Official Journal of the Society of Hospital Pharmacists of Australia
LETTERS TO THE EDITOR ROLE OF PRE-ADMISSION CLINIC AND EMERGENCY DEPARTMENT PHARMACISTS IN MEDICATION RECONCILIATION To the Editor, The release of the SHPA Standards of Practice for Clinical Pharmacy Services in June 2013 highlighted the important role of pharmacists in medication reconciliation and facilitating continuation of medication management during transition between care settings. The literature has shown that pre-admission clinic (PAC) and emergency department (ED) pharmacists improve medication reconciliation for surgical and ED admissions, respectively.1,2 Our institution operates using an electronic medication management system and was involved in the personally controlled electronic health record wave 2 site project in 2012. Two pharmacist positions were implemented in PAC and ED as part of the personally controlled electronic health record wave 2 site project. Their duties included prospectively populating the electronic medications on admission (eMOA) lists by conducting patient interviews and using secondary information sources such as electronic general physician referral letters. The eMOA would then be accessible to all clinicians to facilitate electronic medication reconciliation during transitions of care (e.g. during anaesthetic assessment, on admission, at transfers of care and at discharge). A 1-week audit was undertaken to determine the impact of these two positions on the number of patients seen by a pharmacist and the eMOA completed within 24 h of admission. The audit showed that there was an 18% increase in the number of completed eMOA for patients who had been in hospital for up to 24 h, compared to the same audit performed in 2011. Further, 41% of these eMOA had been completed by the PAC and ED pharmacists. These positions also contributed to increased patient safety by allowing clinical ward pharmacists to perform other duties such as clinical medication reviews, with a 7.9% increase (to 85.8%) of patients clinically reviewed by a pharmacist within 1 day of admission. These findings support the idea that implementing pharmacist-led processes in medication reconciliation in PAC and ED improves the number of eMOA available to all clinicians within 1 day of admission, thus contributing to patient safety and continuity of care. The increased number of eMOA in the electronic medication management system allows for a richer review by medical officers when performing medication reconciliation at discharge, © 2015 Society of Hospital Pharmacists of Australia.
resulting in improvements in completeness and accuracy of discharge medicine lists.3
Carmen Ng, BPharm, GradDipClinPharm Nicole Tolley, BSc Pharmacy Susan Welch, BPharm, CertClinPharm, Department of Pharmacy, St Vincent’s Hospital, Darlinghurst, Australia E-mail:
[email protected] Katrina Richardson, BPharm, DipHospPharm, Information Technology Services Centre, St Vincent’s and Mater Health, Sydney, Australia
REFERENCES 1 SHPA Medicines in focus. FACT SHEET – medication assessment at pre-admission for elective surgery 2012. Available from . Accessed 18 June 2012. 2 SHPA Medicines in focus. FACT SHEET – consider medication misadventure during Emergency Department attendances. 2012. Available from . Accessed 18 June 2012. 3 Lehnbom EC, Raban MZ, Walter SR, Richardson K, Westbrook JI. Do electronic discharge summaries contain more complete medication information? A retrospective analysis of paper versus electronic discharge summaries. Health Inf Manage J 2014; 43: 4–12.
Journal of Pharmacy Practice and Research (2015) 45, 375–380 doi: 10.1002/jppr.1121
