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

Abstract

What is known and objective: The orthogeriatric path (hip-fractured elderly patients) is composed of several transition points (emergency surgery, orthopaedic, geriatric and rehabilitation units). The intervention of clinical pharmacists can ensure the continuity of patients' drug management during their hospital stay. The aim of the study was to assess the implementation of clinical pharmacy activities in an orthogeriatric pathway, regarding its impact on medication error prevention, the healthcare professionals' and patients' satisfaction, and the estimated associated pharmaceutical workload.Methods: Participants were aged 75 or older and managed for proximal femoral fracture. Their admission prescription was reviewed. If they were evaluated at high risk of adverse event (AE), medication reconciliation (MedRec) and pharmaceutical interviews (admission, discharge, and targeted on oral anticoagulant) were added at different steps of their care pathway. The achievement and duration of each clinical

Increasing the number of pharmacist-led medication order reviews using the available workforce: a retrospective study

“…The main strength of this study was the use of a combined approach that aimed to increase the number of medication order reviews for both targeted and non-targeted patients. The priority herein was to keep the same safety level in medication management for high-risk patients, while also allowing lower-risk patients to benefit from clinical pharmacy activities in order to avoid potential harmful medication errors, which to our knowledge was not the case in previous studies 8–12…”

“…Currently, a major problem in the development of clinical pharmacy is human resources, as the lack of pharmacists prevents the implementation of clinical pharmacy activities for all patients. To optimise this activity, several hospitals have defined targeting criteria for the performance of medication order review 8–12. These criteria may be based on specific prescribed medication (high-risk medication list, therapeutic class, polypharmacy), on sociodemographic criteria (age, sex), on laboratory data (renal clearance), on care transitions (admission, transfer, discharge), or on specific pathways (orthogeriatric, emergency unit).…”