Evaluation of Professional Pharmacy Activities Under Advanced Practice Agreements for Inpatients at the McGill University Health Centre

BACKGROUND: A limited number of jurisdictions worldwide authorize independent pharmacist prescribing. Legislative reforms in Quebec (Canada) now empower pharmacists to independently perform certain professional activities. Since 2021, Advanced Practice Agreements at the McGill University Health Centre have enhanced pharmacists' clinical autonomy, though the scope of each agreement varies across units. Limited evidence exists on how these agreements influence prescribing practices. This audit aimed to describe pharmacist-written prescriptions at the McGill University Health Centre, and examine inter-unit differences in prescribing trends. METHODS: This retrospective audit of three hospitals included 300 patients admitted in February, May, and October 2024 across five inpatient units. For each included patients, all prescriptions were reviewed. Descriptive metrics were developed and included total prescriptions, prescriptions per patient per day, proportion of patient days with pharmacist prescriptions, types of interventions, and medication classes. RESULTS: Seventy-nine percent of patients screened had at least one prescription written by a pharmacist. Pharmacists authored 32% of the 18,960 recorded prescriptions with 95% of these written independently. The proportion of pharmacist-written prescriptions varied across services. Most interventions involved prolongation or transfer orders, and initiation of new pharmacotherapies. Pharmacists actively prescribed high-risk medications, including anticoagulants, anticancer therapy, and hypoglycemic agents, highlighting their clinical expertise. CONCLUSION: Advanced Practice Agreements support pharmacists' autonomous prescribing and integration into patient care, with substantial involvement in complex therapies. Variation across units likely reflect differences in agreements' scope and timing of implementation, namely. Future research should evaluate the impact of pharmacist-led prescriptions on issues such as hospital readmissions.