Redesigning prioritization methods using high-risk medicines for clinical pharmacists

Background: Clinical pharmacist (CP) services are delivered to minimise the inherent risks associated with the use of medicines, increase patient safety, and optimise health outcomes. Traditional methods of distributing work for CPs include ward based (allocated beds) or a clinical unit‐/team‐based service. Due to resourcing constraints, CPs are unable to see all patients, so a prioritisation method may include identifying patients prescribed high‐risk medicines. The study hospital currently allocates CPs to specific wards based on complexity of patient case‐mix, bed turn over, and funding. Not all wards have an allocated CP.

Objectives: To determine if CPs are reviewing patients prescribed high‐risk medicines using current allocation techniques.

Methods: A real‐time snapshot audit over a 5‐day period (29/1/18‐2/2/18). Electronic Medicines Management System (EMMS) reports were run at an allocated time each day to determine the number of patients currently admitted and prescribed selected high‐risk medicines. Three CPs reviewed a randomised sample of patients prescribed targeted high‐risk medicines each day to determine which ward the patient was admitted (CP ward vs non‐CP ward), proportion of medicines which were high risk on each ward, and if a CP had reviewed the high‐risk medicine prescribed. The targeted high‐risk medicines were opioids, vancomycin, and oral anticoagulants.

Results: Of the 19 wards within the study hospital, 2 were excluded as are not on EMMS. 11 of the 17 wards had an allocated CP. Over the 5‐day period, 933 patients were identified via the EMMS report to be on a targeted high‐risk medicine. A random sample of 202 (21%) was used for analysis. Within the sample of 202, 2344 individual medicines were prescribed (1339 CP wards vs 1005 non‐CP wards), 305 were high risk medicines (169 CP wards vs 136 non‐CP wards), p = 0.57 indicating no difference between the number of medicines prescribed as well as the ward distribution of patients on high risk medicines. All 17 wards had at least one prescription for a high‐risk medicine (range 2‐43). The two wards with the highest percentage of high‐risk medicines prescribed were not allocated a CP, midwifery (24%), and hospice (31%) (range 10‐31%). Both wards had high use of opioids, midwifery being a relatively low complex patient population. High‐risk medicines were more likely to be reviewed if a patient was admitted on a CP ward (93 [55%] CP wards vs 20 [15%] non‐CP wards).

Conclusions: The allocation of CPs to specific wards does not prioritise review of patients on high risk medicines.