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New hospital pharmacy prescribing model to improve patient flow in hospitals

In a first for South Australia, pharmacists at the Lyell McEwin Hospital will be authorised to prescribe certain medications in a partnered model – freeing up doctors’ time and helping to improve patient flow through the hospital.

Under a new trial, pharmacists credentialed by the Chief Medical Officer will work closely with doctors to undertake a medication review and prescribe medications for nursing staff to administer, to help inpatients move through the emergency department and wards faster.

The new partnered prescribing model is expected to start within weeks at the Lyell McEwin Hospital after further consultation with clinicians and pharmacists, with four pharmacists specially trained to do the prescribing.

Under the trial, hospital pharmacists will be able to prescribe Schedule 2, 3 and 4 medicines – which include medicines for blood pressure, cholesterol, pain relief and diabetes, as well as other regular medicines such as puffers, creams and ointments.

Pharmacists can only prescribe the medication in alignment with an agreed, documented medication management plan developed with the treating doctor.

The new arrangement does not apply to discharge medication, with doctors required to prescribe all discharge medication under the Pharmaceutical Benefits Scheme.

The trial closely follows a model that has been operating successfully in Victorian hospitals for several years, with evidence showing an approximate 10 percent reduction in inpatient length of stay and a decline in medication errors.

The model provides pharmacists with the ability to support patient flow by reducing the time patients spend waiting for a prescription, increasing medication safety and ultimately improving patient flow throughout the hospital stay.

This is another step the Malinauskas Labor Government is taking to optimise clinical workforce and improve patient flow through our hospitals, while at the same time building more hospital beds and hiring more doctors and nurses.

Pharmacists involved in the trial will need to be specifically credentialled, meet defined prerequisites and undergo training under the supervision of a senior doctor.

The trial will run until the end of the year with continual assessment throughout including staff and consumer feedback, before an expected broader rollout across other major public hospitals.

This program will only operate in hospitals, and is separate to interstate trials in community pharmacies of pharmacist prescribing – that is also subject to an ongoing SA Parliament select committee inquiry.

It follows a recent separate $27 million State Budget commitment to roster more doctors, pharmacists, physios and other staff on weekends to ensure timely 7-day patient discharges and reduce Monday bed-block.

That initiative is aimed at helping more medically-ready patients return home or to a more appropriate setting, freeing up hospital beds for those who need them most.

Meanwhile, construction is underway at the Lyell McEwin Hospital to deliver a 48-bed expansion pledged by the Malinauskas Labor Government to increase capacity in Adelaide’s northern suburbs.

The $47 million project will deliver two new 24-bed inpatient wards on Level 3 of Building A, an area that was originally constructed as a ‘cold shell’ in 2013 to accommodate future expansion.

Due for completion in mid-2024, the expansion will provide 48 single rooms with ensuites, including rooms with speciality care features to improve patient comfort and wellbeing for people who require a higher level of support.

This new prescribing trial, which will help improve patient flow, comes as latest figures show June delivered substantially better ambulance response times and ramping than the same time last year, while there is much more work to do.

In June, paramedics reached 69 percent of urgent Priority 1 cases within the recommended 8 minutes – well above the 60 percent target.

That compares to just 47 percent in January 2022, or 51 percent for June last year.

For Priority 2 cases, paramedics reached 57.5 percent of patients within the recommended 16 minutes. That’s compared to just 36 percent in January 2022, or 33 percent for the same time last year.

Ramping in June was at 3,105 hours, compared to 3,854 hours in June last year – a nearly 20 percent reduction, and a nearly 22 percent reduction on the high of March this year (3,968 hours).

This month’s ramping hours were slightly higher (4.5 percent) compared to May’s 2,972 hours.

This comes during a busy time for our hospitals as there was a 5.2 percent jump in daily ED presentations and a 7 percent jump in the most serious three categories of presentations in June compared to the month prior.

Of the hospitals, the Women’s and Children’s Hospital (10% jump) and Lyell McEwin Hospital (8.6% jump) saw the biggest increases in daily ED presentations in June.

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