Validation of electronic clinical progress notes for measuring clinical pharmacy performance

Abstract

Hospital-based clinical pharmacy services improve patient outcomes, reduce medication-related problems, and lower the cost of medication therapy. Measuring the provision of clinical pharmacy services and related outcomes is essential to ensuring quality. Historically, clinical pharmacy performance measurement relied on manual reporting of performance measures, which was time-consuming. This study validated the use of counts of clinical progress notes, stored in hospital electronic medical records (EMRs), as measures of clinical pharmacy service provision. EMR-generated progress notes completed by pharmacy staff for a random sample of 300 adults admitted to three Australian hospitals between May–November 2021 were manually audited. The audit identified the type of progress notes completed, as indicated by their title, and the type of clinical pharmacy services documented. To determine the validity of using counts of these progress notes to indicate the completion of clinical pharmacy services, sensitivity, specificity, and positive predictive value were calculated using the manual audit as a gold standard. A total of 861 progress notes were audited. Progress notes titled PMM (which is short for Pharmacy Medication Management) Medication History, PMM Medication Review, and PMM Discharge Medications demonstrated high specificity and positive predictive values (>98%) for clinical pharmacy services at admission, during the inpatient stay, and at discharge, respectively, with sensitivities of 98%, 90%, and 89%. Counts of EMR-generated clinical pharmacy progress notes accurately measured service provision and can be used as reliable performance measures. Hospitals using EMR-generated clinical progress notes may apply a similar approach to derive accurate and efficient clinical performance measures. Ethical approval was granted by the Central Adelaide Local Health Network Human Research Ethics Committee (Reference no: 16357) and the University of South Australia Human Research Ethics Committee (Reference no: 205782) and the study conforms with the Australian National statement on ethical conduct in human research.