Pharmacy Daily | Hospital pharmacist oversight crucial

RESEARCH conducted in a Victorian hospital found that two-thirds of patients with discharge prescriptions required intervention by pharmacists, raising concerns about patient safety if hospital pharmacist review is bypassed.

The team, led by Associate Professor Simone Taylor, senior pharmacist at Austin Health in Melbourne, reviewed prescriptions from 300 consecutive patient discharges in Apr-Jun 2024.

The vast majority of discharge prescriptions were prepared by medical staff, mostly juniors, while three patients received partnered pharmacist charting.

The median number of regular pre-admission medications per patient was seven, and the median number of regularly scheduled medications on discharge was eight.

Overall, 3,131 discharge prescription items were written, of which 477 (15.2%) required pharmacist intervention, affecting 199 of the 300 patients (66.3%).

The most common types of interventions were: the removal of unnecessary medications (19.5%); addition of needed medications (17.8%); and correcting wrong medication directions (17.0%).

The researchers pointed out that while some of the errors may be of low clinical significance, others have significant potential to cause harm if not corrected before medications are dispensed.

"Errors can also cause patient and carer confusion at a time when they are juggling a lot of information during the transition home," the researchers pointed out.

But with the Australian Digital Health Agency (ADHA) intending to implement electronic hospital discharge prescriptions using electronic tokens sent directly from the prescriber to the patient or their community pharmacy, the lack of hospital pharmacy review raises concerns.

Assoc Prof Taylor told Pharmacy Daily that one reason for conducting the research was to provide the ADHA with evidence to inform workflow discussions.

Community pharmacists do not have access to hospital medical records, making it difficult to detect and resolve errors, she explained.

"Discharge prescriptions are best reviewed and optimised by ward-based hospital pharmacists who have access to the patient's medical notes, treatment plan and treating team before reaching patients or their Active Script Lists," Assoc Prof Taylor said.

The researchers argued that the integration of hospital pharmacist review into electronic discharge workflows "is imperative to ensure medication safety prior to e-token transmission", and suggested Partnered Pharmacist Medication Charting or Prescribing (PPMC/P) could help minimise errors on discharge prescriptions.

"However, PPMC/P doesn't avoid the need for enabling a review step to occur before the e-token is sent, because even in hospitals where it is implemented, the doctors still write some prescriptions independently," Assoc Prof Taylor said.

"We support collaborative models where pharmacists help medical staff to develop their prescribing skills, making prescribing a shared responsibility."

Read the study HERE. KB