Comparison of medication error rate between a doctor-pharmacist collaborative model of prescribing and usual medical prescribing, within the perioperative setting of a non-tertiary hospital.

What is the intervention: A doctor-pharmacist collaborative prescribing model of care. This model of care requires a cooperative practice relationship between a pharmacist, with legal authority to prescribe medications. The physician diagnoses and makes initial treatment decisions for the patient (in our case this meant that the physician determines what elective surgical treatment is required), and the pharmacist initiates, modifies and continues or discontinues medications as appropriate to achieve the agreed patient outcomes. (in our case safe medication management during the perioperative period). An example of this modifying diabetic medication dose during the clear fluid period with bowel prepartion prior to colonoscopy. Who delivers it and their relevant expertise: The pharmacist prescriber was an experienced pharmacist (18 years of experience) who completed an extensive prescribing training program. The prescribing course content and competency was developed and assessed by Queensland University of Technology (QUT). The course was created to provide training for allied health clinicians to prescribe, as part of a research pilot. Course components reflected similar curriculum to the education and training programs available to prepare pharmacist prescribers in the UK by the General Pharmaceutical Council (GPhC) and in New Zealand by the Pharmacy Council of New Zealand. The QUT course was six months in duration plus 120 hours of learning in practice. The framework and competency for the learning in practice component was extensive. Supervision and sign off for the learning in practice component was delivered by designated medical practitioners at the hospital site. The pharmacist prescriber was assessed as competent to prescribe safely and effectively within the agreed scope of practice in clinic, prior to the study commencing. They received orientation education regarding hospital prescribing guidelines, including for perioperative medication management guidelines. How it is delivered (e.g. face to face, online, group, individual): The pharmacist prescriber delivered care face to face with individual patients How often and for how long & where it was delivered: The pharmacist prescriber delivered care to patients on one occasion only, at the time of the patient's consult in the pre-admission clinic (PAC) at Redland Hospital. The The allocated time for consults is approx approx 30 mins. For intervention patients ,the order of consultaion with other clinicians through PAC required them to see the prescribing pharmacist before any physician consults. This was so that the physician (Anaesthetist +/- Surgical resident) could review the prescribing pharmacist's medication management plan. This was an intentional extra safety step built in to the trial protocol. The patient saw each clinician in the PAC once only. Prescribing by the pharmacist prescriber was completed after the patient consultation was completed in the PAC. The pharmacist prescriber prescribed the admission medications on to the patient's inpatient medication chart (this included home medications and surgical prophylaxis only), ready for admission, in the PAC setting, on the same day as the patient attended PAC. Adherence (e.g. reminders, monitoring): The pharmacist prescriber to assess the patient's understanding and ability to adhere to the perioperative medication plan at the end of the consult. The patient would also be provided with a written summary of the plan. A local trial steering committee was implemented as the central governance structure for the trial. Both the principal and associate investigators participated in this committee. The committee reviewed the trial progress and any risks arising from the trial; review and monitoring of incident reporting associated with trial participants; provision of updates to the local Patient Safety & Quality committee. Additionally, ward pharmacists were advised and encouraged to report any medication errors that may be attributed to the trial to the Director of Pharmacy, independently of the pharmacist prescriber.