Collaborative pharmacy model enhancing patient care
The TPCH Pharmacy Collaborative Pharmacist Medication Prescribing (CPMP) team (left to right) are Michelle Hayman, Edward King, Hannah Dinham, Brittany Thomson, Morgan Gibson, Teneale Ryder, Patrick Heberlein, Emma Williams, Jaryth Twine, Amelia Wootten, Mika Varitimos and Liz Robinson.
A collaboration between senior pharmacists and doctors at The Prince Charles Hospital (TPCH) is ensure that patients who present to the emergency department receive the best dose of prescription medications.
TPCH is now using Collaborative Pharmacist Medication Prescribing (CPMP) as a strategy to mitigate prescribing errors, improve the quality use of medicines, and reduce length of stay.
CPMP is a co-prescribing model whereby an authorised pharmacist and a medical practitioner or nurse practitioner reviews a patient’s medication and current medical issues, collaboratively agreeing on a management plan for medicines.
The authorised pharmacist can then prescribe the medicines according to the plan for subsequent administration by nursing staff or supply to the patient.
At TPCH, prescribing pharmacists liaise with admitting medical teams to identify patients in the ED and across the hospital. Preadmission medicines as well as new medicines are prescribed according to the collaborative medication plan.
TPCH Pharmacy Deputy Director Erin Dunn said introducing CPMP at TPCH saw a reduction in acute medical patient length of stay from 3.4 days to 3 days.
“It also saw improvements in the quality of prescribing for patients and documentation of adverse drug reaction history,” Erin said.
“In addition, venous thromboembolism risk assessment documentation improved from 28 per cent to an impressive 98 per cent.
“CPMP offers a practical, scalable and clinically credible way to strengthen medication safety and improve patient flow across acute care.”
Senior pharmacists at TPCH have also recently implemented anti-Xa monitoring to enhance the safety of patients prescribed enoxaparin.
Some blood thinners such as enoxaparin can carry a significant bleeding risk, particularly in patients at extremes of body weight or with renal impairment. Anti-Xa levels measure the activity of anticoagulants in the blood to ensure therapeutic effectiveness and minimise bleeding risks.
TPCH Advanced Pharmacist Mika Varitimos developed an education package for the anti-Xa monitoring pilot, which was delivered to all TPCH pharmacists.
Mika said a chart audit of patients prescribed therapeutic enoxaparin over a five-week period was conducted.
“The post intervention audit of 26 patients found 50 per cent of anti-Xa levels were requested by pharmacists.
“Dose compliance with guidelines improved from 57 per cent pre-intervention to 73 per cent post-intervention.
“Monitoring compliance also improved from 32 per cent to 64 per cent, with no instances of levels being requested without an appropriate indication.
“Pharmacist-requested anti-Xa monitoring improved compliance with dosing and monitoring requirements for therapeutic enoxaparin.”
Pharmacist-requested anti-Xa monitoring has since been expanded from the cardiology wards to all clinical units across TPCH.