Pharmacist-led clinical interventions in Hospital at Home multidisciplinary team meetings

Background

Hospital at home (H@H) is an acute clinical service that provides hospital-level care in the patient’s usual home environment as an alternative to hospital admission. While H@H has existed for many years, the COVID-19 pandemic catalysed a renewed focus on the expansion of H@H services. Therefore, understanding the pharmacist’s role within H@H is now more crucial than ever. This project aimed to quantify and evaluate the clinical interventions made by pharmacists during H@H multidisciplinary team (MDT) meetings.

Objectives

To establish the number, nature, clinical impact, and outcomes of interventions made by H@H pharmacists during MDT meetings between 26 February and 29 March 2024.

Method

An electronic data collection tool was designed, and training provided to all H@H pharmacists on its use. A pilot study was undertaken to test appropriateness. After this, intervention data was collected in real-time during all H@H MDT meetings over a five-week period.

Results

Over the five-week period there were 28 MDT meetings and a total of 267 patients were discussed. A total of 100 pharmacist interventions were recorded, with 88 of these being accepted by the consultant. On 15 occasions, the pharmacist prescribed the new or adjusted medications themselves. The interventions involved a range of medication classes; nine interventions involved high-risk medicines such as anticoagulation, insulin, and opioid analgesia, other interventions most commonly involved antibiotics, antihypertensives and diuretics.

The severity of the harm avoided by each intervention was documented in line with the categories and criteria provided in Trust guidance. One intervention that prevented severe patient harm was an insulin dose reduction in an 80-year-old patient with acute kidney injury secondary to reduced oral intake. The pharmacist independent prescriber wrote a new ‘direction to administer’ form for the district nurses, who were administering this patient’s insulin. Other interventions included identifying that a patient was not prescribed the first-line treatment for infective endocarditis, suggesting an alternative agent and referral to the microbiology team.

37 interventions required additional action outside of the MDT meeting, these included contacting the patient to obtain their medication history or counsel on medication changes, as well as tasks not usually performed by a traditional ward-based pharmacist such as making referrals to other specialist teams and liaising with primary care.

The main intervention themes were avoiding harm (45%), medicines optimisation (36%) and antimicrobial stewardship (14%).

Conclusions

This project demonstrated that the presence of a pharmacist in H@H MDT meetings improves medication safety and patient care. It has also illustrated that the role of the H@H pharmacist in these meetings sometimes transcends the boundaries of a traditional clinical pharmacist.

Limitations include the short data collection period and that interventions made outside of MDT meetings were not captured.

Future work could include gathering data on all pharmacist interventions, and/or cost-saving analysis.

Additional authors: S. McGlen, L. Masson, M-J. Fry, Oxford University Hospitals NHS Foundation Trust

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.