Collaborative P harm a ceutical C are at T allaght Hospital 4 th National Patient Safety Conference Department of Health, Patient Safety First Croke Park.

Collaborative Pharmaceutical Care at

Tallaght Hospital

4th National Patient Safety Conference

Department of Health, Patient Safety First

Croke Park Conference Centre

7th November 2014

May CR et al. BMJ 2009;339:b2803.

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

Current state

Transition state

Future state

Organisation-wide implementation

Project management

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