Validating the Victorian partnered pharmacist charting model in the Western Australian setting

The partnered pharmacist medication charting (PPMC) model is an alternative to traditional medical prescribing (MP) in the hospital setting.1, 2 Pharmacists and medical staff partner to conduct early medication reconciliation, collaborative medication review and joint medication charting.1, 2 The PPMC model was first implemented in Australia at The Alfred Hospital in 2012 and subsequently expanded to multiple hospitals across Victoria.1 This model has demonstrated both feasibility and improved patient safety, with significant reductions in prescribing error rates from 78.7% to 3.7% (p < 0.001, NNT 1.3) compared to standard MP.2 Subsequently, PPMC has also been shown to reduce hospital length of stay.3 We aimed to validate this model in the Western Australian (WA) setting. A prospective cohort study comparing PPMC to standard MP in patients admitted to the acute medical unit (AMU) of a major quaternary metropolitan hospital in WA was undertaken. The AMU was identified as a high complexity, rapid turn-over area likely to benefit from PPMC and improved prescribing accuracy.4 Significant stakeholder consultation with medical, nursing, pharmacy and state regulatory bodies to ensure local support and legislative compliance was undertaken. Given the lack of familiarity with the PPMC role in the WA setting, we limited the scope of the PPMC initially to only include regular, unchanged medications and excluded new and Schedule 8 medications. State law also required the prescriber to sign the order to deem the prescription valid, which differed from Victorian requirements.1, 2 In July 2017, one existing clinical pharmacist full time equivalent (1.0 FTE) was re-allocated to the PPMC role after training. This pharmacist aligned themselves with the admitting medical team performing PPMC at admission, attending medical meetings and ward rounds. An unblinded review of medication charting errors was performed by an independent senior pharmacist within 72 hours of each instance of partnered charting over a 2-month period in 2018 and compared with those made during MP.2 A total of 580 patients were included, 91 patients with 958 medications charted by a PPMC pharmacist and 489 patients with 4817 medications prescribed by MP (Fig. 1). PPMC reduced the medication error rates per patient admission from 60.1% to 4.4% when compared to MP (p = <0.001, NNT 1.8). Medicines known to be associated with high potential for medication-related harm accounted for 131 (20.2%) errors with MP, compared with only 1 error with PPMC.4 Our study was subject to limitations. This was a single-ward pilot of the PPMC model and the secondary outcome clinical outcomes of errors made were not assessed as per the original project.2 Due to staffing constraints, only 1.0 pharmacist FTE was allocated for PPMC, compared with the team of pharmacists credentialed in Victoria.2 These studies were both conducted using paper-based prescribing systems, which are subject to high prescription error rates.5 We have demonstrated that the PPMC model for medication charting on admission to hospital was adaptable to the WA setting and reduced medication errors. PPMC has since been expanded to all pharmacist positions in AMU, General Medicine and Nephrology. This project was approved as a clinical improvement project by the institution's quality improvement committee (GEKO26656), which considered it exempt from requiring human research ethics approval. McLennan C, Kim B, Huynh C, Tran S, Wright C. The authors do not have any conflicts of interest to declare.