Changes in Acute Care Pharmacist Prescribing and Laboratory Ordering over Time: CAPLET Study

Area of Science:

• Pharmacy Practice
• Health Services Research
• Clinical Pharmacology

Background:

• Pharmacists in Alberta, Canada, possess additional prescribing authorization (APA) and practice identification numbers (PRAC-ID) for laboratory test ordering.
• Alberta Health Services mandated APA for pharmacists by 2018; laboratory ordering has been established since 2009.
• A computerized provider order entry (CPOE) system at five Calgary Zone acute care sites enabled tracking of these pharmacist activities.

Purpose of the Study:

• To analyze trends in medication prescribing and laboratory test ordering by acute care pharmacists.
• To compare these prescribing and ordering activities across different hospitals, sites, and specialty teams.
• To evaluate the evolution of expanded scope of practice among hospital-based pharmacists.

Main Methods:

• A retrospective descriptive review of pharmacist orders was conducted.
• Data from a CPOE system covering 2018-2021 from five acute care sites were analyzed.
• Medication and laboratory test ordering patterns were examined over the study period.

Main Results:

• Pharmacist prescribing rates increased by 67.5% (1423 to 2383 per FTE), and laboratory ordering rates increased by 5.5% (235 to 248 per FTE) from 2018 to 2021.
• Significant increases in prescribing were observed across all five hospitals, with the largest gains in cardiology, intensive care, and mental health.
• Vancomycin was the most frequently prescribed medication, and vancomycin trough levels the most frequent lab test; verbal medication orders decreased from 60.0% to 47.4%.

Conclusions:

• Acute care pharmacists demonstrated increased utilization of their expanded scope of practice, particularly in prescribing.
• Prescribing and laboratory ordering by pharmacists are complementary, with frequent co-ordering of related medications and tests.
• Despite progress, the high proportion of verbal medication orders warrants attention to enhance patient safety and optimize CPOE system utilization.