Pharmacist Partnered Medication Charting in the ICU

Aim

To evaluate the impact of Pharmacist Partnered Medication Charting (PPMC) upon discharge from ICU on prescription accuracy, staff acceptability and discharge time.

Outcomes

1. 3.0 errors per discharged patient pre-PPMC, reduced to 0.56 errors per discharged patient post-intervention [95% CI, 1.54 to 3.34; P<0.0001]
2. The proportion of discharge charts that were completed and available for review more than two hours prior scheduled discharge increased from 47% pre-PPMC to 85% post-PPMC
3. Pharmacists prepared 68% of orders, and these charts were less likely to contain a prescribing error compared with charts prepared by MOs prior to PPMC [X2(1, n=34) = 39.9, p=<0.001]
4. It is well received by multidisciplinary staff, with all 34 respondents agreeing that PPMC improved accuracy and legibility
5. >95% of respondents agreed that PPMC was beneficial to clinical practice, and that pharmacists should routinely prepare discharge charts

Background

As medicines management transitions to the digital environment, many hospitals must navigate the complexity of hybrid prescribing models at transitions of care. Prescribing errors at this care transition are common, with local audit demonstrating 85% of transcribed charts (n=70) contain errors.

Discussion

Support from medical and nursing staff was required to undertake the intervention. Engagement from these disciplines was essential in providing timely feedback and context to the intervention. Limitations of the initial study were the fact that only a specific population of patients was enrolled (post-cardiac surgical), which limits applicability of data to all patient cohorts. However, this also helped to narrow the field of nursing and medical staff receiving these patients in terms of education, awareness and feedback.

We have expanded this intervention to include ALL patients discharged from the ICU to paper-based general wards and will be re-auditing the results mid-year. This project has the potential to reduce errors, improve patient flow and save time for staff in medical and nursing disciplines across many areas of the hospital - most importantly in the Emergency Department, pre-admission clinics, long-stay patient chart rewrites and other high turnover and high acuity clinical areas.

References

1. Pharmacy Board of Australia. Position Statement on Pharmacist Prescribing. Accessed at: https://www.pharmacyboard.gov.au/news/professional-practice-issues/pharmacist-prescribing-position-statement.aspx
2. Society of Hospital Pharmacists of Australia, American Society of Health-system Pharmacists. Pharmacy Forecast Australia 2021. Accessed at: Pharmacy Forecast Australia 2021.pdf
3. Tong EY et al. Multi-site evaluation of partnered pharmacist medication charting and in-hospital length of stay. Br J Clin Pharmacol. 2020;86(2):285-290.
4. Sinclair VL et al. Validating the Victorian Partnered Pharmacist Charting Model in the Western Australian Setting. J Pharm Prac Res. Early access published 28 Sept 2020; https://doi.org/10.1002/jppr.1682
5. Tran T et al. 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. Ther Adv Drug Safety. 2019;10:1-10.
6. Taylor S et al. Collaborative doctor-pharmacist prescribing in the emergency department and admissions unit: a study of accuracy and safety. J Pharm Pract Res. 2019;49(2):176-178
7. https://www.shpa.org.au/sites/default/files/uploaded-content/website-content/Fact-sheets-position-statements/shpa_medication_safety_position_statement_sep2020.pdf