Authors (including presenting author) :
LAM YY(1), YANG KT(1), MAK CK(1), Mak LKK (1)
Affiliation :
(1)Department of Pharmacy, Tseung Kwan O Hospital, Kowloon East Cluster
Introduction :
Nowadays, multi-specialty appointments and polypharmacy are not uncommon. Together with frequent hospitalizations, there is increased risk in unintentional discrepancy in therapy and drug omission. In current practice, pharmacists screen prescriptions after medications are picked and no medication reconciliation is involved. Workflow is often interrupted when interventions are made as orders needed to be rectified, picked and rechecked again. This can lead to longer waiting time. Having pharmacist to perform prescription screening and medication reconciliation before vetting may lessen interruptions and enhance medication safety.
Objectives :
(1) To evaluate the effectiveness of having pharmacist prescription screening at vetting stage (2) To evaluate the effect of medication reconciliation for high risk patients on unintended drug omission
Methodology :
A prospective cross-section study was carried out in November 2018. From 3pm to 5pm on weekdays, one pharmacist stationed at vetting station and performed prescription screening before vetting by dispensers. For prescriptions of high risk groups (i.e. discharge prescriptions and specialized out-patient clinic prescriptions for patients ≥ 65 years old with ≥ 5 chronic medications), medication reconciliation would also be conducted. Patients’ drug history, consultation notes and laboratory reports might be reviewed on Electronic Patient Record (ePR) during clinical screening. Patients might be interviewed when necessary. Doctors were contacted for problems identified. Interventions made in October 2018 were reviewed and analyzed as pre-study data.
Result & Outcome :
During study period, 1578 (45.5%) prescriptions were screened by pharmacists before vetting in 17 days. 88 (5.58%) interventions were made before vetting; 43 (48.9%) of them were discovered during medication reconciliation. Among those 43 interventions, 23.3% were related to unintended drug omission. Comparing to pre-study period, total 3939 prescriptions were received and 114 (2.9%) interventions were made from all dispensing stages in 17 days; 12.3% were related to drug omission, which were mostly identified by patients during drug issuing. Clinical screening by pharmacist at vetting stage is beneficial in identifying drug related problems and improves dispensing efficiency. In view of an average of 10 minutes required for extra work caused by each workflow interruption, 15 hours were probably saved during study period. In addition, this pilot study showed a reduction in unintended drug omission through medication reconciliation. The above results provide a strong support to the future expansion of service.
Co-location with:
