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