Collaborative Pharmaceutical Care
at Tallaght Hospital
4th National Patient Safety Conference
Department of Health, Patient Safety First
Croke Park Conference Centre
7th November 2014
May CR et al. BMJ 2009;339:b2803.
Key facts regarding medication safety
26 %
20 %
of Irish people aged 50+ years use 5+
medicines daily
of patient readmissions to hospital within a year
of index discharge are drug-related
8%
of all emergency hospital admissions are drug-related
8%
of incidents reported to the Clinical Indemnity Scheme are drugrelated
6 % of hospital discharges have a potentially severe drug error
Standard care
PACT intervention
Service arrangement
Aligned to a ward
Aligned to a team
Clinical pharmacists
involved
Standard
One of two PACT pharmacists
Service at admission
Admission medication
history taking
Admission medication history
taking & reconciliation
Service during
admission
Minor changes and
endorsements to the drug
chart
Made minor and major
changes to the drug chart, as
required
Routine clinical pharmacy
Routine clinical pharmacy
No service
Discharge medication
reconciliation.
Service at discharge
Made minor and major
changes to the discharge
medication list, as required,
co-signed by a medical
practitioner.
http://qualitysafety.bmj.com/content/early/2014/02/06/bmjqs-2013-002188.full.pdf+html
PACT facilitated a lower prevalence of
medication error
Standard care
(% of patients)
PACT Intervention
(% of patients)
40.5
9.0
Admission
Adj OR* accounting for clustering, 95% CI:
0.14, 0.07-0.31
Discharge
65.3
Adj OR$ accounting for clustering, 95% CI:
13.9
0.07, 0.03-0.15
Adj OR = Adjusted odds ratio, 95% CI = 95% confidence interval
* Binary logistic, adjusted for Charlson co-morbidity index, number of medicines, age.
$ Binary logistic, adjusted for Charlson co-morbidity index, number of medicines$, age, length of stay.
No patient in the PACT group
experienced a potentially severe error
Potential for harm
Standard care
(% of patients)
No error, no harm
34.7
PACT
Intervention
(% of patients)
86.1
Minor harm
5.9
1.9
Moderate harm
53.5
12.0
Severe harm
5.9
0
Number needed to treat
to prevent one potentially severe error = 20
95% CI 10-142
PACT improved the quality of prescribing
(Medication Appropriateness Index)
Period
Standard
PACT
P value
(Mann Whitney U)
Pre-admission MAI
Change, pre-admission to
admission
Admission MAI
Change, pre-admission to
discharge
Discharge MAI
3 (1 to 6.8)
0 (-2 to 4)
4 (2 to 7)
1 (-1 to 6)
5.5 (2.3 to 9)
4 (1 to 7.5)
0.538
-0.5 (-3 to 0)
2.5 (1 to 5)
0.006
0.013
-1 (-3.8 to 0)
2 (0 to 4)
Table: MAI* Medication Appropriateness Index score,
sum per patient (median, interquartile range)
0.000
0.000
Perceptions of providers
“Resource to hand on ward; if have
query – instant resource and very
rapid response” (Consultant)
“Educational from both sides”
(Intern)
“Saves time” (Registrar)
“Especially on discharge, interns
have so many things to do,
medicines may be overlooked”
(Intern)
“Great job satisfaction, great for
suggestions to be acted upon and
to be embraced by the team”
(Pharmacist)
“Drug reconciliation really helpful.
Huge benefit to have pre-admission
medication within 12 hours, decreased
potential for error” (Consultant)
“Issues are dealt with more
promptly as the pharmacist is
on the ward round” (Intern)
Learnings from our PACT journey
Key Players/Leaders
TIME (years)
Research
Pharmacy Management
Value of
evidence
Medical & Nursing
Engagement
Medication Safety Culture
Organisation-wide implementation
Current
state
Transition
state
Project management
Future
state
Acknowledgements
Allen, Ann
Barragry, John
Bennett, Kathleen
Breslin, Niall
Deasy, Evelyn
Delaney, Tim
Fahey, Darragh
Fahey, Tom
Fitzsimons, Michelle
Hayde, Jennifer
Kirke, Ciara
Kirwan, Gráinne
McManamly, Ciara
Moloney, Eddie
O’Byrne, John
O’Leary, Aisling
Redmond, Patrick
Roche, Cicely
Tallon, Maria
Wall, Catherine
Walsh, Cathal