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A randomised trial of pharmacist-led discharge prescribing in an Australian geriatric evaluation and management service


Background Prescribing discharge medications is a potential “next step” for pharmacists in Australian hospitals, however, safety must be demonstrated via a randomised controlled study. Objective To determine if a collaborative, pharmacist led discharge prescribing model results in less patients with medication errors than conventional prescribing for both handwritten and digital prescriptions. Setting Geriatric Medical ward in a quaternary hospital, Australia Methods A prospective, single-blinded randomised controlled study of patients randomised to conventional (control) or a pharmacist-led prescribing (intervention) arms at discharge from hospital. This study had 2 phases; (1) handwritten prescribing and (2) digital prescribing. In addition, the two prescribing methods were compared. Main outcome measures The primary outcome was the percentage of patients with a medication error on their discharge prescription. Results In phase 1, 45 patients were recruited; 21 (control) and 24 (intervention). 95% of control patients and 29% in the intervention arm had at least one medication error, p < 0.0002, relative risk (RR) 0.31, confidence interval (CI) 0.16—0.58. The number of items with at least 1 error reduced from 69 to 4%; p < 0.0001, RR 0.06, CI 0.03—0.11 and fewer items had at least 1 clinically significant error (11% vs 2%, p = 0.0004, RR 0.15, CI 0.04—0.30). In phase 2, 39 patients were recruited; 18 (control) and 21 (intervention). 100% of control patients and 62% in the intervention arm had at least one medication error (p = 0.005, RR 0.62, CI 0.44—0.87). Items with at least 1 error decreased from 21 to 7% (p < 0.0001, RR 0.34, CI 0.44—0.56), there were fewer items with at least 1 clinically significant error (13% vs 5%, p < 0.003, RR 0.4, CI 0.22—0.72). There was no significant change in the primary outcome between handwritten and digital (60% vs 79%, p < 0.055). Conclusion In a geriatric setting, pharmacist-led partnered discharge prescribing results in significantly less patients with medication errors than the conventional method for both handwritten and digital methods.

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The authors would like to acknowledge the following people: Staff of GEMs- Including Dr Alison Cutler, Dr Elizabeth Waldie, Ms Michelle Fuller, Ms Cindy Richards, Ms Kirra Farrar Staff of the Royal Brisbane Hospital Pharmacy- Including Associate Professor Ian Coombes, Associate Professor Danielle Stowasser, Dr Andrew Hale, Mr Cameron Tessier.


Grants Allied Health Professions’ Office of Queensland (AHPOQ): Allied Health Professional Prescribing Training Health Practitioner Research Scheme.

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Correspondence to Shannon Finn.

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Finn, S., D’arcy, E., Donovan, P. et al. A randomised trial of pharmacist-led discharge prescribing in an Australian geriatric evaluation and management service. Int J Clin Pharm 43, 847–857 (2021).

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  • Australia
  • Medication errors
  • Older-persons
  • Patient safety
  • Prescribing