Abstract
Background: One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available.Objective: To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU).Methods: A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded.Results: The review time for one medical record was 8.9 (95% CI, 6.9–10.9) min. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45–1.11) min. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8–18.8) and 12 (9–15) min, respectively, for patients with psychiatric-neurologic disorders compared to those without (p = 0.032). Usually, a daily workload of 240 min was needed for the pharmacist accompanying the round in contrast to 108 min per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9%, and made no comment on 36.9% of the recommendations.Conclusion: Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.
Highlights
Organizations in more than 100 countries are working with the Joint Commission International (JCI), which aims to improve patient safety and quality of health care by offering education, publications, advisory services and international accreditation and certification
A daily workload of 240 min was needed for the pharmacist accompanying the round in contrast to 108 min per day needed to review all the medical records in 95% of the cases
The main reason for hospitalization did not differ significantly between the two groups, except for psychiatric-neurological disorders, which were more frequent in patients with pharmacist recommendations on their forms (25.8 vs. 8.1%, p = 0.024)
Summary
Organizations in more than 100 countries are working with the Joint Commission International (JCI), which aims to improve patient safety and quality of health care by offering education, publications, advisory services and international accreditation and certification. Many medical centers are keen to achieve JCI accreditation and the organization has published standards for hospitals regarding various aspects of patient care (Joint Commission International, 2014, 5th Edn.). One of these sections covers Medication Management and Use, which includes the organization and management of medication, storing, ordering and prescribing, preparing and dispensing, administration and monitoring. One aspect of ordering and prescribing medication is the requirement for a pharmacist, technician or trained professional to review medication orders or prescriptions for appropriateness This process should be carried out before the medication is administered to the patient and JCI standards say that this should involve evaluating specific categories, namely the appropriateness of the drug, the dose, frequency, route of administration, therapeutic duplication, and drug interactions. In many medical centers there is a shortage of staff and a pharmacist is not always available
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