None listed
Conditions
Brief summary
Patient harm from medications is common; 7% of patients (ie 1 in 14) will have a significant medication harm event in hospital, many due to prescribing errors. Direct pharmacist involvement in patient care improves safe medication management by reducing errors. Pharmacists are well known for identifying and rectifying prescribing errors, however, this is usually done after the error is made. We propose shifting from a reactive (waiting for a prescription) to a proactive model, where the pharmacist works collaboratively with the doctor at the point of care. This project will evaluate a pharmacist-physician team-based model compared to usual care in an adult general medical population at two hospital sites. This model will include extended scope roles (e.g. collaborative ordering of medications) and occur throughout the patients entire hospital stay (including at admission, on inpatient ward rounds and at discharge). After patients have discharged, we will retrospectively review patient's electronic medical records and hospital cost data. We hypothesise benefits in safety, medication appropriateness, continuity of care and cost.
Interventions
This project will compare a Collaborative Optimisation and Ordering of Medications (COOM) model to routine/usual care.
This study is a non-randomised trial with patients included based on the medical team to which they are admitted. Medical teams included in this study have equivalent rostering of clinicians, and participate in an equivalent roster of admitting days. Admitted patients are
allocated to teams according to pre-allocated admitting days or prior knowledge of the patient to the medica
This project will compare a Collaborative Optimisation and Ordering of Medications (COOM) model to routine/usual care. This study is a non-randomised trial with patients included based on the medical team to which they are admitted. Medical teams included in this study have equivalent rostering of clinicians, and participate in an equivalent roster of admitting days. Admitted patients are allocated to teams according to pre-allocated admitting days or prior knowledge of the patient to the medical team. Medical teams included in this trial (both intervention and control) are pre-selected based on expressions of interest from medical team consultants at the respective hospitals. This trial is a controlled interventional study that will compare a COOM model with usual care within a general medicine service at two hospital sites. One medical team at each site be allocated a COOM pharmacist (intervention team) whereas other medical teams, receiving usual pharmacy service, will act as control groups. The COOM workflow involves the usual workflow of a doctor assessing the patient and making a diagnosis and the pharmacist conducting a medication history and clinically reviewing medications. The point of difference with the COOM model is that the doctor and pharmacist will collaboratively review medications and develop a plan to optimise the patient’s medications together. In routine/usual care this process, including review of medications and developing plan, usually happens separately by both the doctor and pharmacist. As a result, prescribing errors are retrospectively identified and communicated by the pharmacist to the prescriber. The medication review process involves review of the patient's usual medications (through best possible medication history), reconciliation of these medications in the context of their medical history and reason for presentation to hospital and clinical review (eg. appropriate dose). The proposed COOM model will involve a pharmacist embedded in the medical team - who actively undertakes this review process at the point of prescribing. The review process will occur at key prescribing moments in the Medical Teams usual workflow (including admission to hospital, during consultant ward rounds and discharge from hospital). As such, the specific time required for each review will be individualised to the patient as it will vary depending on the complexity of the patient, medical team workload and hospital factors. In the COOM model, the agreed plan will be documented, and medications will be ordered by either the doctor (usual practice) or the pharmacist (extended scope role). In the control groups, all medications will be ordered by the doctor (usual practice). This intervention will occur at key prescribing moments across a patient’s entire hospital stay (eg. at admission to hospital, on consultant ward rounds throughout the admission and at discharge). The pharmacists on the intervention team will be pharmacists with general registration with Australian Health Practitioner Regulation Agency (AHPRA). They will undergo a credentialling program, designed and administered by the study team, to assess their competency in the COOM model i.e. working with prescribers and ordering medications on an electronic medication chart. Adherence to intervention will be captured through the electronic medication management software at the two hospitals where audits of pharmacist prescribing, and progress notes will be captured and quantified. Retrospective data will be collected on a weekly basis as the intervention is conducted. This data will help the research team to monitor adherence to protocol. All pharmacists across both the intervention teams and control teams will be available to the respective medical teams at the same times on the same days, in line with usual pharmacy hours (i.e. Monday to Friday 8:00am to 5:00pm). Both intervention teams and control teams will receive usual weekend and public holiday pharmacy service. The intended study duration will be 6 months.
Sponsors
Metro South Health
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All adult admission to the General Medicine team allocated the intervention team will automatically be treated using the COOM model (intervention), while patients in the other General Medicine Teams not receiving the COOM model will be treated with the standard pharmacy model and allocated as controls.
Exclusion criteria
Patients will be excluded if they are <18 years of age, have length of in-patient stay <24 hours, are admitted to the Medical Assessment and Planning Unit, or do not receive a pharmacist best possible medication history during admission. They will not be included in the primary outcome analysis if they were not under the designated medical team during their first 24 hours of hospital admission.
Outcome results
None listed