The Pharmaceutical Journal
Vol 269 No 7216 p387
21 September 2002

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Clinical pharmacy services should target discharge of surgical patients

Clinical pharmacists should focus on providing clinical pharmacy services to elective surgical patients on admission and discharge, according to researchers from the centre for practice and policy at the University of London's School of Pharmacy.

Marisa Sagripanti and colleagues say that changes to inpatient admission and discharge processes, such as introducing pre-operative assessment (POA) clinics, are being made in an attempt to make health services more efficient. "However, it is not known how pharmacy services should best be provided within this new model," they say.

The researchers studied the quality of medication history taking by nurses and junior doctors for 76 patients who had attended a POA clinic. They also identified where medication errors occurred between attendance at the clinic and discharge after surgery and assessed whether clinical pharmacy services addressed these risks.

They found that process-related medication risks occurred routinely. These were mainly as a result of incomplete medication history data, prescribing errors and limited time and availability of pharmacy services. They suggest that pharmacists should provide information about medicines that may affect the management of patients during surgery to nurses running POA clinics.

The researchers found that prescribing errors occurred frequently among elective surgical patients — 36 per cent of all medication orders written on admission, 3 per cent of orders written during the patient's stay in hospital, and 27 per cent of orders written on discharge contained a prescribing error. They point out that although it is commonly assumed that errors will be reduced by electronic prescribing, they saw the highest number of errors in the electronic prescription of discharge medication. "A prescriber may be less likely to transcribe the wrong medication by hand than to select incorrectly from a list presented as a series of different medications and formulations," the researchers comment.

They also suggest that providing clinical pharmacy services to wards in the morning may not be optimal because many surgical patients are admitted late in the day. "The role of the clinical pharmacist could be modified to include a focus on new admissions by liaising with the bed manager and ward staff," they say.

The study is published in The International Journal of Pharmacy Practice (2002; 10:161).