Service arrangement | Aligned to a ward | Aligned to a medical team |
Clinical pharmacists involved | Service delivered by routine clinical pharmacists | Service delivered by one of two PACT clinical pharmacists |
Service at admission | Contributed to admission medication history taking | Led admission medication history taking and reconciliation |
Service during admission | Made minor changes and endorsements to the drug prescription and administration chart (drug chart), for example, clarify an intended formulation or notate to facilitate appropriate administration, for example, ‘before food’ | Made minor and major changes to the drug chart, as required, and these were co-signed by a medical practitioner |
| Delivered routine clinical pharmacy tasks (drug chart review; therapeutic drug monitoring; medication review; contribution of suggestions to optimise medication use and medication information queries) | Delivered routine clinical pharmacy tasks (drug chart review; therapeutic drug monitoring; medication review; contribution of suggestions to optimise medication use and medication information queries) |
Service at discharge | No service | Discharge medication reconciliation |
| | Made minor and major changes to the discharge medication list, as required, and these were co-signed by a medical practitioner |