New standard and review reinforce hospital pharmacist role in reducing medicines misadventure

Current best care for the provision of General Medicine pharmacy services by General Medicine pharmacists, including the strengthening case for extended scope across essential and emerging services, is laid out in the latest Standard of Practice from the Society of Hospital Pharmacists of Australia (SHPA).

Developed with input from the Internal Medicine Society of Australia and New Zealand Ltd (IMSANZ) SHPA’s Standard of practice in general medicine for pharmacy services appears in the latest issue of the Journal of Pharmacy Practice and Research (JPPR), alongside a complementary systematic review strengthening the case for broader pharmacist roles to improve medicines-related outcomes through the provision of comprehensive care.

The proposed extended scope includes a collaborative admission medication charting model, pharmacist-led influenza vaccination, pharmacist completion of the medication management plan in the medical discharge summary – leading to a reduction in the rate of errors in these summaries – and documentation of medicine changes via a pharmacist-prepared discharge medication management summary.

SHPA General Medicine Chair Dr Erica Tong says the clinical pharmacist's role in the general medicine unit is both critical and unique.

‘Patients admitted to general medical units are often complex with multiple comorbidities, polypharmacy and at risk for drug-related problems associated with increased morbidity and mortality.

‘For decades clinical pharmacists have routinely contributed to the care of these patients and we know that their presence on daily medical ward rounds, embedded in a multidisciplinary team, is proven to reduce patients’ exposure to a preventable adverse drug events.

‘While their positive impact is generally accepted, clinical pharmacists’ role in general medical units has remained limited. In Australia however, we are seeing emerging support for extending the scope for general medicine pharmacists, with clinical pharmacists often recognised members of general medicine multidisciplinary teams.

‘As detailed in the Standard, there should also be consideration of extended hours of pharmacy service to accommodate the high patient turnover frequently encountered in General Medicine units. As part of a broader clinical service, a 24-hour pharmacy service to optimise the care of patients outside of traditional business hours would be ideal.’

The Standard is featured in the August 2020 issue of JPPR, available through Wiley publishing and free to SHPA members.

SHPA President Peter Fowler says the new Review section of JPPR focuses on practice-shaping articles aligned to SHPA Standards.

‘It is pleasing to see emerging support for an extended scope for pharmacists in General Medicine. This support is edified through this issue’s evaluation of published literature – by Tong et al. – on the effects of clinical pharmacist roles that extend beyond activities considered to be standard clinical practice in Australia.

‘The evidence shows that inpatient medication errors among short-stay patients with complex medication regimens or polypharmacy are significantly reduced when pharmacists partner with medical staff to jointly chart initial medications on admission.

‘SHPA will continue to advocate for the proven impact of hospital pharmacists in all care settings, toward the clear goal of optimal patient care.’