Pharmacist‐Initiated Electronic Discharge Prescribing for Cardiology Patients

Abstract

Aim To determine whether pharmacist‐initiated electronic discharge prescribing would decrease discharge times for selected cardiology patients and improve the accuracy of prescribing by limiting deviations from the intended therapeutic plan. Method A cardiology project team identified system issues impeding patient flow through the ward, including the discharge medication pathway. The stages of the medication pathway were mapped before and after the intervention of pharmacist‐initiated electronic discharge prescribing. The accuracy of prescribing in both phases of the study was measured against evidence‐based standards agreed by the cardiology unit. Results 39 patients were recruited in phase 1 (usual practice) and 35 patients in phase 2 (pharmacist‐initiated discharge prescriptions). The time from a decision to discharge a patient to the completed prescription reaching the patient was significantly reduced from a median of 190 minutes to 50 minutes in the intervention arm (p < 0.0001). However, this result did not translate into patients leaving the hospital earlier. In phase 1, 26% of prescriptions (n = 39) contained at least one error, including 19 clinically significant omissions. In phase 2, no omissions were made but the signing doctor made two changes to the pharmacist‐initiated prescriptions that were unrelated to the evidence‐based standards. Conclusion This pilot study has shown that an experienced pharmacy specialist using an electronic discharge prescribing system can significantly reduce the time elements of the discharge medication pathway. In addition, errors of omission that deviate from evidence‐based practice are reduced. This practice model can be extended to other specialist areas.

Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards

“…In the hospital setting, pharmacist involvement in discharge prescribing has been shown to improve efficiency and patient safety compared to traditional doctor prescribing. [14][15][16][17] For example, it has been shown to reduce the number of prescription amendments needed to correct errors or discrepancies and optimize therapy after the prescription has been prepared. It also reduces time spent by pharmacists and doctors correcting prescriptions, which ultimately results in fewer delays in discharging the patient and greater overall satisfaction with this collaborative approach.…”

Slick scripts: impact on patient flow targets of pharmacists preparing discharge prescriptions in a hospital with an electronic prescribing system

“…There was only one PP recruited during the intervention, which may reduce generalizability; however the improvements in patient flow are consistent with other studies utilizing a pharmacist to prepare discharge prescriptions . The level of experience needed to undertake this role was not evaluated; however, we would recommend that a pharmacist with at least similar experience should undertake this new role, and should have an ability to interact well within a team environment with other health professionals.…”

“…This may improve efficiency of the discharge process and reduce amendments that need to be made to the prescription. Previous studies have explored the impact of pharmacists preparing discharge prescriptions on measures of time efficiency such as the time from the decision to discharge to actual patient discharge; however, they have been limited because of small sample sizes and have not measured the effect on ED transfers .…”

Pharmacist's Role in the Hospital Discharge Process

“…[12][13][14][15] Pharmacists in these areas may be transcribing discharge medication or making advanced protocol-guided decisions at discharge, with the doctor signing the final discharge prescription. 15,16 Furthermore, Australian hospital pharmacists in large public hospitals may also be providing post-discharge, hospitalcommunity pharmacy liaison services for persons at risk of preventable adverse drug events and hospital readmission. 17 In other countries, pharmacists may have a supplementary prescribing role for discharge medications.…”

“…1,11,15,16 • For the pharmacy profession: a new clinical service providing an additional professional role for hospital pharmacists. 15,17 • For the hospital: decreased time to discharge patients and improved bed availability. 17 • For the doctors: decreased need to liaise with pharmacists to clarify discharge prescription issues, decreased time pressures.…”