title: Independent prescribing by hospital pharmacists: Patterns and practices in a Canadian province.
abstract: OBJECTIVE
  Results of a survey to determine the frequency of prescribing by Canadian hospital pharmacists with independent prescribing authority are reported.
  
  
  METHODS
  A Web-based questionnaire was used to collect data on the prescribing activities of a designated group of hospital-affiliated pharmacists in the province of Alberta who had been granted "additional prescribing authorization" (APA) through a peer-review process and were providing clinical pharmacy services in inpatient and/or outpatient settings at the time of the survey (January-March 2014). Descriptive statistics and logistic regression analysis were used to determine the median weekly frequency of prescribing, factors associated with increased use of APA, and perceived prescribing barriers and enablers.
  
  
  RESULTS
  The survey response rate was about 50% (77 of 153 eligible pharmacists). The median self-reported number of prescriptions and medication orders written during an average week was 4.2 (interquartile range, 2.0-10.0) per 10 patients. Antibiotics and anticoagulants were the most commonly prescribed medications. Interdisciplinary care team dynamics was rated as a leading enabler of prescribing but also a leading barrier to the exercise of APA. The greatest motivators to apply for APA were the potential for increased efficiency and the potential for enhanced patient care.
  
  
  CONCLUSIONS
  The survey results indicated that, in an average week, hospital pharmacists with APA prescribed for almost half of the patients they cared for as part of the interdisciplinary team. Prescribing most frequently occurred after team discussion and most often involved adjusting dosages based on organ function and clinical assessment.
authors.affiliation: Taryn Heck, B.Sc.Pharm., ACPR, is Clinical Pharmacist, University of Alberta Hospital, Edmonton, Canada. Mary Gunther, B.Sc. Pharm., ACPR, is Clinical Practice Leader-Pediatric Critical Care, Alberta Health Services (AHS), Edmonton. Lauren Bresee, B.Sc. Pharm., M.Sc., Ph.D., ACPR, is Drug Stewardship Pharmacist-Calgary Zone, AHS, and Adjunct Assistant Professor, Department of Community Health Sciences, University of Calgary, Calgary, Canada. Tania Mysak, B.S.P., Pharm.D., is Director of Practice, Pharmacy Services, AHS, Edmonton. Chloe Mcmillan, B.Sc.Pharm., is Clinical Pharmacist, University of Alberta Hospital. Sheri Koshman, B.Sc.Pharm., Pharm.D., ACPR, is Associate Professor of Medicine, Division of Cardiology, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton.
authors.forename: Taryn
authors.initials: T
authors.lastname: Heck
authors.affiliation: Taryn Heck, B.Sc.Pharm., ACPR, is Clinical Pharmacist, University of Alberta Hospital, Edmonton, Canada. Mary Gunther, B.Sc. Pharm., ACPR, is Clinical Practice Leader-Pediatric Critical Care, Alberta Health Services (AHS), Edmonton. Lauren Bresee, B.Sc. Pharm., M.Sc., Ph.D., ACPR, is Drug Stewardship Pharmacist-Calgary Zone, AHS, and Adjunct Assistant Professor, Department of Community Health Sciences, University of Calgary, Calgary, Canada. Tania Mysak, B.S.P., Pharm.D., is Director of Practice, Pharmacy Services, AHS, Edmonton. Chloe Mcmillan, B.Sc.Pharm., is Clinical Pharmacist, University of Alberta Hospital. Sheri Koshman, B.Sc.Pharm., Pharm.D., ACPR, is Associate Professor of Medicine, Division of Cardiology, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton. mary.gunther@ahs.ca.
authors.forename: Mary
authors.initials: M
authors.lastname: Gunther
