The Clinical Implications of Pharmacist-Led Medication Reviews for Discharge Patients: Enhancing the Quality of Patient Care
Author(s): Yerni Kumar Bokam* and Chakravarthi G
Abstract
Background: Seamless quality of patient care is important right from the admission to the point of discharge. In the process of patient care, appropriate medication management and use is important for a speedy recovery. Clinical pharmacist a key member among the multidisciplinary health care team plays a vital role in enhancing the quality of care by performing a meticulous medication reviews of discharge patients. Therefore, this study aimed to assess the impact of clinical pharmacist in enhancing the quality of patient care by identifying, discussing and correcting the medication discrepancies by performing a meticulous review, eventually producing an error free discharge summary to the patients at discharge.
Materials and Methods: This study was a simultaneous mixed methods design (intervemtional and quantitive), was conducted at a tertiary health care center, which accommodates the doctors of all multispecialiatity departments. The sample size is discussed in the results section. For quantitative data analysis, relevant and the updated version of Microsoft excel is employed. The pharmaco-therapeutic committee proposed that every discharge summary must be meticulously reviewed by the clinical pharmacist before it goes to hands of the patient. However, the baseline group summaries received conventional review, whereas the experimental group of summaries received clinical pharmacist review. Data was analysed using conventional analysis approach.
Results: In a study of 298 patients, with 155 in the pre-intervention group and 143 in the post-intervention group, significant enhancements in medication management were noted after Clinical Pharmacy (CP) intervention. Patients exhibited co-morbidities such as renal insufficiency, hypothyroidism, diabetes mellitus, hypertension, and cardiovascular diseases. Post-intervention, improvements included the elimination of therapeutic and drug duplications, a reduction in incomplete regimens, and a decrease in medication dose and frequency discrepancies. CP intervention also addressed underreporting of drug allergies in discharge summaries and ensured clearer pharmaceutical instructions, reducing instances from 21 to 4. Additionally, a decrease in emergency visits or re-admissions from 4 to 1 was observed, attributed to comprehensive medication lists provided at discharge. Moreover, fewer instances of medications being inappropriately related to meals were noted, with emphasis placed on clarifying administration instructions, particularly for medications requiring consumption before food. This intervention highlighted the importance of addressing medication-related issues comprehensively to improve patient outcomes and reduce risks associated with medication management.
Conclusion: The results of this study highlight the crucial role of clinical pharmacists in improving medication management leading to good patient outcomes in healthcare. By carefully, reviewing medications, addressing discrepancies and ensuring comprehensive pharmaceutical instructions, clinical pharmacists play a vital role in minimizing risks associated with medication errors. The prominent reductions in therapeutic, drug duplications, incomplete regimens and medication dose discrepancies post-intervention highlight the impact of clinical pharmacist intervention on medication safety and efficacy. Moreover, their efforts in clarifying administration instructions of medications contribute to better patient compliance, eventually patient outcomes. The observed decrease in emergency visits and re-admissions further highlights the importance of clinical pharmacists in reducing healthcare hazards. Overall, this study unleashes the essential role of clinical pharmacists in healthcare teams, advocating for their integration into patient care processes to ensure safer and more effective medication management.
