Pharmacist-led Anti-seizure Medication Management: Delegation Protocol Implementation and Impact Analysis
by Christine A. Garmoe, PharmD, Katie E. Sherman, PharmD, Lisa A. Hawk, PharmD, BCPP, Nicholas A. Olszewski, Scott J Hetzel, Rebecca L. Lauscher, PharmD, BCACP, Katherine J. Hartkopf, PharmD, BCACP
"Background: Anti-seizure medication (ASM) management is complicated and time-consuming; delegating management to pharmacists could minimize the burden. Data suggests improved outcomes with pharmacist medication management. Without data in ambulatory settings, there
is a need to identify the impact of delegating ASM management to pharmacists.
Methods: A pharmacist delegation protocol was developed, implemented, and analyzed to evaluate the impact of pharmacist-led ASM management in an epilepsy clinic. This delegation protocol allowed pharmacists to titrate and taper ASMs, sign prescription orders, and enter laboratory orders. A chart review was conducted before and after implementation
of the protocol to determine the time to initiation of ASMs and workflow efficiency.
Results: The pre-implementation cohort included 47 patients; 24 (51%) were male, and the average age was 42 years (SD 18.0). The post- implementation cohort included 50 patients; 24 (48%) were male, and the average age was 45 years (SD 15.8).
The average time to initiation of ASMs was 32.3 hours (SD 31.6) and 35.2 hours (SD 44.5) in the pre- and post-implementation groups, respectively. The average number of electronic medical record (EMR) messages sent between the care team was 4 (SD 1.9) and 0.3 (SD 0.6), respectively.
The number of messages sent by the following groups was reduced after the implementation of the delegation protocol: care team (-3.7; P < 0.001), providers (-1.2; P < 0.001), pharmacists (-1; P < 0.001).
Conclusion: Implementation of a pharmacist-driven ASM management delegation protocol increases the efficiency of caring for patients with epilepsy without sacrificing the timely initiation of ASM medications."
Keywords: Humans, Child, Adult, United States, Anticonvulsants, Pharmacists, Dizziness, Isoenzymes, Sleepiness, Standard of Care, Tremor, Epilepsy, Therapeutic Index, Insurance Coverage, Ataxia, Fatigue, Seizures, Nausea
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2022 May/June Table of Contents
"Background: Anti-seizure medication (ASM) management is complicated and time-consuming; delegating management to pharmacists could minimize the burden. Data suggests improved outcomes with pharmacist medication management. Without data in ambulatory settings, there
is a need to identify the impact of delegating ASM management to pharmacists.
Methods: A pharmacist delegation protocol was developed, implemented, and analyzed to evaluate the impact of pharmacist-led ASM management in an epilepsy clinic. This delegation protocol allowed pharmacists to titrate and taper ASMs, sign prescription orders, and enter laboratory orders. A chart review was conducted before and after implementation
of the protocol to determine the time to initiation of ASMs and workflow efficiency.
Results: The pre-implementation cohort included 47 patients; 24 (51%) were male, and the average age was 42 years (SD 18.0). The post- implementation cohort included 50 patients; 24 (48%) were male, and the average age was 45 years (SD 15.8).
The average time to initiation of ASMs was 32.3 hours (SD 31.6) and 35.2 hours (SD 44.5) in the pre- and post-implementation groups, respectively. The average number of electronic medical record (EMR) messages sent between the care team was 4 (SD 1.9) and 0.3 (SD 0.6), respectively.
The number of messages sent by the following groups was reduced after the implementation of the delegation protocol: care team (-3.7; P < 0.001), providers (-1.2; P < 0.001), pharmacists (-1; P < 0.001).
Conclusion: Implementation of a pharmacist-driven ASM management delegation protocol increases the efficiency of caring for patients with epilepsy without sacrificing the timely initiation of ASM medications."
Keywords: Humans, Child, Adult, United States, Anticonvulsants, Pharmacists, Dizziness, Isoenzymes, Sleepiness, Standard of Care, Tremor, Epilepsy, Therapeutic Index, Insurance Coverage, Ataxia, Fatigue, Seizures, Nausea
Download PDF
2022 May/June Table of Contents