Analysis of clinical intervention records by pharmacists in an Australian principal referral and specialist women's and newborns' hospital

One Year Evaluation of Pharmacist Medication Charting Service in a Principal Referral Women and Newborn Hospital

Background: Accuracy of medication charts on admission to hospital has previously shown that inadvertent omission of therapy was the most common discrepancy, accounting for 40% to 60% of errors. Partnered Pharmacist Medication Charting (PPMC) has shown to reduce medicationrelated problems. Objective: The aim of this study was to evaluate the implementation of Pharmacist Medication Charting (PMC), a derivative of PPMC, in a maternity and gynecological hospital. The occurrence of medication omission identified by the pharmacists was assessed and the pharmacist interventions involving PMC analyzed. Methods: The pharmacist interventions documented from 1st July 2022 to 30th June, 2023 were evaluated using PowerBI for data and trends on the Medication-Related Problems (MRPs) identified, occurrence of PMC, common medications charted by the pharmacists and the pharmacist recommendation and action following the identification of MRPs. Results: A total of 4898 pharmacy interventions was documented in the 12-month period. Of the total interventions documented, 1321 (26.97%) were related to pharmacist medication charting. Of all the interventions related to PMC, 53.29% involved pharmacists charting medications for the continuation or initiation of over-the-counter medications, 13.32% involved pharmacist partnered charting of Prescription Only Medications and Controlled Medications with medical staff, and 33.3% were referred to a credentialled pharmacist for PMC service. With regards to action taken following interventions involving PMC, 1065 (80.62%) were resolved following PMC. Common medications charted by the pharmacists include: macrogol and docusate laxatives (288), pregnancy multivitamin containing iron, iodine and folate (169), colecalciferol (133), iron (127), asthma inhaler (99), paracetamol and ibuprofen (88), nicotine (38), calcium (29), folic acid (26), and pantoprazole (15). Conclusion: Our study demonstrated that hospital pharmacists contribute to the reduction of MRPs, and PMC enables pharmacist to address prescribing omission and conditions untreated in the hospital. This study also reflects skills enhancement in practice for clinical pharmacists and resulted in successful implementation of PMC.

A health integrated platform for pharmacy clinical intervention data management and intelligent visual analytics and reporting

Objective

Our initiative aimed to improve the system used to capture pharmacist clinical interventions to better support staff to document, manage and identify trends in medication-related problems (MRPs). The aim of the study was to develop an electronic tool which is easily accessible by most electronic devices with secure data storage and access.

Methods

A REDCap® database was designed for documentation of pharmacy clinical interventions. Information documented can be retrieved in real-time and can be integrated to Microsoft Power BI® for real-time data visualisation. The dashboards were customised to display useful information including pharmacy clinical intervention details, common MRPs, common medications involved available to users at real time.

Results

A total of 4343 interventions were documented from July 2022 to March 2023. The most common MRPs were omission of regular medications 876 (20.17%), condition untreated 722(16.62%), and contraindications apparent 451 (10.38%). The most common medications involved include iron 244 (5.62%), enoxaparin 231 (5.32%), macrogol laxatives 208 (4.79%), multivitamin 206 (4.74%), colecalciferol 179(4.12%), tramadol 156 (3.59%).

Conclusion

This study demonstrated the significance of integration of health application tools of REDcap and Power BI in the data management and intelligent visual analytics and reporting.

Pharmacist clinical interventions: Five years' experience of an efficient, low-cost, and future-proofed tool

OBJECTIVE

The objective of this study was to describe the development of an efficient and future-proofed tool for the documentation and analysis of clinical interventions (CIs). A secondary objective was to describe CIs recorded over a 5-year period and describe implications of the tool.

METHOD

In 2016, a matrix guide and an advanced spreadsheet were implemented in the study hospital to document all CIs made by pharmacists. The data entry tabs are arranged by month. The summary report dashboard tab provides an automatically generated analysis of the real-time data following pharmacists entering the CI details.

RESULTS

A total of 10,855 CIs were documented over the 5 years period starting from March 2016 to February 2021. The real-time data were utilised for multiple quality improvement initiatives including medical and nursing education, development of business cases and progress monitoring of newly established services. The tool was able to adapt with changes in devices, business intelligence software and migration to cloud storage.

CONCLUSION

The study demonstrates the feasibility of developing a low-cost and low-resource CI documentation tool. This tool provides data with the capability to inform site-specific education strategies, monitor quality improvement services and inform management in business case preparation.

Patient Safety Incidents Related to the Use of Parenteral Nutrition in All Patient Groups: A Systematic Scoping Review

INTRODUCTION

There is limited comprehensive literature focussing on the range of patient safety incidents related to parenteral nutrition (PN).

OBJECTIVE

The aim of this review was to examine patient safety incidents related to the use of PN in all patient age groups.

METHODS

Literature published in the English language between January 2000 and April 2020 were searched across the MEDLINE, CINHAL and Embase databases. Articles were included if they contained PN-related patient safety incidents related to an avoidable event. No restrictions were applied to patient populations. The screening process was undertaken independently by two authors.

RESULTS

In total, 108 records were included in the review: 52 case studies, 54 observation studies (e.g. prevalence studies, surveys) and two experimental studies. All age groups were represented, with 62% of studies in paediatrics (of which two-thirds were neonates) and 23% in adults. They included all medication processes: prescribing, dispensing, compounding, administration and monitoring. Incidents were related to microbial contamination, venous access and specific components (e.g. lipid emulsion, amino acids, glucose, micronutrients and electrolytes) or the whole product. Incident outcomes ranging from near miss to death were reported. Intervention studies looked at the impact on patient safety incidents of computerised tools, healthcare processes, e.g. pharmacist screening, and standardisation. One study demonstrated more severe outcomes with paediatric than with adult PN.

CONCLUSIONS

This review demonstrates the vast range of PN-related patient safety incidents in all patient age groups and all medication process stages. The need for a national study looking at patient safety incidents related to PN in England is highlighted.