Pharmacie, Hospices Civils de Lyon, Lyon, France.
Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
Clin Interv Aging. 2021 Oct 21;16:1857-1867. doi: 10.2147/CIA.S325035. eCollection 2021.
A new model was developed for integrating a personalised clinical pharmacy programme (5P project) into the orthogeriatric care pathway.
To secure the therapeutic care of orthogeriatric patients.
Prospective descriptive study in a multisite teaching hospital from June 2019 to January 2020.
Patients aged ≥75 years admitted for hip fracture.
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.
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%) "high-risk" 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.
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.
开发了一种新模型，将个性化临床药学方案（5P 项目）整合到矫形骨科护理路径中。
确保矫形科患者的治疗护理。
2019 年 6 月至 2020 年 1 月在多地点教学医院进行的前瞻性描述性研究。
年龄≥75 岁因髋部骨折入院的患者。
对所有纳入患者进行处方审查。其他临床药学活动（额外的处方审查、药物学访谈、药物重整）专门针对“高危”患者。记录潜在药物错误（ME），包括药物干预（PI）或非故意差异（UID）。PI 的潜在临床影响由多专业专家小组使用经过验证的工具进行评估。
在纳入的 455 名患者中，发现了 955 个潜在的 ME，即 324/455（71%）名患者有≥1 个潜在的 ME。在急性护理中，对 440/455（97%）名患者进行了处方审查，并提出了 561 项 PI，其中 348/561（62%）项被医生接受。对 213 名患者进行了药物重整，发现了 316 个 UID。在康复病房，对 122 名“高危”患者中的 112 名进行了第二次处方审查，提出了 61 项 PI。对 622 项 PI 中的 519 项（83%）进行了临床影响评估。对 310 项 PI 中的 310 项（60%）达成共识：147 项 PI（47%）被认为具有较小的临床影响，138 项 PI（45%）具有中等临床影响，22 项 PI（7%）具有较大临床影响，2 项 PI（0.6%）具有生命危险，1 项 PI（0.3%）无影响。
5P 项目通过检测大量潜在 ME，包括被认为具有显著临床影响的 PI，从而确保了矫形科护理路径的安全。
