Authors (including presenting author) :
Wong CL(1), Lau HW(1), Chen J(1), Yick PK(1)
Affiliation :
(1)Department of Pharmacy, RTSKH
Introduction :
Medication safety and patient empowerment in medication management are crucial in contemporary healthcare settings. Commencing in October 2022, clinical pharmacists provided routine comprehensive medication management services in four acute medical wards at Ruttonjee Hospital on weekdays. The service encompassed medication reconciliation during transitions of care, inpatient therapeutic optimization, and discharge counseling for patients and their caregivers.
Objectives :
This study aimed to evaluate the impact of clinical pharmacist services on patient care in acute medical wards at RTSKH.
Methodology :
Data from January to December 2023 were collected via Drug Related Problem Database and Clinical Data Analysis and Reporting System. The primary outcome was number of drug-related problems (DRPs) with pharmacist interventions. The secondary outcome was 30-day unplanned readmission rate. Descriptive analyses were performed to analyse DRPs, and Chi-square test was adopted for statistical analysis of readmission data.
Result & Outcome :
Throughout the study period, clinical pharmacists provided discharge counseling to a total of 4,130 patient episodes. Within this cohort, 1,849 DRPs among 1,109 patient episodes were identified and intervened by clinical pharmacists. 14.2% of the identified DRPs involved HA high-alert medications. The major causes of DRPs were related to drug supply on prescription (21.1%), therapeutic omissions (18.2%), dose selections (13.2%), therapeutic duplications (10.1%), and drug choices (9.4%). The acceptance rate of pharmacist interventions by physicians was 99.1%. The service was associated with a statistically significant relative risk reduction of 13.2% in 28-day unplanned readmission rate compared to usual care (13.1% versus 15.1%; ARR 2.0%; RRR 13.2%; p<0.01). These findings underscore the importance of integrating clinical pharmacists into multidisciplinary healthcare team to optimize medication therapy and patient outcomes. The service enhances the quality of in-patient pharmaceutical care, reduces access block especially during surge period and strengthens support to patients in managing post-discharge medications.
