Predictive factors for clinically significant pharmacist interventions at hospital admission

Mongaret, Céline; Quillet, Pauline; Vo, Thi Ha; Aubert, Léa; Fourgeaud, Mathieu; Michelet-Huot, Elise; Bonnet, M.; Bedouch, Pierrick; Slimano, Florian; Gangloff, Sophie C.; Dramé, Moustapha; Hettler, D.

doi:10.1097/md.0000000000009865

Cited by 35 publications

(33 citation statements)

References 45 publications

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“…Most of the unintended discrepancies in this study consisted of drug omissions (72%) as similarly reported in the literature [16, 18, 36–39]. In such cases, the patient is failing to receive a pre-admission home medication that was deemed necessary by a HCP.…”

Section: Discussionsupporting

confidence: 59%

Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals

Karaoui

Chamoun

Fakhir

et al. 2019

BMC Health Serv Res

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Background The Institute for Healthcare Improvement identifies medication reconciliation as the shared responsibility of nurses, pharmacists, and physicians, where each has a defined role. The study aims to assess the clinical impact of pharmacy-led medication reconciliation performed on day one of hospital admission to the internal medicine service. Methods This is a pilot prospective study conducted at two tertiary care teaching hospitals in Lebanon. Student pharmacists who were properly trained and closely supervised, collected the medication history, and pharmacists at the corresponding sites performed the reconciliation process. Interventions related to the unintended discrepancies were relayed to the medical team. The main outcome was the number of unintended discrepancies identified. The time needed for medication history, and the information sources used to complete the Best Possible Medication History were also assessed. The unintended discrepancies were classified by medication class and route of medication administration, by potential severity, and by proximal cause leading to the discrepancy. For the bivariate and multivariable analysis, the dependent variable was the incidence of unintended discrepancies. The “total number of unintended discrepancies” was dichotomized into yes (≥ 1 unintended discrepancy) or no (0 unintended discrepancies). Independent variables tested for their association with the dependent variable consisted of the following: gender, age, creatinine clearance, number of home medications, allergies, previous adverse drug reactions, and number of information sources used to obtain the BPMH. Results were assumed to be significant when p was < 0.05. Results During the study period, 204 patients were included, and 195 unintended discrepancies were identified. The most common discrepancies consisted of medication omission (71.8%), and the most common agents involved were dietary supplements (27.7%). Around 36% of the unintended discrepancies were judged as clinically significant, and only 1% were judged as serious. The most common interventions included the addition of a medication (71.8%) and the adjustment of a dose (12.8%). The number of home medications was significantly associated with the occurrence of unintended discrepancies (ORa = 1.11 (1.03–1.19) p = 0.007). Conclusions Pharmacy-led medication reconciliation upon admission, along with student pharmacist involvement and physician communication can reduce unintended discrepancies and improve medication safety and patient outcomes. Electronic supplementary material The online version of this article (10.1186/s12913-019-4323-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 59%

Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals

Karaoui

Chamoun

Fakhir

et al. 2019

BMC Health Serv Res

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“…This result is higher than that reported in the literature. 12 This is probably explained by the full-time presence of the two pharmacists in the ward and also because they searched additional clinical, biological and treatment data outside the hospital. All PIs were immediately transmitted orally or by phone call to the prescribers and a response was obtained in 100% of the cases.…”

Section: Discussionmentioning

confidence: 99%

Clinical and economic impact of pharmacist interventions in an ambulatory hematology–oncology department

Grégori

Pistre

Boutet

et al. 2020

J Oncol Pharm Pract

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Objectives To evaluate clinical and financial impact of pharmacist interventions in an ambulatory adult hematology–oncology department. Methods All cancer patients receiving a first injectable immuno- and/or chemotherapy regimen were included in this prospective study over a one-year period. The clinical impact of pharmacist interventions made by two clinical pharmacists was rated using the Clinical Economic and Organizational tool. Financial impact was calculated through cost savings and cost avoidance. Main results: Five hundred and fifty-eight patients were included. A total of 1970 pharmacist interventions were performed corresponding to a mean number of 3.5 pharmacist interventions/patient. The clinical impact of pharmacist interventions was classified as negative, null, minor, moderate, major and lethal in 0, 84 (4%), 1353 (68%), 385 (20%), 148 (8%) and 0 cases, respectively. The overall cost savings were €175,563. One hundred and nine (6%) of all pharmacist interventions concerned immuno- or chemotherapy regimen for cost savings of €148,032 (84% of the total amount of cost savings). The cost avoidance was €390,480. Cost avoidance results were robust to sensitivity analyses with cost of preventable adverse drug event as main driver of the model. When the cost of employing a pharmacist was subtracted from the average yearly cost savings plus cost avoidance per pharmacist, this yielded a net benefit of €223,021. The cost–benefit ratio of the clinical pharmacist was €3.7 for every €1 invested. Principal conclusions: To have two full-time clinical pharmacists in a 55-bed ambulatory adult hematology–oncology department is both clinically and financially beneficial.

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“…The French Society of Clinical Pharmacy (SFPC) developed and validated a multidimensional tool for assessing the whole impact of PIs, named CLEO (CLinical, Economic, and Organizational) ( Fig. 1) [17,18]. The CLEO tool includes three independent dimensions to evaluate clinical, economic and organizational impact of PIs to describe the whole impact of PI.…”

Section: Introductionmentioning

confidence: 99%

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Zecchini

Chanoine

et al. 2020

BMC Health Serv Res

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Background: Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit.Methods: A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted. Results: Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers' perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€. Conclusions: PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.

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Predictive factors for clinically significant pharmacist interventions at hospital admission

Abstract: Supplemental Digital Content is available in the text

Cited by 35 publications

References 45 publications

Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals

Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals

Clinical and economic impact of pharmacist interventions in an ambulatory hematology–oncology department

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

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