Advance prescription service (APS) provided by Clinical Ward Pharmacist: Prospective study demonstrating reduction in discharge time of the medical wards

Abstract Description

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Authors (including presenting author) :

Yeung KYD (1), Chan CC (1), Cheung YHT (1), Lau PW (1), Ng CCH (1), Wong HYA (1), Wong VKC (1), Hui LF (3), Wong FFC (1), Chiu F (4), Chui CMW (1), Chan WSC, (2) , Lie KWA (2)

Affiliation :

(1) Department of Pharmacy, Queen Mary Hospital, (2) Department of Medicine, Queen Mary Hospital, (3) Department of Quality and Safety, Queen Mary Hospital and (4) Department of Nursing, Queen Mary Hospital

Introduction :

Overcrowding of medical wards due to lack of patient flow is associated with poorer health outcomes for patients. Hospital overcrowding can result from numerous factors including discharge delays at ward. Several medication related processes could impact adversely on effective discharge of patient. In fact, Advance Prescription Service (APS) provided by Clinical Ward Pharmacist (CWP) was introduced to maximize efficiencies of the discharge process.

Objectives :

To evaluate the impact of APS provided by CWP on patient discharge times and medication safety in medical wards at a teaching hospital of Hong Kong.

Methodology :

Design – Prospective cohort study Participants – All adult patients admitted to medical wards of Queen Mary Hospital from January to September 2018 Intervention – Advance discharge prescription prepared by CWP

Result & Outcome :

Outcome measures - The primary outcome were improvement in median discharge time and the proportion of patients discharged prior to 5pm before and after the implementation of APS. Secondary outcomes included (1) proportions of types and risks of the drug-related problems (DRPs) reviewed by expert panel including ward physician and CWP; (2) average number of interventions accepted by doctors and (3) staff satisfaction with APS. Results: A total of 1,210 advance prescriptions were analyzed in the study period with 802 and 408 advance prescriptions in the pre-implementation and post implementation cohort respectively. Patients whose medications were prepared by APS had a statistically significant reduced median discharge time by 45 minutes from 16:31 to 15:46(p< 0.05). The proportion of patients discharged prior to 5pm after the implementation of APS increased from 55.2% to 60.2% (p=0.03). APS was associated with a reduction in the proportion of patients with high risk DRPs from 6.9% to 5.8% (p< 0.01) and higher average number of interventions accepted by doctors per month (34.9 vs 5.5, p< 0.01). There was a unanimous acceptance of APS by the doctors and nurses. Conclusion: The introduction of APS demonstrated a statistically significant reduced median discharge time, increased the availability of hospital beds and enhanced quality of care of inpatients.