharmacist Medication Charting (PPMC) program. Deakin University 2020. Available at: https://www.safercare.vic.gov.au/improvement/projects/ppmc [Accessed 02/03/2026]

(8) Queensland G. Medicines and Poisons (Medicines)  Regulation 2021 (Qld). Government Regulation. Brisbane: Queensland Government; 2021 2021-09-27.

(9) Tong EY, Roman C, Yip G, Gibbs H, Newnham H et al. Partnered pharmacist charting on admission in the General Medical and Emergency Short-stay Unit – a cluster-randomised  controlled trial in patients with complex medication regimens. Journal of Clinical Pharmacy and Therapeutics. 2016;41(4):414-8.

(10) Dunn E, Vale C. Partnered charting in the Intensive Care Unit: Bridging the digital gap. AdPha Medicines Management Conference.
Adelaide. 2024.