Partnered pharmacist medication charting of the fractured neck of femur clinical care pathway at hospital admission

Background

Neck of femur (NOF) fractures are associated with significant morbidity and mortality. Fractured NOF clinical care pathways (CCPs) standardise care; however, the impact of Partnered Pharmacist Medication Charting (PPMC) in this context remains unexplored.

Aim

To evaluate pharmacist involvement through PPMC on the proportion of patients initiated on the electronic medical record (EMR) integrated Fractured NOF CCP, at hospital admission.

Method

A retrospective, pre- and post-intervention study was conducted in the orthopaedic unit of a tertiary-referral health service. Patients ≥65 years with a primary minimal trauma NOF fracture were included. In the intervention, the Fractured NOF CCP could be initiated through PPMC, in addition to usual care. The primary outcome of the study was the proportion of patients initiated on the CCP and secondary outcomes included the proportion of PPMC initiated CCPs and the time to CCP initiation. Ethical approval was granted by the Alfred Hospital Research and Ethics Committee (Reference no: 779/20) and the study conforms to the Australian National statement on ethical conduct in human research.

Results

A total of 127 patients pre-intervention (January–August 2020) and 149 patients post-intervention (January–August 2021) were included. Fractured NOF CCP initiation increased post-intervention (n = 20, 15.7% vs n = 83, 55.7%, p < 0.0001). Emergency department initiation of the CCP was similar (n = 20, 15.7% vs n = 23, 15.4%, p = 0.94); and median (interquartile range [IQR]) time to initiation increased (0.9 h, IQR 0.4–1.9 h vs 3.9 h, IQR 2.0–6.3 h, p = 0.001). Post-intervention, 60 additional patients were initiated on the CCP through ward care components; median time to initiation was 16.4 h, IQR 11.8–20.6 h, and 61 (73.5%) patients were initiated on the CCP via PPMC.

Conclusion

Pharmacist involvement through PPMC significantly increased the proportion of patients initiated on the Fractured NOF CCP at hospital admission. The delay in initiation post-intervention requires further exploration.