Background
Patients with a haematological malignancy, have more complex admission and discharge requirements compared to other medical specialities. Admissions involve the administration of high-risk medications including chemotherapy and supportive medications. Safe discharge practices involve comprehensive patient education, scheduling outpatient clinic appointments including time-critical follow-up blood tests and organising of subsequent treatments.
Service growth, increased numbers of clinical incidents, combined with a medical officer shortage during the pandemic led to the implementation of a novel inpatient service delivery model.
Objective
To improve patient safety and optimise the efficiency of the haematology inpatient service through establishing a dedicated advanced-scope specialist pharmacist role.
Action (Method)
The ‘Haematology Patient Care Coordinator’ role was developed to enable specialist cancer pharmacists to partner-prescribe inpatient medications (including chemotherapy) and coordinate all discharge plans to ensure continuity of care. Specialist cancer pharmacists are best placed to fulfil this role, based on their understanding of chemotherapy regimens and comprehensive knowledge of treatment requirements. Data was collected to ascertain length of stay, admission costs, completion of venous thromboembolism risk assessment and clinical incidents pre-project implementation. A six-month project commenced in September 2021 with ongoing data collection throughout.
Evaluation
Positive results were achieved in each key performance area. Average length of stay was reduced by 13% with a reduction in average admission costs by 19%. Reported medication-related clinical incidents reduced by 85%. Venous thromboembolism risk assessment screening increased by 70%.
Discussion
This novel approach to managing haematology service delivery with a specialist cancer pharmacist has enabled medical officers to return to direct patient care, streamlined the admission process, and provided a more comprehensive and robust discharge process for haematology patients. The positive impacts on safety and efficiency have resulted in the permanent establishment of the Patient Care Coordinator Role.