Adherence to prescribing guidelines and design of a pharmaceutical care plan for stroke patients

Palenzuela, E. and Kinnear, A.E. and Kinnear, M. (2009) Adherence to prescribing guidelines and design of a pharmaceutical care plan for stroke patients. Pharmacy World and Science, 31 (1). pp. 54-55. ISSN 0928-1231 (http://dx.doi.org/10.1007/s11096-008-9262-z)

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Abstract

Background and objective To evaluate the quality of prescribing in patients with acute stroke using criteria developed from national guidelines and to develop a pharmaceutical care plan (PCP) for stroke patients incorporating these criteria. Design Design of audit criteria and application through prospective case note review. Design and evaluation of a PCP for stroke patients through structured audio-taped focus group discussion and piloting by clinical pharmacists (n = 6). Setting Admission ward and acute stroke unit in a large teaching hospital. Main outcome measures Percentage of overall and individual adherence to 36 audit criteria. Proportion and evaluation of ''Justified''and ''Unjustified'' non-adherence and ''Pharmacist Contribution'' to achieve adherence. Overall perception of the clinical use of the PCP by clinical pharmacists. Results Overall criteria adherence was 79% in 36 criteria applied to 125 patients (53.6% male, mean (SD) age 71.9 (13.7) years). ''Justified'' non-adherence was 8% and ''Unjustified'' non-adherence changed from 13% to 6% after pharmacist contribution. Criteria with 54 Pharm World Sci (2009) 31:40-141 123 the lowest adherence were ''prescription of aspirin as stat dose'(46%) and ''oxygen is prescribed according to local oxygen policy'' (33%).Clinical pharmacists agreed that use of the evidence-based PCP would aid in the provision of consistent quality of pharmaceutical care during the stroke patient's hospital journey and agreed its usefulness both in clinical practice and to support education and training. Conclusions Prescribing adherence to national guidelines was generally good and the pharmacist contributions further improved appropriateness of prescribing. The audit identified a need to redesign the prescription chart and the method of oxygen prescribing to improve prescribing practice in stroke patients. It also indicated the need for the PCP to be initiated by the pharmacist in the admissions unit to ensure timely prescribing of aspirin. Design of the PCP to include evidence-based prescribing criteria in accordance with national strategy provides a tool to aid pharmacists in the provision of equitable pharmaceutical care to stroke patients throughout their hospital journey. Use in routine clinical practice will refine the tool further. Audit of stroke management in primary care will inform further development of the tool to support the continuity of pharmaceutical care between hospital and community.

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