Pharmaceutical Reforms: Clinical Pharmacy Ward Service versus a Medical Team Model

Background: The Australian Pharmaceutical Advisory Council’s (APAC) Guiding principles to achieve continuity in medication management were developed to advocate the continuum of pharmaceutical care for hospital inpatients. As part of the Australian Health Care Agreements, pharmaceutical reforms that include implementation of the APAC guidelines are underway. Clinical pharmacy services at the Royal Adelaide Hospital do not fully comply with the APAC guidelines. Aim: To assess whether key APAC guiding principles are achievable on a medical ward with one full-time equivalent clinical pharmacist. Method: Two clinical ward pharmacy models were investigated. A clinical pharmacy ward service was compared to a medical team model. Patients admitted to a general medical ward were included in the two phases of the study. In Phase A (4 weeks), the clinical pharmacist serviced a 30-bed medical ward and in Phase B (4 weeks) the same clinical pharmacist serviced the same 30-bed medical ward and also provided an extended hours service in the emergency department. During both phases all patients received a medication history interview, ongoing clinical review and discharge medication counselling. Results: 246 patients were admitted to the general medical ward during the study period – 138 in Phase A and 108 in Phase B. 109 (79%) patients were reviewed in Phase A and 83 (77%) patients in Phase B. As a result of the medication history interviews, incorrectly charted medications were amended in 48 (7%) interventions in Phase A and 20 (6%) interventions in Phase B. 207 interventions (Phase A: 129; Phase B: 78) were documented during clinical reviews. Discharge medication counselling was provided to 30 (60%) patients in Phase A and 27 (49%) patients in Phase B. Conclusion: The key APAC guiding principles were partly achievable using the two models investigated. For either model, an increase in staffing resources would be necessary to comply with the APAC guidelines. J Pharm Pract Res 2009; 39: 176-80.