Expansion of the partnered pharmacist medication charting model on admission in the General Medicine Unit - initiation of new medications

Background Increasing life expectancy has seen a continual rise in older patients who present to hospital with acute decompensation. Pharmacists are well equipped to make medication recommendations in these settings to meet patient care needs, promote harm minimisation, and improve workflow efficiency. The Partnered Pharmacist Medication Charting (PPMC) model enables pharmacists to chart regular medications for patients admitted to the General Medicine Unit (GMU) in collaboration with treating clinicians. The model was expanded to assess the safety of pharmacists additionally charting newly initiated medications. Aim The aim of this study was to assess the safety of the expanded PPMC model through the number of medication errors. Method This prospective observational study was conducted at a tertiary hospital. Patients admitted to the GMU and received PPMC were included. Pharmacists were able to chart any new medications as well as the patients' pre-admission medications. The primary outcome was the number of medication errors charted on admission. Medication errors were defined as medications charted outside of the specific recommendations documented in the medication management plan written by the PPMC pharmacist and co-signed by the admitting medical officer. Results A total of 8093 medications were charted by a credentialed pharmacist, with 10% (n = 816) planned newly initiated medications. Eight (0.98%) medication charting errors were identified in the PPMC model, which included five planned medications omitted. Of the 811 newly charted medications, 87 (10.7%) were amended within 24 h, with the majority being due to change in diagnosis or driven by changes in clinical status or investigative results becoming available. Conclusion The expansion of the PPMC model of care to enable pharmacist charting of new medications was found to be safe. The adoption of the model may aid in reducing medication errors, thereby improving patient care and safety.