Assessing the Impact of the Pharmacist Medication Adaptation Policy on Pharmacists and Prescribers at William Osler Health System

Abstract

Background: In 2020, William Osler Health System developed the Pharmacist Medication Adaptation policy to facilitate timely access to medications for patients and prevent medication errors. Objective: To a) determine factors influencing policy implementation b) describe frequency of uptake, patient care areas where medication adaptations occurred, and common reasons for medication adaptation. Methods: Multi-method study involving a confidential, web-based survey with Likert-type and open-ended questions (distributed to 44 eligible pharmacists and 24 prescribers) and a chart review of all Pharmacist Medication Adaptation Order Sets from January 1, 2021 to February 1, 2022. Results: The pharmacist and prescriber surveys had response rates of 70% (n=31) and 42% (n=10), respectively. Timely access to medications and reduced prescriber workload were the top benefits identified. Pharmacist-reported facilitators included: self-confidence, perceived impact on patient care, and prescriber support. Prescribers reported general agreement with medication adaptations made by pharmacists and supported use of the policy. Pharmacists reported “somewhat agreement” with having adequate time to utilize the medication adaptation policy and the overall layout of the adaptation order set. Both pharmacists and prescribers supported expansion of the policy to include additional medical directives – specifically, warfarin dosing. A total of 862 medications were adapted within the first 13 months of implementation. Most medication adaptations occurred in medicine (41%), emergency (29%), and surgery (10%) patient care areas. Most common reasons for medication adaptation were renal dose adjustments (59%), dose/formulation not available or on backorder (29%), and 7% were due to a prescriber written order for the pharmacist to dose/adjust the medication. Conclusion: Overall, pharmacists and prescribers expressed positive perceptions and supported expansion of the medication adaptation policy. Strategies to facilitate more efficient use of the medication adaptation policy and increased prescriber awareness could help increase further uptake of the policy in practice.