Collaborative pharmaceutical care in an Irish hospital: uncontrolled before-after study

Hdl Handle:
http://hdl.handle.net/10147/312814
Title:
Collaborative pharmaceutical care in an Irish hospital: uncontrolled before-after study
Authors:
Grimes, Tamasine C; Deasy, Evelyn; Allen, Ann; O ’ Byrne, John; Delaney, Tim; Barragry, John; Breslin, Niall; Moloney, Eddie; Wall, Catherine
Publisher:
BMJ Quality & Safety
Journal:
BMJ Quality & Safety
Issue Date:
Feb-2014
URI:
http://hdl.handle.net/10147/312814
Additional Links:
http://qualitysafety.bmj.com/content/early/2014/02/06/bmjqs-2013-002188.full.pdf+html
Abstract:
Background We investigated the benefits of the Collaborative Pharmaceutical Care in Tallaght Hospital (PACT) service versus standard ward-based clinical pharmacy in adult inpatients receiving acute medical care, particularly on prevalence of medication error and quality of prescribing. Methods Uncontrolled before-after study, undertaken in consecutive adult medical inpatients admitted and discharged alive, using at least three medications. Standard care involved clinical pharmacists being ward-based, contributing to medication history taking and prescription review, but not involved at discharge. The innovative PACT intervention involved clinical pharmacists being team-based, leading admission and discharge medication reconciliation and undertaking prescription review. Primary outcome measures were prevalence per patient of medication error and potentially severe error. Secondary measures included quality of prescribing using the Medication Appropriateness Index (MAI) in patients aged ≥65 years. Findings Some 233 patients (112 PACT, 121 standard) were included. PACT decreased the prevalence of any medication error at discharge (adjusted OR 0.07 (95% CI 0.03 to 0.15)); number needed to treat (NNT) 3 (95% CI 2 to 3) and no PACT patient experienced a potentially severe error (NNT 20, 95% CI 10 to 142). In patients aged ≥65 years (n=108), PACT improved the MAI score from preadmission to discharge (Mann–Whitney U p<0.05; PACT median −1, IQR −3.75 to 0; standard care median +1, IQR −1 to +6). Conclusions PACT, a collaborative model of pharmaceutical care involving medication reconciliation and review, delivered by clinical pharmacists and physicians, at admission, during inpatient care and at discharge was protective against potentially severe medication errors in acute medical patients and improved the quality of prescribing in older patients.
Item Type:
Article
Language:
en
Keywords:
TEAM WORK; HOSPITALS; PHARMACIES; QUALITY CONTROL; PRESCRIBING
Sponsors:
Funder: Meath Institute

Full metadata record

DC FieldValue Language
dc.contributor.authorGrimes, Tamasine Cen_GB
dc.contributor.authorDeasy, Evelynen_GB
dc.contributor.authorAllen, Annen_GB
dc.contributor.authorO ’ Byrne, Johnen_GB
dc.contributor.authorDelaney, Timen_GB
dc.contributor.authorBarragry, Johnen_GB
dc.contributor.authorBreslin, Niallen_GB
dc.contributor.authorMoloney, Eddieen_GB
dc.contributor.authorWall, Catherineen_GB
dc.date.accessioned2014-02-13T15:15:57Z-
dc.date.available2014-02-13T15:15:57Z-
dc.date.issued2014-02-
dc.identifier.urihttp://hdl.handle.net/10147/312814-
dc.description.abstractBackground We investigated the benefits of the Collaborative Pharmaceutical Care in Tallaght Hospital (PACT) service versus standard ward-based clinical pharmacy in adult inpatients receiving acute medical care, particularly on prevalence of medication error and quality of prescribing. Methods Uncontrolled before-after study, undertaken in consecutive adult medical inpatients admitted and discharged alive, using at least three medications. Standard care involved clinical pharmacists being ward-based, contributing to medication history taking and prescription review, but not involved at discharge. The innovative PACT intervention involved clinical pharmacists being team-based, leading admission and discharge medication reconciliation and undertaking prescription review. Primary outcome measures were prevalence per patient of medication error and potentially severe error. Secondary measures included quality of prescribing using the Medication Appropriateness Index (MAI) in patients aged ≥65 years. Findings Some 233 patients (112 PACT, 121 standard) were included. PACT decreased the prevalence of any medication error at discharge (adjusted OR 0.07 (95% CI 0.03 to 0.15)); number needed to treat (NNT) 3 (95% CI 2 to 3) and no PACT patient experienced a potentially severe error (NNT 20, 95% CI 10 to 142). In patients aged ≥65 years (n=108), PACT improved the MAI score from preadmission to discharge (Mann–Whitney U p<0.05; PACT median −1, IQR −3.75 to 0; standard care median +1, IQR −1 to +6). Conclusions PACT, a collaborative model of pharmaceutical care involving medication reconciliation and review, delivered by clinical pharmacists and physicians, at admission, during inpatient care and at discharge was protective against potentially severe medication errors in acute medical patients and improved the quality of prescribing in older patients.en_GB
dc.description.sponsorshipFunder: Meath Instituteen_GB
dc.language.isoenen
dc.publisherBMJ Quality & Safetyen_GB
dc.relation.urlhttp://qualitysafety.bmj.com/content/early/2014/02/06/bmjqs-2013-002188.full.pdf+htmlen_GB
dc.subjectTEAM WORKen_GB
dc.subjectHOSPITALSen_GB
dc.subjectPHARMACIESen_GB
dc.subjectQUALITY CONTROLen_GB
dc.subjectPRESCRIBINGen_GB
dc.titleCollaborative pharmaceutical care in an Irish hospital: uncontrolled before-after studyen_GB
dc.typeArticleen
dc.identifier.journalBMJ Quality & Safetyen_GB
dc.description.fundingOtheren
dc.description.provinceLeinsteren
dc.description.peer-reviewpeer-reviewen
dc.description.notesThis paper won the overall HSE Open Access Research Award 2014.-
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