Evaluating medication discrepancies and harm: a matched cohort study of collaborative pharmacist prescribing in a statewide healthcare system using electronic prescribing

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INTRODUCTION: Collaborative pharmacist prescribing models involve pharmacists working with doctors and patients to develop medication plans and prescribe medications. Limited evidence exists on the impact of these models on medication discrepancies in hospitals using electronic prescribing systems (EPS). AIM: This study aimed to evaluate the impact of collaborative pharmacist prescribing on medication discrepancies and potential patient harm within a statewide healthcare system using EPS. METHOD: A multi-site matched cohort study involving 240 patients was conducted. EPS data for 120 patients aged ≥ 18 years who received collaborative pharmacist prescribing was matched 1:1 with 120 patients who received usual care of independent medical prescribing. Matching variables were hospital, clinical unit, sex, age, admission date, triage category and pre-admission medication count. The electronic medical record was reviewed to identify undocumented medication discrepancies, which were defined as any unexplained difference between the pharmacist-led medication history and medications prescribed on admission. The frequency of undocumented discrepancies was calculated. An independent multi-disciplinary clinician panel determined potential harm, using the Harm Associated with Medication Error Classification (HAMEC) tool. RESULTS: There were fewer undocumented discrepancies per medication prescribed in the collaborative pharmacist prescribing group compared to usual care (RR 0.04, 95% CI 0.03-0.06) and the relative risk of undocumented discrepancies per patient was lower (RR 0.23, 95% CI 0.13-0.39). The expert clinician panel found that undocumented discrepancies rarely posed serious or severe harm in either group (0 undocumented discrepancies with potential to cause serious or severe harm in the collaborative pharmacist prescribing group compared to 8 in the usual care group). CONCLUSION: The implementation of collaborative pharmacist prescribing within a statewide EPS significantly reduced undocumented discrepancies and lowered the potential for patient harm. As healthcare systems globally shift towards electronic prescribing, this study provides timely and actionable evidence to inform policy and support the adoption of collaborative prescribing models in hospitals using EPS. Such models offer a practical strategy to improve medication safety, reduce patient harm and strengthen interprofessional collaboration at the point of prescribing.

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