Patient Pathway Pharmacist - Optimal Drug-related Care

Patient Pathway Pharmacist: Drug Optimisation for Hip Fracture Patients - Facilitating a Safe Patient Handover: a Descriptive Study

Medication errors represent the most common cause of patient injury and one of the most frequently reported health related deviation in Norway. The addition of a dedicated clinical pharmacist throughout the hip fracture patient pathway (patient pathway pharmacist) is believed to improve patient safety and ensure optimal drug-related patient care. The pharmacist will perform medication reconciliation at admission to hospital, medication review after surgery and assist physicians with discharge summary. Six weeks after discharge the patient pathway pharmacist will perform a second drug reconciliation and medication review. This study will assess the pharmacists' place and specific tasks in the patient pathway, describe areas where the pharmacist contribute to increased quality of care and assess the benefits and/or disadvantages experienced with introducing a patient pathway pharmacist. The estimated number of patients included is 60. Current practice will be determined by investigating the last 50 patients' medical record and a questionnaire to health care professionals involved in treatment of hip fracture patients. Data from medication reconciliation and drug review will be collected and compared to current practice. After the inclusion period, focus group surveys and/or semi-structured interviews will be executed to describe the perceived improvement in the quality of care. Primary endpoints are: 1) Medication reconciliation score at admission 2) Number of inappropriate drugs for elderly 3) Discharge summary score 4) Discharge summaries following procedure. Secondary endpoints are readmissions and mortality after 30 and 90 days. Qualitative endpoints: 1) Health care professionals experience of current drug-related practice 2) Experienced advantages and disadvantages of a patient pathway pharmacist.

Medicine review, Patient handoff, Patient hand over, Intertrochanteric fractures, Trochanteric fractures, Subtrochanteric fractures, Hospital readmission, Hospital readmissions, Injuries, Hip, Hospitalization, Hospitalisation, Hip, Fracture, Femoral fractures, Femoral neck fractures, Medication errors, Medication review, Medication reconciliation

An intervention group is compared to a cross-sectional retrospective group. A group of 60 patients with hip fracture will get an intervention by a clinical pharmacist who performs medication reconciliation and medication review during hospitalisation, they will receive a discharge summary where the medication part is optimised. After six weeks the patients will be get a follow-up with a second medication reconciliation and - review. This group will be compared with the last 50 patients with hip fracture who did not get the intervention.

Medication reconciliation at admission to hospital Medication review post surgery Optimised list of drugs in the discharge summary, in accordance with hospital procedures Medication reconciliation, six weeks after discharge Medication review, six weeks after discharge

Business as usual. The Patient Pathway Pharmacist is not involved and the nurses and physicians are responsible for medicine reconciliation, -review and section in the discharge summary.

Medication reconciliation at admission to hospital Medication review post surgery Optimised list of drugs in the discharge summary, in accordance with hospital procedures Medication reconciliation, six weeks after discharge Medication review, six weeks after discharge

In the discharge summary, the section describing drugs is scored in accordance with the national patient safety program

In the admission summary, the section describing drugs is scored. The score is adjusted from the discharge summary score to fit the admission note.

After surgery the medication review may reduce the number of inappropriate drugs (on the STOPP-list).

A questionnaire will be distributed to all health care professionals involved in the treatment of hip fracture patients

Focus groups or semi-structured interviews will be performed to assess the advantages and/or disadvantages of introducing a patient pathway pharmacist.

Inclusion Criteria: Hip fracture patients in Vestfold county, Norway Exclusion Criteria: Patients under 18 years Terminally ill Hip fracture patients who do not follow the standardized patient pathway at Vestfold Regional Hospital Patients who do not consent to be included in the study

https://www.itryggehender24-7.no/reduser-pasientskader/legemiddelrelaterte-skader/legemiddelsamstemming-og-legemiddelgjennomgang/_/attachment/download/33b5eb0c-4f62-4d42-862f-b9f95f09423c:12bcc5de3b8e1ff2e4bdb9937951300d8d6f35cc/tiltakspakke-for-samstemming-av-legemiddellister.pdf

Score of the drug section in discharge summaries - The Norwegian Patient Safety Programme: In Safe Hands