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