How a Patient Personalised Clinical Pharmacy Programme Can Secure Therapeutic Care in an Orthogeriatric Care Pathway (5P Project)?

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%) "highrisk" 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.

Implementation assessment of a patient personalized clinical pharmacy programme (5P project) into orthogeriatric care pathway

“…The average number of detected UID was consistent compared to other studies with hip‐fractured patients 22 or geriatric patients 23 . One can wonder whether all PI were clinically relevant from a medical point of view, which is why a full‐blown analysis of the potential clinical impact of PI has been performed 15 …”

“…23 One can wonder whether all PI were clinically relevant from a medical point of view, which is why a full-blown analysis of the potential clinical impact of PI has been performed. 15 The present study showed a quite low number of information transmission to primary care actors at discharge. Nevertheless, community and rehabilitation structure pharmacists had a high satisfaction rate.…”

“…The analysis of patient and care pathway characteristics, the clinical relevance of PI, the DRP type and solution according to the French Society of Clinical Pharmacy criteria 17 and the drug class (according to the Anatomical Therapeutic and Chemical classification, 18 ATC) were performed in another study 15 …”

“…14 It is to be noted that another analysis was made to describe the clinical pharmacy activities performed by ward type and to evaluate their potential clinical impact. 15 The aim of the present study was to assess the implementation of clinical pharmacy activities in an orthogeriatric care pathway regarding medication error prevention, healthcare professionals' and patients' satisfaction, and the associated pharmaceutical workload.…”

“…Once the orthogeriatric pathway was selected, a preliminary study was performed in order to identify which clinical pharmacy activities should be performed, at which step of the care pathway they should be implemented, and which criteria should be used to stratify patients according to their risk of AE (high risk, HR, vs low risk, LR) 14 . It is to be noted that another analysis was made to describe the clinical pharmacy activities performed by ward type and to evaluate their potential clinical impact 15 . The aim of the present study was to assess the implementation of clinical pharmacy activities in an orthogeriatric care pathway regarding medication error prevention, healthcare professionals’ and patients’ satisfaction, and the associated pharmaceutical workload.…”