Data from: Perioperative medication management: expanding the role of the preadmission clinic pharmacist in a single centre, randomised controlled trial of collaborative prescribing

Objectives: Current evidence to support non-medical prescribing is predominantly qualitative, with little evaluation of accuracy, safety and appropriateness. Our aim was to evaluate a new model of service for the Australia healthcare system, of inpatient medication prescribing by a pharmacist in an elective surgery pre admission clinic (PAC) against usual care, using an endorsed performance framework. Design: Single centre, randomised controlled, two arm trial Setting: Elective surgery pre admission clinic in Brisbane based tertiary hospital Participants: Four hundred adults scheduled for elective surgery were randomised to intervention or control. Intervention: A pharmacist generated the inpatient medication chart to reflect the patient’s regular medication, made a plan for medication perioperatively and prescribed VTE prophylaxis. In the control arm, the medication chart was generated by the Resident Medical Officers (RMO). Outcome Measures: Primary outcome was frequency of omissions and prescribing errors when compared against the medication history. The clinical significance of omissions was also analysed. Secondary outcome was appropriateness of VTE prophylaxis prescribing. Results: There were significantly less unintended omissions of medications: 11 of 887 (1.2%) intervention orders compared with 383 of 1217 (31.5%) control (p<0.001). There were significantly less prescribing errors involving selection of drug, dose or frequency: 2 in 857 (0.2%) intervention orders compared with 51 in 807 (6.3%) control (p<0.001). Orders with at least one component of the prescription missing, incorrect or unclear occurred in 20826 of 904 (235%) intervention orders and 445667 of 1034 (4364.5%) control (p<0.001). VTE prophylaxis on admission to the ward was appropriate in 93% of intervention patients and 90% control (p=0.29). Conclusion: Medication charts in the intervention arm contained fewer clinically significant omissions, and prescribing errors, when compared to control. There was no difference in appropriateness of VTE prophylaxis on admission between the two groups. Trial Registration: Registered with ANZCTR – ACTR Number ACTRN12609000426280

研究目的：支持非医师处方模式的现有证据多为定性研究，鲜有对其准确性、安全性与适宜性的评估。本研究旨在依托经认可的绩效框架，评估澳大利亚医疗体系中一种新型服务模式——由药剂师在择期手术术前门诊（Pre Admission Clinic, PAC）开具住院患者用药处方，并与常规诊疗方案进行对比。
研究设计：单中心、随机对照、双臂试验
研究场景：布里斯班某三级医院择期手术术前门诊
研究对象：400名拟接受择期手术的成年患者，被随机分配至干预组或对照组
干预方案：干预组中，由药剂师根据患者常规用药情况生成住院用药医嘱单，制定围手术期用药方案并开具静脉血栓栓塞症（Venous Thromboembolism, VTE）预防用药；对照组则由住院医师（Resident Medical Officers, RMO）生成用药医嘱单。
结局指标：主要结局指标为与用药史对比时，用药遗漏与处方错误的发生频率，同时分析用药遗漏的临床意义；次要结局指标为VTE预防用药处方的适宜性。
研究结果：干预组非预期用药遗漏的发生率显著更低：887份干预医嘱中出现11例（1.2%），对照组1217份医嘱中出现383例（31.5%）（p<0.001）。涉及药物选择、剂量或给药频次的处方错误发生率亦显著更低：干预组857份医嘱中出现2例（0.2%），对照组807份医嘱中出现51例（6.3%）（p<0.001）。存在至少一项处方要素缺失、错误或表述不清的医嘱，干预组为904份医嘱中的20826例（235%），对照组为1034份医嘱中的445667例（4364.5%）（p<0.001）。病房入院时的VTE预防用药适宜率，干预组为93%，对照组为90%（p=0.29）。
研究结论：与对照组相比，干预组的用药医嘱单存在更少具有临床意义的用药遗漏与处方错误；两组患者入院时VTE预防用药的适宜性无显著差异。
试验注册：已在澳大利亚新西兰临床试验注册中心（ANZCTR）注册，注册编号为ACTRN12609000426280