Audit on PTWR
Having the pharmacist on the ward establishes close liaison with the medical staff and interventions can be actioned and errors can be quickly rectified. There is pharmacist input at the time of prescribing. An audit of interventions on MAU in September 2010 showed that on a single day 16 out of the patients on the ward that were reviewed there were 11 patients that required interventions and 30 interventions were made. That equates to nearly 3 per patient. If the assumption is made that these reviews would 6 hour then an intervention is made every 12mins.
At present the PTWR is attended by a pharmacist 3 times per week .The pharmacist is proactive in providing advice on all aspects of medicine management improving cost effective use of medicines and the most clinically effective medication taking account of local and national guidelines. The role of the prescribing pharmacist was audited on the post take ward round. On 8 rounds 100 patients were seen and the pharmacist prescribed for 68. For these patients 208 items were prescribed, altered or deleted which equates to 3 items per patient and a prescription intervention made approx every 10mins.
The main areas were
- 47% admission drugs not prescribed
- 13% completing VTE assessments which contributes to the CQUINS target.
- 4% were antibiotic changes in line with policy thus potentially decreasing the incident of C. difficle and resistant organisms such as MRSA.
- 7% were the deleting of clinically inappropriate medication which could have lead to patient harm. For example 7 medications (Atenolol, Simvastatin, Clopidogrel, Doxazosin, Amlodipine, Ramipril and Allopurinol) prescribed for a patient who had no record or indication for them.
- 3% assessed need for drugs within the multidisciplinary team.
- 8% clinically inappropriate e.g. patient prescribed Trimethoprim while on Methotrexate – a potentially fatal interaction
Interventions were also made which results in cost savings with no loss of patient care.
For example
- In 2 patients Atorvastatin 80mg was stopped as deemed as inappropriate, a cost saving of £363 per patient per year.
- 2 patients changed from IV to oral Co-amoxiclav at a saving of £4 per day with no loss of efficacy and increased patient safety.
- Changing IV to oral Paracetamol a saving of £7 per dose
Changing Atorvastatin 20 mg to Simvastatin 40mg a saving of £288 per annum