1. Collaborative P harm a ceutical C are at T allaght Hospital 4 th National Patient Safety Conference Department of Health, Patient Safety First Croke Park Conference Centre 7 th November 2014

2. May CR et al. BMJ 2009;339:b2803.

3. 6 % 8 % 20 % 26 % Key facts regarding medication safety of Irish people aged 50+ years use 5+ medicines daily of patient readmissions to hospital within a year of index discharge are drug-related of all emergency hospital admissions are drug-related of incidents reported to the Clinical Indemnity Scheme are drug- related of hospital discharges have a potentially severe drug error

5. Standard carePACT intervention Service arrangementAligned to a wardAligned to a team Clinical pharmacists involved StandardOne of two PACT pharmacists Service at admissionAdmission medication history taking Admission medication history taking & reconciliation Service during admission Minor changes and endorsements to the drug chart Routine clinical pharmacy Made minor and major changes to the drug chart, as required Routine clinical pharmacy Service at dischargeNo serviceDischarge medication reconciliation. Made minor and major changes to the discharge medication list, as required, co-signed by a medical practitioner.

6. http://qualitysafety.bmj.com/content/early/2014/02/06/bmjqs-2013-002188.full.pdf+html

7. PACT facilitated a lower prevalence of medication error Standard care (% of patients) PACT Intervention (% of patients) Admission 40.59.0 Adj OR* accounting for clustering, 95% CI: 0.14, 0.07-0.31 Discharge 65.313.9 Adj OR $ accounting for clustering, 95% CI: 0.07, 0.03-0.15 Adj OR = Adjusted odds ratio, 95% CI = 95% confidence interval * Binary logistic, adjusted for Charlson co-morbidity index, number of medicines, age. $ Binary logistic, adjusted for Charlson co-morbidity index, number of medicines$, age, length of stay.

8. No patient in the PACT group experienced a potentially severe error Potential for harmStandard care (% of patients) PACT Intervention (% of patients) No error, no harm34.786.1 Minor harm5.91.9 Moderate harm53.512.0 Severe harm5.90 Number needed to treat to prevent one potentially severe error = 20 95% CI 10-142

9. PACT improved the quality of prescribing (Medication Appropriateness Index) PeriodStandardPACTP value (Mann Whitney U) Pre-admission MAI3 (1 to 6.8)4 (1 to 7.5)0.538 Change, pre-admission to admission 0 (-2 to 4)-0.5 (-3 to 0)0.006 Admission MAI4 (2 to 7)2.5 (1 to 5)0.013 Change, pre-admission to discharge 1 (-1 to 6)-1 (-3.8 to 0)0.000 Discharge MAI5.5 (2.3 to 9)2 (0 to 4)0.000 Table: MAI* Medication Appropriateness Index score, sum per patient (median, interquartile range)

10. Perceptions of providers “Resource to hand on ward; if have query – instant resource and very rapid response” (Consultant) “Educational from both sides” (Intern) “Especially on discharge, interns have so many things to do, medicines may be overlooked” (Intern) “Great job satisfaction, great for suggestions to be acted upon and to be embraced by the team” (Pharmacist) “Issues are dealt with more promptly as the pharmacist is on the ward round” (Intern) “Saves time” (Registrar) “Drug reconciliation really helpful. Huge benefit to have pre-admission medication within 12 hours, decreased potential for error” (Consultant)

11. Learnings from our PACT journey Key Players/Leaders Research Pharmacy Management Medical & Nursing Medication Safety Culture TIME (years) Value of evidence Engagement

12. Current state Transition state Future state Organisation-wide implementation Project management

13. Acknowledgements Allen, Ann Barragry, John Bennett, Kathleen Breslin, Niall Deasy, Evelyn Delaney, Tim Fahey, Darragh Fahey, Tom Fitzsimons, Michelle Hayde, Jennifer Kirke, Ciara Kirwan, Gráinne McManamly, Ciara Moloney, Eddie O’Byrne, John O’Leary, Aisling Redmond, Patrick Roche, Cicely Tallon, Maria Wall, Catherine Walsh, Cathal