title: Partnered pharmacist charting on admission in the General Medical and Emergency Short-stay Unit - a cluster-randomised controlled trial in patients with complex medication regimens.
abstract: OBJECTIVE
  Patients admitted to general medical units and emergency short-stay units are often complex with multiple comorbidities, polypharmacy and at risk for drug-related problems associated with increased morbidity and mortality. The aim of this study was to evaluate the effectiveness of a partnered pharmacist charting model completed at the time of admission to prevent medication errors.
  
  
  METHODS
  We conducted an unblinded cluster randomized controlled trial comparing partnered pharmacist charting to standard medical charting among patients admitted to general medical units and emergency short-stay units with complex medication regimens or polypharmacy. This trial was conducted at an adult major referral hospital in metropolitan Melbourne, Australia, with an annual emergency department attendance of approximately 60 000 patients. The evaluation included patients' medication charts written in the period of 16 March 2015 to 27 July 2015. Patients randomized to the intervention were managed using the partnered pharmacist charting model. The primary outcome variable was a medication error identified by an independent assessor within 24 h of admission, who was not part of the patient's admission process.
  
  
  RESULTS
  Of the 473 patients who received standard medical staff charting during the study period, 372 (78·7%) had at least one medication error identified compared to 15 patients (3·7%) on the partnered pharmacist charting arm (P < 0·001). The relative risk of an error with standard medical charting was 21·4 (95% CI: 13·0-35·0) with a number needed to treat (NNT) to prevent one error of 1·3 (95% CI: 1·3-1·4), and the relative risk of a high or extreme risk error with standard medical charting was 150·9 (95% CI: 21·2-1072·9) with a NNT to prevent one high or extreme error of 2·7 (95% CI 2·4-3·1).
  
  
  CONCLUSIONS
  Partnering between medical staff and pharmacists to jointly chart initial medications on admission significantly reduced inpatient medication errors (including errors of high and extreme risk) among general medical and emergency short-stay patients with complex medication regimens or polypharmacy.
authors.affiliation: Pharmacy Department, Alfred Hospital, Melbourne, Vic., Australia.
authors.forename: E Y
authors.initials: EY
authors.lastname: Tong
authors.affiliation: Pharmacy Department, Alfred Hospital, Melbourne, Vic., Australia.
authors.forename: C
authors.initials: C
authors.lastname: Roman
authors.affiliation: Emergency and Trauma Centre, Alfred Hospital, Melbourne, Vic., Australia.
authors.forename: B
authors.initials: B
authors.lastname: Mitra
authors.affiliation: General Medical Unit, Alfred Hospital, Melbourne, Vic., Australia.
authors.forename: G
authors.initials: G
authors.lastname: Yip
authors.affiliation: General Medical Unit, Alfred Hospital, Melbourne, Vic., Australia.
authors.forename: H
authors.initials: H
authors.lastname: Gibbs
authors.affiliation: General Medical Unit, Alfred Hospital, Melbourne, Vic., Australia.
authors.forename: H
authors.initials: H
authors.lastname: Newnham
authors.affiliation: Emergency and Trauma Centre, Alfred Hospital, Melbourne, Vic., Australia.
authors.forename: D P
authors.initials: DP
authors.lastname: Smit
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia.
authors.forename: K
authors.initials: K
authors.lastname: Galbraith
authors.affiliation: Pharmacy Department, Alfred Hospital, Melbourne, Vic., Australia.|Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Dooley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D016000:Cluster Analysis; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006760:Hospitalization; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D019338:Polypharmacy; D024382:Professional Role
keywords: accident and emergency departments; medication; pharmacists; prescribing; prescribing practices