https://orcid.org/0000-0002-8659-6073
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Abstract
Background
A new model was developed for integrating a personalised clinical pharmacy programme (5P project) into the orthogeriatric care pathway.
Objective
To secure the therapeutic care of orthogeriatric patients.
Design and Setting
Prospective descriptive study in a multisite teaching hospital from June 2019 to January 2020.
Subjects
Patients aged ≥75 years admitted for hip fracture.
Methods
A prescription review was performed for all patients at inclusion. Other clinical pharmacy activities (additional prescription review, pharmaceutical interviews, medication reconciliation) were dedicated to “high-risk” patients. Potential medication errors (ME), either pharmaceutical interventions (PI) or unintentional discrepancies (UID), were recorded. The potential clinical impact of PI was evaluated by a pluriprofessional expert panel using a validated tool.
Results
In the 455 patients included, 955 potential ME were detected, that is ≥1 potential ME for 324/455 (71%) patients. In acute care, 561 PI were formulated during prescription review for 440/455 (97%) patients and 348/561 (62%) were accepted by physicians. Medication reconciliation was performed for 213 patients, 316 UID were identified. In rehabilitation units, a second prescription review was performed for 112/122 (92%) “high-risk” patients, leading to 61 PI. The clinical impact was evaluated for 519/622 (83%) PI. A consensus was obtained for 310/519 (60%) PI: 147/310 (47%) were rated as having minor clinical impact, 138/310 (45%) moderate, 22/310 (7%) major, 2/310 (0.6%) vital, and 1/310 (0.3%) null.
Conclusion
The 5P project secured the orthogeriatric care pathway by detecting a great number of potential ME, including PI mostly considered as having a significant clinical impact.
Acknowledgments
The authors gratefully acknowledge all pharmacy students, pharmacy residents, pharmacists, and medical and paramedical professionals who participated to this study. 5P Study Group: GOUTELLE Sylvain, AUSSEDAT Marine, BOURGUIGNON Laurent, JANOLY-DUMENIL Audrey, BOLON-LARGER Magali, DODE Xavier, RANCHON Florence, DELANDE Evariste, CARPENTIER Isabelle, PIVOT Christine, MOUCHOUX Christelle, HOEGY Delphine, BARRAL Marine, MARTIN Julie, MANDY Bruno, RIOUFOL Catherine, DUSSART Claude, BREANT Valentine, LEBOUCHER Gilles, TOUZET Sandrine, DENIS Angélique, BOUVERET Laetitia.
Ethics Approval and Informed Consent
This study was approved by the ethics committee of the Hospices Civils de Lyon on February, 26th 2019 and the Commission nationale de l’informatique et des libertés (CNIL, French national commission on data protection) following MR004 requirements n°18–314 on May, 1st 2019.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.