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Impact d'une équipe mobile de pharmacie clinique dans la conciliation médicamenteuse à l'admission : une étude prospective interventionnelle descriptive

Dujardin, Adeline
(2024)

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Dujardin_14001900_2024.pdf
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Details

Supervisors
Rosart, Laurence ; Marien, Sophie
Faculty
Faculté de pharmacie et des sciences biomédicales
Degree label
Master de spécialisation en pharmacie hospitalière
Abstract
Background: Unintended discrepancies (UD) that represent errors are common at the time of hospital admission. Medication conciliation (MC) is a way to identify and act on discrepancies in a patient’s medication. Objectives: The aim of this study was to evaluate the impact of the mobile team dedicated to MC at admission by quantifying and qualifying UD. Secondary objectives included raising physicians’ awareness of MC, identifying variables predictive of the presence of an UD and evaluating the satisfaction of physicians and mobile team pharmacists. Methods: An 8-week prospective interventional descriptive study was conducted in several units of a Belgian hospital. Eligible patients were adults aged ≥ 65 years, hospitalized for more than 48 hours and admitted within the last 24 hours before MC. On admission, the mobile team compared the best possible medication history to prescriptions to identify UD. To achieve the secondary objectives, physicians received MC training before the study started. To identify variables predictive of the presence of an UD, univariate and multivariate analysis using logistic regression were performed. Results: A total of 135 patients were included with a median age of 72 years. On admission, 102 patients had at least one UD (75,6%), with a median of 2,83 UD per patient. Omission was the most common discrepancy (67,6%) and the cardiovascular drug class was the most frequently implicated (27,6%). 40% of the UD were corrected. Only polymedication (≥ 10 drugs) was associated with the presence of an UD [OR = 2,818, p-value = 0,028]. Physicians found the mobile team’s approach very satisfactory (68,7%), securing (100,0%) and expressed a desire for its continuation (81,2%), unlike pharmacists. Conclusion: The mobile team identified many medication discrepancies and reduced potential harm. This approach effectively raises physician awareness among about importance of MC. Prioritizing patient profiling for MC and integrating medication review could further enhance safety and care quality.