Pharmaceutical interventions on hospital discharge prescriptions: challenges for community pharmacists

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Ressource 1Télécharger: JFSPH16_interventions_community.pdf (1345.80 [Ko])
Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_BAE01D1B714F
Type
Actes de conférence (partie): contribution originale à la littérature scientifique, publiée à l'occasion de conférences scientifiques, dans un ouvrage de compte-rendu (proceedings), ou dans l'édition spéciale d'un journal reconnu (conference proceedings).
Sous-type
Poster: résume de manière illustrée et sur une page unique les résultats d'un projet de recherche. Les résumés de poster doivent être entrés sous "Abstract" et non "Poster".
Collection
Publications
Titre
Pharmaceutical interventions on hospital discharge prescriptions: challenges for community pharmacists
Titre de la conférence
20es Journées Franco-Suisses de Pharmacie Hospitalière
Auteur(s)
Maurer S., Dobrinas M., Neeman M., Tagan D., Sautebin A., Widmer N., Blanc A.-L.
Adresse
Bern, Switzerland, December 1-2, 2016.
Statut éditorial
Publié
Date de publication
2016
Langue
anglais
Résumé
Background & Objectives: Transition between hospital and ambulatory care is a delicate step, which involves several healthcare professionals and presents a considerable risk of drug related problems. The community pharmacist plays an active role in preventing and solving medication errors and can increase patient safety.
Methods: A study was conducted in 14 community pharmacies surrounding a Swiss hospital. Patients discharged from the internal medicine ward of the hospital, taking more than 4 drugs chronically and capable of discernment were included in the study upon their approval. For each hospital discharge prescription, community pharmacists collected data about all the interventions performed and time needed for prescription validation. Analyses of the number and type of pharmaceutical interventions and propositions, time spent on discharge prescriptions and number of medication changes during transition of care were performed.
Results: 64 patients were included in the study. The total number of interventions done by community pharmacists on the 64 discharge prescriptions was 439, representing a mean of 6.9 ± 3.5 (range: 1-16) interventions per patient. No hospital discharge prescription required zero interventions and 61 prescriptions (95%) needed a phone call to the patients’ hospital physician. Most frequent pharmaceutical interventions were: confirming voluntary omission of a drug taken before hospitalisation (31.7%), treatment substitution (20.5%), different dosage compared to history (16.9%), reimbursement issues (8.8%), optimization of galenic formulation (6.6%) and confirming drug omission (6.3%). Roughly half (52%) of hospital discharge prescriptions required between 10 and 20 minutes for pharmaceutical validation, whereas 14% required less than 10 minutes and 6% more than 40 minutes. The most frequent pharmaceutical proposition was the use of a pillbox. In average, there were 17 medication changes per patient at different steps of the transition of care: 10 changes between hospital admission and discharge, 3 changes between hospital discharge and community pharmacy, and 4 changes between community pharmacy and general practitioner appointment.
Discussion & Conclusions: Hospital discharge prescriptions are often complex and present a risk of medication errors. The community pharmacist plays a key role in preventing and identifying drug related problems, but time required for pharmaceutical validation might be a constraint. Medication reconciliation at hospital admission and a better communication of medication changes at discharge may facilitate community pharmacists’ work, ensure continuity of care and thus increase patient safety.
Création de la notice
22/01/2017 17:48
Dernière modification de la notice
21/08/2019 5:36
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