Original Research
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction: Integrated unit-based pharmacists are important members of the interdisciplinary patient care team with advanced knowledge of patients on their unit. They play a key role in providing medication-related clinical interventions to optimize pharmacotherapy and prevent errors.
Research Question or Hypothesis: How does having an integrated unit-based hospital pharmacist impact a patient’s pharmacotherapy-related care during a hospital admission?
Study Design: Retrospective, observational analysis of the type and frequency of clinical interventions made by six integrated medical-surgical unit-based hospital pharmacists covering 153 beds from August 15 to September 16, 2022.
Methods: Pharmacists documented clinical interventions in the electronic medical record during routine practice. Clinical intervention subtype and potential severity for harm for prescribing errors were assigned during documentation using standardized definitions and severity ranking. Two pharmacist investigators independently reviewed interventions for accurate subtype and severity. Clinical interventions, further categorized as medication therapy recommendations or prescribing errors identified, are described.
Results: A total of 638 clinical interventions were documented during 850 pharmacist hours worked; 307 medication therapy recommendations and 331 prescribing errors identified. Sixty-two percent of medication therapy recommendations were a result of pharmacist-initiated consultation with a clinician, 26% clinician-initiated consultation with a pharmacist, and 12% with ancillary staff (e.g., nurse) regarding medication access, use, and compliance. A total of 331 of 2755 medication orders (12%) entered during pharmacist hours were identified to have a prescribing error. Wrong route (19%), wrong duration (13%) and therapy omissions (11%) were the most common prescribing errors identified. Prescribing orders were classified as severe (84%) or low (16%) severity and there were no life-threatening errors documented.
Conclusion: Unit-based pharmacists are able to make clinical interventions related to medication therapy recommendations or interception of prescribing errors by having a more complete understanding of integral patient specific factors due to their integration on the unit and with the patient-care team.
Presenting Author
Stephanie Wiemeier PharmD, BCPSUniversity of Rochester Medical Center
Authors
Nicole M. Acquisto Pharm.D., FCCP, FCCM, FASHP, BCCCP
University of Rochester Medical Center, Strong Memorial Hospital
Danielle Henry PharmD, BCPS
University of Rochester Medical Center