Pharmacists step up and in to medicines safety
Facilitating the safe and effective use of medicines is the core business of pharmacists, especially in hospitals.
The use of medicines is the most common healthcare intervention, with more than nine million of us taking a prescribed medicine every day.
While many medicines are nominally low-risk, or considered low-risk by those who take them, 1.2 million Australians have experienced an adverse medication event in the last six months and medication-related problems lead to 250,000 hospital admissions every year.
Health Minister Greg Hunt’s October 2019 announcement that medicines safety and the quality use of medicines would be Australia’s next national health priority area was an important step in ensuring this slow-burning crisis stands front and centre in the health policy landscape.
The next step is harder: how do we connect the dots on medicines safety to keep more people well, safe and out of hospital?
How do we ensure medicines are being taken in the right way for the right reasons, and make a positive difference to people’s lives, right across the country?
Bridging the gap
At a time of unprecedented focus on medicines safety, hospital pharmacists are positioned to draw on their expertise and practice skills to bridge many of the gaps that contribute to avoidable medicine-related harm and hospitalisation.
Across our hospitals, Australian pharmacists already lead the safe and quality use of medicines through core services. These include taking medication history and reconciliation upon admission, regular medication review during episodes of care, discharge medication counselling and supply and clinical handover to primary healthcare providers.
Once further empowered and supported, however, Australia’s pharmacy workforce can fill our pressing medicines safety gaps by stepping up, and stepping in.
Stepping up includes implementation of the Partnered Pharmacist Medication Charting (PPMC) model and implementation of pharmacist-led medication safety programs.
Stepping in involves the application of interim medication charts at key transition points and ensuring patients have access to clinical pharmacists in health services, seven days a week.
The PPMC model has demonstrated significant improvements in safe and quality care, reducing the proportion of inpatients who experience at least one medication error by almost two-thirds compared with traditional medication charting while also reducing the length of inpatient stay by more than 10%.
The Pharmacy Board of Australia’s position statement on pharmacist prescribing released last October noted there are no regulatory barriers in place for pharmacists to prescribe “via a structured prescribing arrangement or under supervision within a collaborative healthcare environment”, paving the way for rollout of this key medication safety intervention, which also delivers efficiencies for our medical colleagues.
With Australia’s hospital pharmacy workforce well established in the acute setting, highly trained and valued by clinical colleagues, a number of other pharmacist-led medication safety programs can translate into the same improvements in medication safety. These sound simple, but are extremely powerful, and include developing systems and processes to reduce risk of medication errors, performing hospital-wide medication safety audits and providing education for doctors, nurses and pharmacists on safe use of medicines, safe prescribing principles and safe handling of medicines.
When it comes to stepping in, hospital pharmacist expertise is urgently needed to support crucial transitions of care as Australians move from hospital to the home, or to aged care, or vice versa. During these transitions, the probability of medication errors increases sharply, as administration delays and errors are common, particularly in the first 24 to 72 hours after hospital discharge.
Interim medication charts offer a solution, especially for older people discharged to residential aged-care facilities or home care. When prepared by a hospital pharmacist, interim medication charts have been shown to effectively ensure continuity of care and eliminate the need for a GP or locum doctor to perform this essential task on the day of discharge.
A fourth gap that can be addressed by Australia’s hospital pharmacy workforce is the potentially harmful lack of clinical pharmacy services available on weekends. Stepping in to support seven-day-a-week hospital pharmacist care — including through use of telehealth — has already begun in some states and territories, a move that is based on stark logic.
Australian Institute of Health and Welfare statistics highlight that there are more emergency department presentations on weekends compared with weekdays and that 69% of presentations occur between 8 am and 8 pm.
In our hospitals, patients are admitted and discharged seven days a week and, just as medical and nursing units are available, patients admitted to hospital after hours or on weekends should be afforded the same level of pharmacy care as those that present during business hours.
The additional presence of hospital pharmacists to provide care to inpatients and outpatients will prevent medication errors, reduce adverse drug reactions and support clinicians with prescribing advice, all of which are crucial to improving outcomes and ensuring smooth discharge into community care.
By stepping up and stepping in, the roles of hospital pharmacists can be easily augmented, and their potential harnessed, to help prevent medication-related harm and support the safe and quality use of medicines for people receiving care across our health services.
The use of medicines will only increase; now is the time to get it right.
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