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Title: Improving medication safety for home nursing clients: A prospective observational study of a novel clinical pharmacy service-The Visiting Pharmacist (ViP) study.
Austin Authors: Lee, C Y;Beanland, C;Goeman, D;Petrie, N;Petrie, B;Vise, F;Gray, J;Elliott, Rohan A 
Affiliation: Bolton Clarke (formerly Royal District Nursing Service) Institute, Melbourne, Victoria, Australia
Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
Central Clinical School, Monash University, Melbourne, Victoria, Australia
PRN Consulting, Melbourne, Victoria, Australia
Bolton Clarke (formerly Royal District Nursing Service) Clinical Service, Melbourne, Victoria, Australia
Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Dec-2018 2018-05-16
Publication information: Journal of clinical pharmacy and therapeutics 2018; 43(6): 813-821
Abstract: Polypharmacy, medication errors and adverse events are common in older people receiving home nursing medication management support. Access to clinical pharmacists is limited. In Australia, few home nursing clients receive a general practitioner (GP)-initiated pharmacist-led Home Medicines Review, despite their eligibility and community nurses' (CN) efforts to facilitate this. An integrated home nursing clinical pharmacy service, in which CNs directly referred clients to a pharmacist, was therefore developed and piloted. The aim was to explore the number and type of medication-related problems (MRPs) and medication treatment authorization (medication order) discrepancies identified and addressed by clinical pharmacists. Two part-time clinical pharmacists were employed. They reviewed and reconciled clients' medications, educated clients/carers about their medicines, provided advice and support to CNs and worked with clients' GPs and other prescribers to optimize medication regimens and revise/update nurses' medication treatment authorizations. Evaluation involved review of clients' medicines data, including treatment authorizations and pharmacist medication review reports. Eighty-four clients (median 86¬†years, 6 health conditions, 13 medications) were reviewed. The pharmacists identified 334 MRPs (median 4 per client) and 307 medication discrepancies in treatment authorizations (median 2 per client). The pharmacists made 282 recommendations to prescribers to address MRPs; 148 (52.5%) recommendations were acted on, resulting in 190 medication changes for 60 (71.4%) clients (median 2 per client). The pharmacists prepared, or assisted GPs to update, treatment authorizations for 68 (81%) clients. Integrating pharmacists into a home nursing service identified and addressed MRPs and medication treatment authorization discrepancies, hence contributing to enhanced medication safety.
DOI: 10.1111/jcpt.12712
ORCID: 0000-0002-7750-9724
PubMed URL: 29770474
Type: Journal Article
Subjects: clinical pharmacist
community nurse
home nursing
medication reconciliation
medication review
medication-related problems
Appears in Collections:Journal articles

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