An evaluative project of a ward-based pharmacist working within an MDT as part of a ‘Reablement & Frailty’ speciality unit
Authors: Youles D 
Published: November 2024

Abstract

Introduction
Reablement care aims to prevent hospital re-admissions, costly institutional placements, and increase quality of life for frail patients, as well as preventing long-term decisions being made prematurely based on the patient’s current state of health1.
Pharmacist involvement in multi-disciplinary teams (MDT) across other specialities has been demonstrated extensively worldwide as effective in reducing medication errors and providing significant improvements to patient care. However, little research has been conducted specifically within a reablement & frailty setting, and the subsequent impact on the scale and quality of care provided to patients2.

Aim
To identify the responsibilities of a singular ward-based pharmacist working within a ‘reablement & frailty’ MDT and evaluate the subsequent impact on patient care by categorising and quantifying the significance of pharmacist interventions and contributions.

Methods
A three-stage, quantitative service evaluation project:
1. Pharmacist development of two data collection tools to capture responsibilities: one for clinical interventions/recommendations and one for structured medication reviews;
2. Collection of daily interventions on 18-bed reablement unit over 13 days (3-day pilot + 10-day data collection period) by ward pharmacist using above data collection tools;
3. Scoring of each intervention based on two adapted, previously validated scales3:
I. Severity score –potential severity of harm to the patient if contribution was missed (clinically insignificant, significant, serious, or life-threatening)
II. Intervention score –likelihood of contribution preventing hospital re-admission - scale of 1-3 (1 - no likelihood, 2 - possible likelihood, and 3 - high likelihood)
Ethical approval was obtained through the Robert Gordon University university ethics committee in addition to local approval via the Epsom & St Helier hospital’s research & development department.

Results
A total of 88 clinical contributions were made and collected over the 3-day pilot and 10-day data collection period, averaging just under seven contributions per day. Two ‘life-threatening’ interventions were made, both with a high likelihood of preventing a hospital re-admission. Based on potential severity of harm, most entries were scored as ‘significant’ (67%, n=59), followed by ‘serious’ (16%, n=14). Just over half of all clinical interventions (52%, n=46) scored as having either a possible OR high likelihood to prevent a hospital re-admission. The ward doctor actioned 94% (n = 73) of the pharmacist’s recommendations.

Discussion / Conclusion
With an average of just under 7 clinical contributions made daily, it is clear that pharmacist involvement in the ‘reablement & frailty’ MDT can reduce medication error incidence through prompt identification and resolution, optimise medication regimens, and contribute to reducing patient risk of future re-admissions through effective interventions and medicines optimisation.
Due to the different uses of the term ‘reablement’ globally, the findings from this study may not be applicable to all areas of reablement, such as home-based rehabilitation or bed-based respite. However, with this study forming foundation research into a novel reablement unit within secondary care, a promising argument has been made to promote pharmacist inclusion within MDTs across all specialities and the benefit that pharmacist contributions can bring to ensuring holistic care and effective patient reablement.

References
1. NICE, 2017. Intermediate care including reablement - NG74. [Online] Available at: https://www.nice.org.uk/guidance/ng74 [Accessed 9 October 2023].
2. Aspinal, F. et al., 2016. New horizons: Reablement - supporting older people towards independence. Age and Ageing, 45(5), p. 574–578.
3. Buckley, M. et al., 2013. Impact of a Clinical Pharmacy Admission Medication Reconciliation Program on Medication Errors in "High-Risk" Patients. Annals of Pharmacotherapy, 47(12), p. 1599–1610.