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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. [ABSTRACT FROM AUTHOR]

Aim: The role of clinical pharmacists in the care of hospitalised general medicine patients is evolving from a reactive model of care to a model with an emphasis on interdisciplinary care and more advanced models of care. The purpose of this review was to evaluate the published literature on the effects of roles of clinical pharmacists that extend beyond those activities considered to be standard clinical practice in Australia, on clinical outcomes in hospitalised general medicine patients. Data sources: A search of English‐language publications in six databases was conducted. Study selection: Peer‐reviewed, English‐language articles were identified across the date range January 2000 to June 2020. Studies were included if they evaluated an inpatient pharmacy service in a general medicine population and the article included a study design with a clear comparator and outcomes such as medication errors or medication appropriateness. Studies evaluating pharmacists' activities that are considered standard clinical practice for pharmacists in Australia, such as participation on ward rounds, medication reconciliation and patient education were excluded. Results: Twelve studies met the inclusion criteria: four evaluating pharmacist‐led anticoagulation or thromboprophylaxis management, one evaluating pharmacist‐led vaccination, three evaluating a pharmacist charting model, two evaluating pharmacist‐led de‐escalation of therapy, one evaluating a pharmacist intervention in patients with chronic kidney disease and one evaluating pharmacist‐led glycaemic control. Conclusions: The addition of advanced clinical pharmacist services in the care of general medicine inpatients generally resulted in improved care, with no evidence of harm. Future studies should include multiple sites, larger sample sizes, reproducible interventions and identification of patient‐specific factors that lead to improved outcomes. [ABSTRACT FROM AUTHOR]

The article explores the Standards of Practice for Clinical Pharmacy Services (CPS) that was issued by the Society of Hospital Pharmacists of Australia. Topics mentioned include the job responsibilities of GM pharmacists, the patient factors that they need to consider in providing personalized care including the level of impairment and health literacy, and the recommended staffing level for CPS.

Background: Health services are under pressure to accommodate increasing numbers of emergency department presentations. This can contribute to prescribing errors. Integration of a pharmacist into the general medical team may reduce the incidence of prescribing errors on discharge and improve patient flow and medical staff satisfaction. Aim: This study evaluated the effect of an integrated pharmacy service provided to the general medical units (GMUs) on patient flow and medical staff satisfaction. Method: This study was a 4‐week pre‐ and postintervention study involving GMUs at a major metropolitan hospital in Australia. During the intervention period, an integrated clinical pharmacy service, which included attending medical ward rounds and assisting with the preparation of discharge prescriptions, was provided to medical units. The primary endpoint was the median time (min) past 9am that patients were discharged from the ward. Secondary outcomes included the proportion of prescriptions requiring an amendment and medical staff satisfaction with the service. Results: There were 87 and 84 patients discharged from the medical units before and after the intervention. During the intervention period, pharmacists prepared 79% of prescriptions, which reduced the proportion requiring an amendment from 65% to 17% (p < 0.01). Patients were discharged 77 min earlier during the postintervention period (median 380 vs 303 min after 9am; p = 0.03). Medical staff felt the integrated clinical pharmacy service improved patient flow and should be incorporated into standard practice. Conclusions: An integrated clinical pharmacy service with proactive pharmacist intervention within the GMUs improved patient flow and medical staff satisfaction, and decreased prescriptions requiring an amendment. [ABSTRACT FROM AUTHOR]

Background: Proton pump inhibitors (PPI) are extensively prescribed internationally and in Australia. However, minimal information is available on the appropriateness of PPI use in the general medical population. Aim: This study determined the proportion of general medical unit (GMU) inpatients taking a PPI on admission and evaluated the appropriateness of these PPI prescriptions. Methods: A single‐centre prospective observational study was conducted from 6 June to 11 July 2016. Consecutive patients were screened, and those taking a PPI prior to admission were included, whereas those not taking a PPI formed the control cohort. Appropriateness of PPI use was evaluated by: (1) reviewing for concordance with the Australian Therapeutic Guidelines and National Prescribing Service Guidelines on PPI use in gastro‐oesophageal reflux disease; (2) assessment of indication, dose and treatment duration by an expert panel consisting of two general physicians and one senior pharmacist. Results: Among 440 consecutive GMU patients, 198 (45.0%) were taking a PPI on admission. Of these, 66.2% had an inappropriate indication, dose or treatment duration. The largest category of inappropriate PPI use was excessive treatment duration (43.4%). In terms of comorbid conditions, PPI users had a higher prevalence of osteoporosis and/or history of fracture (42.9% vs 27.2%; p < 0.001) and hypomagnesaemia (10.6% vs 3.4%; p = 0.003). Conclusion: Inappropriate PPI use is highly prevalent among GMU inpatients. Given the potential for adverse effects, unnecessary health expenditure and pill burden, strategies should be developed to aid clinicians to consistently consider the utility of continuing long‐term PPI prescriptions in each patient's situation. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Patients admitted to General Medical Units (GMU) and Emergency Short Stay Units (ESSU) are often elderly with multiple comorbidities and the majority are considered to be at high risk of complications from influenza. The aim of this study was to assess the practice of including a pharmacist assessment of appropriateness and charting of influenza vaccination in a partnered pharmacist charting model in a GMU and ESSU. Methods: As part of a partnered pharmacist charting model, the pharmacist assessed each patient for suitability of receiving the influenza vaccination at admission. If it was deemed appropriate by the pharmacist and medical officer, the pharmacist charted the influenza vaccination for administration as an inpatient and this was documented in the discharge summary to the general practitioner. Results: There were 6595 patients admitted to the two units during the study period, of which 316 patients had partnered pharmacist charting. Among these, 52 patients were eligible for vaccination, of which 31 patients (59.6%) had their influenza vaccination charted by a pharmacist. Among the 6279 patients who had their medication charted by a medical officer only, there were no cases of influenza vaccination prescription (p < 0.01). Conclusion: We identified that initiation of the influenza vaccination as part of the partnered pharmacist charting model is feasible and effective in increasing the rates of vaccination among ESSU and GMU patients. [ABSTRACT FROM AUTHOR]