Evaluating the benefit of pharmacist integrated charting of discharge medications on Electronic Discharge Summaries
Janita Singh
BPharm, MSHP | Foundational Resident Pharmacist, Canberra Health Services | janita.singh@act.gov.au
[Pharmacy GRIT article no: 20241396]
This research project was a pre/post observational study aimed at evaluating the benefit of pharmacist integrated charting of discharge medications on electronic discharge summaries. Pharmacist integrated charting of discharge medications is similar to the Partnered Pharmacist Medication Charting model whereby the pharmacist collaborates with the prescriber to finalise discharge medications and goes on to action this on Electronic Discharge. The prescriber then signs off on the final list of pharmacist curated discharge medications.
The accuracy and time taken to generate discharge scripts by medical officers was evaluated against discharge scripts curated by a pharmacist. This study, along with other similar studies around Australia support pharmacist extended scope of practice1,2,3,4 such as, the United Kingdom and United States of America where pharmacists can prescribe medicines.
A year into this study, in November 2023, Digital Health Record ([DHR] Epic Systems Corporation, Verona, WI, USA) was implemented. Not only was this a monumental change for Canberra Health Services, but also for my study. While the overall discharge process became easier through workflow enhancement accessible via DHR, the initial teething process significantly delayed data collection. I was not personally involved in the data the collection process, to avoid bias. This meant, data collection became the sole responsibility of clinical pharmacists allocated to orthopaedic speciality. This proved to be a major barrier to data collection when pharmacists were unable to collect data due to COVID-19 related personal leave, lacked the familiarity and confidence to collect data utilising the newly implemented DHR system, not equipped to balance existing workload and added task of data collection. I must also acknowledge my all-inclusive knowledge gap around information technology.
If I were allowed a ‘do-over,’ I would invest in familiarising myself with the newly implemented DHR software, this would help me better support the pharmacists involved in data collection. I would also take up tutorials in Microsoft Excel [Microsoft Corporation, Redmond, WA, USA] to allow mellifluous data recording and analysis.
In all, this was an invaluable experience for me, it provided me with the opportunity to delve into the world of research. I gained the ability to anticipate barriers to collaborative work and gained insight into potential solutions. I challenged my technical expertise and am now better equipped to troubleshoot related complications. I learnt how to breakdown a study into smaller achievable portions and establish my familiarity with processes which will provide a sound platform for future research. I discovered a newfound value for effective time management while conducting this study, an indispensable learning for personal development and future research.
References
- Elliott RA, Tan V, Chan V, Richardson B, Tanner F, Dorevitch MI. Pharmacist–physician collaboration to improve the accuracy of medication information in electronic medical discharge summaries: effectiveness and sustainability. Pharmacy (Basel) 2020; 8: 2.
- Tong EY, Roman CP, Mitra B, Yip GS, Gibbs H, Newnham HH, et al. Reducing medication errors in hospital discharge summaries: a randomised controlled trial. Med J Aust 2017; 206: 36–39.
- Tran T, Hardidge A, Heland M, Taylor SE, Garrett K, Mitri E, et al. Slick script: impact on patient flow targets of pharmacists preparing discharge prescriptions in a hospital with an electronic prescribing system. J Eval Clin Pract 2017; 23: 333–339.
- Finn S, D’arcy E, Donovan P, Kanagarajah S, Barras M. A randomised trial of pharmacist-led discharge prescribing in an Australian geriatric evaluation and management service. Int J Clin Pharm 2021; 43: 847–857.