Collaborative P harm a ceutical C are at T allaght Hospital 4 th National Patient Safety Conference...
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Transcript of Collaborative P harm a ceutical C are at T allaght Hospital 4 th National Patient Safety Conference...
Collaborative Pharmaceutical Care at
Tallaght Hospital
4th National Patient Safety Conference
Department of Health, Patient Safety First
Croke Park Conference Centre
7th November 2014
6 %
8 %
8 %
20 %
26 %
Key facts regarding medication safety
of Irish people aged 50+ years use 5+ medicines daily
of patient readmissions to hospital within a year of index discharge are drug-related
of all emergency hospital admissions are drug-related
of incidents reported to the Clinical Indemnity Scheme are drug-related
of hospital discharges have a potentially severe drug error
Standard care PACT intervention
Service arrangement Aligned to a ward Aligned to a team
Clinical pharmacists involved
Standard One of two PACT pharmacists
Service at admission Admission medication history taking
Admission medication history taking & reconciliation
Service during admission
Minor changes and endorsements to the drug chart
Routine clinical pharmacy
Made minor and major changes to the drug chart, as required
Routine clinical pharmacy
Service at discharge No service Discharge medication reconciliation.
Made minor and major changes to the discharge medication list, as required, co-signed by a medical practitioner.
http://qualitysafety.bmj.com/content/early/2014/02/06/bmjqs-2013-002188.full.pdf+html
PACT facilitated a lower prevalence of medication error
Standard care (% of patients)
PACT Intervention (% of patients)
Admission
40.5 9.0
Adj OR* accounting for clustering, 95% CI: 0.14, 0.07-0.31
Discharge
65.3 13.9
Adj OR$ accounting for clustering, 95% CI: 0.07, 0.03-0.15
Adj OR = Adjusted odds ratio, 95% CI = 95% confidence interval* Binary logistic, adjusted for Charlson co-morbidity index, number of medicines, age.$ Binary logistic, adjusted for Charlson co-morbidity index, number of medicines$, age, length of stay.
No patient in the PACT group experienced a potentially severe error
Potential for harm Standard care (% of patients)
PACT Intervention(% of patients)
No error, no harm 34.7 86.1
Minor harm 5.9 1.9
Moderate harm 53.5 12.0
Severe harm 5.9 0
Number needed to treat to prevent one potentially severe error = 20
95% CI 10-142
PACT improved the quality of prescribing(Medication Appropriateness Index)
Period Standard PACT P value(Mann Whitney U)
Pre-admission MAI 3 (1 to 6.8) 4 (1 to 7.5) 0.538
Change, pre-admission to admission
0 (-2 to 4) -0.5 (-3 to 0) 0.006
Admission MAI 4 (2 to 7) 2.5 (1 to 5) 0.013
Change, pre-admission to discharge
1 (-1 to 6) -1 (-3.8 to 0) 0.000
Discharge MAI 5.5 (2.3 to 9) 2 (0 to 4) 0.000
Table: MAI* Medication Appropriateness Index score, sum per patient (median, interquartile range)
Perceptions of providers“Resource to hand on ward; if have query – instant resource and very
rapid response” (Consultant)
“Educational from both sides” (Intern)
“Especially on discharge, interns have so many things to do,
medicines may be overlooked” (Intern)
“Great job satisfaction, great for suggestions to be acted upon and
to be embraced by the team” (Pharmacist)
“Issues are dealt with more promptly as the pharmacist is on the ward round” (Intern)
“Saves time” (Registrar)
“Drug reconciliation really helpful. Huge benefit to have pre-admission
medication within 12 hours, decreased potential for error” (Consultant)
Learnings from our PACT journey
Key Players/Leaders
Research Pharmacy Management Medical & Nursing
Medication Safety Culture
TIM
E (y
ears
) Value of evidence Engagement
Acknowledgements
Allen, AnnBarragry, JohnBennett, KathleenBreslin, NiallDeasy, EvelynDelaney, TimFahey, DarraghFahey, TomFitzsimons, MichelleHayde, JenniferKirke, Ciara
Kirwan, GráinneMcManamly, CiaraMoloney, EddieO’Byrne, JohnO’Leary, AislingRedmond, PatrickRoche, CicelyTallon, MariaWall, CatherineWalsh, Cathal