Pharmacist‐assisted prescribing in an Australian hospital: a qualitative study of hospital medical officers’ and nursing staff perspectives

Abstract

Background: Pharmacist-assisted prescribing (also known as pharmacist charting) has been adopted widely across Australia. The perspectives of medical and nursing staff, however, is poorly understood. Aim: To explore the perceived benefits and drawbacks of pharmacist-assisted prescribing on admission and discharge, from the perspective of hospital medical officers (HMOs) and nurses. Methods: Face-to-face, semi-structured interviews were conducted with orthopaedic junior HMOs, the orthogeriatric HMO and nurses during a study evaluating pharmacist-assisted prescribing in an orthopaedic unit. Participants were individually interviewed to explore the perceived impacts of pharmacist-assisted prescribing on patient safety, workflow and HMO skill development. Interviews were audio-recorded and verbatim transcriptions were analysed independently by two investigators using a simple thematic analysis. Results: Interviews were conducted with six HMOs and six nurses. Emergent themes highlighted various factors which may affect the ability of HMOs to prescribe medications accurately and in a timely manner when there is no pharmacist assisting with prescribing, and the impact of pharmacist-assisted prescribing on patient flow, safety and staff workload. Participants felt that having a pharmacist assist with prescribing improved patient safety by reducing prescribing errors and admission charting delays, and assisted with patient flow by reducing delays in discharging patients. Participants felt that pharmacist-assisted prescribing reduced their workload. They noted a drawback was the potential to de-skill HMOs, but felt this was outweighed by the benefits. Conclusions: Hospital medical officers and nurses reported that pharmacist-assisted prescribing had benefits on patient safety, patient flow and workload and that these outweigh the potential drawbacks of potentially de-skilling junior HMOs.

Perceptions and expectations of health professionals regarding hospital pharmacy services and the roles of hospital pharmacists: A qualitative systematic review and meta-synthesis

“… Surgical Doctors/physicians: 5 Nurses: 2 Physician assistants: 2 9 (total = 12) Surveys Mixed-methods Moderate concern Tegegn et al 2018 49 Ethiopia To explore the challenges and opportunities of clinical pharmacy services offered in University of Gondar hospital through health practitioners' perspectives Various Doctors/physician: 5 Nurses: 5 10 (total = 15) Interviews Thematic analysis No or very minor concern Tran et al 2019 50 Australia To evaluate the effect of an integrated pharmacy service provided to the general medical units on patient flow and medical staff satisfaction. Medical Doctors/physician: 10 10 Surveys Thematic analysis Moderate concern Tran et al 2021 51 Australia To explore the perceived benefits and drawbacks of pharmacist-assisted prescribing from the perspectives of hospital medical officers and nursing staff Surgical Doctors/physician: 6 Nurses: 6 12 Interviews Thematic analysis; Content analysis Minor concern Vinterflod et al 2018 52 Sweden To explore physicians' perceptions regarding clinical pharmacy services performed in hospitals operated by Vasterbotten County Council Medical; Geriatric Doctors/physician: 9 9 Interviews Thematic analysis No or very minor concern Classification of each health professional varies between countries, thus some studies may not differentiate between specialised training or positions e.g., between nurses, nurse practitioners and physician assistants; between specialised doctors/physicians and/or general doctors (including medical interns). This study has therefore used broad categories such as “Doctor/Physician” or “Nurses” to facilitate data extraction.…”

“… Australia 26 , 45 , 50 Canada 27 Ethiopia 43 , 49 Indonesia 6 Ireland 44 Malta 21 Mexico 29 Pakistan 23 , 37 Qatar 35 Sweden 31 , 33 , 52 Switzerland 25 UK 41 USA 5 , 28 , 34 , 42 Unknown 24 , 48 Proactive roles in medication-related therapy decisions Collaborative activities or discussions between pharmacists and other members of the multidisciplinary team that occurred before prescribing any medications or making therapeutic decisions. Australia 20 , 38 , 45 , 50 , 51 Ethiopia 49 India 32 Indonesia 6 Malaysia 19 Malta 21 Pakistan 22 South Korea 39 Qatar 35 Sweden 31 , 33 Switzerland 25 USA 28 , 34 , 42 Unknown 48 Drug information and...…”

“… Australia 40 , 45 , 46 Brazil 30 Canada 27 Ethiopia 49 Indonesia 6 Malaysia 19 Malta 21 Pakistan 23 , 37 Sweden 31 , 33 , 47 USA 5 , 34 Unknown 48 Independent prescribing and diagnosis Activities that involved prescribing directly by pharmacists with no or little involvement by other health professionals. Australia 45 , 51 Canada 27 Ethiopia 49 Indonesia 6 Pakistan 22 Research and medication governance Research: activities that involved research and the dissemination of findings to wider communities. Medication governance: activities that involved policy and administrative side of pharmacy including but not limited to antibiotic stewardship, decision-making in therapeutics committees, and hospital formulary development.…”

“…Doctors expressed that hospital pharmacists were important contributors in ward rounds, as pharmacists could provide advice and intervene in real-time as therapeutic decisions are made. 19 , 20 , 21 , 22 , 25 , 28 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 42 , 45 , 48 , 49 , 50 , 51 This was a frequently mentioned role and was rated as Moderate Confidence in the GRADE-CERQual assessment. “Real-time assessment of plan that translates into expedited patient care.…”

“… 22 , 27 In terms of perceptions on pharmacist prescribing, although doctor and nurse participants differed in their opinions such as the extent of prescribing authority and training requirements, both professional groups agreed that the prescribing role of pharmacists would benefit patient safety and treatment outcome (Low Confidence). 6 , 27 , 45 , 49 , 51 “It suits me if clinical pharmacists do prescribe as specialty pharmacists are much better updated with latest drug information.” 49 (Ethiopian Nurse). “Nurses indicated stronger agreement with the concept of pharmacists having prescribing responsibility relative to either pharmacists or physicians.” 27 (Study Author).…”