authors.affiliation: Taryn Heck, B.Sc.Pharm., ACPR, is Clinical Pharmacist, University of Alberta Hospital, Edmonton, Canada. Mary Gunther, B.Sc. Pharm., ACPR, is Clinical Practice Leader-Pediatric Critical Care, Alberta Health Services (AHS), Edmonton. Lauren Bresee, B.Sc. Pharm., M.Sc., Ph.D., ACPR, is Drug Stewardship Pharmacist-Calgary Zone, AHS, and Adjunct Assistant Professor, Department of Community Health Sciences, University of Calgary, Calgary, Canada. Tania Mysak, B.S.P., Pharm.D., is Director of Practice, Pharmacy Services, AHS, Edmonton. Chloe Mcmillan, B.Sc.Pharm., is Clinical Pharmacist, University of Alberta Hospital. Sheri Koshman, B.Sc.Pharm., Pharm.D., ACPR, is Associate Professor of Medicine, Division of Cardiology, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton.
authors.forename: Lauren
authors.initials: L
authors.lastname: Bresee
authors.affiliation: Taryn Heck, B.Sc.Pharm., ACPR, is Clinical Pharmacist, University of Alberta Hospital, Edmonton, Canada. Mary Gunther, B.Sc. Pharm., ACPR, is Clinical Practice Leader-Pediatric Critical Care, Alberta Health Services (AHS), Edmonton. Lauren Bresee, B.Sc. Pharm., M.Sc., Ph.D., ACPR, is Drug Stewardship Pharmacist-Calgary Zone, AHS, and Adjunct Assistant Professor, Department of Community Health Sciences, University of Calgary, Calgary, Canada. Tania Mysak, B.S.P., Pharm.D., is Director of Practice, Pharmacy Services, AHS, Edmonton. Chloe Mcmillan, B.Sc.Pharm., is Clinical Pharmacist, University of Alberta Hospital. Sheri Koshman, B.Sc.Pharm., Pharm.D., ACPR, is Associate Professor of Medicine, Division of Cardiology, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton.
authors.forename: Tania
authors.initials: T
authors.lastname: Mysak
authors.affiliation: Taryn Heck, B.Sc.Pharm., ACPR, is Clinical Pharmacist, University of Alberta Hospital, Edmonton, Canada. Mary Gunther, B.Sc. Pharm., ACPR, is Clinical Practice Leader-Pediatric Critical Care, Alberta Health Services (AHS), Edmonton. Lauren Bresee, B.Sc. Pharm., M.Sc., Ph.D., ACPR, is Drug Stewardship Pharmacist-Calgary Zone, AHS, and Adjunct Assistant Professor, Department of Community Health Sciences, University of Calgary, Calgary, Canada. Tania Mysak, B.S.P., Pharm.D., is Director of Practice, Pharmacy Services, AHS, Edmonton. Chloe Mcmillan, B.Sc.Pharm., is Clinical Pharmacist, University of Alberta Hospital. Sheri Koshman, B.Sc.Pharm., Pharm.D., ACPR, is Associate Professor of Medicine, Division of Cardiology, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton.
authors.forename: Chloe
authors.initials: C
authors.lastname: Mcmillan
authors.affiliation: Taryn Heck, B.Sc.Pharm., ACPR, is Clinical Pharmacist, University of Alberta Hospital, Edmonton, Canada. Mary Gunther, B.Sc. Pharm., ACPR, is Clinical Practice Leader-Pediatric Critical Care, Alberta Health Services (AHS), Edmonton. Lauren Bresee, B.Sc. Pharm., M.Sc., Ph.D., ACPR, is Drug Stewardship Pharmacist-Calgary Zone, AHS, and Adjunct Assistant Professor, Department of Community Health Sciences, University of Calgary, Calgary, Canada. Tania Mysak, B.S.P., Pharm.D., is Director of Practice, Pharmacy Services, AHS, Edmonton. Chloe Mcmillan, B.Sc.Pharm., is Clinical Pharmacist, University of Alberta Hospital. Sheri Koshman, B.Sc.Pharm., Pharm.D., ACPR, is Associate Professor of Medicine, Division of Cardiology, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton.
authors.forename: Sheri
authors.initials: S
authors.lastname: Koshman
mesh_terms: D000328:Adult; D000416:Alberta; D002170:Canada; D015331:Cohort Studies; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000639:trends*; D010607:Pharmacy Service, Hospital / Q000379:methods / Q000639:trends*; D024382:Professional Role; D011795:Surveys and Questionnaires