Evaluation of the impact of evidence based pharmaceutical care bundle delivery on patient outcomes

Background Clinical pharmacists perform patient-centred activities to optimise medicines use and prevent harm. Historically, clinical pharmacy quality indicators have measured an individual activity and are not linked to patient outcomes. Aim To determine the proportion of patients for which bundled pharmaceutical care activities are performed and to investigate associations between patient outcomes and delivery of pharmaceutical care bundles (PCB). Methods Medication history, medication review, discharge medication list and medicines information on the discharge summary were defined within relevant state-wide clinical information systems. Routinely recorded data was extracted at ten participating sites for adult patients who had a non-same day separation. Associations between extent of delivery of all activities as a PCB and 3 patient outcomes were investigated. Results In total 283,813 hospital stays were evaluated. Delivery of the PCB occurred in 26.9% of patients (range 0.6% to 61.2% at participating sites). Patients with a longer length of stay were more likely to receive delivery of the complete PCB (P<0.001). There was no association between bed:clinical pharmacist FTE ratio and delivery of the PCB (r=-0.183, p=0.64) and there was no correlation between PCB and hospital standardised mortality ratio (r=-0.03, p=0.93). Higher rates of delivery of the PCB were associated with lower rates of unplanned readmission within 30 days (r=-0.993, p<0.001). Conclusion Delivery of a PCB consisting of medication history, medication review, discharge medication list and medicines information on the discharge summary was provided to 26.9% of patients. It was associated with lower rates of unplanned readmission within 30 days.