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Medicines safety

Prescribing pharmacist improves timeliness of medicines supply at discharge

The work described here was presented at the Pharmacy Together 2019 conference.

Currently, local practice is that Discharge Advice Letters are completed by medical staff and can often be a time consuming process. A recent study identified that independent prescribing pharmacists (IPPs) completing clinical summaries and discharge prescriptions for medical patients decreased the time from ‘medical decision to discharge’ (MDTD) to actual discharge

This study sought to determine whether adopting a modified version of this intervention (omitting the second pharmacist clinical check) would have a similar effect on discharges from the acute stroke unit at the hospital. Our objective was to determine whether an IPP completing the combined local electronic clinical summary and discharge medicines document (eDAL) improved the timeliness of medicines supply at discharge.

The study, carried out in October 2018, comprised a two week control period, followed by a two week intervention period. In the control period, medical prescribers completed clinical summaries and reviewed the pre-populated (by pharmacy) discharge medicines section before signing off eDALs. Once signed off, eDALs were clinically checked and dispensed on the unit. 

In the intervention period, the independent prescribing pharmacist completed clinical summaries, reviewed the discharge medicines section, signed off and clinically checked eDALs. The IPP only signed off eDALs in the intervention period if she had attended the physician-led stroke ward round where the MDTD was made. 

The independent prescribing pharmacist completed clinical summaries, reviewed the discharge medicines, and clinically checked the electronic clinical summary and discharge medicines document

A data collection form was designed to record time points from MDTD to completion of the accuracy check of discharge medicines. Data were collected prospectively in both periods by the pharmacy team. To provide suitable comparison, only discharges which took place on the day of MDTD were analysed. 

Fifteen patients were discharged in the control period and 26 in the intervention period. Seven eDALs in the intervention period were written by medical prescribers; these were outlying non-stroke patients seen as part of general medical ward round and were excluded from the analysis.  

The median eDAL processing time (MDTD to completion of the accuracy check of discharge medicines on the ward) was significantly less in the intervention group (60 versus 195 minutes). Notably, the median time between the MDTD and clinical summary being commenced was significantly less in the intervention group compared with the control group (8 versus 70 minutes).

An independent prescribing pharmacist working as part of a physician-led stroke team improved the timeliness of medicines supply at discharge by completing both sections of the local eDAL. However, these findings should be interpreted with caution due to the small number of discharges included in the study. A larger study is warranted to include a comparison of the quality of clinical summaries completed by medical prescribers and IPPs and should seek to determine whether the intervention releases medical prescriber time.      

This work was presented as a poster at the Pharmacy Together 2019 conference, organised by UKCPA and Pharmacy Management.

Additional authors:

Lee Jones, David McRae & Dr James White, Prince Charles Hospital, Cwn Taf Morgannwg University Health Board.

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement: 

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

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