Assessing the impact of an expanded scope of practice for pharmacists at a community hospital.

Abstract

In 2009, the College of Pharmacists of British Columbia introduced Professional Practice Policy 58, “Protocol for Medication Management—Adapting a Prescription”. This policy has enhanced pharmacy practice by allowing pharmacists to make changes to prescriptions. More specifically, it allows pharmacists to change a drug dose or formulation, titrate medications, renew prescriptions, and make drug substitutions within the same therapeutic class in all practice settings. This expansion of pharmaceutical services is in line with the objectives of CSHP 2015, increasing the extent to which pharmacists, pharmacy departments, and hospitals improve medication safety and help patients to achieve the best use of medications. An increasing number of published studies are demonstrating that an expanded scope of practice (ESP) for pharmacists improves patient outcomes and enhances pharmacists’ job satisfaction. Patient counselling, medication reconciliation (on admission, transfer, or discharge), and supplementary prescribing by pharmacists have been shown to reduce drug-related problems and readmission to hospital, thereby reducing costs for the health care system. In addition, interventions by hospital pharmacists have been linked to reductions in medication errors, medication costs, and length of hospital stay while improving medication adherence, knowledge, and appropriateness of pharmacologic therapy. Mysak and others developed a proactive practice model to facilitate provision of clinical services by pharmacists, which includes individualizing medication therapy and participating in daily bedside rounds. Those authors found that participating pharmacists felt the model improved job satisfaction and patient safety. The Clinical Executive Committee of Fraser Health endorsed expanding the scope of practice for pharmacists in 2009, and Burnaby Hospital implemented the ESP on April 1, 2012, with the aim of enhancing the timely delivery of patient care and streamlining medication reconciliation after patient admission. ESP at Burnaby Hospital consists of reordering medications for chronic conditions, initiating over-the-counter medications, changing drug formulations, changing drugs within the same therapeutic class, and titrating medication doses. This study was undertaken to determine how implementation of ESP affected pharmacy practice and patient care at Burnaby Hospital, in terms of activities performed and associated outcomes, as well as the experiences of pharmacists and physicians. The specific objective of the study was to describe and assess the impact of ESP for pharmacists at Burnaby Hospital. The primary outcomes were a categorization of the types of ESP activities performed by pharmacists and an assessment of clinical, humanistic, and economic outcomes. The secondary outcome was a description of the ESP experiences of pharmacists and the impact of ESP on physicians, as documented by surveys of these groups of healthcare professionals.