The pharmaceutical care bundle: development and evaluation of an instrument for inpatient monitoring

Abstract

Introduction: Care bundles help healthcare professionals provide the best care possible in a structured and reliable way. The purpose of this study was to develop and apply an instrument for inpatient follow-up by clinical pharmacists, and evaluate its results. Methods:The care bundle was based on previously validated instruments. Population consisted of patients monitored by clinical pharmacists at a general hospital. The study was conducted in two phases: the first involved the development and implementation of the bundle, and the evaluation of pharmaceutical interventions; the second involved analyzing data from patients treated with the bundle over one year. Results:The bundle included fourteen pharmaceutical follow-up criteria used in different patterns by each area of care. In the first phase of the study, 3263 patients were monitored and 536 pharmaceutical interventions were performed, with an 85.3% compliance rate. In the second phase of the study, follow-up data was collected from 21,214 patients. The bundle criteria were used in a similar way in clinical, surgical and cancer patients. Pharmacotherapy review was the most prevalent intervention in all cases (60.1%). Hospital discharge planning and medication reconciliation were performed with a similar frequency in clinical, surgical, pediatric and general patients. Conclusions:The development and validation of a bundle aimed at guiding the clinical activities of pharmacists helped standardize procedures and interventions. Pharmacotherapy review was the bundle criterion with the highest rate of application and interventions due to the hospital's complexity and the need to consider individual patient needs and follow institutional policies.

The role of the pharmacist in the hospital discharge of cancer patients: an integrative review

“…19 According to the Institute for Safe Practice in the Use of Medicines in Canada, as “a formal process in which healthcare professionals work in partnership with patients and families to ensure correct information about medications in use in care transitions.” 20 Pharmacist participation in medication reconciliation at admission or discharge, and the provision of specific pharmaceutical services reduce the frequency of adverse drug events and medication errors, improving both treatment adherence and patients’ medication knowledge. 17…”

“…20 Pharmacist participation in medication reconciliation at admission or discharge, and the provision of specific pharmaceutical services reduce the frequency of adverse drug events and medication errors, improving both treatment adherence and patients' medication knowledge. 17 A pilot project involving medication conciliation was implemented with patients with cancer in exclusive palliative care. 14 Pharmacists made 111 recommendations with an 82.9% acceptability rate.…”

“…This scenario will be possible to develop communication and support skills to facilitate patient adherence to drug therapy. 12 Martinbiancho et al 17 demonstrated that hospital discharge was one of the criteria included in the pharmaceutical care protocol. At discharge, patients with complex needs received guidance on the acquisition of prescribed drugs and information on the administration of drugs through the tube and the adaptation of pharmaceutical formulations for home use.…”

“…However, Walker et al 18 demonstrated that the preparation time was longest for the oncology pharmacists, who spent a median of 60 min per patient (range 10-225 min) preparing for discharge counseling (p < 0.001 for comparisons with general medicine and nephrology wards) suggesting that this population has a greater demand. Martinbiancho et al 17 showed that analgesia interventions were more prevalent in critical, clinical, and cancer patients. Compliance with the pain management scale and appropriate use of analgesics are important strategies in these populations, and especially in cancer pain management.…”

“…Pain is reported by 39.3% to 55% of patients with cancer undergoing treatment and 66.4% of patients with advanced cancer. 17…”