The impact of partnered pharmacist medication charting in the emergency department on the use of potentially inappropriate medications in older people

Tesfay Mehari Atey; Gregory M Peterson; Mohammed S Salahudeen; Barbara C Wimmer

doi:10.3389/fphar.2023.1273655

The impact of partnered pharmacist medication charting in the emergency department on the use of potentially inappropriate medications in older people

Front Pharmacol. 2023 Nov 7:14:1273655. doi: 10.3389/fphar.2023.1273655. eCollection 2023.

Authors

Tesfay Mehari Atey¹, Gregory M Peterson¹, Mohammed S Salahudeen¹, Barbara C Wimmer¹

Affiliation

¹ School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Australia.

Abstract

Introduction: A process redesign, partnered pharmacist medication charting (PPMC), was recently piloted in the emergency department (ED) of a tertiary hospital. The PPMC model was intended to improve medication safety and interdisciplinary collaboration by having pharmacists work closely with medical officers to review and chart medications for patients. This study, therefore, aimed to evaluate the impact of PPMC on potentially inappropriate medication (PIM) use. Methods: A pragmatic concurrent controlled study compared a PPMC group to both early best-possible medication history (BPMH) and usual care groups. In the PPMC group, pharmacists initially documented the BPMH and collaborated with medical officers to co-develop treatment plans and chart medications in ED. The early BPMH group included early BPMH documentation by pharmacists, followed by traditional medication charting by medical officers in ED. The usual care group followed the traditional charting approach by medical officers, without a pharmacist-collected BPMH or collaborative discussion in ED. Included were older people (≥65 years) presenting to the ED with at least one regular medication with subsequent admission to an acute medical unit. PIM outcomes (use of at least one PIM, PIMs per patient and PIMs per medication prescribed) were assessed at ED presentation, ED departure and hospital discharge using Beers criteria. Results: Use of at least one PIM on ED departure was significantly lower for the PPMC group than for the comparison groups (χ², p = 0.040). However, PIM outcomes at hospital discharge were not statistically different between groups. PIM outcomes on ED departure or hospital discharge did not differ from baseline within the comparison groups. Discussion: In conclusion, PIM use on leaving ED, but not at hospital discharge, was reduced with PPMC. Close interprofessional collaboration, as in ED, needs to continue on the wards.

Keywords: co-charting; emergency department; medication charting; partnered pharmacist; potentially inappropriate medication.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The Tasmanian Government’s Department of Health funded the project’s trial implementation. The project trial evaluation study was outsourced to an external research body (University of Tasmania) that received no financial support from the government or any other source. The funding body for the project trial implementation had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The open-access article-processing charge was funded by the School of Pharmacy and Pharmacology, University of Tasmania, Australia